![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 16 to 40 of 72. Go back in thread:
Posted by Elizabeth on May 30, 2001, at 14:08:27
In reply to Re: Codeine for Depression Treatment » Elizabeth, posted by shelliR on May 29, 2001, at 21:26:43
> Elizabeth, I'm a bit confused on this one. Are you talking about alcohol as a toxin when used as an antidepressant, or are you talking about a glass of wine with dinner?
I've said it before: "The difference between a medicine and a poison is the dose." (I know that quote comes from somewhere, but I'm not sure where.) Alcohol is an organic solvent and its intoxicant effects are not unlike those of other solvents (ataxia, CNS depression, etc.), although it is *less* toxic than some of the industrial solvents that some people ingest (for some reason). Alcohol overdoses can be lethal, and lethal polydrug overdoses almost always involve alcohol. Long-term overuse can lead to all sorts of organ failure.
The difference between moderation and excess is a crucial one.
-elizabeth
Posted by Elizabeth on May 30, 2001, at 17:19:52
In reply to Re: Codeine for Depression Treatment » Elizabeth, posted by paulk on May 30, 2001, at 11:00:53
> I’ve heard of this also about time released addreal – There is a need but no one does it
Adderal? That's a once-daily stimulant...why would there be a need for a slow-release formulation?
> If that 1 is yourself it is always interesting. – How long has it been working for you – sounded like a some of the patients were only getting a few weeks worth of relief.
That's a concern I've had, but it seems to be the exception rather than the rule. I've been taking it for about 6 months. (I had tried it before, a few years ago, but quit after a couple months because of side effects.)
> >Demerol is atypical in that it's relatively excitatory compared with morphine.
>
> Put me right to sleep.Demerol has a toxic metabolite (normeperidine) that's very proconvulsant. ("Excitatory" just means that it increases neuronal firing, BTW.)
> >Cocaine is a nonselective monoamine reuptake inhibitor (dopamine, norepinephrine, and serotonin). Medically, cocaine is used only as a local anaesthetic -- very different from systemic use as a psychostimulant.
>
> I wonder if a slow release formula might be a good drug?Nomifensine -- an antidepressant that was withdrawn from the market about 15 years ago -- is a NE-DA reuptake inhibitor. It was supposed to be very effective, in particular for people who'd had no success with other ADs.
> >Yes, some people have said they've successfully augmented ADs with naltrexone. That surprises me, since it's supposed to be a not-very-pleasant drug.
>
> Didn’t bother me at all – per haps a bit of a headache the first day.It's variable, obviously. I would expect it to be neutral at best, tho'. It came as a huge surprise to hear that some people got an AD effect from it. (To my knowledge, it only works in combination with an AD, but even that was something I never would have guessed.)
-elizabeth
Posted by paulk on May 30, 2001, at 20:30:49
In reply to Re: Codeine for Depression Treatment, posted by Elizabeth on May 30, 2001, at 17:19:52
> > I’ve heard of this also about time-released addreal – There is a need but no one does it
>Adderal? That's a once-daily stimulant...why would there be a need for a slow-release formulation?
No, it’s not – usually used 2 – 3 times a day – a mixture of different half-life amphetamines – the idea is to have a tapering effect – (which makes no sense if it is used in multiple dosages???). Adderal used to be marketed under a different name for weight loss use. I tried it to overcome the memory problems I started having with Effexor with out good results. I got one day of good effect followed by a week of diminished returns – tried upping the dose – then a week of really nasty withdrawals.It is also used for ADD – but Ritalin is generally preferred because of its longer half-life.
> > If that 1 is yourself it is always interesting. – How long has it been working for you – sounded like a some of the patients were only getting a few weeks worth of relief.
>That's a concern I've had, but it seems to be the exception rather than the rule. I've been taking it for about 6 months. (I had tried it before, a few years ago, but quit after a couple months because of side effects.)
> > >Demerol is atypical in that it's relatively excitatory compared with morphine.
> > Put me right to sleep.
>Demerol has a toxic metabolite (normeperidine) that's very proconvulsant. ("Excitatory" just means that it increases neuronal firing, BTW.)
It is a very big danger to anyone taking an MAOI. Single does have been fatal.> > >Cocaine is a nonselective monoamine reuptake inhibitor (dopamine, norepinephrine, and serotonin). Medically, cocaine is used only as a local anaesthetic -- very different from systemic use as a psychostimulant.
>
> > I wonder if a slow release formula might be a good drug?>Nomifensine -- an antidepressant that was withdrawn from the market about 15 years ago -- is a NE-DA reuptake inhibitor. It was supposed to be very effective, in particular for people who'd had no success with other ADs.
> > >Yes, some people have said they've successfully augmented ADs with naltrexone. That surprises me, since it's supposed to be a not-very-pleasant drug.
>
> > Didn’t bother me at all – per haps a bit of a headache the first day.>It's variable, obviously. I would expect it to be neutral at best, tho'. It came as a huge surprise to hear that some people got an AD effect from it. (To my knowledge, it only works in combination with an AD, but even that was something I never would have guessed.)
I can only guess at the reasoning for it being a possible AD induced sex dysfunction remedy – perhaps some people get an endorphin response that could interfere with sex – makes some sense – orgasm produces lots of endorphin.
Posted by Pacha on May 31, 2001, at 5:47:34
In reply to Re: Codeine for Depression Treatment » Elizabeth, posted by paulk on May 30, 2001, at 20:30:49
ok i really want to try a low dose of codeine to help my depression. I need advice on: dose, how long it should be taken for, safety, etc....
thanks in advance
Posted by Elizabeth on May 31, 2001, at 20:16:44
In reply to Re: Codeine for Depression Treatment, posted by Pacha on May 31, 2001, at 5:47:34
> ok i really want to try a low dose of codeine to help my depression. I need advice on: dose, how long it should be taken for, safety, etc....
