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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 85 to 109 of 178. Go back in thread:
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
Posted by linkadge on June 18, 2006, at 19:30:28
In reply to Re: Opiate trap!, posted by Hermit on June 18, 2006, at 17:56:36
I agree, antdiepressants are physically addicting. There would be a general tendancy for people to increase their opiate dose, and perhaps many confounding factors for which opiates have been advised against.
Caffiene can be addicting, but some research shows that it has some sort of positive effect on long term mental health. Apparently coffee drinkers are less likely to off themselves. (This study has been replicated).
In forsight, most people would *not* believe that coffee can have a positive effect in depression.
http://biopsychiatry.com/caffsui.htm
Another
Posted by linkadge on June 18, 2006, at 19:40:59
In reply to Re: again: buprenorphine is different » pseudoname, posted by Declan on June 18, 2006, at 18:52:00
Its all about creating a magic bullit. The reason doctors don't see that opiates are a cure, is that they can make anybody feel better. In order to justify depression, doctors need to make a drug that specifically targest depression, without making anybody feel better, lest antidepressants be seen as pep pills (which they are).
So what? Beta blockers will lower anybody's blood pressure, that doesn't mean we can't use them for hypertensives. Abuse potential needs to be separated from antidepressant effect.
Amineptine was an effective antidepressant, was this independant of its abuse potential ?
We took it off the market because it had abuse potential. That is wrong. There are probably thousands of effective antidepressants with minimal abuse potential that will never see the light of day.
I think that if somebody genuinly gains effect from a constant dose of an opiate, then who cares?
Linkadge
Posted by linkadge on June 18, 2006, at 19:44:32
In reply to Re: again: buprenorphine is different, posted by linkadge on June 18, 2006, at 19:40:59
Its like you see somebody on effexor. Initially it works at 75 mg. A few months later they're on 112.5, then 150mg. Soon enought they're maxed out at 450mg. Next step is a seizure I suppose.
It happens on regular antdiepressants. That doesn't mean there aren't those who take 75mg for a few years and then get off.Linakdge
Posted by linkadge on June 18, 2006, at 20:04:28
In reply to Re: again: buprenorphine is different, posted by linkadge on June 18, 2006, at 19:44:32
From the crazymeds.org website:
"SRIs are some of the most physically addictive drugs in existence. To suddenly stop taking them is to feel so very much worse than you were feeling before you ever considered taking meds. There's a term, "brain shivers." You'll know it if you ever experience it. Mouse and I have kicked opiates and we have kicked SSRIs cold turkey. We'll take the opiate kick."
Linkadge
Posted by pseudoname on June 18, 2006, at 20:43:58
In reply to Re: again: buprenorphine is different » pseudoname, posted by Declan on June 18, 2006, at 18:52:00
> We know the long term effects of natural opiates.
What are they? By long-term, you mean 5, 10 years?
> PN, what do you know about the long term effects of bupe?
AFAIK, there's no published data on long-term bupe use at the doses I've been taking it. The studies with opiate addicts are at 8 mg/day or more. (That's also the case with the admittedly few personal accounts I've seen on other forums, which have mostly seemed to be NON-NAIVE and comorbid users.)
And, as with SSRI studies, "long-term" for bupe researchers seems to mean 6 months to a year! It's frustrating. No one can make good projections on the basis of that sort of data.
I would really like to know what happened to the people in Bodkins' 1995 study. Actually, I seriously think I'll contact him about that.
> How long has it been around?
First synthesized in 1969 and used clinically as a parenteral analgesic in 1978. The addiction treatment started in the mid-1990s in Europe, I think.
The first report on its use in depression was published in 1982; the second in 1995; the third in 2005. This is a very slow collection of data.
> I mean, if it was helping *me*, I'd place a bet that it wouldn't be *that* good long term
[Bursts of laughter]
Always nice to hear a word of encouragement.
[More laughter ;-) ]
> OTOH I have had friends say 'I don't want to feel clearer. Why do you think I take opiates in the first place?'
You people sure have a lot more friends than I do.
Posted by Declan on June 19, 2006, at 0:58:50
In reply to long-term buprenorphine » Declan, posted by pseudoname on June 18, 2006, at 20:43:58
Posted by Squiggles on June 19, 2006, at 8:59:07
In reply to Re: Opiate trap!, posted by linkadge on June 18, 2006, at 19:30:28
I don't understand why doctors
have abandoned a scientific approach
to medicine. Has everyone dumped
pharmacology for basketweaving therapy?
GRRRR!Squiggles
Posted by Hermit on June 19, 2006, at 9:42:25
In reply to Dose is important » linkadge, posted by Squiggles on June 19, 2006, at 8:59:07
> I don't understand why doctors
> have abandoned a scientific approach
> to medicine. Has everyone dumped
> pharmacology for basketweaving therapy?Why do you consider some drugs "scientific" and others not?
