![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 35 to 59 of 121. Go back in thread:
Posted by Mair on November 20, 2001, at 21:28:36
In reply to Re: Methadone for depression (DOSES) » Elizabeth, posted by JahL on November 20, 2001, at 17:56:23
Posted by shelliR on November 21, 2001, at 9:17:39
In reply to Re: Methadone for depression (DOSES) » Elizabeth, posted by JahL on November 20, 2001, at 17:56:23
Hi Jah,
> I have a Q if you don't mind. I know it's all guess work but *what would you consider to be a therapeutic dose of Methadone for an opioid-naive individual*?
>
I started on 10mg of oxycontinue twice a day, when I was fairly opiate-naive, (except for small doses of vicodin). I probably would have started even lower, but the smallest pill is 10mg and it wore off after about
eight hours. I think methodone dosing is 1/3 or less of oxycontin, so I will predict starting dose to be at only about 5mg or 2 1/2 mg twice a day.The meth dose is supposed to last 24 hours, but I could feel a let down in the early evening when I took my second dose. I also woke up with a similar depression as with oxy and had the same pattern of waiting about an hour til it kicked in.
Shelli
Posted by shelliR on November 21, 2001, at 9:53:40
In reply to Re: Morphine for depression » shelliR, posted by Elizabeth on November 19, 2001, at 13:02:38
> > I'm sorry, I got so mixed up. It's methodone he's written the prescription for: methadone 10mg tabs; 4 tabs three times daily.
> That's a **lot** of methadone! Then again it might be the right amount, since you do have some tolerance from taking the oxycodone.
Unfortunately, I have a lot of tolerance, which I was not expecting. And although he wrote 3x a day, he told me to take it only twice. So total of 80mg.
I wouldn't mind taking 10-20mg before bed in order to not wake up depressed. I'm not sure why the effects are not lasting longer--it's supposed to be a 24 hour drug. (Of course oxy was supposed to be 12hr and it lasted 8; but this is an even larger discrepency.) I felt a let down (again in my chest) in the early evening--again after about 8 hours.>
> No, but I bet opioid combinations are often used to control pain for dying patients (cancer, etc.). But methadone binds very tightly to opioid receptors (like buprenorphine, only methadone is a full agonist), and as a result it tends to prevent other opioids from doing anything. (This makes it particularly useful for people with heroin dependence.)So if I'm ever injured or in great pain, they would have to give me more methadone? Oxy or morphine would not be at all effective while I'm on methadone?
>
>.... I suppose you could rationalize your use of it by saying that depression is just emotional pain (and honestly, I don't think that depressive pain and nociceptive pain are all that different).My depression absolutely feels like physical pain.
It's like a huge heavy weight pressing on my chest.
I am in therapy, but working on issues that don't feel related to that pain. More about dissociating, not being able to control bad feelings, etc.
It feels almost identical to my oxy dose; there's a tiny bit of high. Yesterday first I took 30mg and didn't feel as good as with my oxy dose, so I added 10mg. The pills are scored so probably should have started at 35mg twice a day. I am hoping to stay at this dose so I didn't want to start at 35 and have to ask my pdoc to raise to 40 so I would feel a little better. I was scared that I felt too good yesterday: (of course it was a beautiful 70 degree day here and I finally taking a break from work to plant bulbs). But at first on oxycontin I felt too high at the lowest dose, and then of course I got too used to them, and had to go up. My measure of how much to take is the pain/pressure in my chest. Its absence is all I am looking for.
When people are on methadone maintenance, do they generally become habituated to their dose and have to raise it (like my experience on oxycontin), or is it a more stable opiate?I hope you are doing well on your combo.
Shelli
Posted by shelliR on November 21, 2001, at 10:48:47
In reply to Re: Methadone/opiates for depression-shelli, scott, posted by nightlight on November 19, 2001, at 8:05:31
Hi Nightlight,
Sorry it took me so long to respond.> But, I couldn't use it daily, supply and side-effect problems. However, knowing that I wd. have a few days (maybe 8-9) that I wanted to rise from my bed helped me 'go on' & keep the faith that I wd. eventually find what was right for me.
I'm sorry that you have a problem around supply. You say you have two wonderful doctors, so I wonder why you are having a supply problem. Maybe this
is something you can work on with them; let them know. Advocate for yourself as much as possible.
You deserve more than 9 good days.I can't speak to the stimulent problem--why they are not prescribing, but hopefully you'll get that all resolved.
Good luck to you,
Shelli
Posted by Elizabeth on November 21, 2001, at 18:39:53
In reply to Re: Methadone/opiates for depression » Elizabeth, posted by nightlight on November 20, 2001, at 7:54:32
> I used Fiorinal #3-a combo of codeine, butalbital, caffeine and aspirin.
Oh, of course! I got Fioricet (the acetaminophen-containing version) for back pain once. Butalbital (the barbiturate ingredient) is one of only a couple barbiturates that are still used much (phenobarbital is also sometimes used as an anticonvulsant).
I tried taking Fioricet more recently (again, for back pain), but I got *really* depressed, which definitely hadn't happened before. My pdoc thought it might have been an interaction with the desipramine I'm taking.
Did you ever try plain codeine, and if so, do you think that Fiorinal w/codeine was any more or less effective (for pain or for depression) than codeine by itself?
-e
Posted by Elizabeth on November 21, 2001, at 19:25:39
In reply to Re: Methadone for depression. » shelliR, posted by JahL on November 20, 2001, at 17:36:47
> I'll do more than slip it into the conversation...I'm at the stage where I'm not bothered about offending the sensibilities of pdocs.
Hey, you're in the UK, aren't you? So you can get Temgesic? I'm sure I've mentioned before that US doctors are reluctant to prescribe injectable drugs to outpatients (especially psychiatric outpatients, regardless of whether there's any history of drug abuse).
> If you make enough noise the NHS is obliged to continue treating you. However it is often the case that pdocs will tell you (or at least me) "there is nothing further I can do for you", at which point you get referred back to yr regular pdoc (again). Back to square one-stylee.
That's so irritating! You know that what they mean is, "There's nothing further that I'm *willing* to do for you."
