Posted by europerep on June 18, 2011, at 16:33:08
In reply to Re: more thoughts on my depression treatment options » europerep, posted by floatingbridge on June 18, 2011, at 12:11:24
Hey fb...
>
Two things happened. One was he asked me about the Ultram er. Great! I said. Well, not so great for pain, but it really helps my mood. The expression on his face led me to believe I had said something really wrong.Haha, yeah, in doctor's speak that is "well, they are so-so for pain, but they give a GREAT high!" *grin*.. doctors are very wary of course of people abusing their pain meds, and that is also justified seeing how many people develop addiction starting with a regular pain med prescription.. Although 9 instead of 6 one day is, hmmm, tolerable I think. The fact that a pain patient *occasionally* takes more than a prescribed dose is commonly seen in pain therapy. Anyways..
> Would that be sustainable? I don't really think so. And the idea (which I do not understand the workings of) 'bupe' worry mr. It's just that I read this thing about synthetic opoids and endogenous depression.This confuses me now. In your last post to Sigismund you said you didn't want tramadol, which I had mistakenly thought you were dreaming of going back to. But if you don't want tramadol then buprenorphine would seem like the only possibility (within the opioid range of course). By the way, buprenorphine is a synthetic opioid too. Synthetic basically just means that it's not one of the natural products of the opium plant. (And the word opioid actually even comprises that information, the natural ones are called opiates.) Since buprenorphine is a quite potent pain med, it might be an ideal choice. It could be combined with, say, milnacipran for fibromyalgia which wouldn't be possible with tramadol because of the risk of serotonin syndrome.
> After all this time I didn't know the types of depression, do looked them up--hence my post--more like notes to myself about the various depressive states I've experienced.Personally, I'm not sure whether these classifications of depressions really have a huge practical value. I mean, if someone is treatment-resistant, they'll throw at you what they have - or at least that's what they should do if they aren't too timid to go beyond SSRIs - pretty much regardless of whether it's 'atypical', 'melancholic', 'endogenous' etc.
In short, if you want to try anything opioid-related but not tramadol, I would indeed recommend you try to get buprenorphine. Whether you *could* get that is probably a different question, and maybe that would even depend on where you are in the States. Also, and I am not trying to "proselytize" here, but over here mixed conditions of pain/depression are sometimes treated with the local version of Marinol. Just a thought.
Best wishes,
ER
poster:europerep
thread:988626
URL: http://www.dr-bob.org/babble/20110610/msgs/988683.html