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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 46 to 70 of 108. Go back in thread:
Posted by Cecilia on March 2, 2002, at 0:56:29
In reply to Re: Addiction » Elizabeth, posted by shelliR on March 1, 2002, at 15:03:00
I think you definitely should consider sueing the doctors and hospital who took you off methadone cold turkey. That`s like operating on someone without anesthesia.
Posted by shelliR on March 2, 2002, at 11:35:28
In reply to Re: sidetrack from Addiction » shelliR, posted by Elizabeth on March 1, 2002, at 20:31:01
>>... I really thought that you could take oxycodone for depression without developing a tolerance. Looks like that's far from certain (and probably not worth the risk).
Elizabeth, stop, PLEASE. You didn't even suggest the oxycontin. My pdoc did and he was the one who prescribed it for me. Not you. You are not even a little bit responsible. Try to let it go.
> > Today I took 0.4mg x 2 and almost no chest pain/depression.
> Excellent! How many hours did each dose last?I would say 7 hours; it's hard to know exactly. I am trying to take the second dose while the first dose is still working, so I don't have to wait a second time for almost an hour for me to feel better. On this dose, I didn't experience depression (after it kicked in) for the whole day and evening.
I have several more weeks (because of the slow tritration) to know whether lamictal will have an impact on my depression. Actually, the temgesic can carry the whole load for relieving me of depression, but I am worried about the need to increase. Because of my experiences before, and because bupe feels just like a full opiate to me, I'm not convinced that I won't build up a tolerance and need more and more. Also I hate waking up every morning with rebound depression. I may try taking some before I go to bed; it's just so expensive--$1 a pill and that's $4 a day so far and would be $6 a day. That's over $2000 a year and the lamictal is also expensive. (so far my pdoc has given me lots of samples). It is, though, all cheaper than the oxy had been. And I do get to deduct all medical expenses from my business, so it's not quite as bad as it sounds--but that, of course, cuts into profit.
There is generic temgesic available over the internet, but I don't know where it's made. If it turns out to be made in a country that has strict generic criteria, than I may try it.
Re injection vs. sublingual, the information on the insert will surprise you:
"buprenorphine is well absorbed in man by the sublingual route, giving plasma level at 2-3 hours after administration which are comparable to those observed at the same time following a similar dose given by a parenteral route."
In somewhat of a round-about way (not giving the reader exact comparisons), they talk about the "delayed onset of peak plasma concentrations following the sublingual dose of buprenorphine" (200 minutes vs. ? for injection). Maybe I missed something, but I can’t find the time of absorption for the parenateral route. Obviously, it's a lot shorter. How long does it take intranasally, and do you overlap doses also?
> Flax seeds, eh? I'll have to try that. Can I find them at my local health food store?Yes, I'm sure. I like the golden a little better than the dark flax seeds. The main thing is that you should grind them before putting them in the yogurt, to get full effectiveness. (They also taste better that way.) I bought a little electric coffee grinder which works great for that, for about $10.
> I've heard it said that Nardil poop-out can lead to a very refractory depression, and this is consistent with my experience. Maybe something like that happened to you too?Well, I think I also had refractory depression before I started the nardil--nothing else has worked my whole adult life.
> > btw, are you feeling well enough to work or take premed classes?
>Yes, I have been for some time, but there are other barriers (lack of driver's license, not living near a university that has an affordable post-bac pre-med program, etc.).I thought you got your driver's license. Are you still trying to learn to drive?
> Be well!You also!
Shelli
Posted by shelliR on March 2, 2002, at 11:43:28
In reply to Re: Addiction-Shelli, posted by Cecilia on March 2, 2002, at 0:56:29
> I think you definitely should consider sueing the doctors and hospital who took you off methadone cold turkey. That`s like operating on someone without anesthesia.
I have to make a formal signed request for my records to find out how much buprenorphine they gave me (after taking me off the methadone), and how everything is documented. I also need to consider how other psychiatrists will act toward me if I sue, if it becomes public. Since I am now taking buprenorphine, I don't want doctors to be worried about giving it to me because I might sue. So the decision whether or not to sue has to be well thought out, and I believe I have at least a year; actually I think I have three years to bring a case against that doctor.