> Yeah me too. I would refuse to go to hospital on grounds of principle (it's been offered a few times). NHS='One Flew Over The Cuckoo's Nest' whilst the private clinics seem to farm institutionalised types unable to function in the real world. Sad but true. I'm sure they're [the clinics] a haven for some tho'.
I'm not sure I get what you mean about the private hospitals. Can you rephrase/elaborate?
> Those that would criticise you have the luxury of not going thru what you are.
Isn't that true all too often?
> I don't have to read any text books with you around :-)
Thanks, I think! < g >
> I have a Q if you don't mind.
Of course I don't mind!
> I know it's all guess work but *what would you consider to be a therapeutic dose of Methadone for an opioid-naive individual*?
I don't know much about methadone -- it's used sometimes for pain, but far more for opioid dependence, and the latter always requires shockingly big doses. I happen to know an opioid-naive guy who tried 10 mg (orally) a while back and says he was "better than well" for a full day. (He was also puking his guts out.) The recommended dose for pain, according to the PDR, is 2.5-10 mg every 3-4 hours, so I was surprised that it lasted so long for him. On the other hand, when addicts are treated with it, they usually need only one dose a day. Confusing.
> I tried around 5ml a few times recently.
How many mg/mL?
> Interesting. A bit dreamy in a not unpleasant kinda way. Good sleep. Bad constipation :-(
Sleep? Opioids (not just bupe) keep me awake! The constipation is an unavoidable and heinous problem. Some people also say that methadone makes them sweat a lot. I think that the best opioid, in terms of ease of use and minimal side effects, is Duragesic, the transdermal fentanyl patch (although wearing a patch for three days, which is how long it's supposed to last, sounds like it could get pretty grody).
-elizabeth
Posted by Elizabeth on November 21, 2001, at 19:39:09
In reply to Re: Morphine for depression » Elizabeth, posted by shelliR on November 21, 2001, at 9:53:40
Shelli,
It sounds like you might need to take methadone three times a day. This is typical for pain patients, although MMT patients do generally just need it once a day. I don't know why this should be different, but it is.
Buprenorphine is shorter-acting than methadone, and I consistently wake up depressed, BTW. Since you can sleep on methadone, though, I think you'd have a better time if you took some at bedtime. Let your doctor know about the problems you've been having with dosing frequency -- it seems he's assuming that your needs will be similar to those of an addict, but they're not, obviously. I'm guessing that, in general, the way that you and I are using opioids is more similar to the way that pain patients use them.
> So if I'm ever injured or in great pain, they would have to give me more methadone? Oxy or morphine would not be at all effective while I'm on methadone?
A high enough dose of oxy or morphine would displace the methadone, but it would have to be *very* high.
> My depression absolutely feels like physical pain.
I feel the same, although I can't really relate to the "weight" analogy. Talk therapy doesn't relieve pain, of course.
> When people are on methadone maintenance, do they generally become habituated to their dose and have to raise it (like my experience on oxycontin), or is it a more stable opiate?
Eventually they reach a dose that they can stay at, although it's often very high. They don't feel anything from it except for relief of cravings and other withdrawal symptoms. If they need pain medication, their tolerance prevents normal doses of opioids from working, of course.
-elizabeth
Posted by judy1 on November 22, 2001, at 17:30:18
In reply to Re: Methadone for depression. » JahL, posted by Elizabeth on November 21, 2001, at 19:25:39
I think that the best opioid, in terms of ease of use and minimal side effects, is Duragesic, the transdermal fentanyl patch (although wearing a patch for three days, which is how long it's supposed to last, sounds like it could get pretty grody).
>
> -elizabeth-well I guess 'grody' ;-) isn't exactly the term I use- I just switch from upper arm to upper arm and it leaves behind some adhesive which is kind of fun to pick at. Still tapering down... judy
Posted by judy1 on November 22, 2001, at 17:34:26
In reply to Re: Methadone for depression. » judy1, posted by shelliR on November 18, 2001, at 20:41:53
Hi Shelli
I'm delighted it's working for you. Looking at January for the baby, maybe if I jump up and down I'll get the free diapers for a year :-)- judy
Posted by shelliR on November 23, 2001, at 0:12:47
In reply to Re: Morphine for depression. » shelliR, posted by SLS on November 19, 2001, at 10:59:55
>Hi Scott.
>
>
> How do you deal with the roller-coaster ride every day? It must be difficult to have your state of being be so immediately tethered to a drug? It's not like taking a regular antidepressant where you can miss a few doses or take it at your convenience without feeling significantly worse. I'd be grateful to take it and have it work, though. It must be emotionally taxing just the same.
The roller-coaster ride is only once a day in the morning and I think that would have been finally disappeared. In the beginning oxycontin stimulated me too much to take it at night at all, and then I woke up with horrible depression. Once I had gotten myself up to 1/2 dose at bedtime the magnitude of the depression was lower. I think eventually I could have tolerated a full dose at night and the morning roller coaster would be allievated. The afternoon dose had some overlap, so it was not noticable.I think that methodone may be different in this respect. Once it gets into my body after a few days, it is supposed to last longer, so I may stil have enough of my evening dose still in me to avoid the depression.
As much as I hate waking up depressed in the morning and having to wait for an hour with the depression, I do have to admit that every morning, I had the most wonderful feeling flow through me during the transition. But I am aware that the change in my body is totally connected to a drug (as you stated "tethered to a drug"). This is a bit unsettling, but probably similar to the feeling of waking up with anxiety and waiting for a benzo to work. It is not, as you pointed out, similar to taking a AD,where is easily able to escape taking notice of the cause and effect (depression/pill/lack of depression)
> Do you think nausea or feeling wierd are predictors of non-response? I found something on the Internet that described that most people using methadone for depression begin to experience improvements by the end of the first week. Some took two weeks.Do you remember where you found that on the internet?
I think Elizabeth has more experience with this since she did have to adjust to buprenorphine, while I did not have to adjust at all to vicidin or oxycontin. I loved them both from the first time. .Today was different than yesterday with the methadone--I think although I took the same dose, it may have been too much. I don't feel as good, and I am having difficulty focusing. When I say didn't feel as good, I am not talking about depression, that is gone, but my body doesn't feel as well, and I may try to go down in dose tomrrow. I have to be somewhat more patient; this is a new drug for me. And yes, Elizabeth might be correct concerning a possible need to adjust and that one bad day is not enough to tell.
