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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by jerrympls on January 10, 2005, at 19:46:03
So, my pdoc and I had a couple plans:
PLAN A: Add metyrapone to Lexapro (as per recent studies) to see if it would help.
PLAN B: If plan A failed, then augment with an opiate.
Well, unfortunately - and somewhat fortunately - Novartis will only dispense Metyrapone to those with Cushing's despite recent studies finding it helps with depression. So, my pdoc said "Let's go to Plan B."
So, after providing him all I could find on the use of opiates for depression and after his own research he agreed to do a "trial" of the addition of an opiate to my current cocktail. Of course we went over all the precautions, etc and made a "contract" of sorts as far as a) seeing each other weekly, b) dosage range c) watch for tolerance, etc....and some other details.
So tomorrow I start Oxycodone CR (Oxycontin 10mg) once daily.
I'm happy that I have a doc who would even consider this none the less actually DO it. All I've been aslking for is a fair trial on an opiate for my TRD - and if it doesn't work or poops out in a week - then I guess we move on to something else. But I'm glad to be able to try it. Hopefully it will work long-term and I won't have problems with tolerance (as some studies have shown).
So, if anyone's interested I'll keep posting my progress??
Jerry
Posted by lunesta on January 10, 2005, at 19:55:31
In reply to The Opiate Trials, posted by jerrympls on January 10, 2005, at 19:46:03
Opiates will usually make anyone happy, especially Oxycontin. Enjoy my friend, but be aware of addiction if you ever need to withdraw.
Some of the population also gets neasua and vomiting from opiates unfortunatly, its usually genetic, but the synthetics are usually tolerated.
Also, Be prepared for diarreha. I would buy a supplement of magnesium sulphate to take to get your bowels moving once the constipation kicks in :)Seriously though, I dont know of anyone who is depressed while on an opiate.
lunesta.
Posted by jerrympls on January 10, 2005, at 20:10:47
In reply to Re: The Opiate Trials » jerrympls, posted by lunesta on January 10, 2005, at 19:55:31
Thanks for the info lunesta. Yes, I'm aware of addiction, etc and my doctor an I talked about it at length. I know opiates are automatic feel good pills - but after reading the research done on patients with treatment-resistant depression my doc was "pleased." Yes I do worry about things in the long-term - but right now my only ohter option is brain surgery.
Again - thanks and I'll keep you all posted.
Jerry :-)
Posted by CareBear04 on January 10, 2005, at 22:30:18
In reply to Re: The Opiate Trials » lunesta, posted by jerrympls on January 10, 2005, at 20:10:47
hey jerry,
funny, i've never heard of opiates for depression. regarding diarrhea-- i think narcotic painkillers are known for constipation and backing you up, not the opposite.
about the depression-- maybe i'm just weird, but when i was put on painkillers in the fall, my mood plummeted faster than ever before. i'm diagnosed as BP II and i was without mood stabilzier coverage, so that contributed, but vicodin, darvocet, and percocet (same oxycodone as oxycontin) made me really suicidal really fast.
i hope opiates work better for you, and i'm really curious as to how you fare. keep posting!
Posted by jujube on January 10, 2005, at 23:37:01
In reply to The Opiate Trials, posted by jerrympls on January 10, 2005, at 19:46:03
Jerry,
I am so happy that you have found a pdoc that is listening to and working with you to try to put in place an effective treatment plan. It must be such a relief to you after struggling for so long. You sound more optimitic than you have in a while, and it is so nice to hear that sense of optimism in your post.
I would be very interested in hearing about your progress.
Good luck to you Jerry. Take good care.
Tamara
> So, my pdoc and I had a couple plans:
>
> PLAN A: Add metyrapone to Lexapro (as per recent studies) to see if it would help.
>
> PLAN B: If plan A failed, then augment with an opiate.
>
> Well, unfortunately - and somewhat fortunately - Novartis will only dispense Metyrapone to those with Cushing's despite recent studies finding it helps with depression. So, my pdoc said "Let's go to Plan B."
>
> So, after providing him all I could find on the use of opiates for depression and after his own research he agreed to do a "trial" of the addition of an opiate to my current cocktail. Of course we went over all the precautions, etc and made a "contract" of sorts as far as a) seeing each other weekly, b) dosage range c) watch for tolerance, etc....and some other details.
>
> So tomorrow I start Oxycodone CR (Oxycontin 10mg) once daily.
>
> I'm happy that I have a doc who would even consider this none the less actually DO it. All I've been aslking for is a fair trial on an opiate for my TRD - and if it doesn't work or poops out in a week - then I guess we move on to something else. But I'm glad to be able to try it. Hopefully it will work long-term and I won't have problems with tolerance (as some studies have shown).
