![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 37 to 61 of 108. Go back in thread:
Posted by Dr. Bob on February 19, 2002, at 8:38:39
In reply to Re: opioid stuff and dealing with doctors, posted by cisco on February 19, 2002, at 0:29:10
> It would be sad if you had to limit the options available to us
I've responded to this at Psycho-Babble Administration:
http://www.dr-bob.org/babble/admin/20011216/msgs/3021.html
Where is where further discussion of this should take place.
Bob
Posted by reese1 on February 19, 2002, at 8:59:43
In reply to Re: cisco from reese, posted by cisco on February 18, 2002, at 3:29:52
hi,
i have a simple question for a change. When using intramuscular medication (such as buprenex) would there be a possible difference of the reaction one would recieve because of difference in needle size.
for example
injection by 3ml 25G x 5/8
or
injection by 3ml 22G x 1 1/2i would think, or it could be psychosomatic, that there is quite a difference in terms of use with 22G x 11/2 when used with buprenex.
wondering what you think?
Posted by shelliR on February 25, 2002, at 10:31:20
In reply to Re: opioid stuff and dealing with doctors » shelliR, posted by Elizabeth on February 15, 2002, at 11:12:37
> Do you really think you were truly addicted to oxycodone? That wasn't my impression. Anyone who takes oxycodone regularly, as you did, will become pharmacologically dependent on it (it might be that this doesn't always happen to people taking it for depression; I'm not sure). That's a normal reaction, not a pathological one. Addiction is when people start having cravings, doing things to get drugs that they would never do otherwise, and so forth.<
Hi Elizabeth,The question of addiction is a very complicated one, I think. I probably had a normal reaction to oxycontin, but what is normal versus pathological, anyway? I increased my dose x5 in a five month period. Still, I suppose, that doesn't clearly proof that I was addicted, but I certainly became habituated easily to that drug. And oxycontin is known for producing an easy habituation. I wouldn't recommend it for depression. If you are pharmacologically dependent, and the medication is taken away from you, you probably would probably feel and do things that you otherwise would not. You might become obsessed about getting the drug.
It is hard for me to clearly identify whether my difficulty in giving up methodone had to do with the resurgence of my depression or withdrawal or both.I am not really disagreeing with you, just saying that I don't think there is a clear distinction between addiction and being pharmacologically dependent. My experience with oxycontin has given me quite a scare. I am very worried that the high dose has changed my brain chemistry-- in the sense that even though I was off all opiates for six weeks, it has taken a higher dose of vicodin (than pre oxycontin) to relieve my depression, since I have resumed taking the drug in the last few days.
I don't think I would take opiates if they did not take away my depression. But I do like opiates, and if I had a recreational drug, it would be my drug of choice. If I took a bit too much, it made it slightly high in a very nice, energizing way. Otherwise at a "regular" dose, I felt quite normal, just without depression in my chest.
But for me now, it is scary to think about using opiates again, because of the fast increase in my tolerance. I have ordered temgesic (sublingual bupe) from the internet and do feel a bit safer taking that because it cannot (so I read) make you high. But I'm not sure whether it will have the same positive effect that hydrocodone or oxycontin had for me. If I'm lucky, it will. Also, there is no guarantee that habituation will not occur. Maybe less likely than with full opiates, but not out of the question.
By the way, sublingual buprenorphine is up before the FDA and should be approved soon. (Of course they have been saying that for almost two years.) Also, I spoke to several of the researchers at McLean re that version of bupe, and neither thought is was less stable than the injectable bupe.
I have been through ect, unsuccessfully, but at least it seems not to have killed too many of my brain cells. And I am exploring hormonal and other physical causes of my depression (see below post).
I think if I didn't know that opiates were an option, I could not continue to live with this pain. So whatever the risk, opiates are giving me some relief and some hope.What else are you taking with the bupe?
Shelli
Posted by Elizabeth on February 26, 2002, at 23:45:58
In reply to Re: Addiction » Elizabeth, posted by shelliR on February 25, 2002, at 10:31:20
> The question of addiction is a very complicated one, I think.
No question about that!
> I probably had a normal reaction to oxycontin, but what is normal versus pathological, anyway?
I'm afraid that we only have DSM-IV to help us identify what's "pathological." The diagnostic criteria for "substance dependence" (i.e., addiction) appear to take into account that there is some relationship between addiction and "physical dependence" (tolerance, withdrawal symptoms), but physical dependence is neither necessary nor sufficient to define addiction. Some addicts aren't physically dependent; some people are physically dependent on a drug but are not addicted. I'm sure that this was the intent of the DSM-IV committee that came up with this criteria set.
The other criteria, of course, are fuzzy (like most DSM-IV diagnostic criteria). They obviously wanted the criteria to be strictly behavioral (to create an illusion of objectivity, I guess). I think that the subjective phenomenon that is central to drug addiction is drug craving (not just the desire to relieve withdrawal symptoms). A frequent consequence of these cravings is "drug seeking behavior": going to different doctors and pharmacies to get multiple prescriptions for the same drug, going to the other side of town early each morning to buy drugs, committing crimes to get the money to pay for the drugs, etc.
Another consequence is that it's very hard to stop taking the drug or limit one's use of it (for example, resolving that "this will be my last hit" on numerous occasions).
"Impairment" (a common DSM buzzword) is another aspect of addiction. Impairment related to drug addiction can lead to things like losing one's job, getting in auto accidents, nodding off with a lit cigarette in one's hand, etc.> I increased my dose x5 in a five month period. Still, I suppose, that doesn't clearly proof that I was addicted, but I certainly became habituated easily to that drug.
Yes, and whether or not you were addicted, I imagine that being "habituated" (good word, BTW) was hard enough. Having to keep raising the dose has to be difficult (how do you know how much to raise it and how often?), and I'm all too familiar with the fear of not being able to get needed medication.
> If you are pharmacologically dependent, and the medication is taken away from you, you probably would probably feel and do things that you otherwise would not. You might become obsessed about getting the drug.
I don't know for sure, but I have a hunch that the obsession has to do with how difficult it is to get oxycodone (or anything that would serve as a substitute). If you have to concentrate all your energy and attention (and anxiety) on something, it's easy to get obsessed with it.
> It is hard for me to clearly identify whether my difficulty in giving up methodone had to do with the resurgence of my depression or withdrawal or both.
