![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 73 to 97 of 170. Go back in thread:
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
Posted by NikkiT2 on May 15, 2001, at 9:14:56
In reply to Re: Methadone » NikkiT2, posted by Elizabeth on May 15, 2001, at 6:54:57
Oh, and so if Effexor is as bad as Metadone, why is Methadone sold on the "black amrket", yet effexor isn't?? Cos Effexor doesn't give you a high... You say Methdone doesn't, but it does, else you wouldn't feel better for it. I just believe, that by taking a drug like methadone, Vicodin etc, you are simply "Putting" off the pain..
nikki
Posted by Elizabeth on May 15, 2001, at 9:39:31
In reply to Re: Methadone » Elizabeth, posted by NikkiT2 on May 15, 2001, at 9:13:19
> 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.I don't think that at all, and I trust you about cocaine withdrawal. I was simply pointing out the absurdity of your proposed definition.
> Brain not working right today, so will leave the rest for alter!! :o)
Alter? Oh my, are we dealing with one of those multiple personality thingies here? :-)
peace,
-elizabeth
Posted by Elizabeth on May 15, 2001, at 10:13:43
In reply to Re: Methadone - ps » Elizabeth, posted by NikkiT2 on May 15, 2001, at 9:14:56
> Oh, and so if Effexor is as bad as Metadone, why is Methadone sold on the "black amrket", yet effexor isn't??
Actually I compared Effexor to cocaine, not methadone. (Personally, I never experienced Effexor w/d symptoms. But I did have the delightful experience of Nardil withdrawal. It's rather like simultaneously withdrawing from Xanax and amphetamine.)
Anyway, as I said above, I was pointing out an absurdity, not making a serious claim. I agree with you that Effexor doesn't make you high (except perhaps if you switch to hypomania on it < g >) and that methadone can. But I don't agree that the law should be used to make medical judgments. Ideally the law regarding the practise of medicine should be minimal (politicians, few of whom have any medical knowledge to speak of, should stay out of the doctor's office) and should be based on scientific and medical facts. But all too often, it's not.
> Cos Effexor doesn't give you a high... You say Methdone doesn't, but it does, else you wouldn't feel better for it.
Once again, *I never said methadone can't cause a high*. Perhaps you are confusing me with someone else. There was someone who posted that, and I actually *corrected* that person's misperception. People can get high on methadone, although people on MMT are taking exactly the right dose to match their tolerance, so they don't get high on what they're taking. Whole different kettle of fish, and the source of the myth that methadone doesn't produce a high.
> I just believe, that by taking a drug like methadone, Vicodin etc, you are simply "Putting" off the pain..
Okay, finally we're getting to your beliefs. That's a good start.
So, can you explain what you mean by that -- how is that different from "putting off the pain" by taking Prozac or Effexor or Nardil or imipramine?
I do think that buprenorphine should be tried before you reach for the heavier stuff (full agonists). *If* buprenorphine doesn't work, the next thing I would probably try would be Ultram (unless I was taking monoaminergic ADs with it), then either methadone, MS Contin, OxyContin (slow-release oxycodone), or Duragesic (the fentanyl patch -- this is the longest-lasting and has the most favourable side effect profile of these four). Long-lasting drugs or slow-release preparations are preferable because they don't cause the ups and downs throughout the day that you get from short-acting drugs.
I also really wish that buprenorphine was available in a metred-dose inhaler (a la Stadol NS), because it is absorbed through that route (although you have to lie down with your head tilted back for several minutes in order to get it to absorb!).
The fact is, I'm functioning better on buprenorphine than I have on *any* of the dozens of monoaminergic ADs and other types of drugs that focus on monoamines (stimulants, neuroleptics, etc.), as well as various mood stabilisers and so forth (I gave the complete list somewhere in response to SalArmy4me's claim that people who are trying opioids really haven't tried all the reasonable options).
