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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by scatterbrained on April 19, 2005, at 22:43:11
Thought this was an interesting article...
Morphine may benefit treatment-resistant OCD patients
Once-weekly morphine therapy can reduce symptoms in some patients with treatment-resistant obsessive-compulsive disorder (OCD), claim investigators."A case series and an open-label trial suggest a role for mu-opioid receptor agonists in the managements of treatment-resistant OCD," observe Lorrin Koran and colleagues, from Stanford University Medical Center in California, USA.
To investigate further, the researchers studied the potential effect of the mu-opioid receptor agonist morphine on the OCD symptoms of 23 patients who had failed between two and six adequate serotonin reuptake inhibitor trials, and had a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score of 20 or above.
The participants were randomly assigned to 2-week blocks of once-weekly oral morphine, lorazepam, an anti-anxiety drug, and placebo. Drug doses were increased, decreased, or maintained in the second week of each treatment in accordance with response and side effects.
After treatment with morphine, the median Y-BOCS score fell from 29 to 25, representing a 13% decrease.
In all, seven (30%) patients were considered responders, based on achieving a 25% or greater decrease in Y-BOCS score.
Morphine responders described the relief of OCD symptoms as being noticeable the day after taking the drug and lasting for 2 to 5 days, with symptoms reduced in both frequency and persistence. The patients also felt better able to resist their compulsions.
In comparison, treatment with lorazepam resulted in a median decrease in Y-BOCS score of just 6%, which was not statistically different from the 7% seen with placebo. Moreover, just four (17%) individuals were considered responders after lorazepam treatment, while none of the patients responded to placebo.
The researchers note that, although they did not witness euphoric effects in any of the participants, and none reported euphoria, their study may have been too short for such complications to become manifest.
They conclude in the Journal of Clinical Psychiatry: "The response seen, its rapidity, and the relative tolerability of the treatment are encouraging and warrant larger and longer term studies" of morphine and another mu-receptor agonists for refractory OCD.
J Clin Psychiatry 2005; 66: 353-359
Posted by Spriggy on April 20, 2005, at 14:15:16
In reply to Morphine may benefit treatment-resistant OCD, posted by scatterbrained on April 19, 2005, at 22:43:11
Posted by Phillipa on April 20, 2005, at 17:48:11
In reply to Morphine may benefit treatment-resistant OCD, posted by scatterbrained on April 19, 2005, at 22:43:11
I don't think it's likely the doc's will go along with this one! Fondly, Phillipa
Posted by scatterbrained on April 21, 2005, at 0:56:18
In reply to Re: Morphine may benefit treatment-resistant OCD, posted by Phillipa on April 20, 2005, at 17:48:11
well, the study was done at Standford, so you never know.I certainly think morhine is a more humane treatment than say psychosurgery for the treatment resistent.
Posted by jerrympls on April 21, 2005, at 2:36:19
In reply to Re: Morphine may benefit treatment-resistant OCD » Phillipa, posted by scatterbrained on April 21, 2005, at 0:56:18
> well, the study was done at Standford, so you never know.I certainly think morhine is a more humane treatment than say psychosurgery for the treatment resistent.
My doc has prescribed me an opiate for my treatment-resistant depression and it's working rather well. Been on it Since December and no tolerance thus far (knock on wood).
Posted by scatterbrained on April 21, 2005, at 2:51:18
In reply to Re: Morphine may benefit treatment-resistant OCD » Phillipa, posted by scatterbrained on April 21, 2005, at 0:56:18
I personally think Morphine and similar drugs are under used in psychiatry, to the point where their potential theraputic advantages remain relatively unknown. I find this sort of stigma nothing less than barbaric. If somebody was in chronic "physical" pain nobody would question them taking a drug like morphine. Most people don't seem to realize that brain disorders such as ocd, major depression, bipolar, ect, are every bit as physical, and shouldn't be confused with the various psychological and behavioral conditions that they sometimes superficially mimic. If somebody is in unbearible physical pain they should be treated for it; regardless of where on their body it's coming from.
