Psycho-Babble Medication Thread 575925

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Re: Opiates for depression? linkadge

Posted by jerrympls on November 13, 2005, at 18:38:27

In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 18:27:16

> By profoundly, I mean that opiates can reverse a suicidal depression in minautes. Mind you, that suicidal depression didn't go anywhere.
>
> So, perhaps in an emergency, opiates could prevent suicide.
>
> But keep in mind, there was an article released in the Toronto Star 6 months ago about people jumping off bridges when they could not find their oxycontin in time. People without previous histories of mental illness.
>
> Linkadge

Ok, but in regards to the pepole jumping off bridges because they ran out of oxycontin is a completely different subject because they were severe addicts. I'm talking about using opiates as adjunct therapies to other depression treatments.

Not everyone is an addict or becomes an addict. What's the difference between the addictive nature of stimulants and benzos and that of opiates?

 

Re: Opiates for depression? linkadge

Posted by jerrympls on November 13, 2005, at 18:42:15

In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 18:21:45

> >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

Thanks for the link and the info.

As far as your statement on addiction, if I miss a dose or two - or even decide to take a day off from the opiate - I do not feel any negative effects. In fact I took 2 weeks off of taking my opiate (because of a script problem). I was worried about withdrawl, however, I didn't experience any.

Many negative things can be said about the use of opiates, but the same can be said of benzos, sleeping meds, and stimulants - yet they are used all the time in psychiatric medicine.

I strongly believe opiates have a place in psychiatric medicine.

Jerry

 

Re: Opiates for depression?

Posted by Squiggles on November 13, 2005, at 18:44:02

In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 18:27:16

> By profoundly, I mean that opiates can reverse a suicidal depression in minautes. Mind you, that suicidal depression didn't go anywhere.

You are speaking of your own experience? But
I don't doubt it and minutes is much better
than 24 hrs., which is what lithium took for
me. Speaking of lithium, the manic side
is as bad as the depressive, though not
necessarily suicidal.
>
> So, perhaps in an emergency, opiates could prevent suicide.

That would be very good, and would
appease those who fear addiction as
it could be used temporarily at least.
>
> But keep in mind, there was an article released in the Toronto Star 6 months ago about people jumping off bridges when they could not find their oxycontin in time. People without previous histories of mental illness.

One more question, do you know if opiates can
be *added* to an AD, or if a doctor decided it
was OK to give an opiate for depression, would
the patient have to be taken off the AD.

The time a drug is taken can make a big
difference in the and is a "high-maintenance" kind of treatment which may be problematic for
a variety of reasons.

Tx for your interesting presentation on
this topic.

Squiggles

 

Re: Opiates for depression?

Posted by linkadge on November 13, 2005, at 18:45:09

In reply to Re: Opiates for depression?, posted by jerrympls on November 13, 2005, at 18:27:55

No, I am not trying to attack you personally.

You are right, that other treatments for psychiatric disorders carry similar risks, namely the benzo's and the stimulants.

You are also right that opiate therapy is safer than ECT.

I'd be hard pressed to agree that it is a safe treament for depression, but I wish you recovery, in any form that it takes.


Linkadge

 

Re: Opiates for depression?

Posted by linkadge on November 13, 2005, at 18:47:30

In reply to Re: Opiates for depression? linkadge, posted by jerrympls on November 13, 2005, at 18:38:27

There is no difference between the addictive potential of opiates, and benzo's or stimulants.

Significant depression can be a symptom of opiate withdrawl, regardless of weather one considers themselves an addict or not.

