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Dr. Bob is Robert Hsiung, MD,
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Posted by flmm on February 24, 2007, at 20:53:46
In reply to Opiates for depression, posted by Quintal on February 24, 2007, at 18:18:40
That's a real freakish tick ya got there Quintal! You should get that checked.
Posted by Quintal on February 24, 2007, at 21:14:30
In reply to Re: Opiates for depression, posted by flmm on February 24, 2007, at 20:53:46
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A friend just e-mailed me this link any truth in it? Or what is your impression abuse and tolerance issues? Thanks Phillipa
http://www.healthypages.net:80/news.asp?newsid=4969
Morphine may help obsessive-compulsive disorder
2005-04-04--------------------------------------------------------------------------------
For people with obsessive-compulsive disorder (OCD) who have not been helped by standard drug treatments, a weekly dose of oral morphine may ease their symptoms, according to a small pilot study.The newer class of antidepressants known as SRIs is approved for treating OCD, but up to 40 percent of patients fail to respond to two or more of these drugs, Dr. Lorrin M. Koran and his associates explain in the Journal of Clinical Psychiatry.
Quite why morphine can be effective is not known, but other small studies have suggested a role for drugs that interact with opioid receptors because there is a high concentration of opioid receptors in an area of the brain thought to be involved in OCD.
For their trial, Koran's group enrolled 23 subjects with OCD who had tried anywhere from two to six different SRIs. The participants were assigned to once-weekly oral morphine, the anti-anxiety drug lorazepam, or an inactive placebo, in random order for two weeks each.
Average scores on a standard OCD scale declined from 29 to 25 while the subjects were taking morphine, and to 27 in the lorazepam phase.
Seven of the 23 subjects were deemed to be responders to morphine based on score decreases of 25 percent or more. There were four subjects who responded to lorazepam.
Among those responding to morphine, the most noticeable effect began the day after taking the drug and lasted for two to five days. These individuals reported decreased frequency and persistence of obsessions and anxiety, as well as an increased ability to resist their compulsions.
The researchers saw no euphoric effects from taking the drugs -- although one subject later admitted to having abused hydrocodone for several years, which he said reduced his OCD symptoms.
"The response seen, its rapidity, and the relative tolerability of the treatment are encouraging and warrant larger and longer term studies" of morphine or other opiate drugs for treatment-resistant OCD, the team concludes.
SOURCE: Journal of Clinical Psychiatry, March 2005
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http://www.dr-bob.org/babble/20070107/msgs/721852.htmlQ
Posted by Quintal on February 24, 2007, at 21:22:41
In reply to Pandora's box, posted by Declan on February 24, 2007, at 19:20:53
>I have my doubts that tianeptine would be easy to give up.
Is it that good? I'm swapping my stash of Parnate for a box of Stablon/Coaxil with a friend in the US. I hope it works as well as I remember it doing last time. I'm not even derpressed, just looking for a bit of motivation and anxiety relief.
Q
Posted by gardenergirl on February 25, 2007, at 0:43:11
In reply to Opiates for depression, posted by Quintal on February 24, 2007, at 18:18:40
Posted by laima on February 25, 2007, at 2:01:36
In reply to Stimulants for depression, posted by Quintal on February 24, 2007, at 17:56:28
Hey Quintal, I am curious, which brand or which generic brand of adderall did you use? I am absolutely enthralled with this topic at the moment... Thanks.
> I've done Adderall on and off for many years. Been off for as long as seven months. It's a rapidly working ad for me. Mood and motivation are better. problem is I build a rapid tolerance to the drug and fall into a bad depression between doses. If you have the disciplne to only take it two days a week you won't build a tolerance and you have two days where you feel good. But that's a hard thing to do. Problem is I could never find an ad that comes close to Adderall. When I'm feeling really bad it's hard to stay off the med. Overall I would recommend not even starting a stimulant. Seems to create more problems than it solves. Sort of a pandora's box so to speak.
