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Dr. Bob is Robert Hsiung, MD,
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Posted by cactus on June 25, 2008, at 13:36:49
In reply to Re: Opiates, oxycodone, posted by undopaminergic on June 25, 2008, at 2:59:58
Posted by okydoky on June 26, 2008, at 10:44:51
In reply to Re: Opiates, oxycodone, posted by undopaminergic on June 25, 2008, at 2:59:58
The more I read about Memantime the more alluring for me it sounds. I think we have corresponded. I believe I found a doctor that will prescribe Subutex for me so I plan on trying to go from now 30-40mg bid Oxycontin to Subutex. And then perhaps adding Memantime to it. If the Subutex does not pan out perhaps adding the Memantime to the Oxycontin instead. For five years I have been fine with an average of 20mg bid and now I need at minimum 30mg at many days 40. I have a difficult time believing this is a tolerance issue. I think it is more likely pain increase. Hard for me to know for sure?I see a lot written on this site about Subutex or Suboxone at low doses for depression but nothing at higher doses? Of course that is not the primary reason I want to try it but it is in the mix. The Mementime would be kind of dual use for me also. Improving cognitive issues and now I am reading the tolerance stuff. I've got a perhaps short time span here when I am not on Lyrica and my brain is functioning better so I need to get off my *ss and get these things started else I won't be able to do it. I realize I can be a pain in the *ss and I apologize once again. I only have a brief interlude here where I am going to be able to function a bit to accomplish any changes so I need to take advantage. As always all input and help is abundantly appreciated.
oky
Posted by undopaminergic on June 27, 2008, at 17:36:33
In reply to Re: Opiates, oxycodone » undopaminergic, posted by okydoky on June 26, 2008, at 10:44:51
>
> I see a lot written on this site about Subutex or Suboxone at low doses for depression but nothing at higher doses? Of course that is not the primary reason I want to try it but it is in the mix.
>It appears that higer doses than about 4 mg of buprenorphine yield little additional benefit, except for more effective blockade of the actions of other opioids such as heroin - this is one of the reasons why it is used as substitution therapy for addicts. For depression and pain, in all cases I've seen described, there seems to be little reason to exceed 4 mg.
Posted by bottlecappie on June 29, 2008, at 0:39:19
In reply to Re: Opiates, oxycodone, posted by undopaminergic on June 27, 2008, at 17:36:33
I have been taking Suboxone for the past 8 months. Prior to that, I had suffered from treatment resistant double depression since my early teens (I'm mid-30's now). I also have chronic pain due to fibromyalgia, and I was addicted to oxy, morphine and dilaudid.
Suboxone is without a doubt the best antidepressant I've ever taken. Since I started sub, I've had the longest unbroken span of time without a depressive episode or decompensation.
I currently take 8mgs a day, in a split dose because I get the best analgesic effect that way. I've tapered down to this dose from 16mgs, and some days I get by on only 4mgs. The main difference I perceive between 4mgs and 8mgs is the amount of time my pain is controlled. It seems that even though buperenorphine binds to the opiate receptors for a really long time, the analgesic effect still wears off after 4-6 hours.
I disagree that there is no added benefit to the higher dose, just based on my personal experience. I definitely feel it when my afternoon dose kicks in, physically and mentally. It doesn't really get me high or anything, but it does make me feel better.
I really hope that more research on the antidepressant effects of buprenorphine will be done. My best friend suffered horribly from refractory depression and ptsd, and since she's been on suboxone she's like a new person. It's amazing, really.
Posted by Crotale on July 4, 2008, at 8:49:42
In reply to Re: Opiates, oxycodone, posted by undopaminergic on June 27, 2008, at 17:36:33
> It appears that higer doses than about 4 mg of buprenorphine yield little additional benefit, except for more effective blockade of the actions of other opioids such as heroin - this is one of the reasons why it is used as substitution therapy for addicts. For depression and pain, in all cases I've seen described, there seems to be little reason to exceed 4 mg.
I take approximately 0.2mg (0.7cc Buprenex). I would think a dose anywhere near 4mg would make me sick to my stomach! I can't imagine how anyone can tolerate such a high dose, other than drug addicts.
