![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 29 to 53 of 62. Go back in thread:
Posted by SLS on April 6, 2001, at 8:08:38
In reply to opiates -- Scott, posted by Elizabeth on April 5, 2001, at 21:23:17
Elizabeth,
Thanks for taking the time to respond. You have cleared up quite a bit for
me. I am much more comfortable with the approach my doctor is taking. That
means a lot.Thanks again.
- Scott
> > I guess my question is this: Whose idea was it to try buprenorphine?
If it was yours, how did you go about selling it to your doctor? Where did
you get the idea from?> My pdoc isn't a specialist in psychopharmacology (he's actually a
psychoanalyst), although I think he's still better than most
psychopharmacologists < g >. So at one point, when it became clear that
Nardil had stopped working, he sent me to a specialist, someone he knew
from residency. The specialist happens to be a researcher who focuses on
novel treatments for depression, and buprenorphine was one of the
treatments he had experimented with (1). He mentioned it as a possibility
because of some of the things I said about my symptoms, but he felt at the
time that it would be worthwhile to try MAOIs again or consider tricyclics
(which I've never been able to tolerate very well). Anyway, eventually my
pdoc and I came to a point where I was doing having trouble functioning on
a day-to-day basis and nothing seemed to be helping, so we decided to try
buprenorphine. It appealed to me in particular because I was pretty sure
it would work (based on past experiences with hydrocodone from my dentist
I knew that I'm one of the people who feel better on opiates -- as I said,
not everybody does), and it was something that would work pretty much
immediately (it takes an hour rather than a month).> (1) Bodkin et al. Buprenorphine treatment of refractory depression.
_Journal of Clinical Psychopharmacology_ 1995 Feb; 15(1):49-57.
Posted by dougb on April 6, 2001, at 16:14:15
In reply to opiates -- Shelli, posted by Elizabeth on April 5, 2001, at 20:55:50
> > approved my small amount to hydrocodeine (about 3.75mg per day).
Be carful that it does not come with a secondary analgesic that might have unwanted side effects.
One of the common combinations is Hydrocodone with acetaminophen.
Acetaminophen (Tylenol)is not good stuff to be taking for extended durations or elevated quantities where it is considered as poisonous:
http://www.lef.org/protocols/prtcl-001.shtml
> -- we should feel like we can speak to our doctors freely, right? -- but it still feels awkward.If your use is legitimate, why? Hydrocodone, according to RXlist.com is the fifth most prescribed rx in the country:
If you still feel squeemish about the subject, check out this page and it's excellent links for lots of good info and tips on dealing with your Dr.:
http://www.widomaker.com/~skipb/2ThePatient.html
It worked for me! My GP prescribed the Hydrocodone as requested.He brought up the subject of dependence, and i pointed out how I am already quite dependent on several AD's but am not really being helped by them
An $18.00 prescription is doing a lot more for me than hundreds for the Zoloft/Remeron/Atavan mix.
The treatment of choice for Depression since Hippocrates up until the 1950's has been one of the opiate class of drugs:
The Therapist/webmaster for the above site has some unorthodox points of view - maybe s\he is just ahead of her time.
> I really don't think using opiates is the best way to treat depression at all,
What is your unhappiness with your outside of the frequent dosing, you mentioned?
Doug B
Posted by ShelliR on April 6, 2001, at 18:49:31
In reply to Re: opiates -- Shelli » Elizabeth, posted by dougb on April 6, 2001, at 16:14:15
Doug and Elizabeth. Thanks so much for the information and support about taking opiates for depression.
Elizabeth, I very much agree that opiates are not the best choice for an antidepressant for most people.
I came to this board about a year ago, specifically asking about opiates because they seemed to be the only thing that relieved by depression at that point. I had taken them for two years without any increase. I had had a very successful run with nardil for many years, but finally last year, back to the depths again.
I had made the connection between opiates and lack of depression when I was given some for a muscle spasm in the center of my stomach, which took a while to be diagnosed as nothing internal. (Then a simple shot with a tiny bit of cortizone got rid of the pain).
