![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Ame Sans Vie on September 12, 2003, at 9:40:19
For anyone who doesn't know, I treat my depression and obsessive-compulsive personality disorder with Ultram, an opioid painkiller with mild serotonin/norepinephrine reuptake inhibition properties. I like to compare it to a combination of hydrocodone (Vicodin) and a good tricyclic, but without side effects.
Anyhoo, my usual dosing schedule is 150mg AM, 150mg noon, 100mg PM... but today I completely forgot about my first dose. That was an experience I'll *never* forget. Just imagine Paxil withdrawal symptoms (e.g. lack of coordination, malaise, brain zaps, weird and unpleasant tingly, numbing sensation throughout the body) combined with opioid withdrawal symptoms (gooseflesh, nausea, chills, akathisia, sweating, tremors). That had to have been the worst hour and a half of my life. Taking my dose relieved these symptoms 100% within 30 minutes.
At least I now have more reason to believe that Ultram's monoamine activity *does* contribute to its effect -- otherwise, I highly doubt I would have gotten the brain zaps, which are pretty exclusive to withdrawal from serotonergics.
Posted by matthhhh on September 12, 2003, at 20:04:15
In reply to Forgot morning Ultram dose -- *never again*!!!!, posted by Ame Sans Vie on September 12, 2003, at 9:40:19
Hey Ame, so i got my ultram and tried a pill and it relieved my anxiety and ocd for the day from 1 50 mg pill. But im a little concerned about the long term use.
Is ultram like oxycontin or heroin? ive heard very bad things about these drugs and opiods. I kind of feel that if i continue with the ultram that im just taking a drug not a medication, if u know what i mean.
Posted by Ame Sans Vie on September 12, 2003, at 22:09:15
In reply to Re: Forgot morning Ultram dose -- *never again*!!!!, posted by matthhhh on September 12, 2003, at 20:04:15
> Hey Ame, so i got my ultram and tried a pill and it relieved my anxiety and ocd for the day from 1 50 mg pill. But im a little concerned about the long term use.
Wow, it lasted the whole day? Can we trade metabolisms? lol
> Is ultram like oxycontin or heroin? ive heard very bad things about these drugs and opiods. I kind of feel that if i continue with the ultram that im just taking a drug not a medication, if u know what i mean.
Ultram shares very little in common with smack, morph, Oxy, or any of that stuff. Its activity at the mu-opioid receptor (the same receptor morphine and heroin target specifically) is 1/6,000 that of morphine. Its active metabolite is about 20 times more potent though, which means that Ultram binds to mu-opioid receptors with about 1/300 the strength that morphine does. Just FYI, heroin is about three times as potent as morphine, and oxycodone is about 50% less potent than morphine.
At first glance, this might make Ultram seem practically useless for pain. But due to its serotonergic/noradrenergic properties, the pain-relief is magnified -- 50mg oral Ultram is approximately equal to 9mg oral morphine, and 100mg Ultram IV is approximately equal to 10mg morphine IV (the reason for the ratio difference between oral and IV dosing is due to morphine's relatively poor oral bioavailability). This makes tramadol just slightly less potent than codeine for pain relief (60mg tramadol = 50mg codeine), but keep in mind that has little to do with its effect on the opioid system. The withdrawal I had this morning was more SSRI-reminiscent than anything, with just some minor opioid-withdrawal symptoms (which I probably perceived as being worse than they actually were because the serotonin-mediated withdrawal had me in a not-so-good frame of mind).
Posted by utopizen on September 12, 2003, at 22:17:10
In reply to Re: Forgot morning Ultram dose -- *never again*!!!!, posted by matthhhh on September 12, 2003, at 20:04:15
> Hey Ame, so i got my ultram and tried a pill and it relieved my anxiety and ocd for the day from 1 50 mg pill. But im a little concerned about the long term use.
> Is ultram like oxycontin or heroin? ive heard very bad things about these drugs and opiods. I kind of feel that if i continue with the ultram that im just taking a drug not a medication, if u know what i mean.
>Very little is understood about the long-term, continious use of Ultram. More is understood of the long-term use of Oxycotin or Vicodin.
Ultram is pretty new. When Vicodin came out, it was advertised as "prescription pain relief you can call in" (it's a schedule III instead of a schedule II, unless that's changed since the 70's or 80's when it came out).
My friend took it for rather severe back pain. Before being prescribed it, her doctor said, hesitantingly, "you're probably going to get addicted to this." It was after she had been trying many different things, and developed an ulcer (she's 19!) from extended use of anti-anflammatories.
