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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 40 to 64 of 97. Go back in thread:
Posted by linkadge on November 8, 2005, at 13:43:21
In reply to Re: Tricyclics and anhedonia, posted by neuroman on November 8, 2005, at 10:24:48
Some of the smartest doctors who initially discovered the antidepressant effects of the TCA's likened their actions to the amphetamines.
When one is taking a drug based on supposed neurochemical abnormalities that may or may not exist, one runs the risk of creating neurochemical abnormaities that never existed.
Linkadge
Posted by Squiggles on November 8, 2005, at 14:29:14
In reply to Re: Tricyclics and anhedonia, posted by linkadge on November 8, 2005, at 13:43:21
> Some of the smartest doctors who initially discovered the antidepressant effects of the TCA's likened their actions to the amphetamines.
>
> When one is taking a drug based on supposed neurochemical abnormalities that may or may not exist, one runs the risk of creating neurochemical abnormaities that never existed.
>
> LinkadgeI don't doubt that neurochemical abnormalities
must exist in order to get abnormal mental
states - the question is *what* abnormalities
and if common to more than one mental derangement.Among the head injuries I have had in my life
(not many), two of them, which may have been
cerebrovascular, like encephalic hypertension
in withdrawal from a K when I was sweating for
a year and my head felt "on fire", and the recent
bang on the head concussion--i noticed two
interesting phenomena in both distinct cases:- depression (transient thank God)
- and a craving for citrus fruits which I hate.
It's not a mystery that concussions create
depression, nor strokes for that matter - why? It's not the same as a genetic
marker.As for the craving for citrus, darn if I know.
As Dr. Torrey has said, many diverse factors
from genetic to viral to bacterial to physical
to chemical can result in neurochemical
abnormalities. But in order to have depression,
perhaps the identical neurochemical abnormality
may exist. In analogous terms, you can have
suffer a bruise of the same intensity and the
same duration and call it b1, but the causes
may vary. It's still a bruise.Squiggles
>
>
>
>
Posted by neuroman on November 8, 2005, at 19:24:23
In reply to Re: Tricyclics and anhedonia, posted by linkadge on November 8, 2005, at 13:43:21
Hi,
>Some of the smartest doctors who initially
discovered the antidepressant effects of the
TCA's likened their actions to the
amphetamines.Interesting. I didn't know this.
>When one is taking a drug based on supposed neurochemical abnormalities that may or may not exist, one runs the risk of creating neurochemical abnormaities that never existed.
There is no doubt that elavil created problems for me that I didn't have prior to taking it. The problem that I have with a drug like elavil is that it does to many things. I'll never know which one of it's actions was helping me and which ones were hurting me. I can only make an educated guess based on my experiences with other medications, my family history, various tests that I've had (which may or may not be of any value), and my instincts, etc. But an educated guess is better than an uneducated guess. Right now I'm guessing that my problems have less to do with serotonin and more to do with dopamine and norepinephrine.
Paul
Posted by paulbwell on November 9, 2005, at 18:20:31
In reply to Re: Opiates for depression?, posted by Squiggles on November 6, 2005, at 11:11:02
> 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.
>
> SquigglesHydrocodone seems to help MANY people with, energy, interest, enthusthiasm, like Matt, here on these boards, who takes 5mgs Hycodan 4x daily-alomg with other meds.
Opiates CAN DEFINATELY assist short-medium term, depression.
Cheers
Posted by Squiggles on November 9, 2005, at 19:05:29
In reply to Re: Opiates for depression?, posted by paulbwell on November 9, 2005, at 18:20:31
Thanks Paulbwell,
What is short medium-term depression?
Squiggles
Posted by paulbwell on November 9, 2005, at 20:10:01
In reply to Re: Opiates for depression?, posted by Squiggles on November 9, 2005, at 19:05:29
> Thanks Paulbwell,
>
> What is short medium-term depression?
>
> Squiggles> Thanks Paulbwell,
>
> What is short, medium-term depression?
>
> SquigglesWeeks-Months? and IN SOME CASES YEARS-i know-unadvisable but????-ask the patient?
Cheers!
Posted by Squiggles on November 10, 2005, at 16:19:52
In reply to Re: Opiates for depression? » Squiggles, posted by paulbwell on November 9, 2005, at 20:10:01
If i were to give my friend advice
as to what to switch to, maybe this
drug would be good or something in its
class; because taking imipramine for
many years may actually start to wear
on the brain -- I think Dr. Preskorn has
some articles on the toxicity of imipramine --
maybe the toxicity increases with age and
time taken? Maybe, it's time for a change?Squiggles
Posted by paulbwell on November 10, 2005, at 22:50:11
In reply to Re: Opiates for depression?, posted by Squiggles on November 9, 2005, at 19:05:29
> Thanks Paulbwell,
>
> What is short medium-term depression?
