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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 62. This is the beginning of the thread.
Posted by dougb on March 28, 2001, at 16:12:14
Hello:
Please put me on your mailing list:
Have not posted here before...
Have been suffering from depression for the last twenty odd years, diagnosed about seven years ago.
Have been thru several dr and lots of ad, currently on 300 mg Zoloft, 30 mg of Remeron, 1 nodoz (!- my idea not the doc's) and Ativan as needed.
Initally felt incredibly well on intro to fify mg of zoloft, for about three months, its been a struggle until recently.
My GP gave me scrip for Hydrocodone/APAP - 5mg for unrelated problem.
This had an immedeate and dramatic effect on my depression, previous 'phantom' pain was gone, both physical and mental, the grey colored spectacles came off.
That was four months ago.
Everyone around me says i look better, have gone on diet, am spending more time with my children, and for the first time I can remember i feel 'normal', whatever that means.
For the first time in two years i' ve been able to work again! (in my 'previous' life i did well as a computer network integrator).
My P-doc, who the county pays, is not having any of the above, and despite several requests. has refused to prescribe a medication that is literally giving me my life back.
(I even gave him 4-5 abstracts from clinical trials that support what has happened to me)
I have not abused this opiate, indeed just one capsule was lasting me 2-4 days as i was cutting it up into quarters.
At this diminished dosage i dont get 'high' but it elevates my mood enough so that i feel good about life again.
When you feel good about life you get involved, further reinforcing the positive results.
Because am now on medicaid/food stamps/tanif etc. (let me tell you, that has been quite an experience!), I dont know what to do.I have about 30 caplets left which is about a 20 day supply at my current regimen.
Any ideas?
Doug B.
PS stealing is not an option
Posted by PhoenixGirl on March 28, 2001, at 16:53:32
In reply to ML Opiates and Treatment resistant Psychiatrists, posted by dougb on March 28, 2001, at 16:12:14
Hi Doug,
Doctors can be jerks (see my recent post "Bad doctors"). I don't know enough about hydrocodone to say whether it's safe for you to take it. The only possible problem I can see would be if you had to keep raising the dose to keep the same effectiveness, and ended up addicted. I would change doctors if possible, or try to find some way to see a non-state doctor. It's hard, I know. You would have to keep shopping around for doctors, which can be very expensive if you don't have insurance. The only other thing I could suggest would be to fake pain in order to get the hydrocodone for that (provided that hydrocodone is safe to take chronically). It's ridiculous that you should have to do that, but you have to look out for your best interests.
> Hello:
>
> Please put me on your mailing list:
>
> Have not posted here before...
>
> Have been suffering from depression for the last twenty odd years, diagnosed about seven years ago.
>
> Have been thru several dr and lots of ad, currently on 300 mg Zoloft, 30 mg of Remeron, 1 nodoz (!- my idea not the doc's) and Ativan as needed.
>
> Initally felt incredibly well on intro to fify mg of zoloft, for about three months, its been a struggle until recently.
>
> My GP gave me scrip for Hydrocodone/APAP - 5mg for unrelated problem.
>
> This had an immedeate and dramatic effect on my depression, previous 'phantom' pain was gone, both physical and mental, the grey colored spectacles came off.
>
> That was four months ago.
>
> Everyone around me says i look better, have gone on diet, am spending more time with my children, and for the first time I can remember i feel 'normal', whatever that means.
>
> For the first time in two years i' ve been able to work again! (in my 'previous' life i did well as a computer network integrator).
>
> My P-doc, who the county pays, is not having any of the above, and despite several requests. has refused to prescribe a medication that is literally giving me my life back.
>
> (I even gave him 4-5 abstracts from clinical trials that support what has happened to me)
>
> I have not abused this opiate, indeed just one capsule was lasting me 2-4 days as i was cutting it up into quarters.
>
> At this diminished dosage i dont get 'high' but it elevates my mood enough so that i feel good about life again.
>
> When you feel good about life you get involved, further reinforcing the positive results.
>
>
> Because am now on medicaid/food stamps/tanif etc. (let me tell you, that has been quite an experience!), I dont know what to do.
>
> I have about 30 caplets left which is about a 20 day supply at my current regimen.
>
> Any ideas?
>
> Doug B.
