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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by g_g_g_unit on November 16, 2013, at 0:40:16
Hi,
I was wondering what peoples' opinions were on buprenorphine as a treatment-option for anxiety/OCD and depression?
How do I find a physician (particularly in Australia) who might consider the idea?
Posted by doxogenic boy on November 16, 2013, at 8:51:51
In reply to buprenorphine, posted by g_g_g_unit on November 16, 2013, at 0:40:16
> I was wondering what peoples' opinions were on buprenorphine as a treatment-option for anxiety/OCD and depression?
I used buprenorphine for treatment resistant depression in 2004. It worked wonders for a few months - my depression was gone, when it stopped working, I used morphine for a short time with little effect. After that I was in a living hell of severe anxiety and depression for five years. I am sure it was the buprenorphine that caused this, because I used morphine for a short time. The lacking effect of morphine was probably due to cross tolerance. http://en.wikipedia.org/wiki/Cross-tolerance
Later in 2004 I had a voluntary stay in a mental hospital. On a leave from the hospital I tried to commit suicide with 1200 mg morphine. After this, I was treated with ECT. None of this had happened if I hadn't used buprenorpine (and morphine). But when buprenorphine worked, it was among the best days of my life.
- doxogenic
Posted by g_g_g_unit on November 16, 2013, at 9:24:42
In reply to Re: buprenorphine » g_g_g_unit, posted by doxogenic boy on November 16, 2013, at 8:51:51
Wow, that's awful doxogenic boy. Thanks for sharing.
So you believe you were in a protracted state of withdrawal for 5 years? What led your doctor to prescribe buprenorphine in the first place?
I have read that combining buprenorphine with low-dose naltrexone will block the mu-agonism and isolate the kappa-antagonism, which is what I'm interested in. That might eliminate some of the side-effects and addiction potential. Of course, getting a doctor to prescribe buprenorphine at all is another matter.
I have searched the Australian directory of psychiatrists for those who treat anxiety AND substance abuse and who are listed as having experience in opiate agonists. Would emailing them be the best bet?
Posted by phidippus on November 16, 2013, at 14:04:32
In reply to buprenorphine, posted by g_g_g_unit on November 16, 2013, at 0:40:16
GET ON AN SSRI AND THEM MESS WITH THIS STUFF.
Buprenorphine is highly addictive and in my experience provides little to no relief for OCD symptoms. I find oxycodone works better.
Eric
Posted by doxogenic boy on November 16, 2013, at 17:57:49
In reply to Re: buprenorphine » doxogenic boy, posted by g_g_g_unit on November 16, 2013, at 9:24:42
>So you believe you were in a protracted state of withdrawal for 5 years?
The condition may have become self-sustained after some time, but I am sure that buprenorphine caused it. I have never had so extreme and constant anxiety and severe depression before for so long time. (I have been depressed and had GAD (and OCD) many for years before this, but not to this extreme extent.)
See also this message:
http://www.dr-bob.org/babble/20070219/msgs/734560.html
Quote
"I don't think anything can compare with the black depression that can arise when the opiates fail. It could be three months. Three years. Maybe never, if you're lucky. But the body eventually can't function with them, and you go into withdrawal, even when on a stable dose. At least I can say it happens, because it happened to me."
End quote> What led your doctor to prescribe buprenorphine in the first place?
I had tried "everything", and I was desperate. I showed him information from the net, such as this:
https://web.archive.org/web/20100505195605/http://balder.prohosting.com/~adhpage/bupe.htmlI have tried Xyrem too, with no antidepressant effect.
>I have read that combining buprenorphine with low-dose naltrexone will block the mu-agonism and isolate the kappa-antagonism, which is what I'm interested in. That might eliminate some of the side-effects and addiction potential. Of course, getting a doctor to prescribe buprenorphine at all is another matter.
It was mentioned something about a combo with buprenorpine in a post recently.
http://www.dr-bob.org/babble/20130930/msgs/1052097.html
Quote:
"ALKS 5461/ Samidorphan-Buprenorphine combo - fast tracked for MDD. Seems fairly novel, a combo of μ-opioid antagonist and mu agonist."
End quote.>I have searched the Australian directory of psychiatrists for those who treat anxiety AND substance abuse and who are listed as having experience in opiate agonists. Would emailing them be the best bet?
I don't know, I live in Norway. But email is good for such purposes, I have got answers from politicians in the Norwegian parliament via email.
- doxogenic
Posted by g_g_g_unit on November 16, 2013, at 23:07:08
In reply to Re: buprenorphine, posted by phidippus on November 16, 2013, at 14:04:32
> GET ON AN SSRI AND THEM MESS WITH THIS STUFF.
