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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 57 to 81 of 100. Go back in thread:
Posted by TheMeanReds on February 23, 2007, at 10:47:30
In reply to Re: Hang on » Declan, posted by yxibow on February 23, 2007, at 2:53:54
I think everyone would be on heroin, if it were still legal, if they 'kept' their dose very low, every day. But that doesnt seem to be the case. History has shown we are at the will of our 'hedonistic impairitive'.
Posted by mattye on February 23, 2007, at 12:53:05
In reply to Re: Who is in denial?, posted by Quintal on February 23, 2007, at 2:25:48
Good point Quintal,
I have actually been able to manage my opiate intake. Mostly because they are expensive and I refuse to do heroin anymore (which is much cheaper than pills. For pills, you are paying for guaranteed purity and dosage. Heroin is waaay too extreme and unpredictable).
I am sure they would be a more effective anti-depressant if I took them therepeutically instead of a means to get high. And actually, for me at least, coming off opiates usually makes me a little cranky, but they have never left me feeling more depressed than I was before I took them.
The reason I don't do stims (coke, speed, adderall) is that the high is too harsh and the comedown is HORRIBLE. I have never felt worse than when I have come down from these drugs. I find it interesting that some addicts have the exact opposite reaction. My theory is that my brain is probably overwired and overstimulated and overstressed to begin with I seek drugs that calm it down. People who seek out stimulants usually are looking for the thrill or rush.
You mentioned benzos too . . . which interestingly I do not find addictive at all and it is impossible to explain this to any doctor who knows my history. Klonopin is very effective for my anxiety and it does not get me high . . . just sleepy if I take too much. In fact, I just came off of it after taking it a month straight and I had no withdrawls or cravings. I think having a month free from anxiety allows me to confront situations that would normally freak me out. My brain learns how to deal with them without the stress and whatnot. When I am back in the situation and off the benzos . . . I have "learned" the more sane way to deal with the situation.
I wonder if the same theory would apply for opiates. Like an aggressive 2 week treatment with opiates to pull the patient out of severe depression while the SSRIs get a chance to stabilize. During people's opiate treatment, they could get aggressive therapy. The opiates would allow the person to open up and talk about the things distressing them . . . thereby processing through the negative thought cycle that feeds the depression and anxiety.
Makes me wonder why opiates and benzos are so controlled while they hand out adderall and ritalin like tic tacs to little kids. Weird. I believe it is our capitalistic culture which is more comfortable with people being focused and productive instead of mellow and subdued.
Matty
> >Seriously, though, don't take opiates unless you absolutely have to. They are addictive - especially for depressed people. I have a lifelong addiction to these drugs that I have only been abstain >from for a few years at a time. They always come back to haunt me, especially when I relapse on my depression / anxiety. I have been clean from heroin for a long time, but I don't think I will >ever be able to kick the pills. They do come in handy if I am in a deep black depression. Rips me right out but dumps me right back when the high wears off.
>
> Everything in that paragraph suggests opiates are acting as reliable and powerful antidepressants, so where is the wishful thinking? In that tolerance will very likely develop and depression will return with a vengeance? In truth this is a very likely outcome with any conventional antidepressant. Everyone who has got to the point of considering an opiate will have experienced this already with conventional antidepressants. All of your pessimistic assertions apply equally to benzos, and as I said earlier in the thread, amphetamines. It seems to me that it is more the 'narcotic' label that colors our perception of what happens when opiates are used to treat depression.
>
> There are augmentation strategies that can be used, as well as other drugs that limit, slow down, or prevent tolerance such as lamotrigine that can be taken concomitantly in the hope of prolonging the antidepressant response.
>
> I'm not sure what it is I'm accused of being in denial of.
>
> Q
Posted by mattye on February 23, 2007, at 13:01:27
In reply to Who is in denial?, posted by Declan on February 23, 2007, at 1:47:33
Not sure what you meant by this. I never said anyone was in denial. I am in no position to judge if someone is in denial, nor do I care. I probably am in denial to some extent myself, but I don't care about that either. You need a certain amount of denial to make it through life. Im no exception.
