![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 26 to 50 of 178. Go back in thread:
Posted by linkadge on June 3, 2006, at 1:16:06
In reply to Re: opioids for depression, posted by willyee on June 2, 2006, at 23:09:29
Hey, I'm looking for answers too. I'm not too proud to admit that.
It is possible that there is something physically or chemically different about a depressed person's brain. We don't really have any evidence to suggest that the current medications are acutally correcting that abnormality.
After having gone through the withdrawl and all, and see how the drugs have changed me, I just feel I'd be foolish to go back on another SSRI etc.
Linkadge
Posted by Paulbwell on June 3, 2006, at 4:25:29
In reply to Re: opioids for depression, posted by linkadge on June 3, 2006, at 1:16:06
> Hey, I'm looking for answers too. I'm not too proud to admit that.
>
> It is possible that there is something physically or chemically different about a depressed person's brain. We don't really have any evidence to suggest that the current medications are acutally correcting that abnormality.
Hi Ya,Of course the SSRI's SSNRI's MAO's TCA'a, ETC DON"T 'correct' brain chemistry-they chemically alter it, sometimes making the wearer of that brain feel better-often not. The human Brain is far to complex for 'correcting imballances' in medicine~2006.
That said, and getting back onto the title topic, I'm no Opi' addict, but have experimented with Morphine IR@SR, Dihydrocodeine, Codeine, in different forms of administrating.
Since 1958 when Imipramine (the first AD came out) medicine has focused on increasing Serotonin, Dopamine, Norephinephrine, with thes meds over the last 40+ years.
Perhaps, just perhaps some mood disorded folk have an imbalance in their brains Endorphin system? (troublesome to face by the med professional i know).
I myself have had potent AD responses from MSIR @Codeine tabs. Aposter here Jerry is LEGALLY scripted 5mgs Hydrocodone (Vicodin) 4x daily, and attributes it to his higher functioning/mood.
Remember Opiods/iates were often given for 'Psych' issues before the biopsychiatric theories of the 1950's~came to the fore, hell, in the early 1900's you could go into ANY drugstore and buy OTC effective dosages of, Opium, Morphine, Cocaine, Heroin, products, designed to 'treat' any ails you could think of.YES Opiates/oids do indeed help depressed mood states, in many, with little SE's relatively
Cheers
Posted by MrBrice on June 3, 2006, at 10:02:07
In reply to Re: opioids for depression-yes for some/most? » linkadge, posted by Paulbwell on June 3, 2006, at 4:25:29
I say NO to this one.
opioids might help you in short terms (1-1.5 years), but then long term effects are just too bad.
It'll flatten your moods, make you dull and lifeless, as I was told and I have seen myself in some people.Please don't do it, this really istn't the good med!
Posted by pseudoname on June 3, 2006, at 11:22:59
In reply to Re: opioids for depression NO, posted by MrBrice on June 3, 2006, at 10:02:07
> opioids might help you in short terms (1-1.5 years), but then long term effects are just too bad.
Hi, Brice. This is an interesting and sobering caution. My results are life-changing so far, but what will happen in 18 months?
I don't know. No one does. You may not be aware of the difference between opioids in general and buprenorphine.
Buprenorphine is a partial opioid ANTagonist, and it's a weak and highly selective agonist. Some patients using it in addiction therapy have taken it safely & effectively over years. Unlike other opioids, it doesn't provide a buzz or high, at least not at the doses I'm using it.
A few people (like Babble's famous Elizabeth) have used buprenorphine for over 18 months without reporting poop-out or worsening mood, but of course that's not proof of safety.
> It'll flatten your moods, make you dull and lifeless, as I was told and I have seen myself in some people
I'm not discounting that possibility, Brice. Not at all. But I think it's unlikely that you have known opioid-naive depressives treated with relatively low-dose buprenorphine.
Will the experience of people who treat themselves by popping Vicodin or OxyContin be the same for those on bupe? It's an empirical issue, since the extrapolation from other opioids is not straightforward. The evidence so far is very limited, but it suggests that buprenorphine will be safe for me.
