![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Caleb462 on December 14, 2003, at 2:48:02
Well, I've been on Nardil 75 mg a bit more than 3 months now, and it finally started showing its effect as of late. I'm also on Buprenorphine 20 mg daily, for opiate addiction maintenance treatment. Buprenorphine helps my problems a lot too.
After 3 months on Nardil and 1 month on Buprenorphine, here is the approximate results:
Depressive Symptoms: 85-90% less.
Social Anxiety Symptoms: 65-80% (varies) less.
Generalized Anxiety Symptoms: 80% less
OCD symptoms: 30-40% less
I have ADD symptoms too, and I think those have probably improved by about 20% or so, suprisingly.I haven't felt this well in about 2 years. It was a long hard struggle, but this nardil/bupe combo has been amazing.
Posted by KellyD on December 14, 2003, at 8:42:39
In reply to Update on my mental health - Nardil + Bupe, posted by Caleb462 on December 14, 2003, at 2:48:02
Posted by maryhelen on December 15, 2003, at 12:49:41
In reply to Update on my mental health - Nardil + Bupe, posted by Caleb462 on December 14, 2003, at 2:48:02
Hi Caleb:
I have been on Nardil since November 3rd, am now up to 90 mg. I also have an opiate addiction. Incredibly, I asked my family doctor not to prescribe them to me anymore, but because of the chronic pain he knows that I am in, next visit he offered them to me anyway, like giving candy to a baby and I had no resistance, took the prescription. I take percocett, and tylenol 3, any opiate really, which both help with the pain, but more importantly the percocett relieves the depression. I won't go into all that the meds I have had for the depression or different therapies (including ECT twice) I have tried over almost 20 years, as it is probably much the same as most others here with treatment resistant depression. I met this pdoc when I was in a substance abuse program and he understands the dilemma I am in, knowing my history of fighting this demon depression, that the opiates has been the only thing that helps the depression and that I need something for chronic pain. He even said that he felt like prescribing the opiates, but knows I take too many now to gain the required effect. He also mentioned Lamitcal to augment the Nardil, as it had helped me greatly when it was augmented with Parnate about 7 months ago, it worked quickly but it stopped working after 3 weeks. I had never felt better in my whole 51 years. I also lost so much of my hair, which would have been fine had the med kept working. Better bald and wear a wig than live in this depression. My pdoc then suggested taking Nardil.
During my last vist, he talked about methadone and then buprenorphine. Methadone does not appeal to me at all. Surfing the web last night, it seems to me that I understand that bupe is used for treatment resistant depression, chronic pain, and opiate withdrawal. I have all three. I am thinking of calling him and asking him to prescribe it.
If I had a choice of getting complete pain relief without opiates, or not being depressed, I would choose living with pain and not being depressed, hands down. I am probably going to end up in a wheelchair and would still take that and live without this disabling hell of depression.
Is it your understanding that bupe helps with what I have mentioned above? Did it help you with both the opiate withdrawal and depression in conjuction with Nardil? Does it make you not crave the other opiates?
Sorry for all of the questions, but I really am at the end of my rope.
I am very happy for that you have found a combination that works for you.
Thanks,
maryhelen
Posted by jack smith on December 16, 2003, at 0:02:23
In reply to Update on my mental health - Nardil + Bupe, posted by Caleb462 on December 14, 2003, at 2:48:02
Caleb,
I have been lurking for a while ever since a long term ban several months ago, but I have followed your progress with nardil. It seems that things didn't get better for you until the bupe was added. Is it possible it's just the Bupe? Perhaps, your opiate addiction was a cause of your depression? Just a thought. And, no use changing something when it's working. Congratulations.
JACK
Posted by Caleb462 on December 16, 2003, at 3:32:44
In reply to Is it possible it's just the Bupe? » Caleb462, posted by jack smith on December 16, 2003, at 0:02:23
> Caleb,
>
> I have been lurking for a while ever since a long term ban several months ago, but I have followed your progress with nardil. It seems that things didn't get better for you until the bupe was added. Is it possible it's just the Bupe? Perhaps, your opiate addiction was a cause of your depression? Just a thought. And, no use changing something when it's working. Congratulations.