>
> PS stealing is not an option
Posted by Fred Potter on March 28, 2001, at 17:12:26
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by PhoenixGirl on March 28, 2001, at 16:53:32
Doug I discovered that 25mg Naltrexone potentiated pooped-out Prozac. I made the mistake of telling the social worker (yes social worker) I had felt wonderful on it. Tut! We can't have that. You're supposed to feel mildly miserable it seems. Because he'd never heard of this effect, he said it was probably placebo. Unlike Hydrocodone, Naltrexone is an anti-abuse drug, so doctor's won't support its use for depression because it wasn't *their* idea I guess. Anyway I had to stop as I can't afford its terrible price here in New Zealand.
Fred
Posted by Elizabeth on March 28, 2001, at 19:34:23
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Fred Potter on March 28, 2001, at 17:12:26
> Doug I discovered that 25mg Naltrexone potentiated pooped-out Prozac. I made the mistake of telling the social worker (yes social worker) I had felt wonderful on it. Tut! We can't have that. You're supposed to feel mildly miserable it seems. Because he'd never heard of this effect, he said it was probably placebo.
Everything I've heard (mainly from doctors who do clinical research on opiates and from addicts who are taking naltrexone to stay off drugs or alcohol) suggests that it isn't a very pleasant-feeling drug, by itself anyway. It might be different with Prozac, or there might be a small number of people who have the opposite reaction. Anyway, the social worker shouldn't have written you off so quickly, IMO.
> Unlike Hydrocodone, Naltrexone is an anti-abuse drug, so doctor's won't support its use for depression because it wasn't *their* idea I guess.
They're more likely to prescribe it than hydrocodone!
Posted by Fred Potter on March 28, 2001, at 20:14:32
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Elizabeth on March 28, 2001, at 19:34:23
> Everything I've heard (mainly from doctors who do clinical research on opiates and from addicts who are taking naltrexone to stay off drugs or alcohol) suggests that it isn't a very pleasant-feeling drug, by itself anyway. It might be different with Prozac, or there might be a small number of people who have the opposite reaction. Anyway, the social worker shouldn't have written you off so quickly, IMO.
---------------------------------------------
I felt wonderful by comparison to how I *had* felt I suppose. I think what I felt was "normal", a feeling I wasn't used to. Certainly naltrexone didn't make me feel unpleasant. Only the price did that
Posted by adams on March 29, 2001, at 0:24:55
In reply to ML Opiates and Treatment resistant Psychiatrists, posted by dougb on March 28, 2001, at 16:12:14
you are taking 1.5 capsules per day, or .5 per day? and you are saying a opiate drug is helping your depression? and you are not developing a tolerance to the drug?
Posted by dougb on March 29, 2001, at 12:22:49
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by adams on March 29, 2001, at 0:24:55
>
> you are taking 1.5 capsules per day, or .5 per day? and you are saying a opiate drug is helping your depression? and you are not developing a tolerance to the drug?
________________________Have been controlling tolerence by going off the drug 1 or2 days a week. This has at least given me 5 'working' days
Posted by dougb on March 29, 2001, at 12:39:10
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by PhoenixGirl on March 28, 2001, at 16:53:32
Thanks for your reply
> The only possible problem I can see would be > if you had to keep raising the dose to keep
> the same effectiveness, and ended up
> addicted.I have, of course, no interest in further screwing up my miserable little existence by getting addicted.
When pdoc said the same thing i reminded him that my body is now somehow addicted to Zoloft, that i started with 50mg am now up to 300, when i have tried to go off of it (while i still have 2 neurons to rub togother), i got _real_ sick.
So the state is now paying for $400 worth of meds, i am actually worse off than when I first starting taking the 'so-called' AD's.
>
The only other thing I could suggest would be to fake pain in order to get the hydrocodone forthat (provided that hydrocodone is safe to take chronically). It's ridiculous that you should have to do that, but you have to look out for your best interests.> _____________________
Said i wouldn't steal, am not sure how convincing a liar i might be, plus i really respect my GP and would feel pretty bad about doing it.
Thanks again for your interest
Doug B
Posted by dougb on March 29, 2001, at 12:57:48
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Fred Potter on March 28, 2001, at 17:12:26
Thanks Fred
When i approached the doctor, i gave him print outs with supporting evidence for Buprenorphine, an opiate with all the fun removed, used in treating addicts.
