![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 93 to 117 of 121. Go back in thread:
Posted by JahL on December 11, 2001, at 19:45:30
In reply to Re: Methadone for depression. » JahL, posted by Elizabeth on December 9, 2001, at 16:04:58
> Jahl, would you be interested in exchanging emails?
Hi Elizabeth. Yeah, definitely. I'll set up a free email a/c. Bear in mind it takes me a couple of days to do anything.
>- you can be pretty resourceful and clever --
and may I say what a fine judge of character you are :)
>and I wonder if maybe you could help me figure out what to do about my own situation.
Seriously, I doubt there's much me & my dilapitated brain could tell She Who Knows Everything Medical. But there's probably something to be gained (certainly on my part) from exchanging experiences & whatnot. There's only so much you can say here...
> > very psychotherapy (Eck!) orientated.
> As you've probably noticed, I share your gag reflex toward talk therapy.Yeah, I thought I had a sympathetic audience on this thread. I won't talk to psychotherapists on principle; I despise them for reinforcing the publicly held notion that people with serious mental illness can cure themselves if only they would *try*. I'd like to see them try. They frequently hock their unscientific treatments on the back of benzo- and opiophobia thus making life more difficult for the likes of you and me who are seeking a *legitimate* (if unconvential) treatment. Anyway, enough of that. I'll start a debate off if I'm not careful.
> I *hate* dealing with bureaucrats. And it's so hard to advocate for yourself and make sure your rights are respected when you're depressed, isn't it?
I've made this point to pdocs many times. What happens to those who are too depressed to advocate for themselves in the way I (just about) am able to? What happens to those who are w/o a decent education or who have no net access? They're often consigned to rot in brain-corroding 'day-care' centers, with no discernable treatment plan.
> Being a regular psych patient can be hell, but I can only imagine how awful it must be for drug addicts. They're treated as though they're sub-human, or at the very best, the worst sort of criminals.)
Yeah, that's kinda the point of my theory. When I refer to Methadone 'users' I mean Heroin addicts; I wasn't aware Methadone was used for pain here in the UK (if it is, they're not telling. And why, when a respectable businessman and I had identical hand tendon operations, did he get different coloured painkillers to me ?!?! Hmmm..). Users have to queue up each day for their little bottle of salvation and be thankful it lasts as long as it does...
> So the question is, are depressives more like pain patients or MMT patients in their opioid dosing requirements? FWIW, I can tell you that I need to take bupe several times a day, whereas I believe that it's used once daily when it's given to addicts for maintenance therapy.Interesting. In the same way, for me Methadone *seems* to work better if taken as for pain.
> > I have a pet theory (actually I just this minute rolled a spliff and dreamt it up) that Methadone users are misinformed re: Methadone half-life so as to punish users for a couple of hours prior to their next dose for daring to be addicted to something that makes them feel good (H). I mean, who do they think they are??!
> I know that it's hard to get benzos in the UK; I wasn't sure about opioids. Here, a lot of doctors still refer to them as "narcotics." That says it all for me.Yeah, the couple of times I have vainly brought up the idea of opioids I have been asked "You mean Heroin?" [writes on notes : 'DRUG ABUSER'].
> > Opiate is an obscene word, especially after 'Dr Death' aka Dr Harold Shipman was found to have been addicted to PETHEDINE-Elizabeth, if you're reading, know anything about this one?-whilst murdering maybe 500 patients with Diamorphine. Even you insular Yanks ( :-) ) must have heard about this one a year or 2 ago.)?
>
> I actually don't know that story, no.I actually meant do you know about Pethidene :-). Since you ask...the guy started out as a GP (community doc) and soon developed a penchant for Pethidene. Later his habit was discovered but he was allowed to continue handling opiates. Anyway, soon after graduating he administered a lethal dose of Diamorphine to an elderly lady patient and pronounced her dead (cardiac arrest). This set the pattern for the following 25 years in which it is thought he murdered some 500 patients (nearly all female, elderly & living alone). He made regular house calls and it was on these that he would generally administer his lethal injections. Apparently he liked 'playing god'. Post-mortems never tested for Morphine (which of course he knew).
It was only a couple of years ago that a local registrar checked the records and realised the senior citizen death rate at his surgery was twice the ntl. average! He is w/o doubt this country's 'greatest' serial killer. When they searched his house they found a *2 litre* (!) stockpile of Diamorphine. All the ammo the govt. needs to further tighten controls...and punish people like myself.
> (BTW, U.S. readers might not recognize some of the drug names you use. Pethidine is what in the U.S. is called meperidine or Demerol -- a very short-acting opioid, not useful for our purposes; and diamorphine is of course diacetylmorphine, better known as heroin.)Opiate information of any kind (except the kind that tells you how many years in prison possession will earn you) is obviously Classified in the UK going by my web search. It's as if they don't exist. I *think* the following could be 'available' (ironic I know) here:
P,SL Buprenorphine (1)
O Codeine (5)
R Dextromoramide (2)
Dextropropoxyphene?
