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Dr. Bob is Robert Hsiung, MD,
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Posted by Declan on November 4, 2006, at 18:24:15
In reply to current meds » ed_uk, posted by pseudoname on November 3, 2006, at 14:00:34
Is the AD effect completely swallowed by tolerance (as seems to be the case with methadone)?
If you can maintain an AD effect from bupe in the face of tolerance that would be great.
Posted by JahL on November 4, 2006, at 21:27:34
In reply to Bupe » pseudoname, posted by Declan on November 4, 2006, at 18:24:15
> Is the AD effect completely swallowed by tolerance (as seems to be the case with methadone)?
I had a marvellous response to Bupe. Unfortunately it lasted just a matter of days.
In contrast low-dose Methadone has gifted me with consistent, sustained AD effects for some 6 years now.
I recently had to stop taking it due to supply problems and experienced no withdrawal symptoms whatsoever. This may not the case with (ex-) heroin addicts who will typically take much higher doses, although my friends on Methadone are in the main satisfied with the help it provides.
My illness is highly responsive to any and all opioids.
J.
Posted by Declan on November 5, 2006, at 0:10:02
In reply to Re: Bupe, posted by JahL on November 4, 2006, at 21:27:34
Geez, I'm impressed that you could take it for 6 years and just stop. It's not like that for me.
But I agree with you about the AD effect of opioids.
Posted by linkadge on November 5, 2006, at 16:22:34
In reply to Re: Bupe » JahL, posted by Declan on November 5, 2006, at 0:10:02
Supposedly opiates induce similar electroencephalographic changes as do the TCA's in depression.
Posted by Phillipa on November 5, 2006, at 17:36:35
In reply to Re: Bupe, posted by linkadge on November 5, 2006, at 16:22:34
All I know is the first time a few months back I took a l percocet at night for pain presribed. I was laughing and my husband noticed. It was great as I haven't laughed in a long time. But I told the doc and he said you'll get addicted. Everythings addictive. Love Phillipa
Posted by Declan on November 6, 2006, at 1:10:48
In reply to Re: Bupe » linkadge, posted by Phillipa on November 5, 2006, at 17:36:35
(in another context)
I don't care if it's horse piss, it works.
Posted by pseudoname on November 6, 2006, at 11:20:56
In reply to Bupe » pseudoname, posted by Declan on November 4, 2006, at 18:24:15
> Is the AD effect completely swallowed by tolerance (as seems to be the case with methadone)?
In fact, there seems (for me) to be NO tolerance-development with buprenorphine to its antidepressant effects. Ironically, I think that's where I got into a problem: I was able, circa April-September, to take a much lower dose of bupe than I had previously required. Then, for the last couple months, when my depression was getting worse, I neglected to increase it back to what it was.
It may be that I don't experience tolerance to bupe because I don't get a buzz or high from it in the first place. It just removes the depressive agony and suicidal thoughts.
I also don't seem to get much if any tolerance to the mild but annoying side-effects (like mild cognitive fuzziness) at the higher doses, either.
I'm greatly relieved that bupe is still effective. As Ed notes, I had been taking a pretty small dose recently. I was trying to avoid the (as I say, mild but still annoying) side effects, and I started to consider myself a "0.3-per-day man". I wish there were a published set of guidelines for bupe's use as an AD.
In related news: My pdoc NEVER CALLED ME BACK about getting ECT. She was supposed to talk to the ECT clinic and then let me know who to call for an initial appointment. I even left another message with her answering service last Wednesday. Unless she's meanwhile been hospitalized herself, I think her silence is inexcusable! The only reason I'm keeping her on as my pdoc is that she's willing to prescribe bupe.
Posted by Crazy Horse on November 6, 2006, at 11:26:09
In reply to Re: considering ECT, posted by blueberry on November 2, 2006, at 16:17:50
> ECT can certainly work. For me I found 3 weeks of it to just about completely get rid of depression. There are other problems though...the forgetfulness from ECT is pretty intense. I find myself writing a lot of notes and reminders to myself which I never had to do before. Though I've never heard of sexual side effects from ECT, I have them pretty fierce, when no amount of any drugs ever gave me much problem. I've been doing 3 outpatient ECT sessions per week for 3 weeks, and now I am going to cut it back to just once a week for a while and see how that goes. All in all it seems like a very effective treatment, but I must admit the side effects of confusion and the sexual dysfunction side effects are pretty intense.
Trust me..those side effects will fade with time.
-Monte
Posted by pseudoname on November 6, 2006, at 12:17:22
In reply to Re: Bupe (no tolerance yet!) » Declan, posted by pseudoname on November 6, 2006, at 11:20:56
(I hadn't yet read this more detailed question when I replied before. Sorry if I'm writing too much; I'm a little lonely right now and I don't have internet access at home for the moment.)
