![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 18 to 42 of 262. Go back in thread:
Posted by Kristi on October 27, 2001, at 20:35:10
In reply to Re: opiates and major depression, posted by androog on October 24, 2001, at 21:17:42
Hi,
I'm curious how your appt. went. Did you get a prescription? Of more than 100 mg???I take Ultram myself, for pain... never really realized it was used for depression, but I guess that explains why my depression has been slightly relieved in the past few months.
Take care, Kristi
> hi folks,
>
> well it's been an interesting week. the pdoc who said he couldn't find enough evidence supporting my claim that ultram really eased my depression, referred me to another doc he thought might be more willing to go out on a ledge. I called this doc, but he charged $500 just to walk in the door and, of course, said he couldn't guarantee he'd try me on anything like ultram.
>
> i got on the internet and went to my walgreen's account and discovered that prior to january 2001, two pdocs had prescribed ultram for me. this was before i had ECT and i had no recollection of it. one of the two who had previously prescribed it for me was a referral that i had gotten from my current pdoc (doc 1). i don't know if i mentioned it before, but doc 1 is strictly by-the-book, and very methodical. i had asked him about ultram numerous times before, but my request fell upon deaf ears.
>
> anyway, i called the doc (doc 2) who had prescribed the full dose of 400mg in the past, and asked if he could give it another try, this time in conjunction with my current anti-depressants. he didn't want to go around doc 1 and suggested i give doc 1 another try and if there were any problems, to have doc 1 call him, doc 2.
>
> confused yet? i'm not done.
>
> i called doc 1, told him of the conversation i had had with doc 2, and much to my surprise, doc 1 said he had recently come across evidence supporting my claims about ultram.
>
> exonerated at last! maybe.
>
> doc 1 won't prescribe any ultram for me without my first coming in to see him. this guy has no clue as to how awful major depression is. if i had a broken leg, would he have me come in to see him in a month (that's when his next opening is)? i don't think so. i find that very few people who have never had it can appreciate the full intensity of major depression. they seem to think it's sadness, and will just eventually go away of its own accord. i think of it as being handcuffed 24 hrs a day to a terrorist. the terrorist is the voice in my head that keeps saying, "i ain't going anywhere, so you might as well just kill yourself. it'll only get worse, and anyone you tell this to will be incapable of understanding the seriousness of this threat. so just do it."
>
> well, i've managed to get an appointment with doc 1 tomorrow by explaining the whole predicament to his very-understanding receptionist. won't he be surprised to see me so soon? he looks at the floor a lot when i talk about stuff that he's not comfortable with, such as my depression.
>
> i'll let you all know the results of tomorrow's appointment. i'm not giving it a lot of hope. i can already see him giving me a script for 100mg a day, which just doesn't cut it. i know - i've tried. it'll take at least the full 400mg to get me back to the point where i can finally start making a living again. and, after awhile, it'll take more than that. tolerance to this type of medication is inevitable, so i'm going to keep trying to get my tramadol (ultram) overseas. it's a lot cheaper, is every bit as effective, and doesn't leave me dependent on someone who doesn't have a clue, other than an intellectual one, to the severity and relentlessness of this beast. book knowledge, yes. street smarts, no.
>
> also, i'm going to try to get out from underneath doc 1 and start seeing doc 2 instead. it's a political quagmire since they know each other, but i think doc 2 is more tuned-in to the nastiness of major depression
>
> thanks once again for hearing me out. i know that my whining to my wife about this eventually just starts to get her down. she's stood by me throughout this ordeal and has helped me immensely. but after awhile even the strongest of people get tired of hearing about all of this negativity. that's where a dicussion group like this can really help. thanks to you, too, dr. bob for providing this forum.
>
> i look forward to the day when i can shutup and get back to the things i once enjoyed. and at this point, i have no qualms whatsoever about being dependent on drugs to get me there.
>
> best of luck to all of you,
> androog
Posted by androog on October 28, 2001, at 14:35:18
In reply to opiates and major depression, posted by androog on October 16, 2001, at 16:49:58
Hi All,
My recent trip to my current pdoc did, indeed, yield some results. After rapping me on the knuckles for my "deceit" (not telling him that i was taking ultram on my own) he proceeded to write a script for 400mg of ultram a day. he was very angry that i had been self-medicating. of course, my telling him about my self-medicating would be akin to telling the warden that i had a nice little tunnel from which to escape my impending death sentence.i told him that i had walked the straight and narrow for over 15 years, taking only those medications prescribed to me by a doctor. after shelling out thousands of dollars seeking a solution to my problem with no results, i decided to take matters into my own hands (and will continue to do so). i told him that i felt like i had reached the end of a long corridor and was faced with 2 doors: one marked "suicide", the other "drug dependency". i told him i didn't have to think long before selecting the "drug dependency" door. he didn't care much for my analogy, probably because it only left him with the "suicide" door to recommend.
