![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 19 to 43 of 43. Go back in thread:
Posted by Quintal on August 13, 2007, at 4:23:46
In reply to Re: Vicodin and Percocet for Depression, posted by linkadge on August 12, 2007, at 21:45:00
>Who knew that marajuanna would contain substance that promote neurogenesis, or that act as potent antipsychotic compounds?
Linkadge, were you smoking marijuana before, or even while, you composed your last post? I know you've said you use it regularly for its antidepressant and tranquillizing properties before, so I'm curious, because I think I recognize some of the characteristic effects on thought processes.
Q
Posted by linkadge on August 13, 2007, at 8:36:08
In reply to Re: Vicodin and Percocet for Depression » linkadge, posted by Quintal on August 12, 2007, at 22:25:40
>therefore therapeutic in this case) effect of >opiates is very common, and often happens very >quickly, regardless of the underlying mechanism>(s), whatever they may be.
I can accept "very common".
Linkadge
Posted by linkadge on August 13, 2007, at 8:38:02
In reply to Re: Vicodin and Percocet for Depression, posted by Sigismund on August 13, 2007, at 4:12:02
>>and that a therapeutic effect can be maintained >>until treatment ends.
>Maybe
These were simply the conclusions of this particular study I am trying to locate at the moment.The babble archives is probably loaded on this topic.
Linkadge
Posted by linkadge on August 13, 2007, at 8:54:31
In reply to Re: Vicodin and Percocet for Depression » linkadge, posted by Quintal on August 13, 2007, at 4:23:46
>Linkadge, were you smoking marijuana before, or >even while, you composed your last post? I know >you've said you use it regularly for its >antidepressant and tranquillizing properties >before, so I'm curious, because I think I >recognize some of the characteristic effects on >thought processes.
To be completely honest, I am clean as a whistle and have been for a while. I don't use it regularly, only occasionally.
I am (genuinly) interested though in what aspect of my though process seems to indicate marajuanna usage?
Is it my over liberal view of regarding the safety of marajuanna and or opiates? Sometimes I just like to play the devils advocate. Give me a month and I may be arguing the other side of the coin.
But seriously though, I'd really be interested if you expand on this assertion though (even by babblemail).
(I was placed on seroquel for hints of a psychotic thought process although even my doctor admits he can't clearly put his finger on anything, or that antipsychotics really did anything to reduce it. I think we agreed it was a personality trait, although not conclusivly.)
Take Care.
Linkadge
Posted by Quintal on August 13, 2007, at 9:49:46
In reply to Re: Vicodin and Percocet for Depression, posted by linkadge on August 13, 2007, at 8:54:31
>Is it my over liberal view of regarding the safety of marajuanna and or opiates?
Definitely not. I'm very liberal in my views on these substances, and benzos too, though you may not believe me on that. See below for an explanation. I like to think though, that I have a realistic appraisal of their limitations.
>Sometimes I just like to play the devils advocate. Give me a month and I may be arguing the other side of the coin.
I see that, and I do it too. I think it encourages interesting and vigorous debate, so I have no problem with it so long as we all keep it civil and try not to take it personally. I find an attitude of openness is most helpful when doing this.
>I am (genuinly) interested though in what aspect of my though process seems to indicate marajuanna usage?
Well okay, link. Since you asked, and know that this is not an attack on you, I'll tell you why I thought you might be smoking marijuana. It's because on a number of threads I've noticed you tend to bring up a great deal of what I consider to be irrelevant material, as if your thoughts go off on a tangent. Also, I think you made some comments, and I'm thinking about the one where you said I had said I could read minds here, that seem to me borderline psychotic at times. They seem to come completely out of the blue, and I've been quite shocked, and concerned by what I've read. If you go through this and the benzo thread I think you'll see what I mean. This is what happens to my own thought patterns, and nearly everyone else I know while under the influence of marijuana. So that's why I thought you might be smoking it. That combined with the fact that you had disclosed you marijuana use to the board on several previous occasions.
Maybe you do have ADHD after all link? Maybe it's ADHD combined with some quasi-psychotic personality traits - have you investigated the BPD diagnosis? I think quasi-psychotic episodes are common with that. Many people have these traits, most definitely myself, and I find they can be managed if you gain enough self-awareness and insight into your thought processes. This is probably a good first step in doing that. I apologize if this has made you feel uncomfortable, accused or embarrassed in any way. My intentions were pure.
Q
Posted by Quintal on August 13, 2007, at 12:45:32
In reply to Re: Vicodin and Percocet for Depression » linkadge, posted by Quintal on August 13, 2007, at 9:49:46
Here is a link to the benzo thread in question: http://www.dr-bob.org/babble/20070730/msgs/774284.html
Q
Posted by Phillipa on August 13, 2007, at 20:04:34
In reply to Re: Vicodin and Percocet for Depression, posted by Quintal on August 13, 2007, at 12:45:32
I personally feel that what Link does in private is his business. And how did benzos return? Love Phillipa
Posted by mike lynch on August 13, 2007, at 20:53:02
In reply to Re: Vicodin and Percocet for Depression » linkadge, posted by Quintal on August 13, 2007, at 4:23:46
>so I'm curious, because I think I recognize some of the characteristic effects on thought processes.