Shelli
Posted by reese1 on March 2, 2002, at 18:44:03
In reply to Re: sidetrack from Addiction » shelliR, posted by Elizabeth on March 1, 2002, at 20:31:01
have had trouble with buprenex. hasn't lifted my depression as it had in the past.
i tried it for a week then stopped hoping that if i tried again in a few weeks it might kick in. Does anybody have any idea why it would work in december 00 but not now?
i've gone up to 0.6 in the morning and still no effect.
any ideas?
reese
Posted by Elizabeth on March 4, 2002, at 1:19:29
In reply to Re: sidetrack from Addiction » Elizabeth, posted by shelliR on March 2, 2002, at 11:35:28
> Elizabeth, stop, PLEASE. You didn't even suggest the oxycontin. My pdoc did and he was the one who prescribed it for me. Not you. You are not even a little bit responsible. Try to let it go.
I understand who did what. For my part, I had believed (prior to your trial) that a person taking opioids for depression would not develop tolerance. I have no doubt that my success with buprenorphine and said belief played a part in what happened. But I also know that you're an opiophile (a word someone came up with for people who need opioids in order to function normally (not necessarily addicts or even daily users)), and that you've been in the unenviable podition of looking for a pdoc willing to prescribe bupe.
Speaking of that, I had a major surprise lately. I made this appointment waaaaay back in December to see this pdoc, and I saw her, and she's okay with the bupe. Well, she wants to read more about it, but she gave me a script. She seems like a good, decent sort. (This after the dreadful guy at the hospital clinic told me that I wouldn't find anyone in the area who would be willing to do it.)
> I would say 7 hours; it's hard to know exactly.
5-7 hours is the range I've observed.
> I am trying to take the second dose while the first dose is still working, so I don't have to wait a second time for almost an hour for me to feel better.
Yeah, I've always done it that way, but still, without the Effexor I was having some ups and downs throughout the day.
> On this dose, I didn't experience depression (after it kicked in) for the whole day and evening.
That's more than 7 hours!
Well anyway, it sounds like it's working great. Hopefully the Lamictal will kick in and then you can reduce your use to PRN so you don't have to worry about tolerance. And there is still a possbility that you won't find that you have to raise the dose. Also, buprenorphine withdrawal is nothing compared to that awful stuff you went through (in that awful hospital).
Rebound depression sucks. I don't know how to deal with that one. I don't get it now, because of the Effexor.
> There is generic temgesic available over the internet, but I don't know where it's made. If it turns out to be made in a country that has strict generic criteria, than I may try it.
I'd like to know, too. Just In Case.
> "buprenorphine is well absorbed in man by the sublingual route, giving plasma level at 2-3 hours after administration which are comparable to those observed at the same time following a similar dose given by a parenteral route."
>
> In somewhat of a round-about way (not giving the reader exact comparisons), they talk about the "delayed onset of peak plasma concentrations following the sublingual dose of buprenorphine" (200 minutes vs. ? for injection). Maybe I missed something, but I can’t find the time of absorption for the parenateral route. Obviously, it's a lot shorter. How long does it take intranasally, and do you overlap doses also?How long to kick in? About an hour. Don't know when peak plasma concentrations are achieved by this route. Yes, I do overlap doses.
Peak effect with IM injection happens at about 1 hour, I think.
> Well, I think I also had refractory depression before I started the nardil--nothing else has worked my whole adult life.
The refractory state I was in after the Nardil pooped out was qualitatively different from the refractory state I was in before I took the Nardil (i.e., depression). Does that make sense?
> I thought you got your driver's license. Are you still trying to learn to drive?
I'm no longer trying. I'm sure you can guess why (I'm a bit shy about discussing it). I'm going to have to depend on being able to get a ride.
Anywayzzz -- looks like we've both got a plan (or plans). I hope things work out for both of us.
Best wishes,
-elizabeth
Posted by reese1 on March 5, 2002, at 13:41:03
In reply to Re: sidetrack from Addiction » shelliR, posted by Elizabeth on March 4, 2002, at 1:19:29
question for all,
my psychiatrist has recently, within the last few weeks, taken me slowly off a good portion of my medication to switch to new things...
i've tapered off
lithium 600mg
neurontin 2400mg
celexa 80mg
adderall 40mg
clonzapam 1mg
rispedal .05i am now taking
effexor xr 300mg
lamactal 25mg (for month to check for side effects)
topomax- but insurance has not approved payment
seroquel-25mg (i find it very intense and takes me a good three hours for my head to wake up in the morning)
buprenexthe buprenex has not been as valuable as i would have thought. do you think this could have something to do with the enormous medication switch?
this question is quite stupid, but i didn't think about it at first.
also since i take it IM. i was prescribed a 3ml 25G5/8's, which was small for an IM injection. Do you think it makes a difference in terms of the one's response? I thought the IM size is 22G x 1 1/2 not 25G x 5/8. Would this make a difference?