>
> Q
Posted by linkadge on February 25, 2007, at 10:57:43
In reply to Re: opiates for depression, posted by Quintal on February 22, 2007, at 20:15:34
>Caffeine seems to mostly increase alertness and >still isn't as effective as amphetamines though >and it is less well tolerated at doses needed to >have the desired effects; most people with ADHD >seem to prefer amphetamines. Caffeine doesn't >seem to be an impressive treatment for ADHD in >spiders(!):
It simply has not been tested alongside traditional stimulants, so I don't think we can comment on its efficacy, although it has been helping people get their work done for the last...ever.
>That is the point I'm getting at link. This drug >does make sense in theory because there have >also been a number of studies that indicate a >deficit in the nordrenergic systems of people >with ADHD. Just as with dopamine, according to >my textbook, there has been a noradrenaline >deficit hypothesis in ADHD (it seems) whenever >it has been convenient to market a new drug that >operates via that mechanism.But, what I am saying is that you cannot say this drug is inneffecive simply because it fails to elevate dopamine in the neucleus accumbens. This drug doesn't work for other reasons.
>That's the whole point I'm getting at link; you >can increase attention span with drugs that act >on neurotransmitters other than dopamine, yet >they don't seem to be as good for treating the >overall problem.No, thats not what I mean, at all. It is possable to increase dopamine in areas of attention without increasing dopamine in areas of reward. That, in my opinion would be just as effective as a drug that happens to target the reward centres as well. Like I said before, there are drugs that enhance dopamine release in the neucleus accumbens which are not effective for ADHD.
>You can say the same thing about benzos and >point to people who have been taking them for >decades and feel they are helping their anxiety >long after the initial sedation and euphoria >have faded. That might be true for some, but as >studies suggest (in benzos for example), most >are receiving little real benefit from the drugs >at that point (hard though it is for them to >believe). They have little more than placebo >brought on by conditioning. I think a lot >depends on the rate at which each person >develops tolerance. For some it's rapid and the >anxiety slaps them in the face and they have no >choice but to admit the drug is no longer >working. For others I suspect it's more >insidious, creeping up over the years so >gradually that they have time to adjust and >develop coping mechanisms. In effect they've >gradually withdrawn from the drug in the >therapeutic sense, in that it is doing little to >help the original problem, yet they are still >dependent on it, but mostly to maintain >equilibrium.
>You seem to be suggesting that the only way to >help all mental illness is to activate the >pleasure centres of the brain. I would think you >are mistaken if you suggest that every >psychiatric drug we have works solely through >this mechanism.>Why would such drugs be any less effective for >ADHD if the reward systems played no part in the >therapeutic response?
Becuase, we know from repeated studies that long term early use of methyphenidate makes the reward centres permanantly dependant on the molecule for proper function. So, when you switch somebody off methylphenidate onto a nonrewarding drug, you've introduced a new problem, depression. Yes, depression can cause attention problems on its own, but without clear evidence of depressive symptoms in the first place you're only changing the intial problem. If the lack of attention was purely due to reward dysfunction, then you'd be dealing with a different issue, ie depression. It a patient comes in saying that they can't concentrate *because* they feel worthless, and life isn't worth living, then this would be depression and not ADHD.
>I was hoping to add some perspective on flmm's >comments about opiates by highlighting the fact >that some people here have been prescribed >amphetamines for this purpose and no such >objections are raised to this as they are with >opiates. I've also noticed some people with >chronic depression deciding that because they >have poor concentration and trouble organising >themselves they must have ADHD, and therefore >need stims to treat this newly discovered co->morbid disorder. That seems a little dubious to >me, hence my comments.I agree with you. My original point was that opiates may be treating depression in some yet undiscovered way, which may indeed have nothing to do with being euphoriants. I merely brougt in stimulants as a example of drugs which while are euphoriants, are not working solely because they are euphoriants.
Linkadge
Posted by linkadge on February 25, 2007, at 11:16:56
In reply to Re: Hang on » Declan, posted by yxibow on February 23, 2007, at 2:53:54
Why do you think addictions research is such a huge area of investigation right now?
People have known for a very long time now that two people can be exposed to a drug, one will become very dependant on it, and abuse it (no slight on this persons character), while the other will not.
It is a simple fact. The same is true for animals. Different breeds of animals respond to drugs of reward differently. Some become addicted, some do not.
We don't know fully why. There is lots of money being put into the area of addictons research, right now, to uncover the exact molecular reasons why some get addicted while others turn it down.