>
> QLike what...about his post would suggest he was under the influence of marijuana? If that's what you're suggesting, Im very curious about this..
Posted by linkadge on August 13, 2007, at 21:38:57
In reply to Re: Vicodin and Percocet for Depression » linkadge, posted by Quintal on August 13, 2007, at 9:49:46
>Well okay, link. Since you asked, and know that >this is not an attack on you, I'll tell you why >I thought you might be smoking marijuana. It's >because on a number of threads I've noticed you >tend to bring up a great deal of what I consider >to be irrelevant material, as if your thoughts >go off on a tangent.
No offence taken. Only part of what I said was meant to be a direct response to previous threads. Some of what I was saying regarding opiates was just (again) some general information, perhaps for expanded discussion (?). I wouldn't say the information is necessarily irrelavant.
>Also, I think you made some comments, and I'm >thinking about the one where you said I had said >I could read minds here, that seem to me >borderline psychotic at times.
I suppose I should have clarified on that when you asked. You had made a few general totality type of statements. At one point you had said something allong the lines of "benzodiazapines cause significant cognitive impairment" instead of what I would see as a more accurate statement of "benzodiazapines can cause cognitive impairment". I was trying to say, that unless you can read the minds of every individual who takes benzodiazapines, it is impossable for you to know whether they are experiencing significant cognitive impairment. I was not trying to imply that you *acutually read minds*.
>They seem to come completely out of the blue, >and I've been quite shocked, and concerned by >what I've read. If you go through this and the >benzo thread I think you'll see what I mean.
I'll try and make a responce there too to clarify.
>This is what happens to my own thought patterns, >and nearly everyone else I know while under the >influence of marijuana. So that's why I thought >you might be smoking it.*For the record* I am currently not under the impression that I can read anybody's mind or that anybody is reading my mind, (or that anybody can read anybodies mind for that matter). I was simply using the expression.
>That combined with the fact that you had >disclosed you marijuana use to the board on >several previous occasions.
I have disclosed that I have smoked on previous occasions, although to my knowledge I have not had any delusions as a result. I am hoping I have not given the impression that I am a heavy user as nothing is farther from the truth.
>Maybe you do have ADHD after all link? Maybe >it's ADHD combined with some quasi-psychotic >personality traits - have you investigated the >BPD diagnosis? I think quasi-psychotic episodes >are common with that.
Well, as much as ADHD may or may not be the case, I don't feel it is fair to diagnose online (as much as I appreciate the support). I am guilty of perhaps not being more clear in my wording, which I will try to rectify in the corresponding thread.
I don't much fit the borderline personality diagnosis (as far as I can tell), although a doctor would probably be best to consult about that. I don't think it has been seriously considered. My relationships (offline, the ones that exist) are fairly stable.
>Many people have these traits, most definitely >myself, and I find they can be managed if you >gain enough self-awareness and insight into your >thought processes. This is probably a good first >step in doing that. I apologize if this has made >you feel uncomfortable, accused or embarrassed >in any way. My intentions were pure.
No problem at all.
Linkadge
Posted by Phillipa on August 13, 2007, at 21:51:46
In reply to Re: Vicodin and Percocet for Depression, posted by linkadge on August 13, 2007, at 21:38:57
I don't thing anyone can read minds as my own important relationships as well are offline and I'm not cognitivly impaired by benzos they relieve anxiety so I can function in our business. My therapist thinks I need a rheumatologist as my autoimmune sytem is out of wack along with the thyroid.
Posted by mike lynch on August 14, 2007, at 0:24:29
In reply to Re: Vicodin and Percocet for Depression, posted by linkadge on August 13, 2007, at 21:38:57
>Maybe you do have ADHD after all link? Maybe >it's >ADHD combined with some quasi-psychotic >personality traits - have you investigated the >BPD >common with that.
I think you're being really ridiculous and condescending.. *Psychotic??*, from an online post that seemed fairly reasonable to me? What is your grudge about?? You're the one who seems to making blind assumptions out of the blue, you're trying to diagnoze people over online!
Posted by Quintal on August 14, 2007, at 3:07:55
In reply to Re: Vicodin and Percocet for Depression, posted by mike lynch on August 14, 2007, at 0:24:29
Linkadge has asserted many times in the past that he has ADHD, and I'm pretty sure he has been prescribed Ritalin at one point, for whatever reason. Recently link reconsidered the diagnosis. That was what my comment regarding ADHD was based on. Linkadge's post above seemed very disorganized to me, showing what I thought could be signs of the typical divergent thought processes that occur under the influence of marijuana. I apologize for the confusion.
>*Psychotic??*, from an online post that seemed fairly reasonable to me?
I was referring to this post:
http://www.dr-bob.org/babble/20070808/msgs/775025.html
This is just one example, there are many more.
And also this comment by linkadge himself in one of the posts above, maybe you missed it?:
"I was placed on seroquel for hints of a psychotic thought process..."
>You're the one who seems to making blind assumptions out of the blue,
I am doing no such thing.
>you're trying to diagnoze people over online!
No I am not.
Q
Posted by Quintal on August 14, 2007, at 4:06:38
In reply to Re: Vicodin and Percocet for Depression, posted by linkadge on August 13, 2007, at 21:38:57
>No offence taken
I'm pleased to hear that. It's good that we can discuss these things openly without taking them personally.
