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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 64 to 88 of 178. Go back in thread:
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
Posted by flmm on June 18, 2006, at 14:34:10
In reply to Re: Opiate trap!, posted by Hermit on June 18, 2006, at 11:39:28
They are not treating the depression anymore, merely addicted to a low maintanance dosage. This is possible as it happened to me!I was able to keep my use low thrughout.However, the depression still gets worse and worse, but because of the addiction, they think it helps! My depression was greatly lifted once off them. You can't possibly know how bad you feel when addicted, it fools you into thinking you feel better. This is what addiction is!
Posted by pseudoname on June 18, 2006, at 17:37:27
In reply to Re: Opiate trap!, posted by Hermit on June 18, 2006, at 11:39:28
Hi, again, Hermit.
> 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.
How do you know so many people treating depression with opioids, including buprenorphine? By contrast, there have only been a handful here at Babble over the years.
Are the depressive opioid patients you've met former abusers? I know you said you had training in chemical dependency counseling.
Posted by flmm on June 18, 2006, at 17:44:08
In reply to Re: Opiate trap!, posted by flmm on June 18, 2006, at 14:34:10
I find it hard to believe a legit p. doc would prescribe opiates for depression. Any good one clearly knows better. It would be a good way to get someone at the bottom, even lower over the long run.
Posted by Hermit on June 18, 2006, at 17:48:25
In reply to How do you know so many opioid patients? » Hermit, posted by pseudoname on June 18, 2006, at 17:37:27
> How do you know so many people treating depression with opioids, including buprenorphine? By contrast, there have only been a handful here at Babble over the years.
There are loads of forums out there for folks who are doing just that. I've also met a lot of people in my own line of work who either have doctors who are willing to give it a try, or who are being prescribed opiates for pain but have begun to use it specifically for depression treatment.
In particular, the groups for kratom use are filled with people treating depression with kratom (an herb that has opiate-like effects, but is legal in the U.S. and much safer).
Two examples:
The Kratom Forum
http://drugbuyers.com/kratom/index.phpThe Kratom Korner
http://www.thekratomkorner.com/Also, the Kratom Group on Yahoo
http://groups.yahoo.com/group/kratom/> Are the depressive opioid patients you've met former abusers? I know you said you had training in chemical dependency counseling.
Yes, some of them are. My work with them has consisted of teaching them how to manage their compulsive impulses. Of course, if they're on heroin or morphine, I do what I can to help them get off of them, usually with the help of kratom. Then I work with them until they know how to use kratom responsibly.
Of course, not everyone is able to, and those are the ones who are just better off abstaining altogether.
Hermit
Posted by Hermit on June 18, 2006, at 17:50:57
In reply to Re: Opiate trap!, posted by flmm on June 18, 2006, at 17:44:08
> I find it hard to believe a legit p. doc would prescribe opiates for depression. Any good one clearly knows better. It would be a good way to get someone at the bottom, even lower over the long run.
It's okay to find it hard to believe, but there are quite a few out there (though, admittedly, not in the majority). Those who are open to "unusual" treatments when all else has failed eventually find there opiates can, indeed, help depression in some patients.
Again, if a person is prone to abusing opiates, then it isn't recommended. Not everyone has this problem, however.
Hermit
Posted by flmm on June 18, 2006, at 17:55:05
In reply to Re: Opiate trap!, posted by Hermit on June 18, 2006, at 17:50:57
It really is the worst idea anyone can have. I believe it really has more to do with addicts talking their doctors into bad ideas more than any "Trend" in treating depression. It would be very easy to list all the negative results that would happen due to long term opiate use for depression!
Posted by Hermit on June 18, 2006, at 17:56:36
In reply to Re: Opiate trap!, posted by flmm on June 18, 2006, at 14:34:10
> They are not treating the depression anymore, merely addicted to a low maintanance dosage.
Physically addicted, yes. But anyone who takes an antidepressant for any length of time will also find themselves physically addicted (which only means that weaning off the medication is necessary rather than stopping suddenly and completely).