Posted by jerrympls on April 21, 2005, at 2:54:46
In reply to Re: Morphine may benefit treatment-resistant OCD, posted by scatterbrained on April 21, 2005, at 2:51:18
> I personally think Morphine and similar drugs are under used in psychiatry, to the point where their potential theraputic advantages remain relatively unknown. I find this sort of stigma nothing less than barbaric. If somebody was in chronic "physical" pain nobody would question them taking a drug like morphine. Most people don't seem to realize that brain disorders such as ocd, major depression, bipolar, ect, are every bit as physical, and shouldn't be confused with the various psychological and behavioral conditions that they sometimes superficially mimic. If somebody is in unbearible physical pain they should be treated for it; regardless of where on their body it's coming from.
AMEN!
Posted by paulbwell on April 21, 2005, at 5:15:27
In reply to Re: Morphine may benefit treatment-resistant OCD » scatterbrained, posted by jerrympls on April 21, 2005, at 2:54:46
> > I personally think Morphine and similar drugs are under used in psychiatry, to the point where their potential theraputic advantages remain relatively unknown. I find this sort of stigma nothing less than barbaric. If somebody was in chronic "physical" pain nobody would question them taking a drug like morphine. Most people don't seem to realize that brain disorders such as ocd, major depression, bipolar, ect, are every bit as physical, and shouldn't be confused with the various psychological and behavioral conditions that they sometimes superficially mimic. If somebody is in unbearible physical pain they should be treated for it; regardless of where on their body it's coming from.
>
> AMEN!
>Have you noticed little things which once MAY have bothered you don't while on hydro Jer?
Posted by jerrympls on April 21, 2005, at 17:54:26
In reply to Re: Morphine may benefit treatment-resistant OCD, posted by paulbwell on April 21, 2005, at 5:15:27
> > > I personally think Morphine and similar drugs are under used in psychiatry, to the point where their potential theraputic advantages remain relatively unknown. I find this sort of stigma nothing less than barbaric. If somebody was in chronic "physical" pain nobody would question them taking a drug like morphine. Most people don't seem to realize that brain disorders such as ocd, major depression, bipolar, ect, are every bit as physical, and shouldn't be confused with the various psychological and behavioral conditions that they sometimes superficially mimic. If somebody is in unbearible physical pain they should be treated for it; regardless of where on their body it's coming from.
> >
> > AMEN!
> >
>
> Have you noticed little things which once MAY have bothered you don't while on hydro Jer?Hey Paul-
You mean as far as things that bothered me stemming from my depression? Totally-here's a sample:
Off the opiate I would really isolate myself socially - lost a lot of friends. Also, motivation, apathy, desire, general interest in things suffered. ON the opiate I've been more social, motivation, apathy have improved and I see things more in long-term opposed to moment to moment in a dark depressed hole.
Is that what you were asking? Of course the addition of the opiate is NOT a miracle cure. I still have bad days, problems with motivation, fatigue, apathy - but I seem to recover from depressive episodes faster.
Jerry
Posted by Paulbwell on April 24, 2005, at 13:54:26
In reply to Re: Morphine may benefit treatment-resistant OCD » paulbwell, posted by jerrympls on April 21, 2005, at 17:54:26
Posted by scatterbrained on April 24, 2005, at 21:20:36
In reply to Re: Morphine may benefit treatment-resistant OCD » paulbwell, posted by jerrympls on April 21, 2005, at 17:54:26
Jerry, do you find that the opiate helps w/ concentration and other cognitive problems associated w/ depression
Posted by jerrympls on April 25, 2005, at 20:57:24
In reply to Re: Morphine may benefit treatment-resistant OCD » jerrympls, posted by scatterbrained on April 24, 2005, at 21:20:36
> Jerry, do you find that the opiate helps w/ concentration and other cognitive problems associated w/ depression
For me it depends on the opiate. I first tried Oxycontin and although it helped with mood it made me foggy and out of it. Hydrocodone acts more as a stimulant and I feel it greatly increases my concentration.