I was just wondering if this might change one's response to the medication.
thank you
reese
Posted by reese1 on March 5, 2002, at 14:11:49
In reply to Re: sidetrack from Addiction » shelliR, posted by Elizabeth on March 4, 2002, at 1:19:29
i was contacted by someone within this group at my email in the past few weeks and i was meaning to write him or her back but i have lost the email that was sent.
if the person that emailed me reads this please contact me again,
reese
Posted by shelliR on March 5, 2002, at 18:42:07
In reply to Re: sidetrack from Addiction, posted by reese1 on March 5, 2002, at 13:41:03
Reese,
I don't know about the question of whether your change in meds has effected your reaction to buprenex, but as far as the dose, why not try a higher dose to see how you feel for a day or two. For me, with opiates and buprenorphine, I can tell in about an hour whether I've taken enough because my after an hour or so my depression lifts. Are you just taking it once a day? If you're only taking it once than you really need a higher dose to get you through.
About your change in meds. First of all it seems strange that your pdoc would change everything at once. But maybe I have misunderstood. And as far as lamictal, she has you on 25mg for a month? :-(
I know about the rash, but I'm starting it at 25mg for four days, 50mg for 4 days, then 100mg, 200mg, all for four days. If 200 isn't enough then I'll go up as far as 400-800. That's the way my last pdoc also started me. A month at 25mg is unnecessarily cautious. Also why would your doctor start you on topamax and lamictal at the same time? They're both classified as mood stabilizers. Is she working by the subtraction method?Sorry the bupe isn't working for you.
Shelli
Posted by reese1 on March 6, 2002, at 4:56:49
In reply to Re: sidetrack from Addiction » reese1, posted by shelliR on March 5, 2002, at 18:42:07
> Reese,
>
> I don't know about the question of whether your change in meds has effected your reaction to buprenex, but as far as the dose, why not try a higher dose to see how you feel for a day or two. For me, with opiates and buprenorphine, I can tell in about an hour whether I've taken enough because my after an hour or so my depression lifts. Are you just taking it once a day? If you're only taking it once than you really need a higher dose to get you through.
>
> About your change in meds. First of all it seems strange that your pdoc would change everything at once. But maybe I have misunderstood. And as far as lamictal, she has you on 25mg for a month? :-(
> I know about the rash, but I'm starting it at 25mg for four days, 50mg for 4 days, then 100mg, 200mg, all for four days. If 200 isn't enough then I'll go up as far as 400-800. That's the way my last pdoc also started me. A month at 25mg is unnecessarily cautious. Also why would your doctor start you on topamax and lamictal at the same time? They're both classified as mood stabilizers. Is she working by the subtraction method?
>
> Sorry the bupe isn't working for you.
>
> Shelli
thank you so much for your letter. it was really nice. the buprenex i think, or maybe believe might have worked today. i took the dose of .6 in the morning. this was the first time i felt any sort of lift.two things made me think this
1. i have been unable to go on the computer. totally imposible. but i was able to go on the computer for hours today.
2. i can not listen to music which i used to listen to constantly. but today i wanted to which is a good if not great sign
i have tried this amount .6 each time. if i was to try to up it so i could get a reaction how high could i go. is it possible to try .9i am not scared of this, i am scared that i have heard that if you take to much it revereses it's ability and becomes useless. this could be a complete lie but i read it somewhere.
i will try anything at this point.
is there a possibility that trying a dose of .9 would work?
i have a lot of buprenex left so i'm not concerned about running out i have used it very seldomly.
also what time or how long does it take for effect?
i was told fifteen minutes but i find it takes more like an hour.
what is your expierence with this?
my meds have been a real mess
my pdoc is good. she cares. but she really wanted me to get on topomax but for some strange reason my 500 dollar a month insurance (blue cross) doesn't cover it. so they want me to pay 400 dollars. so i sent them the info or my pdoc did right away. this was last thursday. 72hrs. but i found out today it's 72hrs when they get to reading it.
