Psycho-Babble Medication Thread 81414

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Looking into this

Posted by floatingbridge on October 23, 2011, at 14:12:00

In reply to Re: opiates and major depression » safire4hope, posted by floatingbridge on October 23, 2011, at 8:24:43

I found two doctors in my area that treat with bupeenephrine (sp) and suboxone for both chronic pain and TRD.

I am assuming there is no escalation factor. If there is, would someone be kind enough to let me know.

I am going to check this out. Pain just limits my world. Apparently, there are a number of people on this for chronic pain. Wish me luck. Any thing I should consider, please let me know.

 

Re: Looking into this

Posted by SLS on October 23, 2011, at 15:30:23

In reply to Looking into this, posted by floatingbridge on October 23, 2011, at 14:12:00

> I found two doctors in my area that treat with bupeenephrine (sp) and suboxone for both chronic pain and TRD.
>
> I am assuming there is no escalation factor. If there is, would someone be kind enough to let me know.
>
> I am going to check this out. Pain just limits my world. Apparently, there are a number of people on this for chronic pain. Wish me luck. Any thing I should consider, please let me know.


Go for it!


- Scott

 

Re: Looking into this

Posted by sigismund on October 24, 2011, at 5:25:28

In reply to Looking into this, posted by floatingbridge on October 23, 2011, at 14:12:00

>I am assuming there is no escalation factor. If there is, would someone be kind enough to let me know.

I've never taken it, but I assume you would need to have lowish expectations or there would need to be dose escalation.

But it would treat the pain, and the depression, and therefore seems to the point.

 

Re: Looking into this » sigismund

Posted by floatingbridge on October 24, 2011, at 10:01:55

In reply to Re: Looking into this, posted by sigismund on October 24, 2011, at 5:25:28

Sigi, what does lowish expectations mean?

So far I have read there are two doses made. One fairly low 2mg and that is what chronic pain patients (fibromyalgia) take. The other 8mg may be given for opoid dependency.

I don't know. I have been reading about it on a fibromyalgia forum. The person on it longest has been two plus years at her starting dose.

The half life is 36 hours, so discontinuation is said to be very attenuated and unpleasant (by some).

Maybe the opoid thing freaks me out. Though could it be worse than some meds I am on or have been?

 

Re: Looking into this » floatingbridge

Posted by sigismund on October 24, 2011, at 10:41:23

In reply to Re: Looking into this » sigismund, posted by floatingbridge on October 24, 2011, at 10:01:55

All opioid dependence is difficult, but bupe dependence is easier than some (methadone) I feel sure.

I meant by lowish expectations that tolerance would be enough to keep any opioid feeling fairly small, and you would have to accept that. But you know all that.

I was always uneasy with you working your way through the psych drugs. If there was sense in that feeling, perhaps it was that you were in pain and sick, rather than depressed? Don't know. Or just my prejudices?

If you go on it, you know there will be a protracted withdrawal syndrome should you come off it, but nothing like methadone. Compared to hydrocodone I could not say.

But at least it makes sense.

 

Re: Looking into this » sigismund

Posted by sigismund on October 24, 2011, at 10:53:59

In reply to Re: Looking into this » floatingbridge, posted by sigismund on October 24, 2011, at 10:41:23

You made a comment (on the politics board) about hydrocodone.

What was it?

Parcelling out the pain in batches? Not quite.

With methadone what you get is a couple of nice hours and then back to normal.

I assume the kappa antagonism (if that is right) avoids the slightly depressing quality that people on methadone experience. Maybe that is where the AD effect (if there is one) will come from?

Certainly my experience with methadone was that it was a zero sum game. Those few nice hours are what you have to pay back, or so I felt.

I was reading about some herb and fibromyalgia. What can it have been? I take curcumin. It is possible to find a dose of that which does not aggravate insomnia (I think). I can't remember what it was now.

As you said, it will be no more traumatic than some meds you have been on. Not in the least in fact, until you try to stop. And even then, not so bad.

