![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 72. This is the beginning of the thread.
Posted by Thomas Schlaeger on May 26, 2001, at 10:44:31
It has been a while someone has submitted to the thread, I however hope that it is read and would be happy about any e-mail reply.
The "controversial" subject is to use codeine in depression treatment. This is "controversial" because the majority of doctors appear to have a different oppinion than their depressive patients.
Basically I have ro confirm what others have said before. The immediate anti-depressive effect of codeine is almost unbelieveable and hence relieves the suffering patient of most of her/his depression symptoms.Every badly depressive person knows the terrible state where one just wants to stay in bed and one is almost unable to wash her/himself and so on. These and other depression symptoms are almost "switched off" by taking codeine.
One of the downsides is that a rather large dosis is required to obtain the desired effect. In my case this is 250-400 mg which lasts for 6-8 hours. There is absolutely no "high" effect, just total normalization allowing me to do all the things which otherwise would be impossible through the depression. Working, shopping, looking after myself, my pet etc.
Whilst medication like codeine against depression was known until the mid.50s, regretfully nowadays it seems completely forgotten. The most important thing for every doctor should be hers/his patient's well being and yet many doctors refuse to prescribe codeine as an intermediate solution. Sad cases are known where depressive patients trick their doctors in prescribing codeine containing cough syrup. This should not be like that, I would wish that the highly anti-depressive component of codeine gets widely known in the medical field again and is prescibed to give relief to depressive patients. I am myself very lucky to have an understanding good doctor, so I don't have to suffer to badly under my depression.
There are some important things to note however. Codeine provides almost instant relief of depression symptoms but this is only a sort of "cover up". Nothing is done with regard to the actual cause of the illness and hence it is very important that standard anti-depressive medicine is taken in addition. In some cases psycho-therapeutic treatment may be necessary as well. Codeine is great in "surviving" your depressive days but it does nothing towards the actual cause.
as I said in the beginning I would be happy to receive comments by anyone concerned.
Thomas, Hamburg, Germany
Posted by kernel on May 26, 2001, at 20:19:53
In reply to Codeine for Depressione Treatment, posted by Thomas Schlaeger on May 26, 2001, at 10:44:31
Hi Thomas,
I also heard that buprenorphine may act in the same manner. Offering immediate results. My only concern would be a tolerance and addiction to these two narcotic type medications.
Tom
> It has been a while someone has submitted to the thread, I however hope that it is read and would be happy about any e-mail reply.
> The "controversial" subject is to use codeine in depression treatment. This is "controversial" because the majority of doctors appear to have a different oppinion than their depressive patients.
> Basically I have ro confirm what others have said before. The immediate anti-depressive effect of codeine is almost unbelieveable and hence relieves the suffering patient of most of her/his depression symptoms.Every badly depressive person knows the terrible state where one just wants to stay in bed and one is almost unable to wash her/himself and so on. These and other depression symptoms are almost "switched off" by taking codeine.
> One of the downsides is that a rather large dosis is required to obtain the desired effect. In my case this is 250-400 mg which lasts for 6-8 hours. There is absolutely no "high" effect, just total normalization allowing me to do all the things which otherwise would be impossible through the depression. Working, shopping, looking after myself, my pet etc.
> Whilst medication like codeine against depression was known until the mid.50s, regretfully nowadays it seems completely forgotten. The most important thing for every doctor should be hers/his patient's well being and yet many doctors refuse to prescribe codeine as an intermediate solution. Sad cases are known where depressive patients trick their doctors in prescribing codeine containing cough syrup. This should not be like that, I would wish that the highly anti-depressive component of codeine gets widely known in the medical field again and is prescibed to give relief to depressive patients. I am myself very lucky to have an understanding good doctor, so I don't have to suffer to badly under my depression.
> There are some important things to note however. Codeine provides almost instant relief of depression symptoms but this is only a sort of "cover up". Nothing is done with regard to the actual cause of the illness and hence it is very important that standard anti-depressive medicine is taken in addition. In some cases psycho-therapeutic treatment may be necessary as well. Codeine is great in "surviving" your depressive days but it does nothing towards the actual cause.
> as I said in the beginning I would be happy to receive comments by anyone concerned.
> Thomas, Hamburg, Germany
Posted by Elizabeth on May 27, 2001, at 0:22:52
In reply to Re: Codeine for Depressione Treatment, posted by kernel on May 26, 2001, at 20:19:53
> I also heard that buprenorphine may act in the same manner. Offering immediate results. My only concern would be a tolerance and addiction to these two narcotic type medications.
For political reasons, there has been little research in this area. However, recent case reports suggest that it is possible to use opioids as antidepressants without developing tolerance. "Addiction" is no more a threat in the use of opioids for depression than it is in their use for pain. Buprenorphine is particularly safe in this regard because it apparently doesn't produce a high at any dose (it is also nonlethal in overdose, another favourable trait for an antidepressant).
