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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 43 to 67 of 262. Go back in thread:
Posted by Dr. Bob on January 25, 2003, at 10:00:23
In reply to Re: opiates and major depression, posted by androog on January 24, 2003, at 13:33:00
> 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:
>
> xxxI know you're trying to help, but I think it's best if the physician is licensed in the state of the patient.
Bob
PS: Follow-ups regarding posting policies should be redirected to Psycho-Babble Administration, thanks.
Posted by Dr. Bob on January 25, 2003, at 11:17:59
In reply to Re: opiates and major depression, posted by Blah on January 23, 2003, at 22:40:06
> 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.
I know you may think you don't have any other options, and the above general questions are fine, but I'd rather specific information that could be used to import prescription medication without a prescription not be exchanged on this site:
http://www.dr-bob.org/babble/faq.html#illegal
Thanks,
Bob
PS: Follow-ups regarding posting policies should be redirected to Psycho-Babble Administration. Here's a link:
Posted by androog on January 25, 2003, at 11:53:22
In reply to Re: licensed physicians » androog, posted by Dr. Bob on January 25, 2003, at 10:00:23
Sorry. This site is a great outlet for people like us and I don't mean to abuse it.
androog
Posted by Mattkit on January 25, 2003, at 13:42:43
In reply to Re: opiates and major depression, posted by androog on January 25, 2003, at 0:08:59
Hi,
I just wanted to relay my thought on the opiate subject too. I also tried many many different antidepressents, many that have some serious side effects on liver like effexor, etc. Nothing ever worked for me also. I finally quit the search and
ended just living miserably for quite some time now. In the past when I ever hurt something like my back once in an accident, my ankle, just basic
strains, and when I was prescribed codeine, or
other opiate drugs for pain, I noticed something,
I would with one pill, have an interest for life
again. This past week on thurs 1/23/03 I had my wisdom teeth removed. They prescribed 15 pills of
Vicoprofin for pain (another opiate), I have taken about 2 per day now and bingo I have a real interest in living again. Since thursday I have
cleaned my house for the first time in months,
I am going out to excercise and my mind has totally changed from depression. I can see I need to find a psychiatrist that is willing to prescribe opiates for depression (non abusing).
We are in such a bullshit world as far as all these docs only prescribing all this anti depresent drugs like prozac, zoloft, etc cause the
pharmacuetical companies pay them to prescribe them. Not to say they havent helped some but really we are all kind of Guinea Pigs as far as the long term goes with these drugs. Oh and they say but "their non addictive" (even though you may hav to tke them forever???). I want something
that works and am just sick of all the bull in
the psyco world. Also wanted to say that I have
taken Ultra tremedol and have had the same interest in life as opiates. Ultram is not an opiate but works the same way as them so its worth giving a try. I also saw the sites where you can get the tremedol so if anyone has success
with this please let me know. Thanks alot Matt
Posted by Mattkit on January 25, 2003, at 13:59:28
In reply to Re: medication without a prescription » Blah, posted by Dr. Bob on January 25, 2003, at 11:17:59
Dr Bob,
What are your thoughts on using opiates for depresion?
I have had some really bad experiences with
psychiatrists and psychotherapists (never discussing the use of opiates with them) but
with being prescribed other drugs where if I wasnt on top of my own medical history and we all know when your depressed its easy to just go along
with the docs, I could have had some serious
liver problems, some docs prescribe stuff and dont even know your medical history. They look at
opiates as "taboo", almost like they just want you
to come back and back for that weekly money they
get from you while putting you on stuff that takes months to see if it works. I think this country needs to do a complete change on psychiatry and get away from the pharmacuetical companies and what their coming out with next.
I agree with some to take it into their own hands
to find their own solution. Especially after the experience I have had in the psychiatric world.
Wasting thousands of dollars and, mostly, time of
MY life.
Posted by androog on January 25, 2003, at 15:07:34
In reply to Re: medication without a prescription, posted by Mattkit on January 25, 2003, at 13:59:28
Hi all,
Does anyone know what the statistics are regarding the success rate of ALL the antidepressants as a group? By this I mean, if you had 100 people who suffered from major depression and treated them all with ALL the drugs marketed as antidepressants, what percentage of the group would show significant improvement?
I'd also like to know, roughly, how many people who suffer from refractory major depression respond signigicantly to opiates.
