![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 71 to 95 of 121. Go back in thread:
Posted by shelliR on December 5, 2001, at 13:59:03
In reply to Re: Methadone for depression. » shelliR, posted by manowar on December 5, 2001, at 13:05:26
Hi Tim,
> From what my pdoc told me, Concerta is just Ritalin XR that works a lot better than the drug Ritalin XR. He told me that 1/3 of it is released immediately, 1/3 is released 3 hours later and the last 1/3 is released 3 hours later. I found that it works great and it is effective for me for 8-10 hours.
>Is Ritalin XR still available? If it is, it might be related to a paten release. Or a way to get around a name that seems to be so associated with ADD?
> Since the Concerta is a timed-release preparation, I don't think it would be a good idea to split it in half. You may need a higher dose for it to be effective.Sorry, you're right. I did come across as if I meant splitting the pill. I actually meant splitting the dose-2 morning, 1 early afternoon.
>
> This is what I'm doing:
> Since the Concerta (72 mg) wears off for me around 4-6 in the afternoon, my pdoc gave me a script for regular Ritalin (20 mg) so that I could take one when the Concerta starts to wear off. The Ritalin last for 3-4 hours.I think that's a good plan. I didn't want to have to keep track of one more pill (to get a prescription of, renewal, etc, of ritalin.) It's already scary (to me) how many different drugs I'm taking for depression.
Shelli
Posted by JahL on December 6, 2001, at 11:34:15
In reply to Re: Morphine for depression. » Lorraine, posted by shelliR on November 28, 2001, at 0:02:48
> > > Anyway, I am excited that the methodone seems positive (although not perfect) and I find myself looking forward to things that may be around the corner. It would be interesting after all of this searching we both ended up with methodone as the pain mood stabilizer after all these other trials.
> Now I am less excited. I want to go back on oxy I think, and I just never know when I'll reach the end of effectiveness. But thers's really no point in not living in the now. I can't control what happens with my body chemistry.Hi Shelli.
Don't presently have the motivation to trawl thru long threads. Was wondering why you wanted to return 2 Oxy. Methadone not doing the trick? Can you tell me why you prefer the 'real' opiates (or is that a silly Q??)? What dose are you taking?
That specialist guy I was telling you about as good as told me to try anything I can get my hands on. He told me they're currently 'burying bodies' which might otherwise be saved were it not for restrictive, draconian govt. legislation concerning opioids and the like. It would seem his hands are tied...
I think Methadone low-dose is helping a little. Now I've got the green (in both senses of the word) light.......
Hope you're doing OK,
J.
Posted by jazzdog on December 6, 2001, at 12:20:58
In reply to Re: Methadone for depression. » shelliR, posted by JahL on December 6, 2001, at 11:34:15
Hi Jahl-
So what did your pharmacologist have to say about depersonalization? And new ideas?
- Jane
Posted by JahL on December 6, 2001, at 18:44:03
In reply to Re: pharmacologist report? » JahL, posted by jazzdog on December 6, 2001, at 12:20:58
> Hi Jahl-
>
> So what did your pharmacologist have to say about depersonalization? And new ideas?Hi Jane.
You know what, I did the full 90 minutes w/o mentioning depersonalisation. Might have something to do with having only 3 hours sleep over 2 days & a sodding 6 hr round trip.Also I'm not especially depersonalised at present and because I've been this way all my life, I only tend to notice when the DP is particularly bad. Actually, I found it pretty easy to connect today & I know I gave a good a/c of myself. I suspect it may have had something to do with the low-dose Methadone I'm taking, though I wouldn't like to comment further until I've upped the dose. I've actually spied a couple of articles implicating the endogenous opioid system in DD disorders. I think there are at least 2 board members here who suffer from dissociative disorder and benefit from opioids...
We concentrated on BPII as a single entity and mainly focussed on the depression. When this remits, so do all my other symptoms.
He said that as far as British psychiatry was concerned I had already pushed the envelope far beyond what was considered 'reasonable' and that I would probably have a better chance treating myself, "given you seem to know more than the average psychiatrist." < g > (I know sh*t-all)
His main suggestion was to retain all present meds and add Tryptophan to augment the SSRI (currently Celexa). Of course this is not popular practice in the US right now because of the past EMS scares but he assures me he has had some success with this method (tho he doesn't deny that there still exists a theoretical risk).
I have a modicum of faith if only because this was the first pdoc I've ever met who truly knows his stuff. No pretence. No picking apart of my childhood. No condemnation for my drug *use*. You get the picture. Easily the most valuable 90 mins I've ever spent with a doc ('cept the one who operated on my hand...) It's just a shame I finally find this person when my journey seems to be nearing its end...
Rgds,
J.PS I'm still technically at the DP unit so I'll keep you abreast of any developments. However they've recently started mumbling about 'disability management' & the like which doesn't sound too promising...
Posted by Lorraine on December 6, 2001, at 20:20:43
In reply to Re: Methadone for depression. » Lorraine, posted by shelliR on December 4, 2001, at 21:30:34
Shelli:
I'll keep you posted. I think the plan is to try the stimulants first. Concerta is supposed to last 12 hours I think--which is a short day so staggering your doses might make sense. I'm on the lowest dosage 16 mg so that's not an option. I'm still not sure where I am with it anyway. Pretty sure the transition from short action to sustained release is done, but then there's figuring out the Neurontin piece, which has come down (from 1500mg a day to about 800-900 mg a day) and my system is probably still adjusting to that decrease. Anyway, cutting a long ramble short, I'll keep you posted. Thanks for the concern.
