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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by floatingbridge on June 22, 2011, at 0:17:19
No, it wasn't offered.
How can it work without escalation?
How can it treat pain as an opoid w/o creating it's own sensitivity to pain?
How is it used as an antidepressant?
I post at the risk of sucking up all the bandwidth here and becoming pariah.
My desperation level is high and my stomach really hurts. I'm going to try and listen to some music and breath.
Posted by sigismund on June 22, 2011, at 2:09:07
In reply to can someone explain subnox (sp) to me?, posted by floatingbridge on June 22, 2011, at 0:17:19
A pariah? Not only in the pharmacy?
Anyway.....
>How can it treat pain as an opoid w/o creating it's own sensitivity to pain?
I have no experience of bupe. I assume tolerance to be total. (If this is your assumption, you'd avoid drugs.) But given the competition..........
I gather you are referring to increased pain during Norco withdrawals.
This may (or may not) be minimised by the long half life of bupe.
>How is it used as an antidepressant?
Kappa opiate antagonism?
People do report this.
Posted by Phillipa on June 22, 2011, at 10:53:48
In reply to can someone explain subnox (sp) to me?, posted by floatingbridge on June 22, 2011, at 0:17:19
FB the person I know who was given it was given it from an addiction specialist to help withdraw from opiods. Long story short she is now addicted to the sub and attending meetings of NA. All from breaking her back from a fall during a hypotension episode taking nardil. Was given opiods got addicted. Last we talked was on nardil and trying hard to get off the sub. That's all I know. Phillipa
Posted by europerep on June 22, 2011, at 16:41:01
In reply to can someone explain subnox (sp) to me?, posted by floatingbridge on June 22, 2011, at 0:17:19
FB, I love your spelling :D... (please don't be mad at me for saying that)
The drug is called buprenorphine, the brand names are either Temgesic, Subutex or Suboxone. The first one is for pain, the second and third ones are for opiate addiction, with the difference that the Suboxone can't be injected and is thus less susceptible to abuse. They can all be used against depression, though I would recommend Temgesic or Subutex. Doses for opiate addiction go up to 32mg/d, whereas doses for both pain and depression are much much lower. Hence less potential for abuse and addiction, though it's still an opioid of course.
For a little more details on buprenorphine in TRD, here's a Q&A from the Psychiatric Times:
Q&A: Buprenorphine for Treatment Resistant Depression?By J. Alexander Bodkin, MD | November 22, 2010
Q:
Are there any recent sources talking about the use of buprenorphine (low dose) for people who were never drug addicts or abusers but who were diagnosed with treatment resistant depression? It seems to me that if stimulants are gaining popularity in treating MDD, why wouldn't we look at low dose buprenorphine which seems to have great results anecdotally for many people with MDD.A:
Buprenorphine is an only mildly abuse-liable drug that is occasionally dramatically helpful in treating depression that does not respond to conventional treatments, even including ECT and MAOIs.Nonetheless, there has been little work published concerning the antidepressant effects of buprenorphine in treatment refractory depression in the absence of opiate dependence since my 1995 paper. I find only one report, by Nyhuis et al in 2008, looking at low-dose sublingual buprenorphine monotherapy in 6 extremely treatment refractory hospitalized patients with a very marked response to a maximum dose of 0.8 to 2.0 mg/d for a total of 7 days of open label treatment. All but one of these subjects experienced full remission acutely.
A study of buprenorphine treatment for late life treatment resistant depression may currently be under way at the University of Pittsburgh by Dr. Jordan Karp, which is described online at Clinical Trials.gov: NCT01071538. This is an open-label study, using low doses (to 1.6 mg/d) for an 8-week treatment period.
An obstacle to depression research in the US may have been the requirement that since buprenorphines approval in 2002 as a sublingual preparation with or without naloxone for substance abuse treatment, a special DEA number must be obtained in order to prescribe it, requiring some prior drug-abuse treatment training. This removed it from ready access for most psychiatrists who specialize in treating mood disorders.
A relevant matter of mounting scientific interest is the potential role of kappa opioid receptor antagonists in depression treatment, which has been very promising in animal models (Carlezon et al, 2009). Buprenorphine is the strongest kappa-receptor antagonist currently available for human use, although it is also a partial agonist at the mu receptor, and the relative importance of the activity at these sites is currently unknown. This may encourage further work in this area in the near future.Follow-up Q (by xxxxx):
If a patient is on buprenorphine for MDD or TRMD, what precautionary measures should be taken? I imagine that undergoing any type of surgery (planned or emergency) could present severe risks with concurrent anesthesia? Should the patient wear a MedID bracelet?How would the patient deal with the need to take occasional or regular pain medications?
And how long do they remain on the buprenorphine? It is becoming readily apparent that discontinuation of buprenorphine is extremely unpleasant and very lengthy. Even with a very gradual tapering off and adjunct medications for symptom management. Just search online and you find countless horror stories of buprenorphine detox.
Depressed patients don't need that misery added to their lives.
