![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by BrittPark on September 23, 2002, at 20:05:59
In the past this subject has resulted in flame wars. I think it's an important topic so I'm bringing it up again. I'm interested in hearing about as many experiences as possible, both bad and good, with opioids for depression. In particular I'd like to see what doses people have taken of which opiates, whether dose escalation was a problem.
I'll start the confessional now. I've had recurrent major depressive episodes for the last 20 years ago. About 1 year ago when I was having another Depressive episode I suggested to my psychiatrist that a low dose of vicodin might be helpful. I'd read Dr. Bodkin's results with buprenorphine, and had experienced a marked improvement in mood when taking vicodin for pain post-operatively in the past. My psychiatrist (bless his soul) said why not, and prescribed me 1 vicodin/5 per day. I found that 2.5 worked just about as well as 5 and took that dose regularly in the evening with good results. More recently I moved up to 5, with my doctor's approval. Whether from tolerance or from poorer affect I don't know. Vicodin works well for me but only for the 4 or 5 hours after I take it. I'd take 4 vicodin/5s a day in a minute if I knew I wouldn't become tolerant.
Now tell me your experiences.
Posted by Jerrympls on September 23, 2002, at 23:32:52
In reply to Opioids and Depression, posted by BrittPark on September 23, 2002, at 20:05:59
Britt-
The use of opiates for treatment resistant depression is not common -but it's not uncommon either. A psychiatrist from Tufts university told me that the use of opiates such as Vicodin is reserved in the "last resort" category - but they ARE used and those with treatment resistant depression respond very well.
I have been on Vicodin for a couple weeks due to a painful surgucal procedure I hadd done. The vicodin almost acts as a stimulant - but doesn't make me high. I almost feel normal - better sense of well being - less anxiety - less social phobia - better sleep - laughing -listening to music, etc...
I wish I could point you to specific studies because I know there are some good ones out there pertaining to this particular subject..
You must have a wonderful doc--and an intelligent one - for him to go ahead with the Vicodin. I've found there i s aHUGE difference between the nervous, paranoid pdocs and the intelligent psychopharmocologist docs who know how to use meds and aren't afraid to use them.
The "serotonin" hyothesis of depression is slowly, but surely, going out of style - in favor for polymonoamine thepories - meaning, researchers are finally seeing that the endogenous opioid system, monoamine system (serotonin, NE, and dopamine), adrenal system (including cortisol) are all contributors of mood/emotion and work in symbiosis. From what I have researched, docs are finally understanding that serotonin imbalances are the beginning - not the end.
If I find some research examples I'll post.
Hope this helps. Feel free to email me
Jerry
slateman@mn.rr.com
Posted by Ed O`Flaherty on September 24, 2002, at 3:26:46
In reply to Opioids and Depression, posted by BrittPark on September 23, 2002, at 20:05:59
While you seem to be coping well so far the use of opiates in depression is really a last resort and most physicians will not recommend them.If you stop taking vicodin now you may suffer from craving,anxiety and depression.Try some other antidepressants perhaps and add omega-3 fish oil to your diet-see www.omega3.20megsfree.com
Posted by BrittPark on September 28, 2002, at 21:44:03
In reply to Re: Opioids and Depression » BrittPark, posted by Jerrympls on September 23, 2002, at 23:32:52
Since there has been little response I think I'll add some more grist to the mill.
It has been found that extremely low doses of naltrexone (an opiate receptor antagonist usually used to treat ODs or as a blocker of opiate effect in detoxed opiate addicts) in combination with an opiate (morphine and oxycodone have been specifically looked at, I think) produced stronger analgesia at lower opiate doses, and seem to inhibit tolerance development. On the strength of this research a company has been formed and is in stage II trials with two combination drugs.
In some people, opiates produce a strong antidepressant effect. They were the treatment of choice for depression before the discovery of the first MAOIs, remember. The difficulty is that most people develop tolerance to opiates with continued usage, such a strong tolerance that the antidepressant effect is lost. I think these new combination agonist-low dose antagonist opiates show promise as a future AD treatment.
I'm currently on a titration run with Lamictal (100mg so far), and I think I'm starting to feel an effect. I hope it continues so I can get off a number of band-aid drugs I'm taking (Ritalin, Benzos). If the lamictal doesn't work I'm thinking of asking my Psychiatrist to let me try a more aggressive opiate treatment (oxycontin), perhaps with low dose naltrexone.
I'm still looking for more people's experience with opioids for depression. There have been several protracted opioid threads in the past. Let's get the latest news. If some of you are hesitant about posting on a controversial topic, send me your stories directly and I'll summarize without names or identifying information.
Britt
Posted by Jerrympls on September 29, 2002, at 0:37:17
In reply to Re: Opioids and Depression, posted by BrittPark on September 28, 2002, at 21:44:03
Britt-
Not to get off topic - but can I ask you why you and your doc choose Lamictal and how has it helped you (if at all)? I haven't gotten to the point of asking my doc for opioid treatment - but I'm sure he'd keep an open mind if we'd tried everything else. I get a strong antidepressant effect from opiates - like Darvocet and Vicodin. Morphine - for some reason - makes me feel terrible - terribly depressed and plain and dysphoric. Years ago, I talked with a man who had tried a (then) novel aumentation approach using Naltrexone with an SSRI. I beleive a Dr. Lee Dante had been researching the combination. Anyway, this man said it helped him when no other med combo had helped. I got my doctor (years ago) to agree to give it a shot - but it was to no avail. Perhaps I wasn't on the right dosage or wasn't on it long enough (I think I was on it for 4-5 weeks). I didn't have any side effects - well, no effects at all.