> Declan
> Themeanreds
> Quintal
>
> but not Mattye.
>
> Is that right?
Posted by pearlcat on February 23, 2007, at 16:46:57
In reply to Hang on, posted by Declan on February 23, 2007, at 1:55:51
I AM A ADDICT! But for so long I have been judged on that and I have just now figured out why I like narcotics. It was not because I wanted to abuse them or get "high" Its because it truly helped with my depression. I cannot get the meds of my choice but I dont think anyone can. I just wanted to know if their was anyone else out there that had the same theory. And no I am not in denial I was hoping that someone could direct me in a route to take with my meds. I have tried everything (AD) under the sun . I am tired of being put on this and put on that till they figure it out. I see a Phsyc that is part of a drug rehab center, solely for the reason that I did not want to be put on anything that I could abuse.....ie....amphetimines. I went that route and my husband thought I had lost my mind. It is like it triggered OCD. Oh well....in a perfect world I guess we could all be happy if we called the shots.
pearlcat
Posted by Declan on February 23, 2007, at 18:50:40
In reply to Re: Who is in denial?, posted by mattye on February 23, 2007, at 13:01:27
No Matt, you never said anyone was in denial. That was flmm, who said Quintal and I were.
Special thanks to you, flmm. You have given me days of delight with only a little affront.How often can you say that?
Posted by Declan on February 23, 2007, at 19:09:33
In reply to Re: Hang on, posted by pearlcat on February 23, 2007, at 16:46:57
Have you considered tianeptine?
It is OK with recovering alcoholics, which suggests something.
And it's been good for me, in recovery too (as we say these days).
Posted by flmm on February 23, 2007, at 21:24:22
In reply to Re: Who is in denial?, posted by Declan on February 23, 2007, at 18:50:40
No thanx needed Declan. That's what i'm here for! Party on dude..............Enjoy the trip!
Posted by flmm on February 23, 2007, at 21:27:03
In reply to Re: Who is in denial? Declan, posted by flmm on February 23, 2007, at 21:24:22
Oh, by the way. Funny how Heroin addicts are popping up on this thread! Heroin is a great an
antidepressant also!
Posted by Quintal on February 23, 2007, at 21:33:51
In reply to Re: Who is in denial? Declan, posted by flmm on February 23, 2007, at 21:27:03
>Oh, by the way. Funny how Heroin addicts are popping up on this thread!
There are no Heroin addicts on this thread.
>Heroin is a great an
antidepressant also!Yes, being an opiate of course.
Q
Posted by Declan on February 24, 2007, at 0:57:27
In reply to Re: Who is in denial? Declan, posted by flmm on February 23, 2007, at 21:24:22
If only (I could)
You have no idea about my life. It's all green tea and healthy food and in bed before 9pm.
No opiates for me.
(But neither do I wish to be congratulated for giving them up.)
For me there is no moral dimension to the opiate thing.
But then I don't live in the US.
Posted by flmm on February 24, 2007, at 9:43:36
In reply to Party on dude » flmm, posted by Declan on February 24, 2007, at 0:57:27
Why would you not take opiates if they were such great antidepressants?!
Posted by bulldog2 on February 24, 2007, at 14:16:35
In reply to Re: Party on dude, posted by flmm on February 24, 2007, at 9:43:36
I've done darvon on and off for many years. Been off for as long as two years. It's a rapidly working ad for me. Mood and motivation are better. problem is I build a rapid tolerance to the drug and fall into a bad depression between doses. If you have the disciplne to only take it two days a week you won't build a tolerance and you have two days where you feel good. But that's a hard thing to do. Problem is I could never find an ad that comes close to darvon. When I'm feeling really bad it's hard to stay off the med. Overall I would recommend not even starting an opiate. Seems to create more problems than it solves. Sort of a pandora's box so to speak.
