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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 100. This is the beginning of the thread.
Posted by pearlcat on February 19, 2007, at 13:52:09
Has anyone experienced that opiates seemed to help with depression,anxiety and add? I know it sounds crazy but it is true . I feel more motivated on these . I guess that is why they are addictive. Yet you cannot get them easily. But you can get crap like lamictal and effexor that can really screw you up! Too bad you cant get them on the internet!
Posted by FredPotter on February 19, 2007, at 14:44:36
In reply to opiates for depression, posted by pearlcat on February 19, 2007, at 13:52:09
I "acquired" some methadone pills once and found they lifted depression after about 3 hours. Maybe coincidence. I also found a similar effect with Naltrexone for a while (go figure - perhaps it's the Tianeptine Paradox = more stuff around, less receptors, less stuff around, more receptors (this is the voice of a layman))
Fred
Posted by Phillipa on February 19, 2007, at 14:50:37
In reply to Re: opiates for depression » pearlcat, posted by FredPotter on February 19, 2007, at 14:44:36
Broke my arm last year and percocet l pill at night had me laughing. They do work for depression. Love Phillipa
Posted by FredPotter on February 19, 2007, at 18:36:52
In reply to Re: opiates for depression, posted by Phillipa on February 19, 2007, at 14:50:37
I suppose we should ask whether they go on working, or does tolerance or poop-out occur. Also it's a lucky or persuasive person who can get his/her Dr to prescribe them. Why, they don't even prescribe opiates for pain unless you're dying and even then they can be deterred by possible "addiction"
Posted by flmm on February 19, 2007, at 21:36:19
In reply to Re: opiates for depression, posted by FredPotter on February 19, 2007, at 18:36:52
Hate to spoil the fun! After awhile these drugs are quite damaging in depression and can make it much, much worse! But hey, like any addictive street drug, it's fun in the begining. I speak from experience from back injury, surgery etc. Most people in chronic pain would do just about anything to get off the flatlining, terrible existence of barely surviving on opiates!
Posted by FredPotter on February 19, 2007, at 21:51:08
In reply to Re: opiates for depression HELL NO, posted by flmm on February 19, 2007, at 21:36:19
I haven't got your experience but it's not what I've heard from others who lead normal lives on carefully controlled doses of opiates. Somehow the tolerance is managed. Anyone know how?
Posted by Phillipa on February 19, 2007, at 22:15:03
In reply to Re: opiates for depression HELL NO, posted by flmm on February 19, 2007, at 21:36:19
My neighbor has a fentanyl patch for hip pain and the opiods as a back up when the pain is really bad. Love Phillipa
Posted by Quintal on February 19, 2007, at 22:58:49
In reply to Re: opiates for depression HELL NO » flmm, posted by FredPotter on February 19, 2007, at 21:51:08
Lamotrigine has been shown to reduce or prevent tolerance to opiates. I use codeine salts myself nad they are very effective for both depression and anxiety. They usually improve motivation and increase energy in depressed people.
Q
Posted by med_empowered on February 20, 2007, at 2:07:04
In reply to Re: opiates for depression HELL NO, posted by Quintal on February 19, 2007, at 22:58:49
I think opiates can be a very, very good thing. High-doses for prolonged periods probably aren't fun, especially since chronic pain is often accompanied by mood and anxiety problems and psychosocial difficulties. Some more helpful docs give patients a stimulant (ritalin, provigil, an amphetamine) to help reduce lethargy. From what I've read (based on research done back when a doc could do this w/o fearing the DEA), such combos can work very, very well; the "speedball" combo tends to counteract sedation and depression and improve quality of life.