Anyway, my next avenue is to check my hormone levels - a full endocrine workup. I also wanted to try augmenting the Lexapro I am on with a dopamine antagonist. However, my doc seems to be leaning towards a trial of Lamictal. I've been on Tegretol, Neurontin, Topamax, Depakote, and Lithium so I'm not sure what Lamictal has to offer (my diagnosis is major depression). So any info on your experiences would be greatly appreciated.
Thanks
Jerry
Posted by BrittPark on September 29, 2002, at 11:09:27
In reply to Re: Opioids and Depression » BrittPark, posted by Jerrympls on September 29, 2002, at 0:37:17
> Britt-
>
> Not to get off topic - but can I ask you why you and your doc choose Lamictal and how has it helped you (if at all)?Jerry,
My diagnosis is Major Depression Recurrent. It is currently recurring. I'm taking imipramine, remeron, cytomel, olanzapine, and xanax, vicodin. This depressive episode is not as severe as usual, but more persistent. At different times I've tried, paxil, modafinil, risperidone, and others too numerous to mention. We decided to try lamictal because various studies and lots of anecdotes have shown it to be effective for depressive symptoms in people with BP and unipolar depression. It seemed the best of the anti-convulsants to try.
The down side of lamictal is that it takes a long time to get to a therapeutic dose (100-300 mg). I've been increasing my dose by 25mg/day a little less than every two weeks. The only side-effect I'v noticed is a little queasiness when I first took it.Britt
Posted by Nala on October 1, 2002, at 16:08:05
In reply to Re: Opioids and Depression, posted by BrittPark on September 28, 2002, at 21:44:03
I don't know if this is info you're interested in, but I've been prescribed Lortab recently and in the past and felt incredible while taking it. I have a diagnosis of Bipolar II with a recent Severe Major Depression episode. I've never felt so bleak in my entire life and this was while I was taking anti-depressants (Remeron 45mg). But, I have always responded phenonimally to opoid-related drugs. I feel as if I'm alive. Otherwise, for the past 5 years, I feel either nothing or doom. I wish psychiatrists would re-think their approach and use this sort of drug. Perhaps this so-called "radical treatment method" could prevent a lot of Bi-polar and Depressive related suicides.
Nala
>
Since there has been little response I think I'll add some more grist to the mill.
>
> It has been found that extremely low doses of naltrexone (an opiate receptor antagonist usually used to treat ODs or as a blocker of opiate effect in detoxed opiate addicts) in combination with an opiate (morphine and oxycodone have been specifically looked at, I think) produced stronger analgesia at lower opiate doses, and seem to inhibit tolerance development. On the strength of this research a company has been formed and is in stage II trials with two combination drugs.
>
> In some people, opiates produce a strong antidepressant effect. They were the treatment of choice for depression before the discovery of the first MAOIs, remember. The difficulty is that most people develop tolerance to opiates with continued usage, such a strong tolerance that the antidepressant effect is lost. I think these new combination agonist-low dose antagonist opiates show promise as a future AD treatment.
>
> I'm currently on a titration run with Lamictal (100mg so far), and I think I'm starting to feel an effect. I hope it continues so I can get off a number of band-aid drugs I'm taking (Ritalin, Benzos). If the lamictal doesn't work I'm thinking of asking my Psychiatrist to let me try a more aggressive opiate treatment (oxycontin), perhaps with low dose naltrexone.
>
> I'm still looking for more people's experience with opioids for depression. There have been several protracted opioid threads in the past. Let's get the latest news. If some of you are hesitant about posting on a controversial topic, send me your stories directly and I'll summarize without names or identifying information.
>
> Britt
>
>
Posted by BrittPark on October 1, 2002, at 18:18:24
In reply to Re: Opioids and Depression, posted by Nala on October 1, 2002, at 16:08:05
Thanks for sharing your experience. I'm sorry you haven't had much luck with other treatments. Try to find an open minded psychiatrist and ask him to look into buprenorphine (a partial opiate agonist) as a treatment for depression. There has been some research done and there is a lot of anecdotal evidence of its efficacy for TRD right here on PB.
I have some further questions. What dose of Lortab have you taken? Did you become tolerant to the AD effect? Did you have to escalate dosage? How long did you take it? (Nosy, ain't I).
I agree with you entirely that psychiatrists, both clinicians and researchers, should be looking into opiate pathways as treatment for depression. There are a few who are doing so, but not nearly enough. There is some hope coming down the pipeline. Look up on the web for a company called Pain Therapeutics. They are in stage two trials with two opiate formulations. One is a combination of morphine and a miniscule amount of naltrexone. The other is oxycodone with a miniscule amount of naltrexone. The research of the company founders has demonstrated that the addition of a small amount of a strong opiate antagonist, naltrexone, to a full agonist not only provides better anelgesia but seems to prevent tolerance developing. The question of course is do these combination drugs retain their mood enhancing effects. I've sent an inquiry to the company, but have received no reply. They probably think I'm a crank.
