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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on February 18, 2003, at 21:16:16
In reply to Re: Buprenorphine-- bee happy » SLS, posted by bee happy on February 18, 2003, at 18:30:07
Hi Bee.
Thanks for your detailed reply.
> So, what's your story?
I suffer from a severe anergic depression that is probably a form of bipolar disorder. Dementia (general definition) is probably the most prominent symptom cluster right now. Without the partial relief I glean from Lamictal + desipramine, I cannot read more than two or three sentences before having to quit or go to sleep. My thoughts are very slow and muddied, and my memory is terrible. The few manic episodes I have had were precipitated by drug intervention. Without an effective treatment, I remain depressed continually. Since 1982 (age 22), I have never experienced a spontaneous remission. The only robust (nearly complete) response to treatment came in 1987 and lasted 9 months. I would most likely be OK today had my doctor at that time not opted to discontinue the drug combination (Parnate + desipramine) due to the emergence of mania. Once the mania was under control using lithium and Klonopin, he decided not to restart the antidepressants. I relapsed within two months. Instead of returning to the previously effective medications, he gave me the newly-approved Prozac to try. I guess it was a new toy. To make a long story short, I have not responded to anything since - not even the original MAOI + TCA combination. It is an unfortunate mistake that some people make to discontinue a particular drug, only to go on to relapse and find that their first exposure to the drug has rendered their brain less responsive to it.
I have been on most of the drugs currently available and many that remain unavailable (foreign and investigational). So, yes, I am very interested to pursue the use of opioids should the next few drug trials I attempt fail.
Among the drugs I have tried are:
Parnate
Nardil
imipramine
desipramine
nortriptyline
amitriptyline
amoxapine
protriptyline
lithium
Depakote
trazodone
Wellbutrin
indalpine
viqualine
Prozac
Paxil
Lamictal
Neurontin
Tegretol
Zyprexa
Risperdal
Effexor
clorgyline
idazoxan
nomifensine
adinazolam
bromocriptine
Cytomel
Synthroid
pemoline
Ritalin
DexedrineI have a list somewhere.
- Scott
Posted by androog on February 18, 2003, at 23:02:04
In reply to Re: Buprenorphine-- bee happy » bee happy, posted by SLS on February 18, 2003, at 21:16:16
hi scott-
i just read your latest post and i have to say that you sure have your thoughts well organized, considering your ailments. it must be tough to keep it that together when you feel as bad as you must.i'm one of the fortunate souls who has responded to tramadol. every day it amazes me how quickly it can drag me out of the hole i wake up in.
stories like yours are really inspirational, since you're still putting up a good fight after all these years. you make me realize i should stop whining so much -- that others have it even worse than i do.
hang in there and keep writing.
androog
Posted by SLS on February 19, 2003, at 11:52:27
In reply to Re: Buprenorphine-- bee happy, posted by androog on February 18, 2003, at 23:02:04
Hi androog.
> stories like yours are really inspirational, since you're still putting up a good fight after all these years. you make me realize i should stop whining so much -- that others have it even worse than i do.
For any given person suffering depression, their's is the worst - and that's certainly bad enough.
Thanks for the caring sentiments. They couldn't have come at a better time.
(It's my birthday).
Take care and be well.
- Scott
Posted by ShelliR on February 19, 2003, at 12:13:12
In reply to Re: Buprenorphine-- bee happy » androog, posted by SLS on February 19, 2003, at 11:52:27
Posted by Jack Smith on February 19, 2003, at 13:05:25
In reply to Re: Buprenorphine-- bee happy » bee happy, posted by SLS on February 18, 2003, at 21:16:16
Scott,
I was just wondering if you have ever been off medication altogether at any period in the last 20 years. Perhaps a break for a couple of months could stimulate your system in some way. Of course that is easy to say but doing it would be much harder.
Also, I assume you have tried ECT. Did it not work for you?
Do you have a family history of mental illness.
Jack
Posted by bee happy on February 19, 2003, at 15:35:11
In reply to Bee and Bupe, posted by kara lynne on February 18, 2003, at 21:12:13
> My doctor said there is a delay in the release of subutex in the US; suboxone has made its debut. Is it legal where you are?