>
> JACKMy opiate addiction was more a result of my depression, but eventually it greatly increased my depression yes. I was depressed before I even began using however. True, things did not got better till the bupe was added. However, I get the feeling that the Nardil was kicking in at the same time. It is hard to explain, but I can just "feel" the Nardil working along with the buprenorphine. Also, I think I have some proof -
On days that I forgot some of my Nardil, say I only ended up taking 45 mg or something, my social anxiety problems increased again. It is as if the bupe is helping me control the depressive-oriented problems, and the Nardil is giving me a boost in the social department. I dunno, it is all conjecture, really. Maybe the Nardil isn't doing anything... but like I said, I seem to "feel" it.
Posted by Caleb462 on December 16, 2003, at 4:03:44
In reply to Re: Question for Caleb ...... bupe, posted by maryhelen on December 15, 2003, at 12:49:41
> Hi Caleb:
>
> I have been on Nardil since November 3rd, am now up to 90 mg. I also have an opiate addiction. Incredibly, I asked my family doctor not to prescribe them to me anymore, but because of the chronic pain he knows that I am in, next visit he offered them to me anyway, like giving candy to a baby and I had no resistance, took the prescription. I take percocett, and tylenol 3, any opiate really, which both help with the pain, but more importantly the percocett relieves the depression. I won't go into all that the meds I have had for the depression or different therapies (including ECT twice) I have tried over almost 20 years, as it is probably much the same as most others here with treatment resistant depression. I met this pdoc when I was in a substance abuse program and he understands the dilemma I am in, knowing my history of fighting this demon depression, that the opiates has been the only thing that helps the depression and that I need something for chronic pain. He even said that he felt like prescribing the opiates, but knows I take too many now to gain the required effect. He also mentioned Lamitcal to augment the Nardil, as it had helped me greatly when it was augmented with Parnate about 7 months ago, it worked quickly but it stopped working after 3 weeks. I had never felt better in my whole 51 years. I also lost so much of my hair, which would have been fine had the med kept working. Better bald and wear a wig than live in this depression. My pdoc then suggested taking Nardil.
>
> During my last vist, he talked about methadone and then buprenorphine. Methadone does not appeal to me at all. Surfing the web last night, it seems to me that I understand that bupe is used for treatment resistant depression, chronic pain, and opiate withdrawal. I have all three. I am thinking of calling him and asking him to prescribe it.Sounds like a great idea. You are right, methadone is probably not an ideal choice in your case. But you may have to consider it on the off-chance that bupe doesn't work. That is a small chance, of course.
>
> If I had a choice of getting complete pain relief without opiates, or not being depressed, I would choose living with pain and not being depressed, hands down. I am probably going to end up in a wheelchair and would still take that and live without this disabling hell of depression.Bupe will probably help your depression greatly. Also, it WILL help your pain. Buprenorphine is also used for pain control. An 8 mg tab of Suboxone (which is what is described for opiate maintainence) is nearly 30 times the normal doses for pain relief (0.2 mg, 0.3 mg).
>
> Is it your understanding that bupe helps with what I have mentioned above? Did it help you with both the opiate withdrawal and depression in conjuction with Nardil? Does it make you not crave the other opiates?Absolutely. In the doctor's office, I took my first doses in 4 mg increments. Once I hit 12 mg, my cravings shut off like a lightbulb - and they have been gone ever since. I mean, I still get some MILD cravings every once in a while - but I'd say bupe provided about 90% relief from cravings initially, and at my current dose of 20 mg, my cravings have reduced by about 99%. It really is amazing.
You should know though, that I was not completely PHYSICALLY addicted, and was primarily psychologically addicted. Meaning I was not going through intense physical withdrawals, thus I can't comment on that - though I'm certain that will be no problem either, you shouldn't have to worry about physical withdrawal either, once you get up to the dose that is right for you.
Speaking of doses, another thing I should mention is that bupe is a very funny drug. Perhaps this comes from its mixed agonist/antagonist actions, but every person is different in what dose they will respond to. You can't just take your level of tolerance and then calculate your bupe dose with that, it probably won't work. I had a relatively small habit compared to say, a heroin addict - yet I had to go to 20 mg, where I know several H addicts who never had to go past 8 mg.
