Posted by Elizabeth on April 5, 2001, at 21:23:17
In reply to Re: ML Opiates and Treatment resistant Psychiatrists » Elizabeth, posted by SLS on April 5, 2001, at 12:52:08
> It never ceases to amaze me the diversity of unconventional treatments appearing on Psycho-Babble.
Well, this isn't so unconventional. Opiates are really the first drugs that were used as ADs, dating back to ancient times.
> I started seeing a new doctor in September. Since he came highly recommended, I am hoping that he would be cognizant of and motivated to use some of these things. So far, he has not revealed any "exotic" treatments that he has alluded to.
I hope that if he does give you more of an idea of what he considers "exotic," you'll share his ideas with us!
> Right now, he is focusing on exploring a few combinations of standard antidepressants that I have not yet given a truly adequate trial. That's OK with me for now.
That's good. It makes sense for him to want to do that, and it also gives him a chance to get to know you. A doctor is more likely to feel comfortable prescribing controlled substances to a patient he knows pretty well.
> I told my doctor about the use of hydrocodone by people here and asked him how often it was used for depression, and if it exerted a true antidepressant effect. His answer was that he thought the perceived relief from depression using hydrocodone was a euphoriant effect no different from that which would be experienced by an otherwise healthy person.
I agree with part of what he's saying. Morphine and other opioid agonists are mood-elevating drugs, and they have this effect on nondepressed and depressed people alike. (They don't do it for everybody, BTW, so don't expect miracles.)
But as for the "euphoriant" part, I don't take a high enough dose to produce euphoria (if that's even possible with buprenorphine, something that's disputed). It doesn't feel like getting high, nor am I tempted to take more in order to try to get high.
I also think that some depressed people probably have problems that are particularly responsive to opiates and less responsive to monoaminergic ADs. One explanation might be a deficit of endogenous opioids (I have no doubt that this is oversimplified, if not outright wrong). Anyway, this is based on my own experience.
> I guess my question is this: Whose idea was it to try buprenorphine? If it was yours, how did you go about selling it to your doctor? Where did you get the idea from?
My pdoc isn't a specialist in psychopharmacology (he's actually a psychoanalyst), although I think he's still better than most psychopharmacologists < g >. So at one point, when it became clear that Nardil had stopped working, he sent me to a specialist, someone he knew from residency. The specialist happens to be a researcher who focuses on novel treatments for depression, and buprenorphine was one of the treatments he had experimented with (1). He mentioned it as a possibility because of some of the things I said about my symptoms, but he felt at the time that it would be worthwhile to try MAOIs again or consider tricyclics (which I've never been able to tolerate very well). Anyway, eventually my pdoc and I came to a point where I was doing having trouble functioning on a day-to-day basis and nothing seemed to be helping, so we decided to try buprenorphine. It appealed to me in particular because I was pretty sure it would work (based on past experiences with hydrocodone from my dentist I knew that I'm one of the people who feel better on opiates -- as I said, not everybody does), and it was something that would work pretty much immediately (it takes an hour rather than a month).
(1) Bodkin et al. Buprenorphine treatment of refractory depression. _Journal of Clinical Psychopharmacology_ 1995 Feb; 15(1):49-57.
poster:Elizabeth
thread:57821
URL: http://www.dr-bob.org/babble/20010403/msgs/58858.html