I'd be hesistant to consider it for off-label purposes, if there's a potential with a drug that has the potential to work. I mean, I don't think anyone wouldn't be less anxious or depressed if they took a Percocet, but that doesn't mean docs are going to start researching it for that purpose. It's used in pain relief because that's basically the only thing that they've got at all... it's either that or Celebrex, I mean that's pretty much the only development out there... pretty sad.
It's unfortunate there's nothing like benzos for depression... I only have social anxiety, so I take Klonopin. I never responded to SSRIs or Neurontin or any of that... I suppose I could give Straterra a shot... but I've exausted pretty much everything, including my patience, with other drugs.
Posted by utopizen on September 12, 2003, at 22:33:06
In reply to Re: Forgot morning Ultram dose -- *never again*!!!! » matthhhh, posted by Ame Sans Vie on September 12, 2003, at 22:09:15
> The withdrawal I had this morning was more SSRI-reminiscent than anything, with just some minor opioid-withdrawal symptoms (which I probably perceived as being worse than they actually were because the serotonin-mediated withdrawal had me in a not-so-good frame of mind).
>
>Your hypothesis is interesting. but your description of withdrawl is really typical of opiate withdrawl. Chills, shakes, these are the things I got freaked out about when I ended my Vicodin therapy for my hand pain. My first instinct was to not take another single pill.
I understand you find parallels between your SSRI withdrawl and your Ultram withdrawl. But, um, introspection was invalidated as a legitimate means of understanding the brain, and its creator continues to be mocked to this day in psych books. So be weary of that, and remember these are things to be concerned about, even if you feel comfortable about the other drugs that you're comparing this to.
Posted by Ame Sans Vie on September 12, 2003, at 22:34:22
In reply to Re: Forgot morning Ultram dose -- *never again*!!!, posted by utopizen on September 12, 2003, at 22:17:10
> I'd be hesistant to consider it for off-label purposes, if there's a potential with a drug that has the potential to work. I mean, I don't think anyone wouldn't be less anxious or depressed if they took a Percocet, but that doesn't mean docs are going to start researching it for that purpose.
You're failing to take into account the very unique properties tramadol possesses. And regarding Percocet, oxycodone alone (in the form of OxyContin) is occasionally prescribed for depression. There is some very good research that indicates a pure mu1-opioid receptor partial agonist could be the perfect candidate for the first FDA-approved opioid antidepressant.
I personally feel much more research needs to focus on the use of opioids in treatment-refractory OCD. We already know they work for depression -- the study "Rapid Remission of OCD Symptoms With Tramadol Hydrochloride" laid the groundwork for this current use of the drug (though OCDers have realized for quite some time that they tend to feel very much at peace during the recovery phase following any surgery... hmmm). And though I can't recall where, some university is carrying out a great deal of research on tramadol benefit in mental health issues.
> It's unfortunate there's nothing like benzos for depression...
Well, most depressives, including treatment-resistant types, will respond to some form of either opioid or stimulant therapy (or a combination of the two). Considering tramadol's triple mechanism of action, in exactly all the right places, it seems very much to me like a "benzo for depression".
Posted by Ame Sans Vie on September 12, 2003, at 22:41:38
In reply to Re: Forgot morning Ultram dose -- *never again*!!!, posted by utopizen on September 12, 2003, at 22:33:06
I've been through heroin, morphine, hydrocodone, opium, and hydromorphone withdrawal. While each one of those drugs shared a very similar withdrawal, leaving me bedridden, the Ultram experience was an entirely different animal. The SSRI-like withdrawal symptoms were absolutely present, and while I physically can't even move when withdrawing from "true" opioids, today I found that moving around helped a good bit -- kept the akathisia at bay.
Posted by jonh kimble on September 12, 2003, at 22:50:00
In reply to Re: Forgot morning Ultram dose -- *never again*!!! » utopizen, posted by Ame Sans Vie on September 12, 2003, at 22:41:38
hey how you all doin. ame, you seriously think oxy could be an aproved ad? that sounds something like fantasy to me, with its addictive potential. my pdoc will hadrly prescribe me clono since he knows ive done coc before so getting oxy would be the accomplishment of the century. but i guess opiods were used as ads at one time so who knows.
by the way how old r u? m/f?
Im m/19
Posted by Ame Sans Vie on September 12, 2003, at 23:22:16
In reply to Re: Forgot morning Ultram dose -- *never again*!!!, posted by jonh kimble on September 12, 2003, at 22:50:00
Well, it's definitely a very rare case that a doctor will suggest the OC's. My past psychiatrists were all terrified when I even proposed the idea of Ultram; my current pdoc actually suggested OxyContin to *me*, but I decided I'd rather go for the Ultram first. And that seems to be working out well.
I'm male, turn 21 in January.