> I made the mistake of telling the social worker (yes social worker) I had felt wonderful on it. Tut! We can't have that.Yeah, and just why is that. Major Depression is a sometime terminal illness, it would seem that, considering that possible outcome, anything they can do to make the inmates a little more comfortable would be a *good* thing.
Doug
Posted by dougb on March 29, 2001, at 13:05:06
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by PhoenixGirl on March 28, 2001, at 16:53:32
PGirl:
Thanks for your replySorry to read about _your_ bad experience. My father used to say: "Doug, if you don't feel that you can trust your doctor, get a new one."
Another thing we tend to lose sight of; Many Dr.'s don't really care about your problems, they were just taught a nice 'bedside' manner in Med school. They're in it for the _____ (you get 3 guesses here)
Keep your chin up and cancel your check, that way you both can have a similar experience...
> The only possible problem I can see would be > if you had to keep raising the dose to keep
> the same effectiveness, and ended up
> addicted.
I have, of course, no interest in further screwing up my miserable little existence by getting addicted.When pdoc said the same thing i reminded him that my body is now somehow addicted to Zoloft, that i started with 50mg am now up to 300, when i have tried to go off of it (while i still have 2 neurons to rub togother), i got _real_ sick.
So the state is now paying for $400 worth of meds, i am actually worse off than when I first starting taking the 'so-called' AD's.
>
The only other thing I could suggest would be to fake pain in order to get the hydrocodone forthat (provided that hydrocodone is safe to take chronically). It's ridiculous that you should have to do that, but you have to look out for your best interests.> _____________________
Said i wouldn't steal, am not sure how convincing a liar i might be, plus i really respect my GP and would feel pretty bad about doing it.
Thanks again for your interest
Doug B
Posted by Elizabeth on March 30, 2001, at 4:17:11
In reply to Re: ML Opiates and Treatment resistant Psychiatrists » Fred Potter, posted by dougb on March 29, 2001, at 12:57:48
> Thanks Fred
>
> When i approached the doctor, i gave him print outs with supporting evidence for Buprenorphine, an opiate with all the fun removed, used in treating addicts.I wouldn't say all the fun is removed < g >. You can't get high off of bupe, but it does provide the sense of being "okay" that some of us have felt we were missing all our lives (this is probably what drives people to get addicted to heroin and heavier opiates). It allows us to appreciate the good things in life (IOW, to experience pleasure normally), and to feel we can deal with the bad things. It doesn't make you happy as such, certainly not euphoric; it does permit you to become happy when good things happen.
It also eliminates opiate cravings in addicted individuals, of course, and lacks major withdrawal symptoms. (Depression is the only serious one I experience.)
Posted by SLS on March 30, 2001, at 9:14:57
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Elizabeth on March 30, 2001, at 4:17:11
> > When i approached the doctor, i gave him print outs with supporting evidence for Buprenorphine, an opiate with all the fun removed, used in treating addicts.
> I wouldn't say all the fun is removed < g >. You can't get high off of bupe, but it does provide the sense of being "okay" that some of us have felt we were missing all our lives (this is probably what drives people to get addicted to heroin and heavier opiates). It allows us to appreciate the good things in life (IOW, to experience pleasure normally), and to feel we can deal with the bad things. It doesn't make you happy as such, certainly not euphoric; it does permit you to become happy when good things happen.
Hi Elizabeth.I hope all is well with you.
Are you still taking Parnate?
How long have you been taking buprenorphine, and how do you feel it has helped you? Would you consider yourself to be at all depressed at this point?
I hope you don't mind listing them, but I would like to know what medication you are currently taking and at what dosages. I am still nowhere near where I need to be to go back to work.
Thanks.
- Scott
Posted by dougb on March 30, 2001, at 11:46:36
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Elizabeth on March 30, 2001, at 4:17:11
Thanks Elizabeth:
What you describe is exactly what the Hydrocodone does for me, at the doasage mentioned.
It may sound counter-intuitive, but if i take too much, instead of feeling normal with energy to do all those little tasks that life requires, i feel sedated with diminished clarity of thought.
Now, you might think that my Dr. in the interest of science or whatever, might be interested in these and following observations.
Instead, he gets this kind of blank stare and goes back to filling out his paperwork or whatever the hell it is, he does when he sees me :-)
I guess he just thinks I'm babbling, eh Dr. B ;- ?