Hermit
Posted by Hermit on June 19, 2006, at 10:03:06
In reply to Re: again: buprenorphine is different, posted by linkadge on June 18, 2006, at 19:40:59
> I think that if somebody genuinly gains effect from a constant dose of an opiate, then who cares?
You'd think!
But the pharmaceutical companies are what run this country. Billions of dollars flow into it daily. If docs started prescribing opiates or kratom, then suddenly there wouldn't be any need for antidepressants, weight loss medications, anti-anxiety meds, ADD stimulants, etc.
Same with marijuana. If that became legal, farmers growing and exporting weed and hemp products could completely erase the national debt. THEN where would we be??
Hermit
Posted by Hermit on June 19, 2006, at 10:10:40
In reply to Re: Opiate trap! » Hermit, posted by Declan on June 18, 2006, at 18:40:41
> 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.
I'm not sure what you mean. What "awful stuff" are you referring to?
Hermit
Posted by Declan on June 19, 2006, at 16:53:02
In reply to Re: Opiates, posted by Hermit on June 19, 2006, at 10:10:40
Hi Hermit
The awful stuff probably differs from drug to drug. With methadone it would be some toxicity, reduction of sex drive, sweating, low grade depression, and difficulty giving up(!). With benzos it's a temperature thing again, sex drive reduction, a generally destabilising effect. Alcohol (in middle age) can lead to sloppy conversations. I just mean the drug effects that are additional to the therapeutic effect.
I have mixed feelings about drugs. Like the school counseller on Southpark I think drugs are bad. OTOH people have very real problems and very real suffering.
The modern world of media etc is not helping us cope with normal human unhappiness (which is bad enough), and some people are sick. I hope these opinions of mine make some kind of sense.
Declan
Posted by Hermit on June 19, 2006, at 17:30:19
In reply to Re: Opiates » Hermit, posted by Declan on June 19, 2006, at 16:53:02
Ok, now I get what you were referring to. :o)
> The awful stuff probably differs from drug to drug. With methadone it would be some toxicity, reduction of sex drive, sweating, low grade depression, and difficulty giving up(!). With benzos it's a temperature thing again, sex drive reduction, a generally destabilising effect. Alcohol (in middle age) can lead to sloppy conversations. I just mean the drug effects that are additional to the therapeutic effect.
Yup, all nasty stuff. Alcohol w/d is the only one that can kill you, though. Interesting that it's legal, eh? :-P
> I have mixed feelings about drugs. Like the school counseller on Southpark I think drugs are bad. OTOH people have very real problems and very real suffering.
I know what you mean. I've gone from being really PRO drug in my younger years (who isn't?) to being completely ANTI drug once I got clean. As I got older and tried to live without antidepressants, I finally accepted that, until I found something better, I was better off taking them. The key, I think, is to make sure there's no other way to deal with the problem.
> The modern world of media etc is not helping us cope with normal human unhappiness (which is bad enough), and some people are sick. I hope these opinions of mine make some kind of sense.
You make perfect sense to me. :-)
Ideally, we'd all have perfect brain chemisty and wonderful childhoods and not have to deal with depression, anxiety disorders, compulsions, etc. That's just not the case. While I don't consider myself "pro-drug" at all, I do believe that those who find some relief from debilitating conditions by using certain chemicals should be allowed to.
Hermit
Posted by flmm on June 19, 2006, at 19:51:26
In reply to Re: Opiates, posted by Hermit on June 19, 2006, at 17:30:19
I must mention, I know all about positive antidepressant effect of opiates! Where in my posts does it say I did not feel "Good" on them? All I meant was that, just like all addictive cns depressant drugs, you are chasing something you will never catch. I felt great for awhile, then it got beyond depression, even though i really never upped my dosage. SSRI meds do not work this way! You can lie to yourselves or your doctors all you want, but you know the truth! I know all about the tricks opiates and other addictive drugs can play on you! SSRI med might be dull, but for most, they even people out, not make them "HIGH"! Been down those roads before!
Posted by Declan on June 19, 2006, at 19:57:06
In reply to Re: Opiates, posted by flmm on June 19, 2006, at 19:51:26
I've never taken SSRIs but one thing you can say about them is that people get off them in a way that they do not usually get off methadone.
I think my current dose of that is (around) 50 micrograms.
Declan
Posted by flmm on June 19, 2006, at 20:03:05
In reply to Re: Opiates » flmm, posted by Declan on June 19, 2006, at 19:57:06
Just because they are hard to get off of does not mean they are not effective, constructive drugs. Opiates, on the other hand , are clearly destructive. SSRI med are very powerfull, and need to be handled with more care then most people think. But for most people, they give them their lives back!