Posted by matthhhh on September 13, 2003, at 8:41:11
In reply to Re: Forgot morning Ultram dose -- *never again*!!! » jonh kimble, posted by Ame Sans Vie on September 12, 2003, at 23:22:16
Hey Ame, I just saw a portion of americas most wanted this last week and they were talking about these people who were robbing the drug stores of the oxycontin. Anyways, the way they were talking about it, it was a very addictive drug.
Also wondering if you have any experience with tryptophan. i saw on another post that many people thought that it was much superior to 5 htp, which didnt do anything for me. DO u have any experience with it?
Posted by femlite on September 13, 2003, at 20:39:03
In reply to Re: Forgot morning Ultram dose -- *never again*!!!, posted by matthhhh on September 13, 2003, at 8:41:11
> Hey Ame, I just saw a portion of americas most wanted this last week and they were talking about these people who were robbing the drug stores of the oxycontin. Anyways, the way they were talking about it, it was a very addictive drug.
Could this be the same US media that called GHB, the date rape drug, (which by the way, is widely used in Europe).
Ironically Orphan Medical is coming out with Xyrem, their version of GHB, and the price is 10x higher, than b4 the date rape rap occured, hmmmm
Morale: dont believe every thing you see (esp. on TV ;}
Posted by temoigneur on September 14, 2003, at 1:05:37
In reply to Forgot morning Ultram dose -- *never again*!!!!, posted by Ame Sans Vie on September 12, 2003, at 9:40:19
> For anyone who doesn't know, I treat my depression and obsessive-compulsive personality disorder with Ultram, an opioid painkiller with mild serotonin/norepinephrine reuptake inhibition properties. I like to compare it to a combination of hydrocodone (Vicodin) and a good tricyclic, but without side effects.
>
> Anyhoo, my usual dosing schedule is 150mg AM, 150mg noon, 100mg PM... but today I completely forgot about my first dose. That was an experience I'll *never* forget. Just imagine Paxil withdrawal symptoms (e.g. lack of coordination, malaise, brain zaps, weird and unpleasant tingly, numbing sensation throughout the body) combined with opioid withdrawal symptoms (gooseflesh, nausea, chills, akathisia, sweating, tremors). That had to have been the worst hour and a half of my life. Taking my dose relieved these symptoms 100% within 30 minutes.
>
> At least I now have more reason to believe that Ultram's monoamine activity *does* contribute to its effect -- otherwise, I highly doubt I would have gotten the brain zaps, which are pretty exclusive to withdrawal from serotonergics.
Ame how are you, I talked to McPac and he told me you knew a lot about anxiety. I suffer from severe anxiety - OCD, GAD, SP, and Panic Attacks, Right now I'm taking Nardil, which works OK, I thought it was helping my OCD until I starting coming off klonopin, I take Nardil 45mg, Klonopin 4mg and zyprexa 7.5 mg, my anxiety is still bad, and I was really interested to hear about the results you were getting from ultram, and was wondering about the drug.
Do you gain tolerance to it, having opiod properties, and if so how quickly does tolerance develop in your opinion. It helps your anxiety all around, I definately have depression too, which hasn't been helped by my doctor telling me there will never be a cure for anxiety in my lifetime. The last few years of my life have been challenging, well I know people don't like to hear others complain but the anxiety has destroyed my life. Would you recommend Ultram? There was one period when I took prozac for the frist time that I felt wonderful for four months, and then the anxiety came back with a vengeance, and I've been struggling to keep my head above water ever since. Right now I'm seeing a Chinese Herbalist - I know it sounds ridiculous perhaps, but when you have all your hope taken away.Anyway I heard you were very knowledgeable about anxiety and I'd love to hear any suggestions you have, I hope you are well,
Ben, (Btw t'es francais non? J'habite au Canada, a Vancouver actuellement, mais si je pourrais gagner la controle contre ma maladie, j'aimerais demenager a Toronto, ou bien Londres. D'accord, je vous souhaite une bonne journee et j'attend votre replie avec l'impatience.)
Posted by utopizen on September 14, 2003, at 13:06:51
In reply to Addiction Fiction » matthhhh, posted by femlite on September 13, 2003, at 20:39:03
> Ironically Orphan Medical is coming out with Xyrem, their version of GHB, and the price is 10x higher, than b4 the date rape rap occured, hmmmm
>Actually, GHB (a.k.a. Sodium Oxybate) *is* addictive. It caused Tardive Dyskinsia. Its tolerance leads to escalation of doses, which can quickly lead to respiratory depression (heart failure, or coma if you're lucky). And withdrawl lasts many weeks.
Xyrem, when used therapeutically, does not cause TD or withdrawl. In a 14-month study, (I have the abstract printed out in front of me from Orphan) no signs of withdrawl were found.
