![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 47 to 71 of 178. Go back in thread:
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
Posted by Hermit on June 16, 2006, at 16:01:12
In reply to Re: OPIA/OIDS FOR DEPRESSION! » Hermit, posted by Paulbwell on June 16, 2006, at 15:45:21
> So what is this 'Kratom'?
In short, a miracle. :-)
See this:
http://www.sagewisdom.org/kratomguide.html
Hermit
Posted by jerrympls on June 17, 2006, at 5:26:12
In reply to Opiates for Depression - YAY!, posted by Hermit on June 16, 2006, at 14:49:30
> 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,
> HermitHey Hermit
I'm right there with ya! I finally convinced my pdoc about 2 years ago to augment my med cocktail with hydrocodone. I gave him every piece of research I could gather regarding the use of opiates for treatment-resistant depression. Finally after discussing it with his collegues - he decided to do it. I'd been on EVERYTHING else - including ECT and the VNS implant.
2 years later and I have not gorwn tolerant to the hydrocodone. I take 5mg 4xdaily and have kept at that dosage for 2 years. It's no miracle cure - but like you said IT WORKS. Doctors should be less focused on the abuse potential of a med and more focused on finding a treatment that will give someone their life back. If it's a controlled substance - WHO CARES!? If it works - then use it. Far too many docs make poor decisions based upon meds that can make someone feel better rapidly! OHHH!! Feel better now as opposed to 12 weeks - 4 months - never?
I'm hereby naming all docs out there who are too afriad to use meds that effect opiate receptors and dopamine - "DOPAPHOBICS!"
You heard it here first folks!!!!!
Jerry
Posted by pseudoname on June 17, 2006, at 8:52:20
In reply to Opiates for Depression - YAY!, posted by Hermit on June 16, 2006, at 14:49:30
Thanks, Hermit.
I’m really glad you posted your story. Lately I’m starting to wonder if maybe a national movement supporting opioid treatment of depression might be starting right here!
> 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.)
I’m glad you were honest about that experience — and good on you for managing it so well. I think we opioid supporters have to be honest about the downsides. Although it’s not a competition, it would put us morally ahead of the SSRI sales reps, LOL.
But I’m a little concerned about the phrasing here:
> Yes, you WILL get physically addicted to them
I agree that sweats & other opioid-typical withdrawal symptoms are a very likely outcome in varying degrees of intensity when abruptly discontinuing longterm use of an opioid. I experienced mild sweats for a few days going without my low doses of buprenorphine. But it’s not quite a foregone conclusion for all people in opioid treatment, and it can be managed by gradual dose reduction.
Also, rather than the word “addiction”, the term currently promoted for use in the U.S. related to those withdrawal symptoms is “physical dependence”.
The American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine got together and produced the following definitions in 2001:
“ADDICTION … is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.
“PHYSICAL DEPENDENCE is a state of adaptation that is manifested by a drug class-specific withdrawal syndrome…”
I think maintaining that distinction can help us combat some of the stigma against opioid use. “Being addicted” triggers all the worst negative connotations in popular thinking. But putting up with physical dependence just means you're tough and willing to do what you gotta do.
:-)Rush Limbaugh aside, addiction does not usually develop in those treated with opioids for pain. AFAIK, no opioid-naive depressives treated with buprenorphine reported any addiction characteristics, even if they had withdrawal symptoms.
I don’t mean to criticize. I loved your post, your enthusiasm, your insights, and your honesty. I’m just suggesting a little clarification on an issue that might be misleading to readers.
Thanks again!
• “Definitions Related to the Use of Opioids for the Treatment of Pain” (2001) http://www.ampainsoc.org/advocacy/opioids2.htm
Posted by Hermit on June 17, 2006, at 11:37:20
In reply to ‘dependence’ vs ‘addiction’ » Hermit, posted by pseudoname on June 17, 2006, at 8:52:20
> But I’m a little concerned about the phrasing here:
>
> > Yes, you WILL get physically addicted to them
>
> I agree that sweats & other opioid-typical withdrawal
> symptoms are a very likely outcome in varying degrees of
> intensity when abruptly discontinuing longterm use of an
> opioid. I experienced mild sweats for a few days going
> without my low doses of buprenorphine. But it’s not quite
> a foregone conclusion for all people in opioid treatment,
> and it can be managed by gradual dose reduction.I'm not sure we disagree here. By "physically addicted," I mean that your body will experience some physical reaction to not having opiates if it has become used to their presence. That's just the way the body responds, and I have NEVER known anyone to use opiates for any significant amount of time who could stop suddenly and not feel any physical w/d.