sucks
so the lamactal i will be going up on. the neurontin was a mix up. i was taking 1800-2400 a day and i went to nothing. so this was a bad bad mix up. so she called in some scripts for me today. i'm currently in oakland, ca staying with my maom instead of going back to a hospital.
so she called in neurontin and the clonzapan which i take only when needed. if i don't sleep for a night or two i will take it to calm me down during the day and it does help me sleep.
but yeah the meds are just weird. i am one of those people who the effect of meds has always been for a short period of time. a week or two, with nardil maybe a month- then my body get's used to it and then it does nothing
the adderall i found helpful for a year but then it's effect drifts from day to day. and the dose needs to be increased. for the last six months i was taking the 30mg pills which i didn't even know they made.
so i would say the pdoc did take me off to quickly it was just confusion with the insurance and me being in california and her wanting to try seroquel 25mg for sleep and to stop the constant pacing.
each day for the eight hours i'm alone in the house i pace forward backwards downstairs upstairs to this room to the next room unable to stop, truly unable to stop, not able to read, not able to listen to music, no iggy pop, or anything. i had an image of this feeling earlier today and it went something like this
wrapped to impale
within the luxury
of breath
encased in
skin
that serves
for
perfection
the thoughts
continually move
as the itch
continues to grow
in the one place
that can not
be
scratchedthis is a terrible poem. i actually can write quite well. but i can never write something i've already written once in my head.
if you could answer my question about the IM injection in terms of size of the deviced use for injection makes a difference?
i have two types a small 25g 5/8 then a long one that is 22g x 1 /2
would it make a difference since the latter one is longer and would get farther into the skin.
what do you use?
and if you don't what do you think?
thank you so much
my real name is doug
so i'm doug not reese
reese is my middle name
i return to manhattan/queens on sunday
take care
hope to hear from you soon
thanks
head that can
Posted by shelliR on March 6, 2002, at 18:44:08
In reply to Re: sidetrack from Addiction » shelliR, posted by reese1 on March 6, 2002, at 4:56:49
Reese,I don't have any knowlege of buprenorphine or buprenex IM. Now that you're back on the computer, you might do some research for yourself. Anyway, glad that it seems to be kicking in.
Shelli
Posted by reese1 on March 6, 2002, at 22:50:02
In reply to Re: sidetrack from Addiction » reese1, posted by shelliR on March 6, 2002, at 18:44:08
sheila,
thank you for responding back. the last two days the buprenex
seems to have kicked in. it's strange. you don't
feel it all at once. it's not like a normal opiate
it seems to slowly move into wihtout your notice.i was curios what others have felt with
buprenexit's interesting. i have absolutly no side
effects at all from it. what are the side
effects that people get.today was nice. i was able to play with my friends
three year old without exhaustion and sadness. i
am really good with kids because i hated being one
so i remember.but usually when i take care of kids it is quite
brutal. i can see what they are going to run into
and all the horror (to me) that is waiting. and i just
see it happening there movement into the future like slow motion.
also what is the highest dose one has tried. currently
i have been taking .6 in the morning. that is all.
i don't take anymore for the rest of the day and night.can someone inject .9 or would that make the buprenex
negate itselfalso if anyone could answer the questions about the
needles one should use for an IM shot i wouuld greatly
appreciate iti know this writing is confusing so i apologize
doug
Posted by reese1 on March 9, 2002, at 17:54:17
In reply to Re: sidetrack from Addiction » reese1, posted by shelliR on March 6, 2002, at 18:44:08
elizabeth,
do you take the medication buprenix - through injection
or sublingualy (spelling?
if you do take it sublingauly could you please tell me how you do it?
the buprenex is now being somewhat effective. It is great in the sense that it doesn't erase what is around you - meaning your problems
thank you all
p.s. i was taking it .6 dose but i have discovered that it is to high. I feel dopey and a little drugged out. Not in the high sense of dope or whatever.
bye bye
Posted by reese1 on March 9, 2002, at 17:56:54
In reply to Re: sidetrack from Addiction, posted by reese1 on March 9, 2002, at 17:54:17
one other question
can it be taken intranasely? And if it can how would one do it without wasting the medication
Posted by Zo on March 9, 2002, at 18:39:03
In reply to Re: sidetrack from Addiction » shelliR, posted by Elizabeth on March 4, 2002, at 1:19:29
Elizabeth,
I realized I must charge you, as PB's resident Buprenex authority, with remembering my experiences with Bupe and adding them to your encycolopedia. Remember that it is available as a troche, and quite effortless to control dosage and to take, that way---and remember that it sent me into *the* agitated mania of my life, suicidal, psychotic. Paradoxically, it was that episode that finally made my Bipolar II dx concrete; my pdoc subracted the bupe, added Lamictal---and I have been steadily undepressed and unsuicidal since then. September, I think it was.I tried my first psych drug in 1985--in 2001, I made it.