I keep reading all of this good stuff about opiates, but surely there are people who have had no luck with, or even deteriorated from, opiates in the treatment of their depression.
androog
Posted by BrittPark on January 25, 2003, at 15:57:49
In reply to Re: medication without a prescription, posted by androog on January 25, 2003, at 15:07:34
> Does anyone know what the statistics are regarding the success rate of ALL the antidepressants as a group? By this I mean, if you had 100 people who suffered from major depression and treated them all with ALL the drugs marketed as antidepressants, what percentage of the group would show significant improvement?
This is a great question. I don't know of any study that speaks to it. My guess is that given enough time and drug trials, the response rate is 80-90%. I base this on what my psychiatrist, a superb psychopharmacologist, has told me. In his practice he's never, given enough time, not successfully treated a patient. That leaves out the people who leave his care. Now he may have been saying that to make me feel more hopeful at the time, but given his character I don't think so.
>
> I'd also like to know, roughly, how many people who suffer from refractory major depression respond signigicantly to opiates.Another great question. I've never found a study even remotely likely to answer it. My guess is that a majority of people would respond well to opioids, based on the number of people I know who have found opioids pleasurable. This begs another question: what percentage of people get a continued AD effect from opioids? I would guess that the number is small because most people develop tolerance. I wish that the whole realm of opioids and psychiatry would get federal funding for research, but don't think I'll see it in my lifetime. The principle in psychiatric research seems to be that anything that makes "normal" people feel better cannot be considered.
>
> I keep reading all of this good stuff about opiates, but surely there are people who have had no luck with, or even deteriorated from, opiates in the treatment of their depression.I'm sure there are many who've not been helped and even hurt by opioids. I'm not, of course, including the large number of people damaged by illicit opioids.
>
> androog
Britt
Posted by Blah on January 25, 2003, at 17:32:02
In reply to Re: opiates and major depression » Blah, posted by ShelliR on January 24, 2003, at 19:46:03
When you say pain doctor what kind of doctor do you mean, an orthopiedist? I probably spelled that wrong. What I'm asking is what would I look under in the yellow pages?
Thanks
> 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 Mattkit on January 25, 2003, at 19:15:02
In reply to Re: opiates and major depression, posted by Blah on January 25, 2003, at 17:32:02
I sure would like to know if it is possible to take opiates in a controlled manner. As with any drugs or alcohol when one is out of control its a
problem. I know alot of people who have a couple
of drinks of wine thru the day and it is not a problem. I wish I could try doing this but with opiates because it seems to me that when they are in my system I have come "up" to the level of how
"normal" people feel. I actually feel normal for once.
Posted by ShelliR on January 25, 2003, at 19:25:40
In reply to Re: opiates and major depression, posted by Blah on January 25, 2003, at 17:32:02
>When you say pain doctor what kind of doctor do you mean, an orthopiedist? I probably spelled that wrong. What I'm asking is what would
I look under in the yellow pages?<My doctor is listed under physical medicine. I was referred to him years ago for a misdiagnosed stomach spasm years ago and more recently for the chest pain. Many of the doctors in the pain field also have a background in anesthesiology.
I just did a yahoo yellow pages search, put in physicians and pain and most specialists were listed either under pain and rehabilitation or pain management. I think I'd go for pain management out of the two, or else get a referral from your internist or primary physician.
Posted by ShelliR on January 25, 2003, at 20:36:39
In reply to Re: opiates and major depression, posted by Blah on January 25, 2003, at 17:32:02
One more thing:
My pain doc wouldn't treat me unless I also was being treated by a psychiatrist. Since my pdoc wouldn't treat me if I was on opiates, I changed pdocs to one that the pain guy recommended. I like the new pdoc; he won't prescribe opiates, but he accepts that I am taking them as part of my treatment. I am exploring other options with him and with my homeopathic doctor.
Posted by bee happy on January 26, 2003, at 21:44:50
In reply to Re: opiates and major depression » Blah, posted by ShelliR on January 25, 2003, at 20:36:39
I have been treated for depression with Buprenorphine for the last 6 months and I knew the first day that it worked for me. If you have a compassionate family doctor who knows you well you might want to ask him or her to try it just for a day or two...to see if it works for you. It is not a triplicate. This drug was studied at Harvard.Find the study on the internet and show your doctor.
Posted by Peter S. on January 26, 2003, at 22:24:18
In reply to Re: opiates and major depression, posted by bee happy on January 26, 2003, at 21:44:50
Hi bee,
Can you say a little more about your buprenorphine experience. How much do you take? HOw often? How do you take it- sublingually? Any side effects?