Why codeine?
-elizabeth
Posted by Elizabeth on May 31, 2001, at 20:43:56
In reply to Re: Codeine for Depression Treatment » Elizabeth, posted by paulk on May 30, 2001, at 20:30:49
> >Adderal? That's a once-daily stimulant...why would there be a need for a slow-release formulation?
>
> No, it’s not – usually used 2 – 3 times a day – a mixture of different half-life amphetamines – the idea is to have a tapering effect – (which makes no sense if it is used in multiple dosages???).According to the PDR (and common practise), Adderall (formerly Obetrol) can/should be used once or twice daily. The mixture of amphetamine salts (it's equal parts d-amphetamine saccharate, d,l-amphetamine aspartate, d-amphetamine sulfate, and d,l-amphetamine sulfate) makes it longer-acting than d-amphetamine or methylphenidate. As a result, it doesn't need to be taken as often, and the mood swings that sometimes accompany psychostimulant treatment are milder or absent. For unknown reasons, Adderall sometimes works better than plain Dexedrine.
> >Demerol has a toxic metabolite (normeperidine) that's very proconvulsant. ("Excitatory" just means that it increases neuronal firing, BTW.)
> It is a very big danger to anyone taking an MAOI. Single does have been fatal.True (there was one very famous case of this in New York). There have been serious interactions with SSRIs and Effexor too. As a result morphine is the preferred analgesic for patients on ADs.
> >It's variable, obviously. I would expect it to be neutral at best, tho'. It came as a huge surprise to hear that some people got an AD effect from it. (To my knowledge, it only works in combination with an AD, but even that was something I never would have guessed.)
>
> I can only guess at the reasoning for it being a possible AD induced sex dysfunction remedy – perhaps some people get an endorphin response that could interfere with sex – makes some sense – orgasm produces lots of endorphin.Naltrexone is an opioid *antagonist*. It blocks the effects of endorphins. This can be helpful for people with certain types of impulse-control problems (notably, self-mutilation) because it blocks stress-induced analgesia. Why it would act as an AD, though, is a mystery to me.
People who've added naltrexone to ADs say that it enhances the antidepressant effects, or brings them back following a loss of effect. I've never heard of anyone using it to help with SSRI-induced sexual dysfunction. That would be even more counterintuitive than using it as an AD. < g >
-elizabeth
Posted by Pacha on June 1, 2001, at 6:42:11
In reply to Re: Codeine for Depression Treatment » Pacha, posted by Elizabeth on May 31, 2001, at 20:16:44
Well it doesn't have to be codeine, but it seems to be one of the milder opiates, least side effects and easier to get hold off.
Although i am also considering Buprenorphine at a low dose. If you could give me any advice.
cheers
Posted by Elizabeth on June 1, 2001, at 16:18:18
In reply to Re: Codeine for Depression Treatment-elizabeth , posted by Pacha on June 1, 2001, at 6:42:11
> Well it doesn't have to be codeine, but it seems to be one of the milder opiates, least side effects and easier to get hold off.
>
> Although i am also considering Buprenorphine at a low dose. If you could give me any advice.Take a look at some of my past posts on the subject -- that should give you some idea. A few links:
http://www.dr-bob.org/babble/20010515/msgs/63531.html
http://www.dr-bob.org/babble/20010515/msgs/63367.html
http://www.dr-bob.org/babble/20010507/msgs/62342.html
http://www.dr-bob.org/babble/20010507/msgs/62358.html
http://www.dr-bob.org/babble/20010507/msgs/62654.html
http://www.dr-bob.org/babble/20010507/msgs/62659.html
http://www.dr-bob.org/babble/20010507/msgs/61853.html
http://www.dr-bob.org/babble/20010507/msgs/62668.html
Ultram might be a good choice because it is not a controlled substance. Its opioid activity is mild and it is also a mild serotonin-norepinephrine reuptake inhibitor.
-elizabeth
Posted by Pacha on June 2, 2001, at 5:04:58
In reply to Re: Codeine for Depression Treatment » Pacha, posted by Elizabeth on June 1, 2001, at 16:18:18
elizabeth am i right in saying your taking Buprenorphine ? What is a good dose to start at ? 0.1, 0.2mg ? and for how long ? r there any side effects at a low dose ?
cheers
Posted by Elizabeth on June 2, 2001, at 14:31:47
In reply to Re: Codeine for Depression Treatment-elizabeth , posted by Pacha on June 2, 2001, at 5:04:58
> elizabeth am i right in saying your taking Buprenorphine ? What is a good dose to start at ? 0.1, 0.2mg ? and for how long ? r there any side effects at a low dose ?
Starting dose depends on the route of administration. I take it intranasally; 0.5 mL (0.15 mg) was the dose I started at (I increased it to 1 mL after a few days).
There are a lot of side effects, even at low doses. They're similar to the side effects of full agonists like morphine: itching, nausea/vomiting, constipation, etc.
-elizabeth
Posted by AMenz on June 4, 2001, at 14:02:15
In reply to Codeine for Depressione Treatment, posted by Thomas Schlaeger on May 26, 2001, at 10:44:31
At what dosage and, since you say it's a temporary, for how many days is it safe to take this.
solution > It has been a while someone has submitted to the thread, I however hope that it is read and would be happy about any e-mail reply.
> The "controversial" subject is to use codeine in depression treatment. This is "controversial" because the majority of doctors appear to have a different oppinion than their depressive patients.
> Basically I have ro confirm what others have said before. The immediate anti-depressive effect of codeine is almost unbelieveable and hence relieves the suffering patient of most of her/his depression symptoms.Every badly depressive person knows the terrible state where one just wants to stay in bed and one is almost unable to wash her/himself and so on. These and other depression symptoms are almost "switched off" by taking codeine.