I can't think of any reason to suppose that monoaminergic systems are the only ones that can break down. People who don't respond to monoaminergic ADs (including amphetamine, etc.) should have the opportunity to take something that actually works. To deny us that is nothing short of immoral. (My mother -- a professional bioethicist, as well as someone who has seen the positive effects that buprenorphine has had on me -- agrees. FWIW.)
-elizabeth
Posted by Dr. Bob on May 15, 2001, at 13:09:22
In reply to Re: Methadone » NikkiT2, posted by Elizabeth on May 15, 2001, at 9:39:31
> I was simply pointing out the absurdity of your proposed definition.
Thanks for keeping your cool during all this, but please be careful with words like "absurdity" that could be taken pejoratively...
Bob
PS: Follow-ups regarding civility should continue to be redirected to Psycho-Babble Administration.
Posted by dougb on May 15, 2001, at 16:52:21
In reply to Re: Methadone, Propoxyphene and APAP » dougb, posted by Elizabeth on May 15, 2001, at 7:24:16
Thanks Elizabeth,
you learn something evry day...> But it has ibuprofen added; excessive amounts can cause GI bleeding. Very serious.
Once you take away the apap or ibuprofen, the drug is reclassified as a Schedule II narcotic, go figure; they take away toxicity and re-categorize it as more dangerous.
I have this (perhaps?) slightly paranoid theory that "they" are really concerned about certain drugs because of the potential effect on citizens wholehearted participation as good drones and consumers....
During the 60's-70's with all of it's preoccupation with pot, etc. The predominant mind-set amoung that group was questioning of authority and questioning of the desirabilty of one's participation in the 'american dream' etc etc.
Posted by JahL on May 15, 2001, at 17:27:26
In reply to of course it's real » Nichole, posted by Elizabeth on May 15, 2001, at 8:47:05
> > 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.Hi Elizabeth.
I'm not looking to take sides here but I've been a long-time observer of yr posts (since back in '99) and I've never seen anything wrong in yr opioid use, given the context in which you place it.
What's caught my attn is this 'reward deficit syndrome'. Anhedonia & cognitive dysfunction characterise my 'depression'. I can honestly say (with the exception of brief SSRI-induced euthymia) I have never, ever, experienced pleasure. As young as 6 or 7 I wld openly express suicidal urges. Despite being suicidal I'm not so much depressed as emotionally desolate; I have this overwhelming 'craving' feeling, like something's missing.
I have been a heavy 'substance-(ab)user' (self-medicator) in the past but *never* had *any* addiction probs. Gave up a 30 unit a day binge-drinking habit overnight. Piece of p*ss. The only drugs I've never tried are the opiates-always felt I'd like them too much.
I guess my question to you is, does this ring any bells? Do the eternal anhedonia (like my mum, *zero* mood reactivity) & 'craving' sensation possibly signify anything to you?
*To anyone out there; I'm not looking for Elizabeth's tacit approval to take opioids. Just after her (what I consider to be) informed opinion on what I consider to be a viable treatment option for a *small subgroup* of depressives. & guess what? I've tried more meds than her (if that's possible). I'm not looking to get high. Been there, done that. Compared to shooting myself (the last option), *trialing* (*possibly*) opioids is a walk in the park.
Thanx for any help E,
J.
(DISCLAIMER: opioids can be habit forming & addictive etc etc)
Posted by JahL on May 15, 2001, at 17:42:54
In reply to Re: Methadone, Propoxyphene and APAP » Elizabeth, posted by dougb on May 15, 2001, at 16:52:21
> > I have this (perhaps?) slightly paranoid theory that "they" are really concerned about certain drugs because of the potential effect on citizens wholehearted participation as good drones and consumers....Hi Doug.
Paranoid? Have you ever heard any Bill Hicks stuff? Please tell me you have.
> > During the 60's-70's with all of it's preoccupation with pot, etc. The predominant mind-set amoung that group was questioning of authority and questioning of the desirabilty of one's participation in the 'american dream' etc etc.Exactly. What do you think, say Bilderberg think of 'mind-broadening' drugs.