> Do you find that after being on x amount of bupe you *lose* the AD effect, or is it maintained. There must be some doses anyway that are more optimal than others. And I suppose that once you move to a higher dose the AD effect off the lower dose has gone? The trouble with methadone is not the effect of methadone as such, but rather how you feel once tolerance has been achieved long term.
For me, a given dose-level of buprenorphine does not seem to lose its effect *due to tolerance*, even over months. The very low 0.25 mg/day I was on remained effective throughout the summer, for example. And if I take an unusually large dose for a few days, the amount *required* for me to get an AD effect does not seem to increase on subsequent days. But also, the AD effect itself doesn't get greater for me with a greater-than-needed dose.
I don't know why I need a larger dose now or last winter than I did during the summer. Given my overall history with bupe, I don't attribute it to tolerance.
My theory on my lack of typical opioid tolerance is due to the fact that I don't get a typical opioid buzz or high from the bupe even if I take a whole lot of it. Not even on my very first day, when I naively took waaaay too much.
But some people apparently do get an opioid buzz from bupe. (Anybody out there?) In those cases, they might develop a tolerance to that but maybe still not to an underlying antidepressant effect? Dunno.
At Dr Bob's presentation about Babble at the Toronto APA convention in May, we went around the room and the Babblers who were there summarized their experience with Babble. I told how I found out about bupe here and now try to help others on Babble learn about it. I'll bet the half-dozen pdocs in the audience were thinking, "Oh great! My patients will visit Babble and then demand that I give them addictive opiates."
But my experience (including this latest little drama) is that buprenorphine is a very safe and — if given a proper chance — enduringly effective antidepressant.
I do wonder, however, if Provigil or Adderall might help the mild cognitive fuzziness that can occur for me at doses above 2 mg/day. Anybody know?
Posted by ed_uk on November 6, 2006, at 13:52:40
In reply to more on buprenorphine tolerance, posted by pseudoname on November 6, 2006, at 12:17:22
Hi PN
Now you're on a higher dose of bupe, and are feeling better............what are your symptoms? ie. which symptoms does bupe leave untreated?
Ed
Posted by pseudoname on November 7, 2006, at 9:43:03
In reply to Re: more on buprenorphine tolerance » pseudoname, posted by ed_uk on November 6, 2006, at 13:52:40
Thanks for the question, Edski.
> what are your symptoms? ie. which symptoms does bupe leave untreated?
I don't do things, or *want* to do them. I don't read books, learn about new things, shower, clean my house, do bookkeeping, spend time with people, enjoy food, etc. Even things that are easy & presumptively pleasurable I have no interest in doing, and I don't enjoy them when I do force myself to do them. Even my fantasies end in indifference. Shall we call that *anhedonia*?
I also have some huge neurotic fears, obsessions, and intrusive thoughts centered around What Other People Think Of Me (chiefly that everyone hates my guts or finds me ridiculous & undeserving), but I suspect that if the anhedonia were cleared up, I could tackle those obsessive thoughts behaviorally / therapeutically / mindfully.
ECT might still help with the anhedonia, might it not? Or perhaps Provigil? Do you think an MAOI might have a different effect for me when I'm on buprenorphine than they did before? I got no response from several MAOI trials 10+ years ago. Don't opioids & MAOIs have an area of intersection in the brain?
Posted by Declan on November 7, 2006, at 11:18:37
In reply to good question » ed_uk, posted by pseudoname on November 7, 2006, at 9:43:03
Hi PN
Wouldn't it be more likely for ECT to help with intrusive thought processes than anhedonia? I can't see how ECT would give you any get up and go. Which brings stimulants to mind. But if you take all that stuff you can end up simply feeling unwell, on top of whatever else you have.
Declan
Posted by ed_uk on November 7, 2006, at 14:34:20
In reply to good question » ed_uk, posted by pseudoname on November 7, 2006, at 9:43:03
Hi PN
Which tricyclic antidepressants have you tried? Perhaps one of the non-sedating tricyclics might help your anhedonia.
Ed
Posted by pseudoname on November 8, 2006, at 11:15:45
In reply to Re: good question, posted by Declan on November 7, 2006, at 11:18:37
Hi, Dek.
> Wouldn't it be more likely for ECT to help with intrusive thought processes than anhedonia?
My understanding from the ECT promotional literature is that it does NOT help with intrusive thoughts or schizophrenic symptoms or mania but does help with more classic depressive symptoms (when it helps at all).
> Which brings stimulants to mind. But if you take all that stuff you can end up simply feeling unwell, on top of whatever else you have.
Yeah. Does that happen even with Provigil? Does anyone know? I.e., does Provigil eventually result in tolerance and after-crash?