>
> So, if anyone's interested I'll keep posting my progress??
>
> Jerry
Posted by sgoose on January 11, 2005, at 4:07:48
In reply to The Opiate Trials, posted by jerrympls on January 10, 2005, at 19:46:03
jerry keep us posted. i am completely supportive of what you are doing and wish i could find a doctor who would give me the choice of opiates for my TRD. I have chronic pain problems and TRD. Never been rx'd an opiate. I'm also a male in my mid twenties but i have no past drug/alcohol problems and been off and on schedule II meds for years. when i did get vicodin for an infection caused by mononeucleosis it changed my world for a few months...the "come down" was nothing but my depression resurfacing and no worse, except for the fact that i had finally found out what it felt like to feel better..........
hope it works out for you! -keep posting.
Posted by Wildman on January 11, 2005, at 5:24:48
In reply to Re: The Opiate Trials, posted by sgoose on January 11, 2005, at 4:07:48
I am amazed that a pdoc is going along with this! Congratulations for finding someone who is more interested in helping you than worrying about all the baggage that goes along with opioids.
You are taking Oxycodone CR 10mg per day? Let's see, that's 10mg over 12 hours or so? That should definitely help your mood.
I, too, augment my meds with the occasional opioid - but I do not have a prescription. Percacet 5 mg 2x/day is what helps me. No "buzz", just a bit of a boost. I only wish that this route was supported by my pdoc. He knows about my "supplementation" and doesn't support it, but also recognizes that this is a small amount and that one needs to be responsible with the stuff.
Wildman
Posted by SLS on January 11, 2005, at 6:58:29
In reply to The Opiate Trials, posted by jerrympls on January 10, 2005, at 19:46:03
> Well, unfortunately - and somewhat fortunately - Novartis will only dispense Metyrapone to those with Cushing's despite recent studies finding it helps with depression.
Hi Jerry.
Who did you speak to at Novartis?
Good luck with your oxycodone trial. I've said a prayer for you.
- Scott
Posted by CareBear04 on January 11, 2005, at 10:47:06
In reply to Re: The Opiate Trials » jerrympls, posted by SLS on January 11, 2005, at 6:58:29
hi all-- so is it established that opiates are helpful for depression? i was sort of under the impression that they are heavy-duty and knock you out, so they're depressants, not antidepressants. that was my experience with percocet and vicodin. i'm still on percocet, which i started in november for throat lacerations. i'm on 7.5/500 2-3 times a day, and i'm itching to get off. it made sense when one dr said to me, "with all the other stuff you're on, the last thing you need is a narcotic addiction!" i'm sure you probably don't have to worry about addiction, esp since you have a good dr to watch out for you, but it's really intersting to hear that opiates can be helpful for depression and not just harmful. is helpful the norm and was my expeirence an anomoly?
Posted by sgoose on January 11, 2005, at 13:18:41
In reply to Re: The Opiate Trials, posted by CareBear04 on January 11, 2005, at 10:47:06
To comment on various things in this thread:
Am I not correct to believe that depression and physical pain are related because of the chemicals in the brain that run into the body are somehow diminished? (and vice versa)
My own theory is that my chronic levels of headaches and other random physical pain are caused by abnormal levels of chemicals in the brain, making my body/brain feel robbed of pleasure and "happiness." I find it remarkable that on a rare occasion I take an opiate med every psychological/physical symptom I have is improved greatly.
Posted by JayDee on January 11, 2005, at 17:29:59
In reply to Re: The Opiate Trials, posted by sgoose on January 11, 2005, at 13:18:41
Anxiety hurts.
Posted by jerrympls on January 11, 2005, at 18:26:52
In reply to Re: The Opiate Trials, posted by sgoose on January 11, 2005, at 4:07:48
> jerry keep us posted. i am completely supportive of what you are doing and wish i could find a doctor who would give me the choice of opiates for my TRD. I have chronic pain problems and TRD. Never been rx'd an opiate. I'm also a male in my mid twenties but i have no past drug/alcohol problems and been off and on schedule II meds for years. when i did get vicodin for an infection caused by mononeucleosis it changed my world for a few months...the "come down" was nothing but my depression resurfacing and no worse, except for the fact that i had finally found out what it felt like to feel better..........
>
> hope it works out for you! -keep posting.HI SGoose-
I've had depression for 13 years. I'm 32 years old now. All treatments have either worked 40-50% or made me worse. Terrible withdrawl too. In my early 20's when I had my wisdom teeth out I had no idea what Vicodin was - but I found out quickly that it made me feel as close to "normal" as I had ever been. I had many close-minded doctors so I kept the fact that this opiate helped my depression. I never thought in a million years anyone would ever prescribe it.