Still, it *could* poop out. Bupe poop-outs have been reported on Babble, but not with the scenario you describe. It could mess up my brain in another 18 months. Check back here; I'll certainly post about it, if able.
> Please don't do it, this really istn't the good med!
If by "this" you mean buprenorphine, I think the generalization is unwarranted.
Posted by linkadge on June 4, 2006, at 2:33:35
In reply to Re: opioids for depression-yes for some/most? » linkadge, posted by Paulbwell on June 3, 2006, at 4:25:29
Yes, opiates can provide unsurpassed emotional wellbeing. The number of people whoever, who can use opiates as a *long term* solution for a mood disorder are probably few. Other than dependance and dose escalation, opiates are probably safer than other antidepressants.
Hopefully the future will provide new ways to modulate the opiate system without the pitfalls of current opiates.Additional targets will hopefully include the endocannabanoid system.
Linkadge
Posted by Paulbwell on June 4, 2006, at 2:51:02
In reply to Re: opioids for depression-yes for some/most? » Paulbwell, posted by linkadge on June 4, 2006, at 2:33:35
> Yes, opiates can provide unsurpassed emotional wellbeing. The number of people whoever, who can use opiates as a *long term* solution for a mood disorder are probably few. Other than dependance and dose escalation, opiates are probably safer than other antidepressants.
>
>
> Hopefully the future will provide new ways to modulate the opiate system without the pitfalls of current opiates.
>
> Additional targets will hopefully include the endocannabanoid system.
>
> Linkadge
>
Hey ya Link!!I know u have been through the ringer, Psychiatricaly speaking, with the usual crap thrown our way~SSRI's TCA's SSNRI's MAO's, MS's AP's AC's.
Yer i'v read yr posts.
"Yes, opiates can provide unsurpassed emotional wellbeing."
Yer i have sure felt that, with my little deluge with 'Morphine Sph 20mg IR tabs'.
Boy i loved the sence of peace and well being thoes pink dolls provided, everything was fineeeeee, aaaarrrrr-HEAVEN!!-alas i havn't had access to em' for a year and a half now so.... tough sh*t.
However to get back to te original point, before ~1950's and "the psychiatric revolution" Opi's were used by everyday folks for MANY ailments-Psych@physical, without the huge stigma of today.
Again i'm no Opi/iod addict, only someone who has trialed some of these compounds, and released the SIGNIFICANT (Pain-physical or Psychic-WTD?) benefits they CAN provide-under the right situations.
Cheers
Posted by linkadge on June 4, 2006, at 2:51:58
In reply to bupreorphine for depression » MrBrice, posted by pseudoname on June 3, 2006, at 11:22:59
As far as flattening you out, thats a possibility. Opiates are naturally released during certain pleasurable activities. If one starts taking regualar opiates, they often have no need to seek out those pleasurable acitivies anymore.
For instance, social contact increases opiate release. Junkies can become antisocial because they have learned that they can activate the parts of the brain they want without having to interact socially.
I wouldn't classify buprenorphine as a regualar opiate, since as you mentioned it does some atypical stuff.
As a side note, regular opiates tend to decrease neurogenesis, this may be of consequence when considering that most antidepressants increase it.
Ideally an antidepressant restores the brain activity necessary to allow an individual to find pleasure in pleasurable activies. The antidepressant itself should not be short-circuting the pleasure centres, else the user would likely give up on pleasurable activities.
(Don't get me wrong, I'm all up for being connected to a pleasure machiene while the robots do all the work, but it may be a little while for that to take place)
As a side note. SSRI's flatten you out too. I hear a lot about how to avoid marajuanna because it makes you amotivational. In my experience, at least, the amotivational effects of the SSRI's are far stronger than that of marajuanna.Linkadge
Posted by Paulbwell on June 4, 2006, at 6:11:48
In reply to Re: bupreorphine for depression, posted by linkadge on June 4, 2006, at 2:51:58
> As far as flattening you out, thats a possibility. Opiates are naturally released during certain pleasurable activities. If one starts taking regualar opiates, they often have no need to seek out those pleasurable acitivies anymore.