Feel better,
Britt
Posted by Nala on October 3, 2002, at 16:21:17
In reply to Re: Opioids and Depression » Nala, posted by BrittPark on October 1, 2002, at 18:18:24
I was prescribed 5mg Lortab; however, 2.5mg seemed to do the trick for me once the physical pain subsided. In the past I have taken it for about 2-3 months in duration without a significant increase in dose. Also, I must mention that I take Adderall 5mg bid. I feel as though it's a synergist with any opiod-related med. I did notice a substantial dysphoric withdrawl upon stopping the Lortab after taking it for the 3 months. However, don't we also experience different somewhat dysphoric states when abruptly discontinuing anti-depressants? yes, indeed.
Nala
Posted by Kon-shuss on September 13, 2003, at 7:57:51
In reply to Re: Opioids and Depression, posted by Nala on October 3, 2002, at 16:21:17
Finally(!)....with much thanks(!)...I have found a site/posting/forum with people like me [who have Treatment-Resistant/Refractory ((Severe)) DEPRESSION]...{unipolar}. And the best part is(!!!), you R all discussing perhaps the BIGgest delima in my life: Trying 2 explain 2 the Docs that the ONLY Medications that Greatly(!) Relieves my horrible Symptoms of Severe Depression (u know the feelings) is that of the Opiate/Opioid full agonists: Morphine, Hydrocodone, and [especially] Oxycodone. Codeine does not however...it seems my body lacks enough enzymic-action to convert it too morphine (i get bad stomach cramps w/ it; OR more likely, it is a relatively weak opiate agonist all while being a partial antagonist as well.
**** To clearify my situation, i'm a 24yr old male struggling with severe mental pain (aka)Severe Depression. It hit me at the peak of my mental and physical peak in life. I was an avid runner and 'jym-junky', enjoying the symbiotic relationship with being strong, mind-body-soul.....all while - euphorically - sucking in every last drop of endorphins, and well, life. On top of that, me being a single male of 19yrs going head-on into college, down-wind of all the female pheromones; hormones all off-the-charts. You cant get that much better in life!
Then 'it' hit me. My depression hit with such precision, that i can -to this day- recall the exact moment, place, and time to where my whole life since then has been a downward-spiral of unexplained hopelessness, dispair, sadness, anxiety, and wanting ALL the pain to end: suicide planning.
To make the long story short for now, after the first year, i was convinced i had mono, anemia, cancer, thyroid problems, something physically wrong. At first it seemed just like i was coming down with the flu or a cold, BUT it never progressed into the cold or flu, .... it just felt like something was sucking the "lifeforce" slowly right out of me. ...I wanted answers....anything to explain my intense fatigue; hypersomnia; no motivation; guilt; shame; sadness.
So jump foreward two years; I was finally diagnosed with Severe Depression, after a full battery of physical blood tests [and the later: psycological tests], urinology, physicals. Mono, anemia, cancer, HIV, liver, kidney, blood, thyroid, .....U name it, they tested it: all results came back negative. As far as the physical tests were concerned, i was "fit as a fissle". As for the Hamilton Depression Scale Test, I was a positive for EVERY Q. So finally, i was diagnosed right.The bad part is, little did i know that i would fit in and become one of the few, the not-so-proud, the Treatment-Resistant/Refractory catagory 4 severe unipolor, atypical, depression.
****Now just 2 jump back 2 the begining from all this for a second, one very important clue has to be stated: As i stated before, i was an avid health and exercise person; pumpin' iron, running, and just overall being in tip-top physical shape, not to mention mentally from the stress relieving endorphins my body avidly produced during my day-to-day activities. My critical clue-point is: when my depression hit me that one day, back when I thought I was just "comming down with something", I just didn't "throw in the towel"....running and weight-training was a passion for me; a deep rooted source of self-contentment and happiness. I kept runnun' and going to the gym, but at a lesser intensity level, cuz I felt kinda sick. This same type of "less-intense workouts" in the past boosted my immune system (by increased metabololism/nutrient uptake/ect.) to such a point my colds where gone in 2 days flat and the flu's where defeated in half normal time...
... ... BUT something was different this time. No matter how intense or less intense i worked out, it just litterally(!) seemed like my body was not producing it's natural pain-killin' endorphins/enkalphins that made working out worthwhile. I even took breaks, a week, sometimes two weeks at a time, figuring i might me overstrenuating myself in some way, even though it made no sense; I felt perfect before and had a complete lack of injuries. All these clues and signs hit me one day.
***That day was after being treat {totally} unsuccessfully for 2+ years buy the docs: Max doses and duration of Prozac, Paxil, Zoloft, Effexor; and max augmention (boosters) of the following: Wellbutrin, Trazodone, Lithium, Depakote, and even Dextroamphetamine. Not even titrated-augmentation Dexadrine 50mg/day w/ 375mg day Effexor XR could pull me out of my "funk" and release me from my fatigue. I mean, it's speed for "crikes-sake"!