Thanks!
Petrer
> I have been treated for depression with Buprenorphine for the last 6 months and I knew the first day that it worked for me. If you have a compassionate family doctor who knows you well you might want to ask him or her to try it just for a day or two...to see if it works for you. It is not a triplicate. This drug was studied at Harvard.Find the study on the internet and show your doctor.
Posted by androog on January 26, 2003, at 22:30:05
In reply to Buprenorphine-- bee happy, posted by Peter S. on January 26, 2003, at 22:24:18
bee-
Can you also tell us if you have built up a tolerance for the buprenorphine?
Thanks,
androog
Posted by Luka62 on January 26, 2003, at 22:30:29
In reply to Re: opiates and major depression » Blah, posted by androog on January 21, 2003, at 13:29:13
WOW! I can't believe there's someone else out there who's had an experience with Ultram and depression. I've been taking Ultram for several years. Mind you, I've been prescribed Ultram for chronic pain. But I definitely noticed early on how it lifts my mood. I'm also on Nardil and Lamictal. Interestingly though, when I was taken off the Nardil for a trial period , the Ultram didn't seem to have any effect, so I figured it must be the interaction.
If I take more than is prescribed, I can start to have breathing difficulty though.
Recently I went to a neurosurgeon who has me taking daily, so I don't have to worry as much about whether my reg doc will rx it. (My psych. doc does not prescribe. it)
Posted by androog on January 27, 2003, at 1:49:04
In reply to Re: opiates and major depression » androog, posted by Luka62 on January 26, 2003, at 22:30:29
Watch out for that Nardil! It put me in the hospital hooked up to an EKG, sucking on nitroglycerin. They didn't tell me I couldn't use OTC nasal spray while on Nardil, just that I couldn't eat certain things.
And they think opiates are dangerous!
Glad to hear the Ultram is working for you.
androog
Posted by Ame Sans Vie on January 27, 2003, at 4:14:08
In reply to Re: opiates and major depression, posted by androog on January 27, 2003, at 1:49:04
Well, in the past I've been prescribed Hycodan (Canadian formulation), propoxyphene HCl, codeine, and hydromorphone. The Hycodan (at a dose of 15mg q8hr) worked especially well-- it both relieved the anxiety, yet didn't have me throwing up all day. I'm interested in trying buprenorphine, and it shouldn't be difficult to obtain it (or hydrocodone) seeing as my pdoc already has me on Klonopin, Valium, Ativan, Xanax, and just a few days ago called in prescriptions for BuSpar and Marinol (which works incredibly well, I might add... I'd rather not be taking it though, on the basis of drug testing for when I finally get out to look for a job. I have the feeling that most employers would frown upon finding THC in your system, even if it were backed up by a Rx). Another consideration is Stadol (butorphanol) nasal spray-- anyone have any experience at all with this stuff? I've used it recreationally years ago, but that was before my disorder(s?) hit full force. TIA!
--Michael
Posted by utopizen on January 27, 2003, at 6:12:34
In reply to Opioids and anxiety...?, posted by Ame Sans Vie on January 27, 2003, at 4:14:08
Okay, I don't know how Canada works, but I'm assuming they did model their drug schedules roughly around ours because we were the first to have them.
While benzos like Klonopin may be controlled, they're a far cry from an opioid. And Marinol is not an exciting drug. If you think this, you are having a placebo effect. It is an isolation of the anti-nausea properties of THC, and is very similar to ondanestron in effect. There's nothing exotic aboutt that.
Your doctor will laugh at you. I'm just trying to bring you down to Earth. Good luck with your anxiety. But why isn't Klonopin working??
> Well, in the past I've been prescribed Hycodan (Canadian formulation), propoxyphene HCl, codeine, and hydromorphone. The Hycodan (at a dose of 15mg q8hr) worked especially well-- it both relieved the anxiety, yet didn't have me throwing up all day. I'm interested in trying buprenorphine, and it shouldn't be difficult to obtain it (or hydrocodone) seeing as my pdoc already has me on Klonopin, Valium, Ativan, Xanax, and just a few days ago called in prescriptions for BuSpar and Marinol (which works incredibly well, I might add... I'd rather not be taking it though, on the basis of drug testing for when I finally get out to look for a job. I have the feeling that most employers would frown upon finding THC in your system, even if it were backed up by a Rx). Another consideration is Stadol (butorphanol) nasal spray-- anyone have any experience at all with this stuff? I've used it recreationally years ago, but that was before my disorder(s?) hit full force. TIA!