>
>
> At my last visit, I was happy to see that he was somewhat receptive to the possibility that opioids might be worth considering. I mentioned oxycodone and buprenorphine. I didn't know about methadone at the time.Receptive enough to let you give it a try, or is he still pretty far away from that? If you want to try it you might want to push harder so you can figure out if this guy might really go in that direction. Also, it is still best to stay on an anti-depressant with an opiate to avoid the dramatic ups and downs if possible, and potentially ly cut down on tolerance. (I'm not sure about that one).
Take care,
Shelli
>
>
Posted by SLS on November 23, 2001, at 8:09:48
In reply to Re: Morphine for depression. » SLS, posted by shelliR on November 23, 2001, at 0:12:47
Hi Shelli.
I bet you were more than just pleasantly surprised that methadone quickly picked up where oxycodone left off. No major disruptions in your life. I know that exercising patience is a difficult feat to perform, but I think you'll find your proper dosage quickly.
> > At my last visit, I was happy to see that he was somewhat receptive to the possibility that opioids might be worth considering. I mentioned oxycodone and buprenorphine. I didn't know about methadone at the time.
> Receptive enough to let you give it a try, or is he still pretty far away from that?
I don't think he would be receptive to making an opioid my next trial.
> If you want to try it you might want to push harder so you can figure out if this guy might really go in that direction.
I see him on Monday. Maybe I'll just ask him point-blank if he'd prescribe methadone or some other opioid within the next six months if I were not sufficiently improved by that time. I am truly grateful - as I am sure lots of other people are - that you have allowed us to watch you as you make adjustments to your treatment regime. Thanks.
> Also, it is still best to stay on an anti-depressant with an opiate to avoid the dramatic ups and downs if possible, and potentially ly cut down on tolerance. (I'm not sure about that one).
Did Lamictal smooth-out your mood shifts while you were taking oxycodone? How much Lamictal were you taking?
Keeping my fingers crossed for you... It looks like you're going to have a real Happy New Year afterall. ;-)
- Scott
Posted by nightlight on November 23, 2001, at 8:39:27
In reply to Re: Methadone/opiates for depression-shelli, scott » nightlight, posted by shelliR on November 21, 2001, at 10:48:47
> Hi Nightlight,
>
>
> Sorry it took me so long to respond.
>
>
>
> > But, I couldn't use it daily, supply and side-effect problems. However, knowing that I wd. have a few days (maybe 8-9) that I wanted to rise from my bed helped me 'go on' & keep the faith that I wd. eventually find what was right for me.
>
> I'm sorry that you have a problem around supply. You say you have two wonderful doctors, so I wonder why you are having a supply problem. Maybe this
> is something you can work on with them; let them know. Advocate for yourself as much as possible.
> You deserve more than 9 good days.
>
> I can't speak to the stimulent problem--why they are not prescribing, but hopefully you'll get that all resolved.
>
> Good luck to you,
>
> ShelliHi Shelli~
Couldn't use it daily also due to the fact that side-effects were bothersome-the itchies, dry skin, &....the dreaded constipation.Plus, altho great for pain, and they helped my depression, they did not help my ADD enough (naturally). And, my body/stomach eventually just
said, No More Fiorinal/codeine. They began to make me feel worse.I went into a bad pain flare (supposedly fibro) & I have herniated discs, a bad one at cervical area, so I saw a new doc (referred by my g.p.). He put me on Soma (carisoprodal) and plain old Darvocette 100's. Plus, I take a beta-blocker and klonopin (generic) form. This has been best for my pain. The Soma was key here. A good muscle relaxer (& very few work for me) makes all the difference when one has FMS/ chronic myofascial pain (which is my biggest bug-a-boo, pain-wise, I believe).
Then, I met a great psychologist 2 months ago who sent me to a great shrink and I have been on Adderall (a stim, finally!!!). It brought me out of the deep depression I was in late summer. We are playing w/stim doses, but life is looking better now, and, finally, I have a ray of HOPE...
I'm also on low-dose Zoloft (50mgs.). The Add. was 30 mgs. 2x's a day, but I think I need some tweaking. I will be trying dexedrine this week, if plans progress as they should.nightlight
Posted by nightlight on November 23, 2001, at 8:55:12
In reply to Fiorinal and Fioricet » nightlight, posted by Elizabeth on November 21, 2001, at 18:39:53
> > I used Fiorinal #3-a combo of codeine, butalbital, caffeine and aspirin.
>
> Oh, of course! I got Fioricet (the acetaminophen-containing version) for back pain once. Butalbital (the barbiturate ingredient) is one of only a couple barbiturates that are still used much (phenobarbital is also sometimes used as an anticonvulsant).
>
Elizabeth,
Yes, ya just don't see those bottles of seconal, nembutal, tuinal, etc..... the way u used too! (In the med cabinets of friends parents, grandparents, etc). No "Return to the Valley of the Dolls" for this generation of the perpetually medicated.
> I tried taking Fioricet more recently (again, for back pain), but I got *really* depressed, which definitely hadn't happened before. My pdoc thought it might have been an interaction with the desipramine I'm taking.
>
> Did you ever try plain codeine, and if so, do you think that Fiorinal w/codeine was any more or less effective (for pain or for depression) than codeine by itself?
>
> -ePlain codeine did nothing for my depression, nor did any of the other many painkillers I have used in search of relief from intense cervical pain. Not even the beloved Vicodins from which I have known so many to find tremendous depression relief. ONLY the F#3's for me.
So, I figure, I realy needed the barbiturate for anxiety, and the codeine for 'synergy'. Now, if I had ever taken some other type of opioid/opiate combined with a barbiturate, the effect might have been equally efficacious.
nightlight
Posted by nightlight on November 23, 2001, at 9:06:29
In reply to Re: Methadone/opiates for depression » nightlight, posted by Elizabeth on November 19, 2001, at 17:12:19
>
> > I am now on a very low-dose narcotic, 60 mgs. stimulent, 2 mgs. klonopin and apotent muscle relaxer.