Some more interesting things:
You can't get high on bupe. You may feel a nice buzz the first few days, but that will fade quickly. You will go back to feeling normal, the way you felt before you ever got hooked (and that is a wonderful feeling). But anyway, bupe has antagonist properties meaning its effects stabilize and eventually bupe has the ability to block its own effects. While the difference between say, 2 mg and 8 mg is fairly drastic. The difference between 8 mg and 16 mg is much subtler - because the effects have already begun to level off. 32 mg is the max dose. After that, bupe's antagonist activity will take over, and will send an addict into withdrawals. Anyway, since you can't get any kind of real high with bupe, you don't have to worry about potentially abusing it either.
One more note on the pain relief - while bupe IS a pain reliever like any narcotic, you have to consider the fact that it simply may not be strong enough to ease all your pain. It will certainly help you mentally, you'll just have to wait and see how it effects you pain-wise. Hopefully, it will be effective.
As for your doctor prescribing it, I'm a little wary on this. The Goverment approved a certain number of U.S. doctors to use bupe (in the forms of subutex and suboxone) to treat opiate addiction. If your doc is not one of these, I'm not sure if he will be able to prescribe subutex or suboxone (the difference: suboxone contains naltrexone, thus if it is crushed and injected it will cause withdrawals. The naltrexone will not has no effect when taken sublingually however - which is how you will be directed to take it).
He can prescribe Buprenex I'm certain of. Buprenex is the original version of buprenorphine that was/is used solely to treat pain. However, I think Buprenex only comes in small doses (0.2 mg) that will not work for opiate maintainence.
I really don't know if un-approved docs can prescribe suboxone/subutex or not. You will just have to ask him. If he can't, you can look for a doctor near you who can. There are many. You can find one by looking here:
http://buprenorphine.samhsa.gov/
I think I've covered everything. Whew, that was a long post. I was going fast, so sorry if it came out sloppy. Anyway, good luck.
>
> Sorry for all of the questions, but I really am at the end of my rope.I understand completely, so was I. No need to apoligise, I am glad to help.
> I am very happy for that you have found a combination that works for you.
>Thanks!
Posted by maryhelen on December 16, 2003, at 19:24:29
In reply to Re: Question for Caleb ...... bupe, posted by Caleb462 on December 16, 2003, at 4:03:44
Hi Caleb:
I cannot thank you enough for taking the time and having the patience to answer my very long post. You have helped me greatly, as I am feeling very hopeless about ever not being depression or conquering the opiate addiction and when I saw your initial post, I felt the first glimmer of hope for the first time in a long time. I really appreciate it, but I still have some questions following some of your comments and I hope you don't mind hanging in with me and anwering a few more questions:
1) > In the doctor's office I took my first dose in 4mg increments...... Question: Does this mean that you stayed in the office for a certain length of time after starting with a much smaller dose? What length of time between each increment? I gather the dose can be raised fairly quickly.
2) > You will go back to feeling normal, the way you felt before you ever got hooked (and that is a wonderful feeling). Question: I do not believe that I have ever felt normal. Indeed, I eventually realized that the opiates I took for my migraines, were also having a positive effect on the depression. I, therefore, believe I had the depression before I progressed into the opiate addiction. Do you think this will make a difference? I musn't forget that I still have hope that the Nardil will begin to work.
3) > But anyway, bupe has antagonist properties meaning its effects stabilize and eventually bupe has the ability to block its own effects. Question: Caleb, I do not understand what this means.
4) > You should know though, that I was not completely PHYSICALLY addicted, and was primarily psychologically addicted. Meaning I was not going through intense physical withdrawals ... Caleb: I also do not go through physical withdrawal when I am out of the pills. My is also psychological, and my withdrawal involves, yes some rebound headache, but worsening of depressive symptoms.
