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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by linkadge on July 1, 2003, at 19:08:02
??
Linkadge
Posted by Caleb462 on July 1, 2003, at 22:03:34
In reply to Are opiates antimanic ???, posted by linkadge on July 1, 2003, at 19:08:02
VERY interesting question. I really don't know, and I don't believe any studies have been done - though I could be wrong. I have a bit of an unhealthy infatuation with opiates/opiods, and having experienced there effects many times - I would assume that in most cases, no, they would not be anti-manic.
They DO suppress cortisol release, but they also inhibit GABA in certain ares of the brain in order to induce dopamine release. Opiods are considered depressants, yes, but they can have excitatory effects. I generally experience what I would call "stimulating relaxation" from them.
Posted by jonh kimble on July 2, 2003, at 0:13:26
In reply to Re: Are opiates antimanic ???, posted by Caleb462 on July 1, 2003, at 22:03:34
im sorry i cant answer your question, i have never taken any opioids, but i would be interested in talking about the potential of opiods in psychiatric use. are there any opiods that can be used long term or any on the horizon that any body knows about? thanks
Posted by Caleb462 on July 2, 2003, at 2:20:28
In reply to Re: opiates, posted by jonh kimble on July 2, 2003, at 0:13:26
> im sorry i cant answer your question, i have never taken any opioids, but i would be interested in talking about the potential of opiods in psychiatric use. are there any opiods that can be used long term or any on the horizon that any body knows about? thanks
There are some doctors, though probably quite rare, who are willing to prescribe opiods for psych. problems. Buprenorphine, I think, is the one most talked about in conjunction with treating depression.
I certainly believe the endogenous opiod system should be heavily studied in regards to psychiatric disorders and treatment. Mu-agonists will likely never be an accepted treatment for depression (mu-agonists are chemicals such as morphine, hydrocodone, oxycodone, fentanyl, etc - all the pain killers). However, things like delta-receptor agonists, kappa-receptor antagonists, and enkephalinase inhibitors (enkephalinase is a substance that degrades the endogenous opiods, basically the MAO of the opiod system) could be great things for depression. Unfortunately, it may be some time, if ever, before any of these type of drugs hit the market.
Posted by judy1 on July 2, 2003, at 11:30:06
In reply to Are opiates antimanic ???, posted by linkadge on July 1, 2003, at 19:08:02
In my case no. They are however very effective anti-depressants and I wish more docs would prescribe them for treatment resistant cases.
take care, judy
Posted by Barbara Cat on July 2, 2003, at 14:54:01
In reply to Are opiates antimanic ???, posted by linkadge on July 1, 2003, at 19:08:02
Opiods and wine trigger a jagged hypomania for me. I get loads of energy and focus. I get a stimulating effect from all opiods and a paradoxical reaction to most other drugs, which might be a quirk of my HPA-axis and cortisol dysreguation.
My question is this. I have fibromyalgia and will take about 10mg oxycodone or hydrocodone infrequently during a bad fibro day. I've also drank wine the same day. I know, I know. No need to lecture me on the dangers of this combo. This is not alot of substances I'm talking about. Just 1 glass of wine 4 hours after taking the opiod. However, the next day after I combine any opiods and wine I am ALWAYS burnt out, wiped out, depressed, jangled, singed.
What is going on with these substances? What neurochemistry do opiods/alcohol effect? Dopamine production/inhibition leading to endorphin dump and depletion? Almost like a cocaine, amphetamine surge. Reactive hypoglycemia caused by simple carbs leading to adrendal/cortisol stress? I understand how this could be a factor with alcohol, but it's a problem only when combined with opiods. How do they potentiated each other?
If I just take opiods I get energized and focussed, but if I add that wine I want to clean house and dance all night and then can't fall asleep. Taken separately is usually no problem, but the combo puts me into rev mode and I pay for days.
Again, I know this is a bad combination but I've been lately noticing these ideosyncracies. It can lift a depression immediately but only temporarily. My wires are getting stripped and I want to know what's going on physically & neurologically. BarbaraCat
Posted by Caleb462 on July 3, 2003, at 2:21:15
In reply to Opiates/alcohol burning questions » linkadge, posted by Barbara Cat on July 2, 2003, at 14:54:01
> Opiods and wine trigger a jagged hypomania for me. I get loads of energy and focus. I get a stimulating effect from all opiods and a paradoxical reaction to most other drugs, which might be a quirk of my HPA-axis and cortisol dysreguation.