In the last few years the combination of nardil and lamictal did work for me, but this last time I gained 15 lbs on the lamictal. (All while doing the treadmill,
weights, and watching my diet. And I lost it all within two weeks of going off of lamictal).It's was hard for my therapist or my pdoc to understand why being overweight was so awful to me. I am also diagnosed with a dissociative disorder, and things
to me do not always look like they do to other people, and I was developing a real adversion to my body.I think I tried about fifteen different combinations of nardil with something else, until I just refused to try anything else. I lost a lot of time this year to sleeping and
feeling disoriented and I felt enough!So I am extremely grateful to both of you for sharing that you also take opiates and it is approved by your doctors. Elizabeth, I did pick up along the way, that as
you said, not everyone has the same positive reaction to opiates and also there is a threshold over which I will feel nausea, instead of feeling good--normal.
Hydocodene can make me a bit high if I take too much, but so does alcohol, and yet I choose in general not to drink or overtake hydrocodone because I'd rather
be more grounded than high.Incidently, I also had a differerent reaction to valium than many people. It totally grounds me--I could be totally floating and not feeling my body from being
dissociative and I could always count on valium to bring me back. Friends of mine without dissociative disorders have the opposite reaction--it makes them sort of
spacey. Now valium also has a bad rap and doctors want to give me klonpin instead, but it doesn't have the same grounding effect for me.About doctors prescribing opiates: My gyn said that in the list of doctors that lose their licenses, the greatest number lose it due to overprescribing opiates. She
said doctors are very carefully watched re opiate prescriptions. She said she would be more comfortable giving me tylenal 3, but I really pushed for straight hydrocodone.She is a very down to earth woman and a really good doctor, so I am confused to have both of you say that there is no problem for doctors to prescribe optiates for depression.
Anyway, thanks for letting me go off, and thanks to both of you for your support and information.
Shelli
Posted by judy1 on April 6, 2001, at 21:05:20
In reply to Re: opiates Elizabeth, Doug- Long (Too long!), posted by ShelliR on April 6, 2001, at 18:49:31
Hi Shelli,
I'm happy to see the support you've gotten for your use of an opiate for an AD. I think I've mentioned my pdoc is willing to prescribe 'small amounts' as an AD or anxiety med- but he is most definitely in the minority. I also agree that people react differently to it, I was interested to read you have a dissociative disorder (like me) and I also respond well to hydrocodone. Just an aside, I get Norco 10/325 to keep the level of APAP down. While I agree with one of the posters that lying about pain isn't really a decent thing to do, I feel depression is a lot worse. take care, judy
Posted by ShelliR on April 6, 2001, at 22:23:06
In reply to Re: opiates Elizabeth, Doug- Long (Too long!) » ShelliR, posted by judy1 on April 6, 2001, at 21:05:20
< I get Norco 10/325 to keep the level of APAP down.Judy, what is APAP?
By the way, how are you doing? I remember you were getting involved in a new program, but I don't remember the name. Then recently you've been talking about staying out of the hospital. Did the program you were talking about not pan out? Are you feeling more stable? shelli
Posted by dougb on April 7, 2001, at 14:05:06
In reply to Re: opiates Elizabeth, Doug- Long (Too long!), posted by ShelliR on April 6, 2001, at 18:49:31
>
so I am confused to have both of you say that there is no problem for doctors to prescribe optiates for depression.Don't recall saying that there was no problem, like your gyn pointed out - there is a problem for her, there is also a possibility of dependency or worse, depending on pre-disposition and peresonal discipline.
Let us know how you are getting on with the Hydro
Doug B
Posted by judy1 on April 8, 2001, at 14:42:27
In reply to Re: opiates » judy1, posted by ShelliR on April 6, 2001, at 22:23:06
Hi Shelli,
Thank you for asking about me. APAP refers to acetaminophen which can cause liver damage if taken in excess. While vicodin has 500mg in each tab- if you take 2 every 4 hours (which is common) then you are pushing the envelope by ingesting 4 grams of acetominphen a day. It's not the hydrocodone that's the problem. The pharmaceutical companies do this because when a narcotic is in combo with another non-opiate analgesic it doesn't fall in the category where a triplicate has to be filled to prescribe. But it sounds like you are using such small doses, this doesn't apply to you. I did enter the STEP-BD program, but have not been consistant- probably due to the depression and SI going on. I'm pretty much relying on my therp. I hope you are well- judy
Posted by dougb on April 9, 2001, at 11:34:18
In reply to Re: opiates » judy1, posted by ShelliR on April 6, 2001, at 22:23:06
>
> < I get Norco 10/325 to keep the level of APAP down.
>
> Judy, what is APAP?
