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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 35 to 59 of 178. Go back in thread:
Posted by Paulbwell on June 4, 2006, at 8:53:26
In reply to Re: bupreorphine for depression pseudoname, posted by MrBrice on June 4, 2006, at 8:37:02
> hi,
>
> I'm not sure if there is a big difference between buprenorphine and the other opiods but i wouldn't take them ever.Buprenorphine is a 'Partial' Opiate against, as opposed to Morphine-like meds which are full MU, Kappa, Opiod aganists.
> I have seen people indeed with other opiods and the effects seem good at first, but after a while the whole personality gets ruined.
Yes-I hear ya!
{Plenty of people who i have known who have been placed on {rozac, Paxil~ETC i hae witnessed a profound personality chamge (deading like state), where they seem to care about less than they did b4. GREAT it this 'treatment' made them happy, by no. Whats the difference in takng these brain anasthetics-SSRI's, or an Opiate/oid to relieve, 'treat' Psychic, Pain?
Cheers
>
> I hope bupe is another sort of med, and doestn't have the same effects if so many people use it tough.
>
> best regards
> Brice
Posted by jerrympls on June 5, 2006, at 3:59:18
In reply to Re: opioids for depression NO, posted by MrBrice on June 3, 2006, at 10:02:07
> I say NO to this one.
>
> opioids might help you in short terms (1-1.5 years), but then long term effects are just too bad.
> It'll flatten your moods, make you dull and lifeless, as I was told and I have seen myself in some people.
>
> Please don't do it, this really istn't the good med!I disagree. My pdoc has had me on a opiate for over 2 years now and I have never had an issues with addiction or tolerance. I'ts been a valuable addition to my med cocktail.
jerry
Posted by pseudoname on June 5, 2006, at 9:04:25
In reply to Re: opioids for depression NO » MrBrice, posted by jerrympls on June 5, 2006, at 3:59:18
I'm really glad Jerry posted.
> > Please don't do it
As people in this thread can attest, Bob has previously given PBCs for statements virtually identical to that, although he's apparently refused to do so in this situation. "Don't do X" is a direct instruction and can obviously be an OVERGENERALIZATION and PRESSURE. Especially in a thread in which someone has just detailed his/her clinical use of X, such a statement can feel accusatory. In this thread, I personally felt put down by it.
However, Brice nicely followed up in this instance by acknowledging that buprenorphine may be different, and I really appreciated that admission. But Jerry's experience would still run afoul of an overall command not to use opioids prescribed by a doctor.
Opioids are very serious drugs. The clinical situations where they are appropriate can be complex. Significant risks, side-effects, stigma, legal issues, and other trade-offs are ALWAYS a part of effective opioid therapy. But opioid use is sometimes *vital* where nothing else can help. These can be life-or-death questions!
Blanket imperatives only add to the stigma, pressure, and other burdens that opioid patients are already dealing with.
Posted by linkadge on June 5, 2006, at 15:11:32
In reply to Re: bupreorphine for depression-Opiates? » linkadge, posted by Paulbwell on June 4, 2006, at 6:11:48
Its not about having to take it daily. Theres no problem in taking a medication daily. But, is the medication going to be effective at a single dose, or are you going to have to continue to increase the dose untill your vital organs shut down.
It is my understanding that most people quickly grow tollerant to any single dose. In terms of pain relief, most people have quicky and completely adapted to the effects of any given dose of an opiate after about a month.
So, its not that I have anything morally wrong with giving people whatever works. But will it work?
Linkadge
Posted by linkadge on June 5, 2006, at 15:22:19
In reply to Re: opioids for depression NO » MrBrice, posted by jerrympls on June 5, 2006, at 3:59:18
>I disagree. My pdoc has had me on a opiate for over >2 years now and I have never had an issues with >addiction or tolerance. I'ts been a valuable >addition to my med cocktail.
But, with the other meds you are taking, is there any way to be sure that, this one is actually keeping you where you are? Isn't it possible that dependance has built to the opiate, but that the other meds are providing relief?
Not trying to dismiss your case at all, just wondering really.
Linkadge
Posted by reese7194 on June 7, 2006, at 16:48:42
In reply to opioids for depression » Phillipa, posted by pseudoname on June 2, 2006, at 10:34:26
i am curious if you found it difficult to find a doc who would use it off label. curious which state you live in. it's a shame that they are only using it for detox.
> Hi, Phillipa.
>
> > How does that med that is for opiod addicts work? Does it make you feel the same way the percocet did for me?