I can understand that. May I ask what the withdrawal symptoms were for you? Buprenorphine doesn't really cause any bad w/d symptoms besides rebound depression (which seems to be a general withdrawal symptom with ADs, for me anyway).
> I am not really disagreeing with you, just saying that I don't think there is a clear distinction between addiction and being pharmacologically dependent.
Sometimes there is. I have a friend whose kid takes Adderall and clonidine for ADD. That six-year-old boy sure isn't an addict. My dad isn't addicted to his cardiovascular medications. I know a yoman who takes oral steroids for asthma; she's not addicted either. But you've got a good point that sometimes it's not too clear.
Something that might be interesting to you: when patients are taking morphine et al. for pain, they don't have much trouble tapering off it when the pain goes away. It's comparable to going off benzos: abrupt stoppage is a no-no, but if you taper off gradually (preferrably with a doctor's assistance), it's not too tough. (I was talking about this stuff with my mom earlier today. She's a biomedical ethist, and we like talking about end-of-life issues, patients' rights, and other medical ethics issues -- and of course drugs.)
> My experience with oxycontin has given me quite a scare.
I have a friend who was an addict when he was younger. He does feel like there have been long lasting changes. He has a high tolerance to opioids, higher than he had when he first started taking them. There are some other kind of weird things about him that make me wonder.
> even though I was off all opiates for six weeks, it has taken a higher dose of vicodin (than pre oxycontin) to relieve my depression, since I have resumed taking the drug in the last few days.
So now you're on Vicodin again? Are you taking it regularly, or as-needed?
> I don't think I would take opiates if they did not take away my depression. But I do like opiates, and if I had a recreational drug, it would be my drug of choice.
I don't seem to get high on them, although it's been pointed out to me that I might not be taking enough to know.
> I have ordered temgesic (sublingual bupe) from the internet and do feel a bit safer taking that because it cannot (so I read) make you high.
Depends how you define high. Personally, *I've* never been high on it. But then, I've never been high on any of 'em. What I've heard from people who have more experience with opioids than I do is that buprenorphine is qualitatively different -- full agonists can make you feel euphoric, bupe just makes you feel content. I think it will still be fine for depression.
> Also, there is no guarantee that habituation will not occur. Maybe less likely than with full opiates, but not out of the question.
I haven't had the problem, and I hope that you won't, either.
> By the way, sublingual buprenorphine is up before the FDA and should be approved soon. (Of course they have been saying that for almost two years.)
YUP!
> Also, I spoke to several of the researchers at McLean re that version of bupe, and neither thought is was less stable than the injectable bupe.
Less "stable?"
> I have been through ect, unsuccessfully, but at least it seems not to have killed too many of my brain cells. And I am exploring hormonal and other physical causes of my depression (see below post).
Eh, it's all physical.
> I think if I didn't know that opiates were an option, I could not continue to live with this pain. So whatever the risk, opiates are giving me some relief and some hope.
>
> What else are you taking with the bupe?So far it's
Effexor XR 150 mg bid
Buprenex 0.3 mg tid
Trileptal 600 mg bid
Ambien 20 mg qhs
Colace 300 mg qd
Xanax 1-2 mg prn
promethazine 25 mg prn
propranolol 20 mg prn
bethanechol 25-50 mg prnShould be enough, shouldn't it?
-elizabeth
Posted by shelliR on February 28, 2002, at 9:38:59
In reply to Re: Addiction » shelliR, posted by Elizabeth on February 26, 2002, at 23:45:58
May I ask what the withdrawal symptoms were for you? Buprenorphine doesn't really cause any bad w/d symptoms besides rebound depression (which seems to be a general withdrawal symptom with ADs, for me anyway).When my ass**** doctor took me off over 100mg of methodone at once and the cube of buprenorphine did not work for me at all (don't know the dose), I was literally screaming in pain on the floor. I have never screamed in pain before, and now it's hard to remember exactly what the pain felt like, just that it was horrible. I remember feeling that I couldn't breathe. And my doctor never responded at all until apparently the staff must have talked to him because he told them to let me out. Once I got through that pain, for the next few days I felt horribly nauseated, as well as depressed. The nausea finally went away, but not the depression. The second time I detoxed from methodone, it was done slowly and I was not in pain, etc. Just horribly depressed.
I have notes from early September that I asked him to try bupe because I was very worried that I had already tripled my dose of oxycontin since July. He refused, telling me I would adjust to the oxycontin and not need to go up. Then after I had doubled my dose two more times, he finally put me on methodone and I had all sorts of bad reactions to the switch. I wish I could sue the bastard, but I think it would be too complicated since I was taking vicodin before he put me on the oxycontin, and especially complicated because I had gotten it off the internet. But I had never taken more than 7.5 a day of vicodin, and here I was up to 260mg of oxycontin.
> So now you're on Vicodin again? Are you taking it regularly, or as-needed?Just as needed until the temgesic arrived. I only had a limited supply and also I wanted to give the bupe a chance before I became further habituated to hydrocodone.
> > I have ordered temgesic (sublingual bupe) from the internet and do feel a bit safer taking that because it cannot (so I read) make you high.
>
> Depends how you define high. Personally, *I've* never been high on it. But then, I've never been high on any of 'em. What I've heard from people who have more experience with opioids than I do is that buprenorphine is qualitatively different -- full agonists can make you feel euphoric, bupe just makes you feel content. I think it will still be fine for depression.Well judging from my first day and a half on the buprenorphine, it certainly can make me high. (Also I remember Zo reporting the same thing from her trial.) It actually feels like any other opiate to me which I didn't anticipate. Opiates give me a certain type of high until I adjust to the dose. Sort of make me speedy and a little floaty at the same time, yet don't impair my thinking or motor skills. Different than just content, though.
I didn't think that the bupe had much of a chance of working for me because of my history with oxycontin and probable change of brain chemistry. I started with 0.6mg twice a day--today I will cut it to 0.4mg x 2 to see what that does. (I started on a high dose just to make sure I gave it the best chance to work.)
> > Also, there is no guarantee that habituation will not occur. Maybe less likely than with full opiates, but not out of the question.
>
> I haven't had the problem, and I hope that you
>> won't, either.I thought you had upped your dose at one point?
Actually I am hoping that the lamictal will kick in for me in a couple of weeks and I might not need to take the bupe on a regular basis.