Why? It's used between 4.5-9mg/night, in two divided doses. And never during the daytime. This is much different from taking doses much higher for recreational value during the day continiously every 90 minutes and during the night several times for many months.
GHB is addicitive if it is abused.
It's IMPOSSIBLE to maintain an addiction at the doses required for recreational use on Xyrem, because no patient would ever get that much prescribed.
The approval of an addictive substance by the FDA is routinely misinterpreted. Desoxyn (methamphetamine HCL) is a very abusable drug, but it's not possible to maintain any dose needed to get high with at the doses prescribed.
I get 20mg/day for my ADD and Idiopathic Hypersomnolence (sleepiness), divided by two doses a day. It's necessary to take about 50mg in a single dose to get high, and you'd have to maintain that high several times within a single day.
Moreover, Ultram *is* proven to cause withdrawl symptoms. You want to try to avoid any drug out there that causes withdrawl symptoms, if you can, even if it seems to take years to find one that will.
I can't imagine anyone being able to exaust so many possibilities that they're even considering Oxycotin for depression. I'd doubt many doctors would consider it before ECT if the case is actually that extreme to begin with.
Ands please, for the love of God, Xyrem is given in tiny doses, only at night. Do not compare that with someone who takes it recreationally, or mixes it with alcohol. Yes, many drugs are "date rape" drugs when mixed with alcohol. Xyrem's approval didn't change that fact.
Posted by Ame Sans Vie on September 14, 2003, at 20:36:48
In reply to Re: Forgot morning Ultram dose -- *never again*!!!!, posted by temoigneur on September 14, 2003, at 1:05:37
J’espère que t’y vois pas d’inconvénient que j’écris ceci en français -- j’dois réviser. :-)
Concernant la tolérance, j’suis pas du tout devenu tolérant pendant ces quèques mois passés, bien que l’on dise que c’est p’t’êt’un phénomène rare, ça. J’prends la dextrométhorphane quotidiennement, et c’t’une possibilité qu’ça empêche la tramadol de causer l’évolution de la tolérance. La dextrométhorphane est antagoniste des récepteurs NMDA (N-méthyl-D-aspartate). Les recherches suggèrent qu'les drogues qui possèdent c’te propriété peuvent retarder ou empêcher la tolérance. Y s’peut que c’te effet est pas limité aux analgésiques narcotiques – c’est possible que z’exercent le même effet avec la cocaïne, le tabac, l’alcool, les benzodiazépines, les amphétamines, le méthylphénidate … p’t’êt’toutes les drogues qui causent la tolerance. Y a quèques aut'antagonistes de NMDA (e.g. memantine, acamprosate), mais j’préfère la dextrométhorphane pour plusieurs raisons: 1. on a pas besoin d’une ordonnance pour l’obtenir; 2. è possède des effets sérotonines qui sont possiblement salutaires; 3. è augmente les effets des opioïdes.
Si la tolérance va développer, j’présume qu’ça s’passerait tout aussi rapidement comme les aut’opioïdes.
La tramadol gaze qu'un peu avec ma phobie sociale, ma panique, ou mon agoraphobie, mais è a été une aubaine pour ma dépression et ma personnalité obsessionnelle-compulsive. Cependant beaucoup d'gens trouvent que c'est très efficace pour toutes sortes d'anxiété. J’recommanderais absolument qu’tu l’essayes – certainement è peut pas êt’pire qu’toutes les aut’médicaments maudites que l’on t’a soumis. :-)
De fait j'habite les E.U. (Texas, pour être exact). C'est simplement que j'ai la passion d'apprend'les langues étrangères, partout l'français. Y a moins d'une pige depuis que j'ai commencé à l'étudier. J'sais, le fait que j'étudie l'français seulement pour m'amuser m'rend carrément dingue en soi, lol.
Je l'trouve intéressant que t'habites Vancouver -- j'prévois d'y déménager aussitôt que j'ai assez d'fric (l'plus tôt sera l'mieux!). Les politiques plus clémentes en c’qui concerne l'herbe, y sont tout à fait attirantes. ;-)
J'dois m'tirer, à la prochaine!
