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Dr. Bob is Robert Hsiung, MD,
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Posted by Hermit on June 18, 2006, at 17:48:25
In reply to How do you know so many opioid patients? » Hermit, posted by pseudoname on June 18, 2006, at 17:37:27
> How do you know so many people treating depression with opioids, including buprenorphine? By contrast, there have only been a handful here at Babble over the years.
There are loads of forums out there for folks who are doing just that. I've also met a lot of people in my own line of work who either have doctors who are willing to give it a try, or who are being prescribed opiates for pain but have begun to use it specifically for depression treatment.
In particular, the groups for kratom use are filled with people treating depression with kratom (an herb that has opiate-like effects, but is legal in the U.S. and much safer).
Two examples:
The Kratom Forum
http://drugbuyers.com/kratom/index.phpThe Kratom Korner
http://www.thekratomkorner.com/Also, the Kratom Group on Yahoo
http://groups.yahoo.com/group/kratom/> Are the depressive opioid patients you've met former abusers? I know you said you had training in chemical dependency counseling.
Yes, some of them are. My work with them has consisted of teaching them how to manage their compulsive impulses. Of course, if they're on heroin or morphine, I do what I can to help them get off of them, usually with the help of kratom. Then I work with them until they know how to use kratom responsibly.
Of course, not everyone is able to, and those are the ones who are just better off abstaining altogether.
Hermit
Posted by Hermit on June 18, 2006, at 17:50:57
In reply to Re: Opiate trap!, posted by flmm on June 18, 2006, at 17:44:08
> I find it hard to believe a legit p. doc would prescribe opiates for depression. Any good one clearly knows better. It would be a good way to get someone at the bottom, even lower over the long run.
It's okay to find it hard to believe, but there are quite a few out there (though, admittedly, not in the majority). Those who are open to "unusual" treatments when all else has failed eventually find there opiates can, indeed, help depression in some patients.
Again, if a person is prone to abusing opiates, then it isn't recommended. Not everyone has this problem, however.
Hermit
Posted by flmm on June 18, 2006, at 17:55:05
In reply to Re: Opiate trap!, posted by Hermit on June 18, 2006, at 17:50:57
It really is the worst idea anyone can have. I believe it really has more to do with addicts talking their doctors into bad ideas more than any "Trend" in treating depression. It would be very easy to list all the negative results that would happen due to long term opiate use for depression!
Posted by Hermit on June 18, 2006, at 17:56:36
In reply to Re: Opiate trap!, posted by flmm on June 18, 2006, at 14:34:10
> They are not treating the depression anymore, merely addicted to a low maintanance dosage.
Physically addicted, yes. But anyone who takes an antidepressant for any length of time will also find themselves physically addicted (which only means that weaning off the medication is necessary rather than stopping suddenly and completely).
> This is possible as it happened to me!I was able to keep my use low thrughout.However, the depression still gets worse and worse, but because of the addiction, they think it helps! My depression was greatly lifted once off them.
You are obviously not a good candidate for opiate treatment for depression; please don't assume that everyone else is just like you. Everyone's chemistry is different, and it's effectiveness has been proven time and time again.
I think I've said this enough times here now.
> You can't possibly know how bad you feel when addicted, it fools you into thinking you feel better. This is what addiction is!
I know quite a bit more about addiction than you think.
It seems you've had some very tough experiences, and I completely understand your concern about others falling into the same situation you did. However, it's very important that you keep an open mind, particularly since there is overwhelming evidence that it definitely does help some people battle depression.
It might more healthy (and fair) for you to say, "It didn't work for me, but if it works for someone else, they should have a right to do whatever works."
Doesn't this seem fair to you?
Hermit
Posted by Declan on June 18, 2006, at 17:57:34
In reply to Re: Opiate trap!, posted by flmm on June 18, 2006, at 11:26:47
I dunno. I'm not so impressed with opiates long term, but IME they compare well with ADs. Honestly, I think we'd be better off chewing coca and drinking poppy tea. But this is where we are.
Declan
Posted by Declan on June 18, 2006, at 18:04:02
In reply to Re: Opiate trap!, posted by flmm on June 18, 2006, at 17:44:08
No, what happens is that depressed people self medicate with opiates and then seek help for their addictions.
Look, I agree about the long term detrimental effects of opiates, especially methadone, but I can't see why psych drugs are any better.