>
> Yeah, that's the one I take: buprenorphine (Subutex) is usually given to opioid addicts in recovery. I've never taken any other opioid, so I don't know how it compares. I don't feel buzzed or high on it at all. On it, I'm just not depressed, and my usual depressive train of thoughts doesn't occur. My usual train of thoughts is like a train that runs off a cliff! Those bad thoughts don't happen for me on buprenorphine and my mood is dramatically improved without the dulling or flatness people can get on SSRIs.
>
> Bupe does have a black-market street value, but I think it's to people who abuse other opioids. I don't know if anyone would abuse bupe alone.
>
> It's a darn shame that doctors are so reluctant or afraid to prescribe it for depression. I guess I'm really lucky. (Finally!)
Posted by Phillipa on June 7, 2006, at 20:12:37
In reply to Opioids for depression » Phillipa, posted by jedi on June 2, 2006, at 4:08:03
Buphrenopine is used by one of the docs in mines practice and there's another one too. For opiate addiciton would that help depression if SSRI's SSNRI's don't work? Love Phillipa
Posted by pseudoname on June 7, 2006, at 20:45:18
In reply to Re: opioids for depression/subutex, posted by reese7194 on June 7, 2006, at 16:48:42
> i am curious if you found it difficult to find a doc who would use it off label.
Yes, quite difficult, in part because both I and my pdoc were misinformed about the law on buprenorphine. She thought she had to have a special DEA waiver to prescribe it, but that's only true in the U.S. when it's Rx'd to opioid addicts for opioid addiction treatment. When we cleared up the law issue, she was willing to try it with me.
> it's a shame that they are only using it for detox.
For detox and ongoing addiction therapy. Since they have a patent, I don't know why they don't do some studies & try to get it approved for depression. Way too much stigma, I guess.
Posted by pseudoname on June 7, 2006, at 21:00:15
In reply to Re: Opioids for depression, posted by Phillipa on June 7, 2006, at 20:12:37
> would that help depression if SSRI's SSNRI's don't work?
Hi, Phillipa.
My experience was with SSRI SNRI TCA MAOI lithium AP and ECT failure, after which buprenorphine did help. Both of the small studies of bupe for depression were with treatment-resistant people. Some of those patients were also prior opioid addicts.
I think I would only suggest considering it after quite a few regular treatments fail.
Posted by stan on June 8, 2006, at 4:45:36
In reply to buprenorphine and AD failure » Phillipa, posted by pseudoname on June 7, 2006, at 21:00:15
pseudo:
do you experience any "mental cloudiness" on the bupe, or does your mind feel just as quick and sharp and clear as it does when you're not using it? if you do have this problem, does it get worse as the dose is increased? just curious....thanks,
stan
>
> I think I would only suggest considering it after quite a few regular treatments fail.
Posted by pulse on June 8, 2006, at 7:21:21
In reply to Re: buprenorphine and AD failure » pseudoname, posted by stan on June 8, 2006, at 4:45:36
i'm curious: i recall elizabeth posting that the side-effects of bupe were very harsh.
i would assume one of the main ones, as with most, if not all opiates, is extreme constipation.
has this been true for you? have you been able to manage it well enough, and, if so, how?
pulse
Posted by Donna Louise on June 8, 2006, at 9:08:16
In reply to Re: Strong comment, posted by Bonnie_CA on June 2, 2006, at 2:40:12
Willyee, you spoke my fears for me. For most of my life, well, until I was nearly 31, I was not a street junkie because I didn't live on the street but that was the only difference. As was said, all I knew was that I hurt and I would take anything to make it go away. I stopped that behavior 20 some years ago but about 15 years ago began this new way of drug seeking to make the pain stop. I am so afraid that it is really no different. I am still looking desperately for a drug that will make me enjoy my life (yes, I have had years of therapy...)I know I must need something, I am not put together right and as was said, I need to do it for the greater good, not just for my own selfish ends. But I am so afraid that all this legal drug seeking and using has just made me worse than ever. I was so hoping the Patch would be "it" and it better than anything else but it is not "it". Now I want to ask for bupe and am reading about it, I am back to narcotics like the old days...Anyway, I know just what you mean. I have had glimpses of what I think should be possible and it is always when i am stopping a drug, the two week period before I crash again. I guess it is some kind of rebound, but I long for it and am obsessed with obtaining it, I don't want to waste my life anymore than it has been wasted. It makes me so sad and scared. It makes me cry.
donna
Posted by pseudoname on June 8, 2006, at 10:30:04
In reply to Re: buprenorphine and AD failure » pseudoname, posted by stan on June 8, 2006, at 4:45:36
Hi, Stan. I'm glad you asked about this because I haven't mentioned it much.