In any event, at the onset of a real bad spell, my whole body starts aching, Flu-like. Which i interpret as my endorphine receptors short-circuiting.
The body manufactures it's own opiates, The Endorphines, the purpose of which are pain control, pleasure and a state of mind we call 'well-being', amoung many others I'm sure.
Interestingly enough, the Alpha, Beta and Gamma endorphine receptors (the locks) are similar enough to the molecular structure (the keys), in the opiates, for the body to accept and use.
When I exercise for a vigorous and extended period of time (thus producing endorphines, i guess) I get euphoric to the point of giddiness.
All this, to my unwashed logic, seems connected:
no endorphines/or receptors not working right = -- > depression,Add opiate (artificial endorphines) = -- > 'well-being'/ healthy psyche.
But hey, - What is wrong with that picture?
Most likely, their are seperate receptors or sub-receptors controlling the different functions ie pain control, euphoria and well-being. And on and on.
The opiates must be like a shotgun, Buprenorphine a little less so and the future will most likely see drugs that will just a single receptor.
Medical wizards will then be able to complement seratonigenic therapy with a 'your-state-of-mind-is-now -- > _Well-Being_!
Thus breaking the 'i-feel-like ____', so i don't do anything, since i don't do anything, i-feel-like ____ spiral.
But, because your doctor has never been there, S/he can only guess at what severe chronic depression is like.
In a more enlightened era, we will recognize many addicts for what they are. Sick people sub-consciously seeking normalacy through self-medication, who have gotten bushwacked in their pursuit of well-being.
Disease = not being at-ease, i don't know about you but that is the understatement of the year when it comes to D.
Sorry to be so long winded, hope my thoughts somehow somewhere make a difference.
Anyway....
This begs the question; get hooked on hydro or whatever to 'earn' a script for a needed medecine?
Also ma'am, do you build up tolerance for this rx?, Thanks
If anyone else is still reading ;-)), what is the diference between Bupernorphine and Naltraxone?
And, do these drugs create a dependence of their own?
If so, how does their withdrawal compare to that of some of the so called AD's (Paxil, et. al)?
Thanks Doug B
Posted by dougb on March 30, 2001, at 12:54:11
In reply to Some thoughts on Opiates and depression » Elizabeth, posted by dougb on March 30, 2001, at 11:46:36
> >
_________________________________________
Mr Heroin Blues!
Honey,before you start fooling with me,
let me tell you how it will be.
I shall succeed and make you my slave.
Those stronger than you have gone to their grave.
You think you can never become a disgrace,
Ending up addicted to poppy seed waste.
So you start inhaling me one afternoon,
But into your veins I'll go very soon.
And once I have entered your vein,
the cravings for me will drive you insane.
You'll sell your bodu fora buck, and turn into something vile and corrupt,
And one day you'll realise the monster you've grown,
and solemly swear to leave me alone.
If you think you can master the mystical knack..
Sweetie try getting me off your back.
You'll vomit, you'll cramp, you'll tie in a knot.
Jangling your nerves will scream for a shot.
he how chills, the cold sweats, the withdrawal pains,
can only be stopped by little white grains.
There is no other way, and no need to look,
Deep down inside you know that you're hooked.
I warn you ahead, and so if you dare, it says in the contract
"till death do us part"
Author unknown.
___________________________________Sobering stuff.....
There is lot's more food for thought at the site:
http://www.drugaid.com.au/guestbook.htmlWas an addict once, not opiates, and let me tell you that if you wanted to go to Hell, you would first pass thru Depression, 3/4 of the way there, but when you got to the stinking little berg called Addiction you were just outside the gates.
If you haven't been there yet, don't bother it ain't worth the trip....(And that IS the understatement of the year)
Doug B
Posted by Mr. Scott on March 30, 2001, at 15:27:36
In reply to ML Opiates and Treatment resistant Psychiatrists, posted by dougb on March 28, 2001, at 16:12:14
Yes... See one of my doctors.. Last time I was in there he tried to get my to take MSContin (Morphine) or at the very least Vicodin..
I don't know where your at (geography) but I understand Mass General has been trying a lot of this opiod depression stuff.
Posted by Elizabeth on March 30, 2001, at 20:15:28
In reply to Re: ML Opiates and Treatment resistant Psychiatrists » Elizabeth, posted by SLS on March 30, 2001, at 9:14:57
> Hi Elizabeth.