> > Also, I spoke to several of the researchers at McLean re that version of bupe, and neither thought is was less stable than the injectable bupe.
>
> Less "stable?"I thought you had used that word when referring to subligual bupe. Maybe you said less reliable; I know that you felt that the sublingual was not as effective as the injectable from earlier posts that I reviewed about bupe. But now there is so much more info available because of the detox and maintenance studies.
> > What else are you taking with the bupe?
>
> So far it's
> Effexor XR 150 mg bid
> Buprenex 0.3 mg tid
> Trileptal 600 mg bid
> Ambien 20 mg qhs
> Colace 300 mg qd
> Xanax 1-2 mg prn
> promethazine 25 mg prn
> propranolol 20 mg prn
> bethanechol 25-50 mg prn
>
> Should be enough, shouldn't it?Whatever works. Have you ever tried a higher dose of bupe to see if it could carry more of the anti-depressant load, or are you purposely staying at a low dose because of possible side effects, etc.?
>
Shellip.s. I truely have you to thank for the lift in my depression. I have been reading your posts about bupe for almost two years now. I don't know if I would have even heard of it, or thought to try it, without your reported success and information about it. So a very deep thanks.
Posted by shelliR on February 28, 2002, at 15:51:44
In reply to Re: Addiction » shelliR, posted by Elizabeth on February 26, 2002, at 23:45:58
actually, p.s.s.
The last pdoc I talked to about bupe said the more you take, the longer it lasts. That surprised me, if it is true.
But I do know that with both .06mg and today with .04mg, the effects have lasted for at least eight hours. About the same as vicodin used to last for me. So I am wondering whether the fact that you take it x3 a day, instead of x2 has to do with the dose, or the type af bupe and the intranasal method. The directions with the temgesic say take every 6 to 8 hours. So is it possible that with a larger dose you might be able to cut it to twice a day? Have you ever tried that?
Posted by Elizabeth on February 28, 2002, at 16:01:18
In reply to Re: Addiction » Elizabeth, posted by shelliR on February 28, 2002, at 9:38:59
> When my ass**** doctor took me off over 100mg of methodone at once and the cube of buprenorphine did not work for me at all (don't know the dose), I was literally screaming in pain on the floor.
My god. That's terrible. The doctor should have known better. I feel responsible in a way since I encouraged you to try opioids, even full agonists, and I'm very sorry for that. I'm just glad nothing happened to you that couldn't be reversed. Doctors who say that opioid withdrawal isn't dangerous don't have any idea what it feels like (and what people can be compelled to do to themselves as a result).
Besides the general emotional agony, the usual withdrawal symptoms people report are hot and cold flashes, lacrimation, lethargy, aches and pains, drippy nose, and of course the lovely nausea and vomiting. I can't believe they didn't give you anything to get you through it. (If I were going to attempt something like that, I'd want to load up on Ativan for agitation, Phenergan for vomiting, clonidine for hot-cold flashes, Inderal for shakes, Benadryl for drippy nose, loperamide for diarrhea, ...you get the idea.)
> I have never screamed in pain before, and now it's hard to remember exactly what the pain felt like, just that it was horrible. I remember feeling that I couldn't breathe. And my doctor never responded at all until apparently the staff must have talked to him because he told them to let me out.
You were in the hospital? You had to go through all that IN THE HOSPITAL???
> I have notes from early September that I asked him to try bupe because I was very worried that I had already tripled my dose of oxycontin since July. He refused, telling me I would adjust to the oxycontin and not need to go up.
My guess is that he assumed that because that is what happens with MMT patients (although the plateau dose may be extremely high). I think that was a mistake.
> I wish I could sue the bastard, but I think it would be too complicated since I was taking vicodin before he put me on the oxycontin, and especially complicated because I had gotten it off the internet. But I had never taken more than 7.5 a day of vicodin, and here I was up to 260mg of oxycontin.
It might be worthwhile to consider talking to a lawyer. I don't think it was wrong for him to let you try the oxycodone and methadone, but to discontinue them abruptly was simply incompetent (the hospital played a part there too).
> > So now you're on Vicodin again? Are you taking it regularly, or as-needed?
>
> Just as needed until the temgesic arrived. I only had a limited supply and also I wanted to give the bupe a chance before I became further habituated to hydrocodone.Ahh. How's the Temgesic? How much are you taking?
> Well judging from my first day and a half on the buprenorphine, it certainly can make me high.
Huh. I didn't feel high, although it definitely did make me dizzy and lightheaded, and sort of speedy/jittery, when I first started it. Are you having any side effects? I found that I had to start at 0.15 mL in order to adjust to it so I wouldn't be vomiting all the time.
> I didn't think that the bupe had much of a chance of working for me because of my history with oxycontin and probable change of brain chemistry. I started with 0.6mg twice a day--today I will cut it to 0.4mg x 2 to see what that does. (I started on a high dose just to make sure I gave it the best chance to work.)
I can understand that, after what you've been through.
> > I haven't had the problem, and I hope that you
> > won't, either.
>
> I thought you had upped your dose at one point?I was taking 0.5 mL for a little while, but that was just to allow myself to adjust to it so the side effects wouldn't hit me like a brick.
> Actually I am hoping that the lamictal will kick in for me in a couple of weeks and I might not need to take the bupe on a regular basis.
Lamictal is good for a lot of people. I hope that it works for you.
> I thought you had used that word when referring to subligual bupe. Maybe you said less reliable; I know that you felt that the sublingual was not as effective as the injectable from earlier posts that I reviewed about bupe.
Not the sublingual formulation (Temgesic, Subutex). What I meant was that using Buprenex (the injectable formulation that's available in the U.S. -- the stuff I get) sublingually may not be as reliable. That's what Dr. Bodkin said; he recommended using it intranasally.
Addicts who take Temgesic often have to use mind-blowingly high doses (16 mg????!!!!). I think that might be in part due to poor absorption via that route (as well as to high tolerance, of course).
> But now there is so much more info available because of the detox and maintenance studies.
Buprenorphine isn't that new; the only thing that's new is that it's been studied in the U.S.
> Whatever works. Have you ever tried a higher dose of bupe to see if it could carry more of the anti-depressant load, or are you purposely staying at a low dose because of possible side effects, etc.?
