Posted by MoonageDaydream on December 15, 2009, at 20:05:26
In reply to Re: Do not do it!, posted by princenamor on October 11, 2008, at 17:17:44
Hi. I've been on Suboxone for 3 years, after a couple years of opioid addiction. I also suffer from treatment-resistant depression and have ADD (inattentive type). Hopefully I can be of some assistance.
First of all, how much Vicodin did you take before starting buprenorphine? The reason you're tired is almost certainly because you're on too high a dose of buprenorphine. Buprenorphine is FAR stronger than many people (including many doctors) realize. I was taking on average 160 mg of Oxycontin or 60 mg of Methadone per day (which is equivalent to ~240-300 mg Hydrocodone; or 30 10/500 Vicodins). Switching to 12 mg of Suboxone was way too much, and even 8 mg was probably more than necessary. I've heard countless stories of people without significant opioid tolerance taking as little as 1 mg and feeling very nauseous and sedated for 16-24 hours. 8-16 mg buprenorphine has been demonstrated to be as effective as 50-80 mg of methadone at keeping opioid abusers clean. Check your pupils...if they're are really tiny in a well-lit room, you're on too much. Unlike most opiates, taking higher dosages of buprenorphine doesn't seem to increase the mood-lifting or euphorigenic properties of the drug.
I have to say that taking opioids for antidepressant purposes on any continuous basis is a recipe for disaster. Withdrawal is agonizing...its like days of torture. And its not the physical symptoms that are so bad...its the psychological aspect that is awful, especially if you have a history of depression. Buprenorphine withdrawal is particularly bad, because it lasts for weeks. I often hear the claim that the withdrawal from buprenorphine is milder than with full agonists. Some people get off it fairly easily so long as they jump off at 1 mg or less; others (such as myself) would take oxycodone w/d anyday over suboxone withdrawal. Do a google search for "Suboxone Withdrawal", and read people's experiences. If I were you, I'd stick with the Vicodin if that's a possibility. Its just as good if not better for lifting mood, and the withdrawal symptoms would be more manageable.
Even if an opioid works for your depression at first, this effect in most cases will cease with continuous use, and you will have to increase the dose to get the same effect. Personally, I don't think the Suboxone ever helped my depression in the 3 years I've been taking it. I'm only taking 0.5 mg per day now, but even at higher doses I can't say it did much to improve my mood or anxiety. It did numb my emotions some at higher doses.
I'm not going to moralize any more about the use of opioids in depression, though. You make a valid point in comparing them to neuroleptics and ECT. I'd just stress the following points: 1) You're going to become physically dependent on buprenorphine, and if it doesn't work the withdrawal is going to suck. 2) It may require increasingly high dosages (whether bupe or Vicodin). 3) There may be other treatments out there that might be a better option in the long term. 4) It's only a matter of time before you start abusing opiates, given your history of depression. It really doesn't matter how strong your will power is, or how responsible you are. 5) 5 years ago, I was a lot like you, thinking that opiates were the only thing that would fix my depression. They were never effective long-term, and now I'm dependent on a drug that does nothing except make me feel how I felt before ever taking opiates.
My advice: Reconsider opiate therapy (unless you've literally tried EVERYTHING else and are debilitated). Please get back to me with your thoughts, and if you could expand a bit more about what medications you have tried in the past, that would help.
poster:MoonageDaydream
thread:850758
URL: http://www.dr-bob.org/babble/subs/20091027/msgs/929451.html