Posted by flmm on February 24, 2007, at 16:50:31
In reply to Re: Party on dude, posted by bulldog2 on February 24, 2007, at 14:16:35
The very definition of an addiction in the making! Thank you Bulldog2.
Posted by Quintal on February 24, 2007, at 17:53:52
In reply to Re: Party on dude, posted by bulldog2 on February 24, 2007, at 14:16:35
I've done Klonopin on and off for many years. Been off for as long as seven months. It's a rapidly working ad for me. Mood and motivation are better. problem is I build a rapid tolerance to the drug and fall into a bad depression between doses. If you have the discipline to only take it two days a week you won't build a tolerance and you have two days where you feel good. But that's a hard thing to do. Problem is I could never find an anxiolytic that comes close to Klonopin. When I'm feeling really bad it's hard to stay off the med. Overall I would recommend not even starting a benzo. Seems to create more problems than it solves. Sort of a pandora's box so to speak.
Q
Posted by Quintal on February 24, 2007, at 17:56:28
In reply to Re: Party on dude, posted by flmm on February 24, 2007, at 16:50:31
I've done Adderall on and off for many years. Been off for as long as seven months. It's a rapidly working ad for me. Mood and motivation are better. problem is I build a rapid tolerance to the drug and fall into a bad depression between doses. If you have the disciplne to only take it two days a week you won't build a tolerance and you have two days where you feel good. But that's a hard thing to do. Problem is I could never find an ad that comes close to Adderall. When I'm feeling really bad it's hard to stay off the med. Overall I would recommend not even starting a stimulant. Seems to create more problems than it solves. Sort of a pandora's box so to speak.
Q
Posted by Quintal on February 24, 2007, at 18:03:18
In reply to Re: Party on dude, posted by bulldog2 on February 24, 2007, at 14:16:35
I've done Parnate on and off for three months. Been off for as long a nine months. It's a rapidly working ad for me. Mood and motivation are better. Problem is I need much more than the 30mg my pdoc is wiling to prescribe. He considers doses of 80-120mg abuse of the drug. Problem is I could never find an ad that comes close to Parnate. All the others give me a brief high then leave me flat and emotionless. I started to cut myself while on high dose citalopram just so I could feel something - feel alive again, even if it was painful. When I'm feeling really bad it's hard to stay off the meds. Overall I would recommend not even starting a antidepressant or any other meds. They seem to create more problems than they solve. Sort of a pandora's box so to speak.
Q
Posted by Quintal on February 24, 2007, at 18:18:40
In reply to Re: Party on dude, posted by bulldog2 on February 24, 2007, at 14:16:35
I've done codeine and tramadol on and off for many years. Been off for as long as a year. They are rapidly working ad's for me. Mood and motivation are better. Problem is I build a rapid tolerance to the drugs and become anxious and apathetic between doses. Problem is I could never find such an overall effective monotherapy that comes close to opiates. Overall I would recommend not even starting any type chemotherapy unless the suffering is intolerable and you can find no other way out, even then, to take them at as low a dose as possible and only to get you through the crisis. They seem to create more problems than they solve when taken daily long-term. I've had many strange illnesses that have resolved since I quit taking antidepressants. Many times I've been dismayed to find the prescribed drugs were actually making me worse and that I've been better without them. Opiates have been the most effective with the least side effects, and the easiest to quit. Despite all of this, once you've had a taste of how good psych drugs can make you feel it's hard to quit searching for a newer, better treatment. Sort of a pandora's box so to speak.
Q
Posted by Declan on February 24, 2007, at 18:52:07
In reply to Re: Party on dude, posted by flmm on February 24, 2007, at 9:43:36
> Why would you not take opiates if they were such great antidepressants?!
I don't think I said they were.
I just wondered what it would look like to make the same excuses for opiates that you make for ADs.
Posted by Declan on February 24, 2007, at 19:20:53
In reply to Opiates for depression, posted by Quintal on February 24, 2007, at 18:18:40
That's how I feel....it's better if people can avoid all drugs.