> One of the downsides is that a rather large dosis is required to obtain the desired effect. In my case this is 250-400 mg which lasts for 6-8 hours. There is absolutely no "high" effect, just total normalization allowing me to do all the things which otherwise would be impossible through the depression. Working, shopping, looking after myself, my pet etc.
> Whilst medication like codeine against depression was known until the mid.50s, regretfully nowadays it seems completely forgotten. The most important thing for every doctor should be hers/his patient's well being and yet many doctors refuse to prescribe codeine as an intermediate solution. Sad cases are known where depressive patients trick their doctors in prescribing codeine containing cough syrup. This should not be like that, I would wish that the highly anti-depressive component of codeine gets widely known in the medical field again and is prescibed to give relief to depressive patients. I am myself very lucky to have an understanding good doctor, so I don't have to suffer to badly under my depression.
> There are some important things to note however. Codeine provides almost instant relief of depression symptoms but this is only a sort of "cover up". Nothing is done with regard to the actual cause of the illness and hence it is very important that standard anti-depressive medicine is taken in addition. In some cases psycho-therapeutic treatment may be necessary as well. Codeine is great in "surviving" your depressive days but it does nothing towards the actual cause.
> as I said in the beginning I would be happy to receive comments by anyone concerned.
> Thomas, Hamburg, Germany
Posted by Elizabeth on June 4, 2001, at 16:35:06
In reply to Re: Codeine for Depressione Treatment, posted by AMenz on June 4, 2001, at 14:02:15
> At what dosage and, since you say it's a temporary, for how many days is it safe to take this.
How safe do you want?
There seems to be a wide range of variability in the rates at which different people develop tolerance.
BTW: there is no evidence or reason to suppose that opioid agonists are "cover-ups" that don't address the "root cause" of depression. (This is an argument commonly made by proponents of "talk" therapies in criticising the use of any drug at all, incidentally.)
-elizabeth
Posted by froggy on June 5, 2001, at 5:49:19
In reply to Re: Codeine for Depression Treatment » AMenz, posted by Elizabeth on June 4, 2001, at 16:35:06
I never really thought about it before but when I was in a bad car accident I had to take 500mg's codine every 4-6 hours and I felt great! I never got too down being in a wheel chair and so much pain.
Recentley I just started taking vicodin again because I am not completely out of pain. I do like the effects when mixed with an AD.
Unfortunatley here the doctors think that codine was developed by Satan and to take one is to become a drug addict. I feel like one when tring to find a doctor that will give me a script.
It is sad what they reduce a person too.
Posted by AMenz on June 5, 2001, at 11:19:40
In reply to Re: Codeine for Depression Treatment » AMenz, posted by Elizabeth on June 4, 2001, at 16:35:06
Codeine is supposed to be addictive. I'm already unable to get off a 1mg benzo daily.
When you say an opioid is it a synthetic or a natural derivative of opium. Better yet since I do not have a science background-what is an opioid agonist, as opposed to an opiate?
What is the action of codeine that it relieves depression and is the effect palliative like, eg. like benzos which wear off quickly and have to be readministered as oppossed to SSRI which and lithium which build up in the bloodstream slowly and take several days to wear off.
I'm almost embarassed to write to you because you seem extremely knowledgeable. What is your background, if I may ask?
> At what dosage and, since you say it's a temporary, for how many days is it safe to take this.
>
> How safe do you want?
>
> There seems to be a wide range of variability in the rates at which different people develop tolerance.
>
> BTW: there is no evidence or reason to suppose that opioid agonists are "cover-ups" that don't address the "root cause" of depression. (This is an argument commonly made by proponents of "talk" therapies in criticising the use of any drug at all, incidentally.)
>
> -elizabeth
Posted by paulk on June 5, 2001, at 12:05:48
In reply to Re: Codeine for Depression Treatment-Elizabeth, posted by AMenz on June 5, 2001, at 11:19:40
>Codeine is supposed to be addictive. I'm already unable to get off a 1mg benzo daily.
I’m not a doctor, but just a life long paient. That being said: Why are you trying to get off? The best way to get off is to switch to a long half-life Benzo like Clonazepam and to taper down – sometimes by as little as Ľ of the dose per week. ( one week at 1mg - next at .75 next at .5 next at .4 next at .3, .2,.1 )
Be aware that you may not be addicted to the benzo at all. What you might be experiencing is the reemergence of symptoms that the benzo is helping you with. That is not addiction. If this is the case you need to ask yourself why you are stopping. I could see switching to Effexor of some other med to deal with anxiety – but if they don’t work for you why not use what works? Some doctors are overly anti benzos – they have seen patients that abused benzos – most mental patents don’t abuse these drugs – and if you are on 1 mg – it sure doesn’t sound like you are.
You want to use the lowest dose that controls your symptoms – that can be quite low for some of us (I take .25mg of Clonazepam). Larger than necessary doses seem to effect memory and learning..
I don’t like the idea of using a benzo “as needed” except in the case of bipolar depression. Most of the time, anxiety can be treated with a regular low dose – going up and down can CAUSE anxiety.
Clonazepam BTW is probably one of the best to use – it has a long half-life and some seritnergic effect as well. Xanex (Alprazolam) has some anti-depressant action but has too short of a half-life to be practical for most (it would be interesting if they came out with a slow release version of it.).
Good luck to you
Posted by Glenn Fagelson on June 5, 2001, at 21:05:36
In reply to opioid antidepressants case series (as promised) » paulk, posted by Elizabeth on May 29, 2001, at 19:48:02
> As promised, here's the case series I referred to in my previous post. Interestingly, the primary author is the same Dr. Stoll who has become known for his work on omega-3 fatty acids for mood disorders.