Lorraine
> Well, I like to know where you're walking, so let me/us know, okay? Is the plan to find the right stimulent with the right mood stabilizer, and leave ADs out of the picture? I am on cercerta. I couldn't adjust to any of the stimulents until I was on with a narcotic. And now I really don't know whether it makes a difference whether or not I take it, even though I'm up to 54mg a day.
> Actually, you could probably take away most of my other drugs and it wouldn't make a difference. I am also up to 400 mg of wellbutrin, but I'm still very very tired late afternoon. I have this theory that life is just too much to last a full day, and if I take a 30minute nap, everything feels better. I'm going to try spliting the concerta to twice a day, try to get around that theory. The only reason I care is when I am not home, or when people want to pick up stuff in the late afternoon, I can't take a nap, and then I almost fall asleep sitting up at about 8pm. (and wake up at 9 or 10, because my body thinks it's a nap, not time to sleep)
>
> Take care,
> Shelli
Posted by jscottb on December 6, 2001, at 21:19:59
In reply to Re: Morphine for depression. » Lorraine, posted by shelliR on November 16, 2001, at 12:30:36
> Wow. I'm really curious about the use of an opiate for depression. I suffer from depression and I still battle my demons with opiates. Although I have been opiate free for almost 4 months, I still fight the battle every day. I got in trouble for prescription fraud, and I must never entertain those thoughts again. I take Paxil for depression, but opiates have always done wonders for that. I admit it. I love opiates. How could I proceed in finding the right doctor? Thanks.
> >
> > Shelli: It's Lorraine jumping in. I just wanted to see how you are doing on the Oxy. Have you stablized? Is your depression under control? I had an allergic reaction to Nardil (inflamed swollen hands, lose of feeling in fingertips--actually listed as a known side effect) and had to go off. I'm deciding my next step and opiates are on the agenda but probably not my next step.
> >
> > Lorraine
>
>
> Hi Lorraine,
>
> Good to hear from you, wish it were under better circumstances. When did the nardil reaction occur?
>
> It's been about five or six weeks since I've been on this dose of oxy and my depression is under control. I don't think that's long enough to tell although I am very hopeful. I just went up another 20mg, but only because I have thought the last time I went up that it was slightly lower than it could be--I mean I'm already habituated, why not feel as good as possible, without feeling at all drugged.
>
> Unfortunately, it looks like I *will* be switching to methodone in a few weeks because they haven't even received the paperwork in my pdoc's office. I am only allowed to get it from them and they are putting zero energy into it. It is horrible timing for a med change in terms of work, but hopefully the transition will not be a huge deal.
>
> If I become unstabilized on either oxy or methodone, it will be a hugh jolt. I am willing to go as high as my pdoc will let me, if it means not being depressed. I am still unstable premenstrually, but that's more fear, and anxiety, specifically around finishing all commitments with work and around the fear that my doctor can stop working with me any time he chooses and I would have to detox. And then I would be at square one with the depression. I also have no guarantee that methodone will have the same effect as oxy, but he
> seems to think so. Monday, I'll ask him why methodone rather than morphine, but I won't hold my breath expecting an answer.
>
> If I feel like this during the next year, that is good enough. My feelings are more good than bad, and the bad involves insecurity rather than depression.
>
> How bad is your depression now? What do you see as possibilities for your next trial. Also, have you
> discussed opiates with your doctor, or are you
> assuming from knowing him,that he will be supportive around this?
>
> BTW, opiates make me anorgasmic, but I figure if I'm ever "involved" I can skip the evening dose. I have never heard Elizabeth say that she has had any sexual problems with buprenorphine.
>
> Good luck on your next decision. Keep us informed.
>
> Shelli
Posted by jazzdog on December 7, 2001, at 12:22:20
In reply to Re: pharmacologist report? » jazzdog, posted by JahL on December 6, 2001, at 18:44:03
Thanks for the update. Good to know somebody is out there who makes some sense to you. Good luck with the tryptophan and methadone.
- Jane
Posted by judy1 on December 8, 2001, at 4:03:01
In reply to Re: Morphine for depression. (how to find doc?), posted by jscottb on December 6, 2001, at 21:19:59
If you are truly treatment resistant, you might try a mood disorder program at a University- many of them use opiates with their patients who don't respond to every other AD and combo. I suspect that people on this board have tried EVERYTHING with their docs and it was kind of a last resort. If you fall in that category, it's worth a shot in asking. As far as the prescription fraud goes, I see that as an effort to self- medicate, but a lot of docs won't. Take care, judy
Posted by Elizabeth on December 8, 2001, at 7:32:24
In reply to Re: Morphine for depression. (how to find doc?) » jscottb, posted by judy1 on December 8, 2001, at 4:03:01
> If you are truly treatment resistant, you might try a mood disorder program at a University- many of them use opiates with their patients who don't respond to every other AD and combo.
I wouldn't say "many." It's unfortunate, but there are a lot of doctors out there who have the rigid, inflexible attitude that opioids are not "appropriate" for treatment of depression. I know there are many of us who only respond to opioids, but I'm afraid we aren't going to see opioid antidepressant treatment become standard in our lifetimes.
> I suspect that people on this board have tried EVERYTHING with their docs and it was kind of a last resort. If you fall in that category, it's worth a shot in asking.
And do your best to make it clear to the doctor that you're not just looking to get high or whatever. Seriously: it seems like doctors almost automatically mistrust anyone who asks for opioids.
