![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 55 to 79 of 170. Go back in thread:
Posted by SLS on May 13, 2001, at 9:20:45
In reply to Re: Methadone - AndrewB and all interested » rogdog, posted by Elizabeth on May 12, 2001, at 19:33:17
> > WE SHOULD ACCEPT THE OPIATES AS A "REAL" TREATMENT FOR DEPRESSION AND ANXIETY.
> They are.
Hi Elizabeth.How prevalent is this recognition among "expert" clinical psychopharmacologists?
I told my doctor about the multiple accounts described on Psycho-Babble of people using oxycodone as an antidepressant. His reply was that it was probably nothing more than the same euphoriant effects that healthy people experience. His tone seemed to indicate that opioids were not within the boundaries of alternatives to be considered for my treatment.
I am getting concerned that my doctor is not the expert he was touted as being (I hope he is not reading this). He is an assistant professor at NYU, and is an active clinician at the hospital. He came highly recommended by the doctor who was recommended by a research clinician at Mass. General / Harvard. The person who was originally recommended had changed his focus to ADD AD/HD, and would not take any cases of affective disorder. Both doctors share an office.
> Furthermore, they can work when nothing else does, probably because all conventional ADs target the monoaminergic systems (although some experimental ADs do affect neuropeptides).
Are you now using, or ever have used, the same opioid consistently as part of your daily regimen for an extended period? If not, why not? If you have discontinued the use of opioids while still moderately to severely depressed, what are the reasons?
I think my last question is one that would best be asked through a more private communication (I'll try not to flirt). I really need to evaluate the personnel whom I am to invest so much time and pain in. If you are willing...
Thanks.
- Scott
Posted by Elizabeth on May 13, 2001, at 13:44:26
In reply to Re: Opiates for depression?, posted by Cecilia on May 12, 2001, at 23:20:17
> I`m quite certain my HMO would never approve of opiates for depression-there`s no way I would even ask.
HMOs vary widely. Mine is a nonprofit that's basically owned by a university (the preferred hospital is the university-affiliated one, of course). The prescription plan is completely separate from the other parts. They recently adopted a formulary, where some drugs are "preferred" and have lower copays, but all prescription drugs are covered at least to some extent. So I can get Buprenex (or the generic that Abbott recently came out with) at any pharmacy that takes my insurance, as long as I have a script.
Most doctors don't even know what buprenorphine is (though some have a negative knee-jerk reaction based on the "-orphine" ending!). I think if they read up on it they'd realise it lacks a lot of the disadvantages associated with other opiates, and they'd be very willing to prescribe it. (The FDA considers it to have less abuse potential than benzos, Ambien, Provigil, and the like.) It would also help if the drug companies would come out with a metred-dose inhaler; right now the only way to administer it effectively requires the use of syringes, which doctors hate to prescribe.
> But I`m curious- I received morphine and Percocet following surgery a few years ago and they certainly didn`t make me high or less depressed or give me any desire to take more once the post-op pain was over.
You and 70% of the population. (Were you depressed at the time?)
> Do the people who respond to opiates for depression find they get an anti-depressant effect when these are taken for pain?
Yes. I was mildly depressed (residually -- I have double depression) when I received Vicodin ES (hydrocodone 7.5mg/APAP 500mg) after having my wisdom teeth out. As soon as I felt it, the not-quite-rightness that I've felt all my life vanished, and my mood returned to normal. A lot of people discover opioids this way. Those who move on to self-medicating with heroin are at high risk for addiction, especially those who take it intravenously (who also risk a number of medical complications such as infections and abscesses). Those who are able to find a doctor willing to prescribe opioids and monitor their use have little risk as long as they use the medication as prescribed.
Codeine in therapeutic doses for pain doesn't seem to have this effect, although it does have the same side effects than stronger drugs like hydrocodone or morphine. I think higher doses of codeine would probably work, but with worse side effects than similarly effective doses of morphine, oxycodone, etc. Buprenorphine works in extremely low doses (i.e., it is very potent, comparable to fentanyl) and is qualitatively distinct from other opioids, although I believe that opioid-experienced people (and rodents) can generally identify it as an opioid.
-elizabeth
Posted by SLS on May 13, 2001, at 15:02:53
In reply to Re: Opiates for depression? » Cecilia, posted by Elizabeth on May 13, 2001, at 13:44:26
Dear Elizabeth,
No need to communicate...
I was able to glean the answer to my question from the content of your post. Thanks.
- Scott> > I`m quite certain my HMO would never approve of opiates for depression-there`s no way I would even ask.
>
> HMOs vary widely. Mine is a nonprofit that's basically owned by a university (the preferred hospital is the university-affiliated one, of course). The prescription plan is completely separate from the other parts. They recently adopted a formulary, where some drugs are "preferred" and have lower copays, but all prescription drugs are covered at least to some extent. So I can get Buprenex (or the generic that Abbott recently came out with) at any pharmacy that takes my insurance, as long as I have a script.
>
> Most doctors don't even know what buprenorphine is (though some have a negative knee-jerk reaction based on the "-orphine" ending!). I think if they read up on it they'd realise it lacks a lot of the disadvantages associated with other opiates, and they'd be very willing to prescribe it. (The FDA considers it to have less abuse potential than benzos, Ambien, Provigil, and the like.) It would also help if the drug companies would come out with a metred-dose inhaler; right now the only way to administer it effectively requires the use of syringes, which doctors hate to prescribe.
>
> > But I`m curious- I received morphine and Percocet following surgery a few years ago and they certainly didn`t make me high or less depressed or give me any desire to take more once the post-op pain was over.
>
> You and 70% of the population. (Were you depressed at the time?)
>
> > Do the people who respond to opiates for depression find they get an anti-depressant effect when these are taken for pain?
>
> Yes. I was mildly depressed (residually -- I have double depression) when I received Vicodin ES (hydrocodone 7.5mg/APAP 500mg) after having my wisdom teeth out. As soon as I felt it, the not-quite-rightness that I've felt all my life vanished, and my mood returned to normal. A lot of people discover opioids this way. Those who move on to self-medicating with heroin are at high risk for addiction, especially those who take it intravenously (who also risk a number of medical complications such as infections and abscesses). Those who are able to find a doctor willing to prescribe opioids and monitor their use have little risk as long as they use the medication as prescribed.