>
>
> Am J Psychiatry 156(12):2017, December 1999
> ©1999 American Psychiatric Association
>
> Treatment Augmentation With Opiates in Severe and Refractory Major Depression
> Andrew L. Stoll, MD, and Stephanie Rueter, BA
> Belmont, Mass.
>
> To the Editor:
>
> Substantial evidence supports the antidepressant efficacy of opiates (1). This report summarizes our open-label experience using the µ-opiate agonists oxycodone or oxymorphone in patients with highly refractory and chronic major depression.
>
> Mr. A was a 44-year-old man with severe and chronic depression. Numerous trials of antidepressants produced only limited benefit. Mr. A also had an extensive history of opiate abuse, and he noted that the only times he ever felt normal and not depressed was during opiate use. Because of the refractory nature of his depressive symptoms and his apparent self-medication with opiates, Mr. A was given a trial of oxycodone under strict supervision. After 18 months of oxycodone treatment (10 mg/day), Mr. A remained in his longest remission from depression without the emergence of opiate tolerance or abuse.
>
> Ms. B was a 45-year-old woman with bipolar disorder and opiate abuse (in remission for 2 years). A trial with standard mood stabilizers had failed, and she had experienced mania with several standard antidepressant drugs. As with Mr. A, Ms. B reported feeling well only when taking opiates, particularly oxymorphone. Oxymorphone (8 mg/day) was thus cautiously added to ongoing lamotrigine therapy (as a mood stabilizer), and she remained well for a minimum of 20 months without drug tolerance or abuse.
>
> Mr. C was a 43-year-old man with chronic major depression that was unresponsive to numerous antidepressants with and without augmentation. Detailed questioning revealed that he once experienced marked antidepressant effects from opiates that he received after a dental procedure. There was no history of opiate abuse, and a cautious trial of oxycodone was initiated. Mr. C experienced a dramatic and gratifying antidepressant response from oxycodone (10 mg t.i.d. for 9 months) without opiate tolerance or abuse.
>
> This report describes three patients with chronic and refractory major depression who were treated with the µ-opiate agonists oxycodone or oxymorphone. All three patients experienced a sustained moderate to marked antidepressant effect from the opiates. The patients described a reduction in psychic pain and distress, much as they would describe the analgesic effects of opiates in treating nocioceptive pain.
>
> Two of the three patients described in this report were previous abusers of opiates. Although the clinical use of opiates in patients with a history of opiate addiction is usually contraindicated, in these cases there was a strong indication that they were self-medicating their mood disorders (2) with illicit opiates. None of the patients abused the opiates, developed tolerance, or started using other, illicit substances.
>
> We used oxycodone in three additional patients without histories of opiate abuse. In two of these three patients, oxycodone produced a similar sustained antidepressant effect. Two of these patients experienced mild-to-moderate constipation, and one experienced daytime drowsiness from the opiates. Opiates should be considered a reasonable option in carefully selected patients who are desperately ill with major depression that is refractory to standard therapies.
>
> REFERENCES
>
> 1. Bodkin JA, Zornberg GL, Lukas SE, Cole JO: Buprenorphine treatment of refractory depression. J Clin Psychopharmacol 1994; 15:49-57.
>
> 2. Khantzian EJ: Self-regulation and self-medication factors in alcoholism and the addictions: similarities and differences. Recent Dev Alcohol 1990; 8:255-271.I do not know about the rest of you, but
Vicodin absolutely ruins my sex drive. It does,
however, have a wonderful anti-depressant effect
with me. I take Vicodin as needed for headaches,
injuries, and sometimes just to reduce the effect
of severe depression. I have been using the
Vocodin for almost 3 years now; I have been very
careful with it because I realize how addicting
it could become. I have in no way become addicted
to Vicodin, but I know that the relief that I get
from it has great potential for abuse. So again,
I am very, very careful with it.
Glenn
Posted by petter on June 6, 2001, at 1:16:24
In reply to Re: Codeine for Depression Treatment-It's true, posted by froggy on June 5, 2001, at 5:49:19
> I never really thought about it before but when I was in a bad car accident I had to take 500mg's codine every 4-6 hours and I felt great! I never got too down being in a wheel chair and so much pain.
> Recentley I just started taking vicodin again because I am not completely out of pain. I do like the effects when mixed with an AD.
> Unfortunatley here the doctors think that codine was developed by Satan and to take one is to become a drug addict. I feel like one when tring to find a doctor that will give me a script.
> It is sad what they reduce a person too.H1!
Whatch up for codeine. It can cause treathment resistent depression I have seen this many times in the hospital were I use to work. Tolerans can also occur.
Take care//Petter
Posted by shelliR on June 6, 2001, at 19:32:41
In reply to Re: Codeine for Depression Treatment » Pacha, posted by Elizabeth on June 1, 2001, at 16:18:18
Elizabeth,
Do you know if the same amount of hydrocodone (which has synthetic codeine, right?) and codeine at the same strength have equal effects. Is codeine phosphate the same as codeine? I tried codeine phosphate 8mg , paracetamol 500mg (actually took
1/2 pill as I do with hydrocodone but I'm not sure if it has the same antidepressant effects. I'm having a really awful day (depression -wise). Maybe I took it less than an hour ago, so that's why I am not yet feeling the antidepressant effects, or maybe synthetic codeine has a different feeling than codeine.Thanks, Shelli
Posted by Elizabeth on June 6, 2001, at 20:54:19
In reply to Re: Codeine for Depression Treatment-Elizabeth, posted by AMenz on June 5, 2001, at 11:19:40
> Codeine is supposed to be addictive. I'm already unable to get off a 1mg benzo daily.