>
> My question is this. I have fibromyalgia and will take about 10mg oxycodone or hydrocodone infrequently during a bad fibro day. I've also drank wine the same day. I know, I know. No need to lecture me on the dangers of this combo. This is not alot of substances I'm talking about. Just 1 glass of wine 4 hours after taking the opiod. However, the next day after I combine any opiods and wine I am ALWAYS burnt out, wiped out, depressed, jangled, singed.
>
> What is going on with these substances? What neurochemistry do opiods/alcohol effect? Dopamine production/inhibition leading to endorphin dump and depletion? Almost like a cocaine, amphetamine surge. Reactive hypoglycemia caused by simple carbs leading to adrendal/cortisol stress? I understand how this could be a factor with alcohol, but it's a problem only when combined with opiods. How do they potentiated each other?
>
> If I just take opiods I get energized and focussed, but if I add that wine I want to clean house and dance all night and then can't fall asleep. Taken separately is usually no problem, but the combo puts me into rev mode and I pay for days.
>
> Again, I know this is a bad combination but I've been lately noticing these ideosyncracies. It can lift a depression immediately but only temporarily. My wires are getting stripped and I want to know what's going on physically & neurologically. BarbaraCat
>The only thing I can really think of is temporary dopamine depletion, caused by the combined dopamine releases from both alcohol and oxycodone.
I'll post more if I think of anything else, come upon anything else.
Also, 10 mg of oxycodone and 1 glass of wine is not a particularly dangerous combo at all. If the doses were higher, then sure.. but that's really nothing to worry about.
Posted by maryhelen on July 3, 2003, at 11:17:03
In reply to Re: Opiates/alcohol burning questions, posted by Caleb462 on July 3, 2003, at 2:21:15
I cannot speak in the same terms as most posters with the incredible knowledge of receptors, neurostransmiters, etc. etc. etc. I selfishly take the knowledge and very much appreciate it.
So simply stated, I always wished that the drug companies, scientists, whomever, could somehow find a way to get the same affect with opiods/opiates without the possibility of addiction.
I became addicted to my pain medications, over the years, as I treated my migraines, back pain, etc. However, I slowly came to realize that these very pills were keeping my depression at bay. Coming off them was the hardest thing I had to do. I needed more and more for the same affect, but will never apologize, because as the depression got worse, I would have committed suicide without the relief I got from them.
I am pretty sure that is what scares doctors into prescribing them. They are terrified that many will get addicted. For those who could control the intake, I wish there was a way to know, and therefore, get the benefits from them that you need.
maryhelen
Posted by Barbara Cat on July 3, 2003, at 13:14:50
In reply to Re: Opiates/alcohol burning questions, posted by Caleb462 on July 3, 2003, at 2:21:15
Thanks Caleb. I appreciate your very informed and helpful posts. I too think it's a dopamine surge and depletion, but why my body is so sensitive to this makes me wonder. Is there something out of whack with my dopaminergic system. Too little dopamine in the neuron vesicles and too many receptors at the receiving end? So perhaps the dopamine that gets released depletes the store, and then the dopamine in the synaptic cleft is stimulating the plethora of receptors into overdrive. But you'd think that the receptors would get the idea that there's not enough to go around and the excess would eventually die off.
All of my meds target NE and Serotonin, but nothing acts on dopamine. You'd think, however, that if I had a deficiency of dopamine that I'd have Parkinson's, or other extrapyramidal symptoms, and I don't. If anything comes to mind about this I'd appreciate your thoughts. - BarbaraCat
Posted by Barbara Cat on July 3, 2003, at 13:37:47
In reply to Re: Opiates/alcohol burning questions, posted by maryhelen on July 3, 2003, at 11:17:03
I agree, Maryhelen. Opiates definitely lift a depression. I have never done anything like heroin, but I've heard from people who have that the feeling they get is like being wrapped in a warm fuzzy blanket and held in the arms of the Mother. The feeling is a very spiritual one, like all is well in a loving universe. A very hard thing to give up, especially when it means you have to return to this painful and harsh existence.