>
> Codeine in therapeutic doses for pain doesn't seem to have this effect, although it does have the same side effects than stronger drugs like hydrocodone or morphine. I think higher doses of codeine would probably work, but with worse side effects than similarly effective doses of morphine, oxycodone, etc. Buprenorphine works in extremely low doses (i.e., it is very potent, comparable to fentanyl) and is qualitatively distinct from other opioids, although I believe that opioid-experienced people (and rodents) can generally identify it as an opioid.
>
> -elizabeth
Posted by NikkiT2 on May 13, 2001, at 15:59:58
In reply to Re: Methadone - AndrewB and all interested, posted by rogdog on May 12, 2001, at 13:28:15
EEFEXOR IS *NOT* ADDICTIVE
METHADONE *IS* ADICTIVE
simple!!!
>
> MY EXPERIENCE WITH METHADONE HAS BEEN THAT IT IS A GOOD ANTI-ANXIETY MED. AND ALSO A GREAT ANTI-DEPRESSANT. i WAS ON IT FOR 3 AND A HALF YEARS THE THING THAT WAS THE WORST WAS THE FACT THAT YOU HAVE TO GET UP EVERY MORNING AND DRIVE DOWN TO THE CLINIC TO GET YOUR "DAILY DOSE". I THINK DOCTORS SHOULD BE LIBERATED IN THERE PRESCRIBING OF DRUG. A LOW DOSE OF METHADONE COULD END UP ON BEING A LIFE SAVER FOR SOME PEOPLE. WE SHOULD ACCEPT THE OPIATES AS A "REAL" TREATMENT FOR DEPRESSION AND ANXIETY. TO GET OFF IT REALLY IS NOT THAT BAD THERE ARE NUMEROUS WAYS TO DETOX FROM METHADONE AND NOT BE TO UNCOMFORTABLE. I HAVE DETOXED FROM METHADONE "COLD TURKEY" AND A GRADUAL DOSE REDUCTION. OPIATES ARE NOT A "BAD DRUG!!!!! PEOPLE REACT TO MEDICATION DIFFERENTLY, SOME MAY HAVE AN ABSOLUTLY TERRIBLE EXPERIENCE WITH EFFEXOR AND BELEIVES IT IS FROM THE DEVIL, WHILE OTHERS COULDNT LIVE WITHOUT IT. JUST MY 2 BITS! ROGDOG
Posted by NikkiT2 on May 13, 2001, at 16:01:19
In reply to Re: Methadone » NikkiT2, posted by Elizabeth on May 12, 2001, at 18:42:54
Yet again, i will state, by medical LAW Effexor is NOT addictive, the withdrawal symptoms are your seratonin levels re-balancing bacially.
Methadone by medical law IS addictive.
nikki
> > Effexor is NOT addictive. Methadone IS addictiove. Its simple.
>
> You pointed to withdrawal symptoms (including rebound depression) as proof that a drug is "addictive." How, exactly, are you defining "addictive?" I don't believe that this is as "simple" a question as you suggest. There is a medical definition (refer to Goodman & Gilman's Pharmacological Basis of Therapeutics -- the standard medical school pharmacology text -- or to "substance dependence" in DSM-IV), but I'd like to know what you mean when you say it.
>
> > No one shoukd be prescribed an addictive drug in my opinion.
>
> At all? Or just for people who "only" have a "mental" condition? (As opposed to, say, pain -- which is just about as "mental" a condition as anything!)
>
> > I was also reffering to a number of friends who have had serious heroin addictions for many years and their experiences.
>
> I know. I have friends who've been in that situation as well (two of them died of it, one just a month before his 25th birthday). It is a tragedy. True addiction, however (I'm using the medical definition of "addiction," BTW), has very little to do with properly monitored medical use. It is very unusual for people prescribed opioids for pain to become addicted (again, in the medical sense). I personally believe that depression can be as serious or more serious as nociceptive pain for which opioids are the standard of care.
>
> > In the UK its very easy to buy black amrket methadone, as people get their script int he morning, and then sell it to buy them selves heroin zs the methadone is so awful.
>
> A big problem with the "war on drugs" is that it's easier (for anyone) to get unsafe, unmonitored, unregulated black market drugs than it is for pain patients who don't respond to other treatments to get the medicine they need. It's harder still for depressed patients who don't respond to anything else to get the medicine *they* need.
>
> Also, the UK isn't the best example -- the UK and US are extremist countries when it comes to drug laws. I could easily counter with a description of the drug laws in other Western countries. The Netherlands -- as an example of the opposite extreme (although their policies and cultural attitudes toward drugs are moderate, not extremist) -- focuses primarily on intensive harm reduction programs; criminal prosecution is largely limited to international drug trafficking. Methadone is readily available to anyone who is registered as an addict -- Dutch addicts don't have to be subjected to the debasing and extremely inconvenient form of maintenance programs that we have in the US. Dutch drug addicts aren't denied jobs or otherwise stigmatised the way they are in the US. Dutch employers don't require employees (or job applicants) to undergo drug testing. And you know what? There's virtually no "drug problem" in the Netherlands -- certainly nothing compared to all the violence associated with the illicit drug trade, the overcrowding of prisons with nonviolent offenders, spread of disease through needle sharing, and other problems that are rampant in the US. Addicts in the Netherlands have a real opportunity to remake their lives
> because the government spends its money on proven effective treatments rather than on ineffective law enforcement as our government does. The rate of addiction in the Netherlands is low and has been stable for a long time. As a percentage of the population, the rate of heroin addiction is less than half of that in the US; the murder rate is less than 1/4 that in the US; the rate of incarceration is about 1/9 that in the US. The Netherlands spends 1/3 the amount of money per capita that the US does on drug enforcement. And their less expensive drug policy *works* (by this time it is beyond any reasonable dispute that the US war on drugs is a pathetic failure -- and an international embarrassment).
>
> > i am just totally against this drug being prescribed for depression as I could see it beocming alot more dangerous.
