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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 73 to 97 of 97. Go back in thread:
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
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.
>
> JerryI 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
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
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
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.
>
> LinkadgeI 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."
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
LetterPMID: 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
LetterPMID: 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
LetterPMID: 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:
EditorialPMID: 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
LetterPMID: 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, TutorialPMID: 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 TrialPMID: 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 ArticlePMID: 3153713 [PubMed - indexed for MEDLINE]
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.
>
> LinkadgeI 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.
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.
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
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
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.
>
>
> LinkadgeI know-- I didn't mean to insinuate that you were saying I was not telling the truth.
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
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
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
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
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
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
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
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
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.
>
> SquigglesYes, 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?
Posted by Jackd on November 15, 2005, at 12:18:02
In reply to Re: Tricyclics and anhedonia, posted by neuroman on November 8, 2005, at 10:24:48
Hey, just read your post and I know I'm kinda jumping in the middle of all this, but I just wanted to add that NMDA receptor antagonists have been shown to prevent/reverse opiate tolerance.
Theoretically they have a wide range of therapeutic uses, and I personally take 60mg of Namenda a day (along with Remeron + Effexor, to great effect).
From what I remember anti-depressants all ultimately affect NMDA receptors to some degree, and NMDA antagonists have possible uses for anhedonia (suggesting a link with dopamine?)among other things (neuropathic pain, possibly depression). This makes sense since dopamine/opiate tolerance has a definite dynamic with NMDA receptors, although I'm pretty sure it's not merely a direct antagonist effect.
By the way when I speak of NMDA antagonists I only mean Namenda (Memantine HCl) as it is a non-competitive, safe NMDA antagonist (the rest are neurotoxic and not clinically in use of course; well except ketamine which is used by Veterinarians I think) if they're considering opiates for depression.
Also people mentioned that Effexor has opiate properties/similarities. It does, and yes Ultram is molecularly identical except for its orientation. Effexor, amitryptiline, and Remeron have been shown to exhibit anticociceptive properties, and are sometimes even prescribed specifically for pain. I personally don't experience any back pain when I'm on Remeron + Effexor.
Good luck finding the right doctor in "your quest"; I too had a similar quest and it was only with lots of homework and coaxing that I was able to get on the combo I'm on now.
Just my two cents.
Posted by spriggy on November 17, 2005, at 18:07:20
In reply to Re: Great discussion, posted by mama141 on November 15, 2005, at 8:25:23
Because of fibromyalgia and lupus, I have hydrocodone that I take 5/500- I try to not take it daily, some days I have to take two, some days I take one half, some days I take nothing.
Depends on the day and my pain/aches.
Anyway, I did notice that even at a very low dose ( cutting 5/500 in half), that about 30 minutes after I took it, I was much calmer, nicer, and happier.
Of course, I recognized it was from the meds and becuase of that, I try to be careful to not use it as my anti depressant (because that's not what *my* doctor prescribed it for).
However, if I had tried EVERYTHING, and felt miserable, and had my doctor's approval and found that this was the one that helped me survive and thrive... I would take it.
I've been to that point of desperation that I would do ANYTHING to feel "normal" and desire life again.
So I'm glad you've found something that works and you have an understanding doctor.
Posted by jerrympls on November 17, 2005, at 18:16:28
In reply to can I say something too.., posted by spriggy on November 17, 2005, at 18:07:20
I think the key is to find an expeiernced psychopharmocologist or get in to seea pdoc at a university because in my experience they are more likely to try off-label therapies like opiate therapy. Gathering research on the subject and taking it to them also helps.
The biggest hurdle is telling them that an opiate makes you feel "normal" without them reacting negatively. In my situation, I had tried so many meds and so many combinations that my doc one day just said in frustration - does ANYTHING make you feel better - and that's when I told her that opiates made me feel much better - even close to "normal." Of course she didn't prescribe an opiate on the spot - she did some research and talked a lot with her colleagues about it before even giving it a trial run.
It's tricky to find a pdoc out there that will do this when everything else has failed. But there ARE docs out there.
Jerry
Posted by Paulbwell on November 18, 2005, at 12:33:38
In reply to Re: can I say something too.. » spriggy, posted by jerrympls on November 17, 2005, at 18:16:28
> I think the key is to find an expeiernced psychopharmocologist or get in to seea pdoc at a university because in my experience they are more likely to try off-label therapies like opiate therapy. Gathering research on the subject and taking it to them also helps.
>
> The biggest hurdle is telling them that an opiate makes you feel "normal" without them reacting negatively. In my situation, I had tried so many meds and so many combinations that my doc one day just said in frustration - does ANYTHING make you feel better - and that's when I told her that opiates made me feel much better - even close to "normal." Of course she didn't prescribe an opiate on the spot - she did some research and talked a lot with her colleagues about it before even giving it a trial run.
>
> It's tricky to find a pdoc out there that will do this when everything else has failed. But there ARE docs out there.
>
> JerryHi YA!
Yesterday i took 150mgs Codeine, after a long break from it-VIcodin=VI,=6 x Codeine? so 5mgs Hydro=30mgs Codeine, so did i threorecically take 25mgs Vicodin?
I can't say it did much for my mood, other than releave the soreness that 2 wasted weeks on sh*t Prozac caused me-althought i'v read that SSRIs can prevent the formation of Morphine fron Codeine so...
I wonder if Vicodin (not having to be changed into Morphine by the liver)would be any different, or maybe Codeine and VI-codeine responders are the same?Cheers
Posted by greenhornet on November 19, 2005, at 14:09:18
In reply to Re: can I say something too.. » spriggy, posted by jerrympls on November 17, 2005, at 18:16:28
> "I think the key is to find an expeiernced psychopharmocologist or get in to seea pdoc at a university because in my experience they are more likely to try off-label therapies like opiate therapy. Gathering research on the subject and taking it to them also helps."
> I heartily agree! If you can find a university hospital/teaching facility within a reasonable distance, and can be PATIENT and PERSISTANT You will probably benifit from the access they have "across departments" ie: Psychiatry/pharmacology etc.
> "The biggest hurdle is telling them that an opiate makes you feel "normal" without them reacting negatively."
AMEN -- but if you look and act anywhere near reasonably intelligent, and are willing to read and "do research", most university teaching centers will find someone who is willing to hear your our and cooperate
"In my situation, I had tried so many meds and so many combinations that my doc one day just said in frustration - does ANYTHING make you feel better - and that's when I told her that opiates made me feel much better - even close to "normal." Of course she didn't prescribe an opiate on the spot - she did some research and talked a lot with her colleagues about it before even giving it a trial run."
>
> "It's tricky to find a pdoc out there that will do this when everything else has failed. But there ARE docs out there."
>
> JerrySo right on Jerry!!
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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