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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 48 to 72 of 77. Go back in thread:
Posted by MoQ on December 29, 2002, at 10:58:39
In reply to Re: opioids, posted by BrittPark on December 20, 2002, at 23:52:22
> A large percentage of people respond well to opioids, depressed or not. I've generally looked forward to things like wisdom teeth being pulled because I know I'll be on vicodin for a day or two. The improvement in mood that I get (and I believe many others get) is remarkable. Indeed before the discovery of the first antidepressants opioids were commonly prescribed for depression.
>Thanks for your response! Until I found this site I thought I was completely alone in this reaction. Take care!
> The problem with opioids is tolerance. Almost everyone develops it sooner or later. So if you're going to use opioids to treat depression, take as little as possible and as mild as possible an opiod. In addition take opioid holidays. I don't know how long they would have to be, and they wouldn't feel like holidays. Other possibilities are mixed agonist antagonists like buprenorphine, which is supposed to produce less tolerance, or tramadol a very week opioid that is also supposed to produce less tolerance.
>
> There is some possibly very good news coming from a company called Pain Therapeutics who are in clinical trials of two drugs, one a morphine formulation and one an oxycodone formulation. The trick of these new drugs is they contain very small amounts of an opioid antagonist (I'm not sure whether it is naloxone or naltrexone). On the surface it sounds silly, but the researchers who founded the company found that the addition of microdoses of antagonists with opiod agonists not only improved analgesia in rats but seemed to block the development of tolerance. Now Murphy's law says that along with the lack of tolerance will come lack of euphoria :( I hope not though.
>
> By the way I do take vicodin for depression at 5/500 in the evening. My psychiatrist prescribes it. I think that if I could take 3 or 4 5/500s a day without becoming tolerant it would eliminate the rest of my depression. Alas, vicodin doesn't work that way, at least for me.
>
> In hopes of better living through better chemistry,
>
> Britt
>
Posted by MoQ on December 29, 2002, at 11:09:56
In reply to Re: Use of opiates in treating depression, posted by jimmygold70 on December 21, 2002, at 12:21:01
> Why mess with opiates? I'd bet you didn't try all treatment options.
>
> My protocol:
> 1) SSRI
> 2) Raise Dose
> 3) Switch SSRI with same higher dose
> 4) Add Edronex (or if not tolerated, move to high dose Effexor)
> 5) SSRI+Edronax+Remeron or Effexor+Remeron
> 6) Add Lamictal
> 7) Add Lithium
> 8) Add amantadine (Symmestrel)
> 9) ECT
> 10) MAO Inhibitor (Nardil/Parnate)
> 11) Going to a well known psychopharmacologist and staying there for a year+
>
> This works for 98% of depressed...
>
> Jimmy
>
> 10)Just a quick FYI: I have tried #1, #2, #3, #4, #5, #6, and am now trying #11. The rest of the options (#7, 8, 9 and 10) were discussed with my psychiatrist of 11 years and her colleagues, and THEY recommended those were roads not to travel down. I am wondering if you are familiar at all with all of the studies that have been conducted regarding the positive anti-depressant effect(s) produced by SMALL AMOUNTS of opiates? (i.e., the fact that they were the medication of choice for depression up until the 1960's; that there has been extensive research conducted at hospitals such as one in Boston; and that there are researchers who are in the process of trying to develop medicinal agents that work with the use of an opiate ingredient). I am not "messing with opioids," I am trying to become as educated as possible on my condition and, after 11 years of suffering, am going through PROPER, MEDICAL channels to explore other treatment options, with the assistance of my doctor, psychiatrist, and now a psychopharmacologist. Perhaps you didn't mean to come across the way you did in your message, but, to say the least, I felt a bit attacked. You do not know my background or what courses of treatment I have undergone, and your tone was rather judgmental. I am just thankful there were other people who provided input, or I would have abruptly stopped looking for help on this site.
Posted by MoQ on December 29, 2002, at 11:21:07
In reply to Re: Use of opiates in treating depression » MoQ, posted by ShelliR on December 19, 2002, at 21:15:51
> Dear MoQ,
>
> I was very much like you when I first started taking vicodin: for several years a very small amount took care of my depression when my AD didn't work. First only premenstrually, then all the time. But my story sort of goes downhill, so be careful.