>
> It's more dangerous for depressed people than typical antidepressants because it causes substantial respiratory depression that can lead to shock, hypoxic brain damage, and even death if it's taken in overdose. Tricyclic antidepressants and MAO inhibitors also carry substantial risks, the former being potentially lethal in overdoses of less than one month's supply.
>
> I also believe that there is a significant possibility that methadone would cause tolerance in patients taking it for depression, as it does in pain patients. However, there have been a number of reports (published and peer-reviewed ones, as well as the cases that I've discussed with my own doctors and teachers) in which patients have been treated for depression with morphine, oxycodone, oxymorphone, and other typical opioid agonists, at a fixed dose, for periods of a year or more without loss of efficacy.
>
> > It is, in my opinion, stupid for someone to suggest this, as, what ever you may feel or think about methadone, IT IS a dangerous drug. This cannot be argued against.
>
> I have a question. Do you think it's okay to call someone "stupid" if you preface it with "in my opinion?"
>
> Many medications that are recognised as being necessary in certain situations are dangerous. Antineoplastic drugs are extremely toxic. The misuse of antibiotics (which is frequent on the part of both patients and doctors) poses a risk to the public as well as to the individual to whom they are prescribed. I could go on, but I'm sure you see my point.
>
> > If you feel I am in the wrong by pointing this out, that is your business, but please do not do things like your little "DR Bob" bit as I am not be abusive toward anyone, name calling etc etc at all.
>
> I disagree with your claim that you aren't engaging in name-calling. You've called people "stupid," "childish" (in the "I'm rubber, you're glue" context), "pathetic," and even referred to someone as a "'person'" in quotes!
>
> If someone else calls you a name, that does not mean you are justified in calling them names in return. I'm sure you're aware that two wrongs don't make a right. This is a moderated board with rules which are quite reasonable and fair, and which, IMO, make it a lot safer a place for people to get support than, say, unmoderated Usenet groups.
>
> > I am stating a case of my personal opinion and experience.
>
> ...in completely different circumstances that are largely irrelevant to the discussion here. My own experience which I have cited here (together with the relevant scientific literature) involved the use of opioids under an experienced doctor's supervision in a medical context. I don't consider my experience with street drug addicts to be relevant to the issue of whether methadone has merit as an AD, which is why I haven't emphasised it until now.
>
> I think it's a terrible idea for people to get Vicodin or whatnot under false pretenses and attempt to self-medicate with it, especially if there is a possibility that safer monoaminergic antidepressants might help. (I also think it's a terrible idea to buy monoaminergic ADs over the internet and try to self-medicate with those.) But I also know how hard it is to get a prescription for opioids for nociceptive pain, let alone psychic pain, which is rarely taken as seriously as it needs to be. I think (as a result of my personal experiences and friendships with heroin addicts as well as my discussions on the subject with professionals who are familiar with the treatment of dually-diagnosed patients) that many patients who do not respond to typical ADs but do respond to opioids would get involved with street drugs if they were unable to get a prescription. And that, as far as I'm concerned, is an absolutely unacceptable risk.
>
> A final note: I said before that I've had friends who were junkies. I know how emotional an issue this can be. Please understand that those are entirely different circumstances from the medical use of opioids, which rarely results in addiction (again, I am using the accepted medical definition). This is a loaded debate -- lots of people (including you and me) have strong feelings about it -- but let's all try to remember to be polite and respectful of those who disagree with us, okay?
>
> Thank you.
>
> -elizabeth
Posted by NikkiT2 on May 13, 2001, at 16:01:26
In reply to Re: Methadone » NikkiT2, posted by Elizabeth on May 12, 2001, at 18:42:54
Yet again, i will state, by medical LAW Effexor is NOT addictive, the withdrawal symptoms are your seratonin levels re-balancing bacially.
Methadone by medical law IS addictive.
nikki
> > Effexor is NOT addictive. Methadone IS addictiove. Its simple.
>
> You pointed to withdrawal symptoms (including rebound depression) as proof that a drug is "addictive." How, exactly, are you defining "addictive?" I don't believe that this is as "simple" a question as you suggest. There is a medical definition (refer to Goodman & Gilman's Pharmacological Basis of Therapeutics -- the standard medical school pharmacology text -- or to "substance dependence" in DSM-IV), but I'd like to know what you mean when you say it.
>
> > No one shoukd be prescribed an addictive drug in my opinion.
>
> At all? Or just for people who "only" have a "mental" condition? (As opposed to, say, pain -- which is just about as "mental" a condition as anything!)
>
> > I was also reffering to a number of friends who have had serious heroin addictions for many years and their experiences.
>
> I know. I have friends who've been in that situation as well (two of them died of it, one just a month before his 25th birthday). It is a tragedy. True addiction, however (I'm using the medical definition of "addiction," BTW), has very little to do with properly monitored medical use. It is very unusual for people prescribed opioids for pain to become addicted (again, in the medical sense). I personally believe that depression can be as serious or more serious as nociceptive pain for which opioids are the standard of care.
>
> > In the UK its very easy to buy black amrket methadone, as people get their script int he morning, and then sell it to buy them selves heroin zs the methadone is so awful.
>
> A big problem with the "war on drugs" is that it's easier (for anyone) to get unsafe, unmonitored, unregulated black market drugs than it is for pain patients who don't respond to other treatments to get the medicine they need. It's harder still for depressed patients who don't respond to anything else to get the medicine *they* need.
>
> Also, the UK isn't the best example -- the UK and US are extremist countries when it comes to drug laws. I could easily counter with a description of the drug laws in other Western countries. The Netherlands -- as an example of the opposite extreme (although their policies and cultural attitudes toward drugs are moderate, not extremist) -- focuses primarily on intensive harm reduction programs; criminal prosecution is largely limited to international drug trafficking. Methadone is readily available to anyone who is registered as an addict -- Dutch addicts don't have to be subjected to the debasing and extremely inconvenient form of maintenance programs that we have in the US. Dutch drug addicts aren't denied jobs or otherwise stigmatised the way they are in the US. Dutch employers don't require employees (or job applicants) to undergo drug testing. And you know what? There's virtually no "drug problem" in the Netherlands -- certainly nothing compared to all the violence associated with the illicit drug trade, the overcrowding of prisons with nonviolent offenders, spread of disease through needle sharing, and other problems that are rampant in the US. Addicts in the Netherlands have a real opportunity to remake their lives
> because the government spends its money on proven effective treatments rather than on ineffective law enforcement as our government does. The rate of addiction in the Netherlands is low and has been stable for a long time. As a percentage of the population, the rate of heroin addiction is less than half of that in the US; the murder rate is less than 1/4 that in the US; the rate of incarceration is about 1/9 that in the US. The Netherlands spends 1/3 the amount of money per capita that the US does on drug enforcement. And their less expensive drug policy *works* (by this time it is beyond any reasonable dispute that the US war on drugs is a pathetic failure -- and an international embarrassment).
