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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by jaclinhyde on October 2, 2008, at 19:25:27
I would like to put a question to Dr. Bob and to the rest of the group if I may. Can someone please explain to me why a doctor will not prescribe Vicodin for depression IF used correctly and not abused? It has been drilled into my head as I am sure it has been done to others that taking Vicodin for anything other than pain constitutes MISuse, but why? Here is my argument.
Say when you were a kid you lost a leg and have been miserable since then. You have been on crutches since then which don't really help very much; it just gets you by. Then one day you are given a new leg (Vicodin)! But, the magic fairy doctor says you can only use it for a few days. You get up on your feet and for the first time since your accident you can function like a normal human being. You get out and do all the things you have dreamed of doing for years. Then poof! the leg is taken away and you are stuck back with the crutches again. People say "oh you must have a problem if you want that leg back" or "that is not what that leg was made for so you can;'t have it."
Sorry for the fairy tale analogy but you get the picture. Why is it alright for a doctor to open up his prescription pad and write one for an antidepressant, which is surely doing some bad stuff to the liver or heart or kidneys etc. in the long run plus has it's own share of side effects to boot but it is NOT alright to write a scrip for Vicodin? I have been on every anti D out there (and when I say everyone I mean laundry list worth of meds) with no relief but none have ever helped. Then one day I get a bad headache, the doctor gives me Vicodin and I am suddenly happy. And I am not talking crazy, throw your clothes off and run nude in the streets happy...I just mean 'clean the house, play with the kids, smile with my husband' happy. SOMEONE TELL ME WHAT IS BAD ABOUT THAT????? I know it can destroy the liver but no one can tell me that there is an antidepressant out there that wouldn't harm an organ if taken in extreme.
Sorry for getting so upset about it but it just doesm't make sense to me. Does anyone know of any doctor that would even consider this as an off label use? Even my social worker thinks I make a good case for it. What do you all think?
Peace and hugs,
Terri
Posted by med_empowered on October 2, 2008, at 22:23:28
In reply to Vicodin ~someone please explain to me why...., posted by jaclinhyde on October 2, 2008, at 19:25:27
People have known for a long time that opiates are good for pretty much whatever sort of pain--physical, emotional, spiritual--that ails you. That's why tinctures of opium were given to anxious 19th century women and why so many melancholy poets ate optium. Even now, some doctors (very few, but some) are willing to give patients Temgesic for depression and other psychiatric problems.
The problem is that psychiatrists and doctors in general have this bizarre idea that its ok to "treat" depression with antidepressants, lithium, antipsychotics, and other drugs that have horrendous side effects and often don't work, but its absolutely unacceptable to actually make miserable people *feel* better.
That's not "treatment"--psychiatric "treatment," apparently, has to be painful and expensive, which may explain why ECT is making a comeback--that's "getting high" or "misusing medication."
Then you have the addiction industry that's sprung up over the past 20 years or so. I don't know if you've noticed, but suddenly anything that doesn't make you feel like crap is "addictive" and must be stopped. Pot is gaining some acceptance, but I'm pretty sure that's just b/c its use is too widespread and too obviously innocuous for the addiction industry to bother launching a full-fledged attack against it like they did in the "Reefer Madness" days.
And there's the DEA and other drug regulating agencies. These days, most states either have or soon will have prescription monitoring systems. These systems, of course, don't just exist to identify doctor shoppers (of whom there are actually very few); they exist to allow the DEA to control the medical profession.
Sorry this is so long and rambling. My point is that although individual doctors have often bought into this BS, the individual doctors aren't really the problem; they're just the part of the problem that we, as patients, have to deal with. The problem is with an ideology that says its not only OK, but desirable, to have control over what people put into their bodies. The problem is also an economic one--I don't know if you've noticed, but Vicodin and other old-school treatments for psychiatric problems (benzos, stimulants) are pretty cheap. I'm pretty sure Big Pharma would be p*ssed if people stopped popping Abilify (which costs several hundred $$$ monthly) and started popping Vicodin (which I think might cost $30 or so, w/o insurance). Obviously, some people are going to slip through the cracks and find a way to legally obtain cheap, fun drugs; luckily, the addiction industry will intervene, with its over-priced shrinks, therapists, etc. to help "detox" people and "break the cycle of addiction."
Its a terrible situation, and I think it may only be getting worse, not better.
However, if you like opiates, you can get tramadol (ultram) online w/o a pre-existing script; since its not a controlled substance, its still possible (in some states) to legally order it off the internet as long as there's a doctor somewhere down the line writing a prescription for it.
Posted by calamityjane on October 2, 2008, at 22:29:27
In reply to It's the war on drugs, posted by med_empowered on October 2, 2008, at 22:23:28
I just wonder what the world would be like if no chemical substances existed whatsoever. if everything was natural. nobody took drugs and nobody needed meds...
Posted by Sigismund on October 2, 2008, at 22:39:06
In reply to It's the war on drugs, posted by med_empowered on October 2, 2008, at 22:23:28
The dispensation we have to live under is an ignominious racket.
Posted by dbc on October 2, 2008, at 22:45:02
In reply to Re: It's the war on drugs, posted by Sigismund on October 2, 2008, at 22:39:06
Opiates are a slippery slope much more so than stimulants. There may be doctors scripting suboxone or maybe even methadone to people under the pretense that they're junkies but for depression. But not plain old opiates like hydrocodone or morphine.
I know for a fact that stimulants are scripted for depression all the time under the guise of ADHD treatment but its much harder to justify opiates when someone starts reviewing your records.
Posted by desolationrower on October 3, 2008, at 1:01:20
In reply to Re: It's the war on drugs, posted by dbc on October 2, 2008, at 22:45:02
I agree that the puritan moralizer are the problem. But it might be easier if you were trying to get buprenorphan or tramadol.