>Here is a good link, if you want more info:
http://www.lef.org/protocols/prtcl-001.shtml
Posted by ShelliR on April 9, 2001, at 13:13:34
In reply to Re: opiates » ShelliR, posted by dougb on April 9, 2001, at 11:34:18
> >
> > < I get Norco 10/325 to keep the level of APAP down.
> >
> > Judy, what is APAP?
> >
>
> Here is a good link, if you want more info:
> http://www.lef.org/protocols/prtcl-001.shtml
Doug, Thanks. It's a good link. Right now I'm taking a 1/2 pill maximum (3.75mg) of hydrocodone daily, so I don't think I have to worry at this point. But it's always good to have the information, especially about ways to counteract possible liver damage if I ever have to take a lot of Tylenol. Shelli
Posted by dougb on April 10, 2001, at 12:33:03
In reply to Re: opiates » dougb, posted by ShelliR on April 9, 2001, at 13:13:34
>Right now I'm taking a 1/2 pill maximum (3.75mg) of hydrocodone daily,
Are you gettting relief at this level of Hydro?
After 5 mo I'm up to 4-6 pills of Hydrocodone/APAP 5/500 (6'4", 340lb is probably a factor as well)
Just stepped up from 2-3 pills/day, which had pretty much pooped-out. I was very happy when the increased dosage started working again. Have seen so many meds work great for a while and then sliding back
Doug
Posted by ShelliR on April 10, 2001, at 13:01:24
In reply to Re: opiates » ShelliR, posted by dougb on April 10, 2001, at 12:33:03
> After 5 mo I'm up to 4-6 pills of Hydrocodone/APAP 5/500 (6'4", 340lb is probably a factor as well)
>
> Just stepped up from 2-3 pills/day, which had pretty much pooped-out. I was very happy when the increased dosage started working again. Have seen so many meds work great for a while and then sliding back
>
> DougDoug, when you first wrote you said,
< I have not abused this opiate, indeed
just one capsule was lasting me 2-4 days
as i was cutting it up into quarters..That was only a few weeks ago.
If I understand you correctly, you have increased your dose by almost 24x in just two weeks?
That is not at all good. Do you realize how much you are taking a day? Then when that is ineffective, you need to increase. You're developing tolerance and unless you stop you will just continue to keep going up. You mention your height and weight, yet a quarter pill was sufficient at the beginning, so this doesn't have to do with body type. This has to do with tolerance. Sorry, but I think you're looking at an addiction, Doug. (Can't you see that by the amount you're increasing?)
Yes, 3.75 mg is enough for me, and I don't take it every day. If I found myself going up past 7.5 mg per day, that would be it for me. I think my body chemistry is unusual (although not unique) in being able to stay at a low dose of codiene.Doug, I think you really need to find a good psychopharmacologist and get yourself to taper off the hydrocodone and on to an antidepressant and mood stablizer.
Do it soon. Your post really scares me because you don't seem to realize what is happening.
Shelli
Posted by ShelliR on April 10, 2001, at 13:11:00
In reply to Re: opiates » dougb, posted by ShelliR on April 10, 2001, at 13:01:24
p.s. Doug, I just looked though this thread and realized that it you who wrote about the hell of addition (heroin, I believe)? Is this for real? Are you really getting yourself immersed in an addiction again? Is your post a serious post? You wrote on March 30, "and now the ugly side." I'm really confused. Shelli
Posted by judy1 on April 10, 2001, at 18:44:09
In reply to Re: opiates » dougb, posted by ShelliR on April 10, 2001, at 13:01:24
Shelli,
You seem to be one of those patients that my pdoc tells me about- the ones he prescribes 1 10mg hydro pill/day and they take 1/2 in the am and the other in the pm. Apparently this has helped their primary complaint of treatment resistant panic/anxiety with secondary depression. Unfortunately my usage parallels Doug's, the development of tolerance (and at 130 pounds, I can't claim a weight factor here). I wonder if that is probably the more normal path of people who use opiates in treatment-resistant depression, but I imagine it's who you talk to. For my pdoc, I'm not the norm, for those specializing in substance abuse I probably am. In standard pain prescriptions, the dose is 1-2 (10mg hydo) every 4 hours, Doug certainly seems to be in that range. The euphoric feeling wears off quickly, if you chase that, I think that's when you get into trouble. I spent a year on ms contin (morphine) after a car accident, taking close to 200mg/day and was able to taper off under a doc's supervision (and that is a much, much more powerful drug), and while not exactly comfortable, it was outpatient and have had much worse experiences with other psychotropics. I didn't intend to get this detailed, I guess I don't see Doug in trouble (yet?) and hope he is honest with his pdoc. Take care, judy
Posted by ShelliR on April 10, 2001, at 22:14:39
In reply to Re: opiates » ShelliR, posted by judy1 on April 10, 2001, at 18:44:09
> In standard pain prescriptions, the dose is 1-2 (10mg hydo) every 4 hours, Doug certainly seems to be in that range..... I guess I don't see Doug in trouble (yet?) and hope he is honest with his pdoc. Take care, judy <
Judy, 1-2 every four hours may be the standard dose for pain, but unless I misunderstood, Doug is using it for his depression, not for pain now. I'm going to have to disagree with you; I think Doug, if not presently in trouble, is headed straight for trouble, especially with a history of addiction. To increase so fast in such a short of time is a sure sign of tolerance and dependence.