In what sense do you have trouble getting off the benzo (Xanax? Klonopin?)? Like, do you feel an urge for it, like you would feel an urge for food after not eating for a while? Do you suffer from rebound anxiety or insomnia or other withdrawal symptoms? (This happens with some antidepressants, like Effexor, Paxil, and Parnate, too, but people who suffer withdrawal symptoms are not considered "addicted" solely by virtue of the withdrawal symptoms. Addiction is understood in terms of craving for a substance.)
> When you say an opioid is it a synthetic or a natural derivative of opium. Better yet since I do not have a science background-what is an opioid agonist, as opposed to an opiate?
"Opioid" or "opioid agonist" refers to a drug that activates opioid receptors; "opioid antagonists" are drugs that block opioid receptors, preventing them from being activated. This is a way of describing a group of drugs based on their effects.
"Opiate" is sometimes used to refer to all opioid agonists, although technically it refers to opium constituents (codeine and morphine, as well as an inactive chemical called thebaine) and chemically close drugs that are derived from them (like hydrocodone, hydromorphone, oxycodone, etc.). This is a way of classifying drugs based on their origin (the opium poppy), or similarity to naturally-occuring chemicals that come from a particular origin.
> What is the action of codeine that it relieves depression and is the effect palliative like, eg. like benzos which wear off quickly and have to be readministered as oppossed to SSRI which and lithium which build up in the bloodstream slowly and take several days to wear off.
The time it takes to reach steady-state levels is not the reason that SSRIs, for example, take a few weeks to work (lithium usually works within a week or two if it's going to work). It has to do with their chronic, rather than direct, effects. Chronic use of opioids or benzodiazepines can cause tolerance to some of their effects (just as you can become tolerant to some of the side effects of antidepressants after using them for a while).
> I'm almost embarassed to write to you because you seem extremely knowledgeable. What is your background, if I may ask?
I don't like to talk about personal stuff on the internet. I'm not a doctor or anything. Please don't be afraid. :-) (Not that you should be afraid of doctors, either. Usually, anyway.)
-elizabeth
Posted by Elizabeth on June 6, 2001, at 21:03:10
In reply to Re: Codeine for Depression Treatment » Elizabeth, posted by shelliR on June 6, 2001, at 19:32:41
> Do you know if the same amount of hydrocodone (which has synthetic codeine, right?) and codeine at the same strength have equal effects.
No ("equipotent" is the word for that). The lowest strength of hydrocodone available in a single pill is 5 mg; the lowest amount of codeine is 15 mg (I think). Codeine is generally weaker than hydrocodone, meaning that hydrocodone is capable of producing greater effects, as well as being more potent (which is just a matter of the effective dose).
> Is codeine phosphate the same as codeine?
It's the salt of codeine that is used clinically. (Some drugs are available as different salts: e.g., lithium carbonate vs. lithium citrate.) Codeine would be the "free base," just as crack is the free base of cocaine hydrochloride.
> 1/2 pill as I do with hydrocodone but I'm not sure if it has the same antidepressant effects.
That's not much codeine, certainly not equivalent to the same dose of hydrocodone.
Don't self-medicate, if you can avoid it. It's a risky thing to do.
-elizabeth
Posted by shelliR on June 6, 2001, at 22:04:45
In reply to Re: Codeine for Depression Treatment » shelliR, posted by Elizabeth on June 6, 2001, at 21:03:10
> Don't self-medicate, if you can avoid it. It's a risky thing to do.
>
> -elizabethThanks for the information, Elizabeth. Actually I have no choice but to self-medicate. My pdoc says it's okay to take the hydorcodone but he won't prescribe it. My gyn will give me enough for 10 days for pms symptoms, but that's it. And I don't believe that I will find a pdoc who will prescribe hyrodocodone for depression (even Dr. bodkin won't anymore).
I am planning to ask my pdoc about Buprenorphine, which I may have a better chance of getting from a doctor. I think I am self-prescribing, rather than self-medicating, in a sense. My pdoc is informed about what I am taking so I'm sure he will warn me if there is any danger involved. But because opiates are so often addictive drugs, doctors other than pain management doctors have to be really careful. I think I mentioned before that my gyn told me that doctors are very carefully monitored for these drugs and she said it is the most common way that doctors get warnings and lose their licenses.
When I was a very young adult and severely depressed (pre-prozac) my pdoc gave me tricyclics and I couldn't take them. They completely disoriented me. I ended up in the hospital (Sheppard-Pratt, supposed to be a good hospital) and again they gave me tricyclics, and again I couldn't adjust. Neither my pdoc or the pdocs in the hospital even suggested a MAOI.
Right after my hospital stay, absolutely on a fluke, I happened to catch Nathan Kline on PBS, and bought his little paperback book (From Sad to Glad). I asked my pdoc why she hadn't put me on one of them and she sort of hemmed and hawed and said, "oh, yes, that was going to be my next suggestion." Like right, thanks. So basically at the age of 22 I felt that I saved my own life because I just happened to have been lucky. And I have never ever put my life totally in the hands of any doctor, without doing my own research. It's much easier now, but there were times I spent entire days at the library at NIH.
I had a pdoc for ten years who is considered the best in the city with treatment resistent depression. She would not even read any of the McLean studies on opiates. Over and over I heard definitively that codeine is not an anti-depressant. So although my preference would be collaboration with a pdoc, I'll take my chances with supervised self-medication.
Shelli
Posted by Elizabeth on June 7, 2001, at 1:47:06
In reply to Re: Codeine for Depression Treatment » Elizabeth, posted by shelliR on June 6, 2001, at 22:04:45
> Thanks for the information, Elizabeth. Actually I have no choice but to self-medicate. My pdoc says it's okay to take the hydorcodone but he won't prescribe it. My gyn will give me enough for 10 days for pms symptoms, but that's it. And I don't believe that I will find a pdoc who will prescribe hyrodocodone for depression (even Dr. bodkin won't anymore).