>
> Again...which narcotic and which muscle relaxant, and what are the doses? (just curious)
>
> > I haave only recently been diagnosed ADD w/endogenous depression,
>
> Did the doctor call it "endogenous depression," or was the exact diagnosis something else. I'm curious because "endogenous depression" is an expression that's not used much anymore in psychiatry. Do you live in the USA?
>
> > Stimulents are what I have needed all along, but, couldn't seem to convince docs why (another story).
>
> For me, opioids act like I would expect stimulants to act!
>
> -elizabethDear Elizabeth~
Present regimen:
Darvocette 100-2x's a day
clonazepam 1mg a.m-1mg pm
carisoprodal 350 mgs. prn daily
propanolol 40 mgs. 2 x's a day
Zoloft 50 mgs. nightly
Adderall 30 mgs. a.m. and mid-dayWill answer more about diagnoses later, it's still a bit fuzzy, my therp is not big on labeling, & I am a bit of a 'mix'.
But, pdoc said ADD straight out, altho that may have been in order to get me on the stims I needed immediately and out of the dark hole I was mired in at the time.
More later~
nightlight
Posted by nightlight on November 23, 2001, at 16:33:45
In reply to Re: Methadone/opiates for depression » Elizabeth, posted by nightlight on November 23, 2001, at 9:06:29
Elizabeth~
Darvocette 100-2x's a day
clonazepam 2mgs a day usually am & pm, as needed
propanolol 80mgs a day, 40 in the am the rest prn
carisoprodal 350mgs *3* x's a day, also prn, but usually take at least 2.(Soma-muscle relaxer)
These are rx'd by my g.p.for chronic pain, and I can play with the dosages, depending upon need, up to these designated dosages. Darvocette is a lightweight narcotic, and would not be sufficient in an acute pain phase. But, for now, while pain is on lower end of the scale, I can deal with this small dosage of actual narcotic painkiller..
My pdoc has prescribed:
Adderall (mixed amphetamine salts)30 mgs. 2x's a day
Zoloft 50 mgs nightlyHe is aware of my other meds, of course. I saw him Wed. and mentioned I was STILL fairly useless, brainwise and physically after 2p.m.
So, he is switching me to dexedrine, in 5 mg. tabs, so I can dose more often, as needed, accordingly, and titrate as needed. Don't know what the difference will be, but, for me, the Adderall was a definite improvement, but maybe too subtle. I could take 20-30 mgs. an hour before getting up in the morning, and still sleep thru the alarm sometimes! Now I have 2 alarms.
I had tried ritalin in the past, but HATED it. It did not stimulate anything in me except irritable agitation which lasted about 45 minutes and then I needed a nap & that was only at max daily dosing, otherwise, I was just mean and tired at lower dosing.> > > I am now on a very low-dose narcotic, 60 mgs. stimulent, 2 mgs. klonopin and apotent muscle relaxer.
> >
> > Again...which narcotic and which muscle relaxant, and what are the doses? (just curious)
> >
> > > I haave only recently been diagnosed ADD w/endogenous depression,> > Did the doctor call it "endogenous depression," or was the exact diagnosis something else. I'm curious because "endogenous depression" is an expression that's not used much anymore in psychiatry. Do you live in the USA?
e.~
Yes, 'endogenous', simply, I believe, to let me know that he believed that there was something off-balance in my physical chemistry and had been, for a very long time. He knew that my previous pdoc thought I was experiencing 'situational' depression and dysfunction and that, even tho no A-D's were working for me, (or ever had, in the many years of drug trials), I'd get better when my environment became less stressful.(My father had recently died of a sudden heart attack and my mom was diagnosed w/organic brain syndrome soon after-I was her caregiver and I had a 4-yr old running around-she was a 40th birthday surprise-my only child-and the backpain situation which had forced me to quit work, leaving all financial responsibility to my husband, etc, etc....). It was a plateload, but so is life, and I was depressed when everything around me had been close to perfect. Former p-doc was downright belligerent.I had been ill for years, but just had not been able to convince him of that. I quit him after 6 months. That was one yr. ago.
I've only seen my present therapist twice. But, we covered a lot of ground. He is perceptive, kind, insightful, *happy* and very intelligent, in an unassuming way-a pleasure to 'visit'.
I'm supposed to see him every 3 wks., but the NYC disaster and another event have interfered w/our seeing each other more often.
He says, at this time, no clear-cut diagnosis, except depression, anxiety and God knows what else.
But, was optimistic about the future, as am I.Interestingly, I have found out that propoxyphene, the narcotic componenent of darvocette, is a potentiator of amphetamine. I guess even drugs can get a little help from their friends! (However, this is a characteristic that can be quite dangerous in some situations..)
> > > Stimulents are what I have needed all along, but, couldn't seem to convince docs why (another story).
> >
> > For me, opioids act like I would expect stimulants to act!
> >
> > -elizabethYES! That is how the F#3 affected me, not a downer, but a depression lifter and motivator to work. I could concentrate better and get things accomplished.
nightlight
ps: yes, I do live in the good ol' U. S. of A.
>
> Dear Elizabeth~
>
> Present regimen:
>
> Darvocette 100-2x's a day
> clonazepam 1mg a.m-1mg pm
> carisoprodal 350 mgs. prn daily
> propanolol 40 mgs. 2 x's a day
> Zoloft 50 mgs. nightly
> Adderall 30 mgs. a.m. and mid-day
>
> Will answer more about diagnoses later, it's still a bit fuzzy, my therp is not big on labeling, & I am a bit of a 'mix'.
>
> But, pdoc said ADD straight out, altho that may have been in order to get me on the stims I needed immediately and out of the dark hole I was mired in at the time.
>
> More later~
> nightlight
Posted by Elizabeth on November 23, 2001, at 19:40:05
In reply to Re: Fiorinal and Fioricet, posted by nightlight on November 23, 2001, at 8:55:12
> Yes, ya just don't see those bottles of seconal, nembutal, tuinal, etc..... the way u used too!
I'm afraid that was before my time!
> Plain codeine did nothing for my depression, nor did any of the other many painkillers I have used in search of relief from intense cervical pain. Not even the beloved Vicodins from which I have known so many to find tremendous depression relief. ONLY the F#3's for me.