>
> --Michael
Posted by androog on January 27, 2003, at 11:31:06
In reply to Re: Opioids and anxiety...?, posted by utopizen on January 27, 2003, at 6:12:34
Hi Everyone,
With regards to Marinol, the makers of the drug have this to say on their website:
"A cannabinoid dose-related “high” (easy laughing, elation and heightened awareness) has been reported by patients receiving Marinol in both the antiemetic (24%) and the lower dose appetite stimulant
clinical trials (8%)..."Having been through the drug ringer, I've noticed that not everyone has the same reaction to any given drug. What might give me a boost might make someone else drowsy. That kind of thing.
So I don't think it's a stretch to believe that Ame Sans Vie (Isn't "Sans Vie" French for "without life"? Cool spooky name for a depressed person!) might experience a feeling of well-being by taking Marinol.
androog
Posted by utopizen on January 27, 2003, at 12:04:41
In reply to Re: Opioids and anxiety...?, posted by androog on January 27, 2003, at 11:31:06
This would explain the similarities in logistical transport between Marinol and Uranium security wise.
But isn't it $40 a pill? Um, I wonder if my health insurance covers it. Must be one of those "Tier 3" drugs that cost a whopping $25 in my co-payment.
> Hi Everyone,
>
> With regards to Marinol, the makers of the drug have this to say on their website:
>
> "A cannabinoid dose-related “high” (easy laughing, elation and heightened awareness) has been reported by patients receiving Marinol in both the antiemetic (24%) and the lower dose appetite stimulant
> clinical trials (8%)..."
>
> Having been through the drug ringer, I've noticed that not everyone has the same reaction to any given drug. What might give me a boost might make someone else drowsy. That kind of thing.
>
> So I don't think it's a stretch to believe that Ame Sans Vie (Isn't "Sans Vie" French for "without life"? Cool spooky name for a depressed person!) might experience a feeling of well-being by taking Marinol.
>
> androog
Posted by bee happy on January 27, 2003, at 15:19:02
In reply to Buprenorphine-- bee happy, posted by Peter S. on January 26, 2003, at 22:24:18
To elaborate on my battle with depression would only make you more depressed. The darkness fell about two years ago. After seeing a therapist for several weeks she came to the conclusion that it must be chemical,and referred me to a "pdoc" for the grueling months of trying all the new improved meds.The ones I can remember are Serzone, Wellbutrin, Prozac, Celexa, all of them made me feel worse..some of them made me physically ill.i had an alergic reaction to Serzone and was a walking mucus membrane for a week. I think I tried about 10 different things within the year. In speaking with my therapist I mentioned(in the very first visit) that I had always felt normal on codiene. That I had in fact had a problem with it in my youth and went through rehab to stop.(17 years ago). One day in session her face lit up and said she had heard of a study using opiates for depression and I should ask the pdoc about it. He had heard of it but wanted to get more information before sending me off with a prescription.Psychiatrists are busy treating some very sick psycotic patients with problems far worse than mine and I knew it would be up to me to find the research.I was very motivated. Here was someone telling me that perhaps I was not a druggie but had been self medicating depression all those years.I found the research study on the internet..right down to individual histories and results. Armed with that...he first tied Tramadol and then Buprenorphine. Tramadol seemed only to relieve the physical achiness that I felt not the anhedonia and fantasies of driving my car off a cliff on the Big Sur Hwy. It did nothing to change my mental state. You asked about dosage and weather I have built up a tolerance. I started on very small dosage .3mg 3 x's a day. and escalated to 2 mg 4 X's a day over the course of three months. It would apprear that I had built up a tolerance if I had not read that in treating with Methadone or Buprenorphine dosage is everything and too little can be as bad as too much. I have leveled off to 2 mg 3x's a day and sometimes I actually forget to take it.So that must say something, I'm not sure what. I have read that buprnorphine maintenance patients can go 2 days without their dose. So, am I just an ex opiate addict on Buprenorphine maintenance or a depression patient on the one drug that works for me? My family doctor likens it to a Diabetic...who without insulin would die. If I were not on this drug I'm not sure I'd be here writing this. It was that bad. I am on a compunded sub lingual gummy lozenge now. But Subutex and Suboxone have already been approved for addiction treatment in the U.S.and your family doctor can prescribe a drug for something other than it was approved. I think you will be hearing alot more about this in the very near future. I hope there is a backlash on this fear of prescribing. Yes there are doctors who might abuse the privilege...monitoring their writing practices is a good thing, but don't make good doctors afraid of using good medicine when necessary. I am lucky to have 2 doctors,who knowing my history, were not afraid. God bless them. Sorry to have gotten off on a moral rant...but "Blah's" story really hit me as the Catch 22 of "modern medicine". He's the reason I posted in the first place. I had been a lurker here for some time and was just checking in to see how some of the folks were doing. I am not Rececca of Sunnybrook Farm. I really do like bees. Alot. You asked about side effects. An odd one considering that opiates are known to constipate. I am a clockwork wonder now. That's all for me. No others. I wish I were better at explaining how it effects me....it's not a high...it's more a feeing of well being. I still get anxious at times and sad or angry when appropriate...it's does not numb me. It makes me feel the way I thought normal people felt all those years when I knew I was not "normal". More in the moment. Be here now. Now, I am. I hope this helps someone. It felt good to tell it. Thanks all.