>
> I was put on oxycontin instead of vicodin, because this new psychiatrist thought it was better because it lasted longer. I got habituated very quickly and had to go up and up until I no longer could afford it. Now I'm on methadone, which doesn't have as good an effect, but is a lot cheaper. But even with the methadone, in order for it to be effective, I'm on a large dose, and unless I keep increasing, it loses its effectiveness for my depression.
>
> If I had to do it all over again, I wouldn't bother finding a psychiatrist to prescribe opiates. I'd get it from a pain doctor and I would stick with the vicodin--the very least I could get away with. I think the oxycontin really messed me up because now even a large dose of vicodin does nothing.
>
> There's a woman on this board, Elizabeth. I'm sure you've run into her posts about buprenorphine if you're doing searches on opiates and depression. She was able to get it from her psychiatrists, but it is only available in liquid form for injections. She uses it intranasally. It was supposed to go on the market here in a sublingual form as an alternative to methadone, but they've put it off at least a year. It's a partial opiate and seems to help people not crave heroin--like methadone. There was a small study on it http://www.biopsychiatry.com/bupref.html-that's an abstract, but I know the whole study is on the internet. Buprenorphine is also "addictive", really the right word is "habituating".
>
> The other bad thing about using opiates for depression is that if you have to go into a hospital, they treat you like shit, like you are a street addict. I kept blacking out from the large doses of effexor they were giving me, but they blamed it on coming off the oxycontin, so they couldn't care less. Anyway, if it's the only thing that works for you, I would go for it, but I'd be surprised if you'll get any support from a psychopharmacologist. The guys from the study no longer prescribe it because they were sued by someone who blamed their dependence on buprenorphine on them.
>
> Sorry, for the bad news, but it's important to know what you may be getting yourself in to. Still, while I am trying other ADs, and homeopothy and acupuncture, I am still taking methadone, because it has kept me alive. Just be careful.
>
> Shellli
By the way, thank you so much for the link you provided. I was able to garner a lot of information that may be useful in my ongoing quest. Thanks again!
Posted by Peter S. on December 30, 2002, at 14:21:11
In reply to Re: Use of opiates in treating depression, posted by MoQ on December 29, 2002, at 11:21:07
On October 8, 2002 Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) received FDA approval for the treatment of opioid dependence.
Apparently doctors will be able to starat prescribing it starting this month.
Posted by Peter S. on December 30, 2002, at 14:27:12
In reply to Buprenorphine Approved, posted by Peter S. on December 30, 2002, at 14:21:11
BTW a special waiver or advanced training is required in substance abuse in order for an MD to be allowed to dispense buprenorphine. There is a limit on the number of patients also.
Posted by BrittPark on December 30, 2002, at 14:32:50
In reply to Re: Buprenorphine Approved, posted by Peter S. on December 30, 2002, at 14:27:12
> BTW a special waiver or advanced training is required in substance abuse in order for an MD to be allowed to dispense buprenorphine. There is a limit on the number of patients also.
Does anyone else detest the DEA as much as I do? ;)
Posted by BrittPark on December 30, 2002, at 14:48:41
In reply to Use of opiates in treating depression, posted by MoQ on December 19, 2002, at 16:39:59
You've probably found your references already. Here's another one: http://opioids.com/tramadol/tramadol.html
You may find other opioid positive abstracts on the same website.Cheers,
Britt
Posted by ShelliR on December 30, 2002, at 18:37:49
In reply to Buprenorphine Approved, posted by Peter S. on December 30, 2002, at 14:21:11
> On October 8, 2002 Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) received FDA approval for the treatment of opioid dependence.
>
> Apparently doctors will be able to starat prescribing it starting this month.
Hi Peter,Where did you read that doctors will be able to start prescribing it this month? (And does "this month" mean December 2002 or January 2003)?
My pdoc (who is not anti-buprenorphine) read that it was not going to be approved (or maybe he meant distributed) for another year, in one of his journals. He won't prescribe drugs with codeine for depression anyway, but he's fine with me getting them from my pain doc.
It's hard for psychiatrists to prescribe narcotics for depression because there are so few studies supporting its success. The buprenorphine studies at Harvard/McLean Hospital have really small sample sizes. So that leaves them open for a law suit if the patient turns around and sues them for getting them "addicted". Especially with all the passion about opiate use and the lack of understanding of the concepts of habituation vs. addiction.