So, this is clearly not a black and white issue. Its just like how an ex alcoholic will preach on the evils of alcohol, and how never to get started, and how to never touch the stuff, while other people have been drinking normally since the dawn of time. (again, no slight on the character of the alcoholic)
So, saying people are in denial, and calling names, and saying that people are just trying to get high, doesn't make any sence, because these drugs don't affect two people the same way.
Its just like how I never understood how people could abuse benzos. I found benzo treatment very repulsive, and made me feel very depressed. Does that mean I am in denial about how addictive benzo's are? Of course not. It just means that it is *not* a black and white issue.We understand that some people have had a very long and difficult road with certain substances. It only seems natural that the answer (**for them**), is indeed to stay completely away from the mentioned substances. Just like how and alcoholic is best to just stay away from alcohol.
This is not, however, the *rule* for everbody.
Perhaps one day, we will have the exact biochemcial answer for why some people get addicted to certain substances while others do not. Until then, you're just going to have to beleive what people say about how these drugs affect them.
Of couse people are taking risks by taking these drugs. It is a risk to try anything with a potential for abuse. But some people are in situations which may warrent very carefull experiementation.
Linkadge
Posted by Larry Hoover on February 25, 2007, at 13:03:22
In reply to Re: Hang on, posted by linkadge on February 25, 2007, at 11:16:56
Posted by Quintal on February 25, 2007, at 14:43:59
In reply to Re: Stimulants for depression » Quintal, posted by laima on February 25, 2007, at 2:01:36
Hi Laima, Adderall is the only med I mentioned there that I haven't taken - it isn't available here. I was using it as a hypothetical argument to show the same could be said of stims as of opiates and benzos. I have a friend that used amphetamines to boost her confidence and self-esteem and treat her depression though, and her story runs like that, worse actually - she ended up having a psychotic episode and spent a few months in the psychiatric hospital until she was stabilized.
Q
Posted by flmm on February 25, 2007, at 14:51:04
In reply to Re: Stimulants for depression » laima, posted by Quintal on February 25, 2007, at 14:43:59
Ya Quintal, kinda figured that out!
Posted by Quintal on February 25, 2007, at 15:19:36
In reply to Re: Stimulants for depression, posted by flmm on February 25, 2007, at 14:51:04
You're just too sharp for your own good flmm.
Q
Posted by laima on February 25, 2007, at 20:40:25
In reply to Re: Stimulants for depression » laima, posted by Quintal on February 25, 2007, at 14:43:59
Oh- yes, I know stims are quite controversial and could easily tip into being harmful instead of helpful- as you say, like benzos or opiates. I was pretty tired, insomniac last night- I might not have comprehended your context here accurately for that reason. (No more 8pm cups of coffee...) Plus I have a one-track-mind at the moment over this Barr-Adderall acquisition, which to me feels like an alarming potential crisis, as I did so poorly on Barr's generic and so well on Shire's brand version. In any case, rest assured I am using only a very low dose, and am being closely watched. Should be alright- I don't even feel like I'm "on" anything. Sorry for confusion. I'm also very sorry to hear of what happened to your friend.
> Hi Laima, Adderall is the only med I mentioned there that I haven't taken - it isn't available here. I was using it as a hypothetical argument to show the same could be said of stims as of opiates and benzos. I have a friend that used amphetamines to boost her confidence and self-esteem and treat her depression though, and her story runs like that, worse actually - she ended up having a psychotic episode and spent a few months in the psychiatric hospital until she was stabilized.
>
> Q
Posted by kelv on February 25, 2007, at 20:40:45
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!
Yes. When i was self medicating with Codeine 200-400mgs i found it helped with all 3, and motivation was good, energy was good (has been used with success in Narcolepsy) and the intense anxiety issues i was dealing with were helped greatly. I also tried Morphine IR and DHC and althought these were more sedating (more of a finished work relaxant to take) were also interesting in their effects, MSIR leaving me too sedated to want to do much at 60-80mgs.
Posted by FredPotter on February 25, 2007, at 21:39:41
In reply to Re: opiates for depression » Phillipa, posted by yxibow on February 23, 2007, at 0:47:44
I buy kava in bags from a local Grocer. It comes straight from Fiji or Tonga. I drink it every day, making it the traditional way, strained through a sheer bag, also from Fiji. It doesn't do much, even when mixed with alcohol and Xanax. My liver tests are frequent and normal.