>Some of what I was saying regarding opiates was just (again) some general information, perhaps for expanded discussion (?).
I wondered if it might be a form of distraction. I was confused by most of it to be honest, because it seemed to have little bearing on the central theme we were discussing, which I thought was tolerance. You see, no matter what mechanisms are behind the therapeutic response, the fact that most people do develop tolerance to opiates (and often very quickly) means that tolerance also develops to those esoteric mechanisms, if indeed they are behind the therapeutic response. So I wondered what your motive was for bringing them up.
I've seen less confident posters withdraw from debate with you on several occasions when presented with esoteric mechanisms like this, and I wondered if you might have learned that this could be a way of getting your opponent to back down, so that you could 'win' the debate, even if it became clear that your original assertions were on shaky ground.
>You had made a few general totality type of statements.
I think I may have omitted qualifiers like 'can' on occasion due to haste, rather than making absolute statements, because as I showed, and as we both agree, cognitive impairment and amnesia at therapeutic doses of benzodiazepines is very common. I think I did use the qualifier 'can' on several occasions but I thought you seemed to focus on the few times I omitted it.
>I was trying to say, that unless you can read the minds of every individual who takes benzodiazapines, it is impossable for you to know whether they are experiencing significant cognitive impairment.
I'm relieved to hear you don't think I really do have supernatural powers. I think I went to considerable length to explain my position, that a minority seem to be unaffected, yet you seemed to persist in finding sentences where, by accident, I had omitted the qualifier 'can', even where I had used sentences containing the qualifier 'can' in the same post. I found that quite challenging.
>Well, as much as ADHD may or may not be the case, I don't feel it is fair to diagnose online (as much as I appreciate the support)
I really wasn't trying to diagnose you link, but I remember you saying that you thought you had ADHD, and that you had been prescribed Ritalin at one point, but I can't remember why. Recently you seem to have changed you mind on the ADHD issue, and, because I noticed that your posts seemed quite disorganized, I thought that this might be a valid diagnosis after all.
>I don't much fit the borderline personality diagnosis (as far as I can tell)
I remember you querying it as an alternative to the bipolar diagnosis that you have often said you disagree with. Again this was just a suggestion, and of course I don't know you in real life so am in no position to diagnose.
>although a doctor would probably be best to consult about that.
Absolutely.
>No problem at all.
I'm pleased to see we can have an open discussion of conflict like this. It's very refreshing. I'm sorry for any misunderstanding and I hope we've gone some way to clearing things up.
Q
Posted by Quintal on August 14, 2007, at 4:24:26
In reply to Re: Vicodin and Percocet for Depression, posted by Phillipa on August 13, 2007, at 21:51:46
Posted by linkadge on August 14, 2007, at 9:31:48
In reply to Re: Vicodin and Percocet for Depression » linkadge, posted by Quintal on August 14, 2007, at 4:06:38
>I wondered if it might be a form of distraction. >I was confused by most of it to be honest, >because it seemed to have little bearing on the >central theme we were discussing, which I >thought was tolerance.
I thought the general theme was on "opaites and depression". Everything I said was within that topic.
>You see, no matter what mechanisms are behind >the therapeutic response, the fact that most >people do develop tolerance to opiates (and >often very quickly) means that tolerance also >develops to those esoteric mechanisms,
Not necessarily. You can easily develop tollerance to one effect of a drug yet not develop tollerance to another effect. "Nardil Euphoria" is a prime example. I am simply arguing that some people apparently do find that they can treat depression long term with opiates. Whenever refering to opiates for depression, people always begin to think of the junkie, or others trying to get high. There is a long history of using opiates to treat depression despite such tollerances. If everybody became a junkie in a week, I think this remedy would not have lasted quite so long.
Most doctors would agree that the painkilling properites of the opiates, and the euphoriant effects are two totally separate mechanisms.
Euphoria is not a prerequisite for analgesia.Along the same lines, there are researchers who believe that opiates effect on mood might be separable from the effect on depression. Like I mentioned the effects of opiates on neurotransmitter systems are diverse.
Consider the effects of ketamine. The current theories are that the euphoriant effects are indeed "side effects", and not responsable for the theraputic effect in clinical depression.
Will you develop tollerance to the euphoriant effects of ketamine? Probably. Does this mean we scrach Ketamine off our litst of potentially usefull drugs for depression? No.
Perhaps the reason you thought my comments were incoherant or off topic was because I failed to draw together my points.
My whole arugment is that you nor I am fully aware of the complexities of the neurobiological effects of opiates. "Stay away from them", may be a good rule of thumb it does not account for individual variences in long term responce.
>I've seen less confident posters withdraw from >debate with you on several occasions when >presented with esoteric mechanisms like this, >and I wondered if you might have learned that >this could be a way of getting your opponent to >back down, so that you could 'win' the debate, >even if it became clear that your original >assertions were on shaky ground.
I am not trying to introduce these mechanisms to "proove a point" or to "win". Like I said before, I am trying to open up discussion. This isn't about winning or loosing.
Do you think that I believe I have prooven anything here? Obviously I havn't proven anything at all. I'm not even trying to prove anything. My main reason for mentioning such "mechanisms" was to suggest that there may be mechanisms destinct from the euphoriant effects of the drugs which are responsable for some individuals ability to use the drugs to treat mood disoders semi-long term.