There exist published reports using morphine, methadone, oxycodone, oxymorphone, and other opioid drugs as well as buprenorphine. I don't know of any that used codeine, but I would expect it to be less effective than the ones that have been studied since it is a very weak mu opioid agonist. (This may be the reason that such a large dose was required in your case, Thomas.)
I disagree with the claim (which has been made on this board before) that opioids do not address the "cause" of depression but merely "mask" or "cover it up." The fact is that there is no known cure for depression, nor has a specific cause for depression been identified. I am therefore baffled by these assertions that a particular drug does or does not address the "root cause" of depression.
-elizabeth
Posted by paulk on May 27, 2001, at 23:33:26
In reply to Re: Codeine for Depression Treatment, posted by Elizabeth on May 27, 2001, at 0:22:52
I have heard of using opiates combined with a narcotic blocker for treatment of depression – kind of a last resort thing – but that may have more to do with drug politics than it should.
Posted by LynnKhat on May 28, 2001, at 4:01:36
In reply to Re: Codeine for Depression Treatment, posted by paulk on May 27, 2001, at 23:33:26
> I have heard of using opiates combined with a narcotic blocker for treatment of depression – kind of a last resort thing – but that may have more to do with drug politics than it should.
Hmmm. I'd hazard the guess that codeine works to alleviate depression because it's a grand high. Which is why a lot of people have trouble with pain medications.
According to Kathleen DesMaisons, opiates raise Beta Endorphin levels quickly--and we are hard-wired to love BEs. Then they crash, then we want more. Evidently, pleasurable activity (exercise, good sex, creativity, mediation, prayer, playing with pets, etc.) is the best way to raise BEs. Foods (like sugar), drugs, deliberately induced stress (like intense conflict or "cutting") also raise BEs, which is why it can be difficult to quit behaviors that look like any sensible person could give them up in a hearbeat.
She is also of the opinion that depression can stem from not getting enough BEs as well as from serotonin problems, which may be why meds are less than optimally effective for some folks.I have to be very careful with pain meds because I like them so much.
I'd be interested in learning more about this--and I'd be wary of trying the codeine approach without scrupulous medical supervision by someone to whom a person could (and would) tell the truth about possible cravings. And most of us are pretty clever about not telling the truth sometimes!
Blessings.
LynnKhat
Posted by dougb on May 28, 2001, at 15:59:04
In reply to Codeine for Depressione Treatment, posted by Thomas Schlaeger on May 26, 2001, at 10:44:31
Thomas:
I have been using codine and analogues for the last 6 months with wonderful results.
After 7 years of hell interspersed with occaisional relief under conventional anti-depressent treatment, i discovered the effect you describe.
Popular misconceptions cause significant impediments in pursuit of this therapy, you may find the following usefull:
-- Do not lie to your doctor about why you need this medecine. Do make sure you emphasize any positive effects this rx has on your behavior, can now do this, this and this.
-- Do not rely on statements like, it makes me feel better, that is not enough.
-- Do find a diferent Dr. if necessary, preferably one who is recently educated, and not an 'old fogey'.
-- Recent studies indicate that opiates under medical supervision carry very low risk of addiction, the following is a snippet of a report appearing in the April 5, 2000 of the Journal of the American Medical Association:
"There's an enormous amount of mythology and misinformation about these drugs," said Dr. Paul Bascom, a pain management expert and assistant professor of medicine at Oregon Health Sciences University in Portland.
He said the risk of addiction is essentially zero in people with no history of drug or alcohol abuse. Studies as far back as 1980 have consistently reached the same conclusion."
-- Visit the following site for advice on dealing with your Dr.:
http://www.widomaker.com/~skipb/panic.html
Good Luck
db
Posted by paulk on May 29, 2001, at 13:11:30
In reply to Re: Codeine for Depression Treatment » paulk, posted by LynnKhat on May 28, 2001, at 4:01:36
> > I have heard of using opiates combined with a narcotic blocker for treatment of depression – kind of a last resort thing – but that may have more to do with drug politics than it should.
>
> Hmmm. I'd hazard the guess that codeine works to alleviate depression because it's a grand high. Which is why a lot of people have trouble with pain medications.
>
Perhaps I did not make it clear – it is the use of an opiate COMBINED with an opiate blocker – which blocks the euphoric effects – that has been used as an antidepressant. (I doubt with overwhelming success or there would have been some write-ups in the press.)I am not encouraging the use of opiates – although I would rank them as a lesser evil than alcohol. Most people, if given a free supply to opiates would chose not to use them – I wouldn’t. I just don’t see why alcohol is legal – even though it is clearly a very dangerous drug – while we criminalize other dangerous drugs.