********)here's the end folks...please bare w/me..........so anyway....back to that "day" i was talking about. I realized a theory that my source(s) of depression were merely NOT becuase of decreased Serotonin, hence the multiple SSRIs, SNRI.......but rather, there is some sort of deficiency with my endocrine systems, specifically the endorphine and enkalphine systems. I have perposely and adevertently proved this to my self, personally. First, lets be frank and honest here folks; for those of us who have a severe disabling mental-illness, the issue of self-medicating certainly comes up, especially if the "non-habit-forming" Rx the doc gave you isn't doing a thing but give you severely-uncomfortable withdraw symtoms when you happen to stop taking them (that's a whole other issue). Self-medicating is a survival instinct and means something is still wrong. I found out alcohol makes me 10x depressed, now matter what setting i'm in.....so laterz for the booz. Medical-grade Marijuana helped greatly for mild to moderate depression in my case at one particular period of time. It lifted me out of the pessimistic-thought cycle, increased my motivation for hope and future goals, and increased my appetite (my depression reaked havoch on my need to eat. But let me say again: Cannabis (Marijuana) can help mild to moderate depression, not the severe type... ... and most importantly, Marijuana effects people different-as oppossed to Nicotine or alcohol- so keep in mind that Medical Marijuana IS NOT FOR EVERYONE.*****
**** But, through and through, at times during my past years of Depression, I had a few left over Vicodans[hyrocodone/tylenol] from a prior wisdom tooth pulling, and a couple Percocets[oxycodone/tylenol]....also some TYLENOL#3[codeine].....I guess i just hung on to them in case of a really bad fever or stubbed toe or something else painfull rather.
We'll, as fate had it, there was a remarkable antidepressant effect upon taking the recommended dosage of Vicodan and especially Percocet (1-2 pills every 4-6hrs).**** For the first time since this dark cloud of disabling-depressive sadness made it's home within my head, i felt alive again, NORMAL...if that makes any sense. This was not at all my very first experience taking a RX narcotic. Like when i was 16 and went snowboarding at a local resort,
my second run down, I landed pretty hard on my ar'ss and got a bad headache. So a friend at the time gave me half a regular Vicodan as i can remember. Man(!) i was knocked-out, sedated. I spent the rest of the day sleeping in the van, as the others shredded the slopes. But that was before my now-seemed "endorphine" depression. Back then, that little bit of Opioid [hydrocodone] combined with a healthy, already, endorphine juiced-up brain was an overload. A knock-out pill 2 me at the time.That was years ago; these years are new now....new of trials and tribulationals with the docs; hopelessness and utter mental-pain, with all these drugs being tried on me with no resolve or avail....they barely keep afloat from suicide.....a good thing yes, but for being on it, weather it be Paxil of Effexor, they start to lose their even miniscule effect of keeping me just barely afloat. I suffer withdraw symptoms that resemble siezure-like shocks, passing-out, rebound drepression, more sucidal thoughts, and anxiety.
But when oxycodone or other strong opioid enters my system now....I feel no sedation, no 'high', no "hopped-up", drugged-up euphoria and imparment,..........I feel as though the dark clouds of depression have been chased off atleat for the time....ohhhh what a wonderfull sensation of feeling normal, back to my past of having energy, not fatigue, back to smiling, instead of crying, back to hope where there was once hopelessness, and motivation instead of moping, and peace instead of anxiety, and restfull dreaming apart from restless nightmares. A paradoxial reaction i say it is. Such an earlier and similar question confused the medical communty: Why give amphetamines, speed, ADDeral, Ritalin [controlled substances normally reserved for narcoleptics]['addictive'] to children and adults whom have ADD/ADHD; people who act as though they are already on stimulants? Why? Because it just works....a paradoxial effect. The same goes for me....:Why give me an addictive, controlled substance, normally reserved for ones in great physical pain, to someone like me who looks as though I'm allready on narcotics: sleepiness, fatige, dull and slow thought process, dull mood, ect? Becuase it just works, .....a paradoxial effect....symptoms reversed! Also, this shouldn't be suprising, that since opiate/opioids elieviate physical pain, why not psychological pain? But of course it cant be denied: Coventional antidepressents (SSRIs;SNRIs;TCAs;and MAOIs) help, eleviate, and repress the same symptoms i have. I wish i was one of those, but i'm not...i have a unique case of being in that small percentage of those who don't respond. I'm not some 'druggy' looking to get high; i'm a person who was once healthy, but now is ill. All i wish is to have my syptoms repressed, so i can go back and catch up to my dreams and life that have been put on hold, and forget the "old life" that even threatened my own being: The ideas for a quick-fix exit out of serious pain: suicide.
I have great hope now for a medicine -that I know with all my being- that will work againts my impending doom of Depression: Time-released Oxycontin prescrbed in conjunction with Nolexone(sp?) to solve the problems of tolerance and long-term use.
The greatest challenge of all will be to communicate this with the well "established-minded" and "Pharmacuitical Company-Programed" Western Medical Doctors,...my fate lies within them.
Thankyou all for reading my thoughts and convictions,
With Hope And Sincerety,Gabriel H. Croissant
Posted by craig allen on September 13, 2003, at 17:30:35
In reply to Re: Opioids and Depression, posted by Kon-shuss on September 13, 2003, at 7:57:51
always reassuring to be reminded that there are other people out there with the same experience as me. i'm an atypical depressive. no, partial or transient response to 20 or so different medications so far. the only thing that makes me feel well are opiates. matter of fact, before i got sober and was treated for "depression," i was addicted to pain killers, then heroin. a couple of times since i've been "sober," i've had to take codeine for physical pain. each time i've been reminded of the profound relief it brings to my mood. the problem with using these drugs of course, is the quick tolerance and all the problems that come with it. if they could develop something that didn't have this nasty problem, for once i'd be a happy guy. well, i could go on and on about this topic but enough for now. thanks for the interesting posts.