Apparently much of the kavalactone content is not water soluble, so I've tried making tinctures using alcohol, glycerol and mixing in lecithin. All less than impressive, but I remember buying an alcoholic tincture of it once that made me feel like I was on week 6 of Paxil.
Any tincture tips anyone? I don't drink alcohol in the week so I'm juggling the Antabuse, which I reckon takes 72 hours to wear off.
I have heard there's a reverse tolerance to kava. That is it gets BETTER. But after 7 years of use it's not very apparent, but I still do it (so there's something in there I like!)
Fred
Posted by FredPotter on February 25, 2007, at 21:47:56
In reply to Re: Hang on » Declan, posted by yxibow on February 23, 2007, at 2:53:54
Hm isn't CH3COOH acetic acid? Much as I like pickled onions and particularly pickled walnuts and rollmops I don't recommend them as a way of getting high :) Fred
Posted by FredPotter on February 25, 2007, at 22:02:52
In reply to Opiates for depression, posted by Quintal on February 24, 2007, at 18:18:40
I've breathed air in and out for many years. Been off for as long as a minute. It is a rapidly working ad for me. Mood and motivation are better. Problem is I become anxious between doses. Problem is I could never find such an overall effective monotherapy that comes close to air. Overall I would recommend not even starting any type of breathing unless the suffering is intolerable and you can find no other way out, even then, to breathe as little as possible and only to get you through the crisis. I've had many strange illnesses that have resolved since I quit breathing. Sort of a pandora's box so to speak.
Posted by Quintal on February 25, 2007, at 22:19:39
In reply to Re: Opiates for depression, posted by FredPotter on February 25, 2007, at 22:02:52
So you're saying drugs have become your only form of sustinence? I don't think so Fred.
Q
Posted by Declan on February 25, 2007, at 23:50:13
In reply to Re: Opiates for depression, posted by FredPotter on February 25, 2007, at 22:02:52
the idea is that there is hope at the end of the light.
Posted by yxibow on February 26, 2007, at 0:00:40
In reply to Re: Hang on » yxibow, posted by FredPotter on February 25, 2007, at 21:47:56
> Hm isn't CH3COOH acetic acid? Much as I like pickled onions and particularly pickled walnuts and rollmops I don't recommend them as a way of getting high :) Fred
Yeah... duh. I made a goof on my organic chemistry. C2H5OH.
Posted by yxibow on February 26, 2007, at 0:06:16
In reply to Re: opiates for depression » yxibow, posted by FredPotter on February 25, 2007, at 21:39:41
> I buy kava in bags from a local Grocer. It comes straight from Fiji or Tonga. I drink it every day, making it the traditional way, strained through a sheer bag, also from Fiji. It doesn't do much, even when mixed with alcohol and Xanax. My liver tests are frequent and normal.
>
> Apparently much of the kavalactone content is not water soluble, so I've tried making tinctures using alcohol, glycerol and mixing in lecithin. All less than impressive, but I remember buying an alcoholic tincture of it once that made me feel like I was on week 6 of Paxil.
>
> Any tincture tips anyone? I don't drink alcohol in the week so I'm juggling the Antabuse, which I reckon takes 72 hours to wear off.
>
> I have heard there's a reverse tolerance to kava. That is it gets BETTER. But after 7 years of use it's not very apparent, but I still do it (so there's something in there I like!)
>
> Fred
I'd advise against drinking it get every day in that manner without kavalactone quantitative analysis, but apparently you've survived it so your liver is strong enough.
I take it occasionally in GAIA liquicaps, which have some raw kava plus measured kavalactone quantities. Whole Foods and I imagine your local natural grocer would carry them. Also, you have to keep these liquicaps in a cool dry place, they will yuck up and start to mold/decompose after a few years. One of them is about the feeling of a mild Xanax pill if you don't take them that often, at least in my opinion.
Posted by Quintal on February 26, 2007, at 9:41:22
In reply to Re: opiates for depression, posted by linkadge on February 25, 2007, at 10:57:43
>But, what I am saying is that you cannot say this drug is inneffecive simply because it fails to elevate dopamine in the neucleus accumbens. This drug doesn't work for other reasons.