It is my contention that IF opiates combined with an opiate blocker turned out to be an excellent antidepressant it wouldn’t be prescribed because of the social stigma attached to opiates.
Again – just to be sure this is not miss understood – I am not recommending anyone use opiates, alcohol or any other dangerous drug – I don’t myself and haven’t seen anything that suggests that they are a long term therapy to depression.
Posted by Elizabeth on May 29, 2001, at 18:12:55
In reply to Re: Codeine for Depression Treatment, posted by paulk on May 27, 2001, at 23:33:26
> I have heard of using opiates combined with a narcotic blocker for treatment of depression – kind of a last resort thing – but that may have more to do with drug politics than it should.
I must be misunderstanding what you're trying to say here...opiates combined with a "narcotic blocker" would be a pretty useless remedy!
-elizabeth
Posted by Elizabeth on May 29, 2001, at 19:37:36
In reply to Re: Codeine for Depression Treatment, posted by paulk on May 29, 2001, at 13:11:30
> Perhaps I did not make it clear – it is the use of an opiate COMBINED with an opiate blocker – which blocks the euphoric effects – that has been used as an antidepressant. (I doubt with overwhelming success or there would have been some write-ups in the press.)
You mean the popular press, right? There have been reports in peer-reviewed scholarly journals (it's hard to do large-scale clinical trials because nobody wants to provide the funding). Some of these published papers are available on the web. Here are a couple of links:
http://balder.prohosting.com/~adhpage/bupe.html
http://www.addict.f2s.com/medarticlemenu.htmlThere's at least one other clinical report that I know of, a case series which was reported in a letter to the editor of the American Journal of Psychiatry. I will post that report in a separate post in this thread.
> I am not encouraging the use of opiates – although I would rank them as a lesser evil than alcohol.
Alcohol is an organic solvent -- I consider it to be more of a toxin than a drug! It's very "dirty." It's more dangerous than just about any medication or recreational drug I can think of that is used today, except maybe inhalants (industrial solvents in paint thinner and such that some people think are a good high) and some antineoplastics.
> Most people, if given a free supply to opiates would chose not to use them – I wouldn’t. I just don’t see why alcohol is legal – even though it is clearly a very dangerous drug – while we criminalize other dangerous drugs.
This baffles me also. For some reason, the government at the time was able to admit that alcohol prohibition was a mistake, but they can't seem to face up to the failure of current drug prohibition laws. I also don't understand how the government can rationalise today's prohibition through federal and state laws and regulatory agencies, when an amendment to the Constitution was required to criminalise alcohol.
On a related note, look at how effective anti-tobacco education has been in getting people to stop smoking. The availability of nicotine substitution and bupropion has helped make it easier to quit, but I think it's the publicity about the dangers of tobacco smoking that has made smoking so unpopular, even though you can buy cigarettes at any convenience store. I think that abuse of currently illegal drugs would be reduced to nearly zero if the government spent its money and effort on education instead of prosecution and imprisonment.
> It is my contention that IF opiates combined with an opiate blocker turned out to be an excellent antidepressant it wouldn’t be prescribed because of the social stigma attached to opiates.
Well, I still don't understand what you mean by "opiates combined with an opiate blocker," but there is a mixed partial agonist/antagonist -- buprenorphine -- that is an effective antidepressant (I know because I take it) and that doesn't get you high. (The paper at http://balder.prohosting.com/~adhpage/bupe.html discusses this drug and its antidepressant properties in depth.) As you surmise, most pdocs are loath to prescribe buprenorphine, not on any scientific or medical basis but because of social stigma. Once they hear that its name ends in "-orphine," they no longer care to hear about its pharmacological properties.
Another drug with a similar pharmacological profile -- dezocine, brand name Dalgan -- used to be available, but it was recently taken off the market because it hadn't been profitable. My guess is that partial mu opioid receptor agonists like buprenorphine and dezocine are not very good pain killers, but the only indication that they're labelled for is pain. (Buprenorphine is currently being studied as an addiction treatment.)
> Again – just to be sure this is not miss understood – I am not recommending anyone use opiates, alcohol or any other dangerous drug – I don’t myself and haven’t seen anything that suggests that they are a long term therapy to depression.
There's no such thing as a completely safe drug. Opioids are safe enough to be used when the need is great enough; for example, they are regularly used for pain (including chronic pain) and as maintenance therapy for addictions. People can function very well while using opioids on a daily basis under a doctor's supervision. I think that if tricyclics -- which can cause potentially lethal cardiac arrhythmias and are quite toxic in overdose -- are safe enough to be used as antidepressants, then opioids are too.