Hi Kara...I get my prescription in California. It's made up for me in lozenge form. Most major cities have at least one pharmacy capable of making compounds. Look in the phone book....this is such a terse answer...I'm on my way out the door. Any other questions...Will be glad to answer later on tonight.Bee
Posted by kara lynne on February 19, 2003, at 20:06:11
In reply to Re: Bee and Bupe, posted by bee happy on February 19, 2003, at 15:35:11
Since it is illegal in California, how do you get it made up for you? My doctor would prescribe it if it were legal. He thought both Subutex and Suboxone were going to be released, but alas only Suboxone is presently available because of "potential for abuse" with Subutex. When it does become available it will therefore be harder to obtain and more expensive, due to the kind hearted and intelligent folks in charge. In any event, is your doctor willing to prescribing it illegally then? It's so frustrating.
Posted by androog on February 19, 2003, at 22:16:12
In reply to Re: Bee and Bupe, posted by kara lynne on February 19, 2003, at 20:06:11
hi folks,
i did a quick search on the internet for subutex and suboxone and the first hit was from the almighty FDA itself. according to them (and they should know) both drugs are legal and available at the pharmacy, but the doc needs to have DEA credentials, which probably involve a secret handshake and a decoder ring ;>)kara lynne, i think maybe your doc needs to see the FDA link below.
http://www.fda.gov/cder/drug/infopage/subutex_suboxone/subutex-qa.htm
Posted by bee happy on February 19, 2003, at 22:35:36
In reply to Re: Bee and Bupe, posted by kara lynne on February 19, 2003, at 20:06:11
Hi again Kara. Buprenorphine is not illegal in the U.S. It has been available for several years for pain. It was recectly approved for opiate addiction treatment and maintenance. But doctors may prescribe a drug for other than it's originally intended use. My doctor heard about the Harvard study using buprenorphine for depression, and used that as his basis for trying it with me for depression. The oxone in suboxone is added to prevent maintenance patients from abusing it (injecting or snorting) or selling it on the street to other addicts.I would imagine that someone taking it as prescribed for depression would not be affected by the additional ingredient,but I don't know that for sure.As I said, there are pharmacies where they can make a sublingual lozenge without the 'oxone' if it turns out that you are sensitive to that ingredient. If you want more information about the Harvard study at McClean hospital, let me know and I'll find the web address for you. You might also look back through the postings here on the board from about jan 25th-feb 14th or so....laura777 and I had an onging dialog during which I gave her alot of that information along with a brief explanation of my experience.Agian, if you can't find it, let me know and I'll look it up for you. The good news is that this drug is a schedule III and because of it's agonist-antangonist properties has less potential for abuse. Am curious, what other medications have you tried...and why do you think this might work for you? Any addiction history? Ever felt more 'normal' when taking pain medication such as codeine or vicodin? Hope this helps. Bee
Posted by bee happy on February 19, 2003, at 22:48:33
In reply to Re: Bee and Bupe, posted by androog on February 19, 2003, at 22:16:12
Androog and Kara..The new fda regs require the registration if the doctor is treating drug dependence.Any family practice doctor can take an 8 hour course and get the certificate. My doctor is treating depression. It was only after trying many antidepressants that he looked into the use of Buprenorphine for depression.
Posted by bee happy on February 19, 2003, at 22:53:56
In reply to Re: Buprenorphine-- bee happy » bee happy, posted by SLS on February 18, 2003, at 21:16:16
Oh Scott. Happy Birthday indeed. I don't know what all those medical names mean but they sound serious. I wish you verrrry well. Bee
Posted by bee happy on February 19, 2003, at 23:28:54
In reply to Re: Bee and Bupe, posted by kara lynne on February 19, 2003, at 20:06:11
http://balder.prohosting.com/~adhpage/bupe.html oops...hope this works...am a bit computer challenged....I think this is the address for the Harvard study....right down to individual patient profiles. Show your Doctor. If he is apposed to trying it because it isn't officially approved for depression, this might help sway him to at least try it.