Posted by Phillipa on June 19, 2006, at 21:06:46
In reply to Re: Opiates » flmm, posted by Declan on June 19, 2006, at 19:57:06
SSRI's don't work for me but the funny thing was when I broke my elbow they gave me percocet and the night my husband said I was laughing haven't done that in a long while. Must have been the percocet. Love Phillipa Think I become an addict.
Posted by Tomatheus on June 19, 2006, at 21:14:30
In reply to Re: Opiates, posted by flmm on June 19, 2006, at 20:03:05
> SSRI med are very powerfull, and need to be handled with more care then most people think. But for most people, they give them their lives back!
Most people?? Where's your evidence to support this? Or are you just going by the propaganda that the pharmaceutical companies are so fond of spouting?
I can't speak for others, but when I took Paxil, it didn't "give me my life back." It was ineffective for my depressive symptoms at lower doses and caused me to cycle between hypomania and severe depression at 60 mg/day. That led to me being diagnosed with bipolar disorder and being prescribed lithium (among other awful meds), which left me with a tremor that still hasn't gone away after having been off the med for a year. The only medication that ever did any good for me was Nardil -- but only the Australian Nardil (when they were still putting silica gel inside the bottles), and only when I prepared it a certain way.
The fact of the matter is that most of these so-called "soft" forms of bipolar disorder never existed before the SSRIs were introduced. And unlike the SSRIs, the TCAs and the MAOIs (and I mean the *real* Nardil and the *real* Parnate, before their respective formulations were changed) were never shown to have a stronger association with suicidal ideation than placebo.
So come on, if you're willing to say that SSRIs give most people their lives back, show me the evidence!
Or how about this: if anybody out there reading this has been "given their life back" (or even benefited in a significant way) from taking an SSRI, why don't you tell us about it? Likewise, let's also hear from those whose lives have been made worse -- or not any better -- from taking SSRIs. Such a survey obviously wouldn't be scientific, but unless you're able to supply us with some scientific evidence to support your claim, the responses posted here would be the best that we have to go by, as far as this thread is concerned.
Tomatheus
Posted by Squiggles on June 19, 2006, at 21:16:20
In reply to Re: Opiates, posted by Phillipa on June 19, 2006, at 21:06:46
Frankly, i don't have the adequate
knowledge in pharmacology to judge
whether opiates would not indeed be
better drugs for depression. They
certainly affect dopamine. That they
are quickly addicting with a very fast
tolerance leap, is something that should
be compared. Maybe, a therapeutic dose
can remain stable for many yrs. before
increasing it.I wrote in another message that seems to
have disappeared, that opiates were used
throughout history for depression, and
lithium too, in the form of lithium bromide
salts were used way before Cade's time.The truth must be out there somewhere.
Squiggles
Posted by Declan on June 20, 2006, at 0:58:10
In reply to Re: Opiates, posted by flmm on June 19, 2006, at 20:03:05
Are opiates destructive? It's not clear to me that they are especially so. The temper of the times may require some such opinion. I knew what I was doing, didn't lie to myself (not about opiates)....I was acting illegally, so I assumed the guilt of that, meaning I guess that I didn't feel any. Why should I care? What are the humane ways of dealing with depersonalisation? I'd given up on me and the world, and felt like I was under water half the time. Why do opiates in particular generate such strong opinion? Because they work? Because they don't? Feels like subconcious processes to me.
Declan
Posted by Declan on June 20, 2006, at 2:53:11
In reply to Re: Opiates, posted by Declan on June 20, 2006, at 0:58:10
Adopting the mandarin style as a cover for ex post facto rationalisation and this forum as an opportunity for creative writing....what do I know? I wouldn't wish addiction on anyone. (Every statement I make is almost false.) When my mother had agitated depression I thought of the kindly country doctor on his horse and carriage, with his dose of laudanum, sitting with her, and holding her hand, telling her that he would stay with her till she slept, and contrasted it to the pathetic treatment she received. Some people are between a rock and a hard place.
Declan
Posted by fuchsia on June 20, 2006, at 5:57:55
In reply to SSRIs » flmm, posted by Tomatheus on June 19, 2006, at 21:14:30
> Or how about this: if anybody out there reading this has been "given their life back" (or even benefited in a significant way) from taking an SSRI, why don't you tell us about it? Likewise, let's also hear from those whose lives have been made worse -- or not any better -- from taking SSRIs. Such a survey obviously wouldn't be scientific, but unless you're able to supply us with some scientific evidence to support your claim, the responses posted here would be the best that we have to go by, as far as this thread is concerned.
>
> TomatheusSSRIs gave me bipolar II (I think, anyway).
But like a lot of people on this board I am struggling to find an effective treatment. I doubt the people here are representative of the general populace.
fuchsia
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