I know of a few doctors who've used opioids with success. It might help if you pitched Ultram to them -- there's been a bit of work with it for depression, social phobia, and OCD. Anyway, as long as a doctor knows you're taking it and what dose you're taking, that's fine. Just don't start self-adjusting your dose or whatever.
> I am planning to ask my pdoc about Buprenorphine, which I may have a better chance of getting from a doctor.
Not from a pdoc. Buprenorphine makes them squeamish because it only comes in the injectible solution and even if you aren't injecting it, you need to use a syringe to take it.
> I think I am self-prescribing, rather than self-medicating, in a sense.
Hence, taking the wrong dose of codeine.
> But because opiates are so often addictive drugs, doctors other than pain management doctors have to be really careful.
Pain management doctors too.
> I think I mentioned before that my gyn told me that doctors are very carefully monitored for these drugs and she said it is the most common way that doctors get warnings and lose their licenses.
I know. It's terrible.
> When I was a very young adult and severely depressed (pre-prozac) my pdoc gave me tricyclics and I couldn't take them. They completely disoriented me. I ended up in the hospital (Sheppard-Pratt, supposed to be a good hospital) and again they gave me tricyclics, and again I couldn't adjust. Neither my pdoc or the pdocs in the hospital even suggested a MAOI.
Wow. I didn't like the side effects of TCAs either, but they were nothing compared to opioids.
> Right after my hospital stay, absolutely on a fluke, I happened to catch Nathan Kline on PBS, and bought his little paperback book (From Sad to Glad).
Careful, you're dating yourself. ;-)
> I asked my pdoc why she hadn't put me on one of them and she sort of hemmed and hawed and said, "oh, yes, that was going to be my next suggestion." Like right, thanks. So basically at the age of 22 I felt that I saved my own life because I just happened to have been lucky. And I have never ever put my life totally in the hands of any doctor, without doing my own research. It's much easier now, but there were times I spent entire days at the library at NIH.
I know how you feel. Due to bad past experiences, I have a certain distrust of pdocs (well, more a "trust but verify" mentality) that makes it hard for me to work with them. I always come in with a list of things I want to do, they always want to hear lots of history and stuff. I should just make a writeup.
> I had a pdoc for ten years who is considered the best in the city with treatment resistent depression. She would not even read any of the McLean studies on opiates.
She wouldn't even *read* them? What kind of doctor is that?
> Over and over I heard definitively that codeine is not an anti-depressant. So although my preference would be collaboration with a pdoc, I'll take my chances with supervised self-medication.
Codeine is a crappy opiate, not the one I would choose if I felt a full agonist were appropriate. How did you come to be switched to that from the hydro?
-elizabeth
Posted by shelliR on June 7, 2001, at 11:43:54
In reply to Re: Codeine for Depression Treatment » shelliR, posted by Elizabeth on June 7, 2001, at 1:47:06
> I know of a few doctors who've used opioids with success. It might help if you pitched Ultram to them -- there's been a bit of work with it for depression, social phobia, and OCD. Anyway, as long as a doctor knows you're taking it and what dose you're taking, that's fine. Just don't start self-adjusting your dose or whatever.Can't take ultram unless I discontinue the nardil, seems like.
>
> Not from a pdoc. Buprenorphine makes them squeamish because it only comes in the injectible solution and even if you aren't injecting it, you need to use a syringe to take it.I am waiting to hear about a consultation at Johns Hopkins, since they have also done that small study on buprenorphine. I want to make sure opiates are a possibility or I don't think it's worth going for the consultation.
>
> > I think I am self-prescribing, rather than self-medicating, in a sense.
>
> Hence, taking the wrong dose of codeine.Well, I can take as much as I need to of codeine; it is easy to get over the internet, so I thought I try it.
> > But because opiates are so often addictive drugs, doctors other than pain management doctors have to be really careful.
>
> Pain management doctors too.I have a call in to a pain management dr. in Virginia who works narcotic protocol programs for pain. I talked to his nurse and am waiting to hear if he would accept me for depression. The other thing is how expensive he is, but since my needs are different, the nurse said he may also not charge me his usual. I am feeling pretty desperate, I talked to my pdoc this morning and he feels he can't help me and I need to find someone else. That in itself is not a great loss, but it is scary to be in the position that only someone both creative and with the willingness to take a risk can treat me. I have relied on nardil for so many years, it is so strange to be in this position.
>
> Wow. I didn't like the side effects of TCAs either, but they were nothing compared to opioids.
I'm talking about such severe disorientation that I couldn't hardly even dress myself. I've had no disorientation with hydrocodone.
> Careful, you're dating yourself. ;-)That's okay. I'm much smarter than I was twenty years ago and have a triving, creative business.
And I am very very afraid of losing that business if I can't control my depression. This last week has been really bad until I take hydrocodone and I don't have enough to take 1/2 pill twice a day, so I have been only taking it once.> I know how you feel. Due to bad past experiences, I have a certain distrust of pdocs (well, more a "trust but verify" mentality) that makes it hard for me to work with them. I always come in with a list of things I want to do, they always want to hear lots of history and stuff. I should just make a writeup.
I have a certain, I think healthy, mistrust of any doctor. A doctor is a person, not a god. I am really good at what I do, but I make mistakes sometimes. I don't exempt doctors from the same possibility. I do tend to find pdocs a bit more arrogant than other doctors. And I do come in with everything typed up--all past medications and results, so that I don't have to spend the whole session answering questions.
>
> > I had a pdoc for ten years who is considered the best in the city with treatment resistent depression. She would not even read any of the McLean studies on opiates.
> She wouldn't even *read* them? What kind of doctor is that?A doctor that you leave after ten years.
>
> > Over and over I heard definitively that codeine is not an anti-depressant. So although my preference would be collaboration with a pdoc, I'll take my chances with supervised self-medication.