~~Michael
Posted by temoigneur on September 17, 2003, at 2:12:26
In reply to Re: Forgot morning Ultram dose -- *never again*!!!! » temoigneur, posted by Ame Sans Vie on September 14, 2003, at 20:36:48
> J’espère que t’y vois pas d’inconvénient que j’écris ceci en français -- j’dois réviser. :-)
>
> Concernant la tolérance, j’suis pas du tout devenu tolérant pendant ces quèques mois passés, bien que l’on dise que c’est p’t’êt’un phénomène rare, ça. J’prends la dextrométhorphane quotidiennement, et c’t’une possibilité qu’ça empêche la tramadol de causer l’évolution de la tolérance. La dextrométhorphane est antagoniste des récepteurs NMDA (N-méthyl-D-aspartate). Les recherches suggèrent qu'les drogues qui possèdent c’te propriété peuvent retarder ou empêcher la tolérance. Y s’peut que c’te effet est pas limité aux analgésiques narcotiques – c’est possible que z’exercent le même effet avec la cocaïne, le tabac, l’alcool, les benzodiazépines, les amphétamines, le méthylphénidate … p’t’êt’toutes les drogues qui causent la tolerance. Y a quèques aut'antagonistes de NMDA (e.g. memantine, acamprosate), mais j’préfère la dextrométhorphane pour plusieurs raisons: 1. on a pas besoin d’une ordonnance pour l’obtenir; 2. è possède des effets sérotonines qui sont possiblement salutaires; 3. è augmente les effets des opioïdes.
>
> Si la tolérance va développer, j’présume qu’ça s’passerait tout aussi rapidement comme les aut’opioïdes.
>
> La tramadol gaze qu'un peu avec ma phobie sociale, ma panique, ou mon agoraphobie, mais è a été une aubaine pour ma dépression et ma personnalité obsessionnelle-compulsive. Cependant beaucoup d'gens trouvent que c'est très efficace pour toutes sortes d'anxiété. J’recommanderais absolument qu’tu l’essayes – certainement è peut pas êt’pire qu’toutes les aut’médicaments maudites que l’on t’a soumis. :-)
>
> De fait j'habite les E.U. (Texas, pour être exact). C'est simplement que j'ai la passion d'apprend'les langues étrangères, partout l'français. Y a moins d'une pige depuis que j'ai commencé à l'étudier. J'sais, le fait que j'étudie l'français seulement pour m'amuser m'rend carrément dingue en soi, lol.
>
> Je l'trouve intéressant que t'habites Vancouver -- j'prévois d'y déménager aussitôt que j'ai assez d'fric (l'plus tôt sera l'mieux!). Les politiques plus clémentes en c’qui concerne l'herbe, y sont tout à fait attirantes. ;-)
>
> J'dois m'tirer, à la prochaine!
>
> ~~Michael
Hi Michael, thank you for your reply, is dextromethorphane spelt the same in English, I'll check my drug database, but again, thank you for your thorough outline of why you prefer this over other NDMA antagonists. One thing, if you come to Vancouver, make sure you keep in contact with your American doctor, Ultram is not available in Canada. I am fortunate, that my mom has a friend who's an MD in the states, it's just convincing my doctor up here to let me try different medications that is difficult.Also, Michael, do you know anything about the long term effects of opiods on the brain, I read that they can slow down thought processes, not to alarm you, obviously it is working brilliantly for you right now, you speak french like a native. I want so much to find something that will allow me to get back into the main stream, I'm on zyprexa and clonazapam right now and it really dulls my mind. Anyway, where do you buy dextromethorphane and can I ask what your dosage is? Also did you start off on the dosage of Tramadol that you take now
Take care, and thank you
Ben
Posted by Ame Sans Vie on September 17, 2003, at 9:52:03
In reply to Re: Forgot morning Ultram dose -- *never again*!!!!, posted by temoigneur on September 17, 2003, at 2:12:26
> Hi Michael, thank you for your reply, is dextromethorphane spelt the same in English, I'll check my drug database, but again, thank you for your thorough outline of why you prefer this over other NDMA antagonists. One thing, if you come to Vancouver, make sure you keep in contact with your American doctor, Ultram is not available in Canada. I am fortunate, that my mom has a friend who's an MD in the states, it's just convincing my doctor up here to let me try different medications that is difficult.
Hi Ben,
Dextromethorphan is the English spelling; it's the dextro isomer of methorphan, which is a very powerful opioid. DXM itself though is not an opioid. In Canada, it's much easier to buy than down here -- people occasionally abuse it as an NMDA antagonist just like PCP and ketamine. So down here they like to either put DXM into a nasty-tasting syrup or package it along with two or three other ingredients (i.e. guaifenesin, pseudoephedrine, phenylpropanolamine, APAP) to prevent abuse. Anyway, it should be available over the counter up there in pill-form (which we don't have here) -- some trade names of Canadian DM are Balminil DM, Croncho-Grippol-DM, DM Syrup, Koffex, Neo-DM, Ornex-DM, Robidex, and Sedatuss. Robitussin Maximum Strength Cough, Vick's Formula 44, and some Sucrets lozenges contain only DXM... they might be available up there.