at any rate, he said he would only write the ultram prescription once a month upon my seeing him, and that there would be no refills. if he found that i was deceiving him in any way, the game was over - he was taking his ball and going home.
this was interesting to me in two ways: 1) he was writing a prescription based on MY recommendation while at the same time chastising me for taking said drug and 2) he was treating me as a common criminal for having a history of substance abuse.
i've found over the years that although major recurring depression and substance abuse have been found to have strong physiological ties, many doctors acknowledge this only superficially. inwardly they harbor the same antiquated images of a bowery bum as do many other unenlightened people.
having had a substance abuse problem for many years, i've given a lot of thought as to what might be the best course of treatment. not once has a doctor asked me what makes my natural state of conciousness so awful that i need to self-medicate. and that's basically what it gets down to. address that problem and the rest will likely take care of itself. the catch is, at least in my case, that treatment would involve the use of opiates, and that doesn't sit well with most docs. i have tried countless antidepressants over the years to no avail. opiates work almost immediately on me and leave me perfectly capable of going about my everday duties. i've tried opiates in the past without telling anyone, and have received only positive feedback concerning my ability to get things done, to socialize and to have a pleasant, sunny disposition. i don't stagger, nod out, drool, dress only in black and come out at night, or any of the other pre-conceived notions of how a drug addict behaves. there's a reason we have opiate receptors.
it is SO frustrating to me to know that there is something out there that will free me, but that our society has placed such powerful sanctions against it that one needs to become a criminal to obtain it. why should society care what i put in my body? we can place liquor. tobacco and double cheeseburgers with fries into our systems anytime we want, and well we should. but when it comes to opiates the attitude is stick 'em in prison or refer 'em to another doc.
Kristi, if taking 100mg of ultram a day relieves your depression slightly, i'd guess that 2, 3, or even 4 times that much would almost entirely eradicate it. of course, i'm not a doctor. but i have had more personal experience with the drug than do most docs. additionally there are now studies that back up my layman's hypothesis.
well, i've spewed forth yet another manifesto in defense of the more liberal use of opiates for those who find that their minds and well-being crave it.
best of luck to all who live in the pit of despair.
androog
Posted by Ed O`Flaherty on October 27, 2002, at 16:47:49
In reply to Re: opiates and major depression, posted by androog on October 18, 2001, at 18:33:01
I came across this thread to-day when I was trying to get a report on Stoll`s article on opiates in depression in the American Journal of Psychiatry published in 1999.
Ultram was mentioned in the thread and I wonder is anybody using it.It is an opiate with a reckoned low likelihood of dependence.It is widely use all over the woprld as an analgesic (tramadol),being a bit stronger than ibuprofen.
Posted by androog on October 27, 2002, at 20:04:14
In reply to Re: opiates and major depression, posted by Ed O`Flaherty on October 27, 2002, at 16:47:49
I'm the fellow that posted the initial thread concerning tramadol and depression. I've been taking the tramadol for almost a year and have been greatly helped by it. Why I had to go and do all the research and twist my doctor's arm before he findly relented to prescribing it, I'll never know.
I realize that I'm prosletyzing, but it is inconceivable to me that the stigma of addiction outweighs the likliehood of suicide in the treatment of the severely depressed. That anyone can sit on their high horse and dole out useless drug after useless drug, all the while telling the patient to come back in three to six weeks, is nothing short of malpractice in my book. If I were to go to my doctor with a compound fracture and he gave me a couple of aspirin and told me to be on my way, he would certainly be guilty of negligence. This situation is hardly different. I would expect somebody who was trained in a specialty such as psychiatry would have some sort of clue as to just how dangerous depression can be. I had repeatedly told three different psychiatrists that opiates worked for me, and got the same dull stare every time. Nobody batted an eye when it came to giving me ECT 17 times, often when I was drunk. Nobody cared much when the ECT did nothing for me other than wipe out years of memories ("there was nothing else we could do" i was told). But eyebrows certainly shot up when I brought up the subject of opiates!
It's been about a year since I posted the original thread (seems much longer than that) and I'm happy to say that tramadol has saved my life. I started taking it on my own when nobody would prescribe it for me, and would continue to do so even if I didn't have a valid prescription. My psychiatrist only prescribed it when I asked him for a referral to someone with a more open mind concerning the subject. To this day he shows little interest in it and doesn't even know what dosage it comes in. Why do I continue to go to him? Tramadol, pure and simple. I've long since given up the notion of anybody in the business (and I mean business) of psychiatry actually being useful (pardon me Dr. Bob). I'm sure there are many out there, but I haven't the time or money to go seeking them out. I pay $150 every month to get a prescription written -- a prescription I had to instruct my shrink to write. In return, I get to stay alive.