>
> Codeine is a crappy opiate, not the one I would choose if I felt a full agonist were appropriate. How did you come to be switched to that from the hydro?I haven't switched; I am trying to build in safety valves since it is such a battle to get enough hydrocodone. I wanted to see if the other would work BEFORE I ran out of hydrocodone. So far I have access to only 10 pills per month.
I can get more hydrocodone with a consultation on the internet, but I would really like a real pdoc to work with me and support my treatment.
>Shelli
Posted by Elizabeth on June 8, 2001, at 14:35:56
In reply to Re: Codeine for Depression Treatment » Elizabeth, posted by shelliR on June 7, 2001, at 11:43:54
> Can't take ultram unless I discontinue the nardil, seems like.
That's true. Ultram is a mild risk, IMO, with SRI type drugs (SSRIs, Effexor, Serzone, etc.) but a serious one with MAOIs.
I'm trying Ultram right now. I think it is well suited to chronic pain (and psychiatric disorders) but is not a great choice for acute pain (or PRN use for other conditions). It takes about 3 hours to work. It has at least one long-acting metabolite (desmethyltramadol). Taking regular scheduled doses over time should result in steady-state plasma levels of desmethyltramadol, leading to a smoother effect than you'll get with typical short-acting opioids (including buprenorphine).
I've found that tramadol doesn't work well for me (even after 3 hours) in the dose range that is supposed to be safe. One might be able to use higher doses by adding an anticonvulsant. I don't know for sure that it would work well even if I went outside the accepted dose range, though.
> I am waiting to hear about a consultation at Johns Hopkins, since they have also done that small study on buprenorphine. I want to make sure opiates are a possibility or I don't think it's worth going for the consultation.
Johns Hopkins...I'm curious, where do you live? (I'm originally from the DC area, is why I ask.)
I'm planning on setting up an appointment for a consultation at Columbia. We can compare notes. < g >
> Well, I can take as much as I need to of codeine; it is easy to get over the internet, so I thought I try it.
Shhh! :-) It's true that it's possible to get a lot of medications (even some that are federal Schedule III, IV, or V controlled substances) on the net, but I expect the government to start cracking down on this. I would not count on the net as a long term source of codeine or other opioids, especially. If you start becoming pharmacologically dependent on it and then are suddenly unable to get it, you could have a very hard time (as many an addict has learned the hard way).
> I have a call in to a pain management dr. in Virginia who works narcotic protocol programs for pain.
That's cool. Some of them are reasonable and understand that tolerance doesn't mean you're abusing the drug; it's just a natural result of taking opioids. Others want to push you into "pain management" which means using non-opioid drugs like NSAIDs and nonpharmacological stuff like acupuncuture (this has become a mainstream thing now), physical therapy, TENS, cognitive-behavioural therapy, etc. -- even if it's ineffective or inadequately effective (as these therapies often are). I felt fortunate to get any medication (Relafen (NSAID), baclofen, and finally Soma after the other two failed!) when I went to a pain clinic at an academic medical centre.
> I talked to his nurse and am waiting to hear if he would accept me for depression.
Good luck...let me know what happens.
People who have pain syndromes as well as depression are most likely to be treated with opioids. I've thought about going to a pain doctor too (chronic back pain which exacerbates my insomnia).
> The other thing is how expensive he is, but since my needs are different, the nurse said he may also not charge me his usual.
Some doctors have a few places in their schedules reserved for people who can't pay the usual charge. One time I was in a partial program (day treatment) and it came out that one of the people in the program was there for free. A lot of the other people were pretty angry when they found out about it because that program was not something that private insurance would usually cover and they don't take Medicaid (as a result, the people in the program were pretty much all young white people from upper- or upper-middle class families).
> I am feeling pretty desperate, I talked to my pdoc this morning and he feels he can't help me and I need to find someone else. That in itself is not a great loss, but it is scary to be in the position that only someone both creative and with the willingness to take a risk can treat me.
I know *exactly* what you mean. I've been in that position too.
Do you want to talk over email? We seem to have a lot of the same situations and problems. I'd like the chance to talk to someone who understands what I'm going through. You know? Anyway, if you'd like to talk, I can post an address where you can reach me.
> I'm talking about such severe disorientation that I couldn't hardly even dress myself. I've had no disorientation with hydrocodone.
Which TCAs did you try? The side effects that caused me to stop TCAs without an adequate trial are similar to the opioid side effects that bother me so much (constipation, dry mouth, etc.), only milder, which is why I'm thinking of trying a TCA again.
> > Careful, you're dating yourself. ;-)
>
> That's okay. I'm much smarter than I was twenty years ago and have a triving, creative business.I'd like to think that most people get smarter as they age (although sometimes this doesn't seem to be true). It sounds like you've got a pretty good thing going -- nice (and encouraging) to hear.
> And I am very very afraid of losing that business if I can't control my depression.A legitimate fear. I'm sure you've suffered losses before as a result of depression. I know I have (which doesn't exactly help make the depression go away).
> I have a certain, I think healthy, mistrust of any doctor. A doctor is a person, not a god.
Right. But a lot of them -- especially "old school" types, but also some younger doctors who I think are trying to emulate their teachers -- think they are, at the least, superior human beings. They're the ones with the education, but they should be able to provide a convincing reason for anything they want you to do (or refuse to do for you).
> I am really good at what I do, but I make mistakes sometimes. I don't exempt doctors from the same possibility. I do tend to find pdocs a bit more arrogant than other doctors.
They work with patients who are more vulnerable and helpless-seeming than the average medical patient. Also, psychiatry is sort of ghettoised by the rest of the medical profession -- psychiatrists aren't seen as "real doctors" by a lot of other doctors. So they sometimes try to compensate for that by being more arrogant. (IMHO)
> And I do come in with everything typed up--all past medications and results, so that I don't have to spend the whole session answering questions.