 

Re: Looking into this

Posted by sigismund on October 24, 2011, at 11:27:38

In reply to Re: Looking into this » sigismund, posted by sigismund on October 24, 2011, at 10:53:59

That herb I was reading about would have been rehmannia.

 

Re: Looking into this » sigismund

Posted by floatingbridge on October 24, 2011, at 13:05:19

In reply to Re: Looking into this, posted by sigismund on October 24, 2011, at 11:27:38

Thanks, sigi. I think rehmannia, that is Chinese? I might be confusing it with rhodilia, which is maoi contradicted.

Yes, I think the kappa activity is the antidepressant quality. That is the sum depth of my knowledge.

So it would be more difficult to discontinue than hydrocodine?

I disliked how it set my pain clock. By the end of my use, it was every four-five hours, and I would be looking at my watch. I didn't really escalate past a certain point because more did not do more and made me very dumb. Plus I did not want to. I wanted to work within that ceiling. But the crap I took from doctors was humiliating at times.

Really, I found tramadol was superior for mood and pain.

I am still mulling this over. Gabapentin is just stupefying. My doc wanted me to take more. He still does. But I do not feel good past 900mg. But that stuff sets my pain clock, too. I don't think there is a way around that when using medication.

I took a hydrocodine two weeks ago. Five milligrams. It felt very freeing. It was easy to move, I felt peaceful, the world was tolerable. I decided to just enjoy the few hours and not try to make it last. I still have this crazy big bottle left from when I quit. I was having a crappy day and said f*ck it.


 

Re: Looking into this » floatingbridge

Posted by floatingbridge on October 24, 2011, at 14:42:18

In reply to Re: Looking into this » sigismund, posted by floatingbridge on October 24, 2011, at 13:05:19

sigi, oh, you said you could not say.

Sometimes I do not read things through very well the first time.

Oh well.

I imagine I would need to talk to a doctor and have all my questions written up ahead. (It's not so much my memory but my distractibility....)

 

Re: Looking into this » floatingbridge

Posted by sigismund on October 24, 2011, at 14:48:43

In reply to Re: Looking into this » sigismund, posted by floatingbridge on October 24, 2011, at 13:05:19

> It felt very freeing. It was easy to move, I felt peaceful, the world was tolerable.

That was exactly my attraction to opiates.

From what I read you would have a few horrible weeks withdrawing from bupe. But the intensity would depend on the dosage.

I took gabapentin (mainly 300mg/d) for a year or so without adverse effect beyond weight gain until the latest thing. But swelling of the feet is no good....you have to be able to walk. I'm suspicious of it now. And I liked it too. If you have a 14 hour flight, it is quite an escape to take 1200mg. Everything becomes so much more fun. I can even approach those in flight computer and my neighbours with some degree of calm. Not as good as hydrocodone of course. There was a time people talked to each other. Maybe that was when I was more attractive? I had a wonderful chat once to an American who lived in Bangkok and was reading Sodom and Gomorrah from Rememberence of Things Past in French. Now no one says a word.

Rehmannia is Chinese and may possibly have something to do with endogenous steroid production. At any rate it is used for adrenal insufficiency (I think) and autoimmune diseases and fibro. I was told that Tian Wang Bu Xin Wan (of which it is an ingredient) would extend my life, which I took to be their polite way of saying they didn't like my chances at that point.

 

Re: opiates and major depression » europerep

Posted by Chairman_MAO on October 24, 2011, at 20:55:46

In reply to Re: opiates and major depression » Chairman_MAO, posted by europerep on October 22, 2011, at 7:19:07


> They can have their careers destroyed regardless of whether they can rationally explain in front of an investigative panel the reasons for giving buprenorphine to TRD patients.

Yes, that is a huge problem and I reject the legitimacy of such panels.