>I think I may have omitted qualifiers like 'can' >on occasion due to haste, rather than making >absolute statements, because as I showed, and as >we both agree, cognitive impairment and amnesia >at therapeutic doses of benzodiazepines is very >common.
Lets keep threads separate.
>yet you seemed to persist in finding sentences >where, by accident, I had omitted the >qualifier 'can', even where I had used sentences >containing the qualifier 'can' in the same post. >I found that quite challenging.
Sometimes it is necessary to be over clear (IMHO) online as text often does not convey the mood of the idea.
>I really wasn't trying to diagnose you link, but >I remember you saying that you thought you had >ADHD, and that you had been prescribed Ritalin >at one point, but I can't remember why. Recently >you seem to have changed you mind on the ADHD >issue, and, because I noticed that your posts >seemed quite disorganized, I thought that this >might be a valid diagnosis after all.
>I think I may have omitted qualifiers like 'can' >on occasion due to haste
I rest my case.
>I remember you querying it as an alternative to >the bipolar diagnosis that you have often said >you disagree with. Again this was just a >suggestion, and of course I don't know you in >real life so am in no position to diagnose.
No worries.
Linkadge
Posted by Quintal on August 14, 2007, at 10:24:51
In reply to Re: Vicodin and Percocet for Depression, posted by linkadge on August 14, 2007, at 9:31:48
>I thought the general theme was on "opaites and depression". Everything I said was within that topic.
The point I raised was the likelihood of tolerance to the mood elevating effect of opiates.
>You can easily develop tollerance to one effect of a drug yet not develop tollerance to another effect.
Here we're talking about the antidepressant, or 'mood elevating' effect, is that right? I'd like to expand on this, because an interesting idea occurred to me; is there a difference between 'euphoriant', 'mood-elevating' and 'antidepressant' effect? If you think these are separate effects I'd be interested to hear why you think that, and how you think they differ.
>Euphoria is not a prerequisite for analgesia.
We're not talking about analgesia. We're talking about the psychoactive effects. It's statements like that which I find provocative. It would be helpful if you said something like "For example, euphoria is not a prerequisite for analgesia". If that was what you were thinking. I would disagree on that particular point though because tolerance to the analgesic effect of opiates often develops quickly too, and in that example you're trying to compare the rate of tolerance to a somatic effect to the rate of tolerance to a psychoactive effect. I think it would be fairer to distinguish between tolerance to two psychoactive effects; the euphoriant effects and the antidepressant effects. But we have yet to establish a definite difference between the two, and I think we need to concentrate on doing that before we move on to the next stage.
>Along the same lines, there are researchers who believe that opiates effect on mood might be separable from the effect on depression.
Okay, I'm very interested in this research. Do you have access to any studies?
>Does this mean we scrach Ketamine off our litst of potentially usefull drugs for depression? No.
I think I've already said that I believe opiates are invaluable in the treatment of depression. There is no doubt in my mind about that. I'm currently using opiates for that purpose.
>Perhaps the reason you thought my comments were incoherant or off topic was because I failed to draw together my points.
Yes, that flood of raw data without a consistent thread of logic, or narrative tying them all together was daunting and confusing. It would be helpful if you talked us through your thoughts as you go along so readers can follow your line of reasoning. You're obviously very knowledgeable on esoteric mechanisms link, but you need to say why a certain piece of information is important and talk us through how it fits in the wider picture.
>My main reason for mentioning such "mechanisms" was to suggest that there may be mechanisms destinct from the euphoriant effects of the drugs which are responsable for some individuals ability to use the drugs to treat mood disoders semi-long term.
Great, let's explore them.
Q
Posted by Deputy 10derheart on August 14, 2007, at 12:51:28
In reply to Re: Vicodin and Percocet for Depression, posted by mike lynch on August 14, 2007, at 0:24:29
> I think you're being really ridiculous and condescending.
> What is your grudge about??
>You're the one who seems to making blind assumptions out of the blue,...Please don't post anything that could lead others to feel accused or put down.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
Follow-ups regarding these issues, as well as replies to the above posts, should of course themselves be civil.
Dr. Bob is always free to override deputy decisions. His email is on the bottom of each page. Please feel free to email him if you believe this decision was made in error.
10derHeart, acting as deputy to Dr. Bob
Posted by cactus on August 14, 2007, at 18:43:08
In reply to Re: Vicodin and Percocet for Depression » linkadge, posted by Quintal on August 14, 2007, at 10:24:51
We can get tabs with 15mg codiene/500mg paracetamol over the counter here. The are great for pain but don't relieve depression in me, they make me sick on occasion. My body doesn't tolerate opiates very well.
Posted by Quintal on August 14, 2007, at 19:19:32
In reply to Re: Vicodin and Percocet for Depression, posted by cactus on August 14, 2007, at 18:43:08
I don't know why that's the case cactus, but it's a shame. The only thing I can think of is that you might be a poor metaboliser of codeine, since codeine is converted into morphine by an enzyme in the body, and morphine is responsible for most of the analgesic and euphoric effects of codeine. Also, were you taking codeine with an SSRI or other psych drug? Because some medicines block this enzyme, dampening the effects of codeine.