Anyway..that's beside the point...opiates have long been a solution, short- and long-term, to humankind's spells of misery and fits of despair. Based on my own experience, I hardly think any of these over-hyped miracle antidepressants will ever come close to matching the calming, soothing power of the opiates. And let's face it: the only reason these are considered "addictive drugs" is b/c no drug company has pushed through an overhyped med w/ opiate action for depression. The instant Pfizer or Eli Lilly or AstraZeneca take a break from pumping out "atypical" antipsychotics and offer up an opiate (one that, for 10-20 years, will be seen as "safe" and "less addictive" than cheaper drugs) for depression, p-docs all over will be spraying them on everyone for everything. And we'll all hear how terribly misinformed medicine was in the dark ages before they realized how beneficial opiates were, blah blah blah....
In the meantime, the best we can do is try to get docs to treat patients w/ mood issues with the same the same concern they're showing junkies. I think this really shows just how much the "mental patient" is disrespected and disregarded, even by the very profession that claims to serve us: drug addicts, a group traditionally seen as morally suspect, are entitled to better, more effective treatments than mental patients. Think about it.
((PS--I dont have a problem with people using/abusing drugs or those who wish to stop and end up labelled as "addicts" or "junkies"; my point is just that the "addict" has usually ranked pretty low on the social totem pole, and I think the way they are treated vs mental patients kind of shows that mental patients are still pretty much devalued and disregarded).
Posted by Crazy Horse on February 20, 2007, at 10:16:38
In reply to opiates for depression, posted by pearlcat on February 19, 2007, at 13:52:09
> Has anyone experienced that opiates seemed to help with depression,anxiety and add? I know it sounds crazy but it is true . I feel more motivated on these . I guess that is why they are addictive. Yet you cannot get them easily. But you can get crap like lamictal and effexor that can really screw you up! Too bad you cant get them on the internet!
Unfortunately they 'poop out' quickly do to tolerance. Otherwise they are great, i agree.
-Monte
Posted by Chairman_MAO on February 20, 2007, at 14:40:56
In reply to opiates for depression, posted by pearlcat on February 19, 2007, at 13:52:09
Try buprenorphine (Suboxone, Subutex, Buprenex). The doses required may be a lot more than 0.3mg qid, though (the "ceiling" dose is 32mg/day sublingually).
Buprenorphine for Depression: The Un-adoptable Orphan
Buprenorphine [BPN] in low (circa 0.3 mg qid) transmucosally (under the tongue or by nose drops) can be dramatically effective in cases of treatment for refractory depression. Its safety and efficacy are not secrets, yet it has received little study and currently receives little clinical use.
Early in BPN's history, Emrich et al (1982) found it a potent antidepressant in drug-refractory depressives. Sporadic supporting reports have appeared in the literature from time to time since then. Most recently, Bodkin et al (1995) reviewed the literature and reported an open trial of 10 cases to further document BPN's value as an antidepressant. When the drug works, it works quickly. Bodkin et al say they see results within several days. We have found that most patients experience benefits of an adequate dose within three hours. The only intolerable side effects are nausea and dysphoria. The effects are seen in 10% to 20% of patients and are quickly obvious....
We have personally treated five patients with BPN in whom the results were impressive. Three were more or less typical cases of depression who had failed adequate trials with various treatments, including, in one case, a thorough course of ECT. Of the two less typical patients, one was a case of panic disorder with onset in childhood and what could better be called dysthymia rather than typical depression.... All five patients were followed for several years while good results were maintained.
Given BPN's availability and demonstrated efficacy, why is it so rarely used in treating depression? Therein hangs a tale. Reckitt and Colman Pharmaceuticals, Inc. [R&C] received their NDA to market BPN as a parenteral analgesic more than a decade ago. It appears that their grand strategy was to get BPN approved as an over-the-counter analgesic. It does indeed have a remarkable safety profile. At high doses, it produces less respiratory depression and cognitive obtunding than morphine, perhaps due to its antagonist action....
Addiction and tolerance are not serious problems. Patients who abruptly stop the drug complain of fatigue, dysphoria, upset stomach, and sometimes piloerection. This pallid imitation of narcotic withdrawal is generally not associated with craving, and indeed patients do not usually associate their symptoms with having stopped the drug until they experience the relief occasioned by restarting their treatment. There are reports of the drug being abused, but then some substace abusers will abuse almost anything. We were told that San Quentin stopped using white scouring powder because substance-abusing inmates were injecting it into themselves!