-elizabeth
Posted by Elizabeth on May 29, 2001, at 19:48:02
In reply to Re: Codeine for Depression Treatment, posted by paulk on May 29, 2001, at 13:11:30
As promised, here's the case series I referred to in my previous post. Interestingly, the primary author is the same Dr. Stoll who has become known for his work on omega-3 fatty acids for mood disorders.
Am J Psychiatry 156(12):2017, December 1999
©1999 American Psychiatric AssociationTreatment Augmentation With Opiates in Severe and Refractory Major Depression
Andrew L. Stoll, MD, and Stephanie Rueter, BA
Belmont, Mass.To the Editor:
Substantial evidence supports the antidepressant efficacy of opiates (1). This report summarizes our open-label experience using the µ-opiate agonists oxycodone or oxymorphone in patients with highly refractory and chronic major depression.
Mr. A was a 44-year-old man with severe and chronic depression. Numerous trials of antidepressants produced only limited benefit. Mr. A also had an extensive history of opiate abuse, and he noted that the only times he ever felt normal and not depressed was during opiate use. Because of the refractory nature of his depressive symptoms and his apparent self-medication with opiates, Mr. A was given a trial of oxycodone under strict supervision. After 18 months of oxycodone treatment (10 mg/day), Mr. A remained in his longest remission from depression without the emergence of opiate tolerance or abuse.
Ms. B was a 45-year-old woman with bipolar disorder and opiate abuse (in remission for 2 years). A trial with standard mood stabilizers had failed, and she had experienced mania with several standard antidepressant drugs. As with Mr. A, Ms. B reported feeling well only when taking opiates, particularly oxymorphone. Oxymorphone (8 mg/day) was thus cautiously added to ongoing lamotrigine therapy (as a mood stabilizer), and she remained well for a minimum of 20 months without drug tolerance or abuse.
Mr. C was a 43-year-old man with chronic major depression that was unresponsive to numerous antidepressants with and without augmentation. Detailed questioning revealed that he once experienced marked antidepressant effects from opiates that he received after a dental procedure. There was no history of opiate abuse, and a cautious trial of oxycodone was initiated. Mr. C experienced a dramatic and gratifying antidepressant response from oxycodone (10 mg t.i.d. for 9 months) without opiate tolerance or abuse.
This report describes three patients with chronic and refractory major depression who were treated with the µ-opiate agonists oxycodone or oxymorphone. All three patients experienced a sustained moderate to marked antidepressant effect from the opiates. The patients described a reduction in psychic pain and distress, much as they would describe the analgesic effects of opiates in treating nocioceptive pain.
Two of the three patients described in this report were previous abusers of opiates. Although the clinical use of opiates in patients with a history of opiate addiction is usually contraindicated, in these cases there was a strong indication that they were self-medicating their mood disorders (2) with illicit opiates. None of the patients abused the opiates, developed tolerance, or started using other, illicit substances.
We used oxycodone in three additional patients without histories of opiate abuse. In two of these three patients, oxycodone produced a similar sustained antidepressant effect. Two of these patients experienced mild-to-moderate constipation, and one experienced daytime drowsiness from the opiates. Opiates should be considered a reasonable option in carefully selected patients who are desperately ill with major depression that is refractory to standard therapies.
REFERENCES
1. Bodkin JA, Zornberg GL, Lukas SE, Cole JO: Buprenorphine treatment of refractory depression. J Clin Psychopharmacol 1994; 15:49-57.
2. Khantzian EJ: Self-regulation and self-medication factors in alcoholism and the addictions: similarities and differences. Recent Dev Alcohol 1990; 8:255-271.
Posted by paulk on May 29, 2001, at 21:16:15
In reply to Re: Codeine for Depression Treatment » paulk, posted by Elizabeth on May 29, 2001, at 19:37:36
>
> You mean the popular press, right?
Yes
> http://balder.prohosting.com/~adhpage/bupe.html
> http://www.addict.f2s.com/medarticlemenu.htmlVery interesting - first time I have seen anything in print on this.
I would have to see a double blind study with a much higher ‘N’ before I would get excited. About my only experience with opiates were Demerol for kidney stones and surgery – I skipped the pain med as much as possible because it would keep me from peeing. – I also used codeine cough syrup for a cold a few times – neither seemed ‘stimulating’ to me?
About the only other information related to narcotics I know about is that Cocaine acts as a norepinephrine reuptake inhibitor (suppose the media would equate cocaine with the SNRIs). I once had medical Cocaine when they were fixing my nose – and hated it. It was like drinking way too much coffee and gave me a headache that lasted the rest of the day. I can’t understand why anyone would pay good money for the experience – I suppose it is just another example that we are all nuro-chemically different. (I have also heard that much of the ‘street cocaine’ is really a mixture of procain and meth-amphetamine – there was a study that showed that users couldn’t tell them apart.)