That's weird. Did you ever take Fiorinal (or Fioricet) without the codiene?
> Darvocette 100-2x's a day
Propoxyphene, the main ingredient in Darvocet, is a *really* weak synthetic opioid. ("Darvocet" is how it's spelled, BTW. The "-cet" ending just means it has Tylenol (aCETaminophen) in it, as with Fioricet -- plain propoxyphene is Darvon.) Propoxyphene is pretty comparable to codeine, in terms of how well it relieves pain, I think (the doses are different, of course).
> carisoprodal 350 mgs. prn daily
Soma is a good muscle relaxant (although not "potent"). I tried this one for back pain ("myofascial pain syndrome") as well as Fioricet; the Soma worked much more reliably.
> propanolol 40 mgs. 2 x's a day
What's this one supposed to be for? I don't think I've ever heard of beta-blockers being used for pain (twice-a-day dosing of propranolol is pretty unusual too).
> Yes, 'endogenous', simply, I believe, to let me know that he believed that there was something off-balance in my physical chemistry and had been, for a very long time. He knew that my previous pdoc thought I was experiencing 'situational' depression and dysfunction and that, even tho no A-D's were working for me, (or ever had, in the many years of drug trials), I'd get better when my environment became less stressful.
Ah. The expression "endogenous depression" is used more in the UK and some other places than here, but the UK definition is different from what your pdoc meant (they use it to mean what DSM-IV calls "major depression with melancholic features" -- helpful to know if you're ever reading European psychiatric literature).
I don't think it's very useful to say that a case of depression is "situational" or "non-situational" since "situational" depression often responds to meds and "non-situational" depression can be very hard to treat (with meds or otherwise). Also the distinction isn't always that clear. (IMO, it usually isn't clear at all.)
-elizabeth
Posted by shelliR on November 23, 2001, at 20:08:47
In reply to Re: Morphine for depression. » shelliR, posted by Lorraine on November 19, 2001, at 9:12:48
Hi Lorraine,
>
>
>... his preference would be for me to try Naltroxone (which I am not wild about because there seems to be little research to support it) and then Methadone.My experience with Naltroxone is that I took it one day and felt awful. It may be one of those one day drugs. If you try it you could potentially feel wonderful in one day also.
It's nice to know that he is thinking this way (and I have been bringing him in articles from time to time--just because that's what I do generally). He's retesting me today with a QEEG to see if he can detect why I am having these sublevel panic attacks and to see if he can figure out why my meds aren't working.
It seems to be that some of your meds were working, but they have too many side effects. Nardil was workng very well; it was the side effects.
His first testing said that amphetamine and mood stabilizer ought to work. I maintain fairly well on Adderall and Neurontin--of course it's only been 10 days since I stopped the Nardil, so I may not have "fallen off the cliff" into depression yet. I maintained well on Adderall and Neurontin during my Parnate washout as well.
Are there any mood stablizers that you haven't tried yet?
Aside from the panic attack stuff, I only seem to be lacking mood support. But I can think and act with just the Adderall and Neurontin. I have more mood lability and I can dip pretty low.
>
> > Is methodone one of the opiates that you are considering? I wish I had more time to read about it. Do you want me to send you the link to the info that I found?That would be great, thanks.
> >
> > Let me know your next strategy. Either the adderall and neurotin are keeping you afloat, or you are the most patient person I know. Maybe bot
ÿI've never been hospitalized. I hate hospitals (bad experiences when a child) plus I have never been suicidal and I think a lot about the impact of my illness on my children so I don't think I'll go that route (on the other hand, that's easy to say as I don't have suicidal ideations as a symptom--the thing that happens is just that all the lights go out in me and I hybernate, slumped in a chair).
Well yes, your depression does not sound as painful as many others have been, at least when you are stable on neurotin and adderall. The same person who would never ever to anything to hurt her children can get stuck in suicidal thinking. And sometime the thinking can get so distorted that she begins to believe that her children would be better off without her.
Sometimes the hospital can just provide an atmosphere where you can be absolutely you for a while, slumped in that chair. I think at times to really act like you feel, releases some of your energy back to you. I used to feel that with my business. If I was here I had to be totally "on" all the time, to go into the hospital gave me a break from responsibility and excuses. During my last short stays, I sort of had the opposite feelings. I didn't want to go to groups and talk about how I felt and how I wanted to change, or make collages about depression in art therapy. I just wanted to find a AD that worked.
Anyway, I am excited that the methodone seems positive (although not perfect) and I find myself looking forward to things that may be around the corner. It would be interesting after all of this searching we both ended up with methodone as the pain mood stabilizer after all these other trials.
Shelli
Posted by Elizabeth on November 23, 2001, at 20:51:25
In reply to Re: Morphine for depression. » Lorraine, posted by shelliR on November 23, 2001, at 20:08:47
> My experience with Naltroxone is that I took it one day and felt awful. It may be one of those one day drugs. If you try it you could potentially feel wonderful in one day also.
FWIW, I've never heard of any depressed person feeling better on naltrexone except for a couple of people who had been taking SSRIs that had pooped out.
-e
Posted by SLS on November 24, 2001, at 8:15:12
In reply to naltrexone » shelliR, posted by Elizabeth on November 23, 2001, at 20:51:25
> > My experience with Naltroxone is that I took it one day and felt awful. It may be one of those one day drugs. If you try it you could potentially feel wonderful in one day also.
>
> FWIW, I've never heard of any depressed person feeling better on naltrexone except for a couple of people who had been taking SSRIs that had pooped out.
>
> -e
One person here described a robust response to naltrexone while taking Nardil.
- Scott
Posted by Elizabeth on November 25, 2001, at 16:10:54
In reply to Re: naltrexone, posted by SLS on November 24, 2001, at 8:15:12
> One person here described a robust response to naltrexone while taking Nardil.
That's interesting. Do you remember any details?