One handicap BPN has had as an antidepressant was the absence of any interest in that application on the part of the manufacturer. The idea of selling BPN as an OTC analgesic was not an unreasonable one, but it did not lead R&C to pursue work on the psychotropic properties of their drug.
It appears tha BPN can be used much as methadone is used in maintaining opiate addicts. While doses of up to 32mg have been used, doses in the order of 6 to 12mg seem best. Compare this to the 0.15mg to 0.3mg doses that are effective in depression. Several studies have reported that BPN is indeed effective in treating opiate dependence, although less so than methadone (Kosten et al 1993 and Strain et al 1994). However, BPN's use in treating addicts, plus the ominous "-norphine" suffix in its name, have been even more of a deterrent to BPN's exploitation as an antidepressant than has R&C's narrow focus on its analgesic applications.
Comparing BPN with classic mu agonist opiates is unfair. BPN is a derivative of thebaine, which has partial mu agonist and kappa antagonist activities. As a partial agonist, it seems to act as a mu antagonist at higher doses, and this provides some protection against it being used in escalating doses by substance abusers. In addition, in low doses it produces minimal or no euphoria. We have a little packet of reprints to send out to pharmacists who call accusingly and question why we are prescribing such a "dangerous narcotic."...
We have continually been frustrated by the resounding lack of interest our colleagues have shown in BPN as an antidepressant. In spite of some promising pilot work, Veterans Administration workers treating post-traumatic stress disorder have declined to study BPN because so many of their clients are substance abusers, and BPN is "narcotic-like."
We discovered that someone had contracted with Cygnus, Inc. to develop a BPN patch. That was accomplished, but the contracting company dropped the project. The developed BPN patch now sits on their shelf. However, after a few cordial lunches, Cygnus indicated they would need a million dollars up front to reactivate production of the patch for a clinical trial. Small business grants are limited to $100,000 to start, so that would not get Cygnus back into the BPN patch business. Also, treatment-refractory depression does not sound like an appealing market to business types. We are not sure the market is so small, and it has been suggested that as many as 20-30% of depressed patients may be treatment-refractory. But certainly, for a single physician, patient accrual is slow. While the patent on BPN has run out, orphan drug status might allow a company to be protected against competition while it recoups its investment and more. But so far there is little interest from industry.
Academia has been similarly uninterested, but with better reason. It's too bad that substance abuse takes a hight priority than depression in congress, but then what is one to expect. And our wildest fantasy does not have the National Institutes of Mental Health approving the trial of such an oddball drug for treatment-refractory depression. In our mind's eye we can see the pink sheet: Reviewer No. 1 says: "We already know that BPN works in depression, so why do it again?", while reviewer No. 2 says: "It's too much of a long shot in these times of short money."...
Research is the art of the possible, and none of us these days can afford to espouse lost causes. But your local pharmacist can dispense BPN without a triplicate, and even supply a syringe and needle so the patient can withdraw the drug form the vial and squirt it under the tongue. You will find it in the Physician's Desk Reference under the trade name "Buprenex" injectable, 0.3mg/ml. So even if the orphan remains un-adoptable, you might want to try BPN on an occasional drug-refractory depressive, and so keep it alive, at least in the lore of those who do tertiary psychopharmacology.
Enoch Callaway
University of California-San Francisco
Tiburon, CA
References:Bodkin JL, Zornberg GL, Lucas SE, Cole JO. (1995): Buprenorphine treatment of refractory depression. Journal of Clinical Psychopharmacology, 16:49-57.
Emrich HM, Vogt P, Herz. (1982): Possible antidepressive effects of opioids: action of buprenorphine. Annals of the New York Academy of Sciences, 398:108-112.
Kosten TR, Schottenfeld R, Ziedonis D, Falcioni J. (1993): Buprenorphine versus methadone maintenance in opioid dependence. J Nerv Mental Dis 181:358-364.