Now, that is NOT placing a judgment on these people. Personally, I think the price is worth not having to deal with crippling depression and fatigue, and I'm in no way ashamed of physical addiction. That doesn't mean I can't control my use, nor does it mean I can't taper off when I wish to stop. Those are entirely different topics. :-)
> Also, rather than the word “addiction”, the term currently
> promoted for use in the U.S. related to those withdrawal
> symptoms is “physical dependence”.Yes, that's what most people think of, but addiction actually refers to dependence, whether psychological or physical. (This is according to my own training in chemical dependency counseling.) Again, I don't think there's anything wrong with being dependant on a drug if it improves one's quality of life.
> I think maintaining that distinction can help us combat some
> of the stigma against opioid use. “Being addicted” triggers all
> the worst negative connotations in popular thinking. But
> putting up with physical dependence just means you're
> tough and willing to do what you gotta do.I agree completely. What I think I tend to react to is the amount of people saying, "opiates aren't addictive" when it would help their cause much more (I think) to just admit that there's a physical dependence while still fighting for their right to use these drugs. Otherwise, "They" just focus on the idea that we're all in denial in order to prove some point about how insidious drug addiction is.
Am I making sense?
> Rush Limbaugh aside, addiction does not usually develop in
> those treated with opioids for pain. AFAIK, no opioid-naive
> depressives treated with buprenorphine reported any
> addiction characteristics, even if they had withdrawal
> symptoms.I think we're just differing in semantics here. The way I mean addiction is in referring to any drug that causes w/d, not necessarily a loss of control. What I would rather see is more people educating themselves about what the term actually means and then educating others. (I really do understand your point, however, and it's good to clarify.)
> I don’t mean to criticize. I loved your post, your enthusiasm,
> your insights, and your honesty. I’m just suggesting a little
> clarification on an issue that might be misleading to readers.I completely appreciate your response! I'm glad you gave me a chance to clarify what I meant. To me, addiction doesn't imply a loss of control -- only that the body will grow used to having an opiate in one's system. Withdrawal, if done through tapering the dose, isn't all that bad, and it always ends. :-)
Hermit
Posted by linkadge on June 17, 2006, at 23:27:13
In reply to Re: ‘dependence’ vs ‘addiction’, posted by Hermit on June 17, 2006, at 11:37:20
What we lack, is the information to suggest that opiates can be used at a "constant dose", to achieve the same level of depressive relief. Ie, can there be a fixed theraputic dose of an opioid for depression? (Jerry's case seems to support their use, but we need more cases.)
Much literature seems to suggest that the use of opiates at any dose, will lead to tolerance after a certain point. That is no good for the depressive condition, since it requires the patient to make the difficult decision to be ever increasing their dose.
That was supposedly the benifit of antidepressants, ie a person could take a fixed theraputic dose, for the duration of treatment.
There is nothing wrong with an individual using an opiate for depression, but if tollerance develops and depression returns, then the patient will have to go through the painstaking process of opiate withdrawl in the midst of a major depressive eposide. (which would not be fun)
As far as the use of stimulants plus opiates, that is certainly getting a little questionable in my opinion. We're essentially talking about speedballing. Combining opiates and stimulants creates a synergistic effect on dopamine release in the neucleus accumbens. Sure thats pleasureable, but this can lead to major crashing.
Now while I believe that it is good that people feel better, we need to keep some common sense. There certainly are some good reasons that doctors advise against some of these combinations.
Coming off an opiate is hard, coming off an opiate plus a stimulant is harder. Throw in a benzodiazapine and you add and additional factor.
The main question though is, will ever increasing doses be requred to maintain relief.
If you didn't have much longer to live, I suppose you just keep increasing indefinately, but most of us are not that close to death.
Linkadge
Posted by linkadge on June 17, 2006, at 23:28:09
In reply to Re: ‘dependence’ vs ‘addiction’, posted by linkadge on June 17, 2006, at 23:27:13
I'm trying to be openminded here. I posted a link below about the theraputic use of an opiates in depression.
Linkadge
Posted by FrequentFryer on June 18, 2006, at 7:06:22
In reply to Opiates for Depression - YAY!, posted by Hermit on June 16, 2006, at 14:49:30
Hi Guys.
Ive kinda almost given up on drugs. All the Anti-d's help a bit but dont really out weight the side effects for me.
But opiates hmmmm..... I know there not toxic... Benzos are opiates though arn't they and they can make you depressed if you take enough of them yeah?
I need to take ALLOT of benzo's to kill my Anxiety / depression & Kratom is illegal in my cuntry. Ive tried methodone before and that absoloutly pissed all over my nasty symptoms but other then that I havnt had much experience with the "downers". Please enlighten me a bit.
