Posted by europerep on January 29, 2015, at 16:39:00
In reply to Re: feeling like im out of options, posted by hello123 on January 28, 2015, at 18:15:00
Hmm, there is a bit of confusion in the thread now. Ed has already pointed out everything about the different mechanisms of action, so I'll just reply directly to what you said.
I don't think it is rational to try naltrexone as a substitute for buprenorphine, for various reasons. Primarily, it lacks the properties of buprenorphine and norbuprenorphine on mu- and delta-receptors, which I would personally suspect to play at least some role in the antidepressant effects of buprenorphine. And naltrexone is actually fairly extensive used for various illnesses (compared to buprenorphine in treatment-resistant depression), so if naltrexone had antidepressant properties, we would have some solid knowledge about it. Not necessarily from the Journal of Clinical Psychiatry, but certainly from patients. I just have difficulty understanding why you seem to have some faith in science and pharmacological treatments, but you stubbornly refuse to try tranylcypromine or phenelzine. Some people call them the gold standard for treatment-resistant depression.
As for what I said about clinicians, I of course meant clinicians who can back their statements up with science, as those who recommend MAOIs for treatment-resistant depression can.
I don't want this here to become some kind of proving-each-other-wrong thing, because that is not my intention. I would personally like it if you reflected a bit about where you're most likely to find a working treatment, and then go in that direction. But you're obviously free to decide, so I'll leave it at that.
poster:europerep
thread:1075467
URL: http://www.dr-bob.org/babble/20150129/msgs/1075728.html