I think every individual reacts differently to drugs, and I think I understand now why my doctors were so concerned that I was taking hydocodone for depression. I got quite a shock when after two weeks ago saying he was taking 1/4 pill, Doug is up to five or six pills a day. Still, I will continue to take it, unless, as I said in my previous post, I start the pattern of going up. I also just started neuotin and am doing the omega 3 thing, so I am feeling more optimistic than I have in a long time, aside from the "permission" to use hydrocodone from my new psychiatrist.
I'm sorry Doug, I do think you are in (or headed for) trouble and I hope you take Judy's advice and talk to your doctor.
shelli
Posted by Elizabeth on April 11, 2001, at 9:36:09
In reply to Re: opiates » dougb, posted by ShelliR on April 10, 2001, at 13:01:24
> That is not at all good. Do you realize how much you are taking a day? Then when that is ineffective, you need to increase. You're developing tolerance and unless you stop you will just continue to keep going up. You mention your height and weight, yet a quarter pill was sufficient at the beginning, so this doesn't have to do with body type. This has to do with tolerance. Sorry, but I think you're looking at an addiction, Doug. (Can't you see that by the amount you're increasing?)
This is a common misunderstanding. Most pain patients who take opiates for any length of time will have to increase the dose. Different people develop tolerance at different rates. Some people who take opiates for depression (even full agonists, like hydrocodone, oxycodone, or morphine) do not have to raise the dose at all. But anyway, tolerance alone does not mean that a person is addicted. Addiction refers to compulsive drug use that results from intense psychological craving. It has little to do with the particular drug being used (although some drugs are much more addicting than others).
I didn't mean to say that there is no problem at all with prescribing opiates or that doctors will (or should) be willing to prescribe them for any patient, but rather that it is okay in some circumstances. Your doctor has to be comfortable with it, obviously. In my experience,
most doctors who are familiar with the use of opiates for depression are comfortable prescribing them in certain cases when people have severe depression and haven't responded to standard ADs.
Posted by dougb on April 11, 2001, at 13:03:26
In reply to Re: opiates » ShelliR, posted by Elizabeth on April 11, 2001, at 9:36:09
> > That is not at all good. Do you realize how much you are taking a day?
Elizabeth:
Thank you for your kind interest.The amount of codeine I'm taking currently is the perscription amount (for pain).
Has my body built up tolerance for codeine, yes, but I expected this.
My body has also built up a tolerance for Zoloft. There was a time when all my problems were solved (more or less) with a 50MG dose per day. Was up to 300MG. + a healthy dose of Remeron.
And i STILL felt like @#@#@!, the only thing that kept me from stopping these meds was that, that made me feel even _worse_.
That little 5 year 'experiment in Psychopharmacology' had ruined my life.
I fully admit that I am becomming dependent on the drug. That was a conscious decision.
But I have been dependent on AD's for years, and THEY DO NOT WORK. If you doubt that look all around you on this board, if they worked (or at least worked for us, here) most of us would not be here.
Morphine was commonly prescribed for alcoholism in this country at one time. And here was their rational:
Alcoholics, beat their wives, and engaged in all kinds of
self-destructive behavior resulting in broken homes, jail-time
etc etc.
So those chronic alcholics were treated with morphine and
Families were functional again, people went back to work and
stayed out of trouble....I do not intend to become addicted, but even a strong dependence on what for me has been practically a miricle drug, is far preferrable to a non-productive depressed existance.