>
> > i am just totally against this drug being prescribed for depression as I could see it beocming alot more dangerous.
>
> It's more dangerous for depressed people than typical antidepressants because it causes substantial respiratory depression that can lead to shock, hypoxic brain damage, and even death if it's taken in overdose. Tricyclic antidepressants and MAO inhibitors also carry substantial risks, the former being potentially lethal in overdoses of less than one month's supply.
>
> I also believe that there is a significant possibility that methadone would cause tolerance in patients taking it for depression, as it does in pain patients. However, there have been a number of reports (published and peer-reviewed ones, as well as the cases that I've discussed with my own doctors and teachers) in which patients have been treated for depression with morphine, oxycodone, oxymorphone, and other typical opioid agonists, at a fixed dose, for periods of a year or more without loss of efficacy.
>
> > It is, in my opinion, stupid for someone to suggest this, as, what ever you may feel or think about methadone, IT IS a dangerous drug. This cannot be argued against.
>
> I have a question. Do you think it's okay to call someone "stupid" if you preface it with "in my opinion?"
>
> Many medications that are recognised as being necessary in certain situations are dangerous. Antineoplastic drugs are extremely toxic. The misuse of antibiotics (which is frequent on the part of both patients and doctors) poses a risk to the public as well as to the individual to whom they are prescribed. I could go on, but I'm sure you see my point.
>
> > If you feel I am in the wrong by pointing this out, that is your business, but please do not do things like your little "DR Bob" bit as I am not be abusive toward anyone, name calling etc etc at all.
>
> I disagree with your claim that you aren't engaging in name-calling. You've called people "stupid," "childish" (in the "I'm rubber, you're glue" context), "pathetic," and even referred to someone as a "'person'" in quotes!
>
> If someone else calls you a name, that does not mean you are justified in calling them names in return. I'm sure you're aware that two wrongs don't make a right. This is a moderated board with rules which are quite reasonable and fair, and which, IMO, make it a lot safer a place for people to get support than, say, unmoderated Usenet groups.
>
> > I am stating a case of my personal opinion and experience.
>
> ...in completely different circumstances that are largely irrelevant to the discussion here. My own experience which I have cited here (together with the relevant scientific literature) involved the use of opioids under an experienced doctor's supervision in a medical context. I don't consider my experience with street drug addicts to be relevant to the issue of whether methadone has merit as an AD, which is why I haven't emphasised it until now.
>
> I think it's a terrible idea for people to get Vicodin or whatnot under false pretenses and attempt to self-medicate with it, especially if there is a possibility that safer monoaminergic antidepressants might help. (I also think it's a terrible idea to buy monoaminergic ADs over the internet and try to self-medicate with those.) But I also know how hard it is to get a prescription for opioids for nociceptive pain, let alone psychic pain, which is rarely taken as seriously as it needs to be. I think (as a result of my personal experiences and friendships with heroin addicts as well as my discussions on the subject with professionals who are familiar with the treatment of dually-diagnosed patients) that many patients who do not respond to typical ADs but do respond to opioids would get involved with street drugs if they were unable to get a prescription. And that, as far as I'm concerned, is an absolutely unacceptable risk.
>
> A final note: I said before that I've had friends who were junkies. I know how emotional an issue this can be. Please understand that those are entirely different circumstances from the medical use of opioids, which rarely results in addiction (again, I am using the accepted medical definition). This is a loaded debate -- lots of people (including you and me) have strong feelings about it -- but let's all try to remember to be polite and respectful of those who disagree with us, okay?
>
> Thank you.
>
> -elizabeth
Posted by NikkiT2 on May 13, 2001, at 16:13:43
In reply to Re: Methadone - AndrewB and all interested » rogdog, posted by Elizabeth on May 12, 2001, at 19:33:17
I am off to Thailand in 4 weeks time.. only for two weeks, but basically just back packing with a group of mates. Anyway, tlaking to a friend that is coming and has been alot oin the past (goes every 2 months for at least 3 weeks! And 8 months last year!).. anyway, we were talking last night and I said something about have to get my hands on some valium somehow as we have ALOT of travelllinga nd little sleep at the beginning / emd. It was a light hearted comment, but she then told me that all these drugs are available over the counter in Thailand and where the best places were to get it all. (eg, Not bangkok central and they think all westerners are junkies, but go to patpong -n the red light district). By the box. Diazepam 10mg are available at 1000 for roughly $100(US). I'd be interested to find out the level of addiction to this drug there is out there. I've never heard of any, but it oculd be hidden, but it will be interesting to see whether the open availablility of it affects its level of use!
nikki
Posted by Dr. Bob on May 13, 2001, at 23:03:19
In reply to Re: Michele » Elizabeth, posted by Michele on May 13, 2001, at 0:14:09
> Elizabeth... you wrote this to me.... I didn't write it. Check the thread or do whatever you need to do.... but I am soooo tired of people taking pieces of a thread and directing it at me... WHEN I DIDN'T EVEN WRITE IT!!!!!!
I don't think she directed it to you, I think she just replied to a post that was directed to you and it kept (as it does by default) that subject line.
Bob
Posted by Cecilia on May 14, 2001, at 3:54:18
In reply to Re: Opiates for depression? » Cecilia, posted by Elizabeth on May 13, 2001, at 13:44:26
> > I`m quite certain my HMO would never approve of opiates for depression-there`s no way I would even ask.
