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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 97. This is the beginning of the thread.
Posted by Squiggles on November 6, 2005, at 9:19:44
Before taking lithium, I did take imipramine,
which felt like taking an organophosphate; not only did it not treat my depression, but i broke
out in a rash and almost fell into the subway
tracks from dizziness and disorientation. I
slept about 3 hrs. per night. Not for me-- but obviously for others.In comparison to lithium which (with the exception
of dose-related brain mishaps) imipramine really
feels like you're taking a pesticide, imho, does not compare to the excellent clarity of the cognitive state that lithium provides, and does not eliminate "anhedonia".In my observation of a particular case in mind,
"anhedonia" hangs over one's head like the fog of a bad S-U-V day in L.A., every day. Perhaps that is the case with many tricyclics. But imipramine is strong enough to eliminate clinical depression where others, esp. SSRIs are not, and so is the only option in this case;Questions:
- are there alternatives/adjuncts equally strong
to imipramine for clinical depression which
also target "anhedonia"?- would opiates work for clinical depression,and if so are there any legal ones or simulated ones available?
Thanks for reading.
Squiggles
Posted by linkadge on November 6, 2005, at 9:30:51
In reply to Tricyclics and anhedonia, posted by Squiggles on November 6, 2005, at 9:19:44
The opiates are strong enought for clinical depression. But only for about two weeks, and then you need more.
I have yet to meet someone who has used opiates long term for depression.
Linkadge
Posted by linkadge on November 6, 2005, at 9:31:36
In reply to Tricyclics and anhedonia, posted by Squiggles on November 6, 2005, at 9:19:44
Might you try a different TCA, perhaps with fewer anticholinergic side effects ?
Linkadge
Posted by Squiggles on November 6, 2005, at 9:37:52
In reply to Re: Tricyclics and anhedonia, posted by linkadge on November 6, 2005, at 9:30:51
> The opiates are strong enought for clinical depression. But only for about two weeks, and then you need more.
>
> I have yet to meet someone who has used opiates long term for depression.
>Thanks linkadge; that is really disappointing.
I was under the impression that you could take
them, get addicted, but do so on a small
incremental scale. In Victorian times
laudenum for example was an OTC drug which
was commonly used (as was quinine and other
non-synthesized drugs, including cocaine);
And some "Victorian gentlemen" for example
would take opiated throughout their life.As you know the benzos and barbiturates before
them are addicting, but there is a blunt line
between steady states and huge increments,
depending on whether you want therapeutic
results or hedonistic addiction.Squiggles
>
> Linkadge
Posted by linkadge on November 6, 2005, at 9:54:30
In reply to Re: Tricyclics and anhedonia, posted by Squiggles on November 6, 2005, at 9:37:52
Some people can take a steady dose of a benzo for a very long time. I don't know if the same can be done with opiates.
There have been a few come here who have investigated the topic, but I havn't heard of any long term sucess stories.
Linkadge
Posted by zeugma on November 6, 2005, at 10:15:20
In reply to Re: Tricyclics and anhedonia, posted by linkadge on November 6, 2005, at 9:54:30
> Some people can take a steady dose of a benzo for a very long time. I don't know if the same can be done with opiates.
Benzos are not useful in reducing anhedonia as far as I know. Stimulants can be useful, but tolerance is a major problem with them. The same is probably true of any drug that modifies the hedonic response such as opiates. People were so excited about tricyclics when they were discovered because they seemed to modify the hedonic response without inducing tolerance.-z
>
> There have been a few come here who have investigated the topic, but I havn't heard of any long term sucess stories.
>
> Linkadge
Posted by Squiggles on November 6, 2005, at 10:22:21
In reply to Re: Tricyclics and anhedonia, posted by zeugma on November 6, 2005, at 10:15:20
> > Some people can take a steady dose of a benzo for a very long time. I don't know if the same can be done with opiates.
>
>
> Benzos are not useful in reducing anhedonia as far as I know. Stimulants can be useful, but tolerance is a major problem with them. The same is probably true of any drug that modifies the hedonic response such as opiates. People were so excited about tricyclics when they were discovered because they seemed to modify the hedonic response without inducing tolerance.
>
> -z
> >
> > There have been a few come here who have investigated the topic, but I havn't heard of any long term sucess stories.
> >
> > Linkadge
>
>I think that benzos work indirectly on
"anhedonia", insofar as they reduce that
part of "unhappiness, lack of motivation,
flat affect, etc." that has to do with
anxiety.I would not be surprised if stimulants
worked as adjuncts.I know Dr. Goodwin worked on a paper
on opiates for depression. I would be
VERY surprised if heroin or morphine did
not make you happy. The question is how
to control addiction before it gets
bad for your health. The current drugs on
the pharmaceutical market are not exactly
good for your health (e.g. tricyclics are
cardiotoxic) and some of the benzos are
quickly addicting while others are not.I suspect a tad of the old fashioned
fear of the evil narcotics about opiates,
that may prevent psychiatritry from
investigating it for depression.Squiggles
Posted by flmm on November 6, 2005, at 10:49:13
In reply to Re: Tricyclics and anhedonia, posted by Squiggles on November 6, 2005, at 10:22:21
As someone who has taken opiates for over a year due to back pain, I can tell you they are not good for depression! As a matter of fact, I think they make it worse. Constant ups and downs. They make you bipolar!Yes there are times you feel great on them, like any street drug, but they can be very unpredictable in your reation. Sometimes you feel good, sometimes depressed, sometimes paranoid, etc. I only hope I can get off them someday and let Lexapro do it's job as the opiates clearly block the good effects of antidepressents. That's my 2 cents!