Declan
Posted by Hermit on June 18, 2006, at 18:11:00
In reply to Re: Opiate trap! » flmm, posted by Declan on June 18, 2006, at 18:04:02
> No, what happens is that depressed people self medicate with opiates and then seek help for their addictions.
True, but also non-depressed folks will self-medicate. It's a compulsive behavior that can be unlearned.
> Look, I agree about the long term detrimental effects of opiates, especially methadone, but I can't see why psych drugs are any better.I know you weren't writing in response to me, but I agree with you anyway. :-) Opiates are actually one of the least harmful drugs to the body when used RESPONSIBLY.
Recent research has shown that long-term antidepressant use seems to cause an actual anatomical change in the neurons they affect, making a person become dependant on the antidepressants. Doesn't sound like such a great solution to me.
Hermit
Posted by pseudoname on June 18, 2006, at 18:38:30
In reply to Re: Opiate trap!, posted by flmm on June 18, 2006, at 14:34:10
I read flmm's history and I think it's serious, sobering, and important.
> This is possible as it happened to me!
However, I'm certain that flmm's "opiate" was not buprenorphine.
I don't yet tire of repeating this: BUPRENORPHINE seems to be DIFFERENT. The 3 tiny studies done so far do not show such adverse effects happening with opioid-naive depressives treated with bupe, which is a partial opioid agonist and partial ANTagonist, quite different from opiATEs like heroin, morphine, oxycodone, etc. It switches on only SOME mu receptors and those very weakly, and (perhaps more importantly) it BLOCKS kappa-opioid receptors.
I have not gotten buzzed or high on buprenorphine, not even to the extent possible from caffeine. Others, including Babble's famous Elizabeth, have reported likewise. Euphoria is not associated with bupe, and it appears to be a lousy painkiller.
Buprenorphine also has a delay in action, at least for me, of 90 minutes to 2 hours, further reducing the likelihood of psychological dependency. Its absence, even after days, does not result in craving or any other characteristics of addiction. Furthermore, in the last 7 months I've significantly REDUCED MY DOSE without loss of antidepressant effect.
Yet I hope flmm would not seek to take it away from me. The result — at this point in my life — would simply be to return me to my usual fluctuating moods of the last several years: from 48 to 57 on the Babbleometer.
On the other hand, with regard to opiates and other powerful mu-agonist opioids, I have no experience. We *know* they work for some and cause problems for others, but we apparently don't yet know how to tell the people apart in advance. On that larger issue (as is usually safe), I heartily endorse Declan's view.
Posted by Declan on June 18, 2006, at 18:40:41
In reply to Re: Opiate trap!, posted by Hermit on June 18, 2006, at 18:11:00
Hi Hermit
Yeah, I agree, and if I'm going to f*ck myself up I would prefer to enjoy it for a while at least, before the awful stuff starts. No offense to those who get help from psych drugs. Tianeptine is helping me; I dunno what it's doing to my brain; and it's the first AD I have been able to take. The world went mad about opiates 40 years ago; the WHO...all madness IMO.
Declan
Posted by Declan on June 18, 2006, at 18:52:00
In reply to again: buprenorphine is different, posted by pseudoname on June 18, 2006, at 18:38:30
The thing I would worry about with bupe is the long term effects (if any). We know the long term effects of natural opiates.
PN, what do you know about the long term effects of bupe? How long has it been around? I mean, if it was helping *me*, I'd place a bet that it wouldn't be *that* good long term but would compare very well with other treatments for depression. But I have no idea, of course.
People on bupe do report feeling clearer than on other opiates. This might refer to an AD effect? OTOH I have had friends say 'I don't want to feel clearer. Why do you think I take opiates in the first place?' OTOH most people on methadone suffer from a low grade depression. I imagine, but cannot be sure, that this would be less true of morphine or heroin, supply being assured (just for argument's sake, shall we say?).
Declan
Posted by linkadge on June 18, 2006, at 19:08:00
In reply to Re: ‘dependence’ vs ‘addiction’, posted by Hermit on June 18, 2006, at 10:51:18
http://www.dr-bob.org/babble/20060610/msgs/657911.html
Sorry, I meant below.
Linkadge
Posted by linkadge on June 18, 2006, at 19:11:15
In reply to Re: Opiate trap!, posted by flmm on June 18, 2006, at 11:26:47
Just to counter what you said. Just because you did not respond well to opiates for depression does not mean other will not either.