I'd like to be able to take just 0.5 mL, but I found that it wasn't enough. Yeah, the side effects are kind of rough, even though I've adapted somewhat. I have tried more than 1 mL before, but I find that I tend to get sort of agitated on high doses.
> p.s. I truely have you to thank for the lift in my depression. I have been reading your posts about bupe for almost two years now. I don't know if I would have even heard of it, or thought to try it, without your reported success and information about it. So a very deep thanks.
You're quite welcome. As I said, I feel really bad and kind of guilty about your experience with the full agonists. I hope very much that things will go better for you with the buprenorphine.
Best wishes, as always.
-elizabeth
Posted by shelliR on March 1, 2002, at 15:03:00
In reply to Re: Addiction » shelliR, posted by Elizabeth on February 28, 2002, at 16:01:18
Hi Elizabeth,
Re screaming in pain:
> My god. That's terrible. The doctor should have known better.I can't believe that he took me off over 100mg of methadone to transfer me over to buprenorphine. From everything I've read, if someone has been takig a large dose of methadone, one should work on reducing the dose of meth down to less than 50mg before the switch. Also I'm wondering if he might have given me like 0.08 or less of bupe, because he gave me one compounded cube. Which of course would do nothing for withdrawal. I have never seen those hospital records; I'm going to try to get hold of them.
<I feel responsible in a way since I encouraged you to try opioids, even full agonists, and I'm very sorry for that. I'm just glad nothing happened to you that couldn't be reversed. Doctors who say that opioid withdrawal isn't dangerous don't have any idea what it feels like (and what people can be compelled to do to themselves as a result).
Elizabeth, absolutely *do not feel ANY guilt*.
I was taking vicodin for several years before my first post on PB, for premenstrual discomfort AND depression.
My first post, (I just did a search), was about taking opiates for depression:
www.dr-bob.org/babble/20000603/msgs/36063.html
So please, do not take on any blame. It has been (and still is) really great for me to have a place to be able to talk about using opiates for depression. Anyway, at one point, I remember you questioning my pdoc when he kept increasing my dose of oxycontin up and up.<Ahh. How's the Temgesic? How much are you taking?
Today I took 0.4mg x 2 and almost no chest pain/depression.
< Huh. I didn't feel high, although it definitely did make me dizzy and lightheaded, and sort of speedy/jittery, when I first started it. Are you having any side effects? I found that I had to start at 0.15 mL in order to adjust to it so I wouldn't be vomiting all the time.
No side effects yet except I may have to start eating ground flax seeds again to get my system moving. I put them in yogurt. They worked really well for me when I was on the oxy.
>Lamictal is good for a lot of people. I hope that it works for you.It worked twice before, but I was also taking nardil. I had a huge, uncomfortable water weight gain though, and will start a diuretic immediately this time if I start to gain weight. The trend was been to keep people on the same AD which has worked before and augment. This of course assumes that the combination is better than the adjunct alone. My new pdoc doesn’t think that the nardil had anything to do with the success of lamictal because the it had already pooped out. This is a different viewpoint than I've heard before, although my last pdoc thought that the lamictal could work solo also.
> Addicts who take Temgesic often have to use mind-blowingly high doses (16 mg????!!!!). I think that might be in part due to poor absorption via that route (as well as to high tolerance, of course).why do you think the absorption is lower sublingually? I haven’t read anything which implies that.
One thing I read from a buprenorphine/detox information website interested/confused me:
"It is particularly important to avoid using other depressant drugs, such as benzodiazepines (‘benzos’), e.g. Valium, with buprenorphine. Using benzodiazepines with buprenorphine may lead to breathing difficulties, coma or death."
Is klonopin a benzo? (Because I know you take klonopin prn.) Have any of your pdocs mentioned this? I do use valium prn and stopped when I started the bupe after I read that. I’ll ask my new pdoc about it next week when I see him.
btw, are you feeling well enough to work or take premed classes?
Take care,Shelli
Posted by Elizabeth on March 1, 2002, at 20:31:01
In reply to Re: Addiction » Elizabeth, posted by shelliR on March 1, 2002, at 15:03:00
> I can't believe that he took me off over 100mg of methadone to transfer me over to buprenorphine. From everything I've read, if someone has been takig a large dose of methadone, one should work on reducing the dose of meth down to less than 50mg before the switch.
Yes, that's my understanding also.
> Also I'm wondering if he might have given me like 0.08 or less of bupe, because he gave me one compounded cube. Which of course would do nothing for withdrawal.
0.08 mg? That would be about a quarter of a mL of the solution. And I'm assuming that you took it by the SL route, right? That could hardly be expected to have any noticeable effect on a person who'd been maintained on 100 mg of methadone.
What made you think that was the dose, though? (Like, why 0.08 in particular?)
> I have never seen those hospital records; I'm going to try to get hold of them.
That's a good idea.
> Elizabeth, absolutely *do not feel ANY guilt*.
Easier said than done. :-} I do wish that it had gone differently for you.
> I was taking vicodin for several years before my first post on PB, for premenstrual discomfort AND depression.
You weren't taking it on a daily basis, though; you were taking it intermittently, to avoid tolerance. I really thought that you could take oxycodone for depression without developing a tolerance. Looks like that's far from certain (and probably not worth the risk).
Anyway, taking a little bit of hydrocodone every now and then is a far cry from taking daily ever-increasing doses of methadone.
> So please, do not take on any blame. It has been (and still is) really great for me to have a place to be able to talk about using opiates for depression. Anyway, at one point, I remember you questioning my pdoc when he kept increasing my dose of oxycontin up and up.
Well, my understanding was that if you find a dose that works but then become tolerant to that dose, chances are that you're going to keep having to raise the dose. (Your experience has reinforced this belief.)
> Today I took 0.4mg x 2 and almost no chest pain/depression.
Excellent! How many hours did each dose last?
> No side effects yet except I may have to start eating ground flax seeds again to get my system moving. I put them in yogurt. They worked really well for me when I was on the oxy.
Flax seeds, eh? I'll have to try that. Can I find them at my local health food store?
> It worked twice before, but I was also taking nardil. I had a huge, uncomfortable water weight gain though, and will start a diuretic immediately this time if I start to gain weight.