-elizabeth
Posted by shelliR on December 8, 2001, at 14:31:27
In reply to Re: Methadone for depression. » shelliR, posted by JahL on December 6, 2001, at 11:34:15
>
> Hi Shelli.
>
Hi Jah,
> I think Methadone low-dose is helping a little. Now I've got the green (in both senses of the word) light.......do you have enough of a source for you to be secure in knowing that if it works, it will be there for you?
And will you see this guy again to see how the new med combo works? Is he still your doctor?
What does this mean: PS I'm still technically at the DP unit so I'll keep you abreast of any developments.
Are you physically in the hospital, or does unit mean your file is still being kept in the huge bureaucratic UK system at a certain specialty and they may continue to treat you?
You can perhaps answer those questions in one answer, because they might all be related, except the supply question.
Its hard to translate the UK system from over here.
I don't know if there is much of a difference in how I feel between methadone and oxycontin. It's more that my doctor is telling me that it "should"
last for at least 12 hours and it's lasting for only 8 hours. And it was a bad time to switch because it's the busy season until christmas with my business. So with the oxy, he was allowing me to take an extra dose at night and now he is fighting that.It's all so crazy with this pdoc. I mean who's taking the med, him or me. It doesn't make me high at all, so way would I say it's wearing off too soon if it wasn't. It just means that I have more
rebound depression in the morning. I already went through that and settled it with oxycontin and now he is again saying your at the highest level, etc. etc. And I say what is the plan, and he has none.
I think it would have been better to start with methadone because the increases in doses would have been so much smaller and I could have started so low. I am taking 110mg, but the oxy had gotten me really high up in mg.Anyway, I am a wreak, I need a new pdoc, but yes, the methadone, even with this guy, is better than no opiates without this guy.
Keep us informed. After Christmas I hope to turn into a person again.
Shelli
Posted by shelliR on December 8, 2001, at 14:49:33
In reply to Re: Morphine for depression. (how to find doc?) » jscottb, posted by judy1 on December 8, 2001, at 4:03:01
> If you are truly treatment resistant, you might try a mood disorder program at a University- many of them use opiates with their patients who don't respond to every other AD and combo. I suspect that people on this board have tried EVERYTHING with their docs and it was kind of a last resort. If you fall in that category, it's worth a shot in asking. As far as the prescription fraud goes, I see that as an effort to self- medicate, but a lot of docs won't. Take care, judy
Hi Judy.
It's always so good to see your name on the board, when you've been or I've been away for a little while. How is your detox going? When you have the baby, please check in and tell us (please?)
After the Christmas rush, I need to find a new pdoc. I would like to restart with opiates, and also find a better combination with my other meds. And I would like to get as far away as I can from my present pdoc who makes me feel sicker.
I don't know what you mean about universities using opiates as a last resort in their mood disorders program. Is this just a California thing--maybe moving over to the east coast in a few years? Any specifics on Universities?
If you feel comfortable to do this (and you have time) could you e-mail me at stacey1012km@yahoo.com so I could ask you for any leads you might have. If not, I have other people helping me with this also, so it's okay. I am just going to have to look and look. It's good that I'm already on methadone I think, and I'm not getting off until I find another pdoc to help me with my meds, even if it means going to another state. I would rather, find someone in my location first (washington, d.c. or baltimore md, or at least on the east coast. California might be my last option, but it is an option). I'm talking about the quality of my life, as you and everyone on this board understands.
Take care,
Shelli
Posted by Elizabeth on December 8, 2001, at 20:03:28
In reply to Re: Methadone for depression. » JahL, posted by shelliR on December 8, 2001, at 14:31:27
> I don't know if there is much of a difference in how I feel between methadone and oxycontin. It's more that my doctor is telling me that it "should"
> last for at least 12 hours and it's lasting for only 8 hours.Methadone is given once daily to addicts on maintenance therapy, but for pain it's supposed to be given several times a day. I think that we're more like pain patients in that respect. (When bupe is used for maintenance treatment of opioid dependence, it's given once daily as well, but I need to take it every 4-6 hrs.)
-elizabeth
Posted by Elizabeth on December 8, 2001, at 20:05:13
In reply to Re:methadone for depression. (how to find doc?) » judy1, posted by shelliR on December 8, 2001, at 14:49:33
> I don't know what you mean about universities using opiates as a last resort in their mood disorders program. Is this just a California thing--maybe moving over to the east coast in a few years? Any specifics on Universities?
I had mostly heard of it being done at Harvard, actually (that's how I originally got prescribed bupe, when I was living in Cambridge).
-e
Posted by shelliR on December 8, 2001, at 20:28:52
In reply to Re: methadone for depression. (how to find doc?) » shelliR, posted by Elizabeth on December 8, 2001, at 20:05:13
> > I don't know what you mean about universities using opiates as a last resort in their mood disorders program. Is this just a California thing--maybe moving over to the east coast in a few years? Any specifics on Universities?
>
> I had mostly heard of it being done at Harvard, actually (that's how I originally got prescribed bupe, when I was living in Cambridge).
>
> -eHi Elizabeth,
Would I call Harvard if I was looking for a consultation, or Bodkin's group at McLean Hospital. How are the two connected?
Also, I am not doing well at all on the methadone; I went straight from a large dose of oxy to a large dose of methadone. I think my body is all mixed up. I feel sick; I am also very very anxious about finishing work stuff, although today I talked to family and friends who said I shouldn't try to finish everything--that I'm too close to unraveling (as my therapist calls it). My life is more important than my product, although I would like to keep as many commitments as possible. My instinct is to not go back to oxycontin if I am looking for a new doctor, that it will look better if I am on methadone. Do you think it matters, or that it would make no difference since both were physician prescribed for depression?