Linkadge

 

Re: Opiates for depression? Squiggles

Posted by jerrympls on November 13, 2005, at 18:47:45

In reply to Re: Opiates for depression?, posted by Squiggles on November 13, 2005, at 18:44:02

> > By profoundly, I mean that opiates can reverse a suicidal depression in minautes. Mind you, that suicidal depression didn't go anywhere.
>
> You are speaking of your own experience? But
> I don't doubt it and minutes is much better
> than 24 hrs., which is what lithium took for
> me. Speaking of lithium, the manic side
> is as bad as the depressive, though not
> necessarily suicidal.
> >
> > So, perhaps in an emergency, opiates could prevent suicide.
>
> That would be very good, and would
> appease those who fear addiction as
> it could be used temporarily at least.
> >
> > But keep in mind, there was an article released in the Toronto Star 6 months ago about people jumping off bridges when they could not find their oxycontin in time. People without previous histories of mental illness.
>
> One more question, do you know if opiates can
> be *added* to an AD, or if a doctor decided it
> was OK to give an opiate for depression, would
> the patient have to be taken off the AD.
>
> The time a drug is taken can make a big
> difference in the and is a "high-maintenance" kind of treatment which may be problematic for
> a variety of reasons.
>
> Tx for your interesting presentation on
> this topic.
>
> Squiggles
>
>

Hi Squiggles-

I don't know if you've been reading any of my posts - but I am on an opiate for depression. The opiate (hydrocodone) was added to my other depression meds, including Lexapro, Adderall & ativan. So YES, opiates can work with antidepressants.

Jerry

 

Re: Opiates for depression?

Posted by Squiggles on November 13, 2005, at 18:50:57

In reply to Re: Opiates for depression? Squiggles, posted by jerrympls on November 13, 2005, at 18:47:45

...
> Hi Squiggles-
>
> I don't know if you've been reading any of my posts - but I am on an opiate for depression. The opiate (hydrocodone) was added to my other depression meds, including Lexapro, Adderall & ativan. So YES, opiates can work with antidepressants.
>
> Jerry

I did not read that Jerry. Thanks - that's
very good and I will suggest to my friend
that she consult her doctor about that -
you may recall the problem we are dealing
with (witht the present tricyclic) is anhedonia.

Thanks for that bit of info.

Squiggles

 

Re: Opiates for depression?

Posted by linkadge on November 13, 2005, at 18:52:29

In reply to Re: Opiates for depression? linkadge, posted by jerrympls on November 13, 2005, at 18:42:15

It is very rare for somebody not to experience withdrawl effects from abruptly stoping a strong opiate, but you know yourself better than I.

Linkadge

 

Re: Opiates for depression?

Posted by linkadge on November 13, 2005, at 18:58:02

In reply to Re: Opiates for depression?, posted by Squiggles on November 13, 2005, at 18:44:02

Depending on the dose and onset of an opiate, I have no doubt that an opiate can relieve depression immediately.

They provide a rapid, dose dependant feeling of well being.

Yes, they can generally be safely be combined with most AD's. Not the MAOI's.

Linkadge

 

Re: Opiates for depression? linkadge

Posted by jerrympls on November 13, 2005, at 18:58:10

In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 18:47:30

> There is no difference between the addictive potential of opiates, and benzo's or stimulants.
>
> Significant depression can be a symptom of opiate withdrawl, regardless of weather one considers themselves an addict or not.
>
> Linkadge

I totally agree that increased depression can and is part of opiate withdrawl - and it's something I worry a little about if & when I have to go off the opiate I am taking.

I think in many cases of treatment-resistant depression, one's reward system is "damaged." Right now there are not many choices to help fix the reward system in psychiatric medicine and the use of opiates may be just a temporary and crude fix --what I'm getting at is that more attention needs to be focused on the reward system instead of the basic serotonin/NE imbalance. Perhaps someday they'll be able to synthesize a med that balances out the reward system and that doesn't cause addiction or withdrawl.