Posted by undopaminergic on July 4, 2008, at 12:09:06
In reply to Re: Opiates, oxycodone » undopaminergic, posted by Crotale on July 4, 2008, at 8:49:42
>
> I take approximately 0.2mg (0.7cc Buprenex). I would think a dose anywhere near 4mg would make me sick to my stomach! I can't imagine how anyone can tolerate such a high dose, other than drug addicts.
>I think you could easily reach 4 mg without nausea by raising the dose in small steps, as tolerated, over a few weeks or so.
Posted by Crotale on July 4, 2008, at 20:54:27
In reply to Re: Opiates, oxycodone, posted by undopaminergic on July 4, 2008, at 12:09:06
> I think you could easily reach 4 mg without nausea by raising the dose in small steps, as tolerated, over a few weeks or so.
But why *would* I???
-Crotale
Posted by undopaminergic on July 6, 2008, at 2:23:28
In reply to Re: Opiates, oxycodone » undopaminergic, posted by Crotale on July 4, 2008, at 20:54:27
> > I think you could easily reach 4 mg without nausea by raising the dose in small steps, as tolerated, over a few weeks or so.
>
> But why *would* I???
>
> -CrotaleI don't know, but maybe to attempt to determine the optimal dose?
Posted by blueboy on July 6, 2008, at 7:00:00
In reply to Opiates, oxycodone, posted by cactus on June 22, 2008, at 4:07:10
It's ironic, isn't it, that the most helpful drugs are addictive? I have a little bipolar problem, and the only thing that brings me relief during painful mixed states is clonazepam -- not as addictive as oxy, but 'tis enough, 'twill suffice. I'm also an alcoholic and like you I'm extremely careful.
I will say, I often wonder if some of the drug laws are not puritanical in nature rather than rational. Many of the commonly prescribed psychoactive drugs seem to me to be "addictive": one becomes increasingly tolerant as they are taken over time and so one needs higher doses, they make you feel better, and sudden discontinuation can cause very uncomfortable withdrawal symptoms.
I suppose one difference is that illegal or "scheduled" drugs (the US term for drugs that not only require a prescription, but have stricter criminal penalties for nonprescription use) are used for pleasure by people without a diagnosed illness.
(There are five levels of scheduled drugs. Heroin is Schedule 1, meaning that a doctor cannot prescribe it for any reason, and it can only be possessed for experimental purposes with a special license. Oxycodone is Schedule 2 (very strictly controlled), Clonazepam is Schedule 4.)
It seems rather silly, in some ways, that oxycodone cannot be prescribed to you for your lifetime, since it helps you so much. So what if you get "addicted"? That just means that you have to take it for the rest of your life.
My (layman's) understanding of opiates is that they have fairly mild long-term damage compared to a lot of drugs prescribed over a person's life. If heroin were discovered today, and administered over a period typically required by the FDA to find a medication safe, it would be approved.
Its deleterious effects , at least compared to other addictive recreational drugs like meth, cocaine, alcohol, etc., seem comparatively minor. In fact, as far as I can tell, heroin addiction is dangerous almost entirely because it is illegal. Overdose is uncommon unless it is taken with another drug, and the greatest dangers come from adulterants, ingestion problems (HIV, damage to blood vessels), and fluctuations in purity. In other words, most of the danger of heroin usage stems from its extreme illegality.
Long term, the problems associated with opiate use are less severe than a great number of drugs commonly taken over one's lifetime, including both legal recreational drugs (alcohol, tobacco, even sugar) and prescription drugs.
Assuming that oxycodone relieves your symptoms better than anything else, I'd be interested in a rational comparison of the damage it would do if taken over a long period, compared to other drugs you might take. Also, it would be interesting to see a profession cost/benefit analysis.
I have faced this problem myself. The only drug that has given me full relief from hypomanic and mixed states of Bipolar II is clonazepam, which is certainly habituating and arguably "addictive". It is, however, a controlled (scheduled) drug.
My thought is that, perhaps, an ongoing course of treatment from clonazepam in whatever amount is needed to control my symptoms would be as safe as, and more effective than, unscheduled prescription drugs that a doctor is much more willing to prescribe over a long duration.
