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Dr. Bob is Robert Hsiung, MD,
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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?
Posted by Quintal on February 21, 2007, at 6:35:53
In reply to Re: opiates for depression HELL NO, posted by flmm on February 20, 2007, at 21:10:45
Actually, if there's one class of drug notorious for rapid tolerance and the severe, suicidal depressions that follow withdrawal, it's the amphetamines. Yet I see many people here using them to treat depression and some spurious cases of ADHD. Relatively little fuss is made of this.
Q
Posted by Larry Hoover on February 21, 2007, at 15:36:01
In reply to opiates for depression, posted by pearlcat on February 19, 2007, at 13:52:09
Here's a recent study showing significantly decreased µ-opioid binding in MDD. Hmmmm....
http://archpsyc.ama-assn.org/cgi/content/abstract/63/11/1199
I think this is why buprenorphine seems to be so effective? I'm not remembering things well right now, so if anyone knows for sure, I'd appreciate the confirmation.
Lar
Posted by linkadge on February 21, 2007, at 16:02:22
In reply to Re: opiates for depression, posted by Quintal on February 21, 2007, at 6:35:53
I don't think it is fair at all for somebody to say that anyone using opiates for depression is merely chasing a high.
We don't fully understand the biochemical abnormalities in depression.
I think it is completely possable, that opiates target some aspect of the affective process, while potentally causing euphoria as a side effect.
It is just like how drugs for ADHD are not treating ADHD *by* causing euphoria. Euphoria is simply a side effect. The theraputic effect is not due to dopamine release in the neucleus accumbens, but rather dopamine release in the frontal cortex.
Similarly, I think it is possable that opiates do something in addition to their abuse poetneial. There is a link, for instance between depression and pain. Opiates affect the activity of substance P for instance. Substance P inhibitors are being investigated as a means to treat depression without euphoria.
So to say that a person using opiates for depression is just trying to get high may not be entirely accurate as there may be two entirely separate procesess at work.
Linkadge
Posted by Quintal on February 21, 2007, at 17:45:07
In reply to Re: opiates for depression, posted by linkadge on February 21, 2007, at 16:02:22
>I don't think it is fair at all for somebody to say that anyone using opiates for depression is merely chasing a high.
I agree. I'm not sure to whom this post was directed, if anyone in particular, but I'll respond anyway........
>It is just like how drugs for ADHD are not treating ADHD *by* causing euphoria. Euphoria is simply a side effect. The theraputic effect is not due to dopamine release in the neucleus accumbens, but rather dopamine release in the frontal cortex.
I think it's hard to tell link, since there are no drugs that specifically release dopamine only in the frontal cortex (that I'm aware of) that could prove it conclusively. The performance of treatments for ADHD that operate selectively via the noradrenergic system, like Strattera seem less impressive than those that (perhaps incidentally) increase dopamine release in the nucleus accumbens. I think to some significant extent the increased efficiency and tolerability of amphetamines used to treat ADHD is due to increased desire and greater capacity to feel reward caused by release of dopamine in the nucleus accumbens, as well as increasing attention span and organisation etc, by releasing dopamine in the frontal cortex. I say this because again, drugs that increase attention span alone and cause little if any euphoria, like Strattera seem to be less effective (and less well tolerated) overall.
I really think a drug that's subjectively more pleasant in its effects will have more treatment responders, because more people will be willing to persevere for the full length of the trial even if the actual benefits aren't that good.
>Similarly, I think it is possable that opiates do something in addition to their abuse poetneial. There is a link, for instance between depression and pain. Opiates affect the activity of substance P for instance. Substance P inhibitors are being investigated as a means to treat depression without euphoria.
I'm sure you know opiates affect many chemicals in the brain link, most of the usual mood-altering culprits dopamine and serotonin for example, as well as any action on substance P. We already have a whole gamut of antidepressants that supposedly treat depression without causing euphoria. They seem to be less effective overall than those that do cause euphoria, especially for treatment resistant depressives, and that is what most of this debate has been about.