Interesting excerpt from one of the links you posted:

"Depressive and dysthymic people often suffer from a dysfunctional opioid system and anhedonia - an incapacity to experience pleasure. Sometimes orthodox "antidepressants" may even make them feel worse. Yet controlled clinical trials of designer narcotics for refractory and/or melancholic depression, let alone their use by "normal" people with "ordinary" mood-disorders, are not imminent."

http://opioids.com/

 

Re: Opiates for depression? Squiggles

Posted by jerrympls on November 13, 2005, at 19:04:13

In reply to Re: Opiates for depression?, posted by Squiggles on November 13, 2005, at 18:50:57

> ...
> > Hi Squiggles-
> >
> > I don't know if you've been reading any of my posts - but I am on an opiate for depression. The opiate (hydrocodone) was added to my other depression meds, including Lexapro, Adderall & ativan. So YES, opiates can work with antidepressants.
> >
> > Jerry
>
> I did not read that Jerry. Thanks - that's
> very good and I will suggest to my friend
> that she consult her doctor about that -
> you may recall the problem we are dealing
> with (witht the present tricyclic) is anhedonia.
>
> Thanks for that bit of info.
>
> Squiggles
>
>

Here's some research on opiates you may want to take to the doctor. It's what I took to mine. I also have one more really interesting study showing how a doc used oxycontin with success in some patients with treatment-resistant depression.


1: J Clin Psychiatry. 2001 Mar;62(3):205-6.

Treatment of refractory major depression with tramadol monotherapy.

Shapira NA, Verduin ML, DeGraw JD.

Publication Types:
Case Reports
Letter

PMID: 11305709 [PubMed - indexed for MEDLINE]

2: Aust N Z J Psychiatry. 2000 Dec;34(6):1032-3.

The efficacy of intramuscular tramadol as a rapid-onset antidepressant.

Spencer C.

Publication Types:
Case Reports
Letter

PMID: 11127616 [PubMed - indexed for MEDLINE]

3: Am J Psychiatry. 1999 Dec;156(12):2017.

Treatment augmentation with opiates in severe and refractory major
depression.

Stoll AL, Rueter S.

Publication Types:
Case Reports
Letter

PMID: 10588427 [PubMed - indexed for MEDLINE]

5: Biol Psychiatry. 1996 Jun 15;39(12):989-90.

Buprenorphine for depression: the un-adoptable orphan.

Callaway E.

Publication Types:
Editorial

PMID: 8780832 [PubMed - indexed for MEDLINE]

6: Am J Psychiatry. 1996 Jun;153(6):843-4.

Mood alterations and tramadol.

Pinkofsky HB, Woodward RA, Reeves RR.

Publication Types:
Case Reports
Letter

PMID: 8633712 [PubMed - indexed for MEDLINE]


8: Biomed Pharmacother. 1996;50(6-7):279-82.

Treatment of depressive syndromes in detoxified drug addicts: use of
methadone.

Laqueille X, Bayle FJ, Spadone C, Jalfre V, Loo H.

Service Hospitalo-Universitaire de Sante Mentale et de Therapeutique,
Centre
Hospitalier Specialise Sainte-Anne, Paris, France.

Depressive syndromes are very frequent in drug-addicted patients. Their
study is particularly difficult on account of the toxic intake which disturbs
the clinical analysis. Methadone has improved our understanding of these
pathologies. In fact, methadone permits treatment of some depressive
disorders typically linked to addiction, such as a motivational symptoms and
depressive mood following intoxication. It brings to the fore the other mood
disorders which are often associated with drug intake.

Publication Types:
Review
Review, Tutorial

PMID: 8952868 [PubMed - indexed for MEDLINE]

9: J Clin Psychopharmacol. 1995 Feb;15(1):49-57.

Buprenorphine treatment of refractory depression.

Bodkin JA, Zornberg GL, Lukas SE, Cole JO.

McLean Hospital, Consolidated Department of Psychiatry, Harvard Medical
School,
Belmont, MA 02178, USA.