> do you experience any "mental cloudiness" on the bupe?
Yes. Also, slight dizziness. (Very slight.)
When I first started bupe in December, I had to take 3 mg a day to notice an antidepressant effect. At that dose, I noticed feeling mentally tired (without being tired) or a gauzy feeling (not quite cloudy LOL), but I could still concentrate on reading & writing and follow a line of thought, and as far as I know my judgment was okay. But I avoided driving in the early days. Those feelings decreased a lot as weeks went on, but they never entirely disappeared.
HOWEVER, when I had med-free days for constipation reasons (see my next reply), I did have odd cognitive problems. For example, one day when I went without bupe, I signed in at Babble under my old posting name and password (from 9 months earlier) without realizing it! That sort of complication went away AFAIK on the second day without bupe or when I went back on the bupe.
In March I lowered my usual dose to 1 mg per day. I got the same benefit and have no explanation why it didn't work at that dose at first. Anyway, now mental gauziness comes and goes. If I increase the dose slightly by taking 0.7 mg in the morning instead of 0.5 (the tablets are hard to split precisely), the gauziness and dizziness appear or get worse but are still tolerable. They don't, as far as I can tell, interfere with writing or comprehension, but I wouldn't climb up on the roof feeling that way.
I should get some computer alertness tests and test the dose response carefully. (Anybody got suggestions?)
Posted by pseudoname on June 8, 2006, at 11:25:46
In reply to Re: buprenorphine SEspseudoname, posted by pulse on June 8, 2006, at 7:21:21
Hiya, pulse.
> i would assume one of the main ones, as with most, if not all opiates, is extreme constipation.
Oh yeah. When I started my buprenorphine trial in Nov/Dec, constipation crept up on me and got worse as the weeks went on. I occasionally took holidays from the bupe just for the purpose of having a bowel movement, which was sometimes similar to giving birth.
(There's too much detail ;-) from those days in my bupe trial thread, before & following this post: http://www.dr-bob.org/babble/20051203/msgs/585836.html)
The constipation problem DID get better as months went on. Under Ed's advice I used Miralax, which was the most help, but far from a cure.
I'm now taking a dose (1 mg/day) about 1/3 of my starting dose, and constipation is no longer an issue. Elizabeth said her constipation never got much better.
I would give the following advice re constipation to anyone about to try buprenorphine:
•Start a high-fiber diet & drinking lots of fluids ASAP before you start taking bupe.
•Start taking Miralax right away, before you begin to have constipation problems, if you can get it.
•Stock up on suppositories & enemae before starting bupe; not that they'll really do any good.
•If at any time you think you could even possibly have a slight feeling like you might maybe want to poop, DO SO IMMEDIATELY. Do not wait.I think the only ongoing side-effect Elizabeth reported was constipation. Nausea occurs early in the process but only for a few days. Nevertheless, I'd also lay in a box of OTC anti-nausea medicine like Bonine before starting bupe.
Posted by pulse on June 8, 2006, at 21:54:16
In reply to buprenorphine and constipation » pulse, posted by pseudoname on June 8, 2006, at 11:25:46
thanks much for all this info!
just as i expected.
well, with my ibs-c, i can now safely say i'll never be able to even try bupe. it IS a fascinating subject to me, nonetheless, and i fully admit i'm envious.
i smoked opium only once back in the day. wowzer. but, it was just TOO good, so i 've never touched any kind of opiates again, except vicoden once for surgery - similar response - for me, perhaps a bit too good. back in that same day, i had a boyfriend who did heroin once; he had same feeling, so never again. scared h*ll outa him.
i do realize bupe is a different scenario, far as these success stories go.
continued success to you!
regards,
pulse
Posted by pseudoname on June 8, 2006, at 22:24:26
In reply to Re: buprenorphine and constipation » pseudoname, posted by pulse on June 8, 2006, at 21:54:16
> well, with my ibs-c, i can now safely say i'll never be able to even try bupe.
Now I wish I hadn't posted only my experience. In the bupe enclosure literature, of 210 people who took *16* mg per day (!) of buprenorphine, only 10% (21) had constipation problems in the first 4 weeks.
Of course, they were already heavy opioid users (addicts)...
Some people who use bupe for depression use VERY small doses effectively, like 0.2 mg per day. It might be possible to titrate up very slowly from even smaller doses using a liquid solution and avoid peristalsis problems.
Also, the AD effect is immediate. A person could take it only every other day, if necessary.
But I know IBS is nothing to fool with. I'm sorry.