Posted by kara lynne on February 20, 2003, at 0:13:10
In reply to Re: Bee and Bupe Kara, posted by bee happy on February 19, 2003, at 23:28:54
Hi Bee, androog,
I actually spoke to the manufacturers of subutex and suboxone today, and they said that subutex is *not* available in the US or in pharmacies, which my doctor said yesterday. It was supposed to be, and may be someday, but it isn't now. I don't know how current what you read from the FDA is. My doctor is pretty well informed, and not opposed to using bupe for depression, but is waiting for subutex to be released....bee, I will go back and read your post again about the legality issues because I guess I don't (and maybe my doc either) understand it all. Any way I could email you personally? Thanks
Posted by kara lynne on February 20, 2003, at 0:28:00
In reply to Re: Bee and Bupe Kara, posted by kara lynne on February 20, 2003, at 0:13:10
...oh, and, my doctor was actually the one to suggest buprenorphine to *me*, over a year ago, after endless failed med trials. He was advised however, not to because of legal issues. I guess he has used it with his addiction patients (he's also an addictionologist), but for some reason learned it was illegal to use for anything else. I know he's not trying to mess with me, but he's concerned about the legal stuff and hasn't had much experience with this in particular. I don't want to make him sound like a dolt, because he's not-- maybe we're just missing some info. Bee, you sound like you have a great doctor!
Posted by bee happy on February 20, 2003, at 10:16:36
In reply to Re: Bee and Bupe Kara, posted by kara lynne on February 20, 2003, at 0:28:00
Kara, Where do you live? Are you so too far from a major city that you dont have a pharmacy capable of making a compound? If so the suboxone form would probably work. You didn't answer my questions about what antidepressants you've tried or if you've ever had an antidepressant reaction from opiates before. That is a pretty good indication that this might work for you. I'm sorry but I'm a little reluctant to give out my email address..Reread the posts from last night and get back to me. Ok? Bee
Posted by kara lynne on February 20, 2003, at 12:16:15
In reply to Re: Bee and Bupe Kara, posted by bee happy on February 20, 2003, at 10:16:36
I understand about the address, I would be reluctant too. Thanks for all the feedback, and I'll let you know what happens.
Posted by kara lynne on February 21, 2003, at 18:58:10
In reply to Re: Bee and Bupe Kara, posted by kara lynne on February 20, 2003, at 12:16:15
Hi bee,
Could you tell me what exactly your doctor writes that he is prescribing the bupe troches for? Of course I know docs can write for things off-label, but my doctor said that the *illegal* part of this is that you can't write a prescription for bupenorphrine in California for anything other than drug detoxification. I'm curious if your doctor dealt with that at all, and what he says the drug is indicated for in your case. Mine is a long story I don't want to get into detail about, and my diagnosis includes chronic pain. He wants to stay away from the Naloxone. Also yes, of course I can find a compounding pharmacy --my doctor told me about them--only, and this is the frustrating part, to be advised later not to go through with it. It's how it's prescribed that seems to be the hitch with him, not that prescribing it at all is illegal.
Posted by bee happy on February 21, 2003, at 20:46:27
In reply to Bee Happy- One Last Question...., posted by kara lynne on February 21, 2003, at 18:58:10
> Hi bee,
> Could you tell me what exactly your doctor writes that he is prescribing the bupe troches for? Of course I know docs can write for things off-label, but my doctor said that the *illegal* part of this is that you can't write a prescription for bupenorphrine in California for anything other than drug detoxification. I'm curious if your doctor dealt with that at all, and what he says the drug is indicated for in your case. Mine is a long story I don't want to get into detail about, and my diagnosis includes chronic pain. He wants to stay away from the Naloxone. Also yes, of course I can find a compounding pharmacy --my doctor told me about them--only, and this is the frustrating part, to be advised later not to go through with it. It's how it's prescribed that seems to be the hitch with him, not that prescribing it at all is illegal.
Hi Kara. My psychiatrist is prescribing for depression. The prescription lable says 'dissolve 1 lozenge 4 times daily'.I know this drug has been available as a pain medication for several years. When I was researching it, the pharmacy in my town gave me the name of a family practice doctor who was prescriboing it for pain...mostly migraine headaches. So how could it be illegal. If your case involves pain,it would seem to me even more reason to be able to prescribe for you....as it is very strong yet has agonist antagonist properties that make it less addictive than say morphine or oxycontin. Perhaps the illegality comes into play if the doctor is writing for drug addiction maintainence without first regestering with the fda or dea. There is a special license for that. But I'm sure my doctor writes for depression that wouldn't respond to any of the new drugs. And I'm also sure that he has the Harvard study to back him up for writing off label.If I were home I would call him and ask him if he would be willing to speak to your doctor,but I am out of the country until the end of april. Is your your doctor a psychiatrist or a pain specialist or a GP?Gee, it's a shame we can't work this email thing out...I understand you not wanting to get into your history on such a public forum.I think I read somewhere on this board that Dr. Bob was going to do something so that emails could be passed through him without going on the board...I'll write to him on the administration line and see if it's possible. I would agree to that if it would work for you.