That reminds me, didn't the legendary Elizabeth of Buprenorphine disappear off babble radar right after announcing she was considering being a participant in a clinical trial for a substance P blocker? I wonder if she ever did attend? Ominous.
Q
Posted by pearlcat on February 21, 2007, at 20:40:39
In reply to Re: opiates for depression » pearlcat, posted by Larry Hoover on February 21, 2007, at 15:36:01
Sometimes I think it is all a plot by the Government! Maybe if they did not hang over docs heads about controlled drugs some of us could get better out there instead of going through years of hell to find out what works. I agree that you do build a tolerance to opiates. However because it can make you feel normal and then help you sleep soundly , maybe that is why people abuse them. Not to get high just to feel happy and motivated. At least that is what is does to me. But, instead you get crap like EFFEXOR and you gain weight, and have a terrible time coming off of it. Maybe to alleviate some of the withdrawel of effexor they should prescribe opiates!!!
Posted by pearlcat on February 21, 2007, at 20:48:19
In reply to Re: opiates for depression, posted by linkadge on February 21, 2007, at 16:02:22
Thank you!!! It IS NOT about chasing a high. Its about getting through life and enjoying it with this illness or illnesses. And if it were to work than why not try it, research it more instead of slamming it and assuming that those of us that it helps are drug addicts.
Posted by linkadge on February 21, 2007, at 20:58:11
In reply to Re: opiates for depression, posted by Quintal on February 21, 2007, at 17:45:07
>I think it's hard to tell link, since there are >no drugs that specifically release dopamine only >in the frontal cortex (that I'm aware of) that >could prove it conclusively.
Caffiene is an example of a stimulant drug which increases dopamine release much more in the frontal cortex than in the neucleus accumbens. While caffine is not patentable, it is probably the number one choice for ADHD for a number of undiagnosed.
But, my point was that there are plenty of drugs that are eupohriants (ie NAA dopamine release) wich are not effective for ADHD. So, the effect of ritalin is not simply due to euphoria.
Just like, for a while people thought the mood effects of amphetamines were inseperable from the weight loss properties. Amphetamine derivitives like fenfluramine however seem to proove this assumption wrong.
>The performance of treatments for ADHD that >operate selectively via the noradrenergic >system, like Strattera seem less impressive than >those that (perhaps incidentally) increase >dopamine release in the nucleus accumbens.
Thats probably because straterra doesn't increase frontal cortex dopamine as much as it does frontal cortex noradrenaline. This drug doesn't make a lot of sense for ADHD since a number of studies indicate noradrenaline is hyperactive compared to dopamine in ADHD. (but thats beside the point)
>I think to some significant extent the increased >efficiency and tolerability of amphetamines used >to treat ADHD is due to increased desire and >greater capacity to feel reward caused by >release of dopamine in the nucleus accumbens, as >well as increasing attention span and >organisation etc, by releasing dopamine in the >frontal cortex. I say this because again, drugs >that increase attention span alone and cause >little if any euphoria, like Strattera seem to >be less effective (and less well tolerated) >overall.
Well, I'd like to comment. For starters we only really have Straterra, which as I mentioned above doesn't really increase frontal cortex dopamine so I wouldn't even use it as a comparitor. Certain supplements like omega-3 have utility in ADHD. The 0-3 fatty acids increase frontal cortex dopamine, but do not directly activate the reward systems. So, I'd say we need more drugs in order to fully know for sure.
Another argument that I would make is that many people who are trying drugs like strattera have already been primed to the reward of ritalin. As such, they are unlikely to find other drugs as effective.
Only time, and more test drugs will fully determine whether activating the reward systms is actually necessary for ADHD drug effect. One would also need to ascertain wheather the reward system in ADHD is actually dysfunctional, because we do know that long term stimulant treatment can make the reward systems dysfunctional.
Another consideration is that ADHD drugs can continue to work, long after the subjective high has subsided.