I've been gaining weight recently. I'm not sure what is behind it; Effexor maybe? I do seem to be eating more than is good for me, but I don't think I'm eating enough to account for the weight gain. It's awkward for me; I've never watched my weight or eating habits before (except when I was on Nardil, I've never needed to), and it's taking some adjusting.
> The trend was been to keep people on the same AD which has worked before and augment.
Yeah, I know. Prozac appeared to work when I was a teenager (though in retrospect it could have just been the passage of time), and as a result I had a terrible time convincing the doctor I sought out in college to let me try something altogether different.
> This of course assumes that the combination is better than the adjunct alone. My new pdoc doesn’t think that the nardil had anything to do with the success of lamictal because the it had already pooped out.
I've heard it said that Nardil poop-out can lead to a very refractory depression, and this is consistent with my experience. Maybe something like that happened to you too?
> why do you think the absorption is lower sublingually? I haven’t read anything which implies that.
I'm sure that SL bioavailability is less than IM. There isn't really that much information about the intranasal route, though, so who knows.
> "It is particularly important to avoid using other depressant drugs, such as benzodiazepines (‘benzos’), e.g. Valium, with buprenorphine. Using benzodiazepines with buprenorphine may lead to breathing difficulties, coma or death."
Oh yeah. That's based on a few isolated case reports where people took overdoses of benzos (heroin addicts seem to like benzos) while on buprenorphine.
> Is klonopin a benzo? (Because I know you take klonopin prn.)
I take Xanax PRN. But yes, both of them are benzodiazepines. I was told to be careful with benzos (and Ambien) when I first started taking buprenorphine, because they might be more sedating. There was this one episode where I took Ambien and slept for 12 hours or something (this was when I'd just started buprenorphine), but I've had no problems since then. (After that I was scared to take benzos or Ambien for a while, though.) I find benzos helpful for taking the edge off, since buprenorphine makes me feel kind of jittery sometimes.
> Have any of your pdocs mentioned this? I do use valium prn and stopped when I started the bupe after I read that. I’ll ask my new pdoc about it next week when I see him.
At a minimum, you should avoid taking it when you'll need to be alert (e.g., driving) until you know what it does to you with the bupe.
> btw, are you feeling well enough to work or take premed classes?
Yes, I have been for some time, but there are other barriers (lack of driver's license, not living near a university that has an affordable post-bac pre-med program, etc.). I am in the process of job hunting, but given my limitations (have to be able to get a ride to and from work) and the state of the job market (bad here, as everywhere), that isn't trivial.
I hope that the Lamictal brings you up to speed so that you can limit your bupe use to PRN. Be well!
-elizabeth
Posted by Cecilia on March 2, 2002, at 0:56:29
In reply to Re: Addiction » Elizabeth, posted by shelliR on March 1, 2002, at 15:03:00
I think you definitely should consider sueing the doctors and hospital who took you off methadone cold turkey. That`s like operating on someone without anesthesia.
Posted by shelliR on March 2, 2002, at 11:35:28
In reply to Re: sidetrack from Addiction » shelliR, posted by Elizabeth on March 1, 2002, at 20:31:01
>>... I really thought that you could take oxycodone for depression without developing a tolerance. Looks like that's far from certain (and probably not worth the risk).
Elizabeth, stop, PLEASE. You didn't even suggest the oxycontin. My pdoc did and he was the one who prescribed it for me. Not you. You are not even a little bit responsible. Try to let it go.
> > Today I took 0.4mg x 2 and almost no chest pain/depression.
> Excellent! How many hours did each dose last?I would say 7 hours; it's hard to know exactly. I am trying to take the second dose while the first dose is still working, so I don't have to wait a second time for almost an hour for me to feel better. On this dose, I didn't experience depression (after it kicked in) for the whole day and evening.
I have several more weeks (because of the slow tritration) to know whether lamictal will have an impact on my depression. Actually, the temgesic can carry the whole load for relieving me of depression, but I am worried about the need to increase. Because of my experiences before, and because bupe feels just like a full opiate to me, I'm not convinced that I won't build up a tolerance and need more and more. Also I hate waking up every morning with rebound depression. I may try taking some before I go to bed; it's just so expensive--$1 a pill and that's $4 a day so far and would be $6 a day. That's over $2000 a year and the lamictal is also expensive. (so far my pdoc has given me lots of samples). It is, though, all cheaper than the oxy had been. And I do get to deduct all medical expenses from my business, so it's not quite as bad as it sounds--but that, of course, cuts into profit.
There is generic temgesic available over the internet, but I don't know where it's made. If it turns out to be made in a country that has strict generic criteria, than I may try it.
Re injection vs. sublingual, the information on the insert will surprise you:
"buprenorphine is well absorbed in man by the sublingual route, giving plasma level at 2-3 hours after administration which are comparable to those observed at the same time following a similar dose given by a parenteral route."
In somewhat of a round-about way (not giving the reader exact comparisons), they talk about the "delayed onset of peak plasma concentrations following the sublingual dose of buprenorphine" (200 minutes vs. ? for injection). Maybe I missed something, but I can’t find the time of absorption for the parenateral route. Obviously, it's a lot shorter. How long does it take intranasally, and do you overlap doses also?
> Flax seeds, eh? I'll have to try that. Can I find them at my local health food store?Yes, I'm sure. I like the golden a little better than the dark flax seeds. The main thing is that you should grind them before putting them in the yogurt, to get full effectiveness. (They also taste better that way.) I bought a little electric coffee grinder which works great for that, for about $10.
> I've heard it said that Nardil poop-out can lead to a very refractory depression, and this is consistent with my experience. Maybe something like that happened to you too?Well, I think I also had refractory depression before I started the nardil--nothing else has worked my whole adult life.
> > btw, are you feeling well enough to work or take premed classes?
>Yes, I have been for some time, but there are other barriers (lack of driver's license, not living near a university that has an affordable post-bac pre-med program, etc.).I thought you got your driver's license. Are you still trying to learn to drive?
> Be well!You also!
Shelli
Posted by shelliR on March 2, 2002, at 11:43:28
In reply to Re: Addiction-Shelli, posted by Cecilia on March 2, 2002, at 0:56:29
> I think you definitely should consider sueing the doctors and hospital who took you off methadone cold turkey. That`s like operating on someone without anesthesia.
