![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 72. Go back in thread:
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
Posted by AMenz on June 4, 2001, at 14:02:15
In reply to Codeine for Depressione Treatment, posted by Thomas Schlaeger on May 26, 2001, at 10:44:31
At what dosage and, since you say it's a temporary, for how many days is it safe to take this.
solution > 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 June 4, 2001, at 16:35:06
In reply to Re: Codeine for Depressione Treatment, posted by AMenz on June 4, 2001, at 14:02:15
> At what dosage and, since you say it's a temporary, for how many days is it safe to take this.
How safe do you want?
There seems to be a wide range of variability in the rates at which different people develop tolerance.
BTW: there is no evidence or reason to suppose that opioid agonists are "cover-ups" that don't address the "root cause" of depression. (This is an argument commonly made by proponents of "talk" therapies in criticising the use of any drug at all, incidentally.)
-elizabeth
Posted by froggy on June 5, 2001, at 5:49:19
In reply to Re: Codeine for Depression Treatment » AMenz, posted by Elizabeth on June 4, 2001, at 16:35:06
I never really thought about it before but when I was in a bad car accident I had to take 500mg's codine every 4-6 hours and I felt great! I never got too down being in a wheel chair and so much pain.
Recentley I just started taking vicodin again because I am not completely out of pain. I do like the effects when mixed with an AD.
Unfortunatley here the doctors think that codine was developed by Satan and to take one is to become a drug addict. I feel like one when tring to find a doctor that will give me a script.
It is sad what they reduce a person too.
Posted by AMenz on June 5, 2001, at 11:19:40
In reply to Re: Codeine for Depression Treatment » AMenz, posted by Elizabeth on June 4, 2001, at 16:35:06
Codeine is supposed to be addictive. I'm already unable to get off a 1mg benzo daily.
When you say an opioid is it a synthetic or a natural derivative of opium. Better yet since I do not have a science background-what is an opioid agonist, as opposed to an opiate?
What is the action of codeine that it relieves depression and is the effect palliative like, eg. like benzos which wear off quickly and have to be readministered as oppossed to SSRI which and lithium which build up in the bloodstream slowly and take several days to wear off.
I'm almost embarassed to write to you because you seem extremely knowledgeable. What is your background, if I may ask?
> At what dosage and, since you say it's a temporary, for how many days is it safe to take this.
>
> How safe do you want?
>
> There seems to be a wide range of variability in the rates at which different people develop tolerance.
>
> BTW: there is no evidence or reason to suppose that opioid agonists are "cover-ups" that don't address the "root cause" of depression. (This is an argument commonly made by proponents of "talk" therapies in criticising the use of any drug at all, incidentally.)
>
> -elizabeth
Posted by paulk on June 5, 2001, at 12:05:48
In reply to Re: Codeine for Depression Treatment-Elizabeth, posted by AMenz on June 5, 2001, at 11:19:40
>Codeine is supposed to be addictive. I'm already unable to get off a 1mg benzo daily.
I’m not a doctor, but just a life long paient. That being said: Why are you trying to get off? The best way to get off is to switch to a long half-life Benzo like Clonazepam and to taper down – sometimes by as little as Ľ of the dose per week. ( one week at 1mg - next at .75 next at .5 next at .4 next at .3, .2,.1 )
Be aware that you may not be addicted to the benzo at all. What you might be experiencing is the reemergence of symptoms that the benzo is helping you with. That is not addiction. If this is the case you need to ask yourself why you are stopping. I could see switching to Effexor of some other med to deal with anxiety – but if they don’t work for you why not use what works? Some doctors are overly anti benzos – they have seen patients that abused benzos – most mental patents don’t abuse these drugs – and if you are on 1 mg – it sure doesn’t sound like you are.
You want to use the lowest dose that controls your symptoms – that can be quite low for some of us (I take .25mg of Clonazepam). Larger than necessary doses seem to effect memory and learning..
I don’t like the idea of using a benzo “as needed” except in the case of bipolar depression. Most of the time, anxiety can be treated with a regular low dose – going up and down can CAUSE anxiety.
Clonazepam BTW is probably one of the best to use – it has a long half-life and some seritnergic effect as well. Xanex (Alprazolam) has some anti-depressant action but has too short of a half-life to be practical for most (it would be interesting if they came out with a slow release version of it.).
Good luck to you
Posted by Glenn Fagelson on June 5, 2001, at 21:05:36
In reply to opioid antidepressants case series (as promised) » paulk, posted by Elizabeth on May 29, 2001, at 19:48:02
> 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 Association
>
> Treatment 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.I do not know about the rest of you, but
Vicodin absolutely ruins my sex drive. It does,
however, have a wonderful anti-depressant effect
with me. I take Vicodin as needed for headaches,
injuries, and sometimes just to reduce the effect
of severe depression. I have been using the
Vocodin for almost 3 years now; I have been very
careful with it because I realize how addicting
it could become. I have in no way become addicted
to Vicodin, but I know that the relief that I get
from it has great potential for abuse. So again,
I am very, very careful with it.