-elizabeth
Posted by nightlight on November 25, 2001, at 16:52:00
In reply to barbs, opioids, etc. » nightlight, posted by Elizabeth on November 23, 2001, at 19:40:05
>
> > Plain codeine did nothing for my depression, nor did any of the other many painkillers I have used in search of relief from intense cervical pain. Not even the beloved Vicodins from which I have known so many to find tremendous depression relief. ONLY the F#3's for me.
> That's weird. Did you ever take Fiorinal (or Fioricet) without the codiene?Elizabeth~
Yes, did not get the same effect, on my pain or depression.
> > Darvocette 100-2x's a day
>
> Propoxyphene, the main ingredient in Darvocet, is a *really* weak synthetic opioid. ("Darvocet" is how it's spelled, BTW. The "-cet" ending just means it has Tylenol (aCETaminophen) in it, as with Fioricet -- plain propoxyphene is Darvon.) Propoxyphene is pretty comparable to codeine, in terms of how well it relieves pain, I think (the doses are different, of course).Propoxyphene napsylate is the main ingredient in Darvocet. (Thanks for the spelling lesson) and propoxyphene hydrochloride is the main ingredient in Darvon. Altho, there is Darvon-N, which is actually propoxyphene napsylate! Darvon 65mgs. is equal in strength to propoxyphene napsylate 100 mgs. Due to that difference (I would think) propoxyphene is considered to be 2/3 to equal the strength of codeine phosphate 30mgs (what u get in Tyl #3, Fiorinal #3, or Fioricet #3).
> > carisoprodal 350 mgs. prn daily
>
> Soma is a good muscle relaxant (although not "potent"). I tried this one for back pain ("myofascial pain syndrome") as well as Fioricet; the Soma worked much more reliably.My description of Soma as potent is strictly empirically based. I tried I had tried Skelaxin, Robaxin, Flexeril & others I cannot remember w/no relief. One doc prescribed finally prescribed clonazepam. Bingo! It worked well for about 2 yrs. I still take it for anxiety and mood regulation, but my myofascial pain got outta hand again. I had asked about soma in the past, but was denied it due to its *supposed* recreational properties. (It had been recommended by ny hairdresser who also had a herniated cervical disc).An ortho finally asked if I had ever tried it, put me on that & the darvocet, and I eased out of a pain flare that had lasted for weeks. I had been taking the Fiorinal #3 but it really had begun to affect me adversely, made me feel worse, like I had more toxins building up in my muscle tissues and more pain.
By the way, what would you consider to be a *potent* muscle relaxer?> > propanolol 40 mgs. 2 x's a day
>
> What's this one supposed to be for? I don't think I've ever heard of beta-blockers being used for pain (twice-a-day dosing of propranolol is pretty unusual too).Why is twice daily dosing unusual? I starting using Inderal/propanolol abbout 4 yrs. ago to helpw/migraine preventio & hypertension that I experienced in the yr. or 2 after my baby was born. I first took 120mgs.extended release once a day. But, my blood pressure was lowish on that, so I went down to 80mgs a day, but,I took it in 2 40mg tabs9immediate release) that were scored. Eventually, my high blood pressure disappeared, don't know why, so now, I only take the propanolol as needed. I can break the tablets easily into 20 or even 10 mgs, as needed. But, some every day. Sometimes only 20 and sometimes up to 80. It is quite good for the squeezing chest pressure I feel when particularly anxious, and if I feel headachey, have visual auras, etc. I use it to help w/potential migraine.
> > Yes, 'endogenous', simply, I believe, to let me know that he believed that there was something off-balance in my physical chemistry and had been, for a very long time. He knew that my previous pdoc thought I was experiencing 'situational' depression and dysfunction and that, even tho no A-D's were working for me, (or ever had, in the many years of drug trials), I'd get better when my environment became less stressful.
>
> Ah. The expression "endogenous depression" is used more in the UK and some other places than here, but the UK definition is different from what your pdoc meant (they use it to mean what DSM-IV calls "major depression with melancholic features" -- helpful to know if you're ever reading European psychiatric literature).I have not delved much into the DSM-IV, I've had way too little free time in the past few yrs., so my grasp of psychiatric argot is weak. I want to learn a lot more. You must be educated in order to be an activist for and protector of your own body/brain and it's 'idiosyncracies' (to put it benignly).
> I don't think it's very useful to say that a case of depression is "situational" or "non-situational" since "situational" depression often responds to meds and "non-situational" depression can be very hard to treat (with meds or otherwise).And, I have read some articles that say otherwise, that they both respond almost equally well to medication (and time). Weird.
Also the distinction isn't always that clear. (IMO, it usually isn't clear at all.)
I have to agree w/you there! Thanks for your response.
nightlight
Posted by Lorraine on November 25, 2001, at 19:31:49
In reply to Re: Morphine for depression. » Lorraine, posted by shelliR on November 23, 2001, at 20:08:47
Shelli:
I am so glad that the Methadone seems to be helping you. What a long struggle you've had; it would be nice if this piece of the puzzle was solid. The site that I referred to that has a lot of stuff on Methadone is this one:
http://www.addict.f2s.com/sitecontents.html
> > He's retesting me today with a QEEG to see if he can detect why I am having these sublevel panic attacks and to see if he can figure out why my meds aren't working.
My redone QEEG confirms pretty much his earlier assessment--that amphetamine and mood stabilizer are the ticket, but that Adderall is not doing the job. So he switched me to ritalin (I've tried dexidrine before). My initial reaction was increased anxiety, but I cut the dose down to 1/4 of a 10 mg tab 4x a day and that helps. I suspect we are going to try Ritalin SR next. He says the amplitude (or voltage) of alpha waves is low--to him this suggests amphetamines. We did a hyperventilating QEEG also, which showed that when I hyperventilate my voltage goes even lower (it should go higher), which he said indicates that under stress I have no power (voltage) to cope--which certainly is true. It is also true that I feel as though I am always trying to manage my power or energy level.
Meanwhile, my alternative medicine doctor tested my amino acid levels and found low levels of several that are implicated with depression (methionine, phenylalinine, tryptophan, tyrosine, and glutamine) so a custom blend of amino acids reflecting my test results is being made. I will try these for 2 months to see if there is any improvement. I have tried a number of these individually, but she believes it is the combination that is important.