Then again, I can't see even my fruitcake pdoc prescribing BOTH an opioid and Provigil at the same time.
Posted by pseudoname on November 8, 2006, at 11:18:56
In reply to Re: good question ? pseudoname, posted by ed_uk on November 7, 2006, at 14:34:20
> Which tricyclic antidepressants have you tried?
I believe I've tried 3, but I don't have my list with me, so I can't be specific. You think a different one might be worth another shot, eh? I'll speak to my pdoc. Thanks for the suggestion.
Posted by ed_uk on November 8, 2006, at 16:27:51
In reply to ECT and intrusive thoughts » Declan, posted by pseudoname on November 8, 2006, at 11:15:45
>Then again, I can't see even my fruitcake pdoc prescribing BOTH an opioid and Provigil at the same time.
Provigil is not a euphoric drug. It's potential for abuse and dependence appears to be fairly minimal. In most countries, Provigil is not subject to any controlled drugs legislation. I think it's Sch IV in the US though.
Ed
Posted by ed_uk on November 8, 2006, at 16:30:35
In reply to tricyclics » ed_uk, posted by pseudoname on November 8, 2006, at 11:18:56
Hi PN
>You think a different one might be worth another shot, eh?
Yes, but not a sedating TCA. You could consider desipramine or nortriptyline. Imipramine might be useful, especially if nort and desip don't help.
Ed x
Posted by Quintal on November 11, 2006, at 18:17:50
In reply to good question » ed_uk, posted by pseudoname on November 7, 2006, at 9:43:03
> Thanks for the question, Edski.
>
> > what are your symptoms? ie. which symptoms does bupe leave untreated?
>
> I don't do things, or *want* to do them. I don't read books, learn about new things, shower, clean my house, do bookkeeping, spend time with people, enjoy food, etc. Even things that are easy & presumptively pleasurable I have no interest in doing, and I don't enjoy them when I do force myself to do them. Even my fantasies end in indifference. Shall we call that *anhedonia*?
>
> I also have some huge neurotic fears, obsessions, and intrusive thoughts centered around What Other People Think Of Me (chiefly that everyone hates my guts or finds me ridiculous & undeserving), but I suspect that if the anhedonia were cleared up, I could tackle those obsessive thoughts behaviorally / therapeutically / mindfully.
>
Pseudoname, have you tried low dose amisulpride (50mg region) for your dysphoria? I have found it's the only med that really helps me with this problem. It has very few side effects at this dose, perhaps a bit of insomnia, otherwise it works brilliantly at helping me actually enjoy life.I imagine amisulpride plus an MAOI like Nardil might be very effctive as amisulpride is mildly stimulating due it its dopamine agonist action at low doses and may help clear grogginess/brain fog caused by Nardil?
Personally I find the effect of low dose amisulpride similar to the effect of Parnate + Klonopin in terms of energy boost and anxiety relief.
Posted by pseudoname on November 14, 2006, at 13:25:13
In reply to Re: good question, posted by Quintal on November 11, 2006, at 18:17:50
Hi, Quintal. Nice to meet you.
> Pseudoname, have you tried low dose amisulpride (50mg region) for your dysphoria?
I have not tried amisulpride/Solian®. I live in the U.S., and as far as I understand, it's not available here at all. Where do you live or how do you get it? (In general terms I mean, not violating Bob's rules….)
> Personally I find the effect of low dose amisulpride similar to the effect of Parnate + Klonopin
Maybe I should try Parnate + Klonopin, then, eh? ECT terrifies me, and I don't know if I can manage it logistically. My life terrifies me. Maybe I should try Klonopin by itself, too.
Posted by Quintal on November 14, 2006, at 16:19:47
In reply to amisulpride (Solian) » Quintal, posted by pseudoname on November 14, 2006, at 13:25:13
> Hi, Quintal. Nice to meet you.
>
> > Pseudoname, have you tried low dose amisulpride (50mg region) for your dysphoria?
>
> I have not tried amisulpride/Solian®. I live in the U.S., and as far as I understand, it's not available here at all. Where do you live or how do you get it? (In general terms I mean, not violating Bob's rules….)
>
> > Personally I find the effect of low dose amisulpride similar to the effect of Parnate + Klonopin
>
> Maybe I should try Parnate + Klonopin, then, eh? ECT terrifies me, and I don't know if I can manage it logistically. My life terrifies me. Maybe I should try Klonopin by itself, too.
--------------------------------------------------
Hi Pseudoname. I live in the UK where I used to get amisulpride free on prescription. I was going to suggest you try sulpiride as an alternative but a web search revealed that neither of them are approved by the FDA for use in the US.