I want to detox from methadone and then either start again slowly, or try buprenorphine. The doctor at the hospital that I've worked with (on the dd unit), has detoxed patients from methadone to buprenorphine--and he said that pills are available and worked well. So I'm confused. Did the pills just become available in the US? He is willing to detox me, but then he wants me off the buprenorphine. I don't want to get into a "no more opiate" situation, or I would go into the hospital and get off the methadone.
I think that I have a better chance of finding a pdoc to work with me and use opiates if I am already on an opiate. Because then they are not liable for "addicting" me. (using the word ignorantly, don't freak :-) ) Do you agree?
Shelli
p.s., are you thinking about retrying effexor?
Posted by JahL on December 8, 2001, at 20:40:05
In reply to Re: Methadone for depression. » JahL, posted by shelliR on December 8, 2001, at 14:31:27
> > I think Methadone low-dose is helping a little. Now I've got the green (in both senses of the word) light.......
>
> do you have enough of a source for you to be secure in knowing that if it works, it will be there for you?Ultimately, yes. When I get my ass into gear I'm pretty determined/resourceful. Actually, my er...pharmacist is on holiday at the mo' and I'm not going to raise the dose above 5ml until supply is g'teed for the foreseeable future. If I took the trouble to look, there are probably a few 'pharmacies' around.
> And will you see this guy again to see how the new med combo works? Is he still your doctor?
Doubt it. It was a one-off referral apparently and it seems my regular pdoc will administer his directions. Whenever he can get round to it. It would be too much to hope to see someone that good more than once. Since we hit it off I probably would've consulted him again but I've pretty much exhausted all the legal options (and many less than legal) he has at his disposal. A case of right person, wrong time.
> What does this mean: PS I'm still technically at the DP unit so I'll keep you abreast of any developments.
> Are you physically in the hospital, or does unit mean your file is still being kept in the huge bureaucratic UK system at a certain specialty and they may continue to treat you?The DP Unit is the Depersonalisation Unit at the Maudsley, which I am becoming increasingly aware of as being very psychotherapy (Eck!) orientated. I recently cancelled an appt (car crash) & they're *yet* to get back to me. F*ck 'em. No matter how bad my depression gets, I will *never* enter hospital. When I'm that bad the last thing I want is people round me (I think you're similar?). I only go to hospitals for 1 hr consultations and that's plenty for me.
> Its hard to translate the UK system from over here.Try and explain this. Yesterday, when I had run out of Lamotrigine, I put in an urgent request for a refill (to my GP - Primary Doc?). Just before the practise closed I got a scrap of paper saying "no Lamotrigine until confirmation from specialist" (even tho' he had prescribed it a no. of times previous). It would seem none of the *3* specialists had bothered to write and tell him I was on 400mg Lamot. This guy I had known for years was ready to abruptly pull me off high dose anti-seizure meds thus putting me at risk of dangerous seizure and w/o doubt plunging me into an acutely suicidal depression. I don't know whether I should forgive him for this. I quite like him but that was inexcusable. Grossly negligent perhaps.
I think someone in my family warned him to phone me; I had my 'gloves' & car keys & was about to drive down and show him what I think of people who put my life at risk (and I don't think that's exaggerating the case. As for my intentions I can't excuse them but I sometimes have a lethal temper >:-( ). Fortunately a half hour phone call sorted it and I'm still a free man :-)
> I don't know if there is much of a difference in how I feel between methadone and oxycontin. It's more that my doctor is telling me that it "should last for at least 12 hours and it's lasting for only 8 hours. And it was a bad time to switch because it's the busy season until christmas with my business. So with the oxy, he was allowing me to take an extra dose at night and now he is fighting that.I must thank you for suggesting spreading the dose; things seem quite calm and smooth. I thought it lasted 24hrs; whatever they say it is, it's probably less. I have a pet theory (actually I just this minute rolled a spliff and dreamt it up) that Methadone users are misinformed re: Methadone half-life so as to punish users for a couple of hours prior to their next dose for daring to be addicted to something that makes them feel good (H). I mean, who do they think they are??!
> It's all so crazy with this pdoc.Tell me about a pdoc who makes life simple and I'll call you a liar :)
> I mean who's taking the med, him or me. It doesn't make me high at all, so way would I say it's wearing off too soon if it wasn't. It just means that I have more rebound depression in the morning.
Doesn't Meth get you through the night? Do you get more rebound because you miss out on the immediate high you get from Oxy (do you have any idea what I'd give for a pot of that? If you think it's hard getting opiates in the States, try living over here. Opiate is an obscene word, especially after 'Dr Death' aka Dr Harold Shipman was found to have been addicted to PETHEDINE-Elizabeth, if you're reading, know anything about this one?-whilst murdering maybe 500 patients with Diamorphine. Even you insular Yanks ( :-) ) must have heard about this one a year or 2 ago.)?
>I already went through that and settled it with oxycontin and now he is again saying your at the highest level, etc. etc. And I say what is the plan, and he has none. I think it would have been better to start with methadone because the increases in doses would have been so much smaller and I could have started so low. I am taking 110mg, but the oxy had gotten me really high up in mg.
You mean start like I have? I guess you'd have to come off the opioids for a while to do that? Doesn't sound like an option for you...
Are you saying that yr present Meth dose doesn't get you through the day? I hope not cos that f***** should raise it to whatever feels comfortable. I don't think you can work that out on a bit of paper...> Anyway, I am a wreak, I need a new pdoc, but yes, the methadone, even with this guy, is better than no opiates without this guy.