Thanks for warning me about the tramadol situation north of the border... maybe I could switch to something else before I make the move. Is buprenorphine available there?> Also, Michael, do you know anything about the long term effects of opiods on the brain, I read that they can slow down thought processes, not to alarm you, obviously it is working brilliantly for you right now, you speak french like a native.
I've never read anything on the subject, though I imagine opioids could have effects similar to benzodiazepines taken long-term (in some people, pretty minor memory loss). And thank you for complimenting my French. :-)
> I want so much to find something that will allow me to get back into the main stream, I'm on zyprexa and clonazapam right now and it really dulls my mind. Anyway, where do you buy dextromethorphane and can I ask what your dosage is? Also did you start off on the dosage of Tramadol that you take now
As far as I know, DXM is available over-the-counter up there, just as it is here -- I take 15mg three times daily (one dose with each dose of tramadol). I started off at 200mg/day tramadol, and we raised it by 100mg each two weeks until I hit 400mg, which is the maximum.
Posted by femlite on September 17, 2003, at 22:21:43
In reply to Re: Forgot morning Ultram dose -- *never again*!!!! » temoigneur, posted by Ame Sans Vie on September 17, 2003, at 9:52:03
> > Also, Michael, do you know anything about the long term effects of opiods on the brain, I read that they can slow down thought processes, not to alarm you, obviously it is working brilliantly for you right now, you speak french like a native.
>
> I've never read anything on the subject, though I imagine opioids could have effects similar to benzodiazepines taken long-term (in some people, pretty minor memory loss). And thank you for complimenting my French. :-)
Ame Sans Vie,Just my expereince, no official data,
My Chess game improved during a one year period on opiods. It improved remarkably towards the end of that time period.
I was a bit more selective about what I chose to remember, and felt enabled to be more selective of what I focused on. It filtered out the constant chatter in my head.
It wasnt till the end of that year that tolerance became a problem and then I quit. Every one responds differentlyOh, my love life was fantastic
during that year :)
Posted by femlite on September 18, 2003, at 0:42:19
In reply to GHB *is* addictive, posted by utopizen on September 14, 2003, at 13:06:51
> Actually, GHB (a.k.a. Sodium Oxybate) *is* addictive. It caused Tardive Dyskinsia. Its tolerance leads to escalation of doses, which can quickly lead to respiratory depression (heart failure, or coma if you're lucky).
Dont you think a large percentage of meds (tolerance aside) have severe and possibly deadly side effects if abused?
>And withdrawl last for months
This is true of most psychoactive drugs. For most people, titration is nes. or debilitating side effects ensue.
> GHB is addicitive if it is abused.
> Moreover, Ultram *is* proven to cause withdrawl symptoms. You want to try to avoid any drug out there that causes withdrawl symptoms, if you can, even if it seems to take years to find one that will.I really do appreciate your concern but
Ive quit Ultram and opiods cold with a few days of achiness and no other symptoms, because as you said few doctors will consider such meds for depression. And I am seeking alternatives.I am on 200mg of Wellbutrin SR now, and the side effects are kickin my behind. Opiods side effects were nearly non-existant, not to metion I was happy and my libido was increased. Nada on the WB.
> I can't imagine anyone being able to exaust so many possibilities that they're even considering Oxycotin for depression. I'd doubt many doctors would consider it before ECT if the case is actually that extreme to begin with.
Many people have discovered the mood elevating (ie.. out depression) benifits of opiods before ever trying ADs.
The addiction advisories you issue about ultram and opiods use seem unsuppor tive.
(not unsupported)
There are many on this site who have recieved bennifit from opiods, have not succumbed to addiction, are concered about tolerance, and waiting for research to find a means of affecting tolerance and hence addiction "potential".It inhibits serious discussion,to find oneself compared with drugstore looters and drug addicts.
IMHO, the media only prints what is sensational (drugstore robberies) and even more senstional and expected, is to add that such drugs "are highly addictive". And thus discouraging real research to take place on the potential of opiods and their use in depression.
The abuse of GHB in Europe and the date rape scandal in the US, prevented GHB from marketability for a long time.
It seems as if some people took advantage of the bad press and found a means of monetary gain in the same breath. (Maybe you understand what happened better than I, thats just the way it seemes to me).I waited a week to write this in hopes that I could convey a more meaningful and less impassioned reply.
I hope Ive been sucessful
Posted by temoigneur on September 18, 2003, at 1:06:19
In reply to Re: Forgot morning Ultram dose -- *never again*!!!! » temoigneur, posted by Ame Sans Vie on September 17, 2003, at 9:52:03
> > Hi Michael, thank you for your reply, is dextromethorphane spelt the same in English, I'll check my drug database, but again, thank you for your thorough outline of why you prefer this over other NDMA antagonists. One thing, if you come to Vancouver, make sure you keep in contact with your American doctor, Ultram is not available in Canada. I am fortunate, that my mom has a friend who's an MD in the states, it's just convincing my doctor up here to let me try different medications that is difficult.