5) > As for your doctor prescribing it, I'm a little wary on this. Caleb ..... I live in Canada. My psychiatrist works for the Centre for Addiction and Mental Health in Toronto, previously four different centres .... The Clarke Institute, a world renowned Centre for treatment of mental illness and research, The Donwood Institute, a well known substance abuse facility, the Addiction Research Foundation (ARF), and the very old Queen Street Mental Health Facility. The four are coming together in one facility and should offer one of the best in the treatment of mental illness and addiction, in Canada and possibly may become world renowned. The reason I mention this, is because I met my current psychiatrist while in the Donwood, the substance abuse facility, but he also works at the Clarke Institute. It was he who mentioned the possiblity of using bupe, so he would be able to prescribe it. He is going to set me up with an appointment with the best Mood Disorder Speicalist in Ontario. However, he also knows I come here to Dr. Bob's and is very receptive to the information I have come to him with in the past when talking about medications. He also believes, and is open to the fact, that it is those of us who experience first hand the medications and would have better knowledge of the drug's reactions and side effects, more so than he would looking at his textbooks. I have gone way off topic, but thought that it may be helpful to others to know the Centre exists, who are within reasonable travelling of it. Yet, I really do not want to go the Specialist, as I feel at this time I would rather tell my pdoc I would like too try the bupe with the Nardil first, as I meet all of the criteria for it. I think I may call him tomorrow and talk to him about it.
Caleb, even if the bupe does not work tremendously for the pain, I would much rather get help with the depression and certainly need to stop taking the opiates. I really don't know how much longer I can stand this depression, and missing out on and being robbed of life. What really is the point of living, mostly in bed, using opiates just to be at social situations, such as Christmas. After 51 years of living I don't see the point, except being forced to live because others would be upset if I died. I don't know Caleb. I guess I am just rambling. I have a daughter and 4 grandchildren, but, as pathetic as this may sound, I get resentful toward them, because it is for my daughter that I really do have to live.
Again, thank you for your time and I am so happy for you that you have found something that is helping you with both opiate addiction and depression.
maryhelen
Posted by jack smith on December 16, 2003, at 23:29:17
In reply to Is it possible it's just the Bupe? » Caleb462, posted by jack smith on December 16, 2003, at 0:02:23
Posted by Caleb462 on December 17, 2003, at 0:26:39
In reply to Re: More Questions for Caleb ...... bupe, posted by maryhelen on December 16, 2003, at 19:24:29
> Hi Caleb:
>
> I cannot thank you enough for taking the time and having the patience to answer my very long post. You have helped me greatly, as I am feeling very hopeless about ever not being depression or conquering the opiate addiction and when I saw your initial post, I felt the first glimmer of hope for the first time in a long time. I really appreciate it, but I still have some questions following some of your comments and I hope you don't mind hanging in with me and anwering a few more questions:
>
> 1) > In the doctor's office I took my first dose in 4mg increments...... Question: Does this mean that you stayed in the office for a certain length of time after starting with a much smaller dose? What length of time between each increment? I gather the dose can be raised fairly quickly.
>I was in the office for a few hours signing papers and then experimenting with dose. I started at 4 mg. The effects came on within about 5-7 minutes. After about 30 minutes, it was obvious I was going to need to go up. Thus I was given another 4 mg, for a total of 8 mg. The effects increased quite a bit - and for the first time I felt the grip of addiction lessening. After another hour or so, I was given an additional 4 mg, for a total of 12 mg. About 5 minutes after taking this last dose, it was like a lightbulb clicked on.. and boom! My cravings dissapeared. I felt free from addiction for the first time since in several months.
> 2) > You will go back to feeling normal, the way you felt before you ever got hooked (and that is a wonderful feeling). Question: I do not believe that I have ever felt normal.
I meant normal in that you will not feel like you did when you were an addict. The pain and craving of constantly needing opiates to function will be gone.
Indeed, I eventually realized that the opiates I took for my migraines, were also having a positive effect on the depression. I, therefore, believe I had the depression before I progressed into the opiate addiction. Do you think this will make a difference?No, I too was depressed before I became an addict, or before I ever began using pain pills.
I musn't forget that I still have hope that the Nardil will begin to work.
Yes, don't give up hope on that. Of course, with the bupe it may not even matter.
