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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 25 to 49 of 63. Go back in thread:
Posted by rxnurse on November 24, 2003, at 17:29:45
In reply to Re: Boy~Do I miss Vicodin!, posted by bsj on November 24, 2003, at 17:06:27
I'm sorry that my opinion upset you. I am not a physician, and do not make medical diagnoses nor give medical advice. I am a concerned health care professional and an ER nurse who has seen multiple intoxications and overdoses resulting from prescription opiates. I do not preach nor advocate abstinence from alcohol or drugs, that would make me a hippocrate. However, when I read the messages on this site and the overwhelming negative effects of substance abuse, I feel somewhat compelled to voice my opinion. It is one opinion out of many!!! Opiates can do wonders for those in need, to say the least! They are also very powerful chemicals that create a false sense of well-being, and this is what may or may not lead to dependence in certain individuals: certainly not everyone who uses them!!!! In short, I care about the members of our society and would like to share my thoughts and opinions on what may be dangerous: this website is the appropriate forum. If ignorance is bliss, what is an education????
Posted by krazybirdlady on November 24, 2003, at 19:32:38
In reply to Re: Boy~Do I miss Vicodin!, posted by rxnurse on November 24, 2003, at 17:29:45
well said rxnurse...maybe education is acknowledging things that we don't want to acknowledge....facts are facts and these drugs can be very dangerous. To everyone who uses them? no, of course not..they are a godsend to some people. but with every drug that makes us feel better lies the potential for abuse, and all the ugly things that go with the word "abuse". you are right that this forum is for opinions and personal experience. whether you agree or don't agree with the poster, we should at least put forth opinions diplomatically.
Posted by rxnurse on November 24, 2003, at 21:21:22
In reply to Re: Boy~Do I miss Vicodin!, posted by krazybirdlady on November 24, 2003, at 19:32:38
Thanks for the support!
Did you mention earlier that you are a pharmacist? How is it that people are able to refill controlled substances without the DEA catching on? Is that true just for triplicate prscriptions? I know with those a copy goes directly to the DEA and they keep track on the number of times a schedule-II substance is given, and the prescribing physician.
Posted by bsj on November 24, 2003, at 21:39:25
In reply to Re: Boy~Do I miss Vicodin!, posted by krazybirdlady on November 24, 2003, at 17:29:19
I don't go to parties. I just recently got my life back, and I work like a fiend. I have a lot to catch up on, and I don't know how long this will last.
But I think there's a de Quincy quote that's appropriate here: "...nobody will laugh long who deals much with opium; its pleasures even are of a grave and solemn complexion; and, in his happiest state, the opium-eater cannot present himself in the character of L'Allegro; even then, he speaks and thinks as becomes Il Penseroso."
Il Penseroso indeed.
As for opiates inducing a "false" sense of well-being: what of SSRIs, TCAs and other politically acceptable depression treatments? Why heavens no! They only make the depressed person feel like himself again, it's said--which is exactly what hydrocodone does for me. Whatever good feelings it brings are, on the contrary, not fake but quite natural and real; it's the constant agony of depression that's truly fake--the drug merely banishes that agony to a corner of my mind where I can let it sit and have its way on occasion; as opposed to its controlling my every waking hour.
Posted by rxnurse on November 24, 2003, at 22:55:22
In reply to Re: Boy~Do I miss Vicodin!, posted by bsj on November 24, 2003, at 21:39:25
You seem convinced your self medication regimine is working for you. I guess you are lucky you have found something that works for your depression. You are the only one who truly knows what you need to feel better and function.
As far as the efficacy of "politically acceptable" antidepressants goes, they do not produce a "high" nor false sense of well-being. They reduce the re-uptake of circulating serotonin, and to a lesser degree norepinephrine. SSRI's and the like restore the amount of neurochemicals in depressed people to the levels of people who do not demonstrate depressive symptoms. This effect does not take an hour but weeks of daily use. Opiates have no affinity for these chemicals, but for opioid or mu receptors in the central nervous system. There is not nor will ever be a comparison clinically between opiates and antidepressants. Opiates are a central nervous system depressant. Opiate withdrawl can kill people, not withdrawl from Prozac. People do not lie, cheat, and steal for antidepressants.
Have you discussed your findings with your physician? I am curious what their opinion on the subject is????
Posted by Dr. Bob on November 24, 2003, at 23:49:11
In reply to Re: Boy~Do I miss Vicodin!, posted by bsj on November 24, 2003, at 17:06:27
> What kind of fear-mongering nonsense is this?