O,P Diamorphine (2)
O,P Dihydrocodeine (1)
O Dipipanone (1)
O Dipipanone & cyclizine 10mg/30mg 4 tablets new July 2000
Topical Fentanyl patches (50mcg) (3)
O Meptazinol (1)
O,P,R Morphine hydrochloride (2)
O,P,R Morphine sulphate (2)
P Nalbuphine (1)
R Oxycodone 90 mg new July 2000
O,P Pentazocine (2)
O Phenazocine 20 mg new July 2000
O Pethidine (1)
O Tramadol (1)See anything you like? :-P DEXTROMORAMIDE (Palfium) & DIPIPANONE (Diconal)-"Pinkies"-seem to be the main ones. Any thoughts?
> I know; it's so frustrating that many pdocs don't seem to believe that you know what your own subjective experience is better than they do!
Don't get me started...
> > > After Christmas I hope to turn into a person again.
> This is the fifth Christmas in a row that I've found myself wishing for the same present.
Let's hope St. Nick gets his act together.
Take care,
J.
Posted by Elizabeth on December 11, 2001, at 21:21:19
In reply to Re: Methadone for depression. » Elizabeth, posted by JahL on December 11, 2001, at 19:45:30
> Hi Elizabeth. Yeah, definitely. I'll set up a free email a/c. Bear in mind it takes me a couple of days to do anything.
Heh, I can identify with you there!
> and may I say what a fine judge of character you are :)
Flattery will get me everywhere, right?
> Seriously, I doubt there's much me & my dilapitated brain could tell She Who Knows Everything Medical. But there's probably something to be gained (certainly on my part) from exchanging experiences & whatnot. There's only so much you can say here...
Well, aside from the fact that I am far from Knowing Everything Medical, the problem I'm having lately isn't exactly a medical problem -- it's more of a problem with medical people.
> > As you've probably noticed, I share your gag reflex toward talk therapy.
>
> Yeah, I thought I had a sympathetic audience on this thread. I won't talk to psychotherapists on principle; I despise them for reinforcing the publicly held notion that people with serious mental illness can cure themselves if only they would *try*. I'd like to see them try.I can only assume that they make that claim to try to rationalize their failure to cure us.
> Anyway, enough of that. I'll start a debate off if I'm not careful.
Debates are fine. Even arguments are okay. It's fights and flame-wars that I could do without. :-}
> I've made this point to pdocs many times. What happens to those who are too depressed to advocate for themselves in the way I (just about) am able to? What happens to those who are w/o a decent education or who have no net access? They're often consigned to rot in brain-corroding 'day-care' centers, with no discernable treatment plan.
That's true. But even if you are educated, even if you can (at least sometimes) advocate for yourself, I think a lot of physicians believe that patients' rights aren't important -- they know what's best for us, and that's the final word.
> Users have to queue up each day for their little bottle of salvation and be thankful it lasts as long as it does...
That's the situation here too. I hear things in the Netherlands are different.
> Interesting. In the same way, for me Methadone *seems* to work better if taken as for pain.
IOW, it doesn't really last all day. So we have our answer.
> Since you ask...the guy started out as a GP (community doc) and soon developed a penchant for Pethidene.
I'm told that IV Demerol is very impressive, although short-lasting (and that Demerol is nothing special when taken orally).
> See anything you like? :-P DEXTROMORAMIDE (Palfium) & DIPIPANONE (Diconal)-"Pinkies"-seem to be the main ones. Any thoughts?
Yeah: I don't know what either of those is (although I think I've heard of Diconal someplace)!
> Let's hope St. Nick gets his act together.
Maybe he's suffering from anergic depression. That would explain a lot.
-e
Posted by judy1 on December 12, 2001, at 10:01:04
In reply to Re: Methadone for depression. » Elizabeth, posted by JahL on December 11, 2001, at 19:45:30
I don't want to start WWIII here, but I'm just curious about your feelings towards psychotherapy. I have had nothing but positive experiences with therapy, particularly psychologists, but I could tell some horror stories about psychiatrists. For me I could not get better w/o the meds and the support of therapy (especially now). I'm sorry you've had such negative experiences. Take care, judy
Posted by JahL on December 12, 2001, at 13:39:47
In reply to Re: Methadone for depression., posted by judy1 on December 12, 2001, at 10:01:04
> I don't want to start WWIII here, but I'm just curious about your feelings towards psychotherapy. I have had nothing but positive experiences with therapy, particularly psychologists, but I could tell some horror stories about psychiatrists.
Hi Judy.
No horror stories as such.