>
> 3) > But anyway, bupe has antagonist properties meaning its effects stabilize and eventually bupe has the ability to block its own effects. Question: Caleb, I do not understand what this means.It is hard to explain. Buprenorphine is not a typical opioid agonist. Let's take for example, oxycodone, which is a typical agonist. Oxycodone binds to and activates the mu-opioid receptors in your brain quite well. As the dose is raised, it continues to bind to more and more receptors and continues to activate them, causing increased effects.
Buprenorphine is also an agonist. However, it is what is known as a partial agonist, or a mixed agonist/antagonist, which ever term you prefer. Like oxycodone (or morphine, hydrocodone, etc.), it binds to your mu-receptors and activates them. However, buprenorphine does not fit into the receptors as well as a normal opioid. Because of this, it DOES activate receptors, but it will prevent other opioids from activating receptors because of its unique binding affinity. This is good, because if you for some reason do get some breakthrough cravings and decide to use, the effects of whatever you use will be lessened greatly.
Anyway, another thing happens because of the way bupe acts at receptors. It causes continued effects as the dose is raised, but only to a certain extent, and to a much lesser degree than a typical opioid. This is because it actually begins to block ITSELF, even as more activation increases. Eventually, at very high doses, the blocking effects will win out completely, and it will turn into an opioid antagonist with no noticeable agonist effects at all. I hope I explained this well enough for you to understand. I know it can be confusing. But anyway, you can go up to a dose of 32 mg and bupe will still posess signifigant action as an agonist. It is useless to go past this dose, however, since the effects will not increase, and eventually the effects will completely stop as bupe becomes an antagonist and actually send you into withdrawal.
>
> 4) > You should know though, that I was not completely PHYSICALLY addicted, and was primarily psychologically addicted. Meaning I was not going through intense physical withdrawals ... Caleb: I also do not go through physical withdrawal when I am out of the pills. My is also psychological, and my withdrawal involves, yes some rebound headache, but worsening of depressive symptoms.
>
> 5) > As for your doctor prescribing it, I'm a little wary on this. Caleb ..... I live in Canada. My psychiatrist works for the Centre for Addiction and Mental Health in Toronto, previously four different centres .... The Clarke Institute, a world renowned Centre for treatment of mental illness and research, The Donwood Institute, a well known substance abuse facility, the Addiction Research Foundation (ARF), and the very old Queen Street Mental Health Facility. The four are coming together in one facility and should offer one of the best in the treatment of mental illness and addiction, in Canada and possibly may become world renowned. The reason I mention this, is because I met my current psychiatrist while in the Donwood, the substance abuse facility, but he also works at the Clarke Institute. It was he who mentioned the possiblity of using bupe, so he would be able to prescribe it. He is going to set me up with an appointment with the best Mood Disorder Speicalist in Ontario. However, he also knows I come here to Dr. Bob's and is very receptive to the information I have come to him with in the past when talking about medications. He also believes, and is open to the fact, that it is those of us who experience first hand the medications and would have better knowledge of the drug's reactions and side effects, more so than he would looking at his textbooks. I have gone way off topic, but thought that it may be helpful to others to know the Centre exists, who are within reasonable travelling of it. Yet, I really do not want to go the Specialist, as I feel at this time I would rather tell my pdoc I would like too try the bupe with the Nardil first, as I meet all of the criteria for it. I think I may call him tomorrow and talk to him about it.
Alright, sounds good. Let me know what happens.>
> Caleb, even if the bupe does not work tremendously for the pain, I would much rather get help with the depression and certainly need to stop taking the opiates.I understand, but you can count on getting atleast some signifigant degree of pain relief, and who knows? Bupe may provide enough pain relief as well.
I really don't know how much longer I can stand this depression, and missing out on and being robbed of life. What really is the point of living, mostly in bed, using opiates just to be at social situations, such as Christmas. After 51 years of living I don't see the point, except being forced to live because others would be upset if I died. I don't know Caleb. I guess I am just rambling.Not rambling at all. I understand how you feel.