> Well, I still don't understand what you mean by "opiates combined with an opiate blocker
It was described to me as a combination of an opiate (which one I don't know) and I think it Revia (Naltrexone). It was some time ago – I tried using Naltrexone to counter the old sex side effect of Effexor – it didn’t work – I told my pys doc about this attempt and he told me of treating some treatment resistant patient with such a mixture.
One last thought on the social stigmas some drugs have – Both Cocaine and Opiates were associated with minorities (blacks and Chinese) when these drugs became disreputable.
Posted by shelliR on May 29, 2001, at 21:26:43
In reply to Re: Codeine for Depression Treatment » paulk, posted by Elizabeth on May 29, 2001, at 19:37:36
> Alcohol is an organic solvent -- I consider it to be more of a toxin than a drug! It's very "dirty." It's more dangerous than just about any medication or recreational drug I can think of that is used today, except maybe inhalants (industrial solvents in paint thinner and such that some people think are a good high) and some antineoplastics.
>Elizabeth, I'm a bit confused on this one. Are you talking about alcohol as a toxin when used as an antidepressant, or are you talking about a glass of wine with dinner? I find it hard to believe that you could be talking about occasional drinking as dangerous and one step before the toxicity of paint thinners. For some people alcohol (probably genetically predispositioned) can be extremely toxic; in general though, I can't somehow understand your thinking about it as a toxin. Alcohol in moderation was been part of religious ceremonies for centuries, and certainly appears not to have taken a large toll on the European population.
Have I misunderstood you?
Shelli
Posted by paulk on May 29, 2001, at 22:00:33
In reply to Re: Codeine for Depression Treatment » Elizabeth, posted by shelliR on May 29, 2001, at 21:26:43
> > Alcohol is an organic solvent -- I consider it to be more of a toxin than a drug! It's very "dirty." It's more dangerous than just about any medication or recreational drug I can think of that is used today, except maybe inhalants (industrial solvents in paint thinner and such that some people think are a good high) and some antineoplastics.
> >
>
> Elizabeth, I'm a bit confused on this one. Are you talking about alcohol as a toxin when used as an antidepressant, or are you talking about a glass of wine with dinner?In such a low dose it won't likely hurt you - but neither would many industrial solvents.
>I find it hard to believe that you could be talking about occasional drinking as dangerous and one step before the toxicity of paint thinners.
Ethanol IS used as a bipolar solvent – and has been used as paint thinner.
>For some people alcohol (probably genetically predispositioned) can be extremely toxic;
One glass of wine make my wife quite sick – allergic reaction well known to Asians.
>in general though, I can't somehow understand your thinking about it as a toxin.
There is the well known medical emergency called alcohol poisoning – where teenagers proving their macho – drink themselves dead. One bottle of vodka can do it. Ask your local ER doctor about it. Alcohol IS a toxin in doses 200% higher than your glass of wine.
>Alcohol in moderation was been part of religious ceremonies for centuries,
Just because a drug is socially acceptable does not change it’s toxicity – alcohol is more dangerous than many drugs we send people to years of jail time for. Opiate addicts can drive safely, and if they have pure medical grade supplies do little more than cause constipation. An alcohol addict is damaging their brain and liver and a danger to those around them.
>and certainly appears not to have taken a large toll on the European population.
Hmmm – Have you ever looked at the traffic fatalities due to drunk drivers? Seems like a large toll to me. – Do you know that over half the hospital population consists of alcoholics? I’m down on alcohol – a drunk crippled my grandmother in a car accident. A different drunk paralyzed my best friend in high school. A drunk robbed me at gunpoint. When I was in treatment for depression I met many who had destroyed their life and the lives of their families with their legal drug. I had an occasional beer when I was younger – never had a problem with it – I don’t drink at all know because it might set a bad example to someone who does have a problem.
Posted by Elizabeth on May 29, 2001, at 23:14:12
In reply to Re: Codeine for Depression Treatment » Elizabeth, posted by paulk on May 29, 2001, at 21:16:15
> Very interesting - first time I have seen anything in print on this.
That's because you don't read the professional journals. :) It's not sensationalistic enough to make the popular news media, I'm afraid. It's hardly news: opium and its derivatives have been in use as psychotropic medicines for thousands of years.
> I would have to see a double blind study with a much higher ‘N’ before I would get excited.Like I said -- no funding. The patents on existing opioids (including buprenorphine) have expired, so the drug companies have no motivation to fund such studies. The lack of acceptance of the idea on the part of the medical community makes it unlikely that new drugs will be developed for this purpose.
I mentioned that buprenorphine is being studied for treatment of heroin addiction. The problem is that the formulation being studied -- a sublingual tablet (buprenorphine is currently available in the U.S. only as an injectible solution) -- is not very effective. I would like to see a metred-dose nasal inhaler (like Stadol NS), but for some reason, nobody seems to be interested in trying that. (I take buprenorphine intranasally, and it works -- not as fast as intramuscular injection, but in about the same dose range.)