This is especially interesting because, if a doctor in the US prescribed oxycodone for a long period of time to a person to treat a "psychological" condition, he would lose his license and be sent to prison.
(Oh well, who expects the government to make sense? Just look at the tax laws.)
Posted by undopaminergic on July 6, 2008, at 9:50:33
In reply to Re: Opiates, oxycodone, posted by blueboy on July 6, 2008, at 7:00:00
>
> This is especially interesting because, if a doctor in the US prescribed oxycodone for a long period of time to a person to treat a "psychological" condition, he would lose his license and be sent to prison.
>That's not true. There is nothing illegal about prescribing opiates for depression or other conditions where they are found useful. It's also being done, but not as often as it ought to.
Posted by Phillipa on July 6, 2008, at 18:53:37
In reply to Re: Opiates, oxycodone, posted by undopaminergic on July 6, 2008, at 9:50:33
I need to find that doc then as l percocet makes me happy and being old means I really don't care about addiction. Valium for over 37 years prescribed at the time 70's was not considered bad and it worked. I went on to raise my family, run a business, and be magna cum laude in nursing school. Also many times over the years I simply stopped the valium and felt fine. No withdrawl was on the same dose then as now. But benzos do not work any longer pdoc said keep me out of withdrawal and to continue them. It's kind of sad to me that the newer meds that docs use some are involved in lawsuits. Makes me wonder. Like the fact that both these classes of meds have been around for decades and no bad things have come out. This is just my opinion. Love Phillipa
Posted by blueboy on July 7, 2008, at 18:21:49
In reply to Re: Opiates, oxycodone, posted by undopaminergic on July 6, 2008, at 9:50:33
> >
> > This is especially interesting because, if a doctor in the US prescribed oxycodone for a long period of time to a person to treat a "psychological" condition, he would lose his license and be sent to prison.
> >
>
> That's not true. There is nothing illegal about prescribing opiates for depression or other conditions where they are found useful. It's also being done, but not as often as it ought to.I've reviewed some literature on the internet and it seems that I was wrong about this. My apologies.
Posted by cactus on July 8, 2008, at 3:03:38
In reply to Re: Opiates, oxycodone, posted by blueboy on July 7, 2008, at 18:21:49
it's the same in my country too, the only way to get it is if you are a know heroin user
Posted by okydoky on July 8, 2008, at 8:26:40
In reply to Re: Opiates, oxycodone, posted by undopaminergic on July 4, 2008, at 12:09:06
I am seeing this new doctor today and am told he will prescribe opiates if I provide evidence I am already on them or anything else for that matter. In that vein I am going specifically to ask him to prescribe Subutex. I know he prescribes it too but not sure about the DEA problem like I had with the previous doc. Even with the DEA letter he was too afraid. Anyway from every conversion thing I read that I could find and there were few, It looks like 3.6mg would be an equivalent dose. Of course at least as a [pill it does not come in this dose anyway. I read one is supposed to start with less than equivalent dose when changing pain meds. Any suggestions on how to "manipulate" the conversation with him to my advantage. (Him prescribing the Subutex) And suggestion as to starting dose? I plan on bringing a copy of the letter with me bu perhaps it would be better not to bring it up unless absolutely necessary? I want to ask him for something to sleep too. Perhaps it would be advisable to do one thing at a time and not bring that up today? Of course I will be influenced by his demeanor ect. Originally I wanted to try it because my urologist suggested it for pan and it was suggested on this site on theory that t*t might work better with Amineptine. I also thought it might help with any tolerance as I will be taking opiates probably the rest of my life. Recently I have had to increase my oxycontin use from 20mg bid to 30mg bid. The last month or so after about 5 years use. But in the last few weeks I had a lot of breakthrough pain and was very depressed and started snorting my 5mg ir oxys. The last week or so I started snorting 10 or 15mg at a time and not of pain necessity. I think it would be better if I left this information out today, although it might be usefull?
My appointment is at 1pm. I know this is last minute so no one might get to this before I go. It would be appreciated if anyone has the time.