Kids who take ritalin for years, are unlikely to be getting any buzz from it, but it still helps their attention.
>I really think a drug that's subjectively more >pleasant in its effects will have more treatment >responders, because more people will be willing >to persevere for the full length of the trial >even if the actual benefits aren't that good.That is certainly true.
>We already have a whole gamut of antidepressants >that supposedly treat depression without causing >euphoria. They seem to be less effective overall >than those that do cause euphoria, especially >for treatment resistant depressives, and that is >what most of this debate has been about.I agree. But, all I am saying is that with some of these drugs, even the ones that cause euphoria, there may still be undetermined mechanisms of theraputic action that could be unrelated to euphoric properties. The neucleus accumens quickly adapts to chemical alterations, so I would argue that if a long term theraputic response is attained, then there is likely something else going on.
Linkadge
Posted by flmm on February 21, 2007, at 21:11:37
In reply to Re: opiates for depression, posted by pearlcat on February 21, 2007, at 20:48:19
Declan,Quintal, you are both in total denial! Yes, something that gets you high can be considered an antidepressant. That is not how ssri meds work. That's probably why a lot of people don't like them. The dreaded "poop out" everyone speaks about here, is merely the leveling out of the medication. You guys think the high should last forever!
Good luck and party on dudes...........
Posted by Quintal on February 21, 2007, at 21:43:07
In reply to Re: opiates for depression, posted by flmm on February 21, 2007, at 21:11:37
>Declan,Quintal, you are both in total denial!
You think we're in denial of what exactly?
>The dreaded "poop out" everyone speaks about here, is merely the leveling out of the medication.
'Poop out' as I understand it is the return of the original symptoms. It is not the levelling out of antidepressant response though some will no doubt claim it is. Yes, the MDMA-like high I got off 20mg escitalopram did fade out over a few weeks.
> You guys think the high should last forever!
????!!!! What have I said to make you think that?
Q
Posted by FredPotter on February 21, 2007, at 22:10:02
In reply to Re: opiates for depression » flmm, posted by Quintal on February 21, 2007, at 21:43:07
yes and the high I got from Paxil lasted one afternoon then it was straight back to the old symptoms. "In denial" sounds a bit AA-like to me
Fred
Posted by kelv on February 21, 2007, at 23:35:07
In reply to Re: opiates for depression » Quintal, posted by FredPotter on February 21, 2007, at 22:10:02
Opiates were commonly used for mood/psych disorders until~1950.
It's fact that some people ONLY get relief from their psychic torment with Opi's, this is a very controversial area to be sure, Opi's are medically restricted to pain relief most hardenly.
It makes sense that Sero/Dopa/Norp are not the only players in mood disorders. Pain, whether from a broken leg or MDD is registered in the same brain area.
Not everyone treated with Opi's seeks an ever increasing dose, Jerrypharmstudent who used to visit here often was scripted 5mgs Hydro 4x daily and maintained it for several years, with little loss of effectiveness-apparently.
I wonder why Oxycontin (Hillybilly Heroin) is public enemy no1 amoung script meds in the US?
Posted by flmm on February 21, 2007, at 23:54:09
In reply to Re: opiates for depression, posted by kelv on February 21, 2007, at 23:35:07
Never been to AA! Never b een addicted to anything! Maybe opiates were used for depression in the 50s! People used to smoke cigarettes in the doctor office in the 50s also! So what..........
Posted by kelv on February 22, 2007, at 0:26:34
In reply to Re: opiates for depression, posted by flmm on February 21, 2007, at 23:54:09
> Never been to AA! Never b een addicted to anything! Maybe opiates were used for depression in the 50s! People used to smoke cigarettes in the doctor office in the 50s also! So what..........
"So what"
Well Mr "Thats not how SSRI's work" i was simply explaining that the early 1900's were a dope fiends paradice, with Morphine, Laudanum, Cocaine available OTC in substantial doses, and were scripted to patients with affective disorders up till ~the 50's.