> i smoked opium only once back in the day. wowzer. but, it was just TOO good
I've never used another opioid, so I can't compare. Buprenorphine doesn't even make me feel "good" like caffeine can. Just non-depressed and non-despairing.
Thanks for replying, pulse. Good luck.
Posted by pulse on June 9, 2006, at 0:26:51
In reply to Re: buprenorphine and constipation » pulse, posted by pseudoname on June 8, 2006, at 22:24:26
well, i'm not the least bit sorry you posted your experience, so, please, don't give that another second's worry.
trust me, i WOULD be one of those 10%!!!
since emsam at full, off at night, cutting into as much as 1/2, and off every other day ALL ko'd my ibs-c, even while taking zelnorm, i could never take bupe or any other opiates...even at teensy doses. i dread and have even put off elective surgery because of what vicodin does re: constipation.
you're most welcome and good luck to you, also.
pulse
Posted by jedi on June 9, 2006, at 3:01:14
In reply to Re: Opioids for depression, posted by Phillipa on June 7, 2006, at 20:12:37
> Buphrenopine is used by one of the docs in mines practice and there's another one too. For opiate addiciton would that help depression if SSRI's SSNRI's don't work? Love Phillipa
Hi,
If I could get a script, I would try buprenorphine in a minute. My depression is treatment resistant, atypical, double depression (dysthymia is always there when not in major depression) with social and generalized anxiety. Nardil is the only medication that has ever really made a dent in it. Prescription opioids have always provided a lift in my mood. Hey, maybe I can fake an opiate addiction and get it that way. Just kidding, but its a thought.
Take care,
JediBuprenorphine treatment of refractory depression.
Link:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed
Full article:
http://www.drugbuyers.com/freeboard/showflat.php?Cat=0&Number=196682Behavioral pharmacology of buprenorphine, with a
focus on preclinical models of reward and addiction
Link:
http://opioids.com/buprenorphine/buprenex.htmlOpiate treatment in ECT-resistant depression
Link:
http://opioids.com/antidepressant/opiates.htmlDepressive symptoms during buprenorphine vs. methadone maintenance: findings from a randomised, controlled trial in opioid dependence.
Link:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15589713&query_hl=7&itool=pubmed_docsum
Posted by jedi on June 9, 2006, at 3:11:16
In reply to Re: Opioids for depression » Phillipa, posted by jedi on June 9, 2006, at 3:01:14
Buprenorphine treatment of refractory depression.
Link:
http://www.biopsychiatry.com/bupref.html
Posted by pseudoname on June 9, 2006, at 9:32:17
In reply to Re: Opioids for depression » Phillipa, posted by jedi on June 9, 2006, at 3:01:14
Hi, jedi. Have we met? ;-)
> If I could get a script, I would try buprenorphine in a minute.
Have you talked about it with your pdoc?
> Hey, maybe I can fake an opiate addiction and get it that way. Just kidding, but its a thought.
There was a guy a few months ago who'd gone to Mexico to get bupe and it worked; couldn't get a U.S. pdoc to script him; went to a rehab clinic, faked addiction, and got it. I can't find that thread now.
> Opiate treatment in ECT-resistant depression
> Link: http://opioids.com/antidepressant/opiates.htmlI really appreciate that Nyhuis abstract; I hadn't seen anything about it. I wish I could read the article!
I started a buprenorphine-for-depression links page at Babble Tips: http://health.groups.yahoo.com/group/psycho-babble-tips/links/buprenorphine_for_de_001146748536/ Someday I want to put up a web page about buprenorphine for TRD, but I'm dragging my feet about that.
Posted by jedi on June 9, 2006, at 22:53:21
In reply to buprenorphine links » jedi, posted by pseudoname on June 9, 2006, at 9:32:17
> I started a buprenorphine-for-depression links page at Babble Tips: http://health.groups.yahoo.com/group/psycho-babble-tips/links/buprenorphine_for_de_001146748536/ Someday I want to put up a web page about buprenorphine for TRD, but I'm dragging my feet about that.
Hi pseudoname,
Thanks a lot for your work on the links to buprenorphine for depression. I'll bet it helps some of us in babbleland find a solution for their refractory depression.
Thanks,
Jedi
Posted by Hermit on June 16, 2006, at 14:49:30
In reply to blanket comands, posted by pseudoname on June 5, 2006, at 9:04:25
A friend turned me on to this thread, and after reading the posts, I am so disheartened about the hell so many people have to go through in order to attempt to justify to others their use of opiates for depression. They shouldn't have to! If it works, we should be thrilled that they don't have to live through the hell of depression anymore.