If I were in a place to track and respond to the bupe threads, I'd also have to talk a a bit about letting any one med becoming the holy grail--having lived that process over and over, for long enough, as have others here of course. I'd add something about Bupe's unavailability helping it appear as Grail--and about my being "saved" after all this time, by something as ordinary as Lamictal. . . at the same time that I'd discourage NO one from going after it. . . I think you understand. You're in a powerful position here to affect the suffering of others, as I know you know. You've given great hope to many; I hope my experiences can add something to your admirable efforts. I'll have to do a post with the whole gory med history. . .
Best,
Zo
Posted by shelliR on March 9, 2002, at 21:10:47
In reply to Re: sidetrack from Addiction » Elizabeth, posted by Zo on March 9, 2002, at 18:39:03
my pdoc subracted the bupe, added Lamictal---and I have been steadily undepressed and unsuicidal since then. September, I think it was.
>> If I were in a place to track and respond to the bupe threads, I'd also have to talk a bit about letting any one med becoming the holy grail--having lived that process over and over, for long enough, as have others here of course. I'd add something about Bupe's unavailability helping it appear as Grail--and about my being "saved" after all this time, by something as ordinary as Lamictal. . . at the same time that I'd discourage NO one from going after it. . . I think you understand. You're in a powerful position here to affect the suffering of others, as I know you know. You've given great hope to many; I hope my experiences can add something to your admirable efforts. I'll have to do a post with the whole gory med history. . .
>Hey Zo,
Hooray, that you are no longer in the depths. That's truly wonderful.
FWI, I think lamictal is not an ordinary drug; From my own experience and reading posts about others' experience on lamictal, I think it *can* be magical for treatment resistant depression. In fact, I am trying it again, this time with a diuretic, hoping to avoid the water weight that made me so uncomfortable and unable to fit into my clothes. Of course, like most drugs, what's magic for some is not magic for all.
Re bupe. I do think if you go through the posts, they are fairly balanced. It is certainly clear from the thread that buprenorphine is very difficult to get from your pdoc. If it works though, it can also be a magic drug for some people with treatment resistant depression. I truly feel that it saved my life. I am hoping the lamictal will take over, but since the titration for that drug is so slow, I absolutely needed something to get me out of my pain and suicidal thinking. Bupe is doing the trick.
I do think you have to treat buprenorphine with the same respect that you do other opiates. My experience is that it did make me a bit high, but I quickly acclimated to it, and now I don't feel high. I would say more energized though. Same as with other opiates. And I am watching to see how much I increase. I went back to Botkin's study and he summarizes what happens with each subject/person and many of them did need to increase; I don't know if anyone went up out of control.As for your experience of setting off a manic episode, any AD could set off that reaction. Elizabeth and I and others have talked about how opiates are energizing to us, so I suppose any drug that can be energizing can result in what you experienced with a bipolar II diagnosis.
Many of the folks who participate on this board are treatment resistant. I think it has been made clear, by even the people taking opiates, that this is not a first line defense against depression. But hope is so very important to help get through this. I think in my posts to Elizabeth, I have been very straight forward about my meltdown on methadone, and she has been straight forward, even in this thread, in admitting that she hadn't fully realized the potential of habituation. So I'm a little curious about the timing of your warning. I also disagree with your implication that Elizabeth is recommending buprenorphine to anyone who has not tried the traditional pharmaceuticals to treat their depression.
Anyway, I know you are trying to be helpful and your posts about bupe *were* helpful to me. I was warned that I might get high on buprenorphine, something I would not have expected from the literature. And knowing that, has made me realize that I may need to increase the bupe, hopefully not in the same way as oxycontin, though. Choosing between death or an opiate, I decided to go for the opiate (partial opiate), and I have no regrets. And I would hope that anyone on PB would make the same decision.