Shelli
Posted by MoQ on December 30, 2002, at 19:04:46
In reply to Re: Use of opiates in treating depression » MoQ, posted by BrittPark on December 30, 2002, at 14:48:41
> You've probably found your references already. Here's another one: http://opioids.com/tramadol/tramadol.html
> You may find other opioid positive abstracts on the same website.
>
> Cheers,
>
> Britt
>Thanks! I did actually find that one via a post that Shelli sent me, but all help is GREATLY appreciated!
Posted by MoQ on December 30, 2002, at 19:07:21
In reply to Re: Buprenorphine Approved » Peter S., posted by ShelliR on December 30, 2002, at 18:37:49
> > On October 8, 2002 Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) received FDA approval for the treatment of opioid dependence.
> >
> > Apparently doctors will be able to starat prescribing it starting this month.
>
>
>
> Hi Peter,
>
> Where did you read that doctors will be able to start prescribing it this month? (And does "this month" mean December 2002 or January 2003)?
>
> My pdoc (who is not anti-buprenorphine) read that it was not going to be approved (or maybe he meant distributed) for another year, in one of his journals. He won't prescribe drugs with codeine for depression anyway, but he's fine with me getting them from my pain doc.
>
> It's hard for psychiatrists to prescribe narcotics for depression because there are so few studies supporting its success. The buprenorphine studies at Harvard/McLean Hospital have really small sample sizes. So that leaves them open for a law suit if the patient turns around and sues them for getting them "addicted". Especially with all the passion about opiate use and the lack of understanding of the concepts of habituation vs. addiction.
>
> Shelli
>You know, I so wish that people would take some personal responsibility, don't you? I mean I work for a law firm and I know that a signed Release doesn't really carry all that much water anyway, but I would be willing to swear before a notary and anyone else who will listen that I promise to never sue my doctor for prescribing me something I ASKED FOR. My family physician had mentioned that doctors are now being sued by patients who asked for narcotic pain relievers and then turned around and blamed the doc for getting them "hooked." It's CRAZY!!!!
Posted by Peter S. on December 31, 2002, at 14:06:42
In reply to Re: Buprenorphine Approved » Peter S., posted by ShelliR on December 30, 2002, at 18:37:49
Hi Shelli,
I read in my local paper (Oakland Tribune) that it could be prescribed starting sometime in January of 03.
> > On October 8, 2002 Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) received FDA approval for the treatment of opioid dependence.
> >
> > Apparently doctors will be able to starat prescribing it starting this month.
>
>
>
> Hi Peter,
>
> Where did you read that doctors will be able to start prescribing it this month? (And does "this month" mean December 2002 or January 2003)?
>
> My pdoc (who is not anti-buprenorphine) read that it was not going to be approved (or maybe he meant distributed) for another year, in one of his journals. He won't prescribe drugs with codeine for depression anyway, but he's fine with me getting them from my pain doc.
>
> It's hard for psychiatrists to prescribe narcotics for depression because there are so few studies supporting its success. The buprenorphine studies at Harvard/McLean Hospital have really small sample sizes. So that leaves them open for a law suit if the patient turns around and sues them for getting them "addicted". Especially with all the passion about opiate use and the lack of understanding of the concepts of habituation vs. addiction.
>
> Shelli
>
Posted by MoQ on January 1, 2003, at 9:22:49
In reply to Re: Buprenorphine Approved, posted by MoQ on December 30, 2002, at 19:07:21
> > > On October 8, 2002 Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) received FDA approval for the treatment of opioid dependence.
> > >
> > > Apparently doctors will be able to starat prescribing it starting this month.
> >
> >
> >
> > Hi Peter,
> >
> > Where did you read that doctors will be able to start prescribing it this month? (And does "this month" mean December 2002 or January 2003)?
> >
> > My pdoc (who is not anti-buprenorphine) read that it was not going to be approved (or maybe he meant distributed) for another year, in one of his journals. He won't prescribe drugs with codeine for depression anyway, but he's fine with me getting them from my pain doc.
