Posted by Jet on February 4, 2002, at 23:00:38
In reply to Re: Not so Helpless :-) » Jet, posted by Elizabeth on February 4, 2002, at 1:16:12
> > Thanks for the info on the Bupe. So, I have to lay down and squirt the Bupe up my nose? Does it burn?
>
> Nope, it feels just like water. You also need to hyperextend your neck (i.e., tilt back your head) so it won't all just go straight down your throat. Chances are you'll get a taste of it now and then -- it's slightly sweet, nothing gross.
>
> > I don't have a place to lay down at work, I would have to lay down in the bathroom floor - ick. Can you sit on the toilet and put your head back?
>
> This is a big problem with this route of administration: the midday dose. What kind of place do you work at? There must be someplace better than the bathroom floor where you could lie down! (I don't know about sitting with your head tilted back, never tried it. I'd expect it to be less effective, but you might be able to make it work.)
>
> > How long does each dose last for you?
>
> About 5 hours, give or take.
>
> > I asked you in an earlier post if I could take it on an as needed basis. And you said yes. That probably isnt a good idea with this drug, is it?
>
> I think it might work fine. If you find you need it very often, though, you should come up with a regular schedule so as to keep things, as you say, on an even keel. I'm not sure how great it would be as a mood stabilizer. Anyway, I think it might be a good idea to try taking it "as-needed" at first, and move on to taking it regularly only if you find that you need to.
>
> > After talking it over with my boyfriend, we have agreed that I need to try it now and not wait. I am taking the Percocet twice and some days three times a day and we are both concerned with what the effects the Tylenol will have on my liver.
>
> Probably not a problem -- you're not getting *that* much of it, although it's really best in general not to take extra medicine that you don't need. I'd be more concerned about dependence, and possibly tolerance, to the oxycodone, especially since you're taking it so frequently.
>
> > Plus, the mood lifting effect is very short, sometimes only lasting an hour after the dose is taken - not worth the liver-damage risk.
>
> OxyContin, a sustained-release formulation of oxycodone (no Tylenol), is a 3-times-a-day med. That would definitely be preferable to Percocet, although I think buprenorphine would be better to try first.
>
> > I also have arthritis and she thinks I have fibromyagia & chronic fatigue. Some days, I just ache all over.
>
> That gives her a lot of reasons for prescribing an opioid. Depression is often accompanied by pain syndromes, and Dr. Bodkin suggested that buprenorphine would be particularly suitable for this kind of syndrome. Although unless there's some specific reason not to (sorry, I can't remember all the specifics of your case), I think you should consider giving Ultram a try first. It's much easier to get and easier to use. Its efficacy is mostly due to a long-acting metabolite, and this makes it potentially very useful for chronic pain. It isn't so helpful for taking as-needed because it takes several hours to kick in; you need to maintain sufficient levels of tramadol and O-desmethyltramadol (the aforementioned metabolite) by taking it about 4 times a day (not a big deal since it's just a pill).
>
> I have chronic pain too (back-neck-shoulder). Lately I've been considering finding a pain specialist who will prescribe buprenorphine for me so I don't have to keep hunting for a psychiatrist who's willing to prescribe it.
>
> > She thinks that my depression is caused from living in the Northwest and if I would just move to someplace sunny I would be fine. I don't agree with her there, because my family is full of depressed people.
>
> Where do they live? Is there a seasonal component in your depression? (Mine's definitely not seasonal: some of my hardest times have been in the summer.)
>
> > The only other OTC med I take is Melatonin. I have a really hard time falling asleep and find that this really helps me. I read though on the boards that someone with my problems should not take this that it will make me worse. What do you think about that?
>
> What did you hear exactly? I think melatonin can make some people feel worse, other better. Of course I had a "paradoxical" reaction to it when I tried it (it kept me awake all night). < g > If you feel it helps you, I'd say stick with it.
>
> Okay, on to your other post:
>
> > I was looking back at posts from July of 2001. You were talking about going off Bupe. Have you? You were talking about trying Despirime (sp?). Did you ever try that and if so, did it work for you?
>
> Desipramine did help, but it turned out I wasn't metabolizing it normally and I would have needed to have serum levels monitored regularly if I were going to keep taking it. The thing that really made me decide to go off it was that I had a seizure.
>
> I'd like to be able to stop taking buprenorphine, or to take it occasionally (as I do Xanax). Besides being hard to use, it has a lot of side effects, some of which are pretty disruptive and difficult to manage (GI distress, amenorrhea, pruritis, "jitters" (not anxiety, but psychomotor activation to a degree that's sometimes uncomfortable), etc.). If the Effexor is a big success, I may be able to reduce my use of buprenorphine or stop taking it altogether. I don't have any expectations either way, though, and I'm prepared to live with the buprenorphine if I need to.
>
> > I have had an emptyness inside of me always that I have tried to fill up with spending money, taking drugs, eating carbs, etc.
>
> That's pretty common, although it's not quite the same as full-blown anhedonia: some people don't get much pleasure from their lives ("emptiness" is a word often used to describe this), so they go to extremes -- overeating, gambling, excessive shopping, drugs, and other "thrill-seeking" behaviors -- because that's the only way they can feel good.
>
> > Thank you for putting your feelings out there like you have.
>
> It's not always easy, so I'm glad you find it helpful.
>
> > I should be paying you instead of my pdoc, who has never once tried to get this information out of me.
>
> Well, I guess if you *want* to.... :-)
>
> > Now, I am going to go and tell him this and tell him it was you who enlightened me. It should go over well....
>
> I'll be very amused to learn the outcome of that discussion!
>
> > Another question for you. If you were me, would you maybe try adding an AD and take the Percocet when needed?
>
> It's *so* hard to make judgments like that. It might help. I don't know. What's your experience been with ADs?
>
> > If I start the Bupe, it seems as though I have to take it regularly because of the withdrawl issues, right?
>
> No, I don't think so. Withdrawal happens if you take it often enough that your body becomes used to having it and then stop taking it. (In any case, buprenorphine withdrawal symptoms are much milder than those of, say, oxycodone.)
>
> > I just don't know what to do at this point. I guess I would like to know if you are still taking it and what else you take.
>
> I presently take:
> Effexor XR 225 mg q.d.
> buprenorphine 1.0 mL (0.3 mg) t.i.d.
> Trileptal 300 mg t.i.d.
> Xanax 1-2 mg p.r.n. [anxiety, over-activation]
> propranolol 10-20 mg p.r.n. [tremor, activation]
>
> and the occasional antihistamine, usually promethazine (for nausea and "the itchies"). (This is not counting OTC stuff -- docusate and sometimes senna for constipation, ChlorTrimeton (a milder antihistamine), antacid/antigas pills for GI problems, etc.) I've thought about asking for trazodone or something for the "jitters" that come with buprenorphine. Also considering going back on Ambien, since the Effexor seems to be causing more sleep problems.
>
> > Did you ever try the Topamax?
>
> No. I'm not bipolar; I need anticonvulsants for seizure prevention, and Trileptal and its older cousin Tegretol are the main treatments for complex partial seizures (the kind I'm supposedly having). We talked about different anticonvulsants, but my doctor wasn't into Topamax because he says it seems to cause cognitive problems for a lot of people.
>
> -elizabethThanks so much Elizabeth for taking the time to answer all of my questions. I'll let you know what I decide to do and what my doctor says. Jet
poster:Jet
thread:91532
URL: http://www.dr-bob.org/babble/20020131/msgs/92903.html