Shelli
Posted by Zo on March 12, 2002, at 2:15:27
In reply to Re: sidetrack from Addiction » Zo, posted by shelliR on March 9, 2002, at 21:10:47
I didn't really mean to imply anything about Elizabeth or anybody at all. . tho I can see I didn't express myself well. Mostly I just wanted to share my experiences. And I do NOT want to discourage anyone from having hopes around Bupe. I just remember a while back when I was trying to get it--and now I do know a compounding pharm near SF, if anyone needs that resource--there was a mini-stampede. So I hoped to add a little balance.
For whatever reason, my mania on Bupe was the worst ever, well beyond pleasure, hello psychosis. Luckily I started emailing my pdoc about hourly. Good ol' email.
You had water retention on Lamictal? I'm just starting Provigil to help set my bio. clock and for alertness, and it seems to be countering the Lamictal eats---which, mind you, are NOTHING like the Zyprexa eats!
I'm glad to have your response, Shelli, and am so glad to catch up with your progress! The first few days on Bupe were sooo nice. Actually, each hit made me high. . but who tells the truth about that. That's just the way life's supposed to be. . .isn't it? Suffused with a quite golden glow?
Zo
Posted by Elizabeth on March 12, 2002, at 8:35:19
In reply to Re: sidetrack from Addiction, posted by reese1 on March 9, 2002, at 17:54:17
> do you take the medication buprenix - through injection
>
> or sublingualy (spelling?Neither. Intranasally. (I've posted about this in the past -- do a search. The way I do it is kind of inconvenient; a pharmacist might be able to make you a metered-dose nasal inhaler, like the one used for Stadol NS). The effective dose seems to be close to the recommended doses for intramuscular injection.
Taking Buprenex solution sublingually is supposed to be a less reliable route because people tend to swallow a lot of it. The formulations intended for SL use (Subutex, Temgesic) are probably more reliable.
You asked about intramuscular injection and the size needles to use. The optimal size is probably 1 1/4", 22 ga. (I say this because I sometimes get a generic that comes in prefilled syringes, and that's the size they use. You might want to ask for this generic if you're injecting it, since retail pharmacies often don't carry a lot of different syringes.)
> p.s. i was taking it .6 dose but i have discovered that it is to high. I feel dopey and a little drugged out. Not in the high sense of dope or whatever.
That is quite a bit to take all at once, especially if you're just starting and if you're injecting it. I started at 0.15 mg (t.i.d., intranasally) because the side effects at 0.3 mg (1 mL) hit too hard (especially nausea).
On the other hand, if you're just taking it once a day, and if that works for you, it seems like a reasonable total daily dose. It's curious that some people can take it once daily. It seems to me that when people are taking it for addiction maintenance treatment, they can get away with taking it once daily, whereas for pain it's supposed to be used about thrice daily (which I find is necessary for me) for pain. It seems that the dosing schedule is variable when it's used as an antidepressant.
HTH
-elizabeth
Posted by Elizabeth on March 12, 2002, at 9:59:28
In reply to Re: sidetrack from Addiction » Elizabeth, posted by Zo on March 9, 2002, at 18:39:03
> I realized I must charge you, as PB's resident Buprenex authority, with remembering my experiences with Bupe and adding them to your encycolopedia.
I'm not really keeping a list of case reports, although perhaps I should try to do that. But yes, I do take into account that a lot of people actually feel worse on opioids, and it's good to have some case reports.
> Remember that it is available as a troche,
Don't you need to get it through a compounding pharmacy to do that? There aren't a lot of those (compounding pharmacies, that is), and compounded nedications tend to be expensive. (And buprenorphine is already pretty expensive.)
> Paradoxically, it was that episode that finally made my Bipolar II dx concrete; my pdoc subracted the bupe, added Lamictal---and I have been steadily undepressed and unsuicidal since then.
I'm not sure that antidepressant-induced mania is proof of bipolar disorder (according to DSM-IV, it's not supposed to be). Of course, if you always get manic on ADs, and you need ADs for depression, then you pretty much have to be on mood stabilizers (I think that's supposed to be considered bipolar NOS, not bipolar II). I got manic (mixed -- very horrible, I know what you're talking about) when I had a severe episode of the central serotonin syndrome, and the weird nasty depression type thing that happened when Nardil pooped out may also have been a mixed state, but these were considered to be isolated cases -- most antidepressants don't make me manic. So I might have a minor *tendency* to manic switching, but nobody would actually say I'm bipolar.
> September, I think it was.
Ahh, September. That was when I had that seizure-whatever-thingie episode. I've been taking Trileptal to prevent stuff like that; I also went off desipramine, which I think was probably a contributor.