>
> HMOs vary widely. Mine is a nonprofit that's basically owned by a university (the preferred hospital is the university-affiliated one, of course). The prescription plan is completely separate from the other parts. They recently adopted a formulary, where some drugs are "preferred" and have lower copays, but all prescription drugs are covered at least to some extent. So I can get Buprenex (or the generic that Abbott recently came out with) at any pharmacy that takes my insurance, as long as I have a script.
>
> Most doctors don't even know what buprenorphine is (though some have a negative knee-jerk reaction based on the "-orphine" ending!). I think if they read up on it they'd realise it lacks a lot of the disadvantages associated with other opiates, and they'd be very willing to prescribe it. (The FDA considers it to have less abuse potential than benzos, Ambien, Provigil, and the like.) It would also help if the drug companies would come out with a metred-dose inhaler; right now the only way to administer it effectively requires the use of syringes, which doctors hate to prescribe.
>
> > But I`m curious- I received morphine and Percocet following surgery a few years ago and they certainly didn`t make me high or less depressed or give me any desire to take more once the post-op pain was over.
>
> You and 70% of the population. (Were you depressed at the time?)
>
> > Do the people who respond to opiates for depression find they get an anti-depressant effect when these are taken for pain?
>
> Yes. I was mildly depressed (residually -- I have double depression) when I received Vicodin ES (hydrocodone 7.5mg/APAP 500mg) after having my wisdom teeth out. As soon as I felt it, the not-quite-rightness that I've felt all my life vanished, and my mood returned to normal. A lot of people discover opioids this way. Those who move on to self-medicating with heroin are at high risk for addiction, especially those who take it intravenously (who also risk a number of medical complications such as infections and abscesses). Those who are able to find a doctor willing to prescribe opioids and monitor their use have little risk as long as they use the medication as prescribed.
>
> Codeine in therapeutic doses for pain doesn't seem to have this effect, although it does have the same side effects than stronger drugs like hydrocodone or morphine. I think higher doses of codeine would probably work, but with worse side effects than similarly effective doses of morphine, oxycodone, etc. Buprenorphine works in extremely low doses (i.e., it is very potent, comparable to fentanyl) and is qualitatively distinct from other opioids, although I believe that opioid-experienced people (and rodents) can generally identify it as an opioid.
>
> -elizabethThanks for your answer, Elizabeth. Yes, I was definitely depressed at the time of my surgery, I`ve been depressed since childhood, severely depressed (though I do my best to hide it)since college age (I`m 51 now). So I guess if my post-op meds did nothing for my mood, that`s a pretty clear indication that opiates would not be the answer for me. I remember at the time thinking "aren`t these drugs supposed to make you feel good-all they do is make me itch". Though ironically I kept pushing the morphine pump button over and over in the vain hope that it would help me sleep-I have severe insomnia under the best of circumstances and lying in a hospital bed with tubes attached to your body is not the best of circumstances. I had nitrous oxide at the dentist once too and certainly had no "high" from it; they told me to push the dial up until I felt relaxed, so I kept pushing but never felt relaxed until all of a sudden I was at the highest dose and feeling sick as a dog. I don`t really get any pleasure from alcohol either or have any desire to drink it. Is it possible to be born without the ability to feel good? I`ve tried so many meds and the only one I could say did anything at all for my depression was Xanax for a few days during a period of extreme anxiety. Right now I`m on clonazepam, trazodone and celexa and they maybe help a little with anxiety, but the depression is still there. People write about feeling their AD "kick in" and it`s like a foreign concept.
Posted by Nichole on May 14, 2001, at 3:59:39
In reply to Re: Opiates for depression?, posted by Cecilia on May 12, 2001, at 23:20:17
I came to this board in search of answers to questions about certain AD's for depression. This is not at all what i thought it was. My god. This is all so sad. Is there someone who monitors this board? And lets it go on? There are people here sir/mam... who are suggesting opiate use for depression. You believe this is right? There are some extremely serious problems with someone who feels these drugs are good for a mental problem Give me a break. Are you all that uneducated? I'm just appalled. May god seriously bless you.
Posted by Lisa Simpson on May 14, 2001, at 13:08:45
In reply to Re: IS THIS FOR REAL?????????, posted by Nichole on May 14, 2001, at 3:59:39
Nicole, you've obviously never had depression so bad and deep that you're willing to try aything (bar ending your life, that is.) Opiates can give you a feeling that to a "normal" person would be an "up - getting high". But to a depressed person it would just be bringing them up the level they deserve to be at, i.e. non-depressed - happy, for goodness sake! And don't we all deserve our chance of that!
Lisa
Posted by Nichole on May 14, 2001, at 13:52:15
In reply to Re: IS THIS FOR REAL?????????, posted by Lisa Simpson on May 14, 2001, at 13:08:45
Lisa,
First of all. I know exactly how these drugs make you feel. If we all start getting scripts from doctors for depression, then soon it will be much harder for people in real physical pain to get a script. They will start monitor so closely. Doctors are monitored as to what they shelve out. Hence, the lawsuits people on here mentioned. Opiates are not desined for this use.Secondly, it honestly sounds like if absolutely nothing else can help them, which is bogus.. then they need a new doctor. They need to check themselves into a hospital and get help is what they need. If there depression is so serious that it warrants this kind of drug use, then that would be a logical sign. They'll end up there anyway.. from addiction.
Just keep on defending them.
Posted by stjames on May 14, 2001, at 14:02:37
In reply to Re: IS THIS FOR REAL????????? » Lisa Simpson, posted by Nichole on May 14, 2001, at 13:52:15
Using Opiates for depression is mentioned in excepted literature. It is not used often but in some people it is the only thing that works. Generally this is after exausting more common treatments. So keep in mind that is is not just people on this board that are advocating this use.
James
Posted by dougb on May 14, 2001, at 17:33:28
In reply to Re: Methadone » DianeD, posted by Elizabeth on May 10, 2001, at 7:10:13
> (Personally, I have tried a number of different opioids and found all of them to be activating. But that's *just me*.
---i also find them to be activating, maybe this has something to do with the subset of depressives who are helped by the opiates.
>
> Vicodin seems like a poor choice to me since it contains acetaminophen ("APAP" -- i.e., Tylenol) as well as hydrocodone.... you may need ever-increasing doses, in which case a combination product such as Vicodin is an absolute no-no.