>
> SquigglesI don't take Imipramine!
Cheers
Posted by jerrympls on November 10, 2005, at 23:27:51
In reply to Re: Opiates for depression?, posted by paulbwell on November 9, 2005, at 18:20:31
> > 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
>
> Hydrocodone seems to help MANY people with, energy, interest, enthusthiasm, like Matt, here on these boards, who takes 5mgs Hycodan 4x daily-alomg with other meds.
>
> Opiates CAN DEFINATELY assist short-medium term, depression.
>
> CheersMy doc has me on HYCODAN, 5mg 4xdaily. I've been on it for a year - works great.
Jerry
Posted by jerrympls on November 10, 2005, at 23:29:49
In reply to Re: Opiates for depression?, posted by flmm on November 6, 2005, at 10:49:13
> 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!
I'm on an opiate for my depression - hydrocodone. I take 5mg 4x daily. Sure it's not as smooth as one would like - but it sure helps my depression. Been on it for a year now and no tolerance.
Jerry
Posted by paulbwell on November 10, 2005, at 23:43:19
In reply to Re: Opiates for depression? » flmm, posted by jerrympls on November 10, 2005, at 23:29:49
> I'm on an opiate for my depression - hydrocodone. I take 5mg 4x daily. Sure it's not as smooth as one would like - but it sure helps my depression. Been on it for a year now and no tolerance.
>
> Jerry
>
>Great to hear Jer, hope it continues.
You provide a sound, reasoned, rational, voice in the use of Opi's in the use of mood disorders, and i wish you continued benefit. If only ALL Docs were not so closed minded.
Apparently Stims, of which you take Dex 15mg Spans? can potentiate Opi's? i wonder if you have found this?
Good luck dude, and good health!-you are an inspiration!
Cheers:)
Posted by jerrympls on November 10, 2005, at 23:59:59
In reply to Re: Opiates for depression? » jerrympls, posted by paulbwell on November 10, 2005, at 23:43:19
> > I'm on an opiate for my depression - hydrocodone. I take 5mg 4x daily. Sure it's not as smooth as one would like - but it sure helps my depression. Been on it for a year now and no tolerance.
> >
> > Jerry
> >
> >
>
> Great to hear Jer, hope it continues.
>
> You provide a sound, reasoned, rational, voice in the use of Opi's in the use of mood disorders, and i wish you continued benefit. If only ALL Docs were not so closed minded.
>
> Apparently Stims, of which you take Dex 15mg Spans? can potentiate Opi's? i wonder if you have found this?
>
> Good luck dude, and good health!-you are an inspiration!
>
> Cheers:)
>I keep telling my doc she should write a paper on my experience since it's been so positive. The more that doctor's publish about opiates helping depression can only help open many closed minded docs.
Actually, I have switched my stim to Adderall - which I find to help much better in the general mood dept. than Dexedrine. I take 20mg XR 3x daily and it (Adderall) works GREAT with the opiate. I only wish there were a longer acting form of hydrocodone.
Thanks for the well wishes! I appreciate it!
Jerry
Posted by paulbwell on November 11, 2005, at 0:11:57
In reply to Re: Opiates for depression? » paulbwell, posted by jerrympls on November 10, 2005, at 23:59:59
> I keep telling my doc she should write a paper on my experience since it's been so positive. The more that doctor's publish about opiates helping depression can only help open many closed minded docs.
>
> Actually, I have switched my stim to Adderall - which I find to help much better in the general mood dept. than Dexedrine. I take 20mg XR 3x daily and it (Adderall) works GREAT with the opiate. I only wish there were a longer acting form of hydrocodone.
>
> Thanks for the well wishes! I appreciate it!
>
> JerryGood to hear your doing well!
You prove all the nay-sayers wrong with their idea of folks needing ever increasing doses of Opis-and your Hycodan being stable for 1 year shows this! good for you!
So you switched from Dex to Adderall? perhaps you had become tolerant to dextroamphetamine only. Most say Dex works better? althought Adderall is popular.
I wonder how they differ? effects?
Cheers dude!!
Posted by jerrympls on November 11, 2005, at 0:19:40
In reply to Re: Opiates for depression? » jerrympls, posted by paulbwell on November 11, 2005, at 0:11:57
> > I keep telling my doc she should write a paper on my experience since it's been so positive. The more that doctor's publish about opiates helping depression can only help open many closed minded docs.
> >
> > Actually, I have switched my stim to Adderall - which I find to help much better in the general mood dept. than Dexedrine. I take 20mg XR 3x daily and it (Adderall) works GREAT with the opiate. I only wish there were a longer acting form of hydrocodone.
> >
> > Thanks for the well wishes! I appreciate it!
> >
> > Jerry
>
> Good to hear your doing well!
>
> You prove all the nay-sayers wrong with their idea of folks needing ever increasing doses of Opis-and your Hycodan being stable for 1 year shows this! good for you!