You know how the argument goes from here so I'll spare us all the effort.
I have my doubts that tianeptine would be easy to give up.
Posted by flmm on February 24, 2007, at 20:53:46
In reply to Opiates for depression, posted by Quintal on February 24, 2007, at 18:18:40
That's a real freakish tick ya got there Quintal! You should get that checked.
Posted by Quintal on February 24, 2007, at 21:14:30
In reply to Re: Opiates for depression, posted by flmm on February 24, 2007, at 20:53:46
__________________________________________________
A friend just e-mailed me this link any truth in it? Or what is your impression abuse and tolerance issues? Thanks Phillipa
http://www.healthypages.net:80/news.asp?newsid=4969
Morphine may help obsessive-compulsive disorder
2005-04-04--------------------------------------------------------------------------------
For people with obsessive-compulsive disorder (OCD) who have not been helped by standard drug treatments, a weekly dose of oral morphine may ease their symptoms, according to a small pilot study.The newer class of antidepressants known as SRIs is approved for treating OCD, but up to 40 percent of patients fail to respond to two or more of these drugs, Dr. Lorrin M. Koran and his associates explain in the Journal of Clinical Psychiatry.
Quite why morphine can be effective is not known, but other small studies have suggested a role for drugs that interact with opioid receptors because there is a high concentration of opioid receptors in an area of the brain thought to be involved in OCD.
For their trial, Koran's group enrolled 23 subjects with OCD who had tried anywhere from two to six different SRIs. The participants were assigned to once-weekly oral morphine, the anti-anxiety drug lorazepam, or an inactive placebo, in random order for two weeks each.
Average scores on a standard OCD scale declined from 29 to 25 while the subjects were taking morphine, and to 27 in the lorazepam phase.
Seven of the 23 subjects were deemed to be responders to morphine based on score decreases of 25 percent or more. There were four subjects who responded to lorazepam.
Among those responding to morphine, the most noticeable effect began the day after taking the drug and lasted for two to five days. These individuals reported decreased frequency and persistence of obsessions and anxiety, as well as an increased ability to resist their compulsions.
The researchers saw no euphoric effects from taking the drugs -- although one subject later admitted to having abused hydrocodone for several years, which he said reduced his OCD symptoms.
"The response seen, its rapidity, and the relative tolerability of the treatment are encouraging and warrant larger and longer term studies" of morphine or other opiate drugs for treatment-resistant OCD, the team concludes.
SOURCE: Journal of Clinical Psychiatry, March 2005
__________________________________________________
http://www.dr-bob.org/babble/20070107/msgs/721852.htmlQ
Posted by Quintal on February 24, 2007, at 21:22:41
In reply to Pandora's box, posted by Declan on February 24, 2007, at 19:20:53
>I have my doubts that tianeptine would be easy to give up.
Is it that good? I'm swapping my stash of Parnate for a box of Stablon/Coaxil with a friend in the US. I hope it works as well as I remember it doing last time. I'm not even derpressed, just looking for a bit of motivation and anxiety relief.
Q
Posted by gardenergirl on February 25, 2007, at 0:43:11
In reply to Opiates for depression, posted by Quintal on February 24, 2007, at 18:18:40
Posted by laima on February 25, 2007, at 2:01:36
In reply to Stimulants for depression, posted by Quintal on February 24, 2007, at 17:56:28
Hey Quintal, I am curious, which brand or which generic brand of adderall did you use? I am absolutely enthralled with this topic at the moment... Thanks.
> I've done Adderall on and off for many years. Been off for as long as seven months. It's a rapidly working ad for me. Mood and motivation are better. problem is I build a rapid tolerance to the drug and fall into a bad depression between doses. If you have the disciplne to only take it two days a week you won't build a tolerance and you have two days where you feel good. But that's a hard thing to do. Problem is I could never find an ad that comes close to Adderall. When I'm feeling really bad it's hard to stay off the med. Overall I would recommend not even starting a stimulant. Seems to create more problems than it solves. Sort of a pandora's box so to speak.