I think maybe it comes down to the nature of yr disorder. I've suffered from this disease (BPII) my entire life and know emphatically that there is absolutely no environmental aspect to it whatsoever. All I need are drugs to correct whatever form of biological dysfunction it is I suffer from. What I don't need are well-meaning but ultimately ignorant (ie no medical training) folk *standing in the way* of me and my medications (and therefore impeding my chances of remission). They do this by insisting there is a psychological bent to my disorder (therefore medication not required and so is*denied* me by my GP). I've been told it's all in my head, that my expectations are too high, that I am one of life's 'malcontentes', that I don't try enough; you get the picture. I've even had my Mum's parenting skills questioned (because she suffers from the same biological disorder as I)-something I take exception to. The psych in Q profusely apologised the week after he had met my mother (and had to eat humble pie), but by then had had enough time to cook up yet another off-the-wall theory about why I am the way I am (er...genetics possibly?). They don't seem to appreciate that what I (we) suffer from is so much more than just 'sadness'. That doesn't begin to describe BP.This is typical of my experience of therapists. Despise is probably too strong a word but it does accurately describe my feelings, distorted tho' they are. I am sure, in fact know, that they do a lot of good work and help a great deal of people. I just wish they'd restrict their help to those that want it and not interfere in medical matters in which their input is irrelevant and often distracting and misleading.
I have a very dysphoric type of depression; to the eternal disbelief of therapists, in general I don't enjoy the company of people and don't want to talk about 'it'. In fact I don't want to talk about anything unrelated to me getting well (it just doesn't interest me). This is the only board I've ever posted on. Talking to a therapist will have no bearing on my health and so there is no point.
I kinda resent the fact that they promise the world, pry extensively into your life and then, for me at least, deliver nothing. Except 2 wasted (and intensely boring) years. I've met many therapists over the years and I found a good number, in particular the more senior men, to be incredibly smug, like they and they alone have 'the answer' (as if).
Like Elizabeth, if I *do* want to talk, I have a good 'social support network' (is that what they call it?) and I am also fortunate enough to have had a good upbringing; my head is largely free of misconceptions and 'issues'. I'm v. lucky in this regard.
I won't get into the issue of causality and how confusing it can be for therapists (Them: "You're depressed *because* you don't go out anymore". Me: "No, I don't go out anymore because I'm acutely depressed, do not feel sociable and have felt this way my entire life. What would be the point of going out if I don't enjoy myself?". They tend not to like rational replies like this :-) )
Anyway, this is screaming to be redirected to PSB (which I naturally steer clear of :-) ) so I'll end it here. To borrow from the therapist parlance, this is a 'triggering' subject for me; it winds me up. I don't think I'd have any problem with therapists if they just confessed that what they principally do is *support* people, not cure them. My opinion does change however when we start talking child abuse, extreme trauma etc. I can't begin to understand this area and I assume a therapist would. Like Elizabeth I feel many people could benefit from counselling; I just don't see why depressives *specifically* need it, why it's forced upon them (it does't follow that if you have depression it's because your thought processes are 'wrong' [to use 'their' technical jargon]). I know dozens of people who are 'well' but nonetheless have something of a tenuous grip on reality and basically need a good talking to.
Remember, and this is is significant, I'm talking about the UK NHS here, where therapy is often forced upon patients who neither want nor need it. If they refuse, they're branded know-alls, egoists & trouble-makers and further treatment is often restricted. This kind of system breeds resentment such as mine. Therapy in the US would seem to be something of a different beast...
>For me I could not get better w/o the meds and the support of therapy (especially now).
That's good. One less reason to hate 'em :)
>Take care
And you,
J
Posted by Elizabeth on December 12, 2001, at 16:03:12
In reply to Re: Methadone for depression. » judy1, posted by JahL on December 12, 2001, at 13:39:47
> I think maybe it comes down to the nature of yr disorder. I've suffered from this disease (BPII) my entire life and know emphatically that there is absolutely no environmental aspect to it whatsoever.
Me too, and I *really* don't like it when "talk therapy" types try to blame my parents for my problems. It's bad enough that they stigmatize *me* for my illness. My parents -- despite the fact that they both suffer from milder versions of the problems that I have -- have done a better job raising me than most parents do (I didn't really start to appreciate them until I started noticing how awful most other people's parents are!) and they are *not* at fault for my illness.
> All I need are drugs to correct whatever form of biological dysfunction it is I suffer from.
At this point, I need more than that, but I've found that talk-therapy isn't the answer. But what I really need is some help getting back on my feet. Sitting and talking about my feelings does not help with this.
> What I don't need are well-meaning but ultimately ignorant (ie no medical training) folk *standing in the way* of me and my medications (and therefore impeding my chances of remission). They do this by insisting there is a psychological bent to my disorder (therefore medication not required and so is*denied* me by my GP).
I think that the problem lies in a sort of black-and-white thinking that pervades psychology and psychiatry -- either you have a "biological" disorder (a "real" disease) or a "psychological" one (in which case we get into blaming the victim, or her parents). This is a fallacy. The "mind" is produced by the brain; it's not some separate, insubstantial entity.
But getting back to the world of therapies, I just wish for people charged with my care to listen to me and believe me when I say that talk therapy (of all sorts) has not done me any good. I know better than they do what my experience has been, after all -- at least, that seems obvious to me.
> They don't seem to appreciate that what I (we) suffer from is so much more than just 'sadness'.
Yes. And they almost invariably have never suffered from depression or any other such disorder themselves. They think they can understand what we go through, but they can't because it's just so far removed from their experience. And they aren't willing to admit to their ignorance (or even to the *possibility* that they don't really know what's going on with us).