>
> For instance, social contact increases opiate release. Junkies can become antisocial because they have learned that they can activate the parts of the brain they want without having to interact socially.
>
> I wouldn't classify buprenorphine as a regualar opiate, since as you mentioned it does some atypical stuff.
>
> As a side note, regular opiates tend to decrease neurogenesis, this may be of consequence when considering that most antidepressants increase it.
>
> Ideally an antidepressant restores the brain activity necessary to allow an individual to find pleasure in pleasurable activies. The antidepressant itself should not be short-circuting the pleasure centres, else the user would likely give up on pleasurable activities.
>
> (Don't get me wrong, I'm all up for being connected to a pleasure machiene while the robots do all the work, but it may be a little while for that to take place)
>
>
> As a side note. SSRI's flatten you out too. I hear a lot about how to avoid marajuanna because it makes you amotivational. In my experience, at least, the amotivational effects of the SSRI's are far stronger than that of marajuanna.
>
> Linkadge
Hi Ya Link!I agree that being enslaved to a med/drug is no way to go.
BUT MANY of the messed-up,folk who come here, have tried ALL the SSRI's ETC-u know the score?
Opiates/IOds have given a new lease on life for many,-WTF does it matter if one takes Paxil, or Bupe/MORPH, daily.
hey were only aroung for ~70-80 years.
WHATEVER GETS YOU THRU THE NIGHT?
Cheers
Posted by MrBrice on June 4, 2006, at 8:37:02
In reply to bupreorphine for depression » MrBrice, posted by pseudoname on June 3, 2006, at 11:22:59
hi,
I'm not sure if there is a big difference between buprenorphine and the other opiods but i wouldn't take them ever.
I have seen people indeed with other opiods and the effects seem good at first, but after a while the whole personality gets ruined.I hope bupe is another sort of med, and doestn't have the same effects if so many people use it tough.
best regards
Brice
Posted by Paulbwell on June 4, 2006, at 8:53:26
In reply to Re: bupreorphine for depression pseudoname, posted by MrBrice on June 4, 2006, at 8:37:02
> hi,
>
> I'm not sure if there is a big difference between buprenorphine and the other opiods but i wouldn't take them ever.Buprenorphine is a 'Partial' Opiate against, as opposed to Morphine-like meds which are full MU, Kappa, Opiod aganists.
> I have seen people indeed with other opiods and the effects seem good at first, but after a while the whole personality gets ruined.
Yes-I hear ya!
{Plenty of people who i have known who have been placed on {rozac, Paxil~ETC i hae witnessed a profound personality chamge (deading like state), where they seem to care about less than they did b4. GREAT it this 'treatment' made them happy, by no. Whats the difference in takng these brain anasthetics-SSRI's, or an Opiate/oid to relieve, 'treat' Psychic, Pain?
Cheers
>
> I hope bupe is another sort of med, and doestn't have the same effects if so many people use it tough.
>
> best regards
> Brice
Posted by jerrympls on June 5, 2006, at 3:59:18
In reply to Re: opioids for depression NO, posted by MrBrice on June 3, 2006, at 10:02:07
> I say NO to this one.
>
> opioids might help you in short terms (1-1.5 years), but then long term effects are just too bad.
> It'll flatten your moods, make you dull and lifeless, as I was told and I have seen myself in some people.
>
> Please don't do it, this really istn't the good med!I disagree. My pdoc has had me on a opiate for over 2 years now and I have never had an issues with addiction or tolerance. I'ts been a valuable addition to my med cocktail.
jerry
Posted by pseudoname on June 5, 2006, at 9:04:25
In reply to Re: opioids for depression NO » MrBrice, posted by jerrympls on June 5, 2006, at 3:59:18
I'm really glad Jerry posted.