Posted by jerrympls on September 13, 2003, at 21:34:52
In reply to Re: Opioids and Depression, posted by craig allen on September 13, 2003, at 17:30:35
Hydrocodone (is in Vicodin) has ALWAYS been the best antidepressant for me - increases my mood to "normal," brings back my motivation, longing to live, reduces fatigue, helpe me sleep better - everything the SSRI's are SUPPOSED to do but never do for many of us. I've never gained any tolerance to opiates - when I've been on them for extended periods of time after a surgery, dental work, etc.
I get so frustrated because doctors throw SSRI's at us saying, "Oh, we'll increase it by 5mg and then you should be fine" or whatever - and I just want to say "Vicodin will save my life not an SSRI!!" How many years of my life do I have to waste being on ineffective meds before a doc tries something "unconventional" like an opiate???? I know that docs do that too because I brought it up to my reseach psych doc once and he said "Yes, there are conditions in which opiates are used for depression."
WELL!?!???!!?!? I'm 31 - have been battleing depression since age 20. Antidepressants, ECT, VNS and therapy have only made me plain, more depressed with side effects. Do I need to beg? Plead my case with research? Cry? attempt suicide? I have a list of all the meds that I've been on over the years and I've been on EVERYTHING - and EVERY combination - then the doctos say - "Well, let's try Prozac again..." for the 4th time!!!!!!!!!!!!!!! NO!!!!!!!!!!!!!!
UGH!!!!! Sorry I'm just so frustrated that depression is/has ruined a GREAT portion of my life, pushed away family and friends....something that could help me sooo much is right there - but doctors would rather prescribe months worth of amphetamines and not something like Vicodin - because "Vicodin is addictive." And amphetamine is not??
I jsut don't get it.....thanks for letting me vent.
Jerry
Posted by Questionmark on September 13, 2003, at 22:45:24
In reply to Re: Opioids and Depression, posted by jerrympls on September 13, 2003, at 21:34:52
Hey, i just wanted to comment on this, and add my own complaints. i don't personally know if opioids would be beneficial for me on a consistent basis (though i do love what they do on the rare times i actually get to try them). But i do think it's FREAKING ridiculous how so many pdocs are so freaking reluctant to try opioids or any other "questionable" drug for patients who really believe they might help them-- especially for those who HAVE tried numerous other drugs. i mean, isn't EVERY drug addictive-- or at least able to cause dependence-- to some extent? Opioids, benzodiazepines, SSRIs, whatEVER-- they can all cause dependence, right? So come on, i mean seriously. Also, (like Jerry kinda said) how bad off does one have to be before they'll consider something like opioids? i mean, if someone's in severe physical pain they won't be morons about giving narcotics, so why not severe psychoLOGical pain?! i mean if someone is suicidally depressed, for example, is that not reason enough to try desperate measures for f***'s sake??? But no, you can't mention anything about being suicidal, cuz then they'll send you to some @#*&ing mental institution and pump you full of antipsychotics or some bull**** like that. It's freaking ridiculous. It's so stupid. People are so stupid. And psychiatrists are no exception to that. Makes me sick. Okay i'm done.
> Hydrocodone (is in Vicodin) has ALWAYS been the best antidepressant for me - increases my mood to "normal," brings back my motivation, longing to live, reduces fatigue, helpe me sleep better - everything the SSRI's are SUPPOSED to do but never do for many of us. I've never gained any tolerance to opiates - when I've been on them for extended periods of time after a surgery, dental work, etc.
>
> I get so frustrated because doctors throw SSRI's at us saying, "Oh, we'll increase it by 5mg and then you should be fine" or whatever - and I just want to say "Vicodin will save my life not an SSRI!!" How many years of my life do I have to waste being on ineffective meds before a doc tries something "unconventional" like an opiate???? I know that docs do that too because I brought it up to my reseach psych doc once and he said "Yes, there are conditions in which opiates are used for depression."
>
> WELL!?!???!!?!? I'm 31 - have been battleing depression since age 20. Antidepressants, ECT, VNS and therapy have only made me plain, more depressed with side effects. Do I need to beg? Plead my case with research? Cry? attempt suicide? I have a list of all the meds that I've been on over the years and I've been on EVERYTHING - and EVERY combination - then the doctos say - "Well, let's try Prozac again..." for the 4th time!!!!!!!!!!!!!!! NO!!!!!!!!!!!!!!
>
> UGH!!!!! Sorry I'm just so frustrated that depression is/has ruined a GREAT portion of my life, pushed away family and friends....something that could help me sooo much is right there - but doctors would rather prescribe months worth of amphetamines and not something like Vicodin - because "Vicodin is addictive." And amphetamine is not??
>
> I jsut don't get it.....thanks for letting me vent.
>
> Jerry
Posted by craig allen on September 14, 2003, at 0:28:11
In reply to Rant, posted by Questionmark on September 13, 2003, at 22:45:24
i'm with you on the rant. the problem of tolerance with opiates is huge however. my experience is that within days, they stop being effective and the doseage continually needs to be increased. as this happens, the withdrawal becomes a constant battle and before you know it, you're in a bad addictive cycle and the depression is a lot worse than it was before. until they develop a drug that eliminates this tolerance process, the opiates aren't going to improve depression long term. they make it much worse. i'm not speaking from a theoretic perspective - i'm basing this on experience. a lot of it. the potential good news, i guess, is that some drugs are in the works. i looked at the website one of the previous posters suggested, Pain Therapeutics, and they are at least claiming to be on to something. if they are, then the battle will be getting psychiatrists to prescribe it. i'll believe all of it when i see it. has anyone been on a long acting opiate with low dose naltrexone? apparently, that is what Pain Therapeutics is developing (a combination drug). if so, how did it work?