That said, I can tell you for a fact that tramadol works for at least one person with refractory depression. I have not built up a toerance to it, the side effects are negligible and increased dosages (yes, i've tried it) only make me dizzy. I would suggest its use for anybody with treatment-resistant depression.
Sorry for spewing forth like this, but as you can see, I'm very bitter about the whole experience. Major depression is a force to be reckoned with and sometimes you have to pull out the big guns to do it. Better sooner than later. Sometimes you only get one chance.
Posted by utopizen on October 27, 2002, at 21:01:58
In reply to Re: opiates and major depression, posted by Ed O`Flaherty on October 27, 2002, at 16:47:49
So, um, was I the only one freaked out after reading Confessions of an Opium Reader?
Posted by Dr. Bob on October 28, 2002, at 8:07:03
In reply to Re: opiates and major depression, posted by utopizen on October 27, 2002, at 21:01:58
> So, um, was I the only one freaked out after reading Confessions of an Opium Reader?
I'd just like to plug the new double double quote feature. But I don't mean to be pushy. Did you deliberately not use it to link to Amazon? If so, I'd be interested in why, over at PBA:
http://www.dr-bob.org/babble/admin/20020918/msgs/7717.html
Thanks,
Bob
Posted by Blah on January 21, 2003, at 10:12:54
In reply to Re: opiates and major depression, posted by androog on October 28, 2001, at 14:35:18
I'm in a similar possition to Androogs. I am 28 and have had depression/dysthymia my entire life (probably have a mix of personality disorder traits too). I started deep psycoanalasys 3 times a week when I was 5. Since high school I have tried: a triciclycate, prozac, serzone, paxil, wellbutrin, rameron, trazidone, zoloft, nardil (an MAOI), effexor, adderal, ritalin, and maybe others as well; I can't remember them all. All of these drugs not only didn't help but made things worse, and I had full trials on most of them (the side effects were just too much, most I stuck it out for 3 months to a year just to find myself deteriorating). Most times a drug doesn't work the frustrated pdocs will blame me for the failier. Once a pdoc said the drug wasn't working because I wasn't execising regularly, I explplained that because of my depression I didn't have the energy to cook meals everyday let alone exercise. Her responce was, "You have to make the energy," truely science at work.
My parents were very emotionaly abusive in weird and a typical ways. I have always had terrible problems concentrating, but have only been critisized for it, even by pdocs and some therapists. I made it through college with few friends, and no one would hire me. I now live on SSI, and my symtems are becoming worse. I haven't had a relationship in over a decade, and even masterbation means nothing to me anymore, just fills me with more hopelessness. I just fired another useless pdoc (a second year resident) who couldn't undersatand that after 23 years of useless treatment I wanted some control. Like most she cared more about her ego than me: "but I'm the Dr. I'm the one with the Phd!" At this point I feel an opioid analgisic is the only thing that will work for me. I'm always dissociating cause everything, EVERYTHING, is so painfull, I also have terrible hypervigulance. To this day I still can't ride a bicycle. I got my father to pay for a mood dissorder specialist. They said on the phone they do rx opiates. I have never done heroin or other hard drugs, I don't drink or smoke, only smoke marijauana occassionaly, and didn't do anything till I was 24; so I have no addiction history unless you want to infantalize me by claiming that using any drug at anytime is addiction, which many pdocs often do. I'll write back later to tell you all how it went.If you write back:
-no mention of ECT. It is a temporary and barbaric practice with perminant damage, and I would sooner commit suicide. Many pdocs and therapist have said it wouldn't work for me anyway.-no mention of other SSRIs I haven't tryed like Celexa. It is obvious this class of drugs is harmful for me, and I see no reason to enter into it again.
Sorry if this sounds rude but I am tired of the same useless advice being doled out by the robots of psychiatry.
-Blah
Posted by BrittPark on January 21, 2003, at 11:14:05
In reply to Re: opiates and major depression, posted by Blah on January 21, 2003, at 10:12:54
I'm sorry you're having a rough time. Before you see your new psychiatrist, do some research on opioids and depression both on the web in general and in the PB archives. The research on opioids for treating depression is sparse but there. The two opioids for which there is some research are buprenorphine and tramadol.
I'm a strong believer in the use of opioids for depression. If it weren't for the spectre of tolerance opioids would be perfect ADs for many people (including me).
Good Luck and Feel Better,
Britt
Posted by androog on January 21, 2003, at 13:29:13
In reply to Re: opiates and major depression, posted by Blah on January 21, 2003, at 10:12:54
Hi All,
Androog here. I wanted to let you know some interesting things about tramadol and how it has worked with my depression. Bear in mind that my memory has some gaping holes in it from the ECT I had done 2 years ago. I still don't retain info very well, so I apologize if I repeat myself in this post.
