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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Rudiger on October 17, 2001, at 13:51:19
Please discuss the role buprenorphine could play in treating patients who have not had the good fortune of responding to virtually all of the approaches you outlined in your talk. Given buprenorphine's exceedingly fast results in treating severe treatment-resistant depression (Bodkin et al) and its very low potential for "addiction," why is there no more research being done on it and why are so few doctors willing to even consider it? Thank you for your thoughts.
Posted by Dr. Bob on October 23, 2001, at 11:11:01
In reply to Nierenberg-Buprenorphine, posted by Rudiger on October 17, 2001, at 13:51:19
From Dr. Nierenberg:
Buprenorphene has not been extensively studied and the long-term risks are, as of yet, unknown. A fear still exists that some patients may get addicted to this opiate agonist/antagonist.
Posted by Rudiger on October 24, 2001, at 0:57:49
In reply to Re: Buprenorphine (response), posted by Dr. Bob on October 23, 2001, at 11:11:01
> From Dr. Nierenberg:
>
> Buprenorphene has not been extensively studied and the long-term risks are, as of yet, unknown. A fear still exists that some patients may get addicted to this opiate agonist/antagonist.
This irrational fear is exactly what's holding back the research and use of buprenorphine. The long-term risks of buprenorphine should be pretty well known by now, since it's been on the market for many years. Doctors may have the luxury of being fearful, but treatment-resistant patients, unfortunately, do not. A very disappointing and unenlightening response from Dr. Nierenberg.
Posted by Elizabeth on October 25, 2001, at 12:37:44
In reply to Re: Buprenorphine (response), posted by Dr. Bob on October 23, 2001, at 11:11:01
> Buprenorphene has not been extensively studied and the long-term risks are, as of yet, unknown.
Why isn't the research being done?
> A fear still exists that some patients may get addicted to this opiate agonist/antagonist.
I'm surprised -- and disappointed -- to read this. Buprenorphine really does not cause a high. There is a pretty low ceiling on its effect; although 0.3 mg is supposed to be equivalent to 10 mg of morphine (IM), the effect of morphine continues to increase as the dose is increased, while buprenorphine reaches a plateau at a pretty low dose. So it's not much of a drug of abuse. I think that, for once, the FDA got it right when they placed buprenorphine in Schedule V. The only reason an addict might want it would be to relieve withdrawal symptoms during a "dry spell."
I've been taking buprenorphine (as an antidepressant) for a year or so. It was first suggested to me in 1996 when I was living in Cambridge. I continue to be impressed by its efficacy, especially after all the treatments that have failed. I haven't become tolerant to the antidepressant effects (although most of the side effects have subsided with time). The physical dependence seems to be mild: missing a dose of Nardil (when I was taking it, that is) was much more unpleasant than missing a dose of buprenorphine is. I don't experience "cravings," nor do I feel tempted to increase the dose. I don't know too many people who've taken buprenorphine or other opioids for depression, but I know that I'm not the only one who's had a positive experience with them. In addition to buprenorphine, there have been reports of successful treatment of depression with tramadol, morphine, methadone, oxycodone, and even oxymorphone (!).
Most people who take full-agonist opioids for pain (even chronic or long-term pain) do not become addicted to them. Shouldn't we treat depressed patients on an individual basis, rather than prejudging them as universally unreliable? My experience with depressives does not lead me to believe that they are less trustworthy than, say, cancer patients.
Some people abuse benzodiazepines. Certainly, many people abuse stimulants. No one (except a few voices on the fringe, maybe) is suggesting that these drugs should not be prescribed for anxiety, mood, sleep, and attention-deficit disorders. Opioids are the oldest antidepressants. I don't suggest that they should be a first-line treatment (mainly because of their side effects, which can be pretty harsh), but with the availability of safe, generally nonaddictive opioids like buprenorphine, how can we simply dismiss them as a legitimate form of treatment?
-elizabeth
Posted by JohnX2 on October 27, 2001, at 11:33:58
In reply to Nierenberg: Re: Buprenorphine (response), posted by Elizabeth on October 25, 2001, at 12:37:44
Bottom line...........If there was a med in the US that was effective
at eliminating stimulant and opiod addiction
would the doctors be more willing to prescribe
these meds? The addiction pathway is well understood
and the ways to co-administer meds to prevent addiction
seem to be too!!!!!!!!PS. I think if memantine works for this, Forest
Labs will be marketing its qualities on top of
the Alzheimers and peripheral neuropathy indications.
The market would be huge.-john
> > Buprenorphene has not been extensively studied and the long-term risks are, as of yet, unknown.
>
> Why isn't the research being done?
>
> > A fear still exists that some patients may get addicted to this opiate agonist/antagonist.
>
> I'm surprised -- and disappointed -- to read this. Buprenorphine really does not cause a high. There is a pretty low ceiling on its effect; although 0.3 mg is supposed to be equivalent to 10 mg of morphine (IM), the effect of morphine continues to increase as the dose is increased, while buprenorphine reaches a plateau at a pretty low dose. So it's not much of a drug of abuse. I think that, for once, the FDA got it right when they placed buprenorphine in Schedule V. The only reason an addict might want it would be to relieve withdrawal symptoms during a "dry spell."
>
> I've been taking buprenorphine (as an antidepressant) for a year or so. It was first suggested to me in 1996 when I was living in Cambridge. I continue to be impressed by its efficacy, especially after all the treatments that have failed. I haven't become tolerant to the antidepressant effects (although most of the side effects have subsided with time). The physical dependence seems to be mild: missing a dose of Nardil (when I was taking it, that is) was much more unpleasant than missing a dose of buprenorphine is. I don't experience "cravings," nor do I feel tempted to increase the dose. I don't know too many people who've taken buprenorphine or other opioids for depression, but I know that I'm not the only one who's had a positive experience with them. In addition to buprenorphine, there have been reports of successful treatment of depression with tramadol, morphine, methadone, oxycodone, and even oxymorphone (!).
>
> Most people who take full-agonist opioids for pain (even chronic or long-term pain) do not become addicted to them. Shouldn't we treat depressed patients on an individual basis, rather than prejudging them as universally unreliable? My experience with depressives does not lead me to believe that they are less trustworthy than, say, cancer patients.
>
> Some people abuse benzodiazepines. Certainly, many people abuse stimulants. No one (except a few voices on the fringe, maybe) is suggesting that these drugs should not be prescribed for anxiety, mood, sleep, and attention-deficit disorders. Opioids are the oldest antidepressants. I don't suggest that they should be a first-line treatment (mainly because of their side effects, which can be pretty harsh), but with the availability of safe, generally nonaddictive opioids like buprenorphine, how can we simply dismiss them as a legitimate form of treatment?
>
> -elizabeth
This is the end of the thread.
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