I am working again, with enthusiasm and zeal. I have been in my little home office every day for months now, working on as many as 3 computer projects at a time!
I am spending quality moments with my family. They all tell me, that I am much better.
Addiction-dependence-tolerance are just words, I am not afraid of those words, I am only afraid of going back to where I was.....
Sincerely
Doug B
Posted by dougb on April 11, 2001, at 14:06:19
In reply to Re: opiates » dougb, posted by ShelliR on April 10, 2001, at 13:01:24
Shelli:
(if i thought anyone was paying close attention to what i was saying, i would have been more accurate...)I discovered the positive effect i was having after a ruptured ear drum where i was prescribed 1-2 tablets every 4 hours for pain.
After several days stopped. When my 'afternoon-demons' (figurative not literal) started again, realized that they had been absent on the codeine.
Started taking previous dose and again i got better and better.
But now, i am faced with a dwindling supply of med, a reaction i could not explain, and an unlikely prospect for refills.
I was also wrestling with the question of whether i was having a legitimate positive reaction to this med or it was just the Siren-Song of the 'evil demon opium'.
Due to scarcity, the above and just scientific interest, i started cutting back on the dose until i could feel no effect.
I remember being suprised at what a powerful substance this must be, that at 1/5 of a pill approx 1mg (i guess), there was a positive reaction to it.
This dose i would take every few hours as needed, thus on a conservative day, i might only take .4 to .5 tablet.
Other days however, would require up to 1.5/day as the week wore on.
My general doc, finally got back in town. After hearing my observations he, thankfully, gave me the requested med.
At that point, i started again on the _original_ dosage, 1-2 every 4 hours. And I stopped 'fasting' on weekends as those days were usually a write-off, just as they had been prior to the codeine.
Soo... i am touched by everyone's concern, but don't feel like my tolerance has spiraled out of control or anything like that.
If you disagree, i welcome your comments
Sincerely
Doug B
Posted by dougb on April 11, 2001, at 14:18:12
In reply to Re: opiates ps to Doug, posted by ShelliR on April 10, 2001, at 13:11:00
>
>
> p.s. Doug, I just looked though this thread and realized that it you who wrote about the hell of addition (heroin, I believe)? Is this for real? Are you really getting yourself immersed in an addiction again? Is your post a serious post? You wrote on March 30, "and now the ugly side." I'm really confused. ShelliNo, ma'am, my addiction/nightly use/whatever had been to a cocaine precursor called 'basuka' in South America, not as strong as crack but still nasty stuff. The point being that i know what addiction is and have no plans of returning to that state.
Thank you
Doug B
Posted by dougb on April 11, 2001, at 14:31:29
In reply to Re: opiates » ShelliR, posted by judy1 on April 10, 2001, at 18:44:09
Judy:
Thanks for sharing, as there is so little info out there on this usage, your experience is all that much more valuable.I have seen several references to a large government study alluding to the fact that in that study less than 1% of that group had any type of addiction problem.
These were pain patients under med supervision.
If anybody knows the link maybe they would be kind enough to post it
DB
Posted by dougb on April 11, 2001, at 14:49:10
In reply to Re: opiates » judy1, posted by ShelliR on April 10, 2001, at 22:14:39
Shelli:
Hope i addressed your concerns in :
Re: opiates; tolerance and addiction
Sorry, forgot to add your name. Also am not taking 10mg but 5mg> History of addiction
don't think this exactly fits either. If over a 2 year period you drank a six-pack every night out in the jungle (worked in small mining operation), but never missed work or neglected other resphonsibilities, you might say that that person was wasting his time in idle pursuits, that he was setting a poor example for others etc.
I think real addiction (and i've seen it) is where you are hocking the furniture, don't have food in the fridge for the kids or are indulging in front of the kids, missing work or getting high during the day, etc, etc.
The place i was at was indeed hellish, thank God it was not worse.
I do need the feedback though, thanks again
DB
Posted by ShelliR on April 11, 2001, at 16:30:08
In reply to Re: opiates , posted by dougb on April 11, 2001, at 14:49:10
Doug, I am not meaning to judge you, and at some points during the last year when my therapist and pdoc gave me hard times about the hydocodone, I also thought: well, the worst that can happpen is I become dependent, or addicted. And then I will get unaddicted. But I'm not going to spend the rest of my life depressed, on the possibility of addiction. Therefore, I continued the hydocodone. So I do understand.The thing about the six pack of beer every night example, is that in your example after two years you are not drinking 50 six packs of beer.