>
> >It seems to be that some of your meds were working, but they have too many side effects. Nardil was workng very well; it was the side effects.You are right. I am making up a chart showing meds tried and whether they were abandoned because I had only a partial response to them or because of side effects.
depression yet. I maintained well on Adderall and Neurontin during my Parnate washout as well.
> > Are there any mood stablizers that you haven't tried yet?Yes, I haven't tried Lithium, Tegretol or Topamax.
>> > > Let me know your next strategy. Either the adderall and neurotin are keeping you afloat, or you are the most patient person I know. Maybe both
I don't know, Shelli, you seem pretty patient to me:-)
> > Well yes, your depression does not sound as painful as many others have been, at least when you are stable on neurotin and adderall. The same person who would never ever to anything to hurt her children can get stuck in suicidal thinking. And sometime the thinking can get so distorted that she begins to believe that her children would be better off without her.
Well, I've certainly thought this before, but I've never acted on it. And, I don't seem to ruminate about it generally. I get the sense some people ruminate about it alot and that some people feel compelled to act on the thought--like maybe these things are different parts of the problem. I think that I think about suicide like someone with MS or some other chronic illness might think about it (this can't be solved, it's no use, i'm just a burden on everyone, they'd be better off without me) and it's worse when I am down. I just know that for some people this is a much tougher problem that can't be thought out of or that feels like it can't be waited out.
>
> Sometimes the hospital can just provide an atmosphere where you can be absolutely you for a while, slumped in that chair. I think at times to really act like you feel, releases some of your energy back to you. I used to feel that with my business. If I was here I had to be totally "on" all the time, to go into the hospital gave me a break from responsibility and excuses.I can really see the appeal to this, Shelli. Family expectations of performance go up when my mood stabilizes and then when my mood falls apart, don't adjust back down, which makes it hard.
>
> Anyway, I am excited that the methodone seems positive (although not perfect) and I find myself looking forward to things that may be around the corner. It would be interesting after all of this searching we both ended up with methodone as the pain mood stabilizer after all these other trials.It would be pretty funny if all roads did lead to Rome for both of our depressions. I'm glad that you have something that is working for you, that your transition wasn't that bad and that the price is right.
Lorraine
Posted by shelliR on November 28, 2001, at 0:02:48
In reply to Re: Morphine for depression. » shelliR, posted by Lorraine on November 25, 2001, at 19:31:49
Lorraine
>
>
>
> > > He's retesting me today with a QEEG to see if he can detect why I am having these sublevel panic attacks and to see if he can figure out why my meds aren't working.Is this paragraph below about the retest the same day, or is this from your last test?
> My redone QEEG confirms pretty much his earlier assessment--that amphetamine and mood stabilizer are the ticket, but that Adderall is not doing the job. So he switched me to ritalin (I've tried dexidrine before). My initial reaction was increased anxiety, but I cut the dose down to 1/4 of a 10 mg tab 4x a day and that helps. I suspect we are going to try Ritalin SR next. He says the amplitude (or voltage) of alpha waves is low--to him this suggests amphetamines. We did a hyperventilating QEEG also, which showed that when I hyperventilate my voltage goes even lower (it should go higher), which he said indicates that under stress I have no power (voltage) to cope--which certainly is true. It is also true that I feel as though I am always trying to manage my power or energy level.I don't know the difference between concerta and ritalin SR. Both are long-lasting ritalin.
>
> Meanwhile, my alternative medicine doctor tested my amino acid levels and found low levels of several that are implicated with depression (methionine, phenylalinine, tryptophan, tyrosine, and glutamine) so a custom blend of amino acids reflecting my test results is being made. I will try these for 2 months to see if there is any improvement. I have tried a number of these individually, but she believes it is the combination that is important.
>
> >
How does your pdoc feel about changing things from your alternative doctor; he doesn't worry that a change of enzymes might affect his tests and sort of muddy the field?> > >It seems to be that some of your meds were working, but they have too many side effects. Nardil was workng very well; it was the side effects.
>
> You are right. I am making up a chart showing meds tried and whether they were abandoned because I had only a partial response to them or because of side effects.
> depression yet. I maintained well on Adderall and Neurontin during my Parnate washout as well.
>
>
> > > Are there any mood stablizers that you haven't tried yet?
>
> Yes, I haven't tried Lithium, Tegretol or Topamax.I did a long trial of Topomax, because at the time I was working with a pdoc who believed in long trials. I pretty much sleep six weeks of my life away, some of it in the hospital. They kept making me get up to go to these stupid groups and I just couldn't stay up. I had to take a 2 hour nap before gropup therapy to get through it.It reminded me of when I used to work in a psychiatric hospital when I first go out of college. It was a heavy duty unit (called intensive care) and they'd give some of these patients enormous amounts of anti-psychotics, then yell at them because they were not paricipating in the group. i gave them credit for even making it to the groups.
> >
>
> > > > Let me know your next strategy. Either the adderall and neurotin are keeping you afloat, or you are the most patient person I know. Maybe both
>
> I don't know, Shelli, you seem pretty patient to me:-)Well, sort of what choice do we have? Although I was quite ready to try opiates before anyone gave it to me because my depression was so painful, sometimes unbearable. It's always hard for me to explain why it is unbearable . And I don't even know what's exactly happening. Like where the hurt eminated from, except from my chest.
>
> > > Well yes, your depression does not sound as painful as many others have been, at least when you are stable on neurotin and adderall. The same person who would never ever to anything to hurt her children can get stuck in suicidal thinking. And sometime the thinking can get so distorted that she begins to believe that her children would be better off without her.
>
> Well, I've certainly thought this before, but I've never acted on it. And, I don't seem to ruminate about it generally. I get the sense some people ruminate about it alot and that some people feel compelled to act on the thought--like maybe these things are different parts of the problem. I think that I think about suicide like someone with MS or some other chronic illness might think about it (this can't be solved, it's no use, i'm just a burden on everyone, they'd be better off without me) and it's worse when I am down. I just know that for some people this is a much tougher problem that can't be thought out of or that feels like it can't be waited out.Before the codeine, I was in the worst place really stuck. Actually, it was when I was already on the oxy and bit stopped working and I didn't think my pdoc would raise it again. I was in horrible pain and I knew I absolutely couldn't kill myself because it would totally mess up the rest of their lives. I can't believe I actually called them and asked them if I could kill myself. It was probably the stupidest thing I ever did because of course I knew what they would say and I also made them feel so bad. And so I couldn't live and I couldn't die. I felt that at least if I went into the hospital no one could be mad at me for not finishing their work. But I really didn't want to go. Then my pdoc increased my dose and things were okay again.