Thanks,
oky
Posted by okydoky on July 8, 2008, at 14:21:36
In reply to Re: Opiates, oxycodone, posted by okydoky on July 8, 2008, at 8:26:40
I went to this new doctor and he said that I was pretty much a mess. He said he was willing to help me and had dealt with complex cases before and with interstitial cystitis but was insistent that I had to trust him an not further complicate things by not being compliant. Said it was ok to have input but... Then he prescribed methadone and said something about NMDA and long and short term pain relief was better with it.I am upset as I do not know him yet to trust him. I have been mistreated and treated poorly by several doctors in the past and have difficulty trusting anyway. I just met him! He said he did not prescribe Suboxone or Subutex and said it was not used for pain even while I told him it was. I was told by the person who suggested him that he did prescribe Suboxone so I am left to ponder.
What about Methadone for pain and it being better as far as my depression is affected?
oky
Posted by bottlecappie on July 8, 2008, at 16:23:29
In reply to Re: Methadone NMDA, posted by okydoky on July 8, 2008, at 14:21:36
It's my understanding that methadone is better for chronic pain than buprenorphine (active ingredient in subutex/suboxone). Subutex & suboxone are only approved in the US for treatment of opiate dependency.
If you are suffering a lot of chronic pain and also have breakthrough pain, subutex might not be a good choice for you because buperenorphine binds so tightly to opiate receptors that it basically renders all other opiate medications ineffective. So, if the subutex wasn't handling your pain, you'd be stuck.
There are some doctors who prescribe subutex/suboxone for pain, but it's my understanding that this is usually done in cases where addiction/dependency is also an issue. It's more difficult to abuse suboxone/subutex because buprenorphine has a ceiling effect.
I currently take suboxone for opiate dependency and it works wonderfully to supress withdrawals and the desire to use. It's a mediocre pain-reliever, in my opinion. It works well for my fibromyalgia but is not great for acute pain or headaches. I do believe it works well as an antidepressant, as that has been my experience, and I was able to discontinue Wellbutrin since I've been on suboxone.
I also took methadone in the past and found it to help with my depression and it was an extrememly effective pain reliever. It lasts for a long time and didn't produce the cravings associated with shorter-acting opiates. It is addictive, as all opiates are, so you might want to be aware of that.
Good luck, and I hope you'll be feeling better soon.
Posted by Sigismund on July 8, 2008, at 19:00:54
In reply to Re: Methadone NMDA, posted by bottlecappie on July 8, 2008, at 16:23:29
I wonder if any opiate (given a flattish blood level) will, once dependence is attained, be of very minimal use?
That said, the advantage of bupe as I understand it, is that there is less depression than with methadone and it is not so difficult to get off.
Certainly methadone is strong enough. But what this means in practice with once a day doseage is that you are affected (pain relief) for maybe weeks, and then you arrive at a steady state situation where you feel better for a few hours after your dose and that is it for the day.
More frequent doseage will not make this better. Blood levels will be flatter still, and therefore the incremental improvement will be extremely shortlived after a dose.
Of course there are worse things than being on methadone, like being in terrible pain. But I don't know how much pain relief you can expect long term.
What is the NMDA thing about?
Posted by okydoky on July 8, 2008, at 20:15:33
In reply to Re: Methadone NMDA, posted by bottlecappie on July 8, 2008, at 16:23:29
It was referenced for me about antidepressants but I cannot remember where. Here is one of many I found when searching psycho-babble not to do with me though: http://www.dr-bob.org/babble/neuro/20080204/msgs/820576.html
I just don't understand nor remember the information . I feel like a jerk.
oky
Posted by okydoky on July 8, 2008, at 20:36:39
In reply to Re: Methadone NMDA, posted by okydoky on July 8, 2008, at 20:15:33
I forgot to say the doctor had made mention of NMDA and kind of mumbled something about it and methadone and depression. Which is the reason I brought it into the conversation.
I know I make everything into a crisis. I just had been feeling quite hopeless and unrealistically had pinned everything on this one meeting with a doctor I had never met.
oky
Posted by garylee on July 10, 2008, at 13:57:42
In reply to Re: Methadone NMDA, posted by okydoky on July 8, 2008, at 20:36:39
> I forgot to say the doctor had made mention of NMDA and kind of mumbled something about it and methadone and depression. Which is the reason I brought it into the conversation.