I agree some antidepressants do seem to be addictive (nardil, which I take isn't, since I can get off easily with no side effects.) But generally ADs have a ceiling over which an increase is not going to increase the sense of feeling good so there is a limit to the addiction possible. (BTW, I call it addiction if there is a negative physical response in discontinuing the drug/med--I don't always associate addiction with inappropriate or negative behavior).
> I think real addiction (and i've seen it) is where you are hocking the furniture, don't have food in the fridge for the kids or are indulging in front of the kids, missing work or getting high during the day, etc, etc.
>The problem with dependence or addiction or whatever you want to call it is when you get up to a large dose and you can't get it from doctors, then at what point do you begin to sell the furniture to buy it on the street, or become involved with deception to keep your level up. I am more skeptical than you are about the consequences.
It seems like this is the way you have decided to go, and although it might not necessarily be my choice, you seem to feel confident of the choice you have made. So I hope it works for you We all make decisions about our lives and live with the consequences.
Shelli
Posted by dougb on April 12, 2001, at 15:34:51
In reply to Re: opiates » dougb, posted by ShelliR on April 11, 2001, at 16:30:08
> I agree some antidepressants do seem to be addictive (nardil, which I take isn't, since I can get off easily with no side effects.) But generally ADs have a ceiling over which an increase is not going to increase the sense of feeling good
Maybe that's why I'm unhappy with the AD's, they don't really make me feel good, or they do for a few weeks, then i slip back.
Most days i hurt all over, and the ad's never did anything for that either, maybe this is why i've resphonded so well to the codeine?
> The problem with dependence or addiction or whatever you want to call it is when you get up to a large dose and you can't get it from doctors, then at what point do you begin to sell the furniture to buy it on the street
I guess this is the point you seperate out the truly addicttve personality, as for me, that would be the point where i would quit, and go back the sofa, if i had to.
> It seems like this is the way you have decided to go,
It sounds so sad when you say it like that..Be happy for me instead. Even if i start sliding back, at least i've had a kind of 'depression vacation' :-)
Thanks again for your kind interest
Doug
Posted by Elizabeth on April 14, 2001, at 4:36:48
In reply to Re: opiates; tolerance and addiction, posted by dougb on April 11, 2001, at 13:03:26
> > > That is not at all good. Do you realize how much you are taking a day?
>
> Elizabeth:
> Thank you for your kind interest.Hi Doug. I just wanted to say that you're quoting Shelli, not me. I quoted the line above in my post in order to respond to it.
> But I have been dependent on AD's for years, and THEY DO NOT WORK. If you doubt that look all around you on this board, if they worked (or at least worked for us, here) most of us would not be here.
I think they do work for most who try them, but there are some people who really do try every antidepressant treatment available and are not helped adequately.
If opioids make you more functional (and it sounds like that's what's happened), and you're able to limit your use to what is needed to feel normal (as opposed to taking more in order to feel high), you're not addicted, although you are probably pharmacologically dependent.
Responding to something in one of your other posts....
> I remember being suprised at what a powerful substance this must be, that at 1/5 of a pill approx 1mg (i guess), there was a positive reaction to it.
Codeine tends to come in tablets with as little as 7.5 mg or as much as 60 mg. So you could have tried anywhere between 1.5 mg and 12 mg. (12 mg is not really very much, 1.5 mg is practically nothing.) Do you happen to know the name of the preparation you are taking?
Posted by Elizabeth on April 14, 2001, at 4:49:52
In reply to Re: opiates » dougb, posted by ShelliR on April 11, 2001, at 16:30:08
> Doug, I am not meaning to judge you, and at some points during the last year when my therapist and pdoc gave me hard times about the hydocodone, I also thought: well, the worst that can happpen is I become dependent, or addicted. And then I will get unaddicted.
Shelli -- my experience is that when people become truly addicted (will discuss this some more later on), they remain that way possibly indefinitely -- they don't get "unaddicted," that is, they can't return to moderate use without getting sucked into pathological use again.
> I agree some antidepressants do seem to be addictive (nardil, which I take isn't, since I can get off easily with no side effects.)
This isn't the actual meaning of the word "addiction" (see my post, "Re: opiates » ShelliR," posted 4/11), but MAOIs do in fact have very bad withdrawal symptoms (panic attacks, abnormal REM sleep and intense dreams or nightmares, moodiness and hyperreactive mood, exaggerated startle response, hypersomnia, etc.) for many people, if discontinued abruptly. ADs are not really addictive at all, although there has been a small number of cases of AD addiction (mainly MAOIs) reported in the literature.