Opiates were used to treat major depression until the mid-1950s. The
advent of opioids with mixed agonist-antagonist or partial agonist activity, with
reduced dependence and abuse liabilities, has made possible the reevaluation of
opioids for this indication. This is of potential importance for the population
of depressed patients who are unresponsive to or intolerant of
conventional antidepressant agents. Ten subjects with treatment-refractory,
unipolar, nonpsychotic, major depression were treated with the opioid partial
agonist buprenorphine in an open-label study. Three subjects were unable to
tolerate more than two doses because of side effects including malaise, nausea,
and dysphoria. The remaining seven completed 4 to 6 weeks of treatment and as
a group showed clinically striking improvement in both subjective and
objective measures of depression. Much of this improvement was observed by the end of 1 week of treatment and persisted throughout the trial. Four subjects
achieved complete remission of symptoms by the end of the trial (Hamilton Rating
Scale for Depression scores < or = 6), two were moderately improved, and
one deteriorated. These findings suggest a possible role for buprenorphine
in treating refractory depression.

Publication Types:
Case Reports
Clinical Trial

PMID: 7714228 [PubMed - indexed for MEDLINE]


11: Int Clin Psychopharmacol. 1988 Jul;3(3):255-66.

Current and historical concepts of opiate treatment in psychiatric
disorders.

Weber MM, Emrich HM.

Max-Planck-Institut fur Psychiatrie, Munchen, Federal Republic of
Germany.

In recent years psychiatric research has rediscovered the theoretical
and clinical importance of opiates, especially for the understanding of
depressive disorders. However, opiate treatment is not a new therapeutic concept
in psychiatry. The use of opium for "melancholia" and "mania" may be traced to ancient classical medicine. After Paracelsus and Sydenham, the psychiatry of the German Romantic Era widely discussed therapeutic opium use with the Engelken family going on to develop a structured opium treatment of depression in the first half of the nineteenth century. Although the underlying scientific problems of psychiatric opium therapy were never solved, it gained an outstanding position as a practical treatment for over 100 years.

Publication Types:
Historical Article

PMID: 3153713 [PubMed - indexed for MEDLINE]

 

Re: Opiates for depression? linkadge

Posted by jerrympls on November 13, 2005, at 19:06:31

In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 18:52:29

> It is very rare for somebody not to experience withdrawl effects from abruptly stoping a strong opiate, but you know yourself better than I.
>
> Linkadge

I swear to you I did not - except for that it probably made me a little bit more depressed - but other than that there were no physical symptoms. Not that I'm proud of that or anything - I'm just stating what happens to me and I would never give false information - because there is no reason to.

 

Re: Opiates for depression? linkadge

Posted by jerrympls on November 13, 2005, at 19:08:24

In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 18:58:02


> Yes, they can generally be safely be combined with most AD's. Not the MAOI's.
>

Actually, only Demerol is contrindicated. I was on Dilauded and then later hydrocodone after a surgery a couple years ago - and I was taking Nardil at the time.


 

Re: Opiates for depression?

Posted by linkadge on November 13, 2005, at 19:10:06

In reply to Re: Opiates for depression? linkadge, posted by jerrympls on November 13, 2005, at 19:06:31

I'm not saying you're not telling the truth. I'm just saying you're atypical.


Linkadge

 

Re: Opiates for depression?

Posted by linkadge on November 13, 2005, at 19:11:08

In reply to Re: Opiates for depression? linkadge, posted by jerrympls on November 13, 2005, at 19:08:24

Tramadol may be contraindicated too. I believe it acts as a reuptake inhibitor so SE/NE.

Linkadge

 

Re: Opiates for depression? linkadge

Posted by jerrympls on November 13, 2005, at 19:12:39

In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 19:10:06

> I'm not saying you're not telling the truth. I'm just saying you're atypical.
>
>
> Linkadge

I know-- I didn't mean to insinuate that you were saying I was not telling the truth.

 

Re: Opiates for depression?

Posted by linkadge on November 13, 2005, at 19:13:59

In reply to Re: Opiates for depression? linkadge, posted by jerrympls on November 13, 2005, at 19:08:24

The SSRI's are not anhedonia busters.

You are right, more focus needs to be put on dysfunctional reward systems. And why they become so dysfunctional in the first place.

Linkadge

 

Re: Opiates for depression?