> If I were in a place to track and respond to the bupe threads, I'd also have to talk a a bit about letting any one med becoming the holy grail--having lived that process over and over, for long enough, as have others here of course.
Yeah, I don't mean to imply that it's some kind of holy grail. I try to warn people about the side effects, potential withdrawal symptoms, etc. I definitely think it's not for everyone; rather, it's something to consider if you're seriously treatment-resistant or can only achieve partial remission with regular ADs and the more common augmentation strategies. I think opioids should pretty much be a last resort (except for ECT) and should probably usually be reserved for severe depressions.
> I'd add something about Bupe's unavailability helping it appear as Grail--and about my being "saved" after all this time, by something as ordinary as Lamictal. . . at the same time that I'd discourage NO one from going after it. . . I think you understand.
I do understand. But I'd actually discourage most people, probably. The reason is that I usually find that people who say they've tried "everything" have left some things out that are worth trying for them (often things like Lamictal, that are, as you say, pretty ordinary).
> You're in a powerful position here to affect the suffering of others, as I know you know. You've given great hope to many; I hope my experiences can add something to your admirable efforts.
Gosh, thanks. :-} I do know that, and it kind of weighs on me -- like, I feel like I have a major responsibility to be very careful in making suggestions. You know? But I really want people to know that there are things that they can try that their doctors aren't likely to suggest spontaneously, and I'm not just talking about buprenorphine here.
> I'll have to do a post with the whole gory med history. . .
I'd like to get a nice history of what happened when you took bupe, in particular. I'm puzzled by the mixed episode thing: of course I've heard of mania induced by monoaminergic ADs, but never before from an opioid. Then again, I've been sort of wondering whether buprenorphine has some unidentified nonopioid effect (perhaps involving catecholamines). What do you think?
-elizabeth
Posted by Lorraine on March 12, 2002, at 10:09:07
In reply to Re: sidetrack from Addiction » Zo, posted by shelliR on March 9, 2002, at 21:10:47
Shelli:
You know I was recently diagnosed with chronic fatigue, after extensive and correct testing by a doctor that I trust. That is not to say that I don't have depression, but that there is a reason that my body is so d***** fatigued all the time and that traditional ADs don't work and that I am so sensitive to meds. So it looks like I need to attack both ends of this, the chronic fatigue, which in my case is several active viruses run amuck (HHV6, Ebstein Bar and Cytalomega) as well as an immune system that is dysfunctional (my NK activity level sucks). What I am saying is that I think beating the "depression" dog alone would not could not provide my answer. I just keep thinking that the pain component of your illness reminds me of chronic fatigue or FMS. And, I see the use of opiates a lot in the discussion of these two conditions. You might look into it. If you do, the hard part is finding a good, reliable, honest doctor to do the tests.
I want to make it clear that I am not saying that just b/c opiates work for you, your problem is something other than depression. It may not be. I'm just suggesting that there may be another piece to your puzzle that you need to consider.
Lorraine
Posted by shelliR on March 14, 2002, at 0:21:08
In reply to Re: sidetrack from Addiction » shelliR, posted by Lorraine on March 12, 2002, at 10:09:07
Hi Lorraine,
Thanks for any and all advice.
I may look into pain centers, although I think I found a new pdoc who will proscribe bupe, but I think I
don’t want to start the intranasal stuff so I will continue to get it off the internet until it becomes FDA approved here. If I
can get documentation that he can proscribe it for pain now; just not for detox, I could probably get it overseas a lot cheaper with a script.
What is with these pdocs <mine and reese's> thinking they can't proscribe it for pain?I am interested to receive a copy of an article my father is sending me about pain, because it has a list of reputable pain centers throughout the country, including one at NIH.
It's so hard to differentiate everything. hormones, possible viruses, etc. And then I think well nardil and lacimtal helped last year (the year before?, until I decided (maybe foolishly) that I couldn't tolerate the weight gain/water retention. So I am trying lamictal again. Do you go for the root cause, or do you medicate the symptoms by using a mood stabilizer, AD, or whatever?
Life is short <at this age, anyway> and I haven't started that route getting all the tests, etc. One reason that I couldn't go further along that route (like the Hedaya route) was that I've already been tested by an osteopath, and he found that I'm allergic to everything-wheat, dairy, sugar and all sugar substitutes, actually almost everything I normally eat. I'm a vegetarian, so I can't, for instance, fill myself up with a lot of free-roaming, antibiotic free chicken. I was having a hard time finding anything to eat--I don't love vegetables and fruit was out.