But anyway, I got "excited" as soon as I found that it worked for me. For a person with TRD, n=1 is enough if they happen to be the 1 in question.
> About my only experience with opiates were Demerol for kidney stones and surgery – I skipped the pain med as much as possible because it would keep me from peeing. – I also used codeine cough syrup for a cold a few times – neither seemed ‘stimulating’ to me?
Codeine is a very weak opiate (I don't think I ever took it while depressed, but I don't recall any interesting effects from it the couple times I had it, either). Demerol is atypical in that it's relatively excitatory compared with morphine.
> About the only other information related to narcotics I know about is that Cocaine acts as a norepinephrine reuptake inhibitor (suppose the media would equate cocaine with the SNRIs).
Cocaine is a nonselective monoamine reuptake inhibitor (dopamine, norepinephrine, and serotonin). Medically, cocaine is used only as a local anaesthetic -- very different from systemic use as a psychostimulant.
> It was described to me as a combination of an opiate (which one I don't know) and I think it Revia (Naltrexone).
There's some research suggesting that ultra-low doses of naltrexone or naloxone can prevent or slow the development of tolerance to morphine. But that's not something that's in clinical use. (The appropriate dose of naltrexone to use in humans hasn't even been established.)
> It was some time ago – I tried using Naltrexone to counter the old sex side effect of Effexor – it didn’t work – I told my pys doc about this attempt and he told me of treating some treatment resistant patient with such a mixture.
Yes, some people have said they've successfully augmented ADs with naltrexone. That surprises me, since it's supposed to be a not-very-pleasant drug.
> One last thought on the social stigmas some drugs have – Both Cocaine and Opiates were associated with minorities (blacks and Chinese) when these drugs became disreputable.
Of course -- same with marijuana. Most drug prohibition grew out of racism.
-elizabeth
Posted by paulk on May 30, 2001, at 11:00:53
In reply to Re: Codeine for Depression Treatment » paulk, posted by Elizabeth on May 29, 2001, at 23:14:12
> >Very interesting - first time I have seen anything in print on this.
>That's because you don't read the professional journals.
Thanks for sharing it.
> > I would have to see a double blind study with a much higher ‘N’ before I would get excited.
>Like I said -- no funding. The patents on existing opioids (including buprenorphine) have expired, so the drug companies have no motivation to fund such studies. The lack of acceptance of the idea on the part of the medical community makes it unlikely that new drugs will be developed for this purpose.
I’ve heard of this also about time released addreal – There is a need but no one does it
>But anyway, I got "excited" as soon as I found that it worked for me. For a person with TRD, n=1 is enough if they happen to be the 1 in question.
If that 1 is yourself it is always interesting. – How long has it been working for you – sounded like a some of the patients were only getting a few weeks worth of relief.>Demerol is atypical in that it's relatively excitatory compared with morphine.
Put me right to sleep.
>Cocaine is a nonselective monoamine reuptake inhibitor (dopamine, norepinephrine, and serotonin). Medically, cocaine is used only as a local anaesthetic -- very different from systemic use as a psychostimulant.
I wonder if a slow release formula might be a good drug?
>Yes, some people have said they've successfully augmented ADs with naltrexone. That surprises me, since it's supposed to be a not-very-pleasant drug.
Didn’t bother me at all – per haps a bit of a headache the first day.
Posted by Elizabeth on May 30, 2001, at 14:08:27
In reply to Re: Codeine for Depression Treatment » Elizabeth, posted by shelliR on May 29, 2001, at 21:26:43
> Elizabeth, I'm a bit confused on this one. Are you talking about alcohol as a toxin when used as an antidepressant, or are you talking about a glass of wine with dinner?
I've said it before: "The difference between a medicine and a poison is the dose." (I know that quote comes from somewhere, but I'm not sure where.) Alcohol is an organic solvent and its intoxicant effects are not unlike those of other solvents (ataxia, CNS depression, etc.), although it is *less* toxic than some of the industrial solvents that some people ingest (for some reason). Alcohol overdoses can be lethal, and lethal polydrug overdoses almost always involve alcohol. Long-term overuse can lead to all sorts of organ failure.
The difference between moderation and excess is a crucial one.
-elizabeth
Posted by Elizabeth on May 30, 2001, at 17:19:52
In reply to Re: Codeine for Depression Treatment » Elizabeth, posted by paulk on May 30, 2001, at 11:00:53
> I’ve heard of this also about time released addreal – There is a need but no one does it
Adderal? That's a once-daily stimulant...why would there be a need for a slow-release formulation?