> But generally ADs have a ceiling over which an increase is not going to increase the sense of feeling good so there is a limit to the addiction possible.
Buprenorphine, a partial mu opioid agonist (which I take), has this property.
> (BTW, I call it addiction if there is a negative physical response in discontinuing the drug/med--I don't always associate addiction with inappropriate or negative behavior).
I think I addressed this in the post I referred you back to. (My info, incidentally, comes from standard pharmacology textbooks.)
Posted by ShelliR on April 14, 2001, at 10:11:27
In reply to Re: opiates » ShelliR, posted by Elizabeth on April 14, 2001, at 4:49:52
Elizabeth
> Shelli -- my experience is that when people become truly addicted (will discuss this some more later on), they remain that way possibly indefinitely -- they don't get "unaddicted," that is, they can't return to moderate use without getting sucked into pathological use again. >
That's an interesting point. When I was dependent (I'll call it, although all the docs were calling it addicted) on valium I never had a craving for it, it never made me high, just got rid of my dissociative feelings. I never saw the problem with it since (1) I do have a dissociative disorder which I was working on in therapy; (2) gereric valium is cheap and (3) there seemed little liklihood that the country would run out of valium.
When I went into the hospital for depression at that time, I did get myself off, but then they started prescribing it again. So basically, I got rid of some of the tolerance so I could start again at lower levels. I don't miss valium except I think when I get those same feelings, I think valium worked a lot better for these than klonopin.
And I have absolutely no regrets for taking it: it helped me function in a way that I would not have been able to function.So in that sense, I suppose it is very similar to what you are saying about the use of opiates, IF ALL ELSE HAS FAILED.
Regarding the use of the word "addiction", you are perhaps correct, although there is no one standard definition of addiction. The DSM-IV uses the expression "substance dependence":
A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any
time in the same 12-month period:
(1) Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
b. Markedly diminished effect with continued use of the same amount of the substance.(2) Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for the substance
b. The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.(3) The substance is often taken in larger amounts or over a longer period than was intended (loss of control).
(4) There is a persistent desire or unsuccessful efforts to cut down or control substance use (loss of control).
(5) A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects (preoccupation).
(6) Important social, occupational, or recreational activities are given up or reduced because of substance use (continuation despite adverse consequences).
(7) The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance. (adverse consequences).
As far as my reaction to Doug, it was probably an overreaction, because first I read 1/4 pill, then in two weeks, it was five or six pills. So I was totally startled.
I had also wanted to ask Doug whether he had seen a specialist in resistant depression, whether he had tried an MAOI with a mood stablizer, etc., but it seemed irrelevant at that point, since Doug had already made his decision. (That's why I included your name in this post, Doug).
I make a day to day decision about hydrocodeine, although not an agoninizing one. Basically if I have bad depression pain in my chest, and I want to get something done workwise or exercise-wise, I will take it. I think I must be getting a little bit high, because the treadmill time (45 minutes) flies by, and I have now associated taking it with making the treadmill experience more pleasant (not a good sign).
I am really interested in the form of opiate you take (I can't remember the name and if I go back I'll lose this post). I thought you said it is only available in Europe, but then you said it is often difficult to get at the pharmacy, so I'll a bit confused. (If I went back, perhaps it might be clearer to me). There's a research psychiatrist at Boston General, I have his name and phone number in another file, that I have read specializes in treatment resistant depression and has an interest in opiate response. I plan to call him next week and ask for feedback. I am a short plane ride from Boston, and have a friend there, so possibily if I feel it's worth it, and he's willing, I could possibly meet with him.
Actually at this point my depression is less than it was several months ago (although certainly not gone) and my anxiety and spaciness are up. As I said in a previous post, I have been doing a mega dose of omega fatty acids daily and have also started taking neurotin, which is a retry for me. Unfortunately it is keeping me from falling asleep, but then when I finally fall asleep I sleep incredibly soundly, so I am a bit confused as to what time to take it. Perhaps in the early evening, but I know it has a very very short half life. Will call my pdoc on Monday.
Anyway, Elizabeth, thank you for keeping the discussion open. And Doug, I can only say that no one should waste spending their life depressed if there is an alternative.Shelli
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.