>
> > It is very much like prescribing morphine or heroin.
>
> Not according to the people who have done research on this for years and years. I trust them more than internet people.
>


> > Risk to who? Overdose is difficult; TCAs are more dangerous.
>
> Ever heard of that pesky addiction thing? Buprenorphine is a drug with abuse potential, like all other opiates. (The hypocrisy about giving Adderall to anyone with ADHD but not giving buprenorphine to TRD patients is a different story.) I agree that a risk-benefit assessment for bupe in TRD can be positive, but buprenorphine is not Prozac.
>
>

You are so snarky I really don't know how to respond. "Abuse potential"? You mean something that someone wants to take? No, buprenorphine is not Prozac. It is a much better drug with greater efficacy which has not been documented to induce dysphoric mania leading to suicides.

Addiction? A vast majority of people that take narcotics do not develop an "addiction"--which in and of itself is a value judgement.

 

Re: opiates and major depression » Chairman_MAO

Posted by Chairman_MAO on October 24, 2011, at 21:01:29

In reply to Re: opiates and major depression » europerep, posted by Chairman_MAO on October 24, 2011, at 20:55:46

>
> (The hypocrisy about giving Adderall to anyone with ADHD but not giving buprenorphine to TRD patients is a different story.)

Actually, it's the same exact story. What about giving dextroamphetamine to someone with TRD? Everyone has a right to drugs, period.

 

Re: opiates and major depression » Chairman_MAO

Posted by europerep on October 25, 2011, at 12:31:38

In reply to Re: opiates and major depression » europerep, posted by Chairman_MAO on October 24, 2011, at 20:55:46

> You are so snarky I really don't know how to respond. "Abuse potential"? You mean something that someone wants to take? No, buprenorphine is not Prozac. It is a much better drug with greater efficacy which has not been documented to induce dysphoric mania leading to suicides.

Can you present any evidence for buprenorphine not having potentially severe side effects in psychiatric patients? I doubt it.

> Addiction? A vast majority of people that take narcotics do not develop an "addiction"--which in and of itself is a value judgement.

Addiction is a quite valid concept, and concern over it is absolutely warranted. Your "vast majority of people" is pretty vague by the way.

> Everyone has a right to drugs, period.

That's a valid opinion, however, there is this thing called "reality". In reality, you need good reasons for giving opioids to patients (including pain patients). That too is warranted.

I'm not sure whether we're not talking past each other. I have tried both buprenorphine and more "typical" opioids for my TRD, and I am thankful for the open-mindedness of my doctor who prescribed me the latter (the buprenorphine thing was a little more complicated, but that's not relevant here). So I totally think these substances have a place in psychiatry. However, *precisely because* they have a place in psychiatry, they should be used with care. Nothing is worse than a legislative backlash after some ill-informed journalist writes an article about opioid prescribing behaviors, which then makes the situation even worse for those patients in need of these drugs.

 

Looked into this » sigismund

Posted by floatingbridge on October 27, 2011, at 9:29:14

In reply to Re: Looking into this » floatingbridge, posted by sigismund on October 24, 2011, at 14:48:43

>Rehmannia is Chinese and may possibly have something to do with endogenous steroid production. At any rate it is used for adrenal insufficiency (I think) and autoimmune diseases and fibro. I was told that Tian Wang Bu Xin Wan (of which it is an ingredient) would extend my life, which I took to be their polite way of saying they didn't like my chances at that point.

This is a formula I think they always give me. I need to go back. I also need to see my osteopath. He is amazing. And he only does soft tissue manipulation. He doesn't sell anything. I appreciate that. The psyiatrist who was alarmed because I said tramadol had a nice mood effect tried selling me all sorts of sh*t.

Btw, I entered (anonymously) the database for suboxone treatment. I said for fibromyalgia and that I was not taking any opoids or narcotics. I get these email messages from doctors that say things like, I have read your application and would be happy to help you with your dependency issues. It's very silly.

 

Re: Looked into this » floatingbridge

Posted by sigismund on October 27, 2011, at 10:20:05

In reply to Looked into this » sigismund, posted by floatingbridge on October 27, 2011, at 9:29:14

You'd have to be careful they didn't want to whack you onto a high dose.

