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Dr. Bob is Robert Hsiung, MD,
dr-bob@uchicago.eduShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by ShelliR on April 11, 2001, at 20:03:37
Dr. Richelson,
Thanks for taking questions.
There are a few of us on this board who have been treated with small amounts of opiates to augment antidepressants for treatment resistant depression. Do you believe that some people are particularly responsive to the anti-depressant effects of opiates? In some cases (on this board) and on the internet in general, there are patients who have been treated with opiates (e.g., hydrocodone), and have found the same amount to continue to be effective for many years, and others who have had to increase because of tolerance. Do you know why that might be the case? What is your feeling about using opiates as part of treatment for depression, when no other drug combinations have succeeded in treating the depression? Do you think targeting opiate receptors will play any role in the development of future anti-depressant medications?
Posted by Dr. Bob on April 14, 2001, at 23:32:57
In reply to Richelson: use of opiates for depression, posted by ShelliR on April 11, 2001, at 20:03:37
> There are a few of us on this board who have been treated with small amounts of opiates to augment antidepressants for treatment resistant depression. Do you believe that some people are particularly responsive to the anti-depressant effects of opiates? In some cases (on this board) and on the internet in general, there are patients who have been treated with opiates (e.g., hydrocodone), and have found the same amount to continue to be effective for many years, and others who have had to increase because of tolerance. Do you know why that might be the case? What is your feeling about using opiates as part of treatment for depression, when no other drug combinations have succeeded in treating the depression? Do you think targeting opiate receptors will play any role in the development of future anti-depressant medications?
Long before the established antidepressants were available, opiates and opioids were used to treat depression. However, for various reasons today, I would not use this class of compounds to treat depression. The mechanisms of tolerance to a drug is very complex and not well understood for most drugs. Some mechanisms involve increased metabolism of the drug and adaptive changes at the cellular level. The theory about tolerance to opioids is that there are adaptive changes at the level of receptors for these compounds. Why tolerance would not develop in some patients, but not others is a mystery.
Posted by frizzaldizzal on June 15, 2006, at 13:49:22
In reply to Re: opiates for depression: Dr. Richelson responds, posted by Dr. Bob on April 14, 2001, at 23:32:57
I took hydrocodone for about 8 years. It was the only thing that would keep me from thinking about suicide. I never went up in the dose, all of the sudden was wasnt working like had been. The depression came back and I was very irritable. I took this med before they had diagnosed me with Bipolar II. I read in a John's Hopkin's University book about Bipolar that Bipolar depression is worse than regular. Since the doctors did not see that I was Bipolar they never put me on a mood stabilizer, and every antidepressant they put me on would quit working, so I always took the hydrocodone to help, even when I was on an antidepressant. I found it by accident. I had surgery and they put me on it, and I realized that it helped and that I was no longer thinking about suicide, so they let me stay on it.
Posted by pseudoname on June 18, 2006, at 17:17:13
In reply to Re: opiates for depression: Dr. Richelson responds, posted by frizzaldizzal on June 15, 2006, at 13:49:22
Thanks, frizzal, for finding this old post by Dr Bob.
Those were the good ol' days: when Bob also posted non-administratively on Babble!
I know that Dr Bob is not opposed to the spread of information about using buprenorphine for depression, and in fact encouraged me to put my links about it on his Babble Tips group at Yahoo.
I don't know if the typical opioid tolerance he was concerned about also occurs with buprenorphine. I have REDUCED my own dose significantly over the last 7 months without loss of effect, but who know what's actually going on physiologically. Maybe I was taking too much at first, or maybe I am in the non-tolerance subgroup, or maybe bupe is different enough that this is not a factor?
This is the end of the thread.
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