Well that's something. I feel the same generally. The pdoc is almost a luxury so long as you get the meds *you* (& you only) know to help. That's the best thing to come out of this referral; I've basically got a regular pdoc who's been instructed to give me almost anything I want. I don't care for his opinion any more. It's thanks in great part to this board that I was able to convince the Good Professor that I was capable of running my own care (or at least more able than a provincial pdoc).
> Keep us informed.
You too.
>After Christmas I hope to turn into a person again.
I'm less hopeful for myself but that would be a great present 4 you.
J.
(sorry for the length-lack of a therapist to talk to y'see :) )
Posted by shelliR on December 9, 2001, at 0:21:54
In reply to Re: Methadone for depression. » shelliR, posted by JahL on December 8, 2001, at 20:40:05
> (sorry for the length-lack of a therapist to talk to y'see :) )
< g >,
shelli
Posted by Elizabeth on December 9, 2001, at 15:28:31
In reply to Re: methadone for depression. (how to find doc?) » Elizabeth, posted by shelliR on December 8, 2001, at 20:28:52
> Would I call Harvard if I was looking for a consultation, or Bodkin's group at McLean Hospital. How are the two connected?
McLean is a private psychiatric teaching hospital affiliated with Harvard Medical School (it's where the story Girl, Interrupted took place). I don't know how you would go about getting a consultation appointment with someone who could help you; you could call McLean (617 855 2000) and ask if Dr. Bodkin would be willing to see you (I believe that he's not taking new patients, but he might be willing to see you if it were a one-time thing). Dr. Stoll (you know, the OmegaBrite guy) is another person at McLean who has published a report on the use of opioids for depression (see: Stoll AL, Rueter S. Treatment augmentation with opiates in severe and refractory major depression. Am J Psychiatry 1999 Dec; 156(12): 2017). My own psychiatrist in Cambridge, who went to HMS, did his residency at McLean, and for some time worked at McLean as the head of an adult inpatient unit (so his ideas and attitudes about psychopharmacology basically arise from the Harvard "culture"), also has used MSIR (morphine) successfully in one patient for depression, besides having prescribed bupe to me. (I found this especially surprising because his main interest is psychoanalysis, rather than psychopharmacology.)
> Also, I am not doing well at all on the methadone; I went straight from a large dose of oxy to a large dose of methadone.
They're similar in potency, I think, and there's going to be cross-tolerance regardless what opioid you try.
> I feel sick; I am also very very anxious about finishing work stuff, although today I talked to family and friends who said I shouldn't try to finish everything--that I'm too close to unraveling (as my therapist calls it).
That's worrisome. What do you mean when you say you feel "sick?" (more specifically, I mean?)
> My life is more important than my product, although I would like to keep as many commitments as possible.
Sometimes, I feel like in today's world, what you "produce" *is* your life. Pretty distressing thought.
> My instinct is to not go back to oxycontin if I am looking for a new doctor, that it will look better if I am on methadone.
I don't know how it will look; that depends a lot on who the looker is. Methadone is very strongly associated with addiction treatment, and it's the most strictly regulated drug that is legal to prescribe at all (which is probably why most doctors who are prescribing opioids for depression don't seem to be using it, even though medically it seems a more logical choice than oxycodone or morphine).
> Do you think it matters, or that it would make no difference since both were physician prescribed for depression?
A lot of times a doctor will refuse to honor another doctor's decision to prescribe an opioid to a psych patient and insist that you go off the opioid if they're to treat you. (Such a doctor will claim not to be interfering with your freedom of choice by doing this since presumably you can always find someone else who'll be willing to prescribe the opioid, but I think this is just a rationalization that allows them to feel like they're not doing anything wrong.) So I wouldn't count on it.
> I want to detox from methadone and then either start again slowly, or try buprenorphine.
Detoxing with buprenorphine (i.e., switching to bupe and then tapering off it) might actually be the best strategy -- with depression being an issue on top of the usual difficulty getting off opioids (and methadone withdrawal sx can last a *LONG* time), you might well find it impossible to get off methadone without having to go to the hospital again. Switching to bupe would be less disruptive; it has very little in the way of withdrawal symptoms, and from what I gather, addicts can often switch to it and then taper off relatively painlessly. The main difficulty would be finding the right dose of bupe to start with.
> The doctor at the hospital that I've worked with (on the dd unit), has detoxed patients from methadone to buprenorphine--and he said that pills are available and worked well.
Really? If you can find out more about this, I would be very interested to know what's up.
> So I'm confused. Did the pills just become available in the US?
Maybe; or maybe he's able to do it on an inpatient basis but can't prescribe it for outpatients for detox or maintenance. It's also possible that he has a supply obtained from abroad; I think there's a lot of red tape involved, but you can do that in a thoroughly legal fashion (as opposed to the internet "grey market" that currently exists).
> He is willing to detox me, but then he wants me off the buprenorphine. I don't want to get into a "no more opiate" situation, or I would go into the hospital and get off the methadone.
It's terrible to feel that doctors are trying to force you into a situation that you know would be bad for you, isn't it? :-( A lot of times, I think, doctors think they know better than you do what's in your best interests. More and more, patients (especially those who make an effort to educate themselves) are challenging that idea.
> I think that I have a better chance of finding a pdoc to work with me and use opiates if I am already on an opiate.
Agreed, although like I said, even then there's no guarantee that any particular doctor will be willing to work with you.
> p.s., are you thinking about retrying effexor?