> I just wish they'd restrict their help to those that want it and not interfere in medical matters in which their input is irrelevant and often distracting and misleading.
I'd say the effect of it can be worse than that: being faulted for what is essentially an illness that we've had all our lives can be extremely damaging to our self-esteem. Undoing this damage is something that perhaps a talk-therapist could help with -- if I were able to find one I could trust.
> Like Elizabeth, if I *do* want to talk, I have a good 'social support network' (is that what they call it?)
I call it "family and friends," personally.
> and I am also fortunate enough to have had a good upbringing; my head is largely free of misconceptions and 'issues'. I'm v. lucky in this regard.
Me too.
> I won't get into the issue of causality and how confusing it can be for therapists (Them: "You're depressed *because* you don't go out anymore". Me: "No, I don't go out anymore because I'm acutely depressed, do not feel sociable and have felt this way my entire life. What would be the point of going out if I don't enjoy myself?". They tend not to like rational replies like this :-) )
I think a lot of it has to do with lack of education and perhaps limited intelligence. A social worker, for example, may not even *understand* a lot of what you're saying. And on the other hand, psychologists (and some of the more talk-oriented psychiatrists) may understand, or at least think they understand, but think they know better than you what's going on in your head.
> To borrow from the therapist parlance, this is a 'triggering' subject for me; it winds me up.
See, this is the sense in which, IMO, trying to force people into talk therapy when they've found it unhelpful or even hurtful, is not only useless, it is actively harmful.
> I don't think I'd have any problem with therapists if they just confessed that what they principally do is *support* people, not cure them.
Me neither.
> Like Elizabeth I feel many people could benefit from counselling; I just don't see why depressives *specifically* need it, why it's forced upon them (it does't follow that if you have depression it's because your thought processes are 'wrong' [to use 'their' technical jargon]).
Well, "depression" covers a wide range of conditions. Let's say "primary depression" when we mean the medical condition -- depression that isn't the "result" of some kind of bad experience or whatever, it's just there; our emotions don't quite work right.
> I know dozens of people who are 'well' but nonetheless have something of a tenuous grip on reality and basically need a good talking to.
Heh. That's true too, and it doesn't mean that what they have is a disease. Talking doesn't cure diseases.
> Remember, and this is is significant, I'm talking about the UK NHS here, where therapy is often forced upon patients who neither want nor need it.
In the US, talk therapy is often forced on patients too, although the coercion is more subtle: for example, a psychiatrist refuses to treat you with medication unless you're in talk therapy.
> If they refuse, they're branded know-alls, egoists & trouble-makers and further treatment is often restricted.
The irony is that the arrogance is coming from the professionals who think they know better than we do what's in our best interests, not from the patients, who genuinely do want to get better.
("doesn't really want to get better" is another stigmatizing label that's often branded on patients who don't "cooperate" with ineffective treatment plans)
-elizabeth
Posted by judy1 on December 12, 2001, at 17:27:36
In reply to Re: Methadone for depression. » JahL, posted by Elizabeth on December 12, 2001, at 16:03:12
I think I understand why you feel so negative Jah and I appreciate you sharing the reasons. I, too, suffer from bipolar 1 and panic disorders, but trauma from child abuse which unfortunately has no medication to help. My therp and pdoc talk weekly and my therp has never given her opinion either way when it comes to meds. (Even though that's a pretty hot topic in the U.S. now- giving psychologists the right to prescribe meds). My pdoc also does therapy, so we're talking a minimum of 2 hrs/wk here, but again I benefit greatly. I want to add that I went through 15 psychiatrists before I was able to find one who genuinely cares about me getting better and is willing to listen to my therapist's opinions. There are no ego games here, I must be one of the fortunate few. Anyway, stopped Duragesic, and take Actiq when I have to- the world's greatest lollipop. Hope you both feel better for the holidays- judy
Posted by Dr. Bob on December 12, 2001, at 20:59:41
In reply to Re: Methadone for depression. » judy1, posted by JahL on December 12, 2001, at 13:39:47
> Anyway, this is screaming to be redirected to PSB (which I naturally steer clear of :-) ) so I'll end it here.
Discussion about therapy should in fact be redirected there, thanks. :-)
Bob
PS: Do people feel it's "bad" to be redirected? No one should. It doesn't mean I want the discussion to end, just that I'd rather have it move to (continue on) a different board. Hmm, if you want to respond to that, please redirect your reply to Psycho-Babble Administration. :-)
Posted by shellir on December 23, 2001, at 22:39:28
In reply to Re: Morphine for depression. » Lorraine, posted by shelliR on November 16, 2001, at 12:30:36
Lorraine, just hoping you are okay and have not answered my other post because you are busy or away for the holidays. Posted earlier to you but I know on this thread you'll get an e-mail, so I'm just trying to connect again.
shelli
Posted by Lorraine on December 24, 2001, at 15:31:45
In reply to Re: trying to catch up with Lorraine » shelliR, posted by shellir on December 23, 2001, at 22:39:28
Sorry, Shelli. I'm OK. Just screaming busy. (12 people for dinner tomorrow; sick cat; meds in flux). I'll try to find your other post. I just haven't been checking in. I haven't used the email notify option. (You can alway email me privately.) I hope all is well with you and the season passes painlessly.