> If that 1 is yourself it is always interesting. – How long has it been working for you – sounded like a some of the patients were only getting a few weeks worth of relief.
That's a concern I've had, but it seems to be the exception rather than the rule. I've been taking it for about 6 months. (I had tried it before, a few years ago, but quit after a couple months because of side effects.)
> >Demerol is atypical in that it's relatively excitatory compared with morphine.
>
> Put me right to sleep.Demerol has a toxic metabolite (normeperidine) that's very proconvulsant. ("Excitatory" just means that it increases neuronal firing, BTW.)
> >Cocaine is a nonselective monoamine reuptake inhibitor (dopamine, norepinephrine, and serotonin). Medically, cocaine is used only as a local anaesthetic -- very different from systemic use as a psychostimulant.
>
> I wonder if a slow release formula might be a good drug?Nomifensine -- an antidepressant that was withdrawn from the market about 15 years ago -- is a NE-DA reuptake inhibitor. It was supposed to be very effective, in particular for people who'd had no success with other ADs.
> >Yes, some people have said they've successfully augmented ADs with naltrexone. That surprises me, since it's supposed to be a not-very-pleasant drug.
>
> Didn’t bother me at all – per haps a bit of a headache the first day.It's variable, obviously. I would expect it to be neutral at best, tho'. It came as a huge surprise to hear that some people got an AD effect from it. (To my knowledge, it only works in combination with an AD, but even that was something I never would have guessed.)
-elizabeth
Posted by paulk on May 30, 2001, at 20:30:49
In reply to Re: Codeine for Depression Treatment, posted by Elizabeth on May 30, 2001, at 17:19:52
> > I’ve heard of this also about time-released addreal – There is a need but no one does it
>Adderal? That's a once-daily stimulant...why would there be a need for a slow-release formulation?
No, it’s not – usually used 2 – 3 times a day – a mixture of different half-life amphetamines – the idea is to have a tapering effect – (which makes no sense if it is used in multiple dosages???). Adderal used to be marketed under a different name for weight loss use. I tried it to overcome the memory problems I started having with Effexor with out good results. I got one day of good effect followed by a week of diminished returns – tried upping the dose – then a week of really nasty withdrawals.It is also used for ADD – but Ritalin is generally preferred because of its longer half-life.
> > If that 1 is yourself it is always interesting. – How long has it been working for you – sounded like a some of the patients were only getting a few weeks worth of relief.
>That's a concern I've had, but it seems to be the exception rather than the rule. I've been taking it for about 6 months. (I had tried it before, a few years ago, but quit after a couple months because of side effects.)
> > >Demerol is atypical in that it's relatively excitatory compared with morphine.
> > Put me right to sleep.
>Demerol has a toxic metabolite (normeperidine) that's very proconvulsant. ("Excitatory" just means that it increases neuronal firing, BTW.)
It is a very big danger to anyone taking an MAOI. Single does have been fatal.> > >Cocaine is a nonselective monoamine reuptake inhibitor (dopamine, norepinephrine, and serotonin). Medically, cocaine is used only as a local anaesthetic -- very different from systemic use as a psychostimulant.
>
> > I wonder if a slow release formula might be a good drug?>Nomifensine -- an antidepressant that was withdrawn from the market about 15 years ago -- is a NE-DA reuptake inhibitor. It was supposed to be very effective, in particular for people who'd had no success with other ADs.
> > >Yes, some people have said they've successfully augmented ADs with naltrexone. That surprises me, since it's supposed to be a not-very-pleasant drug.
>
> > Didn’t bother me at all – per haps a bit of a headache the first day.>It's variable, obviously. I would expect it to be neutral at best, tho'. It came as a huge surprise to hear that some people got an AD effect from it. (To my knowledge, it only works in combination with an AD, but even that was something I never would have guessed.)
I can only guess at the reasoning for it being a possible AD induced sex dysfunction remedy – perhaps some people get an endorphin response that could interfere with sex – makes some sense – orgasm produces lots of endorphin.
Posted by Pacha on May 31, 2001, at 5:47:34
In reply to Re: Codeine for Depression Treatment » Elizabeth, posted by paulk on May 30, 2001, at 20:30:49
ok i really want to try a low dose of codeine to help my depression. I need advice on: dose, how long it should be taken for, safety, etc....
thanks in advance
Posted by Elizabeth on May 31, 2001, at 20:16:44
In reply to Re: Codeine for Depression Treatment, posted by Pacha on May 31, 2001, at 5:47:34
> ok i really want to try a low dose of codeine to help my depression. I need advice on: dose, how long it should be taken for, safety, etc....
Why codeine?
-elizabeth
Posted by Elizabeth on May 31, 2001, at 20:43:56
In reply to Re: Codeine for Depression Treatment » Elizabeth, posted by paulk on May 30, 2001, at 20:30:49
> >Adderal? That's a once-daily stimulant...why would there be a need for a slow-release formulation?