I'm surprised you can be so confident.
I've noticed here for some time that people have a tendency to want to quit meds that no longer give them a feeling of euphoria (a recent example that springs to mind is ace wanting to quit and re-start Nardil to regain the euphoria he felt at the beginning of treatment), and also people constantly flitting from drug to drug despite having had a promising response to some. It makes one wonder what they are looking for, and the precise meaning of the term 'treatment resistant' in these individuals.
>If the lack of attention was purely due to reward dysfunction, then you'd be dealing with a different issue, ie depression. It a patient comes in saying that they can't concentrate *because* they feel worthless, and life isn't worth living, then this would be depression and not ADHD.
I don't think ADHD, depression and anxiety are *purely* due to defunct reward centres but I do think they play a role in varying degrees in many cases, with treatments that produce a sensation of euphoria and wellbeing in general being more effective and better tolerated than those that don't.
>I agree with you. My original point was that opiates may be treating depression in some yet undiscovered way, which may indeed have nothing to do with being euphoriants. I merely brougt in stimulants as a example of drugs which while are euphoriants, are not working solely because they are euphoriants.
I did not say those drugs work only by creating euphoria, but it does seem that drugs which give a subjective feeling of wellbeing in addition to other therapeutic mechanisms are more popular, produce more treatment responders (and are therefore perceived as being more effective) than drugs that cause emotional blunting or numbness etc (especially when treating depression and anxiety).
Q
Posted by FredPotter on February 26, 2007, at 10:59:04
In reply to Re: opiates for depression » linkadge, posted by Quintal on February 26, 2007, at 9:41:22
Quintal you make good points. If the reward circuitry is all working and we're not actually depressed, then it's time for work and achievement to trigger those circuits. In layman's terms, the sense of well-being after a job well done. You can't beat it. Good God I sound like my old headmaster. I'm afraid that if we were all awash with euphoria constantly, nothing would get done.
All the same a bit of temporary euphoria for people who've been through depression would be nice, so long as it's realised that's not the aim of treatment
Fred
Posted by flmm on February 26, 2007, at 21:26:03
In reply to Re: opiates for depression » Quintal, posted by FredPotter on February 26, 2007, at 10:59:04
Oh no Quintal, you are to "Witty" for your own good
Posted by Quintal on February 26, 2007, at 22:40:10
In reply to Re: opiates for depression, posted by flmm on February 26, 2007, at 21:26:03
Okay flmm, you win.
Q
Posted by John45 on September 23, 2010, at 8:21:23
In reply to Bupenorphine in general, posted by yxibow on February 20, 2007, at 20:21:07
Subutex is proving more and more to be HIGHLY effective in most people with long-standing depression/anxiety disorders. LOW doses (0.25-1 mg daily) seem to be all that is needed. I have a long history of anxiety/panic/depressive episodes that have not responded very well to SSRIs. I also take clonazepam (low dose). I have been on Subutex now for 3.5 years and every time I try to stop taking it I feel foul, unmotivated, negative & angry. Yes, there is some withdrawal...yes, there may be some minor side effects...however I truly feel that many people who are life-long depressives are not getting this treatment which has the potential to normalize their lives.
I understand the debate about using opiates for depression....addiction...etc. Buprenorphine is very different than a FULL AGONIST opiate. It also has some properties that no other opiate has, that explains the powerful anti-depressant effects.
Some doctors are realizing its potential as an antidepressant in cases where the patient cannot tolerate or is resistant to conventional antidepressants. Both mental and physical pain are regulated by the same chemical networks in the brain. Depression is commonly accompanied by co-morbid pain symptoms. Endogenous opiates (made by our own bodies), such as endorphins and enkephalins, mediate pain perception in the body. In the brain, they are significantly involved in regulating mood and behavior, and decreasing the perception of pain and depression. Subutexs unique chemical profile may contribute to its strong anti-depressant properties.
By the way, I have NO HISTORY of addiction and no interest in increasing my dose. Please feel free to comment and have a dialogue about this medication. If anyone is interested, I will post my "story." This is too important to not have a dialogue about.
All the best, John
This is the end of the thread.
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