Cocaine is not a particularly pleasant drug (going by what I've seen) but it *should not* be class A in the UK (class A comprises 'hard drugs' ie everything bar pot & speed (which I consider to be far more damaging to the user than Cocaine, but I guess it makes people *more productive* ;-) ), when speed is not.
Paranoid? :-)
J.
Posted by Ann NY on May 15, 2001, at 18:34:30
In reply to Reward Deficit Syndrome. » Elizabeth, posted by JahL on May 15, 2001, at 17:27:26
J.
Your situation sounds so sad, I'm sorry you feel so empty (?). You've never been happy? How old are you? I hope you fall head-over-heels in love soon. That's always a good six week high. Do you trust people? (pls. ignore all if too invasive)
In addition to brain chemistry, it sounds like your psyche is crying out for help. If your Mom has similar problems, maybe she wasn't capable of giving you - a child - the essentials, love, intimacy, affection and all reliably so. Did your family know you were suicidal at 6 years old?
You may want to read some books by John Bradshaw. He has some interesting views and he's an easy read. I don't agree with everything, but he has helped both me and my sister understand ourselves much better which is a good spring board to recovery and happiness.
I too never took hard drugs because I was afraid I'd like them too much. Try to stick with your good instincts for awhile longer. Yes, opiates and cocaine were anti-depressants in pre-1900's Europe and China, but lots of Chinese women would commit suicide by overdosing on opium. I know you're desperate but it may not be the best alternative for you while you're feeling suicidal.
Please don't despair. If you shoot yourself acute procrastinators like myself won't be able to read your posts (instead of writing a term paper). I've had those thoughts too but the future does bring hope.
Hope you'll be feeling better! Hang in there – and keep us posted!
Ann> Hi Elizabeth.
>
> I'm not looking to take sides here but I've been a long-time observer of yr posts (since back in '99) and I've never seen anything wrong in yr opioid use, given the context in which you place it.
>
> What's caught my attn is this 'reward deficit syndrome'. Anhedonia & cognitive dysfunction characterise my 'depression'. I can honestly say (with the exception of brief SSRI-induced euthymia) I have never, ever, experienced pleasure. As young as 6 or 7 I wld openly express suicidal urges. Despite being suicidal I'm not so much depressed as emotionally desolate; I have this overwhelming 'craving' feeling, like something's missing.
>
> I have been a heavy 'substance-(ab)user' (self-medicator) in the past but *never* had *any* addiction probs. Gave up a 30 unit a day binge-drinking habit overnight. Piece of p*ss. The only drugs I've never tried are the opiates-always felt I'd like them too much.
>
> I guess my question to you is, does this ring any bells? Do the eternal anhedonia (like my mum, *zero* mood reactivity) & 'craving' sensation possibly signify anything to you?
>
> *To anyone out there; I'm not looking for Elizabeth's tacit approval to take opioids. Just after her (what I consider to be) informed opinion on what I consider to be a viable treatment option for a *small subgroup* of depressives. & guess what? I've tried more meds than her (if that's possible). I'm not looking to get high. Been there, done that. Compared to shooting myself (the last option), *trialing* (*possibly*) opioids is a walk in the park.
>
> Thanx for any help E,
> J.
> (DISCLAIMER: opioids can be habit forming & addictive etc etc)
Posted by JahL on May 15, 2001, at 19:47:48
In reply to Re: Reward Deficit Syndrome. » JahL, posted by Ann NY on May 15, 2001, at 18:34:30
> > J.
> > Your situation sounds so sad, I'm sorry you feel so empty (?). You've never been happy? How old are you?
Mid-twenties.
> >I hope you fall head-over-heels in love soon. That's always a good six week high. Do you trust people? (pls. ignore all if too invasive)
Nothing to hide.
I trust those who earn my trust but yeah, I give most people the benefit of the doubt
I LOVE women, but w/o emotions (a biological symptom not unlike the affective flattening seen in schizophrenia) it is physically impossible to fall in love (lust is slightly different tho' ;-) . However that's not so much an emotional reaction as animal instinct).> > In addition to brain chemistry, it sounds like your psyche is crying out for help.