Lorraine
> Lorraine, just hoping you are okay and have not answered my other post because you are busy or away for the holidays. Posted earlier to you but I know on this thread you'll get an e-mail, so I'm just trying to connect again.
>
> shelli
Posted by reese1 on October 24, 2002, at 17:59:04
In reply to Re: Methadone/opiates for depression » Elizabeth, posted by nightlight on November 20, 2001, at 7:54:32
what is the typical dosage a pdoc will give of oxycontin for severe problematic depression
it has been fifteen years, ten hospitals and nothing has helped. i'm only 34 and i'm running out of time.
i have been on percocets. nothing.
vicoden nothing.
oxycotin at 20 or 40 mg was very very helpfulhow do you go about explaining this to a doct
who works with opiates. i have an appt nov 1thank you anyone everyone and all
i am so scared that i will get a prescription for
10mg 2 x aday which i know will do nothing but leave me crying from when i wake up till when i go to bed and on my free time walking around from
room to room, from circle to cirlce without stop.
Posted by Chuckie on October 30, 2003, at 15:10:05
In reply to elizabeth about dosing on opiates/ anyone » nightlight, posted by reese1 on October 24, 2002, at 17:59:04
Hey Reese, I'm sorry I can't be much help, I just didn't want you to think nobody is listening.
I'm a new member and up until now I've just been browsing this board, gleaning as much info as I can.
There is probably no pat answer for your question. At least, I haven't seen any. Some have suggested universities. Personally, I'm in a struggle convincing my own Doc to give me *any* opiates.
I only recently discovered the connection between pain medication and depression relief. Actually I only recently acknowledged it; I probably already knew it but I was in denial. The stigma is such that I didn't admit even to myself that I was taking pain meds for anything other than pain.
It was the discussions on this board that made the connection for me. I cried when I saw all the stories so similar to mine.
There have also apparently been some discussions here that were less than supportive. FYI, just so you don't read them and feel bad about yourself. (Unless you really *are* a drug abuser looking for some way to rationalize your habit and/or get more drugs for your monkey, or something like that, in which case you should feel bad.) I haven't seen those discussions, I've just seen references to them. It's probably best to ignore them.
It's probably *not* best to ignore the possibility of addiction or dependence. Be VERY concerned for your long-term health. Be mindful of the consequences of relying on a chemical that can be taken away from you at any time.
Anyway...
After I found this board, I did as much research as I could, and printed it all out for my doc. I also included a bunch of posts from this board, as anecdotal evidence that yes, opiate treatment helps some people with depression.
Here's a few links:
Opioid as Antidepressant
http://balder.prohosting.com/~adhpage/bupe.html
(This is the infamous buprenorphine study published in the Journal of Clinical Psychopharmacology. I also have it saved to disk because I think it's the only full text on the Web.)Bupenorphine for Depression (Editorial):
http://www.sciencething.org/Callaway.pdfAnd a blurb on Tramadol/Depression:
http://opioids.com/tramadol/tramadol.html
...even though it's not properly an opioid, but has similar properties.There was a study on cyclazocine:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=4903692
...but I can't find the text.Here's a paper acknowledging the connection, but not really saying anything useful:
http://www.geocities.com/HotSprings/9740/antimanicevidence.htmlAnd here's a study that shows how opiates might be helpful for depressed rats:
http://www.elsevier.nl/gej-ng/10/33/33/53/43/31/article.html=======
All of which I used for supporting evidence that it's not as crazy as it sounds, and that I really was getting depression relief from narcotic analgesics. Unfortunately with the limited research on the subject, anecdotal support really is the most convincing. The problem is that it's anecdodal. I think my Doc believes me, sorta, but there's always that skepticism and of course, the DEA.
I felt I had a good chance for getting relief with the mixed agonist/antagonist medications, as in theory a Doc should be more inclined to prescribe something with a lower potential for abuse, (and in some cases, less restrictive scheduling.) However, I only researched medications for efficacy and approprateness. I don't know how much any of it costs, or how it's dispensed. E.g. I gather that bupenorphine is VERY expensive, and is an injection. This does me no good, so probably not you either.
You're gonna have extreme difficulty getting that much oxycontin, even if you have pain. Unless you know Rush's doctor? It's too bad you can't get relief from something less high-profile. I think you're asking a lot. But I wish you luck.
I think the keys are honesty, communication, and a willingness to fight for your life. I could be mistaken; my Doc has prescribed tramadol because he obviously doesn't want to presribe narcotics without trying something else first. It's not working, and it makes me feel yucky. And, now that I've admitted to using pain pills for something other than pain, I don't know if he can or will prescribe them to me again. Although I do have a legit injury that causes me chronic pain.
Again, the keys are open communication and honesty. Probably perseverance too, although I completely understand if you're short of that. That said, if honesty fails, I'd advise you to do whatever you need to do to save your life. You have a right to that.