> > Please don't do it
As people in this thread can attest, Bob has previously given PBCs for statements virtually identical to that, although he's apparently refused to do so in this situation. "Don't do X" is a direct instruction and can obviously be an OVERGENERALIZATION and PRESSURE. Especially in a thread in which someone has just detailed his/her clinical use of X, such a statement can feel accusatory. In this thread, I personally felt put down by it.
However, Brice nicely followed up in this instance by acknowledging that buprenorphine may be different, and I really appreciated that admission. But Jerry's experience would still run afoul of an overall command not to use opioids prescribed by a doctor.
Opioids are very serious drugs. The clinical situations where they are appropriate can be complex. Significant risks, side-effects, stigma, legal issues, and other trade-offs are ALWAYS a part of effective opioid therapy. But opioid use is sometimes *vital* where nothing else can help. These can be life-or-death questions!
Blanket imperatives only add to the stigma, pressure, and other burdens that opioid patients are already dealing with.
Posted by linkadge on June 5, 2006, at 15:11:32
In reply to Re: bupreorphine for depression-Opiates? » linkadge, posted by Paulbwell on June 4, 2006, at 6:11:48
Its not about having to take it daily. Theres no problem in taking a medication daily. But, is the medication going to be effective at a single dose, or are you going to have to continue to increase the dose untill your vital organs shut down.
It is my understanding that most people quickly grow tollerant to any single dose. In terms of pain relief, most people have quicky and completely adapted to the effects of any given dose of an opiate after about a month.
So, its not that I have anything morally wrong with giving people whatever works. But will it work?
Linkadge
Posted by linkadge on June 5, 2006, at 15:22:19
In reply to Re: opioids for depression NO » MrBrice, posted by jerrympls on June 5, 2006, at 3:59:18
>I disagree. My pdoc has had me on a opiate for over >2 years now and I have never had an issues with >addiction or tolerance. I'ts been a valuable >addition to my med cocktail.
But, with the other meds you are taking, is there any way to be sure that, this one is actually keeping you where you are? Isn't it possible that dependance has built to the opiate, but that the other meds are providing relief?
Not trying to dismiss your case at all, just wondering really.
Linkadge
Posted by reese7194 on June 7, 2006, at 16:48:42
In reply to opioids for depression » Phillipa, posted by pseudoname on June 2, 2006, at 10:34:26
i am curious if you found it difficult to find a doc who would use it off label. curious which state you live in. it's a shame that they are only using it for detox.
> Hi, Phillipa.
>
> > How does that med that is for opiod addicts work? Does it make you feel the same way the percocet did for me?
>
> Yeah, that's the one I take: buprenorphine (Subutex) is usually given to opioid addicts in recovery. I've never taken any other opioid, so I don't know how it compares. I don't feel buzzed or high on it at all. On it, I'm just not depressed, and my usual depressive train of thoughts doesn't occur. My usual train of thoughts is like a train that runs off a cliff! Those bad thoughts don't happen for me on buprenorphine and my mood is dramatically improved without the dulling or flatness people can get on SSRIs.
>
> Bupe does have a black-market street value, but I think it's to people who abuse other opioids. I don't know if anyone would abuse bupe alone.
>
> It's a darn shame that doctors are so reluctant or afraid to prescribe it for depression. I guess I'm really lucky. (Finally!)
Posted by Phillipa on June 7, 2006, at 20:12:37
In reply to Opioids for depression » Phillipa, posted by jedi on June 2, 2006, at 4:08:03
Buphrenopine is used by one of the docs in mines practice and there's another one too. For opiate addiciton would that help depression if SSRI's SSNRI's don't work? Love Phillipa
Posted by pseudoname on June 7, 2006, at 20:45:18
In reply to Re: opioids for depression/subutex, posted by reese7194 on June 7, 2006, at 16:48:42
> i am curious if you found it difficult to find a doc who would use it off label.
Yes, quite difficult, in part because both I and my pdoc were misinformed about the law on buprenorphine. She thought she had to have a special DEA waiver to prescribe it, but that's only true in the U.S. when it's Rx'd to opioid addicts for opioid addiction treatment. When we cleared up the law issue, she was willing to try it with me.