>
> Q
Posted by linkadge on February 25, 2007, at 10:57:43
In reply to Re: opiates for depression, posted by Quintal on February 22, 2007, at 20:15:34
>Caffeine seems to mostly increase alertness and >still isn't as effective as amphetamines though >and it is less well tolerated at doses needed to >have the desired effects; most people with ADHD >seem to prefer amphetamines. Caffeine doesn't >seem to be an impressive treatment for ADHD in >spiders(!):
It simply has not been tested alongside traditional stimulants, so I don't think we can comment on its efficacy, although it has been helping people get their work done for the last...ever.
>That is the point I'm getting at link. This drug >does make sense in theory because there have >also been a number of studies that indicate a >deficit in the nordrenergic systems of people >with ADHD. Just as with dopamine, according to >my textbook, there has been a noradrenaline >deficit hypothesis in ADHD (it seems) whenever >it has been convenient to market a new drug that >operates via that mechanism.But, what I am saying is that you cannot say this drug is inneffecive simply because it fails to elevate dopamine in the neucleus accumbens. This drug doesn't work for other reasons.
>That's the whole point I'm getting at link; you >can increase attention span with drugs that act >on neurotransmitters other than dopamine, yet >they don't seem to be as good for treating the >overall problem.No, thats not what I mean, at all. It is possable to increase dopamine in areas of attention without increasing dopamine in areas of reward. That, in my opinion would be just as effective as a drug that happens to target the reward centres as well. Like I said before, there are drugs that enhance dopamine release in the neucleus accumbens which are not effective for ADHD.
>You can say the same thing about benzos and >point to people who have been taking them for >decades and feel they are helping their anxiety >long after the initial sedation and euphoria >have faded. That might be true for some, but as >studies suggest (in benzos for example), most >are receiving little real benefit from the drugs >at that point (hard though it is for them to >believe). They have little more than placebo >brought on by conditioning. I think a lot >depends on the rate at which each person >develops tolerance. For some it's rapid and the >anxiety slaps them in the face and they have no >choice but to admit the drug is no longer >working. For others I suspect it's more >insidious, creeping up over the years so >gradually that they have time to adjust and >develop coping mechanisms. In effect they've >gradually withdrawn from the drug in the >therapeutic sense, in that it is doing little to >help the original problem, yet they are still >dependent on it, but mostly to maintain >equilibrium.
>You seem to be suggesting that the only way to >help all mental illness is to activate the >pleasure centres of the brain. I would think you >are mistaken if you suggest that every >psychiatric drug we have works solely through >this mechanism.>Why would such drugs be any less effective for >ADHD if the reward systems played no part in the >therapeutic response?
Becuase, we know from repeated studies that long term early use of methyphenidate makes the reward centres permanantly dependant on the molecule for proper function. So, when you switch somebody off methylphenidate onto a nonrewarding drug, you've introduced a new problem, depression. Yes, depression can cause attention problems on its own, but without clear evidence of depressive symptoms in the first place you're only changing the intial problem. If the lack of attention was purely due to reward dysfunction, then you'd be dealing with a different issue, ie depression. It a patient comes in saying that they can't concentrate *because* they feel worthless, and life isn't worth living, then this would be depression and not ADHD.
>I was hoping to add some perspective on flmm's >comments about opiates by highlighting the fact >that some people here have been prescribed >amphetamines for this purpose and no such >objections are raised to this as they are with >opiates. I've also noticed some people with >chronic depression deciding that because they >have poor concentration and trouble organising >themselves they must have ADHD, and therefore >need stims to treat this newly discovered co->morbid disorder. That seems a little dubious to >me, hence my comments.I agree with you. My original point was that opiates may be treating depression in some yet undiscovered way, which may indeed have nothing to do with being euphoriants. I merely brougt in stimulants as a example of drugs which while are euphoriants, are not working solely because they are euphoriants.
Linkadge
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