> This is possible as it happened to me!I was able to keep my use low thrughout.However, the depression still gets worse and worse, but because of the addiction, they think it helps! My depression was greatly lifted once off them.
You are obviously not a good candidate for opiate treatment for depression; please don't assume that everyone else is just like you. Everyone's chemistry is different, and it's effectiveness has been proven time and time again.
I think I've said this enough times here now.
> You can't possibly know how bad you feel when addicted, it fools you into thinking you feel better. This is what addiction is!
I know quite a bit more about addiction than you think.
It seems you've had some very tough experiences, and I completely understand your concern about others falling into the same situation you did. However, it's very important that you keep an open mind, particularly since there is overwhelming evidence that it definitely does help some people battle depression.
It might more healthy (and fair) for you to say, "It didn't work for me, but if it works for someone else, they should have a right to do whatever works."
Doesn't this seem fair to you?
Hermit
Posted by Declan on June 18, 2006, at 17:57:34
In reply to Re: Opiate trap!, posted by flmm on June 18, 2006, at 11:26:47
I dunno. I'm not so impressed with opiates long term, but IME they compare well with ADs. Honestly, I think we'd be better off chewing coca and drinking poppy tea. But this is where we are.
Declan
Posted by Declan on June 18, 2006, at 18:04:02
In reply to Re: Opiate trap!, posted by flmm on June 18, 2006, at 17:44:08
No, what happens is that depressed people self medicate with opiates and then seek help for their addictions.
Look, I agree about the long term detrimental effects of opiates, especially methadone, but I can't see why psych drugs are any better.
Declan
Posted by Hermit on June 18, 2006, at 18:11:00
In reply to Re: Opiate trap! » flmm, posted by Declan on June 18, 2006, at 18:04:02
> No, what happens is that depressed people self medicate with opiates and then seek help for their addictions.
True, but also non-depressed folks will self-medicate. It's a compulsive behavior that can be unlearned.
> Look, I agree about the long term detrimental effects of opiates, especially methadone, but I can't see why psych drugs are any better.I know you weren't writing in response to me, but I agree with you anyway. :-) Opiates are actually one of the least harmful drugs to the body when used RESPONSIBLY.
Recent research has shown that long-term antidepressant use seems to cause an actual anatomical change in the neurons they affect, making a person become dependant on the antidepressants. Doesn't sound like such a great solution to me.
Hermit
Posted by pseudoname on June 18, 2006, at 18:38:30
In reply to Re: Opiate trap!, posted by flmm on June 18, 2006, at 14:34:10
I read flmm's history and I think it's serious, sobering, and important.
> This is possible as it happened to me!
However, I'm certain that flmm's "opiate" was not buprenorphine.
I don't yet tire of repeating this: BUPRENORPHINE seems to be DIFFERENT. The 3 tiny studies done so far do not show such adverse effects happening with opioid-naive depressives treated with bupe, which is a partial opioid agonist and partial ANTagonist, quite different from opiATEs like heroin, morphine, oxycodone, etc. It switches on only SOME mu receptors and those very weakly, and (perhaps more importantly) it BLOCKS kappa-opioid receptors.
I have not gotten buzzed or high on buprenorphine, not even to the extent possible from caffeine. Others, including Babble's famous Elizabeth, have reported likewise. Euphoria is not associated with bupe, and it appears to be a lousy painkiller.
Buprenorphine also has a delay in action, at least for me, of 90 minutes to 2 hours, further reducing the likelihood of psychological dependency. Its absence, even after days, does not result in craving or any other characteristics of addiction. Furthermore, in the last 7 months I've significantly REDUCED MY DOSE without loss of antidepressant effect.
Yet I hope flmm would not seek to take it away from me. The result — at this point in my life — would simply be to return me to my usual fluctuating moods of the last several years: from 48 to 57 on the Babbleometer.