> it's a shame that they are only using it for detox.
For detox and ongoing addiction therapy. Since they have a patent, I don't know why they don't do some studies & try to get it approved for depression. Way too much stigma, I guess.
Posted by pseudoname on June 7, 2006, at 21:00:15
In reply to Re: Opioids for depression, posted by Phillipa on June 7, 2006, at 20:12:37
> would that help depression if SSRI's SSNRI's don't work?
Hi, Phillipa.
My experience was with SSRI SNRI TCA MAOI lithium AP and ECT failure, after which buprenorphine did help. Both of the small studies of bupe for depression were with treatment-resistant people. Some of those patients were also prior opioid addicts.
I think I would only suggest considering it after quite a few regular treatments fail.
Posted by stan on June 8, 2006, at 4:45:36
In reply to buprenorphine and AD failure » Phillipa, posted by pseudoname on June 7, 2006, at 21:00:15
pseudo:
do you experience any "mental cloudiness" on the bupe, or does your mind feel just as quick and sharp and clear as it does when you're not using it? if you do have this problem, does it get worse as the dose is increased? just curious....thanks,
stan
>
> I think I would only suggest considering it after quite a few regular treatments fail.
Posted by pulse on June 8, 2006, at 7:21:21
In reply to Re: buprenorphine and AD failure » pseudoname, posted by stan on June 8, 2006, at 4:45:36
i'm curious: i recall elizabeth posting that the side-effects of bupe were very harsh.
i would assume one of the main ones, as with most, if not all opiates, is extreme constipation.
has this been true for you? have you been able to manage it well enough, and, if so, how?
pulse
Posted by Donna Louise on June 8, 2006, at 9:08:16
In reply to Re: Strong comment, posted by Bonnie_CA on June 2, 2006, at 2:40:12
Willyee, you spoke my fears for me. For most of my life, well, until I was nearly 31, I was not a street junkie because I didn't live on the street but that was the only difference. As was said, all I knew was that I hurt and I would take anything to make it go away. I stopped that behavior 20 some years ago but about 15 years ago began this new way of drug seeking to make the pain stop. I am so afraid that it is really no different. I am still looking desperately for a drug that will make me enjoy my life (yes, I have had years of therapy...)I know I must need something, I am not put together right and as was said, I need to do it for the greater good, not just for my own selfish ends. But I am so afraid that all this legal drug seeking and using has just made me worse than ever. I was so hoping the Patch would be "it" and it better than anything else but it is not "it". Now I want to ask for bupe and am reading about it, I am back to narcotics like the old days...Anyway, I know just what you mean. I have had glimpses of what I think should be possible and it is always when i am stopping a drug, the two week period before I crash again. I guess it is some kind of rebound, but I long for it and am obsessed with obtaining it, I don't want to waste my life anymore than it has been wasted. It makes me so sad and scared. It makes me cry.
donna
Posted by pseudoname on June 8, 2006, at 10:30:04
In reply to Re: buprenorphine and AD failure » pseudoname, posted by stan on June 8, 2006, at 4:45:36
Hi, Stan. I'm glad you asked about this because I haven't mentioned it much.
> do you experience any "mental cloudiness" on the bupe?
Yes. Also, slight dizziness. (Very slight.)
When I first started bupe in December, I had to take 3 mg a day to notice an antidepressant effect. At that dose, I noticed feeling mentally tired (without being tired) or a gauzy feeling (not quite cloudy LOL), but I could still concentrate on reading & writing and follow a line of thought, and as far as I know my judgment was okay. But I avoided driving in the early days. Those feelings decreased a lot as weeks went on, but they never entirely disappeared.
HOWEVER, when I had med-free days for constipation reasons (see my next reply), I did have odd cognitive problems. For example, one day when I went without bupe, I signed in at Babble under my old posting name and password (from 9 months earlier) without realizing it! That sort of complication went away AFAIK on the second day without bupe or when I went back on the bupe.