Posted by Chairman_MAO on April 26, 2005, at 12:28:57
In reply to Morphine may benefit treatment-resistant OCD, posted by scatterbrained on April 19, 2005, at 22:43:11
Why not just give buprenorphine on an outpatient basis for OCD? I wish most psychiatrists would get it through their skulls that the opioid system is intimiately involved in many forms of mental illness. If we wish to treat mental illnesses properly, as a society we MUST get over our "opioiphobia". Not to mention that if you ask anyone who's kicked an opioid and kicked an SSRI which withdrawal syndrome was worse, I'd bet $20 they'd pick the SSRI. Opioids may produce a more intense reaction, but even the worst opioid withdrawal does not last as long as SSRI withdrawal does. when I miss a dose of Parnate, I feel way more uncomfortable than if I miss a whole day's worth of buprenorphine. Granted, bupe's halflife is longer, but I'm writing this as a reaction to all of the people who think that opioids are "addictive and habit forming" and that ADs are not.
Posted by Paulbwell on April 26, 2005, at 15:13:16
In reply to Re: Morphine may benefit treatment-resistant OCD, posted by Chairman_MAO on April 26, 2005, at 12:28:57
> Why not just give buprenorphine on an outpatient basis for OCD? I wish most psychiatrists would get it through their skulls that the opioid system is intimiately involved in many forms of mental illness. If we wish to treat mental illnesses properly, as a society we MUST get over our "opioiphobia". Not to mention that if you ask anyone who's kicked an opioid and kicked an SSRI which withdrawal syndrome was worse, I'd bet $20 they'd pick the SSRI. Opioids may produce a more intense reaction, but even the worst opioid withdrawal does not last as long as SSRI withdrawal does. when I miss a dose of Parnate, I feel way more uncomfortable than if I miss a whole day's worth of buprenorphine. Granted, bupe's halflife is longer, but I'm writing this as a reaction to all of the people who think that opioids are "addictive and habit forming" and that ADs are not.
Agreed, Their withdrawal is just different, IME. Codeine derived drugs produce a more physical pain in me, sore bones and aches, increased harshness to all of life and my being to it, while the SSRI's produce more mental slowing and theres the dizzy headyness like being at sea and thoes head 'zaps'.
Posted by jerrympls on April 27, 2005, at 1:38:43
In reply to Re: Morphine may benefit treatment-resistant OCD, posted by Chairman_MAO on April 26, 2005, at 12:28:57
> Why not just give buprenorphine on an outpatient basis for OCD? I wish most psychiatrists would get it through their skulls that the opioid system is intimiately involved in many forms of mental illness. If we wish to treat mental illnesses properly, as a society we MUST get over our "opioiphobia". Not to mention that if you ask anyone who's kicked an opioid and kicked an SSRI which withdrawal syndrome was worse, I'd bet $20 they'd pick the SSRI. Opioids may produce a more intense reaction, but even the worst opioid withdrawal does not last as long as SSRI withdrawal does. when I miss a dose of Parnate, I feel way more uncomfortable than if I miss a whole day's worth of buprenorphine. Granted, bupe's halflife is longer, but I'm writing this as a reaction to all of the people who think that opioids are "addictive and habit forming" and that ADs are not.
I agree completely- withdrawl from SSRIs is THE WORST. I have NEVER had withdrawl problems from any other med. Paxil and Nardil were HELL going off of -to the point I almost admitted myself into the hospital.
Posted by lexyr on April 29, 2005, at 12:37:47
In reply to Re: Morphine may benefit treatment-resistant OCD » scatterbrained, posted by jerrympls on April 25, 2005, at 20:57:24
> > Jerry, do you find that the opiate helps w/ concentration and other cognitive problems associated w/ depression
>
> For me it depends on the opiate. I first tried Oxycontin and although it helped with mood it made me foggy and out of it. Hydrocodone acts more as a stimulant and I feel it greatly increases my concentration.
>
> I was Rx vicodin for pain..and found the exact same feeling...stimulated (but not hyper like) able to get organized, work better, etc. But I can't call my doctor and say "oh, by the way this makes me feel good, and get a lot done, can I have some more??) So is there an alternative, because I think this is only avail. by Rx.??
This is the end of the thread.
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