Posted by femlite on September 15, 2003, at 10:39:31
In reply to Re: Rant, posted by craig allen on September 14, 2003, at 0:28:11
> i'm with you on the rant. the problem of tolerance with opiates is huge however. my experience is that within days, they stop being effective and the doseage continually needs to be increased. as this happens, the withdrawal becomes a constant battle and before you know it, you're in a bad addictive cycle and the depression is a lot worse than it was before. until they develop a drug that eliminates this tolerance process, the opiates aren't going to improve depression long term. they make it much worse. i'm not speaking from a theoretic perspective - i'm basing this on experience. a lot of it. the potential good news, i guess, is that some drugs are in the works. i looked at the website one of the previous posters suggested, Pain Therapeutics, and they are at least claiming to be on to something. if they are, then the battle will be getting psychiatrists to prescribe it. i'll believe all of it when i see it. has anyone been on a long acting opiate with low dose naltrexone? apparently, that is what Pain Therapeutics is developing (a combination drug). if so, how did it work?
Hi Craig Allen and QUESTIONMARK,
I guess this is a case of individuals responding differently, just like all the other drugs posted about on this site.
I agree, the tolerance side effect is an issue. But it did not seem like a serious issue for me.
I stayed at the same dose for months When I did move up, I had to split and even quarter my pills to prevent the side effects of sedation or nausea.
So my dose would would increase by quarter doses for a month or so. Maybe I wasnt on them long enough to experience the side effect you describe.
But a year isn't a short amount of time.I am also frustrated at how hysterical people get when the issue of opiods used for depression is brought up.
I had little to no side effects using theraputic doses of opiods, UNLIKE the AD Im on now.
And I quit taking them cold, had a little achiness for a week and then I was fine.I appreciate the courage you all have displayed to bring up this subject. Maybe opiods in their current form are lacking, but as more people speak up, and the demand for research increases, an answer will be found.
The research Ive read indicates that 2 out of every hundred people end up with an abuse problem.
The point you make about opiods increasing depression is a valid concern. It may indicate, (as in the case of other ADs) that opiods are not the right med for some people, a point that needs further research and observation.
Courage
Posted by Kon-shuss on September 16, 2003, at 17:52:48
In reply to Re: Rant -- To QUESTION MARK » craig allen, posted by femlite on September 15, 2003, at 10:39:31
Naltrexone(!) .... yes.....yes...as two other poster's (i believe "craig"&"femlite") mentioned: the biggest problem of using Opiates/Opioids, is that tollerance is built up rapidly.
But as some of us have already mentioned, the tollerance can be stopped, stabilized, and even reversed when small amounts(1.2mg-4.5mg) of the drug Naltexone are given within the dosing regimen of the Opioids/Opiates.To ALL of us on this thread,... expressing their positive (antidepressant) experiences with the use of Opiates/Opioids......Do Not give up, ....AND because we have more than one thing in common, we need to stick together, atleast on this board. ... ...And what about DR.Bob? I would be curious to see his view(s) and/OR take of knowledge on: Treatment-Resistant Depression & Opioids/Opiates, tollerance and Naltrexone.
Peace2ya'll______________"(kon)-shuss"
Posted by Kon-shuss on September 16, 2003, at 18:18:06
In reply to Re: Opioids and Depression, posted by Nala on October 1, 2002, at 16:08:05
Posted by craig allen on September 16, 2003, at 21:29:44
In reply to Re: OpioidsDepression:TheKey2LockTolerance:NALTRE » femlite, posted by Kon-shuss on September 16, 2003, at 17:52:48
hey kon-shuss. have you been on the naltrexone with opioids treatment plan, or have you only read about it? sounds almost too good to be true. opioids with little or no tolerance? i guess they put a man on the moon though and someone even made a seedless watermelon. i'd be more encouraged if i heard from some people who actually have taken this combo and had it work. anyone out there?
Posted by BrittPark on September 16, 2003, at 22:12:13
In reply to Re: OpioidsDepression:TheKey2LockTolerance:NALTRE » Kon-shuss, posted by craig allen on September 16, 2003, at 21:29:44
> hey kon-shuss. have you been on the naltrexone with opioids treatment plan, or have you only read about it? sounds almost too good to be true. opioids with little or no tolerance? i guess they put a man on the moon though and someone even made a seedless watermelon. i'd be more encouraged if i heard from some people who actually have taken this combo and had it work. anyone out there?
Oxytrex, at least, has made it through phase II trials, which have demonstrated safety and efficacy in small studies of 10s of people. The studies, according to Medline have not been published. Oxytrex is now heading into phase III trials which will include 100s of subjects, and should demonstrate clearly whether the formulation produces less or, one hopes, no tolerance. The question, "is OxyTrex effective at improving mood?", the one most relevant to psychiatry will undoubtedly not be answered, at least directly. Pain therapeutics is concerned with OxyTrex's efficacy as an analgesic not as a mood enhancer. I read some months ago that the developers of OxyTrex claimed that it was not euphoriant. This would be bad news for psychiatric purposes, but I have some hope that Pain Therapeutics is trying to avoid any approval hang-ups from "abusibility" concerns by claiming non euphoriant status.