I can't say that I've ever been 'addicted' to them, except that for a number of years I'd have 1/2 a vicodin every night. It would smooth out my evening and give me a pleasant lift to make the dinner and do something. Instead of coming home from my stressful work day and plopping onto the couch if I didn't have my 'lift'.
I agree about finding something that creates that mild euphoria without being harmful. I think it's called 'exercise'. I dragged my fanny out of bed this morning - even though I'm going through a massive fibromyalgia flare - and took a walk. My first 100 years or so were hobbling, but then the lift came and I ended up walking a few miles, feeling great. I know this very well, but still, in the middle of a black depresssion I simply do not want to do anything and exercise usually doesn't even work. Everything feels disordered and I end up sobbing in a heap during my walk. I really don't want my neighbors to know this much about me.
What kind of opiates were you taking? How did you feel on them? How did you manage to kick the addiction? What are your thoughts on the opiates exacerbating your depression even though they kept it from overwhelming you? Could the depression be part of the withdrawal? - Barbara
> I cannot speak in the same terms as most posters with the incredible knowledge of receptors, neurostransmiters, etc. etc. etc. I selfishly take the knowledge and very much appreciate it.
>
> So simply stated, I always wished that the drug companies, scientists, whomever, could somehow find a way to get the same affect with opiods/opiates without the possibility of addiction.
>
> I became addicted to my pain medications, over the years, as I treated my migraines, back pain, etc. However, I slowly came to realize that these very pills were keeping my depression at bay. Coming off them was the hardest thing I had to do. I needed more and more for the same affect, but will never apologize, because as the depression got worse, I would have committed suicide without the relief I got from them.
>
> I am pretty sure that is what scares doctors into prescribing them. They are terrified that many will get addicted. For those who could control the intake, I wish there was a way to know, and therefore, get the benefits from them that you need.
>
> maryhelen
Posted by Rainee on July 5, 2003, at 13:25:17
In reply to Re: Opiates/alcohol burning questions » maryhelen, posted by Barbara Cat on July 3, 2003, at 13:37:47
All I've got to say is when I take just a small amount of a painkiller I feel so good, I can get so much done. it's a shame it'a addictive. sometimes I wish I could surgery just so i'd get some percocet..lol
Rainee
Posted by the blue professor on July 7, 2003, at 2:03:14
In reply to Re: Opiates/alcohol burning questions, posted by Rainee on July 5, 2003, at 13:25:17
Just commenting on the thread. I am a chronic pain sufferer and take 40mg of hydrocodone per day (lortab 10/500 qid). I get no antidepressive effect from it. I feel better if I can go as long a possible without taking it. It is a good pain killer, however, and I am able to continue to hold a full time faculty position. I definitely would be unable to work without it.
I have been taking opiods regularly since 1984. Until about two years ago I used OxyContin, but there was such an uproar about it that I decided to switch off. I may switch back before long since it is safer for long-term use.
Opiods are very safe and effective when carefully used by responsible people. They can be deadly if used irresponsibly. I have had five students and former students that have died from overdose (or mixing with other drugs/alcohol) of prescription painkillers.
As to the reason why physicians are reluctant prescribe them, I do not think it has anything to do with their 'addictive' properties. Amphetamines, barbituates and narcotics used to be prescribed by the ton before they became regulated so tightly. I remember back in the late sixties/early seventies when every other person was taking a diet pill called Obedrin LA. Its main ingredient was methedrine.
I would say that the main reason that drugs like these and the opiods are so hard to obtain now is fear of the DEA. They really come down hard on doctors if there is even a suspicion that they are prescribing too many scheduled drugs. I guess about everyone here knows about that.
Also, this is the age of litigation. Many people are looking for every excuse they can find to file a lawsuit. Sometimes they are justified, but often people are just looking for easy money or a way to put responsibility on someone else for their own actions. Lately, many have sued physicians for getting them 'addicted' to drugs like OxyContin. They claim that they didn't know that it could be habit forming. Sure.
Anyway, as to whether an opiod can be used as an effective antidepressent - I just don't know. Maybe in the short term, but the mood elevating side effect will go away and require higher doses to sustain. This is what turns a dependency into an addiction.
This is the end of the thread.
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