What are you doing about food restrictions?
If I didn't believe that I'll have to go up on dose eventually, and if I felt that everyone wasn't treating me like a criminal, the buprenorphine is great. I don't hurt and I don't feel drugged. (Actually sometimes I wish I did feel drugged; what I went through would maybe feel less confusing and awful.) It also gets rid of all my premenstual pain, nausea and depression.
Anyway, I do think the cause vs. the treatment is important. Most people on this board who have FMS or CFS, seem to be in a lot of pain and that may also lead them to opiates. So does the diagnosis really matter? On the other hand, I admire the systematic way you've gone about looking for an answer, as well as treatment, for your fatigue and depression.
So is provigal still front and center?
Let me know how you're doing,
Shelli
Posted by reese1 on March 14, 2002, at 10:13:16
In reply to Re: sidetrack from Addiction » Lorraine, posted by shelliR on March 14, 2002, at 0:21:08
i'm sorry you feel so awful. like everyon knows here there are no words i can use to express anything or any comfort except to say i'm sorry.
if you need any information on buprenex, in new york, i could help you.
reese
Posted by shelliR on March 14, 2002, at 11:47:08
In reply to Re: sidetrack from Addiction, posted by reese1 on March 14, 2002, at 10:13:16
> i'm sorry you feel so awful. like everyon knows here there are no words i can use to express anything or any comfort except to say i'm sorry.
>
> if you need any information on buprenex, in new york, i could help you.
>
> reeseReese,
Sometimes I think maybe you don't read all of the post, or don't quite get the essence. In my post I said,
"If I didn't believe that I'll have to go up on dose eventually, and if I felt that everyone wasn't treating me like a criminal, the buprenorphine is great. I don't hurt and I don't feel drugged. (Actually sometimes I wish I did feel drugged; what I went through would maybe feel less confusing and awful.) It also gets rid of all my premenstual pain, nausea and depression.
So I am on buprenorphine and my depression has lifted. And my doctor will probably start proscribing it soon. Meanwhile I have found it easy to get off the internet, just expensive.
Do you have a problem reading the whole message? I remember that you said once that sometimes you can't get on the computer, so maybe your ability to concentrate is sometimes diminished. Anyway, thanks for your concern, but it feels strange to get so much concern when things are pretty good right now.
Shelli
Posted by reese1 on March 15, 2002, at 13:28:26
In reply to Re: sidetrack from Addiction » reese1, posted by shelliR on March 14, 2002, at 11:47:08
sorry
for whatever it's worth, sometimes when i read the posts off of email they come in incomplete.
sorry
reese
Posted by Zo on March 16, 2002, at 1:40:26
In reply to Re: buprenorphine reactions, etc. » Zo, posted by Elizabeth on March 12, 2002, at 9:59:28
I think it made me high as a kite from the first dose. Only it was the kind of seeping through the whole body kind of well-being that was secretly the way I wanted to live, all the time, and I didn't care what it took. . .bipolar II thinking. It's a lot like addict thinking. But I didn't have much experience at feeling normally good. My pdoc had faith it was possible. . .
There's no doubt Bupe sent me off on a trip--I began lying to people and to myself about being All Better (a sure sign) and the second week, I couldn't stop painting. I painted feverishly, and that weekend, came up with a real working plan to end it all. Pdoc says Mixed States is *the* most dangerous, because you're manic enough to form a good plan and driven enough to carry it out, and depressed enough to want to.
In retrospect, I thought rapid cycling was life. Yes, two drugs now have sent me into serious mood swings--yet I am clearly bipolar ll--that diagnostic thinking is diminishing, I think. . .And I could never have been so certain were not my "moods" levelled out. The wisdom of hindsight.
What this says about opiates, I don't know. I suspect my Vicodin usage was because it triggered a little mania, just a little. If you've ever been a little manic, it is the most seductive state on earth.
Yet here I am fine. Not manic and not depressed is best of all.
Zo
Posted by reese1 on March 18, 2002, at 18:13:30
In reply to Re: buprenorphine reactions, etc. » Elizabeth, posted by Zo on March 16, 2002, at 1:40:26
i'm becoming tired and somewhat sore of using the IM method for buprenex.
Could someone please explain how one would take it intranasally?
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