>
> Hi Ben,
>
> Dextromethorphan is the English spelling; it's the dextro isomer of methorphan, which is a very powerful opioid. DXM itself though is not an opioid. In Canada, it's much easier to buy than down here -- people occasionally abuse it as an NMDA antagonist just like PCP and ketamine. So down here they like to either put DXM into a nasty-tasting syrup or package it along with two or three other ingredients (i.e. guaifenesin, pseudoephedrine, phenylpropanolamine, APAP) to prevent abuse. Anyway, it should be available over the counter up there in pill-form (which we don't have here) -- some trade names of Canadian DM are Balminil DM, Croncho-Grippol-DM, DM Syrup, Koffex, Neo-DM, Ornex-DM, Robidex, and Sedatuss. Robitussin Maximum Strength Cough, Vick's Formula 44, and some Sucrets lozenges contain only DXM... they might be available up there.
>
Hi Michael great, you give me a wide range of options to keep tolerance at bay. Regarding the Buprenorphine, it's not available up here, except through something called the "Special access program", something your Canadian physician would have to apply for, however I read on the sight that this program was not accepting new applicants right now - if bureaucracy was a cord you could go bungee jumping, anyway, I'm serious about trying tramadol, I'm in pain,(with the OCD and anxiety I am taking a course I've already taken in college just so I won't go crazy, it's aweful, and my family is so supportive, situationally it doesn't get too much better, well, there's some things beyond our control, but.. I was wondering how long you have been been on Tramadol, and if you sense tolerance developing, and if not, do you know of anyone else, through personal contacts, or studies that have the same experience, or is keeping tolerance of Tramadol at bay with DMX a rare phenomina. Michael thank you so much for your responses you're so kind.All the best, and I hope things keep going brilliantly, Ben
> Thanks for warning me about the tramadol situation north of the border... maybe I could switch to something else before I make the move. Is buprenorphine available there?
>
> > Also, Michael, do you know anything about the long term effects of opiods on the brain, I read that they can slow down thought processes, not to alarm you, obviously it is working brilliantly for you right now, you speak french like a native.
>
> I've never read anything on the subject, though I imagine opioids could have effects similar to benzodiazepines taken long-term (in some people, pretty minor memory loss). And thank you for complimenting my French. :-)
>
> > I want so much to find something that will allow me to get back into the main stream, I'm on zyprexa and clonazapam right now and it really dulls my mind. Anyway, where do you buy dextromethorphane and can I ask what your dosage is? Also did you start off on the dosage of Tramadol that you take now
>
> As far as I know, DXM is available over-the-counter up there, just as it is here -- I take 15mg three times daily (one dose with each dose of tramadol). I started off at 200mg/day tramadol, and we raised it by 100mg each two weeks until I hit 400mg, which is the maximum.
Posted by utopizen on September 20, 2003, at 14:29:16
In reply to Re: GHB *is* addictive » utopizen, posted by femlite on September 18, 2003, at 0:42:19
Considering I take Xyrem, I realize it's pretty good.
Posted by Ame Sans Vie on September 21, 2003, at 0:53:24
In reply to Ame s Vie, serious about tramadol, few Q's » Ame Sans Vie, posted by temoigneur on September 18, 2003, at 1:06:19
> Hi Michael great, you give me a wide range of options to keep tolerance at bay.
Just remember to discuss these things with your doctor first! DXM-therapy isn't for everyone -- there are other NMDA antagonists though. Memantine and acamprosate are the two most promising ones apart from DXM (there are many others, but the only ones that immediately come to mind are ketamine and PCP).
> Regarding the Buprenorphine, it's not available up here, except through something called the "Special access program", something your Canadian physician would have to apply for, however I read on the sight that this program was not accepting new applicants right now - if bureaucracy was a cord you could go bungee jumping,
<sigh>... oh well. I may be discontinuing the Ultram and starting Xyrem within a week, depending on whether my pain management doc can persuade Medicaid to cover the ridiculous expense. If I were able to receive Xyrem though, I'm pretty sure I'd stay here. Well... in the U.S. anyway -- not Texas, lol.
> anyway, I'm serious about trying tramadol, I'm in pain,(with the OCD and anxiety I am taking a course I've already taken in college just so I won't go crazy, it's aweful, and my family is so supportive, situationally it doesn't get too much better, well, there's some things beyond our control, but.. I was wondering how long you have been been on Tramadol, and if you sense tolerance developing, and if not, do you know of anyone else, through personal contacts, or studies that have the same experience, or is keeping tolerance of Tramadol at bay with DMX a rare phenomina.