Already started it: I'm on 75 mg of Effexor XR, intending to increase it as high as necessary. My hope is that the anticonvulsant will prevent another ?seizure? like I had last time I took Effexor (if I have another serotonin syndrome-like episode, adding Remeron might also be something to consider). My hope is that I'll find something (or some combination) that can help with the anergia-anhedonia that plagued me even when I was on Parnate and desipramine and wasn't in a full-blown depression, but that will be feasible to take long-term (bupe, because of the side effects, short duration of action, and unreliability (maybe due to the route of administration?), is probably not). That's what I need if I'm to get my life together again. It may end up meaning that I will always have to take bupe (or another opioid) on an as-needed basis, or that I will have to find a different opioid that doesn't cause the problems that I've had with bupe.
So, I'm hoping. I sort of feel like your fate and mine are tied together, and if we succeed, it might help open a door for other people like us who respond to opioids and not much else.
As always -- good luck.
-elizabeth
Posted by Elizabeth on December 9, 2001, at 16:04:58
In reply to Re: Methadone for depression. » shelliR, posted by JahL on December 8, 2001, at 20:40:05
Jahl, would you be interested in exchanging emails? I'm curious as to how you're going about getting treatment, although your methods may not be applicable to me here on the other side of the pond. I can't recall if we've ever written each other before, but I have a Yahoo account where you can write me if you're willing (cybersquid_400@yahoo.com). I agree with your self-assessment -- you can be pretty resourceful and clever -- and I wonder if maybe you could help me figure out what to do about my own situation.
> The DP Unit is the Depersonalisation Unit at the Maudsley, which I am becoming increasingly aware of as being very psychotherapy (Eck!) orientated.
As you've probably noticed, I share your gag reflex toward talk therapy. I also feel bad for you about the troubles you've run into with red tape and bureaucrats and policies and so forth -- I've had similar troubles many times. I *hate* dealing with bureaucrats. And it's so hard to advocate for yourself and make sure your rights are respected when you're depressed, isn't it?
> I must thank you for suggesting spreading the dose; things seem quite calm and smooth. I thought it lasted 24hrs; whatever they say it is, it's probably less.
The dosing schedule for methadone is different depending on what it's being used for. According to the U.S. labelling, pain patients should take it every 3-4 hours. In contrast, addicts on maintenance therapy usually only need it once a day. (I've heard of cases where it wore off before the next morning and people couldn't get a take-home dose from the clinic. Being a regular psych patient can be hell, but I can only imagine how awful it must be for drug addicts. They're treated as though they're sub-human, or at the very best, the worst sort of criminals.)
So the question is, are depressives more like pain patients or MMT patients in their opioid dosing requirements? FWIW, I can tell you that I need to take bupe several times a day, whereas I believe that it's used once daily when it's given to addicts for maintenance therapy.
> I have a pet theory (actually I just this minute rolled a spliff and dreamt it up) that Methadone users are misinformed re: Methadone half-life so as to punish users for a couple of hours prior to their next dose for daring to be addicted to something that makes them feel good (H). I mean, who do they think they are??!
Usually once a day is enough, actually. But (see above) for people who need it more often, it can be really awful.
> If you think it's hard getting opiates in the States, try living over here.
I know that it's hard to get benzos in the UK; I wasn't sure about opioids. Here, a lot of doctors still refer to them as "narcotics." That says it all for me.
> Opiate is an obscene word, especially after 'Dr Death' aka Dr Harold Shipman was found to have been addicted to PETHEDINE-Elizabeth, if you're reading, know anything about this one?-whilst murdering maybe 500 patients with Diamorphine. Even you insular Yanks ( :-) ) must have heard about this one a year or 2 ago.)?
I actually don't know that story, no. I often lapse in following national news, let alone international. What exactly was the deal?
(BTW, U.S. readers might not recognize some of the drug names you use. Pethidine is what in the U.S. is called meperidine or Demerol -- a very short-acting opioid, not useful for our purposes; and diamorphine is of course diacetylmorphine, better known as heroin.)
> You mean start like I have? I guess you'd have to come off the opioids for a while to do that?
Yes. And from what I know, methadone can be VERY hard to get off of (especially at high doses) because the w/d, while not as intense as what you'd get from quitting heroin, goes on for an excruciatingly long time.
> Well that's something. I feel the same generally. The pdoc is almost a luxury so long as you get the meds *you* (& you only) know to help.
I know; it's so frustrating that many pdocs don't seem to believe that you know what your own subjective experience is better than they do!
> > After Christmas I hope to turn into a person again.
>
> I'm less hopeful for myself but that would be a great present 4 you.This is the fifth Christmas in a row that I've found myself wishing for the same present.
Best wishes to you.