Personally, SSRI's sent me into a downward spiral of increasing depression and suicidialty.
So clearly, drugs can affect people in different ways.
Linakdge
Posted by linkadge on June 18, 2006, at 19:16:32
In reply to Re: Opiate trap!, posted by flmm on June 18, 2006, at 14:34:10
Opiates are multi mechanism drugs. They will increase dopamine in the pleasure centres of the brain, but their painkilling properites are independant of this.
It is hard to know. I think there is a tendancy for those who's depression is not ameliorated by opiates to blame the opiates for increasing depression, while this may not be the case.
Some people may geting relief from this surge of activity in the pleasure centres of the brain, but not from other properties of the opiate.
It would be interesting to see, if the antidepressant effect is maintained with coadministration of an agent that blocks the increase in dopamine in the neucleus accumbens.
Linkadge
Posted by linkadge on June 18, 2006, at 19:24:06
In reply to Re: Opiate trap!, posted by flmm on June 18, 2006, at 17:44:08
>I find it hard to believe a legit p. doc would >prescribe opiates for depression. Any good one >clearly knows better. It would be a good way to >get someone at the bottom, even lower over the >long run.
Most of the doctors who go this route, are not doing it with complete agreability. Some of these patients have literally tried every other drug, including ECT. I would recomend a patient be put on opiates before ECT. Less brain dammage.
Think of it this way. Drugs like methylpenidate also posess abuse potential. This abuse potential however, is independant of its actions in ADD. The same could be true for opiates, but that the abuse potential squelches out further research.
There may be some form of opiate dysregulation at the heard of certain depressive disorders. Some studies have even linked postive responces to noradrenergic agents with increase in endorhpen levels.
Opiates for instance, are effective in some animal models of depression. They can ameliorate dysfunctional HPA axis function often much better and much faster than SSRI's or other antidepressants.
There seems to be growing evidence that they do have application in certain depressive disorders when use judiciously and appropriately.
Linkadge
Posted by linkadge on June 18, 2006, at 19:30:28
In reply to Re: Opiate trap!, posted by Hermit on June 18, 2006, at 17:56:36
I agree, antdiepressants are physically addicting. There would be a general tendancy for people to increase their opiate dose, and perhaps many confounding factors for which opiates have been advised against.
Caffiene can be addicting, but some research shows that it has some sort of positive effect on long term mental health. Apparently coffee drinkers are less likely to off themselves. (This study has been replicated).
In forsight, most people would *not* believe that coffee can have a positive effect in depression.
http://biopsychiatry.com/caffsui.htm
Another
Posted by linkadge on June 18, 2006, at 19:40:59
In reply to Re: again: buprenorphine is different » pseudoname, posted by Declan on June 18, 2006, at 18:52:00
Its all about creating a magic bullit. The reason doctors don't see that opiates are a cure, is that they can make anybody feel better. In order to justify depression, doctors need to make a drug that specifically targest depression, without making anybody feel better, lest antidepressants be seen as pep pills (which they are).
So what? Beta blockers will lower anybody's blood pressure, that doesn't mean we can't use them for hypertensives. Abuse potential needs to be separated from antidepressant effect.
Amineptine was an effective antidepressant, was this independant of its abuse potential ?
We took it off the market because it had abuse potential. That is wrong. There are probably thousands of effective antidepressants with minimal abuse potential that will never see the light of day.
I think that if somebody genuinly gains effect from a constant dose of an opiate, then who cares?
Linkadge
Posted by linkadge on June 18, 2006, at 19:44:32
In reply to Re: again: buprenorphine is different, posted by linkadge on June 18, 2006, at 19:40:59
Its like you see somebody on effexor. Initially it works at 75 mg. A few months later they're on 112.5, then 150mg. Soon enought they're maxed out at 450mg. Next step is a seizure I suppose.
It happens on regular antdiepressants. That doesn't mean there aren't those who take 75mg for a few years and then get off.Linakdge
Posted by linkadge on June 18, 2006, at 20:04:28
In reply to Re: again: buprenorphine is different, posted by linkadge on June 18, 2006, at 19:44:32
From the crazymeds.org website:
"SRIs are some of the most physically addictive drugs in existence. To suddenly stop taking them is to feel so very much worse than you were feeling before you ever considered taking meds. There's a term, "brain shivers." You'll know it if you ever experience it. Mouse and I have kicked opiates and we have kicked SSRIs cold turkey. We'll take the opiate kick."