I think, from my perusal of the animal studies, that OxyTrex will turn out to be, if not completely non-tolerance-building, much less so than simple oxycodone. It will probably be a few years before there will be even any anecdotal evidence of its efficacy or non-efficacy for mood disorders.
Remember good clinical studies are a much better guides than individual experiences, to the effectiveness of drugs.
Cheers,
Britt
Posted by Liligoth on September 17, 2003, at 3:00:51
In reply to Re: OpioidsDepression:TheKey2LockTolerance:NALTRE, posted by BrittPark on September 16, 2003, at 22:12:13
from what Ive read of others' experience there isnt a big problem with building tolerance to buprenorphine. I dont know whether this is true & due to the fact that it has agonist & antagonist properties. So far for me it is having a far stronger effect now Im on a lower dose but managing to take the sublingual tabs properly. Before I was just swallowing it all. Even so it doesnt produce that opiate like euphoria but is very effective on my mood.
Posted by craig allen on September 17, 2003, at 19:18:53
In reply to Re: OpioidsDepression:TheKey2LockTolerance:NALTRE, posted by Liligoth on September 17, 2003, at 3:00:51
interesting on the buprenorphine. i think i was on it once while in detox. if i remember, the brand name is bupronex? why were you prescribed this drug - to treat mood problems or something else? do you get a crash when it stops working? i'll take this drug up with my doc, see if i get anywhere.
Posted by Liligoth on September 18, 2003, at 2:30:58
In reply to Re: OpioidsDepression:TheKey2LockTolerance:NALTRE » Liligoth, posted by craig allen on September 17, 2003, at 19:18:53
> interesting on the buprenorphine. i think i was on it once while in detox. if i remember, the brand name is bupronex? why were you prescribed this drug - to treat mood problems or something else? do you get a crash when it stops working? i'll take this drug up with my doc, see if i get anywhere.
Hi Craig, I think Bupronex is one form of it available in the US. I take one called Temgesic & it is prescribed for depression. I hasnt crashed out yet - its only been about 5-6 weeks. So far so good. Good Luck!
Posted by Kon-shuss on September 18, 2003, at 3:00:41
In reply to Re: OpioidsDepression:TheKey2LockTolerance:NALTRE » Liligoth, posted by craig allen on September 17, 2003, at 19:18:53
...yep, that gal sure knows her stuff ;)
... so as Britt pointed out in her last quirey, "...in the future when one takes OxyTrex, how would we know if the psychological effect can keep up to par with the analgesic effects?" Well, if you ask me, I'am totally convinced they go HAND-IN-HAND,.... that is 2 say......: if the analgesic [physiological] tolerance properties are stabilized in use of OxyTrex, then the psychological [antidepressant] tolerance properties MUST be stabilized as well. (Narcotics* are antidepressants BECAUSE of their unique analgesic mechanisms'/pathways in the body)
* =Meaning, Full-Opiate Agonist(s)
I really cant be that surprised to find out that the ONLY medication (out of a long list of failed) I have responded to, with marked antidepressant effects, is that of the full-opiate agonists (morphine, oxycodone, hyrocodone, ect.)..... I mean, to really describe the true disabling, even 'life threatening', symptoms of my Severe [treatment-resistant/refrectory] Depression, is as simply as: chronic mental/emotional pain. Pain in one sense is not merely that different than that of the other sense. Prescription pain medication is what i responded to(unfortunately), becuase 'pain' is what i deal with on a chronic level. I say "unfortunatelly" fittingly, because I wish I'd responded to the traditional and orthodox meds over the years.
Also, ... in case someone has not read all the threads previous: The above references to "analgesics/narcotics/Full-Opiate Agonists" and "antidepressant", IT IS TO SAY, Opiate agonists [such as morphine, hydrocodone, oxycodone, ect] can and have a pronounced antidepressant effect upon a small percentage of people suffering from: Severe [Treatment-Resistant/Refractory] Depression....BUT THE LAST BIT OF INFO I WANNA SHARE WITH YA'LL, is some more in-depth evidence on exactly how *SMALL DOSES* of the 'full-opiate ''Antagonist'' -NALTREXONE- stabilizes the tolerance of long/short term use of the 'full-opiate ''Agonist'' - OXYCODONE.
So; from what i have read and know,... the main reason [full]Opiate agonists **-aka-:narcotics: morphine, oxycodone, hydrocodone, hydromorphine, fenatyl, dimorphine[heroin], ect.-** build tolerace in the user MUCH FASTER than compared to other non-narc CNS depressants and CNS stimulants is this: Not only do Opiates/Opioids react the body into producing less of its own, natural opiates (endorphins/enkalphins) over duration and dose-intensity, THEY also react the body into producing MORE opiate receptors. And that's the 'key difference' right there.....; 'that' production of "More opiate receptors", combined with the under-production of endorphins/enkalphins IS what really makes the body's tolerance climb fast and high...(all relative to dose-intensity and duration, of course). And here's the real "kicker": those newly-produced receptors are actually "pseudo-receptors", meaning: they don't work.......they just have opiate-receptor affinity, and that's all. They just allow an opiate/opioid or endorphin/enkalphin to bind there (with no cell action) other then to keep 'em there. THAT IS THE KEY DIFFERENCE in terms of tolerance build-up when compared to other non-narc CNS depressants and CNS stimulants. (With benzo's and barbituates, tolerance is created when the body starts to under-produce it's natural GABA ((and an increase of some more enzymes)).)(With cocaine and meth/amphetamine, tolerance is created when the body starts to under-produce it's natural Dopamine and Norepinephrine ((and an increase of some more enzymes)).) AND ALSO, IT MUST BE NOTED, & generally speaking, that tolerance with ANY SUBSTANCE (least of which NARCOTICS) is also the result -to some degree- of the substances' respected enzyme being produced increasingly, of which alcohol tolerance results especially and completely in this "enzyme category"."wssshhhhhheewww"....