>
> I know I make everything into a crisis. I just had been feeling quite hopeless and unrealistically had pinned everything on this one meeting with a doctor I had never met.
>
> oky
>Hi All
My brother has been taking Meth for about 7 years now for his depression. It gives him energy and he's able to get up and unction 'fairly' normally day to day. He hasn't changed his dose in the whole time of taking it, and I believe he only takes a tiny dose compared to Heroin users.
Unfortunatley he has to get it illegally as docs in the UK will not and cannot prescribe for Bipolar or depression of any kind, it's for Heroin addicts only and you have to visit a Drugs and Alcohol clinic for it.
I too have tried Meth, didn't do alot for me, I have a very high tolerance to all meds, have always seemed to have to take to highest doses to get any benefits. Subutex on the other hand almost brought me into remission, just on 4mg at night. I was a different person. It pooped out after a month or s though, and the consipation was terrible! I'd like to try Suboxone (with Naltrexone) next, see if the tolerance doesn't come into the equation...
Opiates should be an option for all Treament Resistant Depression, it's just the few that abuse it that ruin it for the rest of us. My 2 cents anyway...
Gary
Posted by okydoky on July 13, 2008, at 23:42:04
In reply to Re: Methadone NMDA, posted by garylee on July 10, 2008, at 13:57:42
I have tried Avinza (morphine) for three days now. Having been on oxycontin for years I cannot believe how much better I feel mentally on the Avinza. Several people are trying Subutex or Suboxone for depression or have been using it.
I have not found any published material comparing different opiates as antidepressants. It would be interesting to read and helpful most especially to those of us in need of pain meds anyway and useful for those of us with trd.
Does anyone know of any published materials? I found a bit about meth or morphine etc. but nothing comparing any of them. Or have any theories as to which one(s) might be most effective?
Posted by Sigismund on July 13, 2008, at 23:53:21
In reply to Opiates for depression what's best?, posted by okydoky on July 13, 2008, at 23:42:04
>I have tried Avinza (morphine) for three days now. Having been on oxycontin for years I cannot believe how much better I feel mentally on the Avinza.
Makes absolute sense to me.
The main drawback is the constipation.
Posted by okydoky on July 14, 2008, at 0:14:51
In reply to Re: Opiates for depression what's best? » okydoky, posted by Sigismund on July 13, 2008, at 23:53:21
Why does it make sense? I don't know yet if the constipation is any worse than I have on the oxycontin. Dealt fine on 40mg/day on 60 did not have it under control yet but I think I would have given time. Lots of fiber and some magnesium and drink a lot of fluids every day. I guess I will know soon enough:)
oky
Posted by okydoky on July 27, 2008, at 12:54:22
In reply to Re: Opiates for depression what's best? » okydoky, posted by Sigismund on July 13, 2008, at 23:53:21
Since you brought it up:)
I thought I could continue to keep the constipation under control but when I increased the oxycontin I never completely had a handle on it and it continues to be a problem on Avinza.
I thought perhaps the pain specialist I am to see on August 4th might have some answers but in the mean time any suggestions?
oky
Posted by Crotale on July 27, 2008, at 14:53:50
In reply to Re: The main drawback is the constipation » Sigismund, posted by okydoky on July 27, 2008, at 12:54:22
That's my experience with opioids also. The constipation and the itching. The latter can be dealt with using nondrowsy antihistamines like loratadine. (Benadryl has the potential to cause constipation, which is not what you want more of!)
Some high-fiber foods...well, there are some really tasty cereal bars out there. Also, stick to bread and pasta with whole-grain. Umm...there are really quite a few things you can eat, if you have the fortune to have an appetite :-}, that will help keep the constipation under control. Unfortunately, at least in my experience (been on buprenorphine for nearly 10 years), this side effect does *not* go away with time.
What dose Oxycontin are you on? What about the morphine? and why are you on both of those (if I may ask???)
-Crotale
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