Just be sure you always remain honest with yourself, so you do the right thing for yourself, and not talk yourself into doing something potentially very, very, bad for yourself.
Posted by Aurora on October 30, 2003, at 22:36:22
In reply to Re: elizabeth about dosing on opiates/ anyone, posted by Chuckie on October 30, 2003, at 15:10:05
Dear Chuckie and "reese1" (posted on October 24, 2002 "elizabeth about dosing on opiates/anyone")
I'm a new member and can share new information on buprenorphine. It is now available in sublingual tablet form, under the trade name of Suboxone (a 4:1 combination of buprenorphine and naloxone). Naloxone has no clinical effect when taken sublingually as directed--but if made into solution and injected, it induces immediate painful opiate withdrawal. Naloxone was added to prevent diversion to the street as a cash drug, and has been very successful in these first 9 months, according to the DEA.
A wealth of information is available on the government's website: www.buprenorphine.samhsa.gov including a "Physician Locator". Also, you can call 1-877-SUBOXONE and clinical staff will answer your questions.
The FDA's indication is for treatment of opioid dependence, so you may need to educate your physician regarding treatment for depression with the clinical article's in Chuckie's posting of 10/30/03. A University of California psychiatrist (director of that UC's Dept. of Psychiatry), said he anticipates their greatest use of Suboxone will be for treatment of depression, not opioid dependence or pain (other possible uses). He had read the 1996 editorial published in "Biological Psychiatry", entitled "Buprenorphine for Depression: The Un-adoptable Orphan", which Chuckie included in his 10/30/03 posting. He said buprenorphine apparently has a very fast onset of AD action (2-4 hours) and with insurance companies' pressure for fast discharges from the hospital, it could be helpful both to patients (faster relief) and insurance companies (shorter hospital stays). He would then taper patients off buprenorphine (Suboxone) after a few weeks when their conventional AD had time to take effect.
The tablets come in 2 mg and 8 mg and it's once-a-day dosing (half-life ranges from 37-92 hours). It's probably too early to know what the average dosing is for depression (range is 4-32 mg for opioid dependence). Bottom line is: dose to effect. As a partial mu opioid agonist, buprenorpohine has a ceiling effect: taken alone, overdosing will not result in respiratory lethality, unlike full opioid agonists.
Another psychiatrist has successfully treated two patients with treatment resistant depression using Suboxone. They had tried everything. Nothing had worked. They had very fast results with Suboxone and have been on it about three months.
Obviously there is no one medication for everyone. Suboxone is working from some, and it's helpful to have another option when there are patients who haven't received relief from existing medications, or who have had incomplete response with an AD.
I hope this may be helpful to some. In any case, never give up your search for a successful treatment. As long as there's life, there's hope. We have to care enough about ourselves to keep trying. After decades of struggling with major depression, I met a pdoc I trusted and finally agreed to try ADs (since exercizing alone wasn't enough). It took trials on five ADs before I found the one right for me, and two years later, I needed to add Provigil for energy. It's a whole new life. I feel grateful and blessed--definitely worth the long journey.
Sending wishes for your healing,
Aurora
Posted by Ame Sans Vie on October 31, 2003, at 7:57:51
In reply to Re: elizabeth about dosing on opiates/ anyone, posted by Chuckie on October 30, 2003, at 15:10:05
Perhaps OxyContin *is* a bit much to ask for, even from a doctor who is not opiophobic. I find that some extended-release forms (especially Avinza) work at least as well as the hillbilly heroin for depression -- and Avinza is a 1 dose/24-hour pill, so that would save you the trouble of taking extra pills and going on the now-it's-working/now-it's-not rollercoaster provided by twice daily dosing. Two 120mg capsules in the morning worked great for me while I was on it. I never found MS-Contin to be very effective, and Duragesic transdermal (fentanyl patches) were rather depressing for me -- surprising considering fentanyl's "China white" reputation on the street. I found codeine far too weak, of course, as I did hydrocodone (needed 300mg/50mg respectively to feel depression relief). Ultram (mixed mu-opioid agonist, 5-HT/NE reuptake inhibitor) is a wonderful drug and I personally find it better for depression than either morphine or oxycodone. Gotta take DLPA and an NMDA antagonist with your opioids though... anything you can do to prevent tolerance. I take DLPA 2,250mg/day and dextromethorphan 60mg/day to prevent amphetamine tolerance, and have used the same cocktail to prevent Ultram tolerance -- works like a charm.
Finally, just wanted to note that there is also a form of buprenorphine sublingual tablets available without the naloxone, called Subutex.
Michael
Posted by femlite on October 31, 2003, at 11:33:49
In reply to Re: elizabeth about dosing on opiates/ anyone, posted by Chuckie on October 30, 2003, at 15:10:05
I thought Id hop in here as one who started seeking treatment for depression also as a result of expereiencing depression free days under pain managment treatment.
I have finally and acutally been called a "DRUG SEEKER" by my last pdoc (over the phone).
What exactly is a drug seeker?When someone is in pain, be it mental, or physical, how has it become stigmatized to seek relief. I have never abused (taken more than prescribed) any medication Ive been given.