On the other hand, with regard to opiates and other powerful mu-agonist opioids, I have no experience. We *know* they work for some and cause problems for others, but we apparently don't yet know how to tell the people apart in advance. On that larger issue (as is usually safe), I heartily endorse Declan's view.
Posted by Declan on June 18, 2006, at 18:40:41
In reply to Re: Opiate trap!, posted by Hermit on June 18, 2006, at 18:11:00
Hi Hermit
Yeah, I agree, and if I'm going to f*ck myself up I would prefer to enjoy it for a while at least, before the awful stuff starts. No offense to those who get help from psych drugs. Tianeptine is helping me; I dunno what it's doing to my brain; and it's the first AD I have been able to take. The world went mad about opiates 40 years ago; the WHO...all madness IMO.
Declan
Posted by Declan on June 18, 2006, at 18:52:00
In reply to again: buprenorphine is different, posted by pseudoname on June 18, 2006, at 18:38:30
The thing I would worry about with bupe is the long term effects (if any). We know the long term effects of natural opiates.
PN, what do you know about the long term effects of bupe? How long has it been around? I mean, if it was helping *me*, I'd place a bet that it wouldn't be *that* good long term but would compare very well with other treatments for depression. But I have no idea, of course.
People on bupe do report feeling clearer than on other opiates. This might refer to an AD effect? OTOH I have had friends say 'I don't want to feel clearer. Why do you think I take opiates in the first place?' OTOH most people on methadone suffer from a low grade depression. I imagine, but cannot be sure, that this would be less true of morphine or heroin, supply being assured (just for argument's sake, shall we say?).
Declan
Posted by linkadge on June 18, 2006, at 19:08:00
In reply to Re: ‘dependence’ vs ‘addiction’, posted by Hermit on June 18, 2006, at 10:51:18
http://www.dr-bob.org/babble/20060610/msgs/657911.html
Sorry, I meant below.
Linkadge
Posted by linkadge on June 18, 2006, at 19:11:15
In reply to Re: Opiate trap!, posted by flmm on June 18, 2006, at 11:26:47
Just to counter what you said. Just because you did not respond well to opiates for depression does not mean other will not either.
Personally, SSRI's sent me into a downward spiral of increasing depression and suicidialty.
So clearly, drugs can affect people in different ways.
Linakdge
Posted by linkadge on June 18, 2006, at 19:16:32
In reply to Re: Opiate trap!, posted by flmm on June 18, 2006, at 14:34:10
Opiates are multi mechanism drugs. They will increase dopamine in the pleasure centres of the brain, but their painkilling properites are independant of this.
It is hard to know. I think there is a tendancy for those who's depression is not ameliorated by opiates to blame the opiates for increasing depression, while this may not be the case.
Some people may geting relief from this surge of activity in the pleasure centres of the brain, but not from other properties of the opiate.
It would be interesting to see, if the antidepressant effect is maintained with coadministration of an agent that blocks the increase in dopamine in the neucleus accumbens.
Linkadge
Posted by linkadge on June 18, 2006, at 19:24:06
In reply to Re: Opiate trap!, posted by flmm on June 18, 2006, at 17:44:08
>I find it hard to believe a legit p. doc would >prescribe opiates for depression. Any good one >clearly knows better. It would be a good way to >get someone at the bottom, even lower over the >long run.
Most of the doctors who go this route, are not doing it with complete agreability. Some of these patients have literally tried every other drug, including ECT. I would recomend a patient be put on opiates before ECT. Less brain dammage.
Think of it this way. Drugs like methylpenidate also posess abuse potential. This abuse potential however, is independant of its actions in ADD. The same could be true for opiates, but that the abuse potential squelches out further research.
There may be some form of opiate dysregulation at the heard of certain depressive disorders. Some studies have even linked postive responces to noradrenergic agents with increase in endorhpen levels.
Opiates for instance, are effective in some animal models of depression. They can ameliorate dysfunctional HPA axis function often much better and much faster than SSRI's or other antidepressants.
There seems to be growing evidence that they do have application in certain depressive disorders when use judiciously and appropriately.
Linkadge
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