I can see how you'd think this but I only gave these rather personal details in order to contextualise, or frame, my (controversial) question.
You would not believe how intact my psyche is! I've handled some pretty heavy sh*t with honours:-) .*Nothing* fazes me.> > If your Mom has similar problems, maybe she wasn't capable of giving you - a child - the essentials, love, intimacy, affection and all reliably so.
I didn't know she suffered from depression until I was 18. She hid it. I couldn't put it into words how great a mother she is.
> > Did your family know you were suicidal at 6 years old?
Perhaps an idea but I wasn't deeply depressed @ the time & seemed a contented kid.
> > You may want to read some books by John Bradshaw. He has some interesting views and he's an easy read. I don't agree with everything, but he has helped both me and my sister understand ourselves much better which is a good spring board to recovery and happiness.
Good. Therapy & self-help books aren't my bag however. Been there, done that :-). My illness is highly biologically-orientated (no self-esteem probs etc). I am a fully paid-up member of the 'Med-heads' society! Mood stabilizers are currently damping down the suicidal thang. It's only my opinion but I believe psychotherapy & the like *rarely* 'cure' depressive illness.
I'm not being facetious when I say the average psychotherapist would learn much more from a session with me than I wld with them. I stump them, but can dismantle *their* personalities with ease. In the end it became a kinda sport.
> > I too never took hard drugs because I was afraid I'd like them too much.
I can honestly say that I would not be half the person I am were it not for my hard-core drug experiences. I met some good people thru them. Not recommened for everyone of course.
> > Try to stick with your good instincts for awhile longer.
We'll see :-)
> >Yes, opiates and cocaine were anti-depressants in pre-1900's Europe and China, but lots of Chinese women would commit suicide by overdosing on opium. I know you're desperate but it may not be the best alternative for you while you're feeling suicidal.
I've tried opium. Slept thru it, but v. nice %-)
> > Please don't despair. If you shoot yourself acute procrastinators like myself [[ me too ]] won't be able to read your posts (instead of writing a term paper). I've had those thoughts too but the future does bring hope.I'm not about to shoot myself. Too much self-control for that. Just a (n irrevocable) decision made 2 yrs ago that should *all* treatments fail, I'm outta here. If I'm at a party & I'm not enjoying myself, I leave. No biggie.
> > Hope you'll be feeling better! Hang in there – and keep us posted!Thank you for yr kind words; I'm hanging with a firm grip!
J.
Posted by Ann NY on May 15, 2001, at 22:37:48
In reply to Re: Reward Deficit Syndrome.long » Ann NY, posted by JahL on May 15, 2001, at 19:47:48
Wow, I guess I completely miss read your original post. You said you were suicidal and I believed you. Now I know.
> I LOVE women, but w/o emotions (a biological
Sorry to hear this is a problem. I hope it isn't permanent. Love isn't meds but it is very profound and healing when it's real.> >I'm not so much depressed as emotionally desolate
The overall gist I was trying to make was simply: Maybe you would benefit by trying to connect a little more with the whole you: heart soul mind etc. But I that didn't work for you. Sorry I miss read.
> You would not believe how intact my psyche is! I've handled some pretty heavy sh*t with honours:-) .*Nothing* fazes me.
I'm glad you're so confident and healthy, but isn't that part of the problem, nothing fazes you??> >I couldn't put it into words how great a mother she is.
I'm sure she was a very loving mother, I never meant to suggest anything less. However, personally, I couldn't image the demands of raising a family while depressed! I can barely take care of myself. In my experience, my parents were also very depressed while I was growing up. It was a very loving family but personally, I can't say that my parents' depression didn't effect me.
Luckily, you are one who wasn't seriously effected by a parent's chronic illness. Having a great mother is a wonderful gift that some go without.> >Good. Therapy & self-help books aren't my bag however. Been there, done that :-). My illness is highly biologically-orientated (no self-esteem probs etc). I am a fully paid-up member of the 'Med-heads' society!
> >It's only my opinion but I believe psychotherapy & the like *rarely* 'cure' depressive illness.