Strain EC, Stitzer ML, Liebson IA, Bigelow GE. (1994): Buprenorphine vs. methadone in the treatment of opioid-dependent cocaine users. Psychopharmacology 116:401-406.
Posted by Chairman_MAO on February 20, 2007, at 14:41:37
In reply to Re: opiates for depression HELL NO, posted by flmm on February 19, 2007, at 21:36:19
Those people need to be given amphetamine.
Posted by Larry Hoover on February 20, 2007, at 17:20:36
In reply to Re: opiates for depression HELL NO, posted by flmm on February 19, 2007, at 21:36:19
> Hate to spoil the fun! After awhile these drugs are quite damaging in depression and can make it much, much worse! But hey, like any addictive street drug, it's fun in the begining. I speak from experience from back injury, surgery etc. Most people in chronic pain would do just about anything to get off the flatlining, terrible existence of barely surviving on opiates!
Nothing like the voice of experience....
Unfortunately, I have to weigh in on this side, also.I don't think anything can compare with the black depression that can arise when the opiates fail. It could be three months. Three years. Maybe never, if you're lucky. But the body eventually can't function with them, and you go into withdrawal, even when on a stable dose. At least I can say it happens, because it happened to me.
Now, the idea of using buprenorphine might well be the exception to the rule, but that's because it is an exceptional opiate (thebiate?). I'd be willing to give that a shot, not only because of the antidepressant effect, but also the pain suppressing quality of the drug.
I just want to say, there is a dark side to opiates. I don't care how careful you are, the darkness can come.
Lar
Posted by Quintal on February 20, 2007, at 17:47:10
In reply to Re: opiates for depression HELL NO » flmm, posted by Larry Hoover on February 20, 2007, at 17:20:36
I agree up to a point Larry, as I'm in a similar position to the one you were in not so long ago, right now myself but with OTC analgesics containing codeine. The same thing happens to some people with conventional antidepressants though (and that happened to me too) so I don't think it's fair to rule out opiates because of that. I'm very interested in buprenorphine too and I would like to try it if I ever get the chance.
Q
Posted by Phillipa on February 20, 2007, at 18:28:12
In reply to Re: opiates for depression HELL NO, posted by Quintal on February 20, 2007, at 17:47:10
Me too. you know they have a detox facility here in Charlotte that uses bupe but you have to be an addict first. Love Phillipa
Posted by yxibow on February 20, 2007, at 20:21:07
In reply to Re: opiates for depression HELL NO » Quintal, posted by Phillipa on February 20, 2007, at 18:28:12
I'm considering a doctor consultation for small PRN amounts of bupenorphine for eye and psychiatric pain for my visual somatiform disorder.
What is the general sensation of bupenorphine vis a vis other opiates such as codeine, oxycontin, percocet, etc, considering it is only C-V, from someone who has taken it specifically for some sort of pain or other disorder. I know its use is generally for detox, but who knows.
-- tidings.
Posted by flmm on February 20, 2007, at 21:10:45
In reply to Re: opiates for depression HELL NO » flmm, posted by Larry Hoover on February 20, 2007, at 17:20:36
Thank you for your sane sense of reason Larry! I think people become desperate and think opiates will work long term, they do not! Also, when they "poop out" it is not like an ssri pooping out, where it just seems to not work as well. They crash and actually make you more depressed,even if not increasing the dose, which most people do. This is the continuous withdrawal I think you are refering to. It is not an antidepressant, it is merely chasing a high! Which is what most depressed people did when they were younger and did not understand why they wanted to be high. It's called self medicating, and the road goes bleak very soon! Good luck to those that can handle it..............
Posted by Declan on February 20, 2007, at 21:59:27
In reply to Re: opiates for depression HELL NO » flmm, posted by Larry Hoover on February 20, 2007, at 17:20:36
>I don't think anything can compare with the black depression that can arise when the opiates fail.<
Maybe if you are in physical pain? Opiates generally fail inasmuch as tolerance decreases the effect and something happens in the brain that makes dose escalation beside the point. Everyone I knew on methadone maintenance had low grade depression, but methadone is the worst opiate I know of.