-elizabeth
Posted by judy1 on December 9, 2001, at 16:56:56
In reply to Re:methadone for depression. (how to find doc?) » judy1, posted by shelliR on December 8, 2001, at 14:49:33
Hi Shelli,
I'm glad Elizabeth was able to provide you with a lead on the East coast; my pdoc came out of a program at UCLA. Perhaps I'm being naiive, but I would hope if you had your records showing how well you respond to opiates and how treatment-resistant you were to standard AD treatment, some pdoc would be open to your regime. To save time I would often call the Psychiatry Dept at a U (I've spoken to someone at Hopkins, so they must have a mood disorders program) and ask to speak to the Director or author of the paper that Elizabeth mentioned. I've really been successful for some reason, maybe I sound pathetic. I also have gotten opiates on-line (PillBox) when desperate- but it's expensive and I, like the rest on this thread, would prefer to be under a dr's care. I've been very successful in my tapering, anxiety that is treated with benzos and depression- I've gotten Actiq, a short acting fentanyl lonzenge (thanks Elizabeth) for emergency use. I'm a believer in therapy, sometimes 3x/week. When I have my baby (thank you for asking), I'll ask Dr. Bob if I can post a picture :-). I wish you all the best, and if you want me to e-mail alternatives to getting opiates, I'll be happy to. Take care of yourself, judy
Posted by Lorraine on December 10, 2001, at 19:18:06
In reply to Re: Methadone for depression. » JahL, posted by Elizabeth on December 9, 2001, at 16:04:58
Elizabeth:
Haven't posted to you for a while, but do think of you often. Just wanted to chime in that I think you are a remarkably fine person already and I can't imagine what type of person you would evolve into if you get your wish (other than a happier person:-). Anyway, wanted to let you know that your advice on this board has been invaluable to me and many others.
Lorraine
> > > After Christmas I hope to turn into a person again.
> >
> > I'm less hopeful for myself but that would be a great present 4 you.
>
> This is the fifth Christmas in a row that I've found myself wishing for the same present.
>
> Best wishes to you.
>
> -elizabeth
Posted by Elizabeth on December 10, 2001, at 20:15:55
In reply to Re: Methadone for depression. » Elizabeth, posted by Lorraine on December 10, 2001, at 19:18:06
Lorraine --
**blush**
Thanks. I do what I can. It's *really* nice to feel appreciated.
best wishes & happy holidays
-elizabeth
Posted by Lorraine on December 10, 2001, at 20:17:37
In reply to Re: Methadone for depression. » JahL, posted by shelliR on December 9, 2001, at 0:21:54
Shelli:
Just checking in to see how you are doing and wondering what decisions you are leaning towards. Remember that you are a great person and have helped me immeasurably when things have been tough. I hope that things become easier for you soon. I'm glad to read all of the great advice you have been getting.
Lorraine
Posted by JahL on December 11, 2001, at 19:45:30
In reply to Re: Methadone for depression. » JahL, posted by Elizabeth on December 9, 2001, at 16:04:58
> Jahl, would you be interested in exchanging emails?
Hi Elizabeth. Yeah, definitely. I'll set up a free email a/c. Bear in mind it takes me a couple of days to do anything.
>- you can be pretty resourceful and clever --
and may I say what a fine judge of character you are :)
>and I wonder if maybe you could help me figure out what to do about my own situation.
Seriously, I doubt there's much me & my dilapitated brain could tell She Who Knows Everything Medical. But there's probably something to be gained (certainly on my part) from exchanging experiences & whatnot. There's only so much you can say here...
> > very psychotherapy (Eck!) orientated.
> As you've probably noticed, I share your gag reflex toward talk therapy.Yeah, I thought I had a sympathetic audience on this thread. I won't talk to psychotherapists on principle; I despise them for reinforcing the publicly held notion that people with serious mental illness can cure themselves if only they would *try*. I'd like to see them try. They frequently hock their unscientific treatments on the back of benzo- and opiophobia thus making life more difficult for the likes of you and me who are seeking a *legitimate* (if unconvential) treatment. Anyway, enough of that. I'll start a debate off if I'm not careful.
> I *hate* dealing with bureaucrats. And it's so hard to advocate for yourself and make sure your rights are respected when you're depressed, isn't it?
I've made this point to pdocs many times. What happens to those who are too depressed to advocate for themselves in the way I (just about) am able to? What happens to those who are w/o a decent education or who have no net access? They're often consigned to rot in brain-corroding 'day-care' centers, with no discernable treatment plan.
> Being a regular psych patient can be hell, but I can only imagine how awful it must be for drug addicts. They're treated as though they're sub-human, or at the very best, the worst sort of criminals.)
Yeah, that's kinda the point of my theory. When I refer to Methadone 'users' I mean Heroin addicts; I wasn't aware Methadone was used for pain here in the UK (if it is, they're not telling. And why, when a respectable businessman and I had identical hand tendon operations, did he get different coloured painkillers to me ?!?! Hmmm..). Users have to queue up each day for their little bottle of salvation and be thankful it lasts as long as it does...
> So the question is, are depressives more like pain patients or MMT patients in their opioid dosing requirements? FWIW, I can tell you that I need to take bupe several times a day, whereas I believe that it's used once daily when it's given to addicts for maintenance therapy.Interesting. In the same way, for me Methadone *seems* to work better if taken as for pain.
> > I have a pet theory (actually I just this minute rolled a spliff and dreamt it up) that Methadone users are misinformed re: Methadone half-life so as to punish users for a couple of hours prior to their next dose for daring to be addicted to something that makes them feel good (H). I mean, who do they think they are??!
> I know that it's hard to get benzos in the UK; I wasn't sure about opioids. Here, a lot of doctors still refer to them as "narcotics." That says it all for me.Yeah, the couple of times I have vainly brought up the idea of opioids I have been asked "You mean Heroin?" [writes on notes : 'DRUG ABUSER'].
> > Opiate is an obscene word, especially after 'Dr Death' aka Dr Harold Shipman was found to have been addicted to PETHEDINE-Elizabeth, if you're reading, know anything about this one?-whilst murdering maybe 500 patients with Diamorphine. Even you insular Yanks ( :-) ) must have heard about this one a year or 2 ago.)?