Q
Posted by linkadge on August 14, 2007, at 21:43:58
In reply to Re: Vicodin and Percocet for Depression » linkadge, posted by Quintal on August 14, 2007, at 10:24:51
>The point I raised was the likelihood of >tolerance to the mood elevating effect of
>opiates.But who says I am required to stay within the confines of how you think the thread should behave? I am allowed to just make general comments. They needn't always have a specific point.
>Here we're talking about the antidepressant, >or 'mood elevating' effect, is that right? I'd >like to expand on this, because an interesting >idea occurred to me; is there a difference >between 'euphoriant', 'mood-elevating' >and 'antidepressant' effect? If you think these >are separate effects I'd be interested to hear >why you think that, and how you think they >differ.Yes, this is what I am getting at. Most antidepressants are capable of alleviating depression without producing euphoria. Their antidepressant effect is not dependant on direct stimulation of the neucleus accumbens. SSRI's, for example, have little street value. Euphoria is not a prerequisite for an antidepressant effect.
The term "mood elevating" is abiguous as it applies to the effects of antidepressants and euphoriants.
It is not necessarily a continuoum of effects as most would agree that the antidepressant effects of SSRI's cannot be furthered to euphoria by taking a higher dose, unless of course one is bipolar in which case this may be a separate phenomina.
The reason I think that the terms "antidepressant" and "euphoriant" are destinct is because we have classes of drugs that can fairly selectivly achieve either one or the other effect. Confounding the issue, we also have classes of drugs which may produce both euphoria and an antidepressant effect, ie Parnate, Nardil, Amineptine, ketamine, certain cannabanoids, and possably the opiates etc.>We're not talking about analgesia. We're talking >about the psychoactive effects.
I realize that. I was just making a point that opiates are criticized as painkillers on account of their euphoriant effect, so perhaps likewise, opiates are criticized as antidepressants on account of their euphoriant effects.
I agree, at this point the notion that there is an antidepressant effect of the opiates that is destinct from the euphoriant effect is only speculative. But my whole point here is that there are researchers who believe this to be the case and are therefore studying the substances in this respect.
>It's statements like that which I find >provocative. It would be helpful if you said >something like "For example, euphoria is not a >prerequisite for analgesia".I doin't understand (?) that is what I said. "Euphoria is not a prerequisite for analgesia." How is that not a true statement (??)
(ie we have painkillers that are not euphoriants)>If that was what you were thinking. I would >disagree on that particular point though because >tolerance to the analgesic effect of opiates >often develops quickly too, and in that example >you're trying to compare the rate of tolerance >to a somatic effect to the rate of tolerance to >a psychoactive effect.
Well, there's a study for you. Compare the rate of tollerances. If you were to find statistically significant differences in the rates of euphoria, analgesia, and depressive relaspse, then perhaps this would add to the possability that separate mechanisms are at play.
Lets keep in mind here that for some people the SSRI's poop out in a month, and for some people they last for years. If we assume these accounts are correct, then we have issues of both tollerance, and varying rates of tollerance. This doesn't prevent the SSRI's from being used clinically as antidepressants.
>I think it would be fairer to distinguish >between tolerance to two psychoactive effects; >the euphoriant effects and the antidepressant >effects. But we have yet to establish a definite >difference between the two, and I think we need >to concentrate on doing that before we move on >to the next stage.Analgesia is reduction in physical pain. Euphoria is the production of abnormally elevated well being, and an antidepressant effect is a reduction in the symptoms of clinical depression. There is some overlap, obviously, but neither is a subset of the other. For instance, euphoriants need not necessarily reduce core symptoms of depression. For instance, amphetamine is a euphoriant, but many not help symptoms such as lack of appetite, insomnia, anxiety, guilt, disrupted HPA axis.
>Okay, I'm very interested in this research. Do >you have access to any studies?
Well, I do know that there is a bit research along the lines of "substance P". Opiates apparently reduce substance P neurotransmission in limbic regions. If I am not mistaken, some of the antidepressant effect of the opiates has been attributed to such effects. The substance P inhibitors have antidepressant effect without abuse liability. So, just the fact that the opiates reduce substance P, which, as we now know, can be modulated without producing euphoria, is a bit of a testament to how the opiates may be affecting some aspects of the effective processing *in addition* to producing euphoria.
>Yes, that flood of raw data without a consistent >thread of logic, or narrative tying them all >together was daunting and confusing.Allright, we need not add insult to injury.
>It would be helpful if you talked us through >your thoughts as you go along so readers can >follow your line of reasoning.
Speak for yourself. Let other posters let me know if they were as baffled as yourself.
>You're obviously
>very knowledgeable on esoteric mechanisms link, >but you need to say why a certain piece of >information is important and talk us through how >it fits in the wider picture.Ideally yes. I will try to do better. But this is "psycho-babble". You wil need to excuse me if I do indeed babble. Not everything I am saying needs to have a point. I never knew there was a rule about being required to make sence. Some of what I say can just be taken for what it is.
Linkadge
Posted by Phillipa on August 14, 2007, at 22:03:21
In reply to Re: Vicodin and Percocet for Depression, posted by linkadge on August 14, 2007, at 21:43:58
Link I find you very clear although you are much smarter than me I learn a lot from reading your posts and I thank-you for that. Love Phillipa
Posted by Quintal on August 15, 2007, at 0:32:15
In reply to Re: Vicodin and Percocet for Depression, posted by linkadge on August 14, 2007, at 21:43:58
>But who says I am required to stay within the confines of how you think the thread should behave?