I just don't think it's quite that bad.
No worse than benzo addiction.
Oh dear, I've used the A word innapropriately again....someone can correct me.
Posted by Larry Hoover on February 20, 2007, at 22:07:39
In reply to Re: opiates for depression HELL NO, posted by Declan on February 20, 2007, at 21:59:27
> >I don't think anything can compare with the black depression that can arise when the opiates fail.<
>
> Maybe if you are in physical pain? Opiates generally fail inasmuch as tolerance decreases the effect and something happens in the brain that makes dose escalation beside the point.It may be particularly prominent with oxycodone, that black depression, but I've heard it from many people. Not just people who used it for pain, either. Anecdote, I know, but....I don't think this sort of thing gets published.
Lar
Posted by Quintal on February 20, 2007, at 22:14:30
In reply to Re: opiates for depression HELL NO, posted by flmm on February 20, 2007, at 21:10:45
>I think people become desperate and think opiates will work long term, they do not!
They work as long as any other antidepressant; sometimes a few days, sometimes a few weeks, sometimes a few months, sometimes a few years, and it is a such a wonderful release for the person when they do work for treatment resistant depressives. We are talking about people who have tried nearly everything in the book afterall, not as some faddy new remedy for treating everyday blues.
>Also, when they "poop out" it is not like an ssri pooping out, where it just seems to not work as well.
The flip side to this is that just like with opiates when the SSRI/SNRI poops out you often face not only returning depression and anxiety, but at the most inopportune time you have to endure a nasty withdrawal syndrome to boot.
>It is not an antidepressant, it is merely chasing a high!
How do you define 'antidepressant'? Anything that ameliorates depression is an antidepressant to my mind, but I would argue that opiates are, in truth, more authentic antidepressants than drugs like SSRIs that seem to exert their antidepressant effect most often by reducing the capacity to feel emotion.
>It's called self medicating, and the road goes bleak very soon!
It's not self-medicating if the opiate is prescribed by a doctor. The road of conventional antidepressants has gone blank for many people here already, that's why they are considering opiates.
>Good luck to those that can handle it..............
Thank you.
Q
Posted by Declan on February 20, 2007, at 22:30:58
In reply to Re: opiates for depression F*CK YEAH!, posted by Quintal on February 20, 2007, at 22:14:30
O yeah.
Some people are more responsible than others.
Some people worry about PR more than others.
Some people couldn't give a rats.
Posted by Quintal on February 20, 2007, at 22:42:02
In reply to Merely chasing a high, posted by Declan on February 20, 2007, at 22:30:58
...........doesn't bother me.
I've yet to find anything that works as an antidepressant for me that lacks abuse potential; i.e. gets me high to some extent. That's what I mean by true antidepressants being mood elevators rather than anaesthetics.
Q
Posted by Declan on February 20, 2007, at 22:44:50
In reply to Re: Merely chasing a high, posted by Quintal on February 20, 2007, at 22:42:02
Well yes.
The standards of the industry are such that we are meant to be grateful for feeling half dead, but bugger that.
Posted by Declan on February 21, 2007, at 0:59:00
In reply to Re: Merely chasing a high, posted by Declan on February 20, 2007, at 22:44:50
Opiates 'help many people, period! Are they perfect? NO! They make a significant difference in my, and many other people I know, lives. Anxiety and depression is a complex and difficult disease. The drugs can only do so much! Maybe some of you complainers should look at other ways to help yourself, and be grateful for the help available to us!'
Really, who knows?
Posted by Declan on February 21, 2007, at 1:04:49
In reply to Re: opiates for depression HELL NO » Declan, posted by Larry Hoover on February 20, 2007, at 22:07:39
Well, yes Larry.
Giving up methadone felt like this endless thing, terrible really, and I wouldn't wish it on anyone.
The cure is often worse than the disease, hey?
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