Right, because I've never tried SSRIs before. In fact, I'm on one as we speak.
>
> Buprenorphine is highly addictive and in my experience provides little to no relief for OCD symptoms. I find oxycodone works better.
>
> EricThanks for the input.
Posted by europerep on November 17, 2013, at 5:19:33
In reply to Re: buprenorphine, posted by phidippus on November 16, 2013, at 14:04:32
Suggesting oxycodone instead of buprenorphine, because buprenorphine has an addictive potential, must be a joke. Oxycodone has a far bigger abuse potential, is more addictive and on top of that is more dangerous in an overdose.
I've taken buprenorphine, and when I realized it didn't work for me even at moderately high doses, I slowly tapered off of it and then stopped taking it. Tapering off of buprenorphine was easier than venlafaxine, and not because I was one of those horror cases of venlafaxine discontinuation syndrome. Going off of venlafaxine was relatively easy, buprenorphine was even easier.
Of course this cannot be generalized, and there are indeed a very small number of people who take buprenorphine (usually for opiate addiction) and who find it extremely hard to get off of it. But, if a trial of buprenorphine in depression is warranted (by symptom severity and lack of success with other drugs), the risk of addiction is, in my opinion, a manageable risk.
Posted by phidippus on November 17, 2013, at 18:19:16
In reply to Re: buprenorphine » phidippus, posted by g_g_g_unit on November 16, 2013, at 23:07:08
>Right, because I've never tried SSRIs before.
Have you tried at least 3?
Bottom line is you have to keep trying ADs because low seratonin is key in OCD disfunction. You could also try high dose Tramadol.
>In fact, I'm on one as we speak.
Cool! Which one?
Eric
Posted by g_g_g_unit on November 20, 2013, at 21:13:20
In reply to Re: buprenorphine » g_g_g_unit, posted by phidippus on November 17, 2013, at 18:19:16
> >Right, because I've never tried SSRIs before.
>
> Have you tried at least 3?Yeah .. Prozac, Zoloft, Lexapro and Luvox.
>
> Bottom line is you have to keep trying ADs because low seratonin is key in OCD disfunction. You could also try high dose Tramadol.
>
> >In fact, I'm on one as we speak.
>
> Cool! Which one?
>Well, it's not technically an SSRI, and wasn't my choice, but Cymbalta. I'm finding it far too activating though.
Posted by phidippus on November 21, 2013, at 17:34:13
In reply to Re: buprenorphine » phidippus, posted by g_g_g_unit on November 20, 2013, at 21:13:20
How long have you bee on Cymbalta? How is it too activating? Remember, you tend to get revved up when you get on a new med.
Eric
Posted by g_g_g_unit on November 21, 2013, at 21:25:24
In reply to Re: buprenorphine » g_g_g_unit, posted by phidippus on November 21, 2013, at 17:34:13
> How long have you bee on Cymbalta? How is it too activating? Remember, you tend to get revved up when you get on a new med.
>
> EricAbout a week. I can deal with feeling anxious, but I'm having a lot of trouble sitting still, which I hate. I've tried adding it propanolol (up to 40mg as needed, but it feels like weak sauce).
Posted by phidippus on November 22, 2013, at 14:22:05
In reply to Re: buprenorphine » phidippus, posted by g_g_g_unit on November 21, 2013, at 21:25:24
40 mg is a relatively low dose of Propanalol for the purposes of treating AD induced akathisia. I'd recommend 80 mg a day.
What are you thinking about when you become restless?
Eric
Posted by g_g_g_unit on November 23, 2013, at 6:59:00
In reply to Re: buprenorphine » g_g_g_unit, posted by phidippus on November 22, 2013, at 14:22:05
> 40 mg is a relatively low dose of Propanalol for the purposes of treating AD induced akathisia. I'd recommend 80 mg a day.
>
> What are you thinking about when you become restless?
>
> EricActually, I've been using antihistamines consistently as a sleep aid over the past year and
finally decided to discontinue them (due to oversleeping, weight gain, irritability). I neglected to take a Cymbalta dose the past few days and the same symptoms are present, as well as nausea and itchiness .. so it might be antihistamine withdrawal. I'll add the Cymbalta back in once things have settled.I don't know if any thoughts specifically accompany the restlessness .. I just feel physically uncomfortable, grind my teeth/clench my jaw, feel more of an urge to do stuff with my hands like play with my cellphone etc. It's like a bad caffeine trip.
This is the end of the thread.
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