 

Re: Looked into this » sigismund

Posted by europerep on October 27, 2011, at 10:33:41

In reply to Re: Looked into this » floatingbridge, posted by sigismund on October 27, 2011, at 10:20:05

> You'd have to be careful they didn't want to whack you onto a high dose.

Good point. In fact, even the 2mg Subutex are actually designated for opiate replacement therapy. Buprenorphine against pain starts at 0.2mg (Temgesic), and there is also an 0.4mg formulation (Temgesic forte). This is over here at least. Buprenorphine for depression can be a little higher than that, but for some people a dose around 1 mg is perfect. The Subutex 2mg can be split though, so they may be of use nonetheless.

 

Re: Looked into this » europerep

Posted by floatingbridge on October 27, 2011, at 11:47:56

In reply to Re: Looked into this » sigismund, posted by europerep on October 27, 2011, at 10:33:41

As I read, I noticed that. I thought a 2mg starting dose would have some severe side-effects for me.

I have run into that name Temgesic here, so the States must have it.

The entire thing is on hold. I'm lucky to get gabapentin for pain at this point.

I have read two things. The first is there is supposed to be no escalation. The second, which I am not sure is true, it that I read instead of sensitizing the opoid receptors the active ingredient gives them a rest, or as one person put it, 'helps heal them'. I find this a little too good to be true myself.

Obviously, I don't know the scientific terms of this discussion....

 

Re: Looked into this

Posted by sigismund on October 27, 2011, at 21:27:33

In reply to Re: Looked into this » europerep, posted by floatingbridge on October 27, 2011, at 11:47:56

> I read instead of sensitizing the opoid receptors the active ingredient gives them a rest, or as one person put it, 'helps heal them'. I find this a little too good to be true myself.


Just more ideology. What is the score? I forget. It is a partial agonist, an inverse antagonist or what? Anyway, after a certain point, the more you take the less it works. So the mu opiate recptors can't be maxed out, if that is what is meant.

 

Re: Looked into this » sigismund

Posted by floatingbridge on October 27, 2011, at 22:00:45

In reply to Re: Looked into this, posted by sigismund on October 27, 2011, at 21:27:33

>just more ideology

Yes, of course. Frankly, if that were the case, it should be put in the water like floride.

I really have no idea what it's about. You know much more than I do.

There is something about the way the chemical binds to the mu receptors--very tightly, so it knocks everything else out of the way. That is not the naloxone or whatever, it's the Bupe that does this.

 

Re: Looked into this

Posted by sigismund on October 28, 2011, at 3:45:10

In reply to Re: Looked into this » sigismund, posted by floatingbridge on October 27, 2011, at 22:00:45

> Frankly, if that were the case, it should be put in the water like floride.

You make me laugh.

There this stuff about two things minimalising tolerance

1. memantine
2. That opiate antagonist thing that I have forgotten. often put in with bupe so if you inject it nothing happens in spite of the venotoxicity.

 

Re: opiates and major depression

Posted by alchemy on October 31, 2011, at 19:54:54

In reply to opiates and major depression, posted by androog on October 16, 2001, at 16:49:58

> I have suffered from depression for over 30 years and have tried about every antidepressant on the market to no avail. I've even had 17 sessions of ECT which left me with nothing more than a bad memory and a huge bill.

Tears are flowing with hearing about the 30 years of depression. I am about to turn 39 and I am almost at 30 years at well. I've had ECT, TMS, and meds galore. To be so close to 40 with no progression in any area, because it's a challenge to get through the day.

I support opiates being used for depression at a certain point. You definitely have reached that point.

I didn't feel anything from Percocet. Doesn't that have some opiate in it?