I have to make a formal signed request for my records to find out how much buprenorphine they gave me (after taking me off the methadone), and how everything is documented. I also need to consider how other psychiatrists will act toward me if I sue, if it becomes public. Since I am now taking buprenorphine, I don't want doctors to be worried about giving it to me because I might sue. So the decision whether or not to sue has to be well thought out, and I believe I have at least a year; actually I think I have three years to bring a case against that doctor.
Shelli
Posted by reese1 on March 2, 2002, at 18:44:03
In reply to Re: sidetrack from Addiction » shelliR, posted by Elizabeth on March 1, 2002, at 20:31:01
have had trouble with buprenex. hasn't lifted my depression as it had in the past.
i tried it for a week then stopped hoping that if i tried again in a few weeks it might kick in. Does anybody have any idea why it would work in december 00 but not now?
i've gone up to 0.6 in the morning and still no effect.
any ideas?
reese
Posted by Elizabeth on March 4, 2002, at 1:19:29
In reply to Re: sidetrack from Addiction » Elizabeth, posted by shelliR on March 2, 2002, at 11:35:28
> Elizabeth, stop, PLEASE. You didn't even suggest the oxycontin. My pdoc did and he was the one who prescribed it for me. Not you. You are not even a little bit responsible. Try to let it go.
I understand who did what. For my part, I had believed (prior to your trial) that a person taking opioids for depression would not develop tolerance. I have no doubt that my success with buprenorphine and said belief played a part in what happened. But I also know that you're an opiophile (a word someone came up with for people who need opioids in order to function normally (not necessarily addicts or even daily users)), and that you've been in the unenviable podition of looking for a pdoc willing to prescribe bupe.
Speaking of that, I had a major surprise lately. I made this appointment waaaaay back in December to see this pdoc, and I saw her, and she's okay with the bupe. Well, she wants to read more about it, but she gave me a script. She seems like a good, decent sort. (This after the dreadful guy at the hospital clinic told me that I wouldn't find anyone in the area who would be willing to do it.)
> I would say 7 hours; it's hard to know exactly.
5-7 hours is the range I've observed.
> I am trying to take the second dose while the first dose is still working, so I don't have to wait a second time for almost an hour for me to feel better.
Yeah, I've always done it that way, but still, without the Effexor I was having some ups and downs throughout the day.
> On this dose, I didn't experience depression (after it kicked in) for the whole day and evening.
That's more than 7 hours!
Well anyway, it sounds like it's working great. Hopefully the Lamictal will kick in and then you can reduce your use to PRN so you don't have to worry about tolerance. And there is still a possbility that you won't find that you have to raise the dose. Also, buprenorphine withdrawal is nothing compared to that awful stuff you went through (in that awful hospital).
Rebound depression sucks. I don't know how to deal with that one. I don't get it now, because of the Effexor.
> There is generic temgesic available over the internet, but I don't know where it's made. If it turns out to be made in a country that has strict generic criteria, than I may try it.
I'd like to know, too. Just In Case.
> "buprenorphine is well absorbed in man by the sublingual route, giving plasma level at 2-3 hours after administration which are comparable to those observed at the same time following a similar dose given by a parenteral route."
>
> In somewhat of a round-about way (not giving the reader exact comparisons), they talk about the "delayed onset of peak plasma concentrations following the sublingual dose of buprenorphine" (200 minutes vs. ? for injection). Maybe I missed something, but I can’t find the time of absorption for the parenateral route. Obviously, it's a lot shorter. How long does it take intranasally, and do you overlap doses also?How long to kick in? About an hour. Don't know when peak plasma concentrations are achieved by this route. Yes, I do overlap doses.
Peak effect with IM injection happens at about 1 hour, I think.
> Well, I think I also had refractory depression before I started the nardil--nothing else has worked my whole adult life.
The refractory state I was in after the Nardil pooped out was qualitatively different from the refractory state I was in before I took the Nardil (i.e., depression). Does that make sense?
> I thought you got your driver's license. Are you still trying to learn to drive?
I'm no longer trying. I'm sure you can guess why (I'm a bit shy about discussing it). I'm going to have to depend on being able to get a ride.
Anywayzzz -- looks like we've both got a plan (or plans). I hope things work out for both of us.
Best wishes,
-elizabeth
Posted by reese1 on March 5, 2002, at 13:41:03
In reply to Re: sidetrack from Addiction » shelliR, posted by Elizabeth on March 4, 2002, at 1:19:29
question for all,
my psychiatrist has recently, within the last few weeks, taken me slowly off a good portion of my medication to switch to new things...
i've tapered off
lithium 600mg
neurontin 2400mg
celexa 80mg
adderall 40mg
clonzapam 1mg
rispedal .05i am now taking
effexor xr 300mg
lamactal 25mg (for month to check for side effects)
topomax- but insurance has not approved payment
seroquel-25mg (i find it very intense and takes me a good three hours for my head to wake up in the morning)
buprenexthe buprenex has not been as valuable as i would have thought. do you think this could have something to do with the enormous medication switch?
this question is quite stupid, but i didn't think about it at first.
also since i take it IM. i was prescribed a 3ml 25G5/8's, which was small for an IM injection. Do you think it makes a difference in terms of the one's response? I thought the IM size is 22G x 1 1/2 not 25G x 5/8. Would this make a difference?
I was just wondering if this might change one's response to the medication.
thank you
reese
Posted by reese1 on March 5, 2002, at 14:11:49
In reply to Re: sidetrack from Addiction » shelliR, posted by Elizabeth on March 4, 2002, at 1:19:29
i was contacted by someone within this group at my email in the past few weeks and i was meaning to write him or her back but i have lost the email that was sent.
if the person that emailed me reads this please contact me again,
reese
Posted by shelliR on March 5, 2002, at 18:42:07
In reply to Re: sidetrack from Addiction, posted by reese1 on March 5, 2002, at 13:41:03
Reese,
I don't know about the question of whether your change in meds has effected your reaction to buprenex, but as far as the dose, why not try a higher dose to see how you feel for a day or two. For me, with opiates and buprenorphine, I can tell in about an hour whether I've taken enough because my after an hour or so my depression lifts. Are you just taking it once a day? If you're only taking it once than you really need a higher dose to get you through.