> there are too many persons like yourself who have nothing to offer but fear
>
> Your overbroad generalization of "...ultimately you will pay dearly in the end" is what evoked my ire; it's the very same deterministic garbage put out by AA.> Hers is an attitude I see all too often; and frankly, I'm tired of it. it's just BS I'm scooping out of the way.
Different points of view are fine, and in fact encouraged, but please don't post anything that could lead others to feel accused or put down, thanks.
Bob
PS: Follow-ups regarding posting policies, and complaints about posts, should be redirected to Psycho-Babble Administration; otherwise, they may be deleted.
Posted by bsj on November 25, 2003, at 2:30:13
In reply to Re: Boy~Do I miss Vicodin!, posted by rxnurse on November 24, 2003, at 22:55:22
"As far as the efficacy of 'politically acceptable' antidepressants goes, they do not
produce a "high" nor false sense of well-being. They reduce the re-uptake of circulating
serotonin, and to a lesser degree norepinephrine. SSRI's and the like restore the amount
of neurochemicals in depressed people to the levels of people who do not demonstrate
depressive symptoms. This effect does not take an hour but weeks of daily use. Opiates
have no affinity for these chemicals, but for opioid or mu receptors in the central
nervous system. There is not nor will ever be a comparison clinically between opiates and
antidepressants."That's the party line; do you write ads for drug-makers, by any chance?
But you completely ignore the likelihood that some with depression suffer from manfulction of
the endogenous opioid systems. It would be _astounding_ if these systems alone were immunue
to dysfunction. SSRIs and the like wouldn't do squat for these people; and right now
the only treatments available are opiates. They're crude drugs, to be sure, but
there's no alternative. The serotonin and dopamine theories of depression are hot in
acadamia right now; so there won't be many people researching alternative drugs. It
would be nice to see someone working on an antidepressant derived from morphine or some
other opiate; but I'm not holding my breath. I really don't like the fact that I have
to choke down hydrocodone pills twice a day or I spend all my time staring at the ceiling
and thinking about killing myself.But as for mainstream antidepressants: I guess you missed that study in the BRITISH JOURNAL OF PSYCHIATRY where it was shown that, on the whole, ADs and placebos perform on a comparable level; something like 80% of the response to ADs are attributable to the placebo effect. OUCH. Mainstream ADs are third-rate psychotropics; they're like psychic powers: they work largely when you BELIEVE. (What was all that stuff about
reducing the re-uptake of circulating serotonin?)"Opiates are a central nervous system depressant."
In textbooks from the 1950s they are; but today, it's apparent that they're far more than
that. Opiates have a lot of actions that are poorly understood or not understood at all.
To fit them into the neat "central nervous system depressant" box shows your ignorance."Opiate withdrawl can kill people"
Not otherwise healthy people.
"...not withdrawl from Prozac."
I don't know; it wouldn't surprise me if there were deaths associated with withdrawal
from Paxil or Effexor. Withdrawal from the former was the worst two weeks of
my life.
Posted by bsj on November 25, 2003, at 2:31:53
In reply to Re: please be civil » bsj, posted by Dr. Bob on November 24, 2003, at 23:49:11
All right; I'll play nice. But I hate misinformation and the casual disregard--or worse, accusation--that some have for those in pain.
Posted by krazybirdlady on November 25, 2003, at 14:00:02
In reply to Re: Boy~Do I miss Vicodin! » krazybirdlady, posted by rxnurse on November 24, 2003, at 21:21:22
rxnurse....i am in Canada so different regulations apply. but yes, we have a drug monitoring system in place. it is very hard, however, to monitor all the information. it is usually only a DR. that constantly prescribes certain drugs to many, many patients that raises a red flag. that is why so many DR's are reluctant to prescribe opiates on an ongoing basis. however, even at that, certain conditions DO require that they do so. see how hard it is? most people who are becoming trully dependant turn to the streets eventually, as they are given no choice.
Posted by bsj on November 25, 2003, at 14:46:50
In reply to Re: Boy~Do I miss Vicodin! » rxnurse, posted by krazybirdlady on November 25, 2003, at 14:00:02
"most people who are becoming trully dependant turn to the streets eventually, as they are given no choice."
Absolutely true. I recently left a doctor after being told he would never prescribe hydrocodone or any other opiate for depression. He wanted me to have ECT--which I've _already_ had, three and half years ago. I was ok while in the hospital during the treatment, but within a week of going back home, it was the same old thing again. My doctor at the time told me that I'd likely need followups for the rest of my life; so instead, he put me on Adderall (which worked great before I started having panic attacks).