Glenn
Posted by petter on June 6, 2001, at 1:16:24
In reply to Re: Codeine for Depression Treatment-It's true, posted by froggy on June 5, 2001, at 5:49:19
> I never really thought about it before but when I was in a bad car accident I had to take 500mg's codine every 4-6 hours and I felt great! I never got too down being in a wheel chair and so much pain.
> Recentley I just started taking vicodin again because I am not completely out of pain. I do like the effects when mixed with an AD.
> Unfortunatley here the doctors think that codine was developed by Satan and to take one is to become a drug addict. I feel like one when tring to find a doctor that will give me a script.
> It is sad what they reduce a person too.H1!
Whatch up for codeine. It can cause treathment resistent depression I have seen this many times in the hospital were I use to work. Tolerans can also occur.
Take care//Petter
Posted by shelliR on June 6, 2001, at 19:32:41
In reply to Re: Codeine for Depression Treatment » Pacha, posted by Elizabeth on June 1, 2001, at 16:18:18
Elizabeth,
Do you know if the same amount of hydrocodone (which has synthetic codeine, right?) and codeine at the same strength have equal effects. Is codeine phosphate the same as codeine? I tried codeine phosphate 8mg , paracetamol 500mg (actually took
1/2 pill as I do with hydrocodone but I'm not sure if it has the same antidepressant effects. I'm having a really awful day (depression -wise). Maybe I took it less than an hour ago, so that's why I am not yet feeling the antidepressant effects, or maybe synthetic codeine has a different feeling than codeine.Thanks, Shelli
Posted by Elizabeth on June 6, 2001, at 20:54:19
In reply to Re: Codeine for Depression Treatment-Elizabeth, posted by AMenz on June 5, 2001, at 11:19:40
> Codeine is supposed to be addictive. I'm already unable to get off a 1mg benzo daily.
In what sense do you have trouble getting off the benzo (Xanax? Klonopin?)? Like, do you feel an urge for it, like you would feel an urge for food after not eating for a while? Do you suffer from rebound anxiety or insomnia or other withdrawal symptoms? (This happens with some antidepressants, like Effexor, Paxil, and Parnate, too, but people who suffer withdrawal symptoms are not considered "addicted" solely by virtue of the withdrawal symptoms. Addiction is understood in terms of craving for a substance.)
> When you say an opioid is it a synthetic or a natural derivative of opium. Better yet since I do not have a science background-what is an opioid agonist, as opposed to an opiate?
"Opioid" or "opioid agonist" refers to a drug that activates opioid receptors; "opioid antagonists" are drugs that block opioid receptors, preventing them from being activated. This is a way of describing a group of drugs based on their effects.
"Opiate" is sometimes used to refer to all opioid agonists, although technically it refers to opium constituents (codeine and morphine, as well as an inactive chemical called thebaine) and chemically close drugs that are derived from them (like hydrocodone, hydromorphone, oxycodone, etc.). This is a way of classifying drugs based on their origin (the opium poppy), or similarity to naturally-occuring chemicals that come from a particular origin.
> What is the action of codeine that it relieves depression and is the effect palliative like, eg. like benzos which wear off quickly and have to be readministered as oppossed to SSRI which and lithium which build up in the bloodstream slowly and take several days to wear off.
The time it takes to reach steady-state levels is not the reason that SSRIs, for example, take a few weeks to work (lithium usually works within a week or two if it's going to work). It has to do with their chronic, rather than direct, effects. Chronic use of opioids or benzodiazepines can cause tolerance to some of their effects (just as you can become tolerant to some of the side effects of antidepressants after using them for a while).
> I'm almost embarassed to write to you because you seem extremely knowledgeable. What is your background, if I may ask?
I don't like to talk about personal stuff on the internet. I'm not a doctor or anything. Please don't be afraid. :-) (Not that you should be afraid of doctors, either. Usually, anyway.)
-elizabeth
Posted by Elizabeth on June 6, 2001, at 21:03:10
In reply to Re: Codeine for Depression Treatment » Elizabeth, posted by shelliR on June 6, 2001, at 19:32:41
> Do you know if the same amount of hydrocodone (which has synthetic codeine, right?) and codeine at the same strength have equal effects.
No ("equipotent" is the word for that). The lowest strength of hydrocodone available in a single pill is 5 mg; the lowest amount of codeine is 15 mg (I think). Codeine is generally weaker than hydrocodone, meaning that hydrocodone is capable of producing greater effects, as well as being more potent (which is just a matter of the effective dose).
> Is codeine phosphate the same as codeine?
It's the salt of codeine that is used clinically. (Some drugs are available as different salts: e.g., lithium carbonate vs. lithium citrate.) Codeine would be the "free base," just as crack is the free base of cocaine hydrochloride.
> 1/2 pill as I do with hydrocodone but I'm not sure if it has the same antidepressant effects.
That's not much codeine, certainly not equivalent to the same dose of hydrocodone.
Don't self-medicate, if you can avoid it. It's a risky thing to do.
-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.