You seemed to be addressing some of the points in my post. It helps is you stay on-topic, or people are liable to become confused, especially when dealing with subjects of a technical nature. It's not a question of how I think the thread should behave.
>I am allowed to just make general comments.
I think you've objected very strongly on the few occasions where I have accidentally omitted qualifiers like 'can' from a few sentences. I expect other people to abide by the standards they ask of me.
>They needn't always have a specific point.
What is their purpose if they have no specific point? Are you able to prevent yourself from making comments that have no specific point? If you are, I'd be grateful if you made an effort to do that when communicating with me, and I will do the same in return.
>The term "mood elevating" is abiguous as it applies to the effects of antidepressants and euphoriants.
I know, that's what I was hoping to address.
>I agree, at this point the notion that there is an antidepressant effect of the opiates that is destinct from the euphoriant effect is only speculative.
Good.
>But my whole point here is that there are researchers who believe this to be the case and are therefore studying the substances in this respect.
Are you aware of any published studies that conclude that opiates have a distinct antidepressant effect that is separate from the euphoriant effect?
>I doin't understand (?) that is what I said. "Euphoria is not a prerequisite for analgesia." How is that not a true statement (??)
I wasn't saying that statement was untrue. I was saying that analgesia is a somatic effect and antidepressant and euphoriant are psychoactive effects, and I think it would be fairer to compare two psychoactive effects, such as euphoriant and antidepressant. You provided examples of drugs that can be both euphoriant and antidepressant here: "we also have classes of drugs which may produce both euphoria and an antidepressant effect, ie Parnate, Nardil, Amineptine, ketamine, certain cannabanoids, and possably the opiates etc.". Yes, I understand what you're saying now and I agree there are drugs that have both euphoriant and antidepressant effects.
>For instance, euphoriants need not necessarily reduce core symptoms of depression. For instance, amphetamine is a euphoriant, but many not help symptoms such as lack of appetite, insomnia, anxiety, guilt, disrupted HPA axis.
Euphoria is an abnormally elevated mood, and depression is abnormally low mood, so they're opposites really. I don't see how one could be truly euphoric and depressed at the same time. Amphetamine can have powerful antidepressant effects in the sense that mood is elevated. I think this example is confounded because amphetamine is likely to mimic, as side effects, those core symptoms you describe - because it is a powerful stimulant. Therefore common side effects are reduced appetite, insomnia and anxiety. You can't distinguish between lingering depressive symptoms and medication side effects in this particular example because the medication causes as side effects symptoms that are similar to some of the core symptoms of depression. Are you playing Devil's Advocate there link?
>Well, I do know that there is a bit research along the lines of "substance P". Opiates apparently reduce substance P neurotransmission in limbic regions. If I am not mistaken, some of the antidepressant effect of the opiates has been attributed to such effects
I would like to see the studies.
>So, just the fact that the opiates reduce substance P, which, as we now know, can be modulated without producing euphoria, is a bit of a testament to how the opiates may be affecting some aspects of the effective processing *in addition* to producing euphoria.
There is possibility in what you're saying. Opiates may exert some effect on mood by reducing substance P (if that's what studies have shown). I think it's a bit of a stretch though, to attribute anything more than an ancillary role of substance P to the effects of opiates have on mood when their euphoriant (i.e. mood-lifting) effects are most prominent, well researched and extremely well documented. Yes, it's an interesting possibility but needs to be supported by more research. Again, I would like to see these studies that show antidepressant effects that are separate from the euphoriant effects.
In my own experience, I'm finding that the effect opiates have on my mood is directly proportional to the euphoriant effects. As euphoria is fading due to tolerance, so is the antidepressant effect. All other long-term opiate users I've talked to have found the same thing - when tolerance to the euphoriant effects of opiates is complete they no longer have any beneficial effect on mood. Some reach a point where they start to feel depressed despite taking the drug. I'm well aware this is not scientific proof, but it suggests a strong anecdotal link between the euphoriant effects and the antidepressant effect to me.
>You wil need to excuse me if I do indeed babble.
Likewise?
>Not everything I am saying needs to have a point.
Okay.
>I never knew there was a rule about being required to make sence.
I don't know what to say to this.
>Some of what I say can just be taken for what it is.
Can it? Who by, and why is that? Can some of what I say just be taken for what it is?
Q
Posted by linkadge on August 15, 2007, at 13:02:15
In reply to Re: Vicodin and Percocet for Depression » linkadge, posted by Quintal on August 15, 2007, at 0:32:15
>You seemed to be addressing some of the points >in my post. It helps is you stay on-topic, or >people are liable to become confused, especially >when dealing with subjects of a technical >nature. It's not a question of how I think the >thread should behave.
Speak for yourself. If others are confused they can let me know.
>I think you've objected very strongly on the few >occasions where I have accidentally omitted >qualifiers like 'can' from a few sentences. I >expect other people to abide by the standards >they ask of me.
I though thats what this was about :)
It would have been clearer (for me) that you use the word *can* in your statement. Others may have understood your post completely. You don't have to change the way you post on my account.
>What is their purpose if they have no specific >point?