Posted by bee happy on February 21, 2003, at 21:44:36
In reply to Bee Happy- One Last Question...., posted by kara lynne on February 21, 2003, at 18:58:10
Oh Kara I was looking for this yesterday but couldn't find it...Here is a little snippet from the Faq page of this site.Our Doctors should and do have the right to prescribe off label when then feel it's warrented.My Pdoc felt safe in trying this drug because of the Harvard study.What does FDA approval mean?
It is important to recognize that it is never a drug or other
product that is approved or not approved, but a claim about the
use of the drug or product... Neither the FDA nor the Federal
government regulate the practice of medicine. Any approved
product may be used by a licensed practitioner for uses other
than those stated in the product label. Off-label use is not
illegal, but means that the data to support that use have not
been independently reviewed by the FDA. --US Food and Drug
Administration
Posted by bee happy on February 21, 2003, at 22:29:56
In reply to Bee Happy- One Last Question...., posted by kara lynne on February 21, 2003, at 18:58:10
Hi again Kara...Have you got the babble mail feature working? If so we can write to each other through that...no email addresses are posted and our messages go through this site addressed to our board names...just go to the FAQ section and toward the end are instructions on how to turn on the Babble Mail feature. I just regestered so you can babble me when you've regestered too. Wow what a mouth full..Bee
Posted by kara lynne on February 21, 2003, at 22:45:51
In reply to Re: Bee Happy- One Last Question...., posted by bee happy on February 21, 2003, at 22:29:56
I really thank you for all of that, and for going to the trouble to find out how to email (semi) personally. It may take me a while, but I'll try to do it. Boy, it really is hard to understand what my doctor is talking about at this point. He's out of town, or I would have called him. I will definitely call him next week. Ok, when I get back tonight I'll see if I can't try babble mail to try and clarify more for you (if it's possible!). Thanks again
bee.
Posted by bee happy on February 21, 2003, at 23:16:45
In reply to Thanks Bee!!, posted by kara lynne on February 21, 2003, at 22:45:51
Kara! Wah!!! I just tried the babblemail test and it came up with a message 'this url not found on server'...oh well I have a message into Dr. Bob asking what the next step should be . More later...tomorrow...Bee
Posted by kara lynne on February 22, 2003, at 2:36:19
In reply to Re: Thanks Bee!!, posted by bee happy on February 21, 2003, at 23:16:45
That's ok, we'll try tomorrow. But since I*have* you here, I'll ask you yet another question-- if you don't mind--- how much do the troches cost? I heard they would be very expensive. Ok, I've harrassed you enough! Have a good night, and thanks again.
Posted by Dr. Bob on February 22, 2003, at 8:09:18
In reply to Re: Thanks Bee!!, posted by bee happy on February 21, 2003, at 23:16:45
> Kara! Wah!!! I just tried the babblemail test and it came up with a message 'this url not found on server'
Sorry, I don't have it working yet. Thanks for your patience,
Bob
Posted by bee happy on February 22, 2003, at 20:56:13
In reply to Re: Thanks Bee!!, posted by kara lynne on February 22, 2003, at 2:36:19
> That's ok, we'll try tomorrow. But since I*have* you here, I'll ask you yet another question-- if you don't mind--- how much do the troches cost? I heard they would be very expensive. Ok, I've harrassed you enough! Have a good night, and thanks again.
Kara. I must be one of the luckiest patients on this board. Not only do my family doctor, therapist, and psychiatrist all agree that this is the answer for my depression, I also have a small home town pharmacist who is also the salt of the earth and when he first quoted the $595 per month I almost choked. He then said if I were to continue with this drug he would work something out. The price is $425 per month. Yes that is alot...but my will to live is worth every penny.Also I think I read somewhere on this board that some insurances do cover all but a small copay. Does this make a difference for you?
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