The gray and black markets for pills aren't the cheapest source of hydrocodone ($200-$300 for 60 pills), but there's a steady supply and no alternative. I'd love to find a doctor who'd put me on hydrocodone and keep me on it, but that's not a realistic short-term goal. I hold the hope that they exist, but I have no idea who they are or where they're at.
Posted by rxnurse on November 25, 2003, at 20:20:31
In reply to Re: Boy~Do I miss Vicodin!, posted by bsj on November 25, 2003, at 14:46:50
Your anger and resentment is really overwhelming. You don't need to prove anything to me, I've heard it all before. Like I said earlier, I am not a physician nor a pharmacist. I share my knowledge which is based on clinical experience, personal experience, and from years of reading textbooks. Projecting your frustration on me lacks merit and is really very sad. If your medication regime is working for you, go for it. I spoke with a psychiatrist at work today about this issue, she just laughed.
Posted by krazybirdlady on November 25, 2003, at 21:07:29
In reply to Re: Boy~Do I miss Vicodin!, posted by bsj on November 25, 2003, at 14:46:50
bsj, i am sorry but i don't know ANY doctor, anywhere who would prescribe oxycodone for depression. this is not because they are afraid to, but because it's not in your best interest. that is their job, to look out for your best interest. my job is to make sure that you are following your prescription, and not refilling it to frequently (if it has refills). i am aware that it is alleviating your pain, but your pain may take ever increasing quantities to bring under control. and as rxnurse stated, and she is correct...opiate withdrawl CAN kill you. if you choose this medication anyway, fine. it is your life. just don't twist the facts to tout your own cause.
Posted by bsj on November 25, 2003, at 21:54:24
In reply to Re: Boy~Do I miss Vicodin!, posted by krazybirdlady on November 25, 2003, at 21:07:29
I've been through every kind of antidepressant known to man over the last five years. FIVE YEARS of my life have been more or less wasted. Yes, I'm thorughly pissed off at the charlatans who claimed they could help me. And I'm fully right to be pissed off. I have very little faith left in pyschiarty.
Someone in my situation has only a small number of options. I chose to get off my ass and try to help myself. Of course hydrocodone will fail me eventually--everything eventually fails; but for now, it works, and that's all that matters.
Posted by bsj on November 25, 2003, at 22:12:08
In reply to Re: Boy~Do I miss Vicodin!, posted by rxnurse on November 25, 2003, at 20:20:31
Ask your psych buddy what she does with severe refractory cases (besides pawning them off on someone else, as most seem to do). I'd be _very_ interested in hearing her answer (esp. when ECT hasn't worked and stimulants are contraindicated).
Posted by krazybirdlady on November 25, 2003, at 23:22:27
In reply to Re: Boy~Do I miss Vicodin!, posted by bsj on November 25, 2003, at 21:54:24
bsj..yes i see your excasperation. you are getting relief now...and that's all that matters at this point. are you willing to look down the road, however, and see the pitfalls? you could either be more depressed than you have ever thought you could be, or taking far too much of this drug and realizing that you have to find an off-ramp...
Posted by bsj on November 25, 2003, at 23:43:28
In reply to Re: Boy~Do I miss Vicodin!, posted by krazybirdlady on November 25, 2003, at 23:22:27
"are you willing to look down the road, however, and see the pitfalls? you could either be more depressed than you have ever thought you could be, or taking far too much of this drug and realizing that you have to find an off-ramp..."
I've pretty much accepted that suicide is in my future. One day, the medication will stop working and something will lay me so low that I'll do it; it's just a matter of time. I've had close calls before. If that seems bleak, I guess it is, but it's a reasonable conclusion. Sometimes I want so badly just to go to sleep and not wake up.
Posted by Dr. Bob on November 26, 2003, at 0:00:25
In reply to Re: please be civil, posted by bsj on November 25, 2003, at 2:31:53
Posted by krazybirdlady on November 26, 2003, at 0:05:37
In reply to Re: Boy~Do I miss Vicodin!, posted by bsj on November 25, 2003, at 23:43:28
i think you are smarter than to use a "self fulfilling prophecy". if i might ask (and if it's none of my business, that's fine), how old are you? how long with the depression? relationships? exhausted all other avenues? (honestly}...
Posted by Dr. Bob on November 26, 2003, at 0:07:16
In reply to Re: Boy~Do I miss Vicodin!, posted by bsj on November 25, 2003, at 21:54:24
> I chose to get off my *ss and try to help myself.
Hi again, please don't use language that could offend others, either. Thanks,
Bob
Posted by bsj on November 26, 2003, at 0:24:43
In reply to Re: Boy~Do I miss Vicodin!, posted by krazybirdlady on November 26, 2003, at 0:05:37
I'm 26. This thing's been killing me since age 18--or maybe before; I have a horrible memory, and I could've been depressed for most of my life and not known it.