Hi!
> I hope all is well with you.
Getting there.
> Are you still taking Parnate?
Yes, but just 30mg/day.
> How long have you been taking buprenorphine, and how do you feel it has helped you?
How long...hmm, I must have started it again around Christmas, so that would be 3 months, not counting the time I was in the hospital (3 weeks -- different thread).
It helps tremendously with negative symptoms, such as anhedonia and anergia, that the Parnate doesn't touch. It also lifts my mood, of course. (I don't know at what dose the ceiling effect occurs, but I am apparently nowhere near it.) And, although this effect seems to be unique to me, it is very activating with no period of sedation or "nodding."
The side effects are a big down side, and I do worry about tolerance. Supposedly, delta antagonists can prevent tolerance. I wonder if anybody is working on developing a mixed mu agonist/delta antagonist?
> Would you consider yourself to be at all depressed at this point?
I'm not at 100% yet, no. A problem with bupe for me is that it's short-acting, so I get a lot of ups and downs throughout the day. Another problem is that the disastrous condition of the stock market has led many manufacturers to cut down production of drugs, and unusual drugs like bupe are the first ones to go, so I've been having a hard time finding it. (Most pharmacies don't carry it, of course, but now I'm finding that the wholesalers are all out of it too.)
> I hope you don't mind listing them, but I would like to know what medication you are currently taking and at what dosages. I am still nowhere near where I need to be to go back to work.
I know what you mean.
Parnate 10mg tid
buprenorphine 0.3mg tid
Claritin 20mg qd
docusate 100mg tid
iron and calcium supplements
Metamucil whenever possible
a bunch of random stuff prn
Posted by ShelliR on March 30, 2001, at 21:00:29
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Elizabeth on March 30, 2001, at 20:15:28
Hi Elizabeth. What is a delta antagonist? Also is buprenorphine "allowed" to be prescribed for depression? Thanks, Shelli
p.s. HI SCOTT!
Posted by ShelliR on March 30, 2001, at 21:04:47
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Mr. Scott on March 30, 2001, at 15:27:36
>
> I don't know where your at (geography) but I understand Mass General has been trying a lot of this opiod depression stuff.Mr. Scott,
Do you live in the Boston area? Do you know any more about exactly how mass general has been trying a lot "of this opiod depression stuff"? Are there controlled studies going on there? Thank you for any information. Shelli
Posted by SLS on March 31, 2001, at 10:11:22
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Elizabeth on March 30, 2001, at 20:15:28
Thank you, Elizabeth.
:-)
- Scott
> > I hope you don't mind listing them, but I would like to know what medication you are currently taking and at what dosages. I am still nowhere near where I need to be to go back to work.
>
> I know what you mean.
>
> Parnate 10mg tid
> buprenorphine 0.3mg tid
> Claritin 20mg qd
> docusate 100mg tid
> iron and calcium supplements
> Metamucil whenever possible
> a bunch of random stuff prn
Posted by dougb on March 31, 2001, at 12:00:23
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Mr. Scott on March 30, 2001, at 15:27:36
> Yes... See one of my doctors.. Last time I was in there he tried to get my to take MSContin (Morphine) or at the very least Vicodin..
>
> I don't know where your at (geography) but I understand Mass General has been trying a lot of this opiod depression stuff.Mr. Scott:
Thank you for your reply.Am in Texas, but if you would kindly give me your Dr.'s name and phone number, will contact.
Doug B
Posted by ShelliR on March 31, 2001, at 12:55:36
In reply to Re: ML Opiates and Treatment resistant Psychiatrists » Mr. Scott, posted by dougb on March 31, 2001, at 12:00:23
> > I don't know where your at (geography) but I understand Mass General has been trying a lot of this opiod depression stuff.
>
> Mr. Scott:
> Thank you for your reply.
>
> Am in Texas, but if you would kindly give me your Dr.'s name and phone number, will contact.
>
> Doug BDoug B, I'm completely confused. Are you also Mr. Scott?
Why would I give a stranger on the internet my Dr.'s name and number? I was interested in checking if there are studies on opiates at mass general. My post was directed to Mr. Scott. Why did you answer my post? You've completely lost me. ShelliR
Posted by Mr. Scott on April 1, 2001, at 11:30:28
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by ShelliR on March 30, 2001, at 21:04:47
> >
> > I don't know where your at (geography) but I understand Mass General has been trying a lot of this opiod depression stuff.