-d/r
Posted by seldomseen on October 3, 2008, at 6:09:31
In reply to It's the war on drugs, posted by med_empowered on October 2, 2008, at 22:23:28
"I don't know if you've noticed, but suddenly anything that doesn't make you feel like crap is "addictive" and must be stopped."
I laughed out loud when I read this. It's so true.
Posted by seldomseen on October 3, 2008, at 6:24:13
In reply to Vicodin ~someone please explain to me why...., posted by jaclinhyde on October 2, 2008, at 19:25:27
Terri,
To me, there is a two-fold reason why opiates aren't more widely used to treat depression.
First, I think some pdocs *would* actually prescribe opiates for severe depression if these drugs weren't so highly regulated and monitored.
Docs can lose their license to practice and go to jail for off label use or non-judicious use of these meds.
Whether it's fair or not, these drugs have marked street value and are often abused. Now whether or not that should matter when it comes to treatment with these drugs is a different issue.
Second, there is a widely held belief (I think) that the current drugs for depression actually *treat* the underlying causes for depression. I don't know if this belief is correct, but medically, it makes these drugs much more attractive for the prescriber.
Opiates, on the other hand, may be seen as just masking the symptoms of depression. I think this also explains the reticence with which some providers prescribe benzos.
Frankly, I think there is more than enough anecdotal evidence that there should be some studies looking at long term use of opiates for the treatment of depression. What should be directly addressed is whether these drugs can provide sustained relief, or whether the effect is simply temporary.
Seldom.
Posted by Phillipa on October 3, 2008, at 10:57:18
In reply to Re: It's the war on drugs » med_empowered, posted by seldomseen on October 3, 2008, at 6:09:31
Seldom agree as l percocet a day and I felt "normal" Phillipa
Posted by jaclinhyde on October 3, 2008, at 12:18:31
In reply to Re: Vicodin ~someone please explain to me why.... » jaclinhyde, posted by seldomseen on October 3, 2008, at 6:24:13
> Opiates, on the other hand, may be seen as just masking the symptoms of depression. I think this also explains the reticence with which some providers prescribe benzos.
>
> Frankly, I think there is more than enough anecdotal evidence that there should be some studies looking at long term use of opiates for the treatment of depression. What should be directly addressed is whether these drugs can provide sustained relief, or whether the effect is simply temporary.
>
> Seldom.Thank you, all of you for your thoughful answers. Seldom, you obviously have a good reason to be on this board so you know how I 'feel.' As to anti-d's fixing the problem....I don't believe it. In the end the result is the same; a person feels better. If I take one road to get to my destination and you take another what does it matter as long as we both arrive? Like I said I have done the anti-d's with no relief (yes, including the MAOI's) so where is the fairness is taking away the only happiness I have ever felt because the drug is not an anti depressant. As for how long the ride will last who knows? So many antidepressants have pooped out on me it isn't funny. I would sell my soul to be able to function again like I could with Vicodin. Am I supposed to fake a headache and run from urgent care to urgent care just to get them? What can I do?
Hugs,
Terri
Posted by Phillipa on October 3, 2008, at 19:24:08
In reply to Re: Vicodin ~someone please explain to me why...., posted by jaclinhyde on October 3, 2008, at 12:18:31
I don't know but do know that they work the opiates and no it's not fair. Love Phillipa
Posted by jaclinhyde on October 3, 2008, at 19:34:34
In reply to Re: Vicodin ~someone please explain to me why.... » jaclinhyde, posted by Phillipa on October 3, 2008, at 19:24:08
One of my favorite lines from House is in the very first episode where he is talking to a group of patients and says something to the effect of:
"You may see me take some of these. They are called Vicodin and no, you can't have any...they're mine. And no I do NOT have a drug problem, I have a PAIN problem."
Amen brother!
Terri
Posted by seldomseen on October 4, 2008, at 11:45:08
In reply to Re: Vicodin ~someone please explain to me why...., posted by jaclinhyde on October 3, 2008, at 12:18:31
"Endogenous opioid tone" is a clinical term that describes the level of circulating natural opiate peptides that circulate in all of us.
You may have heard of endorphins. These are part of the factors that make up endogenous opioid tone.
There is some evidence that suggests that people with depression have low endogenous opioid tone that contributes to the condition.
I would suggest that you have a rational talk with your pdoc about your response to the Vicodin. It could be very clinically significant and give him/her a springboard from which to try a new treatment. This is of course assuming that he/she won't prescribe an opiate for you.
Have you considered tramadol (ultram) or potentially Effexor?
On a side note, I'm not a big fan of Vicodin or percocet, but not because of the opiate. These drugs also contain acetaminophen, which is IMO one of the most dangerous drugs available OTC.
Seldom
Posted by jaclinhyde on October 9, 2008, at 17:54:44
In reply to Re: Vicodin ~someone please explain to me why.... » jaclinhyde, posted by seldomseen on October 4, 2008, at 11:45:08
Yep, gone down the (side) Effexor route with no success but couldn't get off of it without the feeling that sticking pins under my nails would be more fun so we swung sideways to Cymbalta. Now I am trying to get off of that because it too doesn't work. Which brings up another Vicodin question; why can't I find a doctor with the guts to at least give it to me to help withdraw off of these other monsters? I woke up the other day with the worst muscle and joint pain I have ever had because of Cymbalta withdrawal plus I have been so messed up from TAPERING off of it. Again, Vicodin would help me get off of it easier. It would take away the pain plus stabilize my mood. But of course that would make me a bad person to even consider using it off label like that.....
Grrrrrrrrrrr...............
This is the end of the thread.
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