Feeling abused and looking for feed back :{
Posted by Chuckie on October 31, 2003, at 12:41:30
In reply to Drug Seekers Unite? Anonymous? » Chuckie, posted by femlite on October 31, 2003, at 11:33:49
> I have finally and acutally been called a "DRUG SEEKER" by my last pdoc (over the phone).
> What exactly is a drug seeker?LOL
No, not at you, for you.
I was just thinking that same thing yesterday. It's one of the 'indicators' of drug abuse/addiction/moral failing. Does the patient engage in 'drug seeking behavior?'
You're bobdang right I do! Now give me some so I don't have to seek them, mm'k?
Posted by femlite on October 31, 2003, at 12:56:04
In reply to Re: Drug Seekers Unite? Anonymous?, posted by Chuckie on October 31, 2003, at 12:41:30
Posted by Chuckie on October 31, 2003, at 13:21:20
In reply to Re: elizabeth about dosing on opiates/ anyone, posted by Ame Sans Vie on October 31, 2003, at 7:57:51
>Ultram (mixed mu-opioid agonist, 5-HT/NE reuptake inhibitor) is a wonderful drug and I personally find it better for depression than either morphine or oxycodone.
I'm glad you're finding relief w/Ultram. I had big hopes for it since it's not properly an opioid and really represents a low risk of addiction. I mean I'm sure you can get dependent on it, but I think that's a small price to pay for the relief, whatever the drug. It would just be nice to be dependent on something that doesn't hurt so bad if you have to stop for some reason.
Unfortunately it doesn't work for me, because it makes me feel yucky, among other bad things. It reminds me of tricyclic anti-depressants, which I took for ten years to no real effect except I got fat and felt yucky most of the time.
It certainly doesn't provide the 'normalizing' effect that I was looking for. It does remove my craving for opiates, which is nice I guess, but wasn't really my point. Not much help if it doesn't help my depression and makes me feel bad as well.
>Gotta take DLPA and an NMDA antagonist with your opioids though... anything you can do to prevent tolerance.
Great, now more stuff I need to research. This is a real chore... especially when I put a medication into Google and get 20,000 hits on websites where I can buy it for too much money. :(
Still, since one of my goals must needs be to convince my Doc that I'm not going to abuse the drugs, I need to learn about whatever helps assure that.
So, maybe he would just prescribe me hydrocodone, if he could prescribe an opiate antagonist at the same time? And would the medication still be effective?
I'm not a medical professional or a pharmacist, so I'm unsure how exactly the medication benefits me. IOW, I was investigating the mixed agonist/antagonists because of their lower potential for addiction or abuse, mostly for the benefit of my Doc, so he wouldn't be so reluctant. Personally, I know I can take care of myself and self-regulate, but he has to justify himself to the DEA. Anyway, to my limited knowledge, it just seems like an antagonist might cancel out the benefits. But then I can't rely on intuition when I'm asking for a treatment that most people find counterintuitive.
> Finally, just wanted to note that there is also a form of buprenorphine sublingual tablets available without the naloxone, called Subutex.
Yah, but can a GP prescribe it for something other than addiction? And I've heard the stuff is REALLY expensive. I can probably cope with something that costs maybe $100/mo., just because I would probably be $100/mo. more productive. Much more than that would maybe interfere with the bill-paying.
Posted by Ame Sans Vie on October 31, 2003, at 14:45:25
In reply to Re: elizabeth about dosing on opiates/ anyone, posted by Chuckie on October 31, 2003, at 13:21:20
> I'm glad you're finding relief w/Ultram.
Thanks, but unfortunately I had to discontinue it last week. It was worsening my fibro pain so much that I had trouble ever getting out of bed.
> I had big hopes for it since it's not properly an opioid and really represents a low risk of addiction. I mean I'm sure you can get dependent on it, but I think that's a small price to pay for the relief, whatever the drug. It would just be nice to be dependent on something that doesn't hurt so bad if you have to stop for some reason.
Well, the addiction risk is pretty low, you're right about that, but the withdrawal is insane. It's not opioid withdrawal -- there are none of the typical opioid abstinence symptoms. It feels exactly like Paxil or Luvox withdrawal, which makes me think that its "mild 5-HT/NE reuptake inhibition properties" aren't quite so mild as they think. I started taking Prozac and quit the Ultram that very day -- once I had the 5-HT/NE action of the Prozac in my system, the withdrawal was a piece of cake. The other times I tried to quit I was constantly contemplating suicide.
> Unfortunately it doesn't work for me, because it makes me feel yucky, among other bad things. It reminds me of tricyclic anti-depressants, which I took for ten years to no real effect except I got fat and felt yucky most of the time.
>
> It certainly doesn't provide the 'normalizing' effect that I was looking for. It does remove my craving for opiates, which is nice I guess, but wasn't really my point. Not much help if it doesn't help my depression and makes me feel bad as well.That's too bad... one thing I've noticed myself is that lower doses can be more sluggish and tricyclic-feeling (yuck) while dosages of about 400mg/day (which I was taking) are more uplifting and activating. How large was your dose?