About four years ago I moved from my hometown of about 20,000 to Minneapolis and got accepted into the VNS study. Unfortunately that didn't work either. Finally I got in to see psychiatrists at the University (which is a teaching hospital). One day about a year ago my previous doc - finally out of suggestions - said "Is there ANYTHING that makes you feel good?" I paused.....and replied: "Vicodin. It doesn't make me goofy, it makes me feel much bettter and close to normal." Suprinsgly she was very receptive - talked with other gollegues and started me on a trial of hydrocodone for a month. Eventually the higher-ups got nervous about the clinic getting in trouble or something and I was taken off of it and the trial was deemed a failure.
Now to the present. New doc - same clinic. I told myself that I wasn't going to be in the closet about it and would keep bringing it up and bringing in any studies I could find. At first, my doc was mildly receptive (This was in the summer 2004). Then finally in the last month he suddenly seemed to warm up to the idea of another trial on opiates - after we'd tried some other meds (like Cymbalta because it just came out).
Then I saw him a couple days ago and he asked "Well, I'm open to doing a trial of an opiate if you'd like." I was kinda stunned. He said he'd read my reasearch I'd brought in and had actually done some on his own and found more info on the use of opiates for depression. So, of course I said "yes."
We were going to go with Vicodin - because I KNOW that works. BUt it would be taking 4 pills a day and Vicodin has Tylenol in it (we looked for a hydrocodone only preparation but couldn't find anything). So, the extended release oxycodone seemed the reasonable alternative. Once-a-day dosing and it's very similar to hydrocodone.
(sorry this is so long). Anyway, after taking it today, I didn't feel incredibly better - but I have noticed some major improvements in reduction of apathy, increase in sociability, decrease in depressive thinking, decrease in intense feelings of rejection, etc. I did feel a little irritable - but I don't know if that's the opiate or not.
Anyway, he said that if necessary I could eventually go up to 30mg - but no further. I see him weekly for updates.
Beggers can't be choosers - but either I do need a higher dosage or hydrocodone just works better for me. He also said that if oxycodone doesn't work that we may just try Vicodin. But I guess I need to give it time - no rush.
ANd yes - psychic pain and physical pain release similar chemicals in the brain. They're very much related.
Hopefully my trial with an opiate will be a success, then they'll have one more positive study to add to the stack!
I'll keep everyone posted.
Thanks
Jerry
Posted by CareBear04 on January 12, 2005, at 1:52:48
In reply to Re: The Opiate Trials, posted by jerrympls on January 11, 2005, at 18:26:52
hey-- i'm really glad to hear that your looong trials to find a dr willing to prescribe have worked out. i actually talked to my dr about it a little today, and she said that there are some types of anxiety that only opiates-- percocet, in this case-- address. she agreed that i wasn't in the euphoria category but thought it might be doingn something just the same. i'm kind of eager to get off of it and other drugs because i'm not sure what's making my head so messed up so that my cognitive function has probably been halved in the past few months.
but it's great that your dr is so open to it. i've had some really adventerous pdocs, but asking for an opiate... i think they still would've thought i was drug-seeking. good for you for sticking with it!
Posted by Wildman on January 12, 2005, at 6:03:40
In reply to Re: The Opiate Trials, posted by jerrympls on January 11, 2005, at 18:26:52
Four 7.5/500 vicodins a day will not make you exceed the daily recommended limit for acetaminophen. I believe 4g per day is a safe limit - so don't sweat it.
If you still are concerned, I believe there are 10/325 of hydrocodone available out there.
I agree that hydro affects the brain differently than oxycodone - very similar for pain, but different in the other effects.
I know these things help me as well...
Wildman
Posted by jerrympls on January 12, 2005, at 18:46:19
In reply to Re: The Opiate Trials, posted by Wildman on January 12, 2005, at 6:03:40
> Four 7.5/500 vicodins a day will not make you exceed the daily recommended limit for acetaminophen. I believe 4g per day is a safe limit - so don't sweat it.
>
> If you still are concerned, I believe there are 10/325 of hydrocodone available out there.
>
> I agree that hydro affects the brain differently than oxycodone - very similar for pain, but different in the other effects.
>
> I know these things help me as well...
>
> WildmanI think I get a better effect from hydrocodone. I wonder how exactly hydrocodone and oxycodone differ. I know they hit the same opiate receptors - but I get muchbetter mood control with hydrocodone. So far this Oxycontin isn't helping as much as I would have htought. We'll see...
Jerry
This is the end of the thread.
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