First, I should mention that I am a recovering alcohoic ( I hate that term -- sounds like I'll recover some day and be able to drink resonsibly). I have also been through the drug ringer with regards to my chemical dependency.
Second, the fact that I have this history of chemical dependence has raised a red flag with every pdoc I have ever seen. They shudder at the thought of giving someone like me a potentially addictive drug. They don't shudder at the mention of suicide, which is apparently preferable to chemical dependence, as is frying your brain with ECT.
That said, I 'm happy to report that in the almost two years that I have been taking tramadol my intake has actually dropped. In fact, I am taking only about half of what I was taking a year ago.
This is interesting to me because addiction usually (always?) involves an increased tolerance of the addictive substance. This has not been my experience with tramadol.I must admit that in the past I have tried taking more tramadol than I really need. Once an addict always an addict. The result of the excessive tramadol intake on me has been negative -- dizziness and disorientation rather than the euphoria I would have expected. This has worked in my favor because I no longer take more than I need. The tramadol seems to have a fail-safe mechanism built into it to foil my addictive tendencies. It's a great relief to me to know that I won't have to keep increasing my dosage -- not because I'm that concerned about addiction, but because of the lack of availability of the tramadol. Addiction can be reversed, suicide cannot.
With regards to Blah's experience with pdocs, I have had the same thing happen over and over. It has become clear to me that the vast majority of those who treat major depression have never experienced it. They say "Take this drug and see me in 3 weeks". This is akin to saying "Take aspirin for 3 weeks and we'll see if that relieves the pain of your compound fracture". It's nothing short of cruelty, but in an ignorant sort of way.
Blah, people like us have to accept the fact that the severity of our disease is something most pdocs only read about. Problem is, words don't begin to describe the horror of major depression, so unless they've experienced it firsthand, they'll only know what they read in a book or hear from their patients. Try describing sight to a person who has been blind since birth. It's not much different than what we go through with our pdocs.
I have no idea, of course, if tramadol will work for everyone. It probably won't. I also don't know what kind of pysical toll, if any, it has taken on my body. Only time will tell.
What I do know is that if it had not been for the tramadol I would probably not be here to write this. I figure I have lived at least a year longer than I would have without it, so any injurious effects I've experienced from it are, in my mind, offset by my increased longevity and quality of life.
I'm not a physician and I 'm operating solely on the basis of my experience, but ignorance coupled with experience is better than ignorance alone, and the treatment I was receiving involved only ignorance.
Blah, don't do something rash while there are still options open to you, even if those options are unorthodox. I never thought I'd feel okay again when I was in the pit of despair, yet here I am writing this post when I should be working ;>)
I know how awful you feel and how scared you can get when you start to believe that suicide is the only answer. Words ring hollow when you're hurting like you must be, but I'll use 'em anyhow. Something will work for you, and your depression is NOT your fault. Call around and see if there is a pdoc in your area that is willing to use tramadol or opiates to treat depression. That's what I did, and I was surprised at the response.
Hang in there, Blah!
Androog
Posted by juanantoniod on January 22, 2003, at 1:27:44
In reply to Re: opiates and major depression » Blah, posted by androog on January 21, 2003, at 13:29:13
Hi, Androog!
I agree with almost everything you've said and been through. I would just like to know if you take your Ultram in divided doses and if so, how often, or in one daily dose?
Best wishes,
Antonio
Posted by djmmm on January 22, 2003, at 8:42:35
In reply to Re: opiates and major depression , posted by juanantoniod on January 22, 2003, at 1:27:44
For what it's worth, tramadol's major pharmalogical effects are mediated through serotonin and norepinephrine reuptake. It only has minor effects on the opioid system. It is very similar to Effexor.
Posted by BrittPark on January 22, 2003, at 11:11:49
In reply to Re: opiates and major depression , posted by djmmm on January 22, 2003, at 8:42:35
> For what it's worth, tramadol's major pharmalogical effects are mediated through serotonin and norepinephrine reuptake. It only has minor effects on the opioid system. It is very similar to Effexor.
IIRC, tramadol's analgesic effect is about 50/50 opioid/catecholamine. In animal studies naloxone reverses about 50% of its analgesic effect.
Tramadol itself binds very poorly to opiate receptors but it 0-desmethyl metabolite binds much more strongly, though still relatively weekly.Now as to its mechanism as an AD it may well be NE/5-HT that's the key. But I'm betting that it is also the opiate receptor activity.