>
> So you switched from Dex to Adderall? perhaps you had become tolerant to dextroamphetamine only. Most say Dex works better? althought Adderall is popular.
>
> I wonder how they differ? effects?
>
> Cheers dude!!I didn't grow tolerant to the dex. I switched mainly because Adderall helps reverse a lot of the sexual side effects from the Lexapro. For me, Dexedrine helps with energy and concentration mostly - whereas Adderall helps with those too but also gives a more "natural" feeling of well-being - and is smoother (well, the XR form anyway). Dexedrine is a little bit rough around the edges - but not by much. I used to have a lot of severe nighttime anxiety and rumination when my Dexedrine wore off - but not so with Adderall - another reason I like it.
Jerry :-)
Posted by paulbwell on November 11, 2005, at 0:28:29
In reply to Re: Opiates for depression? » paulbwell, posted by jerrympls on November 11, 2005, at 0:19:40
Hi Ya!
you seem to have blocked me from yr MSN? bring me back on man-we could talk n stuff?
YES?
Posted by jerrympls on November 11, 2005, at 0:31:10
In reply to Re: Opiates for depression?, posted by paulbwell on November 11, 2005, at 0:28:29
> Hi Ya!
>
> you seem to have blocked me from yr MSN? bring me back on man-we could talk n stuff?
>
> YES?I've blocked you? I haven't been on in a long time. Perhaps some other night - I'm dead tired - was driving all day today!
Posted by paulbwell on November 11, 2005, at 0:38:41
In reply to Re: Opiates for depression? » paulbwell, posted by jerrympls on November 11, 2005, at 0:31:10
>
> I've blocked you? I haven't been on in a long time. Perhaps some other night - I'm dead tired - was driving all day today!
>
OK dude-have a good rest.we'll chat later maybe?
i'm online
Posted by linkadge on November 13, 2005, at 9:35:57
In reply to Re: Opiates for depression?, posted by paulbwell on November 11, 2005, at 0:38:41
As positive as jerrympls's story is, there have been equally many (if not many more) people who have used opiates without sucess in treating mood disorders.
Most people who go to withdrawl clinics to stop opiate addictions are really suffering from an underlying mood disorder.
Sometimes tollerance to drugs does not appear in the form one might expect.
Different opiates have different rates of tollerance.
Linkadge
Posted by Squiggles on November 13, 2005, at 9:38:25
In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 9:35:57
Linkadge,
do you think that *some* opiates might
work on depression, but not on manic-depression
for example?Squiggles
Posted by jerrympls on November 13, 2005, at 11:28:57
In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 9:35:57
> As positive as jerrympls's story is, there have been equally many (if not many more) people who have used opiates without sucess in treating mood disorders.
>
> Most people who go to withdrawl clinics to stop opiate addictions are really suffering from an underlying mood disorder.
>
> Sometimes tollerance to drugs does not appear in the form one might expect.
>
> Different opiates have different rates of tollerance.
>
>
>
> LinkadgeJust for the record - I've always said that opiate therapy is NOT a cure-all. I still have had some depressive episodes while on the hydrocodone. And I agree it's not something that would work for everyone.
Also - Do you have the research that lists the rate of tolerance for various opiates? I find it hard to believe that scientists know the exact time it takes for anyone taking opiates to develop tolerance. But I could be wrong. And what do you mean by saying sometimes tolerance to drugs does not appear in the form one might expect?
Sorry if I come across a bit defensive but I get the feeling - and correct me if I am wrong - that you are trying to negate my experience. All I can say is that opiate therapy works for me and works well - and that I am not the only one by a longshot. I haven't developed tolerance after a year - but that's not to say I will never develop tolerance. Also, I am not an addict (not that you said that) and never have had a problem with addiction to anything.
So I guess I'm lucky.
Posted by linkadge on November 13, 2005, at 17:47:39
In reply to Re: Opiates for depression?, posted by Squiggles on November 13, 2005, at 9:38:25
Opiates can profoundly, if only temporarily, help depression, and the depressive phase of bipolar disorder.
Their long term safety or efficacy however, has never been shown.
They work in depression, because they directly activate the pleasure centres of the brain, like all other agents of abuse, something that other antidepressants don't do.
Another consideration is that, while virtually all antidepressant compounds to date promote neurogenesis, the opiates do not, infact they tend to lead to brain atrophy.The neucleus accumbens has incredably effective homeostatic mechanisms.
If tollerance to the effects are slow, then it is highly likely that the withdrawl effects will be long lasting.
Linkadge
Posted by Squiggles on November 13, 2005, at 17:58:07
In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 17:47:39
> Opiates can profoundly, if only temporarily, help depression, and the depressive phase of bipolar disorder.
>
> Their long term safety or efficacy however, has never been shown.