I'm one of those people who were helped by opiates. Originally prescribed for fibromyalgia, I quickly discovered it helped depression and chronic fatigue, as well. In my case, I just let the use of this substance get out of hand, so I stopped. (I had a 3 week withdrawal to deal with.)
But even now, I would fight for anyone's right to use opiates in this way. IT WORKS. Period. Yes, you WILL get physically addicted to them, but you have to weigh that against living daily with suicidal tendencies, pain, and/or no energy or interest in living. I say let these people make their own choice, and support that choice wholeheartedly. It's what they need -- and what I needed.
I think it's time the medical community either come up with a similar and better solution, or stop harrassing those of us who have found an effective (although not perfect) way to handle these conditions.
(BTW, all of you using opiates in this way it to yourself to do a search for "kratom" on the internet ASAP.)
Peace,
Hermit
Posted by Paulbwell on June 16, 2006, at 15:20:03
In reply to Opiates for Depression - YAY!, posted by Hermit on June 16, 2006, at 14:49:30
Hi Ya,
Opiates/opioids are the original and best antidepressants. In fact, the tradition of antidepressants that began with imipramine (1958-OPIs and Amps, Amps+Barb combos) were routingly used before this, is more biopsychiatric sophistry than advance in treatment. Opioids are also much, much less toxic than the new drugs. People have been using opium poppy alkaloids for thousands of years. Aside from "dependence", (Paxil, Efferor are easy to get off for many??) there is virtually no risk, save overdose, which is honestly almost impossible to do unless you're using it intraveinously, or swallowing handfulls) (overdose is IMPOSSIBLE with buprenorphine). Unfortunately, I doubt--unless you have lots of money- or are famous (like Courtney Love, Rush Limbar, Ozzy- who were given Opi's) you will ever find a doctor to prescribe schedule II drugs--ESPECIALLY opioids--for depression. You DO NOT want to take Vicodin long-term because of the other TOXIC painkiller in it.
You may want to consider asking your doctor about buprenorphine/tramadol (or a better opioid) + stimulant (preferably dextroamphetamine), under the guise of treating your ADD. Stimulates potentiate the analgesic and antidepressant effects of opioids and also attenuate some of their adverse effects.
As a veteran of:
-Prozac
-Paxil
-Imipramine
-Serzone
-Celexa
-Effexorwith some pretty bloody horrible SEs from these (aside from ALL but Prozac working AT ALL), I have taken:
-MSIR, 20mg tabs, 60-80mgs
-Kapanol MS SR 20mg caps
-DHC 60mgSR tabs, 60-180mgs
-Codeine 60-400mgsAnd found that MS helped mood, somewhat sedating, Codeine i found good AD effects with, and added all day alertness and energy-like Oxy (apparently some Narcoleptics find it works), while providing a very good stress barrier, which i usually don't have.
My 2 Cents.
Cheers
Posted by Hermit on June 16, 2006, at 15:34:03
In reply to OPIA/OIDS FOR DEPRESSION! » Hermit, posted by Paulbwell on June 16, 2006, at 15:20:03
> You DO NOT want to take Vicodin long-term because of the
> other TOXIC painkiller in it.That's very true. Isn't it interesting that they put a dangerous drug in with a relatively harmless one when it would be just as easy to take a Tylenol if you really needed one? Hmmmm.
> And found that MS helped mood, somewhat sedating,
> Codeine i found good AD effects with, and added all day
> alertness and energy-like Oxy (apparently some Narcoleptics
> find it works), while providing a very good stress barrier,
> which i usually don't have.I've used all the stuff you mentioned, as well, and I also found that opiates help with ADD. So far, even better than that has been kratom. :-)
Hermit
Posted by Paulbwell on June 16, 2006, at 15:45:21
In reply to Re: OPIA/OIDS FOR DEPRESSION!, posted by Hermit on June 16, 2006, at 15:34:03
> > You DO NOT want to take Vicodin long-term because of the
> > other TOXIC painkiller in it.
>
> That's very true. Isn't it interesting that they put a dangerous drug in with a relatively harmless one when it would be just as easy to take a Tylenol if you really needed one? Hmmmm.
>
> > And found that MS helped mood, somewhat sedating,
> > Codeine i found good AD effects with, and added all day
> > alertness and energy-like Oxy (apparently some Narcoleptics
> > find it works), while providing a very good stress barrier,
> > which i usually don't have.
>
> I've used all the stuff you mentioned, as well, and I also found that opiates help with ADD. So far, even better than that has been kratom. :-)
>
> Hermit
Hi Ya!So what is this 'Kratom'?
Do tell
Cheers
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Dr. Bob is Robert Hsiung, MD,
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