Cheers,
Britt
Posted by androog on January 22, 2003, at 13:37:17
In reply to Re: opiates and major depression , posted by juanantoniod on January 22, 2003, at 1:27:44
Hi Everyone,
I need to correct a statement I made on my last post. In that post I said that I didn't develop a tolerance to tramadol. My wife reminded me that when I first started taking tramadol for my depression about 2 years ago I only needed 150 mg. I DID develop a tolerance to normal doasages of the tramadol. I kept taking more to get the desired effect. When I got up to 800 mg I hit a plateau. That was back in late 2001, and I still respond to that amount. I realize that that is twice the recommended daily dose, but that's what it takes to get me out of my pit, and the pit is somewhere I'm not going to again, if I can help it.
I take an initial dose of 600 mg and then spread the other 200 mg out over the rest of the day.
About 50 minutes after I take the initial dose I start to feel the depression lift.
About 1 hour after I take my first dose, I get a brief feeling of euphoria or something close to it. This lasts perhaps 5-10 minutes, after that I just feel ok -- no euphoria, no depression. I have to wonder if the euphoria part is really just a feeling of normalcy that seems exaggerated because it eradicates the hell of depression so quickly. Or maybe it's the weak opioid mechanism at work. Could be that's why it takes so much to get me there. But that doesn't explain why the same dose every day has the same effect it did over a year-and-a-half ago.
It's certainly possible that a pure opiod would stop my depression with a smaller dose, but the very word "opioid" elicits a knee-jerk response from the docs I mention it to. I'd like to give opioids a go, but I can't find a doc that'll go that route.
One more thing I neglected to mention is that I also take 200 mg of the tricyclic doxepin a day. This alone doesn't do anything, but it probably enhances the effect of the tramadol. I've read that tramadol can increase the serotonin-raising effects of antidepressants.
I think that's it for now.
Take care, and don't give up the ship.
androog
Posted by androog on January 22, 2003, at 13:54:59
In reply to Re: opiates and major depression » djmmm, posted by BrittPark on January 22, 2003, at 11:11:49
Exercise really does help. I've been a regular exerciser for about 17 years. I fitness-walk for at least 30 mins. a day 5 or more days of the week. 10 minutes or so after I excercise my mood goes up another notch.
Like Blah, when I was suicidal it was next to impossible to get myself to exercise. The few times I tried it, it didn't help.
Laying an exercise guilt trip on an already depressed individual only adds fuel to the fire and indicates a lack of understanding of the depths of depression on the part of whomever is laying on the guilt trip.
I recommend exercise, but don't find fault in a person who is unable to do it. After all, even the majority of Americans who are NOT depressed can't seem to bring themselves to exercise.
androog
Posted by jrbecker on January 22, 2003, at 23:01:37
In reply to ps, posted by androog on January 22, 2003, at 13:54:59
I've never responded well to most traditional ADs either. If you ever do find an opitate-friendly doc in the Chicagoland area, I would like to know about him/her as well.
Would appreciate it if you could drop me a line if that ever happens:
good luck with everything.
Posted by Blah on January 23, 2003, at 7:33:49
In reply to opiates and major depression » androog, posted by jrbecker on January 22, 2003, at 23:01:37
> I've never responded well to most traditional ADs either. If you ever do find an opitate-friendly doc in the Chicagoland area, I would like to know about him/her as well.
>
> Would appreciate it if you could drop me a line if that ever happens:
>
> jrbecker76@hotmail.com
>
If you could send me some names too that would be good. I am also in the chicago area. On the phone these new Pdocs seem opioid friendly, but my distrust of doctors has grown so strong I'm not counting on it. We'll find out today.You can send any info to:
Thanks
Blah
Posted by androog on January 23, 2003, at 11:11:34
In reply to Re: opiates and major depression, posted by Blah on January 23, 2003, at 7:33:49
Wow!
Thank you to those who have responded to my previous posts so positively. I kind of expected to be skinned alive for my views on opiates. Instead, people have been very supportive.
I thought I should mention that I have stopped looking for a sympathetic pdoc. I found one that'll write a prescription for tramadol (Ultram) and I'm just going to stick with him. Oddly enough, I decided to stay with him because he basically stays out of my way and doesn't try to anything new. At this point, his only function as far as I'm concerned is as a prescription-writer. After many years of trying different antidepressants and ECT, I realized I was pouring a lot of money into a pretty inaffective sries of treatments and getting nowhere but broke. That's why I have taken my treatment into my own hands.
For better or worse, I'm going to do what it takes to keep myself off the road to suicide.