>
> No, it’s not – usually used 2 – 3 times a day – a mixture of different half-life amphetamines – the idea is to have a tapering effect – (which makes no sense if it is used in multiple dosages???).According to the PDR (and common practise), Adderall (formerly Obetrol) can/should be used once or twice daily. The mixture of amphetamine salts (it's equal parts d-amphetamine saccharate, d,l-amphetamine aspartate, d-amphetamine sulfate, and d,l-amphetamine sulfate) makes it longer-acting than d-amphetamine or methylphenidate. As a result, it doesn't need to be taken as often, and the mood swings that sometimes accompany psychostimulant treatment are milder or absent. For unknown reasons, Adderall sometimes works better than plain Dexedrine.
> >Demerol has a toxic metabolite (normeperidine) that's very proconvulsant. ("Excitatory" just means that it increases neuronal firing, BTW.)
> It is a very big danger to anyone taking an MAOI. Single does have been fatal.True (there was one very famous case of this in New York). There have been serious interactions with SSRIs and Effexor too. As a result morphine is the preferred analgesic for patients on ADs.
> >It's variable, obviously. I would expect it to be neutral at best, tho'. It came as a huge surprise to hear that some people got an AD effect from it. (To my knowledge, it only works in combination with an AD, but even that was something I never would have guessed.)
>
> I can only guess at the reasoning for it being a possible AD induced sex dysfunction remedy – perhaps some people get an endorphin response that could interfere with sex – makes some sense – orgasm produces lots of endorphin.Naltrexone is an opioid *antagonist*. It blocks the effects of endorphins. This can be helpful for people with certain types of impulse-control problems (notably, self-mutilation) because it blocks stress-induced analgesia. Why it would act as an AD, though, is a mystery to me.
People who've added naltrexone to ADs say that it enhances the antidepressant effects, or brings them back following a loss of effect. I've never heard of anyone using it to help with SSRI-induced sexual dysfunction. That would be even more counterintuitive than using it as an AD. < g >
-elizabeth
Posted by Pacha on June 1, 2001, at 6:42:11
In reply to Re: Codeine for Depression Treatment » Pacha, posted by Elizabeth on May 31, 2001, at 20:16:44
Well it doesn't have to be codeine, but it seems to be one of the milder opiates, least side effects and easier to get hold off.
Although i am also considering Buprenorphine at a low dose. If you could give me any advice.
cheers
Posted by Elizabeth on June 1, 2001, at 16:18:18
In reply to Re: Codeine for Depression Treatment-elizabeth , posted by Pacha on June 1, 2001, at 6:42:11
> Well it doesn't have to be codeine, but it seems to be one of the milder opiates, least side effects and easier to get hold off.
>
> Although i am also considering Buprenorphine at a low dose. If you could give me any advice.Take a look at some of my past posts on the subject -- that should give you some idea. A few links:
http://www.dr-bob.org/babble/20010515/msgs/63531.html
http://www.dr-bob.org/babble/20010515/msgs/63367.html
http://www.dr-bob.org/babble/20010507/msgs/62342.html
http://www.dr-bob.org/babble/20010507/msgs/62358.html
http://www.dr-bob.org/babble/20010507/msgs/62654.html
http://www.dr-bob.org/babble/20010507/msgs/62659.html
http://www.dr-bob.org/babble/20010507/msgs/61853.html
http://www.dr-bob.org/babble/20010507/msgs/62668.html
Ultram might be a good choice because it is not a controlled substance. Its opioid activity is mild and it is also a mild serotonin-norepinephrine reuptake inhibitor.
-elizabeth
Posted by Pacha on June 2, 2001, at 5:04:58
In reply to Re: Codeine for Depression Treatment » Pacha, posted by Elizabeth on June 1, 2001, at 16:18:18
elizabeth am i right in saying your taking Buprenorphine ? What is a good dose to start at ? 0.1, 0.2mg ? and for how long ? r there any side effects at a low dose ?
cheers
Posted by Elizabeth on June 2, 2001, at 14:31:47
In reply to Re: Codeine for Depression Treatment-elizabeth , posted by Pacha on June 2, 2001, at 5:04:58
> elizabeth am i right in saying your taking Buprenorphine ? What is a good dose to start at ? 0.1, 0.2mg ? and for how long ? r there any side effects at a low dose ?
Starting dose depends on the route of administration. I take it intranasally; 0.5 mL (0.15 mg) was the dose I started at (I increased it to 1 mL after a few days).
There are a lot of side effects, even at low doses. They're similar to the side effects of full agonists like morphine: itching, nausea/vomiting, constipation, etc.
-elizabeth
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.