---Vicoprofen is Vicoden without the APAP
>
---Darvon-N (propoxyphene) has not additives. Is an alternative you may with to explore, chemically related to Methadone, it has the following things in it's favor:
- At the lower dosage it has a rather flat delivery curve so it feels like less of a 'rollercoaster' than Hydroc.
- Over a period of days, the metabolite builds up in the system, so give it 3-4 days before you give up on it
- I find myself frequently going 6 hours between dosses instead of 3-4 in Hydroc.
Posted by Dr. Bob on May 14, 2001, at 17:40:00
In reply to Re: IS THIS FOR REAL?????????, posted by Nichole on May 14, 2001, at 3:59:39
> There are some extremely serious problems with someone who feels these drugs are good for a mental problem Give me a break. Are you all that uneducated? I'm just appalled. May god seriously bless you.
Please don't put down others here, thanks,
Bob
PS: Any follow-ups regarding civility, if not redirected to Psycho-Babble Administration, may be deleted.
Posted by SLS on May 14, 2001, at 17:45:58
In reply to Re: IS THIS FOR REAL????????? » Lisa Simpson, posted by Nichole on May 14, 2001, at 13:52:15
Dear Nichole,
I am not taking an adversarial position to you, so please don't consider this post as an attack of any kind. You are not alone in your opinion, and the citation I included at the end of this post should provide more information to enhance the discussion for everyone.
I hope you had the opportunity to read the post I addressed to you in the other thread containing a similar theme. Your skepticism is healthy. As I suggested in my other post, it is sometimes difficult to keep an open mind, especially when a contention deviates so much from the currently accepted or traditional treatment modalities. Much can come from the type of dialogue we have here. For instance, I took your opinion seriously and decided to investigate the matter further. In doing so, I found something that I believe will be informative for both you and I, and hopefully for anyone else following this thread. It is not a short piece, and at times does not make for easy reading, but the introduction and discussion at the end are worth a reading. The article appeared in one of the most respected medical journals, the Journal of Clinical Psychopharmacology. At the end of the article is the bibliography that contains a wealth of equally respected and well-known authors. This is truly a serious investigation into the utility of opiates, particularly buprenorphine, in the treatment of treatment-resistant depression. It is worth noting that this article was published in 1995, so we are not talking about a novel or radical idea.
It is worth keeping an open mind.
Article: Buprenorphine Treatment of Refractory Depression
http://balder.prohosting.com/~adhpage/bupe.html
Sincerely,
Scott
Posted by dougb on May 14, 2001, at 17:53:13
In reply to Re: Opiates for depression-Cecilia, posted by Michele on May 12, 2001, at 23:53:24
>
> Same here. They took away my pain... but pretty much just knocked me out.
--- That may be an indication that either the dose is too high, or not enough time has elapsed between doses.Try taking a 'mini-dose' and bump up from there.
My experience has indicated that the ideal dosage (at least for me) was not the same as the PDR reccomended, in fact after 6 months I just discovered that by not crowding my doses to close together, i have a better result
Your mileage may vary of course
Doug B
Posted by Elizabeth on May 15, 2001, at 6:24:59
In reply to As a little aside (not angry or anything!!!!!), posted by NikkiT2 on May 13, 2001, at 16:13:43
> I am off to Thailand in 4 weeks time.. only for two weeks, but basically just back packing with a group of mates.
Bon voyage!
I don't know addiction rates for different bzds, but as far as abuse potential goes, I'd expect diazepam (Valium) to be a "preferred benzo" among, ahh, nonmedical users. Valium is rapidly taken up into the CNS, so it "hits" very quicky. (Its effects only last a fraction as long as its half-life and those of its main active metabolite would suggest because it's redistributed throughout the body soon thereafter.)
-elizabeth
Posted by NikkiT2 on May 15, 2001, at 6:54:51
In reply to benzos and your upcoming travel » NikkiT2, posted by Elizabeth on May 15, 2001, at 6:24:59
*g* I personally luuuurve diazapam.. its one of the few meds that have ever helped me (only ever takenas an emergency over very short time - 3 days max) but I won't take them due to their addiction level, and thats on my med notes, so it also won't be prescribed for me... How tempting it will be to be able to buy them in such quantity over the counter!!!
nikki
> > I am off to Thailand in 4 weeks time.. only for two weeks, but basically just back packing with a group of mates.
>
> Bon voyage!
>
> I don't know addiction rates for different bzds, but as far as abuse potential goes, I'd expect diazepam (Valium) to be a "preferred benzo" among, ahh, nonmedical users. Valium is rapidly taken up into the CNS, so it "hits" very quicky. (Its effects only last a fraction as long as its half-life and those of its main active metabolite would suggest because it's redistributed throughout the body soon thereafter.)
>
> -elizabeth
Posted by Elizabeth on May 15, 2001, at 6:54:57
In reply to Re: Methadone » Elizabeth, posted by NikkiT2 on May 13, 2001, at 16:01:19
> Yet again, i will state, by medical LAW Effexor is NOT addictive, the withdrawal symptoms are your seratonin levels re-balancing bacially.
That's interesting that you should say that. Cocaine is a drug that works by nonselective monoamine reuptake inhibition, just like Effexor. Cocaine also has withdrawal symptoms when a person has been using it chronically. These withdrawal symptoms are, like those associated with Effexor, presumed to be the result of the same "re-balancing" process you speak of.
> Methadone by medical law IS addictive.
I requested that you provide a definition for "addictive" (yours, although ambiguous, is clearly not consistent with the accepted medical definition, BTW). I infer from your post that you define it to mean "the government [of your country] says that it is addictive [at the present moment in history]." I think you said you're in the UK, so I can't say what the laws are there, but I can give you a rundown of the laws here (USA) on the subject of Effexor vs. methadone.