And now the fine print:
Please remember that I'm not qualified to dispense medical advice. I'm only saying what has worked for me and am not trying to convince anyone to take tramadol or opiates. We all respond differently to medications. Ultram mixed with standard antidepressants can have serious consequences, from what I've read. I took a chance and it worked for me. But what works for me could possibly kill someone else.androog
Posted by BrittPark on January 23, 2003, at 11:28:55
In reply to Re: opiates and major depression, posted by androog on January 23, 2003, at 11:11:34
The most dangerous outcome from tramadol use is seizures. In general tramadol seems to increase the likelihood of seizures 2-6 fold. That may sound like a lot but remember that original likelihood of seizures is quite low. Those who are taking certain antidepressants (TCAs eg) that lower the seizure threshold are somewhat more at risk but I haven't been able to find a number. I would advise caution.
Here are some Medline Abstracts
Tramadol and seizures: a surveillance study in a managed care population.
Gardner JS, Blough D, Drinkard CR, Shatin D, Anderson G, Graham D, Alderfer R.
Department of Pharmacy, University of Washington, Seattle 98195, USA.
STUDY OBJECTIVE: To investigate the occurrence of tramadol-associated seizures. DESIGN: Retrospective cohort and case-control studies. SETTING: UnitedHealth Group-affiliated independent practice model health plans, from different regions of the United States, contracting with large networks of physicians. INTERVENTION: Analysis of administrative data from a large U.S. managed care population. PATIENTS: A cohort of 9218 adult tramadol users and 37,232 concurrent nonusers. MEASUREMENTS AND MAIN RESULTS: Fewer than 1% of users (80) had a presumed incident seizure claim after the first tramadol prescription. Risk of seizure claim was increased 2- to 6-fold among users adjusted for selected comorbidities and concomitant drugs. Risk was highest among those aged 25-54 years, those with more than four tramadol prescriptions, and those with history of alcohol abuse, stroke, or head injury. A case-control study among users was conducted to validate incident seizure outcomes from medical records. Only eight cases were confirmed, and all had cofactors associated with increased seizure risk. CONCLUSION: In a general population, risk of seizure may be associated with long-term therapy with tramadol or the presence of cofactors, or confined to a small sensitive population subset.
Incidence of first-time idiopathic seizures in users of tramadol.Gasse C, Derby L, Vasilakis-Scaramozza C, Jick H.
Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, Germany.
STUDY OBJECTIVE: To assess the risk of idiopathic incident seizures among patients who ever took tramadol. DESIGN: Nested case-control design. SETTING: General Practice Research Database from November 1996-August 1998. PATIENTS: Eleven thousand three hundred eighty-three patients. INTERVENTION: Comparison of risks of idiopathic incident seizures during exposed and unexposed times among patients who had ever taken tramadol and other analgesics with 90-day follow-up. MEASUREMENTS AND MAIN RESULTS: Among the 11,383 subjects we identified 21 cases of idiopathic seizures, 10 of which were categorized as definite cases and 11 categorized as possible cases. Three patients were exposed to tramadol alone in the previous 90 days, 10 to opiates, three to both tramadol and opiates, one to other analgesics, and four to no analgesics. CONCLUSION: The risk of idiopathic seizures was similarly elevated in each analgesic exposure category compared with nonusers, suggesting that the risk for patients taking tramadol was not increased compared with other analgesics.
Whatever it takes,
Britt
Posted by androog on January 23, 2003, at 14:43:25
In reply to Re: opiates and major depression » androog, posted by BrittPark on January 23, 2003, at 11:28:55
Hi Britt,
Thank you so much for the unbiased scientific info on tramadol. I've been trying to find out more about it, but I have no science background and haven't met with much success.
I'd read that there was an increased risk of seizures in people who take the stuff, but that was about it.
This info enables me, and other people in the same boat, to make a more informed decision regarding its use.
I've had 17 ETC-induced seizures, but I still know next to nothing about seizures.What exactly occurs when one has a grand mal seizure? Is there brain damage? Does it always interefere with memory?
Thanks
androog
Posted by Blah on January 23, 2003, at 22:40:06
In reply to Re: opiates and major depression, posted by androog on January 23, 2003, at 14:43:25
Hi Androog and all:
I saw the mood disorder specialist today, and even though the first visit is $345 not much happened. He said he wouldn't give me an opioid analgesic untill I tried some mood stabalizers and antipsycotics. I'm willing to do that, but he was not willing to say how many I had to try before we could rule them out and move on to opiates. It would be great if one of them worked, but after all the "wonder drugs" I tried just to have them make me worse I don't have a lot of trust left.