> >I'm not so much depressed as emotionally desolateWhen I referred to your psyche needing help I was speaking on more of a metaphysical level. I was thinking along the lines of trying to integrate you're intellect with your emotions and/or subconscious? Personally, I believe for me to be truly healthy, I need to have a strong relationship with my mind, heart and soul. Yes meds are great and necessary but they can't solve everything. Since you said meds aren't making you happy and you've never once been truly happy I was pointing out a different issue to investigate that might help. Now I know this didn't work for you. I'm sure a new drug will come into the market soon. My Dr. said there is a new med coming into the US market this summer. It has had great success in Europe and I was going to go on it if Effexor didn't help me.
> >I stump them, but can dismantle *their* personalities with ease. In the end it became a kinda sport.
I never suggested you augment your ego needs by proving to a psychiatrist that you were smarter than him/her. I never suggested seeing a psychiatrist. But have you ever trusted a therapist? A therapist doesn't have to have a superior IQ in order to build a trusting relationship. One where a patient can let go of defenses and put the intellect aside so that issues regarding real human relationships can be discussed with sincerity. But yes I do know how it feels sitting in a session feeling like you are wasting your time b/c dr. doesn't get it.> >The only drugs I've never tried are the opiates-always felt I'd like them too much.
> > I can honestly say that I would not be half the person I am were it not for my hard-core drug experiences. I met some good people thru them. Not recommened for everyone of course.
> >I've tried opium. Slept thru it, but v. nice %-)
??? I was relating to your original reasoning for not taking opiates "always felt I'd like them too much"
> >. Despite being suicidal I'm not so much depressed as emotionally desolate.> >Compared to shooting myself (the last option), *trialing* (*possibly*) opioids is a walk in the park.
> I'm not about to shoot myself. Too much self-control for that. Just a (n irrevocable) decision made 2 yrs ago that should *all* treatments fail, I'm outta here. If I'm at a party & I'm not enjoying myself, I leave. No biggie.
If you're not considering suicide please don't make references in your post that you are. It is a very serious issue, I simply thought you were serious.
> Thank you for yr kind words; I'm hanging with a firm grip!
>
Well I hope so, telling everyone here that you are suicidal doesn't sound like you have a firm grip. But now, if you say you're suicidal again I won't believe you. I'm still new to the board and I don’t know people's personalities yet.I hope things get better for you. :)
Posted by Marie1 on May 16, 2001, at 7:47:09
In reply to of course it's real » Nichole, posted by Elizabeth on May 15, 2001, at 8:47:05
What do you mean by "reward deficit syndrome"? I mean, what characterizes it?
I've been following this thread and feel real sympathy for people who don't get relief from their depression from the usual AD's, but have no doubt that can be the case. I guess I'm just lucky Prozac works well for me.
Posted by dougb on May 16, 2001, at 10:55:52
In reply to Re: paranoia » dougb, posted by JahL on May 15, 2001, at 17:42:54
> Hi Doug.
>
> Paranoid? Have you ever heard any Bill Hicks stuff? Please tell me you have.
---No but a quick web search turned up some samples of his comic performances on mp3, will try to check it out, one labeled "War on Drugs" I and II looks appropriate
> Cocaine is not a particularly pleasant drug (going by what I've seen) but it *should not* be class A in the UK (class A comprises 'hard drugs' ie everything bar pot & speed (which I consider to be far more damaging to the user than Cocaine,--Dunno about that, tried crack once and by the end of the evening i spent 30 minutes crawling around on the floor looking for a lost rock the size of 1 cooked pinto bean. I _never_ want to go back there again.
Posted by JahL on May 16, 2001, at 12:08:54
In reply to Re: paranoia » JahL, posted by dougb on May 16, 2001, at 10:55:52
> > Cocaine is not a particularly pleasant drug (going by what I've seen) but it *should not* be class A in the UK (class A comprises 'hard drugs' ie everything bar pot & speed (which I consider to be far more damaging to the user than Cocaine,
> --Dunno about that, tried crack once and by the end of the evening i spent 30 minutes crawling around on the floor looking for a lost rock the size of 1 cooked pinto bean. I _never_ want to go back there again.Crack's a different story altogether.