A:
xxxxx's concerns were brought to my attention by the Psychiatric Times, and I was asked to respond. The dosage of burenorphine required for treating refractory depression is very low relative to the dosages conventionally used for detoxification and maintenance for primary opiate dependency. Thus the problems associated with buprenorphine use are minimized. The risk of interaction with benzodiazepines and other agents used in anesthesia is low, and does not require wearing a medic-alert bracelet, though a patient on buprenorphine should inform all of their treating physicians of all medications they are using. The effectiveness of conventional opiate medication for acute use in temporary pain relief is minimally interfered with by low-dose buprenorphine. And the difficulty of buprenorphine discontinuation when, as with any antidepressant, the period of high risk for depressive recurrence is considered to have passed, is much milder than is discontinuation from high dose buprenorphine treatment of opiate dependency, and probably comparable to the difficulties of discontinuation of many of the medicines used to treated major depression. Whether the risks associated with buprenorphine treatment add unneeded misery to the life of the a patient who suffers from otherwise treatment refractory depression depends entirely on how great the suffering has been from the depressive illness under treatment. This requires a careful risk-benefit analysis to be carried out mutually between patient and physician, and often other concerned parties, as with many of the serious treatment decisions encountered in the practice of medicine. J. Alexander Bodkin, M.D.
Posted by floatingbridge on June 22, 2011, at 17:06:53
In reply to Re: can someone explain subnox (sp) to me? » floatingbridge, posted by europerep on June 22, 2011, at 16:41:01
Thanks europerep. I can remember how to spell your name because you told me what it meant. But yeah, no hiding my spelling deficit :-) I decided not to let it stop me from asking questions (my spell check does not recognize many pharmaceutical words, and, well...). So please enjoy :-)
This was very helpful. I'm not going that
route this time around, but am still curious. That kappa receptor action (this one being antagonist) pops up frequently. What that means means nothing to me right now, but I have a
little time to hit Wikipedia....Thanks from the States!
fb
Posted by europerep on June 22, 2011, at 17:53:40
In reply to Re: can someone explain subnox (sp) to me? » europerep, posted by floatingbridge on June 22, 2011, at 17:06:53
> Thanks europerep. I can remember how to spell your name because you told me what it meant. But yeah, no hiding my spelling deficit :-) I decided not to let it stop me from asking questions (my spell check does not recognize many pharmaceutical words, and, well...). So please enjoy :-)
Don't worry, it's cute ;)..
> This was very helpful. I'm not going that
> route this time around, but am still curious. That kappa receptor action (this one being antagonist) pops up frequently. What that means means nothing to me right now, but I have a
> little time to hit Wikipedia....
Yeah, the kappa antagonism.. they thought kappa AGOnists (not antagnonists) could eventually replace regular opioid painkillers, but in clinical trials it turned out kappa agonists made people dysphoric and eventually depressed.. hence the idea that kappa antagonists might do the opposite, and that appears to be the case. However, buprenorphine also has a metabolite norbuprenorphine that is a delta-receptor agonist, and I personally believe this contributes to the antidepressant effects as well (amitriptyline and nortriptyline also increase delta activity). So, all these things distinguish buprenorphine from the regular opioids, and make it ideal for treatment of depression (only IF one wants go with an opioid of course).I gotta go to bed now, I'll post a little more tomorrow on what I'd suggest you do right now, because to me it seems like your thoughts are a little bit "all over the place", is that right? It would probably be important to make a choice (Parnate, NArdil, etc.) and then pursue that. And when that fails, maybe buprenorphine would be worta try?
Anyhow gotta go,
see you tomorrow!ER
Posted by Christ_empowered on June 22, 2011, at 18:13:34
In reply to Re: can someone explain subnox (sp) to me? » floatingbridge, posted by europerep on June 22, 2011, at 17:53:40
opioids have a long history of treating human pain, both emotional and physical. Laudanum, a tincture of opium, was popular for melancholy men and women (mostly women) in the 19th century. From what I understand, the last paper on using pain killers in depression before the somewhat renewed interest lately was published in the 50s. I read online that some doctors have used pain killers in schizophrenia, too. I don't get the brain mechanisms, but it makes sense: opiates help anxiety, tension, melancholy, and ease aches and pains (and relieve somatic symptoms of anxiety and mood problems).
I think temgesic is one of the more popular opioids for psychiatric indications because its supposed to be less addictive and euphoria-inducing (I think its a schedule III, not a schedule II like methadone and some other pain killers).
Posted by floatingbridge on June 22, 2011, at 20:08:20
In reply to Re: can someone explain subnox (sp) to me? » floatingbridge, posted by europerep on June 22, 2011, at 17:53:40
Thanks, er for the additional info about the Delta receptor and ami & nort. Those two are up for consideration.
I hope you're doing well on your treatment plan.
Yes, true about not being all over the place. Right now I am down to 20mg of norco which I want to taper and some very old lunesta.
Goodnight.
fb
Posted by SLS on June 25, 2011, at 5:56:51
In reply to Re: can someone explain subnox (sp) to me? » floatingbridge, posted by europerep on June 22, 2011, at 17:53:40
Suboxone is a combination of two drugs and is used primarily as a substitute for heroin in detoxification protocols. Suboxone is a preparation of buprenorphine and naloxone. You are better off using a preparation of buprenorphine only (Temgesic; Subutex; Buprenex). I believe naloxone would make pain disorders and depression worse. Buprenorphine, on the other hand, would reduce pain and possibly improve depression.
- Scott
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