What's worse is he wants me to go into the hospital for a month or more so I can try more more quickly, but if I do that he still won't commit to a time when I could switch to an opioid if they didn't work. I can't try every mood stabalizer and antipsycotic. Once you try 2 or 3 drugs from a certain school you cancel that school out; to try them all is a waste of time and abuse of the body. I'm not sure what to do I'd go in the hospital if I knew that he'd rx opioids if nothing worked but he's making it clear he'll wait as long as he can to do that, and my mental and ecconomic situation requires me to get better now. In a few years I won't get supplemental money from my mother, and Bush could easily kill SSI (social security disability) even sooner. Emotionaly I have no hope left, and today I thought about suicide maybe more serious than I ever have. I have no hope or passion left, for anything. Yet this doctor still won't give me some kind of assurance that opioids could be used soon if nothing works. I'm not sure what to do.ANDROOG, I may need to do the internet ordering. xxx Is it better to buy a cheap membership to one of those low price ones, or buy from the ones with regular prices but with no membership. xxx Also, can you get arrested for doing this , should I not use my credit card, and is it safe to have it shipped to my home.
Thanks
Blah
Posted by BrittPark on January 24, 2003, at 11:31:42
In reply to Re: opiates and major depression, posted by androog on January 23, 2003, at 14:43:25
Seizures are sudden firings of a large number of neurons in the brain. They manifest themselve in many ways: from a short blackout, to a grand mal seizure in which all the muscles in the body tense and untense. Most seizures are not dangerous but some can cause breathing to stop and lead to death. The other danger of course is that seizures can occur at dangerous moments, such as driving a car.
Perhaps someone with more expertise could comment further.
Cheers,
Britt
Posted by juanantoniod on January 24, 2003, at 12:19:15
In reply to Re: opiates and major depression, posted by Blah on January 23, 2003, at 22:40:06
Hi, Blah
I completely relate to your posting about losing hope and going for suicide as an option. I'm on my last trial of medications before probably moving on to ECT, then if that does not work, strongly considering voluntary euthanasia.
I'm not trying to be all cliche and say that things could get better overnight with new treatments, medications and such. However, the release of Strattera is a hope in that direction and then the eventual release of Lilly's new AD, Cymbalta (duloxetine) could be helpful as well.
And, as you said, you haven't tried opiates.
So, please understand that I'm not saying hang on at all costs, but please at least exhaust all options before you go to the final one. Believe me, I know how difficult that sounds, but I know how you feel.
Take care,
Antonio
> Hi Androog and all:
>
> I saw the mood disorder specialist today, and even though the first visit is $345 not much happened. He said he wouldn't give me an opioid analgesic untill I tried some mood stabalizers and antipsycotics. I'm willing to do that, but he was not willing to say how many I had to try before we could rule them out and move on to opiates. It would be great if one of them worked, but after all the "wonder drugs" I tried just to have them make me worse I don't have a lot of trust left.
>
> What's worse is he wants me to go into the hospital for a month or more so I can try more more quickly, but if I do that he still won't commit to a time when I could switch to an opioid if they didn't work. I can't try every mood stabalizer and antipsycotic. Once you try 2 or 3 drugs from a certain school you cancel that school out; to try them all is a waste of time and abuse of the body. I'm not sure what to do I'd go in the hospital if I knew that he'd rx opioids if nothing worked but he's making it clear he'll wait as long as he can to do that, and my mental and ecconomic situation requires me to get better now. In a few years I won't get supplemental money from my mother, and Bush could easily kill SSI (social security disability) even sooner. Emotionaly I have no hope left, and today I thought about suicide maybe more serious than I ever have. I have no hope or passion left, for anything. Yet this doctor still won't give me some kind of assurance that opioids could be used soon if nothing works. I'm not sure what to do.
>
> ANDROOG, I may need to do the internet ordering. What are the best companies to use. Is it better to buy a cheap membership to one of those low price ones, or buy from the ones with regular prices but with no membership. Do you know of any sites still in operation that are good. Please either email this info to me at the address in my last post, or put it on the board. Also, can you get arrested for doing this , should I not use my credit card, and is it safe to have it shipped to my home.
>
> Thanks
> Blah
Posted by androog on January 24, 2003, at 13:33:00
In reply to Re: opiates and major depression, posted by Blah on January 23, 2003, at 22:40:06
Hi Blah,
I'm sorry to hear about your experience with the pdoc. It sounds to me like the old carrot-on- a -stick routine. There seems to be an endless loop of drug combinations that can be tried on a person with refractory depression.
I don't know if you're being strung along or if your new pdoc really intends to try opiates or tramadol. I was lucky enough to find a legit doc to write my scripts, but it took some pushing on my part -- something that doesn't come easily when you're seriously depressed.
There are sites on the internet where it appears you can get tramadol legally with the benefit of an online consultation. I say "appears to be legal" because I'm not a lawyer and can't state for a fact that it is legal. A simple search on the internet took me to one such site:
xxx
Once again, I have to say that I'm not a doctor and can't make any recommendations to you regarding your decision to try to find or use tramadol. I say this because I don't in any way want to be construed as offering medical advice or trying to prescribe medicine. I think you can understand my dilemma.