In March I lowered my usual dose to 1 mg per day. I got the same benefit and have no explanation why it didn't work at that dose at first. Anyway, now mental gauziness comes and goes. If I increase the dose slightly by taking 0.7 mg in the morning instead of 0.5 (the tablets are hard to split precisely), the gauziness and dizziness appear or get worse but are still tolerable. They don't, as far as I can tell, interfere with writing or comprehension, but I wouldn't climb up on the roof feeling that way.
I should get some computer alertness tests and test the dose response carefully. (Anybody got suggestions?)
Posted by pseudoname on June 8, 2006, at 11:25:46
In reply to Re: buprenorphine SEspseudoname, posted by pulse on June 8, 2006, at 7:21:21
Hiya, pulse.
> i would assume one of the main ones, as with most, if not all opiates, is extreme constipation.
Oh yeah. When I started my buprenorphine trial in Nov/Dec, constipation crept up on me and got worse as the weeks went on. I occasionally took holidays from the bupe just for the purpose of having a bowel movement, which was sometimes similar to giving birth.
(There's too much detail ;-) from those days in my bupe trial thread, before & following this post: http://www.dr-bob.org/babble/20051203/msgs/585836.html)
The constipation problem DID get better as months went on. Under Ed's advice I used Miralax, which was the most help, but far from a cure.
I'm now taking a dose (1 mg/day) about 1/3 of my starting dose, and constipation is no longer an issue. Elizabeth said her constipation never got much better.
I would give the following advice re constipation to anyone about to try buprenorphine:
•Start a high-fiber diet & drinking lots of fluids ASAP before you start taking bupe.
•Start taking Miralax right away, before you begin to have constipation problems, if you can get it.
•Stock up on suppositories & enemae before starting bupe; not that they'll really do any good.
•If at any time you think you could even possibly have a slight feeling like you might maybe want to poop, DO SO IMMEDIATELY. Do not wait.I think the only ongoing side-effect Elizabeth reported was constipation. Nausea occurs early in the process but only for a few days. Nevertheless, I'd also lay in a box of OTC anti-nausea medicine like Bonine before starting bupe.
Posted by pulse on June 8, 2006, at 21:54:16
In reply to buprenorphine and constipation » pulse, posted by pseudoname on June 8, 2006, at 11:25:46
thanks much for all this info!
just as i expected.
well, with my ibs-c, i can now safely say i'll never be able to even try bupe. it IS a fascinating subject to me, nonetheless, and i fully admit i'm envious.
i smoked opium only once back in the day. wowzer. but, it was just TOO good, so i 've never touched any kind of opiates again, except vicoden once for surgery - similar response - for me, perhaps a bit too good. back in that same day, i had a boyfriend who did heroin once; he had same feeling, so never again. scared h*ll outa him.
i do realize bupe is a different scenario, far as these success stories go.
continued success to you!
regards,
pulse
Posted by pseudoname on June 8, 2006, at 22:24:26
In reply to Re: buprenorphine and constipation » pseudoname, posted by pulse on June 8, 2006, at 21:54:16
> well, with my ibs-c, i can now safely say i'll never be able to even try bupe.
Now I wish I hadn't posted only my experience. In the bupe enclosure literature, of 210 people who took *16* mg per day (!) of buprenorphine, only 10% (21) had constipation problems in the first 4 weeks.
Of course, they were already heavy opioid users (addicts)...
Some people who use bupe for depression use VERY small doses effectively, like 0.2 mg per day. It might be possible to titrate up very slowly from even smaller doses using a liquid solution and avoid peristalsis problems.
Also, the AD effect is immediate. A person could take it only every other day, if necessary.
But I know IBS is nothing to fool with. I'm sorry.
> i smoked opium only once back in the day. wowzer. but, it was just TOO good
I've never used another opioid, so I can't compare. Buprenorphine doesn't even make me feel "good" like caffeine can. Just non-depressed and non-despairing.
Thanks for replying, pulse. Good luck.
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.