 

Re: opiates and major depression » europerep

Posted by Chairman_MAO on October 31, 2011, at 20:59:05

In reply to Re: opiates and major depression » Chairman_MAO, posted by europerep on October 25, 2011, at 12:31:38

> > You are so snarky I really don't know how to respond. "Abuse potential"? You mean something that someone wants to take? No, buprenorphine is not Prozac. It is a much better drug with greater efficacy which has not been documented to induce dysphoric mania leading to suicides.
>
> Can you present any evidence for buprenorphine not having potentially severe side effects in psychiatric patients? I doubt it.
>
Which "side effects" (in pharmacology, there are only effect, "side effect" is a value judgement) would these be exactly? How am I supposed to prove a negative?

> > Addiction? A vast majority of people that take narcotics do not develop an "addiction"--which in and of itself is a value judgement.
>
> Addiction is a quite valid concept, and concern over it is absolutely warranted. Your "vast majority of people" is pretty vague by the way.
>
http://peele.net/lib/moa3.html
http://www.globalizationofaddiction.ca/

Two internationally recognized authorities. Enjoy.

> > Everyone has a right to drugs, period.
>
> That's a valid opinion, however, there is this thing called "reality". In reality, you need good reasons for giving opioids to patients (including pain patients). That too is warranted.
>
No, really, in reality there is thing called the "constitution", and with decisions such as Roe v. Wade and the abolition of slavery, I own my body. I decide what goes in it. If I am not harming anyone, leave me alone. If I harm someone, then punish me.

> I'm not sure whether we're not talking past each other. I have tried both buprenorphine and more "typical" opioids for my TRD, and I am thankful for the open-mindedness of my doctor who prescribed me the latter (the buprenorphine thing was a little more complicated, but that's not relevant here). So I totally think these substances have a place in psychiatry. However, *precisely because* they have a place in psychiatry, they should be used with care.

All drugs should be used with care. The brute fact is that we know more about the long-term effects of opioid use than we do about SSRIs. They are generally benign.

> Nothing is worse than a legislative backlash after some ill-informed journalist writes an article about opioid prescribing behaviors, which then makes the situation even worse for those patients in need of these drugs.

Yeah, which is why we should be protected from these idiot legislators and our right to drugs restored.

 

Re: opiates and major depression » alchemy

Posted by floatingbridge on November 1, 2011, at 0:41:16

In reply to Re: opiates and major depression, posted by alchemy on October 31, 2011, at 19:54:54

Hi Alchemy,

I'm not sure. Yes, percocet is opiate based. Suboxone has buprenorphine which is semi-synthetic, so I think it works as a partial agonist. It may have other qualities too, that set it apart from an regular opiate. Maybe someone can comment on this.

I have heard that some people are not opiate responders. I don't know what that means regarding suboxone response or if your experience with percocet falls within that category.

I certainly am sorry you have endured depression this long.

Hugs to you.

 

Re: opiates and major depression

Posted by CaptainAmerica1967 on November 1, 2011, at 4:48:31

In reply to Re: opiates and major depression, posted by alchemy on October 31, 2011, at 19:54:54

> > I have suffered from depression for over 30 years and have tried about every antidepressant on the market to no avail. I've even had 17 sessions of ECT which left me with nothing more than a bad memory and a huge bill.
>
> Tears are flowing with hearing about the 30 years of depression. I am about to turn 39 and I am almost at 30 years at well. I've had ECT, TMS, and meds galore. To be so close to 40 with no progression in any area, because it's a challenge to get through the day.
>
> I support opiates being used for depression at a certain point. You definitely have reached that point.
>
> I didn't feel anything from Percocet. Doesn't that have some opiate in it?