> >
> > It's hard for psychiatrists to prescribe narcotics for depression because there are so few studies supporting its success. The buprenorphine studies at Harvard/McLean Hospital have really small sample sizes. So that leaves them open for a law suit if the patient turns around and sues them for getting them "addicted". Especially with all the passion about opiate use and the lack of understanding of the concepts of habituation vs. addiction.
> >
> > Shelli
> >
>
> You know, I so wish that people would take some personal responsibility, don't you? I mean I work for a law firm and I know that a signed Release doesn't really carry all that much water anyway, but I would be willing to swear before a notary and anyone else who will listen that I promise to never sue my doctor for prescribing me something I ASKED FOR. My family physician had mentioned that doctors are now being sued by patients who asked for narcotic pain relievers and then turned around and blamed the doc for getting them "hooked." It's CRAZY!!!!O.K., I admit that I am a bit confused with regard to the Buprenorphine. Gosh, and I'm not even sure how to phrase this. Does the bup still act like an opiate acts with regard to controlling and treating the depression, depersonalization, anxiety, panic attacks, etc.? Or is it merely to stop you from using opiates? I guess I don't understand how stopping opiate use is going to help me when it is the opiate itself that has helped my symptoms and suffering/discomfort for the past five years. Please enlighten me! Thanks!
Posted by BrittPark on January 1, 2003, at 14:19:35
In reply to Re: Use of opiates in treating depression » MoQ, posted by BrittPark on December 30, 2002, at 14:48:41
Here's a link to a disheartening article (to those of us who respond well to opioids as ADs) about OxyTrex and MorViva:
http://www.annieappleseedproject.org/ullownaltopr.html
OxyTrex and MorViva are preparations of Oxycodone and Morphine respectively, in clinical trials by a company called Pain Therapeutics.
Posted by ShelliR on January 1, 2003, at 19:53:55
In reply to Re: Buprenorphine Approved » MoQ, posted by MoQ on January 1, 2003, at 9:22:49
> O.K., I admit that I am a bit confused with regard to the Buprenorphine. Gosh, and I'm not even sure how to phrase this. Does the bup still act like an opiate acts with regard to controlling and treating the depression, depersonalization, anxiety, panic attacks, etc.? Or is it merely to stop you from using opiates? I guess I don't understand how stopping opiate use is going to help me when it is the opiate itself that has helped my symptoms and suffering/discomfort for the past five years. Please enlighten me! Thanks!
Since you don't use opiates to get high, the part about detoxing *doesn't* really apply to you. Doctors think that since buprenorphine is only a partial opiate, it is not as addictive, and would still satisfy the addict's cravings. Especially since it will be mostly used mixed with naltrexone, which would make street drugs feel very unpleasant. So an "addict" could either stay on buprenorphine or bupe plus naltrexone, or could get off all opiates, since it is easier to get first switch to bupe, then detox.
I was anxious to try buprenorphine because I was hoping that I would not become habituated on it, yet it got rid of the depression in the same manner that full opiates did. That didn't happen for me; I did have to go up and finally it became impossible for me to get over the internet, anyway. At this point my doctor doesn't really think there's much benefit in bupe over methadone for me, as I was hoping.Elizabeth was able to keep the same small dose for several years--using it as an adjunct to effexor. If it is truely coming out this month, I'm going to bring it up with my pain doctor, get his take on it.
Hope this does make some sense to you.
Shelli
Posted by rally on January 3, 2003, at 18:33:19
In reply to Re: Use of opiates in treating depression » MoQ, posted by BrittPark on December 30, 2002, at 14:48:41
it is great i have found this
i have been taking dihydrocodeine for a long time for pain but this last few yers to try and ward of on coming depression
can any one tell me which came first opiates causing the depression or the depression
Posted by BrittPark on January 3, 2003, at 19:00:03
In reply to Re: Use of opiates in treating depression » BrittPark, posted by rally on January 3, 2003, at 18:33:19
It's very hard to say whether the depression is made worse by opiates or better. My guess though is that since you've been taking opiates for a long time that they are doing little one way of the other. I think, on average, more people are made to feel better by opiates than worse. However, tolerance to opiates tends to develop rapidly for most people. You might try tapering off the opiates, wait a little bit and try again. You might find improvement then. Also if you aren't seeing a psychiatrist I suggest that you do so. An AD might be the thing you need. I believe that opiates are very effective ADs (for some people) but the currently available opioids are with perhaps a few exceptions (tramadol, buprenorphine) not effective for long term use. Tolerance builds all too rapidly.