The suggestion that you go into the hospital is a little scary to me. Having been in the cuckoo's nest myself, I think the whole thing was simply aimed at protecting me from myself. It was my experience that they couldn't do much more for me in the hospital than they could do on an outpatient basis. Even the ECT, which was started in the hospital, was completed on an outpatient basis. The big difference to me is that the hospital stay was VERY expensive. Also, from what little I can remember and what I'm told by my wife, I was treated like an inmate. Cigarettes (I've since quit smoking. Yea!) were used as rewards and my wife was not allowed to visit me unless she attended certain classes. Try pulling that on someone who is hospitalized for, say, diabetes.
I truly wish I could be of more help to you. I would love to be able to write a prescription for you, if only to give you temporary relief -- a "breather". What you are experiencing is more awful than most people could ever understand, and is something nobody should be forced to endure. It's just plain cruel to allow anyone to exist in your state without trying something that might possibly bring immediate relief.
Please don't do anything rash. Pursue all your options. I'm convinced that each one of us will respond to something, it's just a matter of finding what that something is.
androog
Posted by ShelliR on January 24, 2003, at 19:46:03
In reply to Re: opiates and major depression, posted by Blah on January 23, 2003, at 22:40:06
It's an amazing thing to me how seldom it is that doctors can really relate to true suicidal urges, and how horribly painful depression can be, both physically as well as psychologically. Suicide is obviously not just a threat, and a week of hospitalization (usually the commitment for suicidal ideation) is not going to do very much to change such painful, long-term miswiring.
I recently seen several articles talking about the interaction between pain and depression. If there is any physical aspects to your depression/pain, I would go to a pain specialist before ordering opiates off the internet.
I was able to be honest with my pain doctor, saying that I was very depressed but also I had unrelenting pain in my chest. And I didn't know where one started and the other ended. My honesty with psychiatrists mostly got me labeled a drug addict, although one psychiatrist put me on oxycontin which was not a good idea either. If I was trying now to save my life, I'd lobby for buprenorphine; it just came out in sublingual form. It's purpose is to treat addiction, much like methadone, only buprenorphine is allowed to be prescribed in a doctor's office and is a partial opiate. I know the liquid form (for IM use) is also legally prescribed for pain; I'm not sure if the new sublingual release can be prescribed for pain yet. Buprenorphine can also be habituating, but less likely, since it has both agonist and antagonist properties.
It's hard for me to believe that after trying over 20 combinations of drugs to try to relieve my depression, doctors were way more worried about me becoming an addict than me being dead. The last time I was put in the hospital, taken off of opiates and pumped with too much effexor for my body, I got out and tried to kill myself. (Seriously tried). That was the last time I allowed byself to believe it was better to be dead than to be addicted (habituated) to opiates.
I think it is a very serious decision to take opiates for depression, but it's hard for me to believe that it was so hard for me to choose opiates over death because of the total lack of help and total lack of support I received in the psychiatric community for treatment resistent depression. I am also still looking for other options so I won't have to be dependent on opiates for the rest of my life, if there is another equally effective and less controversial alternative. I have become habituated to a pretty large dose of methadone and don't know when or if this dose will lose it's effectiveness. Presently, I am also being treated by a homeopathic MD.
"Be careful out there"
Shelli
Posted by androog on January 25, 2003, at 0:08:59
In reply to Re: opiates and major depression » Blah, posted by ShelliR on January 24, 2003, at 19:46:03
The buprenorphine that Shelli suggests is a great idea. It has a "ceiling" that only allows it to take you so high, unlike the heavier stuff like morphine. Personally, I don't really understand what the problem is with feeling good, but I think docs are more likely to prescribe if they don't think you're having too much fun.
When I was at the lowest point of my depression I kept having this fantasy of what I called "The Hat". You stick it on your shrink and he/she feels exactly what you feel. You stick it on their head with epoxy and tell em you'll be back in three weeks to chip it off. Then you sit back and see what comes off their prescription pad. I'll bet it wouldn't be Prozac.
Blah and Antonio, I'm really getting scared with this talk of suicide. Please get on the phone, or have somebody else get on the phone, and call every shrink, pain specialist or witch doctor in the book until you find someone who will at least try you on some sort of painkiller. It doesn't have to be a shrink; dentist's have the authority to write these prescriptions, too -- all it takes is a bad toothache on the weekend. I hate to suggest that, but I think you need relief soon.
When I first discovered painkillers worked on my depression it gave me a lot of hope and helped to keep me going. Even though I had nobody at that time to write a prescription for the stuff, it helped just finally knowing there was something that worked. I think that same kind of hope would help you a lot.
Get creative in your quest for help and don't feel all alone -- there are plenty of us out here who share your experience and who really mean it when we say "I know how you feel".
androog
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