>
> They work in depression, because they directly activate the pleasure centres of the brain, like all other agents of abuse, something that other antidepressants don't do.
>
> Another consideration is that, while virtually all antidepressant compounds to date promote neurogenesis, the opiates do not, infact they tend to lead to brain atrophy.
>
> The neucleus accumbens has incredably effective homeostatic mechanisms.
>
> If tollerance to the effects are slow, then it is highly likely that the withdrawl effects will be long lasting.
>
> LinkadgeWell, its efficacy does sound ambiguous
(how is "profoundly" to be compared to
other antidepressants or treatments?)
for different kinds of depression,
but it may be worth a try if a doctor
approves and can monitor the addiction.If it is very powerful in lifting depression
it may also be a good substitute to
ECT. I have read the arguments that
make this possibly equally ambiguous
treatment justifiable on the grounds
of its speed of reversing suicidal
depression.Squiggles
Posted by jerrympls on November 13, 2005, at 18:08:44
In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 17:47:39
> Opiates can profoundly, if only temporarily, help depression, and the depressive phase of bipolar disorder.
>
> Their long term safety or efficacy however, has never been shown.
>
> They work in depression, because they directly activate the pleasure centres of the brain, like all other agents of abuse, something that other antidepressants don't do.
>
> Another consideration is that, while virtually all antidepressant compounds to date promote neurogenesis, the opiates do not, infact they tend to lead to brain atrophy.
>
> The neucleus accumbens has incredably effective homeostatic mechanisms.
>
> If tollerance to the effects are slow, then it is highly likely that the withdrawl effects will be long lasting.
>
> Linkadge
>
>How long is temporarily? A couple months? a year? 2 years? OH and I did stop taking the hydrocodone for a week without any withdrawl symptoms. Not sure why you're making such generalizations. And for someone like me who has been through the gauntlet of med combos - I would gladly take being on an opiate to my only other option (according to my docs) brain surgery.
Many antidepressant meds do not have long-term safety & efficacy data - and the withdrawl from some SSRIs can be just as bad as a controlled substance.
Link - why are you so negative about the use of opiates for depression? I'm not saying that everything you've posted is wrong or that one shouldn't take into consideration before starting an opiate (under a doctor's care). But you just seem against it.
And like I've always said - opiates are not a cure and they don't fix everything. They do, however, work with dopamine, NE and other neurotransmitters in the brain. When I take the hydrocodone, I do not feel high or buzzed - I feel almost clost to "normal."
I'm interested in how opiates lead to brain atrophy? Do you have any info you can share on that?
Thanks
Jerry
Posted by jerrympls on November 13, 2005, at 18:15:40
In reply to Re: Opiates for depression?, posted by Squiggles on November 13, 2005, at 17:58:07
Here's an interesting article I found that suggests watching TV causes the same amount of brain atrophy as opiates do:
Posted by linkadge on November 13, 2005, at 18:21:45
In reply to Re: Opiates for depression? » linkadge, posted by jerrympls on November 13, 2005, at 11:28:57
>Also - Do you have the research that lists the >rate of tolerance for various opiates?
Not specifically, but there is a lot of research done on the effects of opiate tollerance. Methadone, for instance is used as a subsitute for heroin because of the difference in tollerance rates. Most users know, however, that methadone is no less addicting.
The following article is about vicodin, and how tollerance seems to develop more slowly (at least in animal models) to the euphoria, and analgesia.
http://opioids.com/hydrocodone/vicodin.html
>I find it hard to believe that scientists know >the exact time it takes for anyone taking >opiates to develop tolerance.
They don't know specifically, (ie. for any one individual), but opiate tollerance has been one of the biggest pharmacudial issues, in search for effective nonadicting painkillers. Comparisons are made between opiates, in terms of their euphoriant properties, their painkilling properties, and their latencies for tollerance. Some of those proceedures are listed in the above article.
>But I could be wrong. And what do you mean by >saying sometimes tolerance to drugs does not >appear in the form one might expect?
Tollerance can be measured by the degree severity of withdrawl. Ie, missing your 2nd dose would be much easier than missing your 365th dose.
If a particular opiate has a slow tollerance latency, then it is harder to be attuned to the signs.
>Sorry if I come across a bit defensive but I get >the feeling - and correct me if I am wrong - ?>that you are trying to negate my experience. All >I can say is that opiate therapy works for me >and works well - and that I am not the only one >by a longshot. I haven't developed tolerance >after a year - but that's not to say I will >never develop tolerance. Also, I am not an >addict (not that you said that) and never have >had a problem with addiction to anything.It will come down to what your definition of addicting is. In my definition, something is addicting if missing it would cause significant imparment to your daily functioning.
I'm not trying to negate what you are saying, but I would be concerned for the long term mental health of anybody who used opiates for the treatment of a mood disorder.
Linkadge
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