I'm sure I've heard of people using amisulpride in America though. In fact I saw a thread on this topic a few days ago. There are legal ways of obtaining amisulpride in the US as it is not an illicit drug as such, just has no current medical licence. You may be able to import it if you can convince your pdoc it is likely to be sufficiently effective for your problems. Amisulpride was found to be more effective in treating dysthymia and depression than Prozac in one study, I'm sure there are others: http://en.wikipedia.org/wiki/Amisulpride
I would be surprised if Parnate + amisulpride + buprenorphine did not lift your dysthymia. Have you considered augmenting an MAOI and/or your buprenorphine with lamotrigine (Lamictal)? Lamotrigine also seems effective in preventing tolerance/sustaining the effects etc of opiates and possibly augmenting their effect, as well as being an effective antidepressant and mood stabilizer in itself. Here is one study I found that demonstrates this effect, but there are others that are more convincing: http://ajp.psychiatryonline.org/cgi/content/full/156/12/2017
I recall the legendary Elizabeth of buprenorphine solved her dysthymia problem by adding a pinch of lithium to her MAOI. Perhaps lamotrigine would have fewer side effects though?
Klonopin helps with jitteriness and insomnia caused by Parnate and obviously soothes any residual anxiety. I found that Parnate antagonised the sedative effect of Klonopin during the day (although it was still effective for anxiety), but sedation recurred at night when the stimulant effect of Parnate wore off, which was good as it helped me sleep soundly without additional meds.
I’m getting tired of playing the medication game myself as nothing worked for very long, either that or I abused it (Klonopin) and was forced to withdraw. As an alternative to ECT / psychosurgery / suicide I am going out on a limb and venturing to Peru to participate in an Ayahuasca healing ceremony. I’m terrified of Ayahuasca, and being a social phobe, going to Peru without my comforting meds is even more terrifying than the Aya itself. It is going to be the biggest challenge of my life but I see no meaning or direction in the way I’m living right now.
Have you considered something like this pseudoname? It may be even more difficult to manage logistically, but it may be an greater mental/spiritual shock than ECT, and I suspect it would give you much more insight and lasting benefit (and perhaps even some cognitive enhancement?) than ECT.
Just a thought.
Posted by Quintal on November 14, 2006, at 17:07:11
In reply to Re: tricyclics  » pseudoname, posted by ed_uk on November 8, 2006, at 16:30:35
> Hi PN
>
> >You think a different one might be worth another shot, eh?
>
> Yes, but not a sedating TCA. You could consider desipramine or nortriptyline. Imipramine might be useful, especially if nort and desip don't help.
>
> Ed xHave you tried trimipramine pseudoname? After reviewing some of the earlier posts on this thread I noticed a question regarding tricyclics and this reminded me that trimipramine also has some D2 receptor agonist/antagonist effects like amisulpride.
Trimipramine also has beneficial effects on sleep architecture, promoting REM sleep where most ADs suppress it. Trimipramine also soothes mild anxiety. Here is a link that has more info: http://en.wikipedia.org/wiki/Trimipramine
It is a sedating tricyclic however, but some people find tricyclics very effective for these problems at sub theraputic doses.
I hope posting of external links is allowed here (I'm new) :-)
Posted by pseudoname on November 15, 2006, at 12:39:16
In reply to Trimipramine, posted by Quintal on November 14, 2006, at 17:07:11
> Have you tried trimipramine pseudoname?
I have not. Anxiolytic properties are something I could probably do well with, however. Another idea; thanks.
> I hope posting of external links is allowed here (I'm new) :-)
External links are fine as long as the linked page itself is civil by Babble standards: no F-words, for example, no put-downs, no political insults, no obscenities, no deliberate misinformation, etc. Wiki medication articles are generally fine.
Posted by ed_uk on November 15, 2006, at 15:40:40
In reply to Trimipramine, posted by Quintal on November 14, 2006, at 17:07:11
Hi Q
>I hope posting of external links is allowed here (I'm new) :-)
Welcome to babble! I was actually wondering whether you used to post a few years ago under a different name!
Ed
Posted by Quintal on November 15, 2006, at 17:33:54
In reply to Re: Trimipramine » Quintal, posted by ed_uk on November 15, 2006, at 15:40:40
> Hi Q
>
> >I hope posting of external links is allowed here (I'm new) :-)
>
> Welcome to babble! I was actually wondering whether you used to post a few years ago under a different name!
>
> EdHi Ed,
I once posted a reply to a query about moclobemide a few years ago and asked a question about the Marplan I was taking at the time. I don't think you would have remembered that though? I forgot my password when I came to log in again so I set up a new account. Who did you think I used to post as?
Q
Posted by ed_uk on November 16, 2006, at 12:51:55
In reply to Re: Trimipramine, posted by Quintal on November 15, 2006, at 17:33:54
Hi Q
>Who did you think I used to post as?
No one specific, you just 'sounded' like an 'old timer' somehow! :)
Ed
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