I wasn't actually suggesting Cocaine shouldn't be Class A, just that it's classification makes no sense in terms of speed's Class B status.J.
Posted by JahL on May 16, 2001, at 13:36:46
In reply to Re: Reward Deficit Syndrome.long » JahL, posted by Ann NY on May 15, 2001, at 22:37:48
> > Wow, I guess I completely miss read your original post. You said you were suicidal and I believed you. Now I know.
Sarcasm has no place on this board.
I *am* suicidal. Just because I am not sitting here slitting my wrists, *doesn't* me I don't harbour intense suicidal feelings.> >Love isn't meds
Didn't say it was.
> >isn't that part of the problem, nothing fazes you??
No, it means that I can reason or rationalise most things, so they do not become an 'issue' with me. If I said 'everything fazes me', you'd probably be telling me *that's* my problem. Which is it?
> > I'm sure she was a very loving mother, I never meant to suggest anything less. However, personally, I couldn't image the demands of raising a family while depressed!
That's yr experience. Let's leave her out of this. I understand yr point but trust me, her problems did not contribute to my own. Besides I didn't say she was depressed per se, just that she is mood-unreactive.
> > You said meds aren't making you happy and you've never once been truly happy.
No, I said I've only ever been happy *on* meds (however briefly). Where does this leave yr argument?
I've been misdiagnosed in the past & was prescribed drugs contraindicated for my condition. Now I'm (just recently) on mood-stabilizers, my condition seems to be improving a little by the day, & we haven't finished adding meds yet.
> > > >I stump them, but can dismantle *their* personalities with ease. In the end it became a kinda sport.
> > I never suggested you augment your ego needs by proving to a psychiatrist that you were smarter than him/her.They shouldn't attempt to bedazzle me with their so-called intelligence in the first place. I treat others as they treat me (& live my life by the virtuous 'Do unto others..' motto). This is why it became sport. After their conventional 'theories' had been proved to have no foundation in fact or rationale, inevitably they would try & engage me in a battle of the IQs. Inevitably I won. My ego is very well adjusted thank-you-very-much. It needs no augmenting.
> > But have you ever trusted a therapist?
Implicitly. I would not have borrowed $10000 to pay for therapy if I did not have at least some faith in it. I wld bet I have seen more therapists than you.
> >defenses
What defenses? I've had this brought up so many times. Sometimes anger is just that, anger. A symptom rather than a cause or exacerbating factor.
> > If you're not considering suicide please don't make references in your post that you are. It is a very serious issue, I simply thought you were serious.You say you're new here. Please don't try to tell me what I can or cannot post here. I am not responsible for how you react to a post. I *am* suicidal. I *consider* it every minute of every day. I *am* serious. Suicidality involves obsessive suicidal thoughts & a desire to act upon these. I have both. What part of this don't you understand? If you take the time to read a few more posts you will see a no. of regulars (quite rightly) describe their depression as suicidal. They are still posting. Does this mean they're not suicidal? Think about it.
> > Well I hope so, telling everyone here that you are suicidal doesn't sound like you have a firm grip.
I object to that statement. Please go back & read my posts properly. It's not me advising people to 'integrate yr intellect with yr emotions'. Whatever that means. You cannot 'integrate' one entity with itself (ie *no* emotions!).
> > But now, if you say you're suicidal again I won't believe you.
More fool you. I suggest you aquaint yourself with just what it means to be suicidal.
Ann, I think the problem here is that we come from 2 different planets (this is not an insult). I don't place much store in all that 'learn to love yourself' ,& 'get to know yr inner child' stuff. I'm not saying that it's necessarily bad advice; I think it's OK advice for everyone, but doesn't have any particular relevance to the treatment of serious depressive illnesses (besides, I've done plenty of 'work' on myself). Just my opinion. I also think you confuse me with my condition. We're rapidly becoming one, but there's still a clear line of separation.