You're lifelong history sounds similar to mine possibly; over 100 medications (labeled and off labeled, some non-FDA or UK approved meds) in my lifetime since this dreadful disease started when I was 16y/o and am currently 44y/o equals 28 years but feels like more as I used to use sleep deprivation two to three nights in a row a week while on Nardil by being on a super high dose (increases cortisol too) but as soon as I got any amount of REM sleep, back to the TRD ( I also have REM sleep disorder-muscles aren't paralyzed during REM sleep and like most depressed patients, fall into REM sleep too quickly-shortened REM latency, but the sleep deprivation made me feel completely normal for those days except being sleepy (my brain had to have calmed down from overactivity without recharging via REM sleep deprivation-same theory with Deep Brain Stimulation now that all depressed patients have overactive brain area's as shown on PET and SPECT SCANs and only with remission of depression does the brain calm down to being normal-instead of overactivity of blood flow/uptake of glucose; DBS by constantly stimulating certain areas of the brain like stimulants calm the ADHD patient, calm the overactive TRD patient's brain but after 15 years of sleep deprivation and several close calls of being in an accident, I gave it up.

The 70 ECT at the age of 18-19y/o in 1985-1986 didn't have any positive effect or help and I developed REM sleep disorder/behavior after all of the ECTS, but don't know if it caused it.

I haven't been on psycho-babble for awhile until several weeks ago when I mentioned the positive effect buprenorphine for the refractory depressed patient, particularly the only kappa opioid antagonist in use and in my belief from readiing and in the minds of some other physicians, psychiatric researchers, believe that this is the reason behind bup (Subutex's) success with severe, chronic, daily treatment resistant depression even with anxiety. Bup calms the brain by blocking kappa receptors that seem to be overactive as stated by Richard Greer, M.D. of NAABT. Several pharmaceuticals being worked on as kappa opioid antagonist.

If you've been depressed that long like me, I'm willing to try almost anything that isn't going to kill me or severely damage me in any way. You'll take an antidepressant the rest of your life of some form so physicians or the FDA that get upset with psychiatrists that RX buprenorphine for depression is wrong. Would they rather you kill yourself or not have an active or productive live just because there's a potential for addiction with buprenorphine but a lot less than other opioids. I've tried tramadol and it didn't do much and morphine in the ER which made me feel better but not better like buprenorphine.

I'm surprised you tried TMS after having had ECT (unless you tried TMS first)as most psychiatrist or the ones I've spoken to like Ivan Goldberg, M.D. (Depression Central website) who only treats the toughest of all patients, says he tells his patient not to waste their money on TMS if they've already had ECT and ECT didn't help. Remember, some psychiatrist are business professionals too wanting to make tons of money and if they have spent money on a TMS machine/device (very expensive) and you walk into their office and tell them you've already tried ECT, they might say I think you stil should try the TMS device when I think it would be a waste of money.

My goal is finish my medical autobiography with tips that psychiatrist never mention including physical exercise, cold water-shower-bath therapy, sleep deprivation and some others and my whole experience and thoughts about the disease in a way to prevent suicide in the future as suicide (not all suicides from depression, but many are) according to the World Health Organization thinks it likely that suicide will be the number 2 killer second only to heart disease by the year 2020. Many suicides aren't reported and that's why it's not ranked higher currently, but that will change in the near future.

Best wishes in trying buprenorphine-Subutex if you plan to try it. 1995 Harvard Study by Bodkin and currently a clinicaltrials.org is studying the effects of bup in late life TRD (BUILD study?).

I'm waiting for a DBS study even though I've tried to get into two but was excluded because I had several seizure on 1000 mgs of trazodone or medication induced seizure, but will without that part out and that I had 70 ECT as the same psychiatrist did both and will always get excluded from a study as they want no other history of any neurological problems whether drug induced or having an actual disease.

 

Re: opiates and major depression » CaptainAmerica1967

Posted by SLS on November 1, 2011, at 5:40:40

In reply to Re: opiates and major depression, posted by CaptainAmerica1967 on November 1, 2011, at 4:48:31

Hi.

> Best wishes in trying buprenorphine-Subutex if you plan to try it. 1995 Harvard Study by Bodkin and currently a clinicaltrials.org is studying the effects of bup in late life TRD (BUILD study?)


Would you be able to post a link to the study?

Thanks.

I am hoping that I won't need buprenorphine, but I guess I should start working on my doctor now to try to get him to change his mind. He doesn't want to use it on me.


- Scott


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