I'm not absolutely sure how long I've been taking the tramadol... about 14 weeks, I suppose. I've noticed no tolerance whatsoever to the antidepressant-antiobsessional effects, though the pleasant opioid effect quickly wears off. Most medical sources comment that tramadol causes a mild tolerance and moderate dependence, but of course they're talking about its use as an analgesic. The case reports of tramadol in depression/OCD treatment that I initially used to convince my pdoc to prescribe it for me never mentioned tolerance. It seemed that the dose always leveled off at the 300-400mg range. But as for the DXM, I really can't say much of anything as there hasn't been a whole lot of research (if any) into using it for this purpose. I've never come across a case report either. But the abilities of memantine and acamprosate to delay or prevent tolerance is fairly well-documented, and the mechanism of action is the same. It's only at disassociative recreational doses (depending on body weight, anywhere from perhaps 400mg-2 grams) that DXM has any significant effects in other areas of the brain, primarily at sigma receptors, where PCP is also quite active.
>Michael thank you so much for your responses you're so kind.
>
> All the best, and I hope things keep going brilliantly, BenNo problem at all, and good luck to you! Let me know how things unravel. :-)
Posted by utopizen on September 21, 2003, at 14:57:29
In reply to Re: Ame s Vie, serious about tramadol, few Q's » temoigneur, posted by Ame Sans Vie on September 21, 2003, at 0:53:24
> <sigh>... oh well. I may be discontinuing the Ultram and starting Xyrem within a week, depending on whether my pain management doc can persuade Medicaid to cover the ridiculous expense. If I were able to receive Xyrem though, I'm pretty sure I'd stay here. Well... in the U.S. anyway -- not Texas, lol.
>Have you been on Xyrem before? Assuming your doc is comfortable with it, has prescribed it before (this is a rare doc, even among the most experienced sleep docs) you are lucky if you get it in a month. I'd expect three weeks *after* your doctor actually sends in the prescription.
If your doc hasn't prescribed it before, it may take a few appts. worth just to nudge him into calling Orphan. And then he has to review safety/efficacy materials they give him, he needs to talk with a sales rep to nudge him some more, and then watch a video and listen to a phone recording about how to ensure it's properly prescribed. Then he has to wait for you to do the same-- watch a video, etc. Then it has to be mailed overnight to you.
I see the top sleep doc in the country, but I had to see the top sleep doc/psychopharmacologist in the country just to get Xyrem considered... won a Psychopharmacology Award, published hundreds of things, etc... Professor.
Posted by Ame Sans Vie on September 21, 2003, at 19:05:57
In reply to Re: Ame s Vie, serious about tramadol, few Q's » Ame Sans Vie, posted by utopizen on September 21, 2003, at 14:57:29
> Have you been on Xyrem before?
For a month, but not through this doctor.
> Assuming your doc is comfortable with it, has prescribed it before (this is a rare doc, even among the most experienced sleep docs) you are lucky if you get it in a month. I'd expect three weeks *after* your doctor actually sends in the prescription.
Well that's kind of depressing. It's a pain management specialist I'm going to be seeing who claims to have quite a few fibro patients on Xyrem, and that would be the same purpose for which I would primarily be taking it. If it allows me to discontinue my DextroStat, Ultram, and/or Klonopin, so much the better. But when I got the prescription the last time, it arrived at my house about four days after all the necessary paperwork was filled out and the prescription faxed in. If I end up looking at a month before it arrives, then I'm not even going to bother... I'll go with the OxyContin.
> If your doc hasn't prescribed it before, it may take a few appts. worth just to nudge him into calling Orphan. And then he has to review safety/efficacy materials they give him, he needs to talk with a sales rep to nudge him some more, and then watch a video and listen to a phone recording about how to ensure it's properly prescribed. Then he has to wait for you to do the same-- watch a video, etc. Then it has to be mailed overnight to you.
So the fact that I've had it prescribed before may speed up the process, I assume. But this is all probably not even worth discussing since I'm almost positive Medicaid won't cover the cost.
> I see the top sleep doc in the country, but I had to see the top sleep doc/psychopharmacologist in the country just to get Xyrem considered... won a Psychopharmacology Award, published hundreds of things, etc... Professor.
I have no idea what this guy's credentials are -- he's just the closest pain management specialist to where I live, which I find completely absurd. I'm in a large city (Beaumont, TX) yet I'm going to have to travel 80 miles once or twice a month to Houston to get my meds? This whole thing is quickly turning into one big nightmare.
This is the end of the thread.
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