Anyway I've gone into the therapy thing a no. of times on these boards recently & don't have the time or inclination to do so again.
How about we agree to differ & leave it at this? There's far too much tension on this board as it is. You can carry on mistrusting me ("I won't believe you"). I have some real difficulties with yr take on my condition & wld rather you made no further comment upon it. Not all depression is the same. Remember that.
Back to the opioids discussion...
Sincerely,
J.
Posted by Elizabeth on May 16, 2001, at 18:39:42
In reply to Re: Methadone, Propoxyphene and APAP » Elizabeth, posted by dougb on May 15, 2001, at 16:52:21
> Once you take away the apap or ibuprofen, the drug is reclassified as a Schedule II narcotic, go figure; they take away toxicity and re-categorize it as more dangerous.
Exactly! (As a lawyer friend put it when I explained the drug laws to him: "you mean they add poison to it to make it safer???")
OTOH, Percocet (oxycodone + APAP) is C-II (I assume that Percodan (oxycodone + aspirin) is too, but you never hear about that one anymore).
> During the 60's-70's with all of it's preoccupation with pot, etc. The predominant mind-set amoung that group was questioning of authority and questioning of the desirabilty of one's participation in the 'american dream' etc etc.
So I hear. Did you see the movie _Pleasantville_? It was billed as this lighthearted little comedy, but really it's quite subversive. (This becomes a little bit painfully obvious later on in the film.) I assume it's a metaphor for the transformation of the '50s into the '60s.
-elizabeth
Posted by Elizabeth on May 16, 2001, at 19:04:00
In reply to Reward Deficit Syndrome. » Elizabeth, posted by JahL on May 15, 2001, at 17:27:26
> I'm not looking to take sides here but I've been a long-time observer of yr posts (since back in '99) and I've never seen anything wrong in yr opioid use, given the context in which you place it.
Thank you. It's nice to know that somebody out there thinks it's okay for me to take the drugs that my doctor prescribed! < g > I think context is important, too.
> What's caught my attn is this 'reward deficit syndrome'.I wish I could remember where I first heard that expression. Looking into it, it appears the term is "reward deficiency syndrome." Here're a couple links (I'm sure a good search would turn up more):
There's another temperamental trait, "sensation seeking" (or "thrill seeking"), that also puts people at risk for substance abuse. Supposedly this is what separates the "tweakers" (people who prefer stimulants like cocaine and methamphetamine) from the addicts who specifically prefer opioids -- sensation seekers prefer the thrill and excitement of stimulants.
I think that sensation-seeking and RDS might be related but are not identical.
> Anhedonia & cognitive dysfunction characterise my 'depression'. I can honestly say (with the exception of brief SSRI-induced euthymia) I have never, ever, experienced pleasure. As young as 6 or 7 I wld openly express suicidal urges. Despite being suicidal I'm not so much depressed as emotionally desolate; I have this overwhelming 'craving' feeling, like something's missing.
That's what a lot of addicts say -- that they feel an emptiness or a void that can only be filled by heroin. This leads to self-medicating, which IMO is extremely dangerous.
> I guess my question to you is, does this ring any bells? Do the eternal anhedonia (like my mum, *zero* mood reactivity) & 'craving' sensation possibly signify anything to you?
Yeah, it sounds like the way heroin addicts describe the pain that they felt before they discovered dope. I sort of feel bad telling you that because if I were in your position, I'd be scared sh*tless. But it's the truth: your words are hauntingly familiar. Please take this warning seriously.
If you're in a country where outpatient buprenorphine maintenance is legal, I'd suggest trying to get that. It's pretty much impossible to get high on it so you're not at any risk there (you also can't kill yourself by ODing on it). Addicts don't particularly like buprenorphine, although it does show up on the black market sometimes because of its capacity for blocking withdrawal symptoms.
> *To anyone out there; I'm not looking for Elizabeth's tacit approval to take opioids.
My approval isn't worth much, seeing as I don't have a DEA license. < g >
> Just after her (what I consider to be) informed opinion on what I consider to be a viable treatment option for a *small subgroup* of depressives.