Linkadge
Posted by pseudoname on June 18, 2006, at 20:43:58
In reply to Re: again: buprenorphine is different » pseudoname, posted by Declan on June 18, 2006, at 18:52:00
> We know the long term effects of natural opiates.
What are they? By long-term, you mean 5, 10 years?
> PN, what do you know about the long term effects of bupe?
AFAIK, there's no published data on long-term bupe use at the doses I've been taking it. The studies with opiate addicts are at 8 mg/day or more. (That's also the case with the admittedly few personal accounts I've seen on other forums, which have mostly seemed to be NON-NAIVE and comorbid users.)
And, as with SSRI studies, "long-term" for bupe researchers seems to mean 6 months to a year! It's frustrating. No one can make good projections on the basis of that sort of data.
I would really like to know what happened to the people in Bodkins' 1995 study. Actually, I seriously think I'll contact him about that.
> How long has it been around?
First synthesized in 1969 and used clinically as a parenteral analgesic in 1978. The addiction treatment started in the mid-1990s in Europe, I think.
The first report on its use in depression was published in 1982; the second in 1995; the third in 2005. This is a very slow collection of data.
> I mean, if it was helping *me*, I'd place a bet that it wouldn't be *that* good long term
[Bursts of laughter]
Always nice to hear a word of encouragement.
[More laughter ;-) ]
> OTOH I have had friends say 'I don't want to feel clearer. Why do you think I take opiates in the first place?'
You people sure have a lot more friends than I do.
Posted by Declan on June 19, 2006, at 0:58:50
In reply to long-term buprenorphine » Declan, posted by pseudoname on June 18, 2006, at 20:43:58
Posted by Squiggles on June 19, 2006, at 8:59:07
In reply to Re: Opiate trap!, posted by linkadge on June 18, 2006, at 19:30:28
I don't understand why doctors
have abandoned a scientific approach
to medicine. Has everyone dumped
pharmacology for basketweaving therapy?
GRRRR!Squiggles
Posted by Hermit on June 19, 2006, at 9:42:25
In reply to Dose is important » linkadge, posted by Squiggles on June 19, 2006, at 8:59:07
> I don't understand why doctors
> have abandoned a scientific approach
> to medicine. Has everyone dumped
> pharmacology for basketweaving therapy?Why do you consider some drugs "scientific" and others not?
Hermit
Posted by Hermit on June 19, 2006, at 10:03:06
In reply to Re: again: buprenorphine is different, posted by linkadge on June 18, 2006, at 19:40:59
> I think that if somebody genuinly gains effect from a constant dose of an opiate, then who cares?
You'd think!
But the pharmaceutical companies are what run this country. Billions of dollars flow into it daily. If docs started prescribing opiates or kratom, then suddenly there wouldn't be any need for antidepressants, weight loss medications, anti-anxiety meds, ADD stimulants, etc.
Same with marijuana. If that became legal, farmers growing and exporting weed and hemp products could completely erase the national debt. THEN where would we be??
Hermit
Posted by Hermit on June 19, 2006, at 10:10:40
In reply to Re: Opiate trap! » Hermit, posted by Declan on June 18, 2006, at 18:40:41
> Yeah, I agree, and if I'm going to f*ck myself up I would prefer to enjoy it for a while at least, before the awful stuff starts. No offense to those who get help from psych drugs. Tianeptine is helping me; I dunno what it's doing to my brain; and it's the first AD I have been able to take.
I'm not sure what you mean. What "awful stuff" are you referring to?
Hermit
Posted by Declan on June 19, 2006, at 16:53:02
In reply to Re: Opiates, posted by Hermit on June 19, 2006, at 10:10:40
Hi Hermit
The awful stuff probably differs from drug to drug. With methadone it would be some toxicity, reduction of sex drive, sweating, low grade depression, and difficulty giving up(!). With benzos it's a temperature thing again, sex drive reduction, a generally destabilising effect. Alcohol (in middle age) can lead to sloppy conversations. I just mean the drug effects that are additional to the therapeutic effect.
I have mixed feelings about drugs. Like the school counseller on Southpark I think drugs are bad. OTOH people have very real problems and very real suffering.
The modern world of media etc is not helping us cope with normal human unhappiness (which is bad enough), and some people are sick. I hope these opinions of mine make some kind of sense.
Declan
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