Posted by christophrejmc on January 25, 2002, at 1:01:58
In reply to Re: opioids » christophrejmc, posted by Elizabeth on January 24, 2002, at 12:47:08
> > Is there any reason why buprenorphine would be a better choice for depression than the other opiates?
>
> There are several, which are discussed in the Bodkin et al. article. The following factors make buprenorphine a better choice than a full agonist.
>
> - less toxicity in overdose
> - little or no potential for abuse or addiction
> - much milder withdrawal symptoms
> - lacks Ultram's potential for precipitating seizures
> - action lasts longer than most opioidsThanks, although the last point is probably the only one that matters to me at this point.
> > Strangely, it's easier for me to get schedule IIs than the lesser controlled opiates (legally, btw).
>
> Buprenorphine in particular, or less controlled opioids in general (e.g., Stadol, Talwin, Nubain, etc.)? Doctors often shy away from buprenorphine because it's only available (in the U.S.) in an injectable formulation.Mostly because of the formulation (my PDR [a bit dated -- 1996] lists Stadol as the only one that comes in a non-injectable form) but also because they are not prescribed as much.
> > I know that some people have had good responses from morphine/oxycodone/methadone, but I'd rather not mess with anything potentially "addictive."
>
> I think that's reasonable. IMO, it's a good idea to try buprenorphine first, and move on to full agonists (probably MS Contin, OxyContin, or Duragesic) only if buprenorphine benefits you, but (1) the effect of buprenorphine is not sufficient, and you need something "stronger;" or (2) you are unable to tolerate buprenorphine. (Fentanyl is probably the most tolerable of the opioids, although it's probably a bad idea to ask your doctor for it.) I don't think it's worthwhile to try full agonists if buprenorphine doesn't help at all, although it's generally worth trying different doses -- sometimes higher doses may work better, but sometimes you may actually find *lower* doses more effective. In general, because the side effects of opioids can be pretty harsh, I'd advise starting at a low-end dose. (I started at 0.5 mL t.i.d.)> > Are there any other mixed agonists that are worth trying (and that don't require IV/IM injection)? Thanks for any information.
>
> Probably not. You might try Stadol (butorphanol), a kappa agonist/mu antagonist, especially if you're one of those people who feel worse on opioids (most people have at least tried codeine or hydrocodone at some point, so you're liable to have some idea how they affect you). But usually depressed people feel worse on kappa agonists. There was another drug on the market called Dalgan (dezocine) with a pharmacological profile similar to that of buprenorphine, but I think that dezocine is no longer available. (IIRC, Dalgan was an injection-only drug too, anyway.)I was going to try to get Stadol NS (Nasal Spray), but it seems like there are too few reasons not to try the "harder" opiates (Ultram doesn't seem to be very efficacious and I'm afraid of adding it to an MAOI [currently, I am taking Nardil]). The only opioids I've used were Vicodin and codeine. I remember the Vicodin making me feel somewhat better (both physically and psychically), but codeine did absolutely nothing at moderate doses (for my mood or my nasal pain).
> HTH
It does, thanks.
> BTW, buprenorphine doesn't have to be injected. It's effective when taken intranasally and sublingually (although the dose, at least in the latter case, is much higher than the injected dose).
>
> -eYeah, but it sounds like the alternative routes are a pain in the ass.
Thanks for your help,
Christophre
poster:christophrejmc
thread:4588
URL: http://www.dr-bob.org/babble/20020124/msgs/91500.html