Feel Better,
Britt
Posted by Cisco on January 4, 2003, at 12:34:01
In reply to Re: Use of opiates in treating depression » rally, posted by BrittPark on January 3, 2003, at 19:00:03
Opioids will absolutely relieve many depressive symptoms.
However, due to the unavoidable progression of tolerance and dependence, or withdrawals and abstinence syndrome, opioids are a "Pandora's Box", which should not be opened, except for emergent nociception, IMHO.Cisco
Posted by rally on January 4, 2003, at 17:51:36
In reply to The Cure is Worse than the Disease, posted by Cisco on January 4, 2003, at 12:34:01
cisco could you please elaborate on what you have said and explain to me what you mean as i do not really understand the phrases used
Posted by MoQ on January 5, 2003, at 8:15:11
In reply to The Cure is Worse than the Disease, posted by Cisco on January 4, 2003, at 12:34:01
> Opioids will absolutely relieve many depressive symptoms.
> However, due to the unavoidable progression of tolerance and dependence, or withdrawals and abstinence syndrome, opioids are a "Pandora's Box", which should not be opened, except for emergent nociception, IMHO.
>
> Cisco
Cisco, I still would much rather live with a few days every once in a blue moon (in my case, everyone is different, I know) of "withdrawal" and then re-start the 1 pill per day of Vicodin and relieve my symptoms than live 24/7, 365 days a week with the awful suicidal, depersonalization, depressive, and panic problems. Doesn't that seem to make some sense at all? I know it is probably hard to relate to how different things affect different people if it is not that way for oneself. People with Crohn's disease (at a very progressed state) are on CONSTANT morphine, in the form of a pump, 24 hours a day. Would it be better to take them off the morphine and just have them suffer? Sorry, I'm soap-boxing now, and this is not at all directed at you, Cisco. I just am completely and utterly perplexed at why a substance would be invented to help people and then people are told they are not allowed to use it. I have never tried ecstacy (nor will I), but I have watched a lot of documentaries on it and (as I am sure just about all of you are familiar with) it was invented as an antidepressant to help those who really were not responding to anything. The doctors had FABULOUS results!!!! But then MDMA got into the wrong hands and people who didn't need it for MEDICAL reasons ruined it for everyone. It is still out there for people to obtain illegally, but those who may really benefit from it are not allowed access to it. I for one am not the type of person that is going to dabble in something that is only available on the street. I want my treatment to be supervised by a doctor, psychiatrist, psychopharmacologist, etc., so I am doing everying in the most possible "correct" way. All I want and hope for is to be healthy once again and enjoy life. I work a hard job, am a very responsible person, am a wife and mother, and am certainly a "benefit" to society by whatever standards "THEY" have given. So I am at a loss as to what it is that I am doing that is so taboo.
Posted by MoQ on January 5, 2003, at 8:19:45
In reply to Re: Use of opiates in treating depression » rally, posted by BrittPark on January 3, 2003, at 19:00:03
> It's very hard to say whether the depression is made worse by opiates or better. My guess though is that since you've been taking opiates for a long time that they are doing little one way of the other. I think, on average, more people are made to feel better by opiates than worse. However, tolerance to opiates tends to develop rapidly for most people. You might try tapering off the opiates, wait a little bit and try again. You might find improvement then. Also if you aren't seeing a psychiatrist I suggest that you do so. An AD might be the thing you need. I believe that opiates are very effective ADs (for some people) but the currently available opioids are with perhaps a few exceptions (tramadol, buprenorphine) not effective for long term use. Tolerance builds all too rapidly.
>
> Feel Better,
>
> Britt
>Britt, quick question for you. I have been reading various posts about the buprenorphine and how it is basically an antagonist to opiates. I have asked for some clarification from people and although they have responded I am still a bit confused. Especially now with you indicating, seemingly, that bupinorephrine is a form of an opiate that may have a longer lasting potential. If I am benefiting from Vicodin (1-1.5 tabs a day), if that is substituted for the "medically acceptable" bup at my upcoming psychopharmacological appointment, does that mean I will have adverse effects if I take Vicodin, or will it act in the same manner Vicodin does insofar as my symptoms are concerned? Thanks so much for your courtesies and informative feedback!