>
> Mr. Scott,
> Do you live in the Boston area? Do you know any more about exactly how mass general has been trying a lot "of this opiod depression stuff"? Are there controlled studies going on there? Thank you for any information. ShelliHi Shelli,
Actually No I live in Chicago. My Doc who is wishing to try Opioids told me that Mass General is the cutting edge facility working on the Opioid treatment of depression. I haven't even begun lokking into it yet, but When I find some info I will post.
mrscott
Posted by dougb on April 1, 2001, at 15:09:34
In reply to Re: ML Opiates and Treatment resistant Psychiatrists » dougb, posted by ShelliR on March 31, 2001, at 12:55:36
> Doug B, I'm completely confused. Are you also Mr. Scott?
No but there must be a good multiple personality joke here somewhere :-)
>
> Why would I give a stranger on the internet my Dr.'s name and number?
Of course you would not, there is a mix up here...
When i look back at the message thread, i see no message from me to you. Re-read the message in question and see if that does not clarify.As i am directing a message to you, you should see a subject line like this:
Re: Blah Blah > >SheliR
Sincerely
Doug B
Posted by Elizabeth on April 5, 2001, at 7:43:53
In reply to Re: ML Opiates and Treatment resistant Psychiatrists » Elizabeth, posted by ShelliR on March 30, 2001, at 21:00:29
> Hi Elizabeth. What is a delta antagonist? Also is buprenorphine "allowed" to be prescribed for depression? Thanks, Shelli
Hi Shelli. There are 3 different types of opioid receptors (that we know of at present, at least), named mu, kappa, and delta (there are also subtypes of these, e.g. mu-1 and mu-2, but let's not get into that). Activation of the mu receptor is responsible for most of the beneficial effects that opioids are known for. Kappa agonists (e.g., Stadol) also have some analgesic action, moreso for women than for men. The delta receptor may also have something to do with relieving pain, but it also seems to be involved in the development of tolerance. Most of the opioids currently marketed for pain are nonselective agonists at all three subtypes. There are a few exceptions, including buprenorphine (Buprenex), butorphanol (stadol), nalbuphine (Nubain), and pentazocine (Talwin).
Buprenorphine is officially labelled for pain, but it's perfectly legal for doctors to prescribe it for off-label uses including depression. (This applies in the U.S., other countries may have different rules.)
Posted by ShelliR on April 5, 2001, at 12:34:52
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Elizabeth on April 5, 2001, at 7:43:53
> > Hi Elizabeth. What is a delta antagonist? Also is buprenorphine "allowed" to be prescribed for depression? Thanks, Shelli
>
> Hi Shelli. There are 3 different types of opioid receptors (that we know of at present, at least), named mu, kappa, and delta (there are also subtypes of these, e.g. mu-1 and mu-2, but let's not get into that). Activation of the mu receptor is responsible for most of the beneficial effects that opioids are known for. Kappa agonists (e.g., Stadol) also have some analgesic action, moreso for women than for men. The delta receptor may also have something to do with relieving pain, but it also seems to be involved in the development of tolerance. Most of the opioids currently marketed for pain are nonselective agonists at all three subtypes. There are a few exceptions, including buprenorphine (Buprenex), butorphanol (stadol), nalbuphine (Nubain), and pentazocine (Talwin).
>
> Buprenorphine is officially labelled for pain, but it's perfectly legal for doctors to prescribe it for off-label uses including depression. (This applies in the U.S., other countries may have different rules.)Thanks Elizabeth for the information. I just went to a new pdoc yesterday and he approved my small amount to hydrocodeine (about 3.75mg per day). He says, however, he cannot prescribe it for me because you can not prescribe it for depression. Right now I am getting it from my gyn for premenstral pain.
When I read what you wrote I wondered if I should be talking about buprenorphine or some other form of opiate with my doctor. However, I don't believe he is much of a specialist in this and I am so grateful to find a pdoc who can accept that I take this, that I don't know if I want to push it any further.
Perhaps along the line it ought to be a neurologist I consult with? It seems the main reason you suggest not using codeine because of the higher risk of addiction which I have not experienced yet, after three years, but of course I cannot rule it out in the future. shelli
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