Listen dude, not everyone who has run the gamut of meds and Doc merry go round typical AD reguime seeking relief from their everyday psychic pain is 'chasing a high'-actually this expression often refers to smoking Heroin of foil,
I have taken:
-Codeine~300-400mgs
-DHC~240mgs
-MSIR~60-80mgs
-MSSR~100mgs
and found they sure did a number on a depressed mood, althought i didn't take them long enought to experience tolerance.
Posted by yxibow on February 22, 2007, at 1:23:47
In reply to Re: opiates for depression, posted by kelv on February 21, 2007, at 23:35:07
> Opiates were commonly used for mood/psych disorders until~1950.
>
> It's fact that some people ONLY get relief from their psychic torment with Opi's, this is a very controversial area to be sure, Opi's are medically restricted to pain relief most hardenly.
>
> It makes sense that Sero/Dopa/Norp are not the only players in mood disorders. Pain, whether from a broken leg or MDD is registered in the same brain area.
>
> Not everyone treated with Opi's seeks an ever increasing dose, Jerrypharmstudent who used to visit here often was scripted 5mgs Hydro 4x daily and maintained it for several years, with little loss of effectiveness-apparently.
>
> I wonder why Oxycontin (Hillybilly Heroin) is public enemy no1 amoung script meds in the US?
Its because its abused the most in the US to the point where most pharmacies lock up anything that isnt C-IV or so or lesser, because there have been bold and brazen holdups of pharmacies caught on tape many times.
Yes, we can blame the media cycle and all that, but the fact is, people know its available, its manufactured in fair quantities because its good for modest to fairly strong pain and if you can't treat an illness the do no wrong credo among progressive doctors is to treat pain.
And the number one way to treat pain in people who don't respond to OTC ibuprofen (People would fall asleep at the 800mg I take for pain, I guess I'm a fast metabolizer of most of what I take) or esoteric prescription NSAIDs that most people haven't even heard of like mefenamic acid and ketoprofen other wierd things that aren't prescribed much any more, is opiates.
They're restricted to pain because doctors who have advocated for it and even have had small trials of it for mood disorders recently, have had their medical license yanked or put on probation. And if your psychiatrist doesn't have a license, you're sh*t out of luck to put it bluntly.
Yes, we can all blame the DEA and the Controlled Substances Act of 1970 and the Misuse of Drugs Act in Great Britain in 1971, but the fact is for better or worse, things like oxycontin compete with meth for street drugs in the US. Xanax and Valium pale in comparison.
Should we convince the NIMH and other government agencies to have trials of things like bupenorphine for depression -- I don't see why not. A good majority of drug trials in the US don't necessarily start in big pharma -- they start in state sponsored places, universities, government health agencies, and when molecules are tested in small trials and proven effective, they're sold to drug companies. The drug companies further contract out to smaller pharmaceutical agencies to further pursue trials of medications, through phase trials and the like. I know its a royal pain to wait for the next big thing. I want the next big thing because I want my life back after it was inexplicably robbed five years ago. But some of that has to come from within.Have doctors petition the FDA to run small trials -- I know I'm sounding silly and pedantic but maybe it will work. Doctors really do want to hold on to their license and what they put on a prescription goes to a pharmacy. In fact an unnamed pharmacy who I am familiar with and like the pharmacist had a conversation with my doctor just to see what the diagnosis since I am on polypharmacy. Things go noticed by good pharmacists that prescriptions are being given for valid reasons. No worries there, but what if the pharmacist questioned your doctor about an opiate? Ultimately there are rules about having to report things, and I don't know what they are but they exist. You don't want to lose your doctor. That's all I can say.
-- tidings
Posted by TheMeanReds on February 22, 2007, at 13:13:31
In reply to opiates for depression, posted by pearlcat on February 19, 2007, at 13:52:09
Its informative, sarcastic, and just plain horrible sometimes. Its great.
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