By US law, venlafaxine is not a controlled substance, while methadone is (according to the Controlled Substances Act of 1970). Venlafaxine is not believed to have significant potential for abuse; therefore, it is not placed in any of the controlled substance categories (Schedules). Methadone is considered to have high potential for abuse and accepted medical uses, so it is a Schedule II controlled substance. (Drugs considered to have *no* accepted medical use and a high potential for abuse are placed in Schedule I, although a number of these, such as marijuana and LSD, are not addictive.) Methadone is a controlled substance because it is considered (rightly) to have *abuse potential* -- *not* because it is considered "addictive."
On the other hand, the US government, at least, makes some egregious mistakes in evaluation of "abuse potential." For example, sibutramine (Meridia) -- a serotonin/norepinephrine reuptake inhibitor that is extremely similar both chemically and pharmacodynamically to venlafaxine (Effexor), is a Schedule IV controlled substance while Effexor is not a controlled substance at all! The reason? Effexor is marketed as an antidepressant while Meridia is marketed for weight loss (traditionally, diet pills have been abused because most of the effective diet pills are stimulants). That's *it*. Meridia likely has no more potential for abuse than does Effexor.
Personally, I choose to be informed on medical matters by science rather than by law. Laws are determined by cultural values and are subject to change at any given time; the pharmacological properties of a substance are not changed simply by legalising or criminalising a substance, nor by travelling to a country where the drug laws are different.
Even if you believe that [current] law [in your country] should govern questions of medical ethics, it is perfectly ethical to prescribe opiates for depression (or any other off-label use), since it is legal (in the US, at least; I imagine the laws are similar in the UK since the cultural attitudes are similar).
-elizabeth
Posted by Elizabeth on May 15, 2001, at 6:59:56
In reply to Re: benzos and your upcoming travel » Elizabeth, posted by NikkiT2 on May 15, 2001, at 6:54:51
> *g* I personally luuuurve diazapam.. its one of the few meds that have ever helped me (only ever takenas an emergency over very short time - 3 days max) but I won't take them due to their addiction level, and thats on my med notes, so it also won't be prescribed for me... How tempting it will be to be able to buy them in such quantity over the counter!!!
Benzos really aren't all that addictive for most people, but if you know that you're one of the people who get off on them, I think it's a good idea for you to stay away (and I *always* think it's a bad idea to self-medicate -- even if you're taking over-the-counter drugs, you should let your doctor know what you use and follow his or her advise about how to use it). If you're travelling with friends, I suggest you let them know that you feel you shouldn't be buying any Valium, so they can help you resist if you do find yourself feeling tempted.
Best of luck!
-elizabeth
Posted by Elizabeth on May 15, 2001, at 7:24:16
In reply to Re: Methadone, Propoxyphene and APAP, posted by dougb on May 14, 2001, at 17:33:28
> > (Personally, I have tried a number of different opioids and found all of them to be activating. But that's *just me*.
> ---i also find them to be activating, maybe this has something to do with the subset of depressives who are helped by the opiates.You might be on to something, although there are also some responders who find them sedating or neutral.
> ---Vicoprofen is Vicoden without the APAP
But it has ibuprofen added; excessive amounts can cause GI bleeding. Very serious.
-elizabeth
Posted by Elizabeth on May 15, 2001, at 8:47:05
In reply to Re: IS THIS FOR REAL????????? » Lisa Simpson, posted by Nichole on May 14, 2001, at 13:52:15
> First of all. I know exactly how these drugs make you feel.
"How these drugs make you feel" varies widely from person to person; most people don't particularly enjoy opioids, particularly if they stick to the relatively low therapeutic doses for common injuries and illnesses (dental work, broken bones, etc., as opposed to cancer). I once took a friend (who'd never taken any opioid before) to the ER after he suffered a knee injury; he had a *dysphoric* reaction to Percocet (whose active ingredient, oxycodone, is considered one of the more mood-elevating opioids).
> If we all start getting scripts from doctors for depression, then soon it will be much harder for people in real physical pain to get a script. They will start monitor so closely. Doctors are monitored as to what they shelve out. Hence, the lawsuits people on here mentioned. Opiates are not desined for this use.
I think that the Feds will start getting upset if this use of opioids becomes *common*. I doubt it will become common, however, because everybody seems to agree that even if it's permissible, it should be regarded as pretty much a last resort. (I noted in another thread that I personally still consider ECT to be the last resort -- that is something that really scares me, whereas I've clearly demonstrated the ability to use opioids responsibly, so there is little danger of becoming addicted, or for that matter of anything else.)
Again, I'm highly dubious whenever I hear of a patient suing a doctor for something (particularly a psych patient). Doctors who prescribe opioids for chronic use should *always* make sure the patient signs an informed consent form stating that the patient agrees to use the drug only as directed.
> Secondly, it honestly sounds like if absolutely nothing else can help them, which is bogus.. then they need a new doctor. They need to check themselves into a hospital and get help is what they need.
Been there, done that. In fact, I was in a hospital when buprenorphine came up (the *second* time it was suggested to me, BTW) as a serious option. Almost a year after I stopped it the first time (due to very annoying side effects -- *very* bad constipation, itchies, dry mouth, irregular periods, etc., and the hope that I could figure out a way to get on high dose Parnate which would presumably solve all my problems), I was started on it again when I ended up back in the hospital, about a year later. (And this was a relatively provincial hospital (I was visiting my parents at the time), not the Harvard teaching hospital where Dr. Bodkin works. They read up on it a little bit, spoke to my doctor in Boston, and decided it would be fine. Furthermore, when they saw the effect it had on me, they decided I was ready to be discharged -- they didn't label me a drug addict at all.
If you really believe that there's *always* something else that can help, please refer to my 5/12/01 response to SalArmy4me (title was "Re: Oy Vey: Opiates » SalArmy4me" -- original thread title was "Whats the best opiate for depression?" dated 5/6/01).
> If there depression is so serious that it warrants this kind of drug use, then that would be a logical sign. They'll end up there anyway.. from addiction.
There's a definite risk of that in people who have "reward deficit syndrome." This is a form of depression with significant anhedonia which is hypothesised to result from a dysfunction in the opioidergic system (since opioids are effective, it's unlikely to be due to the same morphological changes -- decreases in receptor-effector coupling -- that occur in opioid addicts). This is, IMHO, all the more reason to provide these people with appropriate medical treatment. The effects of addiction can be devastating -- particularly in countries like the US that have draconian anti-drug laws and cultural attitudes, and that choose to spend their money on law enforcement rather than on harm reduction and medical treatment.