Yes, that's how I feel. I don't think that most people with depression (especially mild-moderate depression) need or should use opioids. (Aside from addiction issues, the side effects suck! Buprenorphine is supposed to have milder ones than heroin and other full agonists, too...I can't imagine anybody taking this stuff as some kind of joy ride.)
> & guess what? I've tried more meds than her (if that's possible).
Maybe we can compare lists sometime. < g >
> I'm not looking to get high. Been there, done that. Compared to shooting myself (the last option), *trialing* (*possibly*) opioids is a walk in the park.
There's no "good" way to kill yourself, but leaving a bloody mess for your loved ones (or even complete strangers) to discover seems like one of the worse ways.
Best wishes and hopes.
-elizabeth
Posted by JahL on May 16, 2001, at 20:06:03
In reply to Re: Reward Deficit Syndrome., posted by Elizabeth on May 16, 2001, at 19:04:00
Thanks for responding.
> > There's another temperamental trait, "sensation seeking" (or "thrill seeking"), that also puts people at risk for substance abuse. Supposedly this is what separates the "tweakers" (people who prefer stimulants like cocaine and methamphetamine) from the addicts who specifically prefer opioids -- sensation seekers prefer the thrill and excitement of stimulants.
That's interesting. I used to be a big-time thrill-seeker (how pre-disposed to substance-abuse can you get??!!), car-surfing (Teen-Wolf stylee!) & the like. If I wasn't so depressed I'd be jumping out of planes, base-jumping etc.
Strangely enough I'm not too big on stims. Coke used to get me high briefly but would soon turn me mean & moody. Speed (+E) was good for clubbing but generally makes me climb the walls. Didn't particularly care for ADD stims.
The only drugs I got a real kick out of were ALCOHOL (I wonder how many of those that attacked you regularly imbibe this state-endorsed DRUG, which in any one yr is directly responsible for as many deaths as opiates have been in the last century), E & the psychedelics (which cld be considered 'mental thrill-seeking' in high enough doses).
> > >Do the eternal anhedonia (like my mum, *zero* mood reactivity) & 'craving' sensation possibly signify anything to you?
> > Yeah, it sounds like the way heroin addicts describe the pain that they felt before they discovered dope. I sort of feel bad telling you that because if I were in your position, I'd be scared sh*tless. But it's the truth: your words are hauntingly familiar. Please take this warning seriously.I do. My (not inconsiderable) intuition tells me you're probably right (& you're *certainly* not 'pushing' [as if] in this instance ;-) ! )
> > If you're in a country where outpatient buprenorphine maintenance is legal, I'd suggest trying to get that.That's what I hoped to try first. Unfortunately I'm UK (psychiatry is stuck in the dark ages). However I've just e-mailed 3 specialist psychopharmacologists advising them not to respond unless they are prepared to look @ truly novel treatments. 2 have responded so far!
> > There's no "good" way to kill yourself, but leaving a bloody mess for your loved ones (or even complete strangers) to discover seems like one of the worse ways.
I agree, but it's so *final*, which is why it appeals. I wouldn't want anyone to think it was an accident or a cry for help (it wldn't be). But lets not dwell on that; I have plenty more chemicals to poison myself with first :-) !
I have been contemplating chasing the dragon for some time (v easy for me to obtain heroin) but given yr info I'll abstain. Thanks for framing my symptoms in a context that makes sense for once. I'll keep perservering with the AEDs also.
J.
Posted by dougb on May 17, 2001, at 17:13:17
In reply to Re: paranoia » dougb, posted by JahL on May 16, 2001, at 12:08:54
> Crack's a different story altogether.
> I wasn't actually suggesting Cocaine shouldn't be Class A, just that it's classification makes no sense in terms of speed's Class B status.
---I agree with that, i know a guy in Colombia who snorted cocaine for years and outside of a messed up nose, (perforated septum)he was otherwise socially functional. (no recommendation intended)But speed does people in quickly and makes them ugly, internally and externally.
Doug
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