Who says I need to have a purpose.
>Are you aware of any published studies that >conclude that opiates have a distinct >antidepressant effect that is separate from the >euphoriant effect?
See below.
>Euphoria is an abnormally elevated mood, and >depression is abnormally low mood, so they're >opposites really. I don't see how one could be >truly euphoric and depressed at the same time.
Easy. Its called "mixed states", and it can occur when severly depressed patients self medicate.
There is lots of research on what destinquishes an antdiepressant from a euphoriant. Some findings are the following:
Drugs of abuse (in general) reduce hippocampal proliferation and neurogenesis. Ie cocaine, amphetamines, nicotine etc, wherase antidepressants enhance it. (Not sure what effects opiates have)
Drugs of abuse and antidepressants have destinct and divergent patterns of gene expression (BDNF). Antidepressants increase hippocampal levels of BDNF, but not affecting gene transcription in the neucleus accumbens. Drugs of abuse generally have no positive effect on gene transcription in the hippocampus but tend to increase BDNF in the neucleus accumbens. Enhancing BDNF in the NAA produces a behavioral depressant effect wherase the opposite is true to increasing BDNF in the hippocampus.
See: (pertaining to the effect of BDNF in the neucleus accumbens on behavioral depression)
And since you asked, here are, in no particular order, a number of studies pertaining to some of what I have been saying. I cannot locate some studies, but there is a lot of reading here on the topic of convergent effects of opiates and antidepressants in some patients, as well as some of the possable antidepressant mechanisms of the opiates. There are listed below certain antidepressant effects of the opiates which have been teased away from the euphorint effects.
1) The effect of morphine on endogious depressives.
http://www.opioids.com/antidepressant/history.html
2) Is morphine an antidepressant? (animal model)
http://biopsychiatry.com/lhmorph.htm
3) Opiates, depressives, and the HPA axis.
http://opioids.com/naloxone/depcrf.html
4) The effects of various opiate receptor agonists and antagonists on learned helplessnes
http://opioids.com/enkephalinase/lhelplessness.html
5) Antidepressant, antimanic & Antipanic effects of opiates.
http://opioids.com/cogmood/antidepressant.html
6) Historical concepts of opiate treatment in psychiatry
http://opioids.com/cogmood/history.html
7) Opiate receptor downregulation in the theraptutic effect of imipramine
http://biopsychiatry.com/imipramine-deltaopioid.htm
8) Opiate system in efficacy of venlafaxine
http://biopsychiatry.com/venlafaxine-opioidergic.htm
9) The opiate system in the theraptutic effect of fluoxetine
http://biopsychiatry.com/fluoxopi.htm
10) The effect of buprenorphine in depression.
http://biopsychiatry.com/bupref.html
11) The antidepressant effect of substane P inhibitors
http://biopsychiatry.com/subp.htm
http://biopsychiatry.com/substancep-antag.htm12) Substance P in Major depression
http://biopsychiatry.com/substancep-depression.htm
13) The effects of opiates on substance P
http://www.nature.com/nature/journal/v268/n5620/abs/268549a0.html
14) Mu and delta opiate receptor occupancy on the inhibition of substance P. Feldman, et.
al, 1997).Reference within text:
http://www.humboldt.edu/~morgan/opia_s04.htm
15) Naloxone blocks the anxianxiety effect of neuropeptide y
http://www.medscape.com/medline/abstract/11311731
16) Neuropeptide Y neurotransmission may be associated with the mechanism of action of various antidepressant treatments
http://biopsychiatry.com/neuropep-y.htm17) Morphine, a mood brigtening smart drug
http://opioids.com/cogmood/morphine.html
18) Case studies, long term relief of depression in highly refractory cases with fixed doses of oxycodone.
http://opioids.com/antidepressant/opiate.html
19) Use of opiates in highly refractory AD and ECT nonresponce.
http://opioids.com/antidepressant/opiates.html
20) The DST and as predictor of responce to opiates.
http://opioids.com/antidepressant/depression-subtypes.html
21) Methadone and morphine in depression
http://opioids.com/antidepressant/index.html
22) The antdiepressant effect of endomorphins.
http://opioids.com/endomorphins/antidepressant.html
There are a lot of interesting links on studies with particular bearing to some of the mentioned connections between opiates, depression, and the behavioral and antidepressant effects of opiate receptor modulation.>In my own experience, I'm finding that the >effect opiates have on my mood is directly >proportional to the euphoriant effects. As >euphoria is fading due to tolerance, so is the >antidepressant effect.
I hope you find some of the above case reports of interest. Listed is one individual who achieved his longest state of clinical remision with a fixed dose of oxcodone. I would assume that a euphoriant effect would not have lasted almost 2 years on a fixed dose. And if it did..all the better!
Linkadge
Posted by Quintal on August 15, 2007, at 18:24:05
In reply to Re: Vicodin and Percocet for Depression, posted by linkadge on August 15, 2007, at 13:02:15
>It would have been clearer (for me) that you use the word *can* in your statement. Others may have understood your post completely.
I did use the word 'can' on several occasions but you seemed to persist in finding examples of where I had used sentences without it, sometimes even with in the same post. As I said earlier, by doing this I thought you seemed to be asking for a higher standard of communication than you yourself were willing to provide. You don't have to alter your posting style on my account, but I think it is common courtesy to do so when demanding care and clarity from others.