That's why my pdocs threats are so scary to me; I can't control when I reach the end of the helpfulness of a dose.> >
> > Sometimes the hospital can just provide an atmosphere where you can be absolutely you for a while, slumped in that chair. I think at times to really act like you feel, releases some of your energy back to you. I used to feel that with my business. If I was here I had to be totally "on" all the time, to go into the hospital gave me a break from responsibility and excuses.
>
> I can really see the appeal to this, Shelli. Family expectations of performance go up when my mood stabilizes and then when my mood falls apart, don't adjust back down, which makes it hard.Can your family always tell when you're depressed? Is there that big a difference in your behavior toawrd everyone?
>
> >
> > Anyway, I am excited that the methodone seems positive (although not perfect) and I find myself looking forward to things that may be around the corner. It would be interesting after all of this searching we both ended up with methodone as the pain mood stabilizer after all these other trials.Now I am less excited. I want to go back on oxy I think, and I just never know when I'll reach the end of effectiveness. But thers's really no point in not living in the now. I can't control what happens with my body chemistry.
>
> It would be pretty funny if all roads did lead to Rome for both of our depressions. I'm glad that you have something that is working for you, that your transition wasn't that bad and that the price is right.
>
shelli
Posted by Elizabeth on November 28, 2001, at 15:58:17
In reply to Re: barbs, opioids, etc. » Elizabeth, posted by nightlight on November 25, 2001, at 16:52:00
> Propoxyphene napsylate is the main ingredient in Darvocet. (Thanks for the spelling lesson)
And thank *you* for the propoxyphene salts lesson! :-)
> My description of Soma as potent is strictly empirically based.
"Potent" just means that it works in low doses (it's a relevant thing, of course). I usually find that 700 mg of carisoprodol is optimal for my back pain. Compared with, say, 0.3 mg of buprenorphine, that seems like a lot. < g >
> I tried I had tried Skelaxin, Robaxin, Flexeril & others I cannot remember w/no relief.
Those are what I call "fake muscle relaxants" -- the only reason they seem to work at all is because they're sedating (I think they're all antihistamines and/or anticholinergics). Flexeril, for example, is similar to amitriptyline, which works for neuropathic pain but not for musculoskeletal pain.
> One doc prescribed finally prescribed clonazepam. Bingo! It worked well for about 2 yrs. I still take it for anxiety and mood regulation, but my myofascial pain got outta hand again.
Yeah, I've tried using various benzos as muscle relaxants too. Valium worked pretty well the first few times I took it but now it doesn't work at all. (I tried up to 40 mg -- nothing.) I wasn't taking it regularly -- not every day or even every week, just every once in a while. I think that with benzos, as with most of the drugs marketed as muscle relaxants, a lot of the apparent effect is due to sedation.
> I had asked about soma in the past, but was denied it due to its *supposed* recreational properties.
It's related to meprobamate (Miltown, the benzos' predecessor) and I think a small amount is metabolized to meprobamate. Meprobamate was supposed to be a bit of a party drug (compared with the benzos, anyway) and I guess some people get a kick out of Soma too. (It's definitely not something you should take if you're planning on drinking or operating heavy machinery, anyway.) Glad you were able to get it. I always feel like doctors are playing games trying to see if I'm a "drug seeker," so when they recommend something that I know won't work initially, I just go ahead and give it a try. (In this case, I had to take baclofen for a month before I was able to get Soma. Then the doctor in question wrote a script for me to take Soma 3 times a day, which is much more than I use it in real life.)
> I had been taking the Fiorinal #3 but it really had begun to affect me adversely, made me feel worse, like I had more toxins building up in my muscle tissues and more pain.
I know the feeling.
> By the way, what would you consider to be a *potent* muscle relaxer?
Hmm. Well, barbiturates are usually effective at around 100 mg, but I wouldn't count that as much more potent than the typical 350 mg dose of Soma (same order of magnitude). Valium, with doses starting at 5 mg, would be considered more potent. Even Valium is considered "low potency" for a benzo, though. Potency isn't generally the most relevant characteristic to consider when you're picking out a med, IMO.
> Why is twice daily dosing unusual?
I was wrong about that, sorry. I was thinking of something else. Propranolol is usually given 2-3 times daily.
I seem to recall that it's not all that unusual for women to develop hypertension when they're pregnant. I don't know why, though -- you might ask your doctor about it if you're planning on having any more kids.
> It is quite good for the squeezing chest pressure I feel when particularly anxious, and if I feel headachey, have visual auras, etc. I use it to help w/potential migraine.
It's effective for preventing migraines and also, often, for the peripheral manifestations of anxiety, like chest pain, shakes, tachycardia, etc. (I use it for essential tremor. Good stuff.)
> I have not delved much into the DSM-IV, I've had way too little free time in the past few yrs., so my grasp of psychiatric argot is weak.
"Endogenous depression" isn't used in DSM-IV anyway.
> And, I have read some articles that say otherwise, that they both respond almost equally well to medication (and time). Weird.
Yes, that's true. You can try to label someone "situationally" or "nonsituationally" depressed, but it isn't much of a predictor of how they will respond to treatment.
-elizabeth
Posted by Elizabeth on November 28, 2001, at 16:06:52
In reply to Re: Morphine for depression. » Lorraine, posted by shelliR on November 28, 2001, at 0:02:48
> I don't know the difference between concerta and ritalin SR. Both are long-lasting ritalin.
They use different controlled-release technologies. Concerta is supposed to be better (i.e., lasts longer).
> Can your family always tell when you're depressed? Is there that big a difference in your behavior toawrd everyone?
You make it sound like you can usually "fake it." Can you? I can up to a point, but when the depression gets really bad, I can't really hide it (and often I don't even care about hiding it by the time it's that bad).
-elizabeth
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