Posted by juanantoniod on January 27, 2003, at 16:26:33
In reply to Re: opiates and major depression, posted by androog on January 27, 2003, at 1:49:04
I just did a search for Buprenorphine and deprssion in Medline and came up with 0 matches. Anyone else have better luck locating the studies supporting opiate use for depression?
Antonio
Posted by juanantoniod on January 27, 2003, at 18:38:27
In reply to Re: opiates and major depression, posted by juanantoniod on January 27, 2003, at 16:26:33
Forgive my ignorance. I just went to the Journal of Clinical Psychiatry's Website for this information and found the article. You may find them at psychiatrist.com.
> I just did a search for Buprenorphine and deprssion in Medline and came up with 0 matches. Anyone else have better luck locating the studies supporting opiate use for depression?
>
> Antonio
Posted by BrittPark on January 27, 2003, at 18:51:47
In reply to Re: opiates and major depression, posted by juanantoniod on January 27, 2003, at 16:26:33
I just did a medline on "buprenorphine depression" and got 161 hits. Almost all are concerned with respiratory depression. There are three relevant references:
Biol Psychiatry 1996 Jun 15;39(12):989-90
Buprenorphine for depression: the un-adoptable orphan.Callaway E.
Publication Types:
EditorialJ Clin Psychopharmacol 1995 Feb;15(1):49-57
Buprenorphine treatment of refractory depression.Bodkin JA, Zornberg GL, Lukas SE, Cole JO.
McLean Hospital, Consolidated Department of Psychiatry, Harvard Medical School, Belmont, MA 02178, USA.
Opiates were used to treat major depression until the mid-1950s. The advent of opioids with mixed agonist-antagonist or partial agonist activity, with reduced dependence and abuse liabilities, has made possible the reevaluation of opioids for this indication. This is of potential importance for the population of depressed patients who are unresponsive to or intolerant of conventional antidepressant agents. Ten subjects with treatment-refractory, unipolar, nonpsychotic, major depression were treated with the opioid partial agonist buprenorphine in an open-label study. Three subjects were unable to tolerate more than two doses because of side effects including malaise, nausea, and dysphoria. The remaining seven completed 4 to 6 weeks of treatment and as a group showed clinically striking improvement in both subjective and objective measures of depression. Much of this improvement was observed by the end of 1 week of treatment and persisted throughout the trial. Four subjects achieved complete remission of symptoms by the end of the trial (Hamilton Rating Scale for Depression scores < or = 6), two were moderately improved, and one deteriorated. These findings suggest a possible role for buprenorphine in treating refractory depression.
Lancet 1982 Sep 25;2(8300):709
Antidepressant effects of buprenorphine.
Emrich HM, Vogt P, Herz A, Kissling W.
Publication Types:
Clinical Trial
Letter
Randomized Controlled TrialAs you can see there hasn't been much research into opioids as antidepressants. My guess is that the DEA discourages the NIH from funding such studies. Sad but true for the forseeable future.
Cheers,
Britt
Posted by BrittPark on January 27, 2003, at 19:57:25
In reply to Re: opiates and major depression, posted by juanantoniod on January 27, 2003, at 18:38:27
I found a pdf of a Dr. Callaway's editorial. It pretty much sums up the sad state of opioid therapy.
It can be found at http://www.sciencething.org/Callaway.pdf
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