About your change in meds. First of all it seems strange that your pdoc would change everything at once. But maybe I have misunderstood. And as far as lamictal, she has you on 25mg for a month? :-(
I know about the rash, but I'm starting it at 25mg for four days, 50mg for 4 days, then 100mg, 200mg, all for four days. If 200 isn't enough then I'll go up as far as 400-800. That's the way my last pdoc also started me. A month at 25mg is unnecessarily cautious. Also why would your doctor start you on topamax and lamictal at the same time? They're both classified as mood stabilizers. Is she working by the subtraction method?Sorry the bupe isn't working for you.
Shelli
Posted by reese1 on March 6, 2002, at 4:56:49
In reply to Re: sidetrack from Addiction » reese1, posted by shelliR on March 5, 2002, at 18:42:07
> Reese,
>
> I don't know about the question of whether your change in meds has effected your reaction to buprenex, but as far as the dose, why not try a higher dose to see how you feel for a day or two. For me, with opiates and buprenorphine, I can tell in about an hour whether I've taken enough because my after an hour or so my depression lifts. Are you just taking it once a day? If you're only taking it once than you really need a higher dose to get you through.
>
> About your change in meds. First of all it seems strange that your pdoc would change everything at once. But maybe I have misunderstood. And as far as lamictal, she has you on 25mg for a month? :-(
> I know about the rash, but I'm starting it at 25mg for four days, 50mg for 4 days, then 100mg, 200mg, all for four days. If 200 isn't enough then I'll go up as far as 400-800. That's the way my last pdoc also started me. A month at 25mg is unnecessarily cautious. Also why would your doctor start you on topamax and lamictal at the same time? They're both classified as mood stabilizers. Is she working by the subtraction method?
>
> Sorry the bupe isn't working for you.
>
> Shelli
thank you so much for your letter. it was really nice. the buprenex i think, or maybe believe might have worked today. i took the dose of .6 in the morning. this was the first time i felt any sort of lift.two things made me think this
1. i have been unable to go on the computer. totally imposible. but i was able to go on the computer for hours today.
2. i can not listen to music which i used to listen to constantly. but today i wanted to which is a good if not great sign
i have tried this amount .6 each time. if i was to try to up it so i could get a reaction how high could i go. is it possible to try .9i am not scared of this, i am scared that i have heard that if you take to much it revereses it's ability and becomes useless. this could be a complete lie but i read it somewhere.
i will try anything at this point.
is there a possibility that trying a dose of .9 would work?
i have a lot of buprenex left so i'm not concerned about running out i have used it very seldomly.
also what time or how long does it take for effect?
i was told fifteen minutes but i find it takes more like an hour.
what is your expierence with this?
my meds have been a real mess
my pdoc is good. she cares. but she really wanted me to get on topomax but for some strange reason my 500 dollar a month insurance (blue cross) doesn't cover it. so they want me to pay 400 dollars. so i sent them the info or my pdoc did right away. this was last thursday. 72hrs. but i found out today it's 72hrs when they get to reading it.
sucks
so the lamactal i will be going up on. the neurontin was a mix up. i was taking 1800-2400 a day and i went to nothing. so this was a bad bad mix up. so she called in some scripts for me today. i'm currently in oakland, ca staying with my maom instead of going back to a hospital.
so she called in neurontin and the clonzapan which i take only when needed. if i don't sleep for a night or two i will take it to calm me down during the day and it does help me sleep.
but yeah the meds are just weird. i am one of those people who the effect of meds has always been for a short period of time. a week or two, with nardil maybe a month- then my body get's used to it and then it does nothing
the adderall i found helpful for a year but then it's effect drifts from day to day. and the dose needs to be increased. for the last six months i was taking the 30mg pills which i didn't even know they made.
so i would say the pdoc did take me off to quickly it was just confusion with the insurance and me being in california and her wanting to try seroquel 25mg for sleep and to stop the constant pacing.
each day for the eight hours i'm alone in the house i pace forward backwards downstairs upstairs to this room to the next room unable to stop, truly unable to stop, not able to read, not able to listen to music, no iggy pop, or anything. i had an image of this feeling earlier today and it went something like this
wrapped to impale
within the luxury
of breath
encased in
skin
that serves
for
perfection
the thoughts
continually move
as the itch
continues to grow
in the one place
that can not
be
scratchedthis is a terrible poem. i actually can write quite well. but i can never write something i've already written once in my head.
if you could answer my question about the IM injection in terms of size of the deviced use for injection makes a difference?
i have two types a small 25g 5/8 then a long one that is 22g x 1 /2
would it make a difference since the latter one is longer and would get farther into the skin.
what do you use?
and if you don't what do you think?
thank you so much
my real name is doug
so i'm doug not reese
reese is my middle name
i return to manhattan/queens on sunday
take care
hope to hear from you soon
thanks
head that can
Posted by shelliR on March 6, 2002, at 18:44:08
In reply to Re: sidetrack from Addiction » shelliR, posted by reese1 on March 6, 2002, at 4:56:49
Reese,I don't have any knowlege of buprenorphine or buprenex IM. Now that you're back on the computer, you might do some research for yourself. Anyway, glad that it seems to be kicking in.
Shelli
Posted by reese1 on March 6, 2002, at 22:50:02
In reply to Re: sidetrack from Addiction » reese1, posted by shelliR on March 6, 2002, at 18:44:08
sheila,
thank you for responding back. the last two days the buprenex
seems to have kicked in. it's strange. you don't
feel it all at once. it's not like a normal opiate
it seems to slowly move into wihtout your notice.i was curios what others have felt with
buprenexit's interesting. i have absolutly no side
effects at all from it. what are the side
effects that people get.today was nice. i was able to play with my friends
three year old without exhaustion and sadness. i
am really good with kids because i hated being one
so i remember.but usually when i take care of kids it is quite
brutal. i can see what they are going to run into
and all the horror (to me) that is waiting. and i just
see it happening there movement into the future like slow motion.
also what is the highest dose one has tried. currently
i have been taking .6 in the morning. that is all.
i don't take anymore for the rest of the day and night.can someone inject .9 or would that make the buprenex
negate itselfalso if anyone could answer the questions about the
needles one should use for an IM shot i wouuld greatly
appreciate iti know this writing is confusing so i apologize
doug
Posted by reese1 on March 9, 2002, at 17:54:17
In reply to Re: sidetrack from Addiction » reese1, posted by shelliR on March 6, 2002, at 18:44:08
elizabeth,
do you take the medication buprenix - through injection
or sublingualy (spelling?