Ahh, treatement; started in on it with high hopes, with a college counselor five years ago. I've seen half a dozen psychiatrists since then and tried enough medications to qualify for a Guiness record. I have the full list in my notes; it goes:
Zoloft
Paxil
Serzone
Effexor
Elavil
Sinequan
Augmentation of the above with lithium and thyroid hormone
Buspar
Nardil
WellbutrinOnly the Wellbutrin had a positive effect at 200mg/day; it helped me sleep less than 20 hours a day. I think my hellish encounter with the Paxil made me even worse. After that, I let them give me bilateral ECT as much as they wanted, on the hope that maybe something would go wrong and I'd die on the table (it has a 4 in 10,000 deathrate). It scrambled my brains for several months after. Finally came the Adderall--which worked; God, did it work! I took it for two years before I started having panic attacks; the Adderall always would trigger one.
So, have I traveled all known roads? It sure seems like it. My current regimie is likely to be just a warm place between the past and me dead in the bathtub some morning.
Posted by krazybirdlady on November 26, 2003, at 1:12:10
In reply to Re: Boy~Do I miss Vicodin!, posted by bsj on November 26, 2003, at 0:24:43
well, you have travelled an awful lot of roads. my question right now however is did you ever take anything other than the adderal. when panic attacks hit, did you stop or did you try something else in the stimulants? not that adderal is without it's dependant properties, it's just about as bad as opiates...but for some, it's a life-line. not that i'm condoning it, but you seem to slip between the cracks as far as diagnosis is concerned. well, mental illness is hit or miss as far as meds are concerned anyway...just wondering if you persued the "upper way", to it's conclusion...
Posted by bsj on November 26, 2003, at 4:55:01
In reply to Re: Boy~Do I miss Vicodin!, posted by krazybirdlady on November 26, 2003, at 1:12:10
"my question right now however is did you ever take anything other than the adderal."
We tried several different combinations of SSRI with Adderall and the Adderall alone. There was a hiatus of the Adderall there as he put me on Celexa, to tame the panic; it helped marginally...but with the re-introduction of the Adderall, the panic came right back. He finally withdrew the Adderall entirely.
"...but for some, it's a life-line."
It was definitely mine.
"just wondering if you persued the "upper way", to it's conclusion..."
I pursued it as far as the doctor would go and then some. After the Adderall was withdrawan, we tried Cylert briefly, which didn't work. He said it was a milder stimulant; yeah, so mild that it did nothing for me. Later I ordered Provigil online and took it for a month; nothing but insomnia. It wasn't like hydrocodone was the first club out of the bag; but at least it doesn't send me climbing the walls in terror.
Posted by bsj on November 26, 2003, at 12:55:07
In reply to Re: Boy~Do I miss Vicodin!, posted by rxnurse on November 25, 2003, at 20:20:31
rxnurse:
Since you seem to fancy yourself knowledgeable about matters of neuropharmacology, why not address the issues I raised, instead of personally attacking me?
Posted by rxnurse on November 26, 2003, at 15:23:53
In reply to Re: Boy~Do I miss Vicodin!, posted by bsj on November 26, 2003, at 12:55:07
If you are feeling attacked, I'm sorry. I understand you are frustrated with the system as a whole, not just me. I too have been suffering from major depression since my early teen years and have tried almost all of the meds you have! So, I can personally relate/understand what you have been through! Try not to take things so personally, it's just not worth the headache.
Posted by KimberlyDi on November 26, 2003, at 15:48:22
In reply to Re: Boy~Do I miss Vicodin!, posted by rxnurse on November 26, 2003, at 15:23:53
bsj:
take a chill pill dude. (just a saying, not meant literally.) i wish you could see all your posts, the big picture. angry, defensive, and then hopeless, admitting you'll end up a suicide. Rxnurse didn't personally attack you, she tried to get to know your personal experience by asking questions. Even i clicked after reading a few of your more "down" posts, realizing "I can relate to that".
You believe you can use certain drugs without risk of addiction to fix whatever chemical mix your brain has... while she believes it is too risky. One can be cool with both ideas.
:)
> If you are feeling attacked, I'm sorry. I understand you are frustrated with the system as a whole, not just me. I too have been suffering from major depression since my early teen years and have tried almost all of the meds you have! So, I can personally relate/understand what you have been through! Try not to take things so personally, it's just not worth the headache.
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Dr. Bob is Robert Hsiung, MD,
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