-elizabeth
Posted by Elizabeth on May 15, 2001, at 9:02:31
In reply to Re: Opiates for depression?-Elizabeth, posted by Cecilia on May 14, 2001, at 3:54:18
> Thanks for your answer, Elizabeth. Yes, I was definitely depressed at the time of my surgery, I`ve been depressed since childhood, severely depressed (though I do my best to hide it)since college age (I`m 51 now). So I guess if my post-op meds did nothing for my mood, that`s a pretty clear indication that opiates would not be the answer for me.
Probably not. Although, IME, pain seems to "eat" opioids, just as anxiety "eats" benzos. When I'm in pain of some sort (like menstrual cramps or something), I typically need a higher dose of buprenorphine than usual. (Similarly, when I take Xanax for a panic attack, it's completely nonsedating, whereas the same amount would make me at least a little drowsy under relatively normal circumstances.)
> I remember at the time thinking "aren`t these drugs supposed to make you feel good-all they do is make me itch."
Yes. Most opioids (I think fentanyl might be an exception) cause histamine release, resulting in a lot of itching. Benadryl or any other antihistamine will do the trick (I've found that I need relatively large amounts, though, like 75-100mg of Benadryl).
> Though ironically I kept pushing the morphine pump button over and over in the vain hope that it would help me sleep-I have severe insomnia under the best of circumstances and lying in a hospital bed with tubes attached to your body is not the best of circumstances.
As you discovered, morphine isn't sedating for everybody! Do you know how much you ended up taking? (I take it you had PCA. Apparently when I was in the hospital recently they had me on IV morphine for a while, but I was comatose and don't remember anything about it!)
> I had nitrous oxide at the dentist once too and certainly had no "high" from it; they told me to push the dial up until I felt relaxed, so I kept pushing but never felt relaxed until all of a sudden I was at the highest dose and feeling sick as a dog.
N2O is a general anaesthetic...some people get nauseated on it, most get very dizzy and spaced out. (It used to be a popular party drug when I was in college, believe it or not.)
> I don`t really get any pleasure from alcohol either or have any desire to drink it.
Me neither; I think that by the time I take enough to be intoxicating, I'm already asleep/passed out! I did manage to get truly smashed once in college (right after my number theory final < g >), but even then...well, I won't get into the gory details. ;-)
> Is it possible to be born without the ability to feel good? I`ve tried so many meds and the only one I could say did anything at all for my depression was Xanax for a few days during a period of extreme anxiety.
Did you know that Xanax sometimes works -- in *very* high doses (like 10mg/day) -- for depression? You'd definitely be physiologically dependent if you were on that much, though, and benzos are *hard* to get off of (some say harder than heroin -- certainly more dangerous).
> Right now I`m on clonazepam, trazodone and celexa and they maybe help a little with anxiety, but the depression is still there. People write about feeling their AD "kick in" and it`s like a foreign concept.
God, I'm sorry. I hope you get to experience it one day. You know that scene in _The Wizard of Oz_ where Dorothy steps out of her house and suddenly everything is in colour? It's like that.
-elizabeth
Posted by NikkiT2 on May 15, 2001, at 9:13:19
In reply to Re: Methadone » NikkiT2, posted by Elizabeth on May 15, 2001, at 6:54:57
I can assure you Cocaine withdrawal is *nothing* like withdrawal from effexor!!!
You seemt ot hink Methadone and Effexor should be treated equally, thats what I find so hard.
Brain not working right today, so will leave the rest for alter!! :o)
Nikki x
> > Yet again, i will state, by medical LAW Effexor is NOT addictive, the withdrawal symptoms are your seratonin levels re-balancing bacially.
>
> That's interesting that you should say that. Cocaine is a drug that works by nonselective monoamine reuptake inhibition, just like Effexor. Cocaine also has withdrawal symptoms when a person has been using it chronically. These withdrawal symptoms are, like those associated with Effexor, presumed to be the result of the same "re-balancing" process you speak of.
>
> > Methadone by medical law IS addictive.
>
> I requested that you provide a definition for "addictive" (yours, although ambiguous, is clearly not consistent with the accepted medical definition, BTW). I infer from your post that you define it to mean "the government [of your country] says that it is addictive [at the present moment in history]." I think you said you're in the UK, so I can't say what the laws are there, but I can give you a rundown of the laws here (USA) on the subject of Effexor vs. methadone.
>
> By US law, venlafaxine is not a controlled substance, while methadone is (according to the Controlled Substances Act of 1970). Venlafaxine is not believed to have significant potential for abuse; therefore, it is not placed in any of the controlled substance categories (Schedules). Methadone is considered to have high potential for abuse and accepted medical uses, so it is a Schedule II controlled substance. (Drugs considered to have *no* accepted medical use and a high potential for abuse are placed in Schedule I, although a number of these, such as marijuana and LSD, are not addictive.) Methadone is a controlled substance because it is considered (rightly) to have *abuse potential* -- *not* because it is considered "addictive."
>
> On the other hand, the US government, at least, makes some egregious mistakes in evaluation of "abuse potential." For example, sibutramine (Meridia) -- a serotonin/norepinephrine reuptake inhibitor that is extremely similar both chemically and pharmacodynamically to venlafaxine (Effexor), is a Schedule IV controlled substance while Effexor is not a controlled substance at all! The reason? Effexor is marketed as an antidepressant while Meridia is marketed for weight loss (traditionally, diet pills have been abused because most of the effective diet pills are stimulants). That's *it*. Meridia likely has no more potential for abuse than does Effexor.
>
> Personally, I choose to be informed on medical matters by science rather than by law. Laws are determined by cultural values and are subject to change at any given time; the pharmacological properties of a substance are not changed simply by legalising or criminalising a substance, nor by travelling to a country where the drug laws are different.
>
> Even if you believe that [current] law [in your country] should govern questions of medical ethics, it is perfectly ethical to prescribe opiates for depression (or any other off-label use), since it is legal (in the US, at least; I imagine the laws are similar in the UK since the cultural attitudes are similar).
>
> -elizabeth
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