NOW,... this is where low doses of NALTREXONE comes into play when stabilizing tolerance to Opiates and/or Opioids (ie: morphine; oxycodone):............ We'll, first of which should be understood of Naltrexone, is that it is a full-opiate receptor antagonist, meaning, if taken at a full dose (say, 50mg) with the body having a full dose of Opiates/Opioids on it, Naltrexone binds to the Opiate/Opioid receptors, "kicking out" the Opiate/Opioid substance and completely REVERSING the previous 'narcotic' effects. Contrary to what was shown on the movie "Pulp Fiction";... the scene where the woman overdoses on some high-grade heroin and in return they "antidote" her with a IV shot of adrenaline directly into the heart. Come on(!)... ...you're talkin' about some serious 'speedballin'. A full dose IV shot of Naltrexone is the true overdose antidote,...and not in the heart, either. That's why it was made in the first place;... ...Naltrexone (or Noxolone) reverses the effects of narcotics, as said before;... a true narcotic antidote, not only made for OD's, but for use during detox programs.
THAT BEING SAID, concerning what a full dose of Naltrexone demonstrates in the presence of narcotics (Opiates/Opioids)... ... there is the issue of the recently found properties [and now, benefits] of LOW DOSES of Naltrexone with full doses of Opiate/Opioid narcotics [ie: morphine and oxycodone, respectively].
*****The recently found property upon giving low doses of Naltrexone with full doses of an Opioid narcotic [example: 2.5mg/day Naltrexone WITH 60mg/day Oxycontin(time-releaseOxycodone)] IS: TOLERANCE TO THE OXYCONTIN WAS STABILIZED.
This pheonomena of low-dose Naltrexone to stabilize the tolerance of powerfull narcotics, shows the great benefit of making the long-term use of powerfull time-released Opioids CONSIDERABLY SAFER(!), by many times fold. Because before (and still present), people who need long-trem use of narcotics are having to take several 160mg time-release oxycodone's per day(!) due to the unstabilized tolerance that continues to climb after only over a year or so of use;... ... ... Outrageous amounts of narcotics being consumed that it definately 'opens the gate up' on drug-costs, side effects, and most importantly, SAFETY! Now imagine that tolerance has been stabilized, and that the same person need only AT MOST 80mg/day Oxycontin and retain all the same pain-relieving effects for years.SO HOW DOES LOW DOSES OF NALTREXONE DO THIS?.....this ability to stabilize one's tolerance to narcotics?
: current evidence shows that the low-doses of Naltrexone simply seems to INHIBIT the formation of those "pseudo"opiate-receptors... ...the one's that form normally when full-opiate agonist narcotics are taken WITHOUT low dose full-opiate antagonists [Naltrexone; Naloxone].
Man(!)....the evidence really shows, that if the formation of those extra, 'fake' opiate-receptors can be stopped, tolerance stops signifigantly with it.
OK...that was a lot....but i had 2 share that with ya'll and those who might stumble-upon it in the near future.
And as BrittPark stated before, those people at Pain Theraputics know of the benefits, too.....they're not too far off from releasing their two-in-one pill on the market... with a fitting name to suit it: "OxyTrex": Oxycodone(time-release)w/ low-dose Naltrexone.
Thankx 'Britt' 4 the company name so I could see their website: www.PainTheraputics.netAlso, BrittPark....where did you find the info on the MS Contin/Naltrexone pill.?....i couldn't find any info on the time-release morphine-sulphate w/Naltrexone type medication. Only OxyTrex info I could find at Pain Theraputics. hmmmmmm?
Peace>>>>"(Kon)-shuss"
Posted by Liligoth on September 18, 2003, at 18:25:25
In reply to Re: OpioidsDepression: (BrittPark rules!), posted by Kon-shuss on September 18, 2003, at 3:00:41
hey Konshuss thanks for making the effort of posting all that I had been wondering how that effect worked & now I know! :)
cheers,
Posted by craig allen on September 18, 2003, at 20:49:10
In reply to Re: OpioidsDepression: (BrittPark rules!), posted by Kon-shuss on September 18, 2003, at 3:00:41
good post, real informative. thanks for taking the time. why wait for oxytrex though? if you can get a doc to go for it, why not just take the oxycontin and a low dose naltrexone? i've been walking around in mental pain for many years now too. i'm ready for something that helps. frustrating. i read all the pro-nardil posts on this board and finally decided to wean off effexor and then endure the washout. i'm now in my sixth week of nardil and i'm in as bad a shape as ever. it's ridiculous all the failed medications and their side effects i'm constantly enduring. obviously, my problem isn't serotonin, norepenephrine, dopamine related. so what are my options? give me some oxytrex already. i'm sick and tired. sorry to rant.
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