>You don't have to change the way you post on my account.
Likewise, but it does help ease communication.
>Who says I need to have a purpose.
Do you understand why I might be confused and alarmed by posts that have no apparent purpose? If I have time I will compose a post in reply to one of your questions that has no point, reason, rhyme nor purpose. And does not make sense. How do you think it would feel to be the recipient of such a post?
>Drugs of abuse and antidepressants have destinct and divergent patterns of gene expression (BDNF). Antidepressants increase hippocampal levels of BDNF, but not affecting gene transcription in the neucleus accumbens. Drugs of abuse generally have no positive effect on gene transcription in the hippocampus but tend to increase BDNF in the neucleus accumbens. Enhancing BDNF in the NAA produces a behavioral depressant effect wherase the opposite is true to increasing BDNF in the hippocampus.
Is this linked to the role of BDNF is the mesolimbic dopamine pathway? I see from the first article you provided (and thank you for doing so) that increased BDNF expression in this pathway also produces a behavioral depressant response. Since dopaminergic input from the VTA modulates activity in the NAcc, and does this via the mesolimbic pathway, it would seem that BDNF has an inhibitory role on dopaminergic transmission in the mesolimbic pathway, and thereby the NAcc, which would then produce a behavioral depressant response?
This is slightly confusing because drugs of abuse, like the amphetamine example in the previous post, have been used, and are indeed used, in treatment resistant depression because of their 'mood elevating' effect, which seems quite the opposite of a behavioral depressant response.
>And since you asked, here are, in no particular order, a number of studies pertaining to some of what I have been saying.
Thank you for locating these studies link. I will try to organize them according to topic, assess their relevance, and see what I can glean from them.
>I hope you find some of the above case reports of interest. Listed is one individual who achieved his longest state of clinical remision with a fixed dose of oxcodone. I would assume that a euphoriant effect would not have lasted almost 2 years on a fixed dose. And if it did..all the better!
Yes, achieving the same level of euphoria from a fixed dose of oxycodone taken continuously for two years would be very unusual. It's also possible though, that the level of euphoria did decline over the course of treatment, but that he still felt, and was grateful for, the small relief still provided. I believe a similar thing occurs with long-term benzodiazepine use. For me, after almost one year of continuous use codeine still has some small euphoriant effect, I'd estimate less than 1/10th of what it was in the beginning, yet I still manage better with this small mercy than having no relief at all.
Q
Posted by linkadge on August 15, 2007, at 20:29:57
In reply to Re: Vicodin and Percocet for Depression » linkadge, posted by Quintal on August 15, 2007, at 18:24:05
>You don't have to alter your posting style on my >account, but I think it is common courtesy to do >so when demanding care and clarity from others.
I don't think I demanded anything of you.
>Do you understand why I might be confused and >alarmed by posts that have no apparent purpose?
I don't think 'alarmed' is the right word. They might be confused. I have read many posts that I have not understood. I usually ask a followup question and things become more clear.
>Is this linked to the role of BDNF is the >mesolimbic dopamine pathway? I see from the >first article you provided (and thank you for >doing so) that increased BDNF expression in this >pathway also produces a behavioral depressant >response. Since dopaminergic input from the VTA >modulates activity in the NAcc, and does this >via the mesolimbic pathway, it would seem that >BDNF has an inhibitory role on dopaminergic >transmission in the mesolimbic pathway, and >thereby the NAcc, which would then produce a >behavioral depressant response?Not sure how it works. I do know that repeated administration of many drugs of abuse such as cocaine upregulates such transcripts in the mentioned regions.
>This is slightly confusing because drugs of >abuse, like the amphetamine example in the >previous post, have been used, and are indeed >used, in treatment resistant depression because >of their 'mood elevating' effect, which seems >quite the opposite of a behavioral depressant >response.
Depression is a documented possable side effect of long term amphetamine administration. I see where you are going with this, so let me just say that I am not the one who has chosen to classify drugs as they have been classified. Yes, in some models amphetamines pass as antidepressants. Indeed, some of the early researchers of the TCA's noted that they shared with the amphetamines the ability to inhibit the reuptake of certain monoamines.
To me, the bottom line is wheather the effect is sustainable. If amphetamines work for you, long term, as an antidepressant, then all the power to you.
>Yes, achieving the same level of euphoria from a >fixed dose of oxycodone taken continuously for >two years would be very unusual. It's also >possible though, that the level of euphoria did >decline over the course of treatment, but that >he still felt, and was grateful for, the small >relief still provided. I believe a similar thing >occurs with long-term benzodiazepine use. For >me, after almost one year of continuous use >codeine still has some small euphoriant effect, >I'd estimate less than 1/10th of what it was in >the beginning, yet I still manage better with >this small mercy than having no relief at all.
Thats what it should be all about. Using what works for you.
Some believe the real danger in adopting a liberal attitude about the use of opiates for depression is that individuals become addicted.
But, as it is becoming clearer, and clearer to some, conventional antidepressants somtimes fair no better on such domains.
Tollerance, dosage escalation, poop out, withdrawl, are terms that unfortunatly apply to SSRI's SNRI's TCA's MAOI's for some people.
Linakdge
This is the end of the thread.
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