Posted by Larry Hoover on January 5, 2003, at 8:32:01
In reply to Re: The Cure is Worse than the Disease » Cisco, posted by rally on January 4, 2003, at 17:51:36
> cisco could you please elaborate on what you have said and explain to me what you mean as i do not really understand the phrases used
Cisco said that opiates should be reserved for the short-term treatment of pain, as long-term treatments of any sort tend to require escalating doses to retain efficacy.
Posted by BrittPark on January 5, 2003, at 10:16:13
In reply to In response to Britt, posted by MoQ on January 5, 2003, at 8:19:45
It's my understanding that buprenorphine is a partial opiate agonist. It therefore works like any other opiate up to a certain dosage but after that it starts working as an opiate antagonist. It's therefore self limiting which is why it is used to treat opiate addicts. Someone with a better handle on the pharmacology, please post and corect any errors.
Cheers,
Britt
Posted by Cisco on January 16, 2003, at 0:39:46
In reply to Re: The Cure is Worse than the Disease » Cisco, posted by rally on January 4, 2003, at 17:51:36
That was a myopic post. I apologise.
Allow me, (forgive me) to re-phrase:
Opioids can be a God-send to Chronic pain sufferer's. A restoration of a semblance of a life.
I was referring to healthy individuals considering a regimine of opioids for depressive relief.
The "Pandora's Box" is mostly due to the War on Drugs, secondarily to inherent shortcomings of the opioids: Dependence, Tolerance, and withdrawal.
Yeah, right: Are there any SSRI's that don't fall into the same category?
Judge what drug is right and correct for your particular situation. Don't rely on the Medical/Pharmaceutical complex for answers.
Lies are more prevalent than truth.
Be cautious and aware of the pitfalls of ALL drugs.
Have I made myself obtuse?
Cisco
Posted by reese1 on February 6, 2003, at 8:09:34
In reply to Re: Buprenorphine Approved » Peter S., posted by ShelliR on December 30, 2002, at 18:37:49
> > On October 8, 2002 Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) received FDA approval for the treatment of opioid dependence.
> >
> > Apparently doctors will be able to starat prescribing it starting this month.
>
>
>
> Hi Peter,
>
> Where did you read that doctors will be able to start prescribing it this month? (And does "this month" mean December 2002 or January 2003)?
>
> My pdoc (who is not anti-buprenorphine) read that it was not going to be approved (or maybe he meant distributed) for another year, in one of his journals. He won't prescribe drugs with codeine for depression anyway, but he's fine with me getting them from my pain doc.
>
> It's hard for psychiatrists to prescribe narcotics for depression because there are so few studies supporting its success. The buprenorphine studies at Harvard/McLean Hospital have really small sample sizes. So that leaves them open for a law suit if the patient turns around and sues them for getting them "addicted". Especially with all the passion about opiate use and the lack of understanding of the concepts of habituation vs. addiction.
>
> Shelli
>
hi shelli, we've talked before the reason the testing for buprenorphine was so small is the doctor was screwed over and forced to stop i've talked to a doctor at mcclean who has found opiates to be very very very helpfulreese
tanyagrover96@yahoo.com
give me an emai
if you need help or more info
Posted by Chairman_MAO on October 25, 2005, at 17:41:28
In reply to Use of opiates in treating depression, posted by MoQ on December 19, 2002, at 16:39:59
If your doctor deems "opioid therapy" appropriate, there will be no reason for him to Rx you anything with an NSAID in it; they just add toxicity. There's really no reason for him to start with anything less than OxyContin.
That said, I recommend buprenorphine as the first-line opioid for depression. Far milder withdrawal than full agonists, vastly increased safety in overdose, and a unique receptor binding profile (kappa antagonism, conferring antipsychotic/antimanic activity possibly) make it ideal for depression. Many people prefer buprenorphine to traditional opioids for depression because it tends to be more activating as well. It's also superb for anxiety; I believe it should be prescribed in lieu of benzodiazepines in many circumstances (hell, its withdrawal syndrome is a lot easier to deal with and never life-threatening!).
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Dr. Bob is Robert Hsiung, MD,
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