if you do take it sublingauly could you please tell me how you do it?
the buprenex is now being somewhat effective. It is great in the sense that it doesn't erase what is around you - meaning your problems
thank you all
p.s. i was taking it .6 dose but i have discovered that it is to high. I feel dopey and a little drugged out. Not in the high sense of dope or whatever.
bye bye
Posted by reese1 on March 9, 2002, at 17:56:54
In reply to Re: sidetrack from Addiction, posted by reese1 on March 9, 2002, at 17:54:17
one other question
can it be taken intranasely? And if it can how would one do it without wasting the medication
Posted by Zo on March 9, 2002, at 18:39:03
In reply to Re: sidetrack from Addiction » shelliR, posted by Elizabeth on March 4, 2002, at 1:19:29
Elizabeth,
I realized I must charge you, as PB's resident Buprenex authority, with remembering my experiences with Bupe and adding them to your encycolopedia. Remember that it is available as a troche, and quite effortless to control dosage and to take, that way---and remember that it sent me into *the* agitated mania of my life, suicidal, psychotic. Paradoxically, it was that episode that finally made my Bipolar II dx concrete; my pdoc subracted the bupe, added Lamictal---and I have been steadily undepressed and unsuicidal since then. September, I think it was.I tried my first psych drug in 1985--in 2001, I made it.
If I were in a place to track and respond to the bupe threads, I'd also have to talk a a bit about letting any one med becoming the holy grail--having lived that process over and over, for long enough, as have others here of course. I'd add something about Bupe's unavailability helping it appear as Grail--and about my being "saved" after all this time, by something as ordinary as Lamictal. . . at the same time that I'd discourage NO one from going after it. . . I think you understand. You're in a powerful position here to affect the suffering of others, as I know you know. You've given great hope to many; I hope my experiences can add something to your admirable efforts. I'll have to do a post with the whole gory med history. . .
Best,
Zo
Posted by shelliR on March 9, 2002, at 21:10:47
In reply to Re: sidetrack from Addiction » Elizabeth, posted by Zo on March 9, 2002, at 18:39:03
my pdoc subracted the bupe, added Lamictal---and I have been steadily undepressed and unsuicidal since then. September, I think it was.
>> If I were in a place to track and respond to the bupe threads, I'd also have to talk a bit about letting any one med becoming the holy grail--having lived that process over and over, for long enough, as have others here of course. I'd add something about Bupe's unavailability helping it appear as Grail--and about my being "saved" after all this time, by something as ordinary as Lamictal. . . at the same time that I'd discourage NO one from going after it. . . I think you understand. You're in a powerful position here to affect the suffering of others, as I know you know. You've given great hope to many; I hope my experiences can add something to your admirable efforts. I'll have to do a post with the whole gory med history. . .
>Hey Zo,
Hooray, that you are no longer in the depths. That's truly wonderful.
FWI, I think lamictal is not an ordinary drug; From my own experience and reading posts about others' experience on lamictal, I think it *can* be magical for treatment resistant depression. In fact, I am trying it again, this time with a diuretic, hoping to avoid the water weight that made me so uncomfortable and unable to fit into my clothes. Of course, like most drugs, what's magic for some is not magic for all.
Re bupe. I do think if you go through the posts, they are fairly balanced. It is certainly clear from the thread that buprenorphine is very difficult to get from your pdoc. If it works though, it can also be a magic drug for some people with treatment resistant depression. I truly feel that it saved my life. I am hoping the lamictal will take over, but since the titration for that drug is so slow, I absolutely needed something to get me out of my pain and suicidal thinking. Bupe is doing the trick.
I do think you have to treat buprenorphine with the same respect that you do other opiates. My experience is that it did make me a bit high, but I quickly acclimated to it, and now I don't feel high. I would say more energized though. Same as with other opiates. And I am watching to see how much I increase. I went back to Botkin's study and he summarizes what happens with each subject/person and many of them did need to increase; I don't know if anyone went up out of control.As for your experience of setting off a manic episode, any AD could set off that reaction. Elizabeth and I and others have talked about how opiates are energizing to us, so I suppose any drug that can be energizing can result in what you experienced with a bipolar II diagnosis.
Many of the folks who participate on this board are treatment resistant. I think it has been made clear, by even the people taking opiates, that this is not a first line defense against depression. But hope is so very important to help get through this. I think in my posts to Elizabeth, I have been very straight forward about my meltdown on methadone, and she has been straight forward, even in this thread, in admitting that she hadn't fully realized the potential of habituation. So I'm a little curious about the timing of your warning. I also disagree with your implication that Elizabeth is recommending buprenorphine to anyone who has not tried the traditional pharmaceuticals to treat their depression.
Anyway, I know you are trying to be helpful and your posts about bupe *were* helpful to me. I was warned that I might get high on buprenorphine, something I would not have expected from the literature. And knowing that, has made me realize that I may need to increase the bupe, hopefully not in the same way as oxycontin, though. Choosing between death or an opiate, I decided to go for the opiate (partial opiate), and I have no regrets. And I would hope that anyone on PB would make the same decision.
Shelli
Posted by Zo on March 12, 2002, at 2:15:27
In reply to Re: sidetrack from Addiction » Zo, posted by shelliR on March 9, 2002, at 21:10:47
I didn't really mean to imply anything about Elizabeth or anybody at all. . tho I can see I didn't express myself well. Mostly I just wanted to share my experiences. And I do NOT want to discourage anyone from having hopes around Bupe. I just remember a while back when I was trying to get it--and now I do know a compounding pharm near SF, if anyone needs that resource--there was a mini-stampede. So I hoped to add a little balance.
For whatever reason, my mania on Bupe was the worst ever, well beyond pleasure, hello psychosis. Luckily I started emailing my pdoc about hourly. Good ol' email.
You had water retention on Lamictal? I'm just starting Provigil to help set my bio. clock and for alertness, and it seems to be countering the Lamictal eats---which, mind you, are NOTHING like the Zyprexa eats!
I'm glad to have your response, Shelli, and am so glad to catch up with your progress! The first few days on Bupe were sooo nice. Actually, each hit made me high. . but who tells the truth about that. That's just the way life's supposed to be. . .isn't it? Suffused with a quite golden glow?
Zo
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