Posted by linkadge on November 13, 2005, at 19:20:47

In reply to Re: Opiates for depression? linkadge, posted by jerrympls on November 13, 2005, at 19:12:39

I discovered the antidepressant properites of codiene, after I had my wisdom teeth extracted.

I am *very* sensitive to opiate withdrawl. I experienced the most profound exasperation of my depression during codiene withdrawl.

I don't need to say much about the situation, but I am lucky I am still alive.

I just would not want anyone else to have to go through a similar situation.

Linkadge

 

Great discussion

Posted by gardenergirl on November 13, 2005, at 22:50:18

In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 19:20:47

Interesting discussion, and it's a great example of remaining civil while disagreeing.

Just wanted to toss in some positive reinforcement... Don't mind me. :-)

gg

 

Re: Great discussion

Posted by ed_uk on November 14, 2005, at 13:04:50

In reply to Great discussion, posted by gardenergirl on November 13, 2005, at 22:50:18

I don't find opioids euphoric. Anyone else?

Ed

 

Re: Great discussion

Posted by linkadge on November 14, 2005, at 15:03:01

In reply to Re: Great discussion, posted by ed_uk on November 14, 2005, at 13:04:50

Have you taken the right ones / right doses ?

Linkadge

 

Re: Great discussion linkadge

Posted by ed_uk on November 14, 2005, at 15:19:46

In reply to Re: Great discussion, posted by linkadge on November 14, 2005, at 15:03:01

I've taken codeine and dihydrocodeine. I've tried a wide range of doses.

Ed

 

Re: Great discussion

Posted by linkadge on November 14, 2005, at 16:55:34

In reply to Re: Great discussion linkadge, posted by ed_uk on November 14, 2005, at 15:19:46

Antidepressants have been known to at times reduce the euphoriant properites of certain substances.

I personally noticed that nicotine gum was more pleasureable off SSRI's than on them.

The euphoriant properties of Ecstacy are largely nullified by SSRI's. (or so I've heard)

Linkadge


 

Re: Great discussion

Posted by Squiggles on November 14, 2005, at 17:06:38

In reply to Re: Great discussion, posted by linkadge on November 14, 2005, at 16:55:34

That may be just as well. If opiates
are indeed effective, safe,
antidepressants, with the morally
appropriate amount of unpleasant side effects
they may become more acceptable and politically
correct in psychiatry.

I do fear that anything that makes you
feel "good" or "happy" will be rejected
just on those grounds and not on the
power of narcotic addiction; at least as long
as a Puritanical approach to treatment
is with us.

Squiggles

 

Re: Great discussion

Posted by mama141 on November 15, 2005, at 8:25:23

In reply to Re: Great discussion, posted by Squiggles on November 14, 2005, at 17:06:38

> That may be just as well. If opiates
> are indeed effective, safe,
> antidepressants, with the morally
> appropriate amount of unpleasant side effects
> they may become more acceptable and politically
> correct in psychiatry.
>
> I do fear that anything that makes you
> feel "good" or "happy" will be rejected
> just on those grounds and not on the
> power of narcotic addiction; at least as long
> as a Puritanical approach to treatment
> is with us.
>
> Squiggles

Yes, good discussion. I've posted in this vein before over on the "substance use" board. I think it is partially dependent on what one defines as euphoric. For me I "feel better" if my pain is lessened, but I would not call what I "feel" euphoric. I think there is also some ambiguity here with the terms "abuse", "withdrawal", "dependence", and "addiction"
In my own experience, when I asked my family doc about the effecacy of opioids, he was really only concerned that I would get constipated!
To clarify, I take Vicodin 500mgm for degenerative osteoarthritis. Sometimes I go days without any - other times, I take up to four a day. If I must stay on the four a day regime for more than a week I taper off over a two day period. I have been doing this for a number of years with no problems.
Also, one physician would not perscribe Ultram for me when I was on an SSRI -- anyone else have a similar experience?


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