>
> I actually don't know that story, no.I actually meant do you know about Pethidene :-). Since you ask...the guy started out as a GP (community doc) and soon developed a penchant for Pethidene. Later his habit was discovered but he was allowed to continue handling opiates. Anyway, soon after graduating he administered a lethal dose of Diamorphine to an elderly lady patient and pronounced her dead (cardiac arrest). This set the pattern for the following 25 years in which it is thought he murdered some 500 patients (nearly all female, elderly & living alone). He made regular house calls and it was on these that he would generally administer his lethal injections. Apparently he liked 'playing god'. Post-mortems never tested for Morphine (which of course he knew).
It was only a couple of years ago that a local registrar checked the records and realised the senior citizen death rate at his surgery was twice the ntl. average! He is w/o doubt this country's 'greatest' serial killer. When they searched his house they found a *2 litre* (!) stockpile of Diamorphine. All the ammo the govt. needs to further tighten controls...and punish people like myself.
> (BTW, U.S. readers might not recognize some of the drug names you use. Pethidine is what in the U.S. is called meperidine or Demerol -- a very short-acting opioid, not useful for our purposes; and diamorphine is of course diacetylmorphine, better known as heroin.)Opiate information of any kind (except the kind that tells you how many years in prison possession will earn you) is obviously Classified in the UK going by my web search. It's as if they don't exist. I *think* the following could be 'available' (ironic I know) here:
P,SL Buprenorphine (1)
O Codeine (5)
R Dextromoramide (2)
Dextropropoxyphene?
O,P Diamorphine (2)
O,P Dihydrocodeine (1)
O Dipipanone (1)
O Dipipanone & cyclizine 10mg/30mg 4 tablets new July 2000
Topical Fentanyl patches (50mcg) (3)
O Meptazinol (1)
O,P,R Morphine hydrochloride (2)
O,P,R Morphine sulphate (2)
P Nalbuphine (1)
R Oxycodone 90 mg new July 2000
O,P Pentazocine (2)
O Phenazocine 20 mg new July 2000
O Pethidine (1)
O Tramadol (1)See anything you like? :-P DEXTROMORAMIDE (Palfium) & DIPIPANONE (Diconal)-"Pinkies"-seem to be the main ones. Any thoughts?
> I know; it's so frustrating that many pdocs don't seem to believe that you know what your own subjective experience is better than they do!
Don't get me started...
> > > After Christmas I hope to turn into a person again.
> This is the fifth Christmas in a row that I've found myself wishing for the same present.
Let's hope St. Nick gets his act together.
Take care,
J.
Posted by Elizabeth on December 11, 2001, at 21:21:19
In reply to Re: Methadone for depression. » Elizabeth, posted by JahL on December 11, 2001, at 19:45:30
> Hi Elizabeth. Yeah, definitely. I'll set up a free email a/c. Bear in mind it takes me a couple of days to do anything.
Heh, I can identify with you there!
> and may I say what a fine judge of character you are :)
Flattery will get me everywhere, right?
> Seriously, I doubt there's much me & my dilapitated brain could tell She Who Knows Everything Medical. But there's probably something to be gained (certainly on my part) from exchanging experiences & whatnot. There's only so much you can say here...
Well, aside from the fact that I am far from Knowing Everything Medical, the problem I'm having lately isn't exactly a medical problem -- it's more of a problem with medical people.
> > As you've probably noticed, I share your gag reflex toward talk therapy.
>
> Yeah, I thought I had a sympathetic audience on this thread. I won't talk to psychotherapists on principle; I despise them for reinforcing the publicly held notion that people with serious mental illness can cure themselves if only they would *try*. I'd like to see them try.I can only assume that they make that claim to try to rationalize their failure to cure us.
> Anyway, enough of that. I'll start a debate off if I'm not careful.
Debates are fine. Even arguments are okay. It's fights and flame-wars that I could do without. :-}
> I've made this point to pdocs many times. What happens to those who are too depressed to advocate for themselves in the way I (just about) am able to? What happens to those who are w/o a decent education or who have no net access? They're often consigned to rot in brain-corroding 'day-care' centers, with no discernable treatment plan.
That's true. But even if you are educated, even if you can (at least sometimes) advocate for yourself, I think a lot of physicians believe that patients' rights aren't important -- they know what's best for us, and that's the final word.
> Users have to queue up each day for their little bottle of salvation and be thankful it lasts as long as it does...
That's the situation here too. I hear things in the Netherlands are different.
> Interesting. In the same way, for me Methadone *seems* to work better if taken as for pain.
IOW, it doesn't really last all day. So we have our answer.
> Since you ask...the guy started out as a GP (community doc) and soon developed a penchant for Pethidene.
I'm told that IV Demerol is very impressive, although short-lasting (and that Demerol is nothing special when taken orally).
> See anything you like? :-P DEXTROMORAMIDE (Palfium) & DIPIPANONE (Diconal)-"Pinkies"-seem to be the main ones. Any thoughts?
Yeah: I don't know what either of those is (although I think I've heard of Diconal someplace)!
> Let's hope St. Nick gets his act together.
Maybe he's suffering from anergic depression. That would explain a lot.
-e
Posted by judy1 on December 12, 2001, at 10:01:04
In reply to Re: Methadone for depression. » Elizabeth, posted by JahL on December 11, 2001, at 19:45:30
I don't want to start WWIII here, but I'm just curious about your feelings towards psychotherapy. I have had nothing but positive experiences with therapy, particularly psychologists, but I could tell some horror stories about psychiatrists. For me I could not get better w/o the meds and the support of therapy (especially now). I'm sorry you've had such negative experiences. Take care, judy
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