Posted by Squiggles on November 6, 2005, at 11:11:02
In reply to Re: Opiates for depression?, posted by flmm on November 6, 2005, at 10:49:13
Hmm, that's interesting. So, I guess
the chemical composition of opiates
is not conducive to an anti-depressant
effect, such as Lexapro, or others.Squiggles
Posted by iforgotmypassword on November 6, 2005, at 11:32:44
In reply to Re: Opiates for depression?, posted by Squiggles on November 6, 2005, at 11:11:02
there is an abstract on pubmed about this, i also recall mention of it having a similar structure to tramadol (Ultram). this may make sense as it is supposed to be a phenethylamine, and that is supposed to carry with it opiod properties. (that seems to be why D-phenylalanine is used for chronic pain)
Posted by Squiggles on November 6, 2005, at 12:39:36
In reply to effexor is supposed to have opiod effects..., posted by iforgotmypassword on November 6, 2005, at 11:32:44
> there is an abstract on pubmed about this, i also recall mention of it having a similar structure to tramadol (Ultram). this may make sense as it is supposed to be a phenethylamine, and that is supposed to carry with it opiod properties. (that seems to be why D-phenylalanine is used for chronic pain)
I don't know the chemistry of pain killers,
but I know they can be as addicting as
opioids, e.g. OXYCONTIN, so perhaps they
habituate the same areas or parts of the brain.
And Ultram, as pain killer may fall into this
category?Anyway, there are some issues that should
be kept distinct in this opiate question,
i think:a) is the chemistry of opiates superiour
to that of other ADs for depression;b) can the addicting properties be managed
well so that it can be taken for a long time?c) if the above are feasable, is there a
political/government/economic quagmire
that cannot be resolved *even if the opiates
prove to be better*?d) can substitutes like the one you mention
(Effexor was too weak in this case of endogenous,
maybe even organic depression) be made chemically
equivalent.thanks for your input.
Squiggles
Posted by iforgotmypassword on November 6, 2005, at 15:00:37
In reply to Re: effexor is supposed to have opiod effects..., posted by Squiggles on November 6, 2005, at 12:39:36
remeron makes effexor extremely effective. this combination has saved peoples lives with full remission, and is compared closely with ECT.
Posted by Squiggles on November 6, 2005, at 15:02:25
In reply to Re: effexor is supposed to have opiod effects..., posted by iforgotmypassword on November 6, 2005, at 15:00:37
Remeron and effexor; maybe some doctors
know about this;thanks
Squiggles
Posted by flmm on November 6, 2005, at 16:10:31
In reply to Re: effexor is supposed to have opiod effects..., posted by Squiggles on November 6, 2005, at 15:02:25
I will say this about Effexor, when I took it about 1 year ago, I felt really good, and my back pain did not bother me near as much. However, on it's own, my blood pressure went way up and I got nervous a lot, kind of unstable feeling. I could not stay on it. Pherhaps it would work good as a low dose add on to Lexapro. I had another good response to Cymbalta with Lex, but not on it's own! I think I will always need an ssri as my main drug to keep me calm, but maybe I should think in terms of adding things to Lex. I am sick of opiates!
Posted by Squiggles on November 6, 2005, at 16:35:48
In reply to Re: effexor is supposed to have opiod effects..., posted by flmm on November 6, 2005, at 16:10:31
> I will say this about Effexor, when I took it about 1 year ago, I felt really good, and my back pain did not bother me near as much. However, on it's own, my blood pressure went way up and I got nervous a lot, kind of unstable feeling. I could not stay on it. Pherhaps it would work good as a low dose add on to Lexapro. I had another good response to Cymbalta with Lex, but not on it's own! I think I will always need an ssri as my main drug to keep me calm, but maybe I should think in terms of adding things to Lex. I am sick of opiates!
For the case I am speaking of, SSRIs are
just too weak for clinical depression; and
perhaps as you using them as adjuncts
may be the best thing to do.So you're sick of opiates :-)
I didn't even know they were available,
unless you've got underground connections.Squiggles
Posted by linkadge on November 6, 2005, at 17:31:09
In reply to Re: effexor is supposed to have opiod effects..., posted by Squiggles on November 6, 2005, at 16:35:48
To say that SSRI's are too weak for clinical depression makes no sence.
They may be too weak for your depression, but they are effective for a certain group of people.
For me, MAOI's were "too weak" for depression.
Parnate just made me blue, and mildly psychotic,
but others would consider them "big guns".
For while I had no sucess with effexor, followed by success with zoloft. So I think it depends on many personal factors.