I have a daughter and 4 grandchildren, but, as pathetic as this may sound, I get resentful toward them, because it is for my daughter that I really do have to live.
>
> Again, thank you for your time and I am so happy for you that you have found something that is helping you with both opiate addiction and depression.
>
> maryhelenThank you again, and I'm glad that you may finally find a way out of your depression. You sound like a great person, who is unfortunately having to go through some horrible things. I wish you all the luck in the world! Bupe is really a great drug, trust me.
Keep me updated.
Posted by Caleb462 on December 17, 2003, at 0:28:20
In reply to What were you using? (nm) » jack smith, posted by jack smith on December 16, 2003, at 23:29:17
Me? Primarily hydrocodone, anywhere from 20 mg to 120 mg a day. Also some oxycodone for a short perioid, and occasionally codeine and propoxyphene.
Posted by maryhelen on December 17, 2003, at 11:46:55
In reply to Re: What were you using?, posted by Caleb462 on December 17, 2003, at 0:28:20
I mainly use percocets right now which I find give me the best anti-depressant effect and pain relief. There is no feeling of being 'high' just a feeling of calm, feeling mellow, not being depressed, able to work, socialize, do housework etc., be on computer, put simply be part of life ......... my problems are still there but seem less significant and manageable and not magnified to the point of being insurmountable, take a back seat, so to speak. Otherwise, end up staying in bed unable to function, in the unbearble grips of this hell of depression, useless and feeling worthless, hopeless and pathetic. Unfortunately, I need about 25 - 30 of these pills a day for this effect.
I am addicted to and have taken Fironal, Oxycontin, Tylenol 3's by the handful, morphine. I am addicted to any such drug before I even take it. I unwittingly began taking a drug called Dilaudid, a drug 9 times more powerful than morphine, used to treat cancer patients in last stages of their pain. I was offered it when the woman, at the time from whom I bought percs from, couldn't get them. I looked it up in my prescription drug book and it was just listed with all of the other anaelegics, for pain relief. Injected it in my thigh muscle. Was not afraid of doing so, as that is how I took my med, Imitrex for migraines, by injection. Pills were $25.00 each. I only used it for 3 months and became so psychologically dependent that I became within a hair's width of committing suicide when I was withdrawing from it. I had thought at that point I had experienced depression as low as I could go. Have never experienced, nor could describe the depression following the withdrawal from this drug. Ended up in going to emergency knowing I would be certified, or most certainly die, spent weeks in a psych ward followed by a substance abuse program. Years ago now, but have since resumed my use of opiates, had never really stopped using them but had long breaks from them and still found I was depressed even after the drugs had been out my system for months. I am getting them prescribed now by a doctor. By the way, the woman who gave me the Dilaudid died. She injected it into her veins and died of an accidental overdose. I loved that drug. I would even admit right now that if I was handed it today, I would not bat an eyelash and would use it. Much stronger than percs, much more physically and mentally soothing. Yet, no one knows I am taking these drugs as I do not appear stoned or stumbling, as I was when I took Fironal for my migraines. Another aside, I once saw a TV show on the last days of Elvis. Of all the multitude of drugs he took, Dilaudid was the last one he had his prescriptions for. It was then I found I had been taking synthetic heroin. Also, the woman supplying it found that when she tried to get off it, she had the most unbearable physical withdrawal. I never experienced that kind of withdrawal with the extreme nausea and throwing up, chills, diahrea (sp), muscle aches and spasms, unbearable headache. Mine was the worst depression I had ever experienced, plain and simple, nothing physical. It is strange how different we all are.
Sorry, I don't seem to know how to post without rambling on and on. Just trying to give my experience.
I also, understand doctor's reluctance to prescibe these drugs for depression, given that most people would develop a tolerance, dependence or addiction. I feel very badly for those who could manage them and could get the relief from their depression, but are not able to get it prescribed for them.
I am praying and hoping that the Nardil will begin to work and that the bupe will address the issues of opiate dependence and chronic pain, which almost becomes secondary.
Caleb, thanks again for posting about your success with the combinationof Nardil and bupe and giving me hope. What would we do without each other?
Sorry again for the long post.
maryhelen
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.