Like what kind of opiate would you recommend for Social Anxiety and availability. (availability = something a doctor might actually prescribe)
Posted by Hermit on June 18, 2006, at 10:49:47
In reply to Re: Opiates for Depression - YAY!, posted by FrequentFryer on June 18, 2006, at 7:06:22
> But opiates hmmmm..... I know there not toxic... Benzos are opiates though arn't they and they can make you depressed if you take enough of them yeah?
Nope, benzos (like Xanax) are NOT opiates. They are "anxiolytics," or anti-anxiety medications. To my knowledge, benzos can't make you depressed, but they certainly can make you sleepy if you take too many.
> I need to take ALLOT of benzo's to kill my Anxiety / depression & Kratom is illegal in my cuntry. Ive tried methodone before and that absoloutly pissed all over my nasty symptoms but other then that I havnt had much experience with the "downers". Please enlighten me a bit.
Which country do you live in? That's a shame that kratom is illegal. For me, I've found it to be the best thing for social anxiety.
You may want to talk to your doctor about trying an antidepressant. There have been some studies with folks who have social anxiety who did very well with Effexor and Paxil. There are much newer antidepressants on the market now that may be even better.
> Like what kind of opiate would you recommend for Social Anxiety and availability. (availability = something a doctor might actually prescribe)
Well, in the U.S., no doctor will prescribe an opiate for social anxiety because opiates are only "indicated" for pain management. Most doctors I know will prescribe an antidepressant for that, however. Have you tried that?
Another options for you might be counseling. It really depends on what your social anxiety stems from, but if you can manage it without drugs, I think that is always the best way to go.
Hermit
Posted by Hermit on June 18, 2006, at 10:51:18
In reply to Re: ‘dependence’ vs ‘addiction’, posted by linkadge on June 17, 2006, at 23:28:09
> I'm trying to be openminded here. I posted a link below about the theraputic use of an opiates in depression.
I must be missing something. Where is the link? :-)
Hermit
Posted by Hermit on June 18, 2006, at 10:57:47
In reply to Re: ‘dependence’ vs ‘addiction’, posted by linkadge on June 17, 2006, at 23:27:13
> The main question though is, will ever increasing doses be requred to maintain relief.
You bring up an excellent point, and this is central to the question of whether it should be prescribed.
Tolerance does usually build when one takes opiates for any amount of time. However, I've run across a few people who have been on a maintenance dose for years and it's still working for them.
What I think is happening is that those people who continually up their dose are looking for the high associated with opiates. In my recent experience, the high quickly goes away when taking the same dose, BUT the antidepressant effects still work. We have to be careful NOT to up the dose just because the euphoria is no longer persent. And we have to educate others not to do it, either. True, this will be difficult with some people, and maybe those are the ones who shouldn't use opiates. It takes some amount of control and responsibility, but peope have and are doing it.
Kratom is not an opiate, even though it behaves a lot like one. I find that sometimes taking a smaller dose than normal is actually BETTER, and ends up being more stimulating than sedating. No need to "speedball" with this stuff at all.
Hermit
Posted by flmm on June 18, 2006, at 11:26:47
In reply to Re: ‘dependence’ vs ‘addiction’, posted by Hermit on June 18, 2006, at 10:57:47
As someone with chronic pain, I have been on opiates for 2 years and antidepressants for 10. Opiates do not, over the long run, treat depression. That is just a fact. Sure they make you feel better in the begining, but like any addictive drug, it is a downward spiral of higher dosage, rebounding deeper depression,anxiety, anti-social behavior, apathy, suicide thoughts etc. I am glad I got off vicoden. Great for pain but watch out over time. I never got so depressed in my life until I finally got off them. They are a trap towards desperation!
Posted by Hermit on June 18, 2006, at 11:39:28
In reply to Re: Opiate trap!, posted by flmm on June 18, 2006, at 11:26:47
> As someone with chronic pain, I have been on opiates for 2 years and antidepressants for 10. Opiates do not, over the long run, treat depression. That is just a fact. Sure they make you feel better in the begining, but like any addictive drug, it is a downward spiral of higher dosage, rebounding deeper depression,anxiety, anti-social behavior, apathy, suicide thoughts etc.
I guess you missed my previous post(?)
Again, I have know MANY people who are on a maintenance dose of opiates (everything from buponorphine to Vicodin) who have been treating their depression successfully for MANY YEARS. As I said, these are the people who do NOT raise the dosage, even when the euphoria goes away.
I'm in no way condoning an escalating use of opiates for depression, but I will condone the RESPONSIBLE use of opiates for depression. For those who simply believe that they cannot control their use, I would agree that they should stay away from them, but they have helped far too many people (myself included) to say that NO one should use them for depression.
Hermit
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