Linkadge
Posted by Squiggles on November 6, 2005, at 17:35:24
In reply to Re: effexor is supposed to have opiod effects..., posted by linkadge on November 6, 2005, at 17:31:09
Yes, that's true; i am speaking from
years of observing someone who has
clinical (very deep, possibly brain-damage
depression).I'm a happy beeper on lithium - wouldn't
touch tricyclics.Squiggles
Posted by linkadge on November 6, 2005, at 19:06:14
In reply to Re: effexor is supposed to have opiod effects..., posted by Squiggles on November 6, 2005, at 17:35:24
I've been on lithium SSRI's MAOI's and TCA's. THe lithium helped some aspects of the depression, but did not help the anhedonia.
Linkadge
Posted by Squiggles on November 6, 2005, at 19:23:11
In reply to Re: effexor is supposed to have opiod effects..., posted by linkadge on November 6, 2005, at 19:06:14
Hmm... what was your lithium dose,
how long where you on it, how much
do you weigh, and what was your diagnosis?
Also, was your thyroid checked?Of course you don't have to answer if
these questions are personal for you.Squiggles
Posted by flmm on November 6, 2005, at 19:25:06
In reply to Re: effexor is supposed to have opiod effects..., posted by Squiggles on November 6, 2005, at 19:23:11
The legal pain killers are the ones I am refering to! ie. Vicoden etc...
Posted by Squiggles on November 6, 2005, at 19:55:59
In reply to Re: effexor is supposed to have opiod effects..., posted by flmm on November 6, 2005, at 19:25:06
> The legal pain killers are the ones I am refering to! ie. Vicoden etc...
Oh I see. If other drugs work for your depression
that is to be preferred of course. But I would
not be bothered by "addiction" of opiates. It
is easier to withdraw from these than from benzos,
especially some benzos which are impossible to
withdraw from.If an addicting drug was really good for depression and could be managed by a doctor
so that the increments would not hurt your
health any more than the customary ADs, I
would say they were better.But in your case they are not and I can
understand that. BTW, benzos do work for
back pain, esp. clonazepam, which is very
addicting but has miminum tolerance.Squiggles
Posted by linkadge on November 6, 2005, at 20:29:02
In reply to Re: effexor is supposed to have opiod effects..., posted by Squiggles on November 6, 2005, at 19:23:11
My lithium dose (this time around) was 600mg, although I have been as high as 1500mg (for 7 months)
My diagnosis is unipolar depression (by most doctors) and bipolar disorder by 2 doctors.
I weigh about 140 pounds.
Thyroid is good.
Linkadge
Posted by linkadge on November 6, 2005, at 20:31:00
In reply to Re: effexor is supposed to have opiod effects..., posted by Squiggles on November 6, 2005, at 19:55:59
I think addiction potential again, also depends on the person.
I had zero problem getting off 3mg of clonazepam, but had a hell of a time getting off codiene.
Linkadge
Posted by Squiggles on November 6, 2005, at 20:38:52
In reply to Re: effexor is supposed to have opiod effects..., posted by linkadge on November 6, 2005, at 20:29:02
> My lithium dose (this time around) was 600mg, although I have been as high as 1500mg (for 7 months)
>Doctors tend to start you high (1200mg) esp.
if you are manic, and lower it after 6 months,
given blood stability monitoring.I take 900mg - anything more would be toxic
now and anything less (judging by my unlucky
break with the pharmaceutical supplier) would
be catastrophic.I have read that lithium (in itself or as
an adjunct is give for unipolar) but I have
not seen it work in some of my friends.
I think it would work in acute severe depression
to lift you out of it -- after that, I don't
know - unipolar and bipolar brains may be
different.> My diagnosis is unipolar depression (by most doctors) and bipolar disorder by 2 doctors.
Diagnosis is not an easy thing right now -
maybe future neurologic correlations will
solve that. I now *know* I am bipolar by
the serendipitous mistate made by the pharmacy --
no mistaking it. Before that, even one of my doctors was unsure.
>
> I weigh about 140 pounds.900mg lithium should do it.
>
> Thyroid is good.Hypo or hyper is important for lithium dosing.
Squiggles
>
Posted by Squiggles on November 6, 2005, at 21:02:24
In reply to Re: effexor is supposed to have opiod effects..., posted by linkadge on November 6, 2005, at 20:31:00
> I think addiction potential again, also depends on the person.
:-}
>
> I had zero problem getting off 3mg of clonazepam, but had a hell of a time getting off codiene.
>
>
Like any addicting drug (and even ADs which
are not said to be addicting per se but
withdrawal brings on the notorious "discontinuation syndrome"), certain variables
play a role in how difficult getting off
will be:- time the drug has been taken
- dose that has been taken during that time
- abrupt or slow discontinuation from the
drug- other drugs causing a cross tolerance;
- and last, very last, the non-physical aspect
of withdrawal -- the personality of the person;
but I believe that if you give the same amount
of crack to Clint Eastwood and to Woody Allen,
under the same conditions, they will have
equal difficulty in getting off.The same rule of pharmacology applies to
many drugs - if not, the preparation would
of pharmaceuticals would have to be tailored
differently for every single individual on
the planet, give or take a few pounds and
personal quirks.Squiggles
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