I need to write up a history, too. My records are terribly confusing, and pdocs I've seen in the past often like to minimise what they put on paper (because of confidentiality concerns -- they do document things that really need to be documented for legal reasons, but they try to avoid having a lot of incriminating records for insurance companies to peruse).
> > She wouldn't even *read* them? What kind of doctor is that?
>
> A doctor that you leave after ten years.What I'm wondering, I guess, is how you stayed with her for so long.
> I haven't switched; I am trying to build in safety valves since it is such a battle to get enough hydrocodone. I wanted to see if the other would work BEFORE I ran out of hydrocodone. So far I have access to only 10 pills per month.
Ouch. 10 doses (or even 20) would not be enough for me to get by on. (Buprenorphine is really a 3x/day med, and hydrocodone and codeine are, if anything, shorter-acting.)
> I can get more hydrocodone with a consultation on the internet, but I would really like a real pdoc to work with me and support my treatment.
In the best of all possible worlds....
-elizabeth
Posted by shelliR on June 8, 2001, at 22:42:05
In reply to Re: Codeine; early report on Ultram trial; stuff » shelliR, posted by Elizabeth on June 8, 2001, at 14:35:56
Hi Elizabeth--I didn't realize that you were doing an ultram trial. Doesn't sound like a good start. What precipiated the change from Buprenorphine?
Here's my update:
First of all I talked to Dr. B from McLean . It is nice that researchers answer their own phones! Nice for me anyway. Poor guy, this is my fourth phone call to him, but I am very appreciative and offered to send him a fee, (rejected offer!). I was thinking of going into the hospital to get off Nardi and start selegiline, and my potential doctor from the hospital called Dr. B also because he had never used selegiline with anyone.Okay: his advice. "Try selegiline" and he gave me the name of the researcher at NIMH who did a large study on it with geriatric patients . I talked to that researcher today (a dr. sunderland) and he told me that there was no difference in side effects, including anxiety, between the placebo group and medicated group. Because I told him I had "heard" on the interernet that it can make you shakey. He said that was not his experience in the study, but I think we at PB may be a different breed.
So back to Dr. B. My therapist was saying that she thought the hydrocodone was making me worse and I said I thought the lack of effectiveness of nardil was the reason for very nearly falling apart off and on for the last year and a half. Then I come home and I have an e-mail from a mostly former babbler who (very respectfully) asked the same question. So that prompted my call to Dr. B at 5:30 pm yesterday. I was so happy he answered and wasn't angry that I called again. He felt it was not the hydrocodone, that it was the ineffectivenss of nardil for me now and made several suggestions. I also asked him if he felt that buprenorphine would be better for me, and he said as long as I wasn't increasing the hydro, he wouldn't bother.
Then today my usual doctor at the hospital got me in touch with another attending doctor at the hospital on a unit I won't go on (the regular adult unit--too big, too scary, too lonely for me) and he actually suggested that I go on oxycoton (sp?) (I think it was that, not oxycodone) because it would be longer lasting. I was stunned that a doctor was suggesting this to me. He wants me to go into the hospital and I can go to the unit I feel safe on (dissociative disorders unit) and he will be my doctor. And I called the head doctor of that unit, who I have known for years and I told her that he might want to prescribe an opiate for me. She didn't blink, and acknowledged that for some people it is effective. I was so overwhelmed with gratitute that two doctors in one hour didn't tell me that I was going to become an addict and that opiates are NOT ANTIDEPRESSANTS that I actually started to cry!
So I am (I think) going to go into the hospitial Sunday evening and try to work out a drug regiment with the doctor I talked to today. The only problem is that I've talked to him before and he doesn't listen well to me. He's not big on selegiline and suggested that I try sonata also, even though I've already tried a very small dose of ridilin, and all stimulents do not feel right for me. So I'm a bit nervous, because I would like to stick to the selegiline plan. (He's a real cocktail guy, and cocktail docs don't like MAOIs because it gives them less choices). But my therapist is threatening to terminate with me unless I find a pdoc who supports my use of hydro and supervises me, and I wasn't at all feeling optimistic I would be able to do that until I talked to him.
Talked to the people at Johns Hopkins, was not impressed that they had anything differerent to offer me, and since I don't have a pdoc at the moment, they couldn't see me anyway for a consultation.
I stayed with my pdoc for ten years because I was doing pretty well most of the time, she was always available for me, and was willing to mix meds that other docs wouldn't at the time, e.g., nardil and serzone together. We then had a lot "debates" about the hydro and I felt like at the end she just started throwing meds at me--all the atyp antipsy which I hated. When I wouldn't try zeprexa because of weight gain, she said I didn't really want to get well, and that was the end.
And I agree--I don't think this internet thing is going to last. I think it's actually really crazy.
So I will go into the hospital on Sunday. I've been there five times through the years before, it's a great staff and a small unit, it's not scary to me, but it's not a mood disorder unit. So it's good to have the other doctor involved. I'm hoping no more than a week, usually when I go in it's for about 5 days, but I'm not sure because of this medication thing. I'll have a laptop, but I don't know if there will be a phone to hook it up to. You can bring in your cell phone, but otherwise there are just payphones, unless the staff lets me use one of their lines. Actually, there is jack in the smoking room, but I don't think I could stand to go in there for even five minutes with that air.
I can email you-- if you create and post a temporary e-mail address from yahoo or hotmail then I can send you my real one. But that would I think be if we wanted to exchange personal info--like exactly where I live in the d.c. area, what my work is, etc., and same for you. For regular med stuff I think it's better to keep it on the board, people don't have to read it, but it might catch the eye of someone who has had similar experiences that we wouldn't otherwise find out about if our posts were off the board.
Shelli
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