> >Gotta take DLPA and an NMDA antagonist with your opioids though... anything you can do to prevent tolerance.
>
> Great, now more stuff I need to research. This is a real chore... especially when I put a medication into Google and get 20,000 hits on websites where I can buy it for too much money. :(
>lol, there are some posts on this board dealing with NMDA antagonists not very long ago. I'll dig them up and post the links. DLPA is a must, though, provided you can take it. the D- isomer of phenylalanine inhibits the enzyme which breaks down endorphins and enkephalins, raising levels of those substances in our brains, and the L-isomer primary goes on to form thyroid hormone, tyrosine, dopamine, norepinephrine, epinephrine and alpha-phenylethylamine. Plain DPA is available if you don't want the stimulating element of LPA.
> Still, since one of my goals must needs be to convince my Doc that I'm not going to abuse the drugs, I need to learn about whatever helps assure that.
>
> So, maybe he would just prescribe me hydrocodone, if he could prescribe an opiate antagonist at the same time? And would the medication still be effective?Sure -- this is something that is actually just now catching on in pain clinics. An opioid (usually morphine) is prescribed along with a small dose of naltrexone; the morphine's action isn't inhibited and tolerance build-up is often very much delayed.
> I'm not a medical professional or a pharmacist, so I'm unsure how exactly the medication benefits me.
Well, I personally feel that depressed people who really, truly feel "right" on narcotic analgesics (as in not just "high") probably have some sort of endogenous disfunction/deficiency involved with opioid peptides. Not an original idea by far, but it's one that I've read quite a bit about and which seems to make plenty of sense.
> IOW, I was investigating the mixed agonist/antagonists because of their lower potential for addiction or abuse, mostly for the benefit of my Doc, so he wouldn't be so reluctant. Personally, I know I can take care of myself and self-regulate, but he has to justify himself to the DEA. Anyway, to my limited knowledge, it just seems like an antagonist might cancel out the benefits. But then I can't rely on intuition when I'm asking for a treatment that most people find counterintuitive.
Like I said, not a problem whatsoever -- I believe that the antagonists don't actually begin to block binding of exogenous opioid agonists when taken orally except at doses somewhat larger than those used for tolerance prevention. But that raises the question, "how do they work at such low doses then"? I'll have to look into it, lol.
Also, the dextromethorphan I mentioned would probably be less expensive to use than naltrexone (I have no clue how much naltrexone costs; DXM is OTC at less than $20 for a month's supply. And probably is more effective. A morphine/dextromethorphan product called MorphiDex is being studied now, with good results.
> > Finally, just wanted to note that there is also a form of buprenorphine sublingual tablets available without the naloxone, called Subutex.
>
> Yah, but can a GP prescribe it for something other than addiction?They can be prescribed for off-label usage, but the physician must have a special second DEA number which authorizes him/her to prescribe Subutex/Suboxone. Just curious, do you just see a GP -- not a psychiatrist?
> And I've heard the stuff is REALLY expensive. I can probably cope with something that costs maybe $100/mo., just because I would probably be $100/mo. more productive. Much more than that would maybe interfere with the bill-paying.
Oh yeah, I'm sure it's enormously expensive. There is the injectable form though (not sure about the price on it) which can be taken intranasally or sublingually to avoid injections.
Posted by Chuckie on October 31, 2003, at 17:31:12
In reply to Re: elizabeth about dosing on opiates/ anyone » Chuckie, posted by Ame Sans Vie on October 31, 2003, at 14:45:25
> > I'm glad you're finding relief w/Ultram.
>
> Thanks, but unfortunately I had to discontinue it last week. It was worsening my fibro pain so much that I had trouble ever getting out of bed.<Yah, that's one the other problems I have with it, I do have legit chronic pain and it doesn't help much. People must react differently to it because I've heard lots of success stories, but I guess that's true of any medication.
My body thinks the most evil drug on Earth is Prozac. Go figure.
> Well, the addiction risk is pretty low, you're right about that, but the withdrawal is insane. It's not opioid withdrawal -- there are none of the typical opioid abstinence symptoms. It feels exactly like Paxil or Luvox withdrawal, which makes me think that its "mild 5-HT/NE reuptake inhibition properties" aren't quite so mild as they think. I started taking Prozac and quit the Ultram that very day -- once I had the 5-HT/NE action of the Prozac in my system, the withdrawal was a piece of cake. The other times I tried to quit I was constantly contemplating suicide.<
Good grief! I hope that doesn't happen to me. I think I can take it or leave it, and I'd rather leave it. But then I've only taken it for a month, so to give it a fair trial.
> That's too bad... one thing I've noticed myself is that lower doses can be more sluggish and tricyclic-feeling (yuck) while dosages of about 400mg/day (which I was taking) are more uplifting and activating. How large was your dose?<
50mg x2, 4 times a day. Somewhere I read, and my Doc said something about it too, that 400mg/day is the most for anyone under any circumstances, after which er... something really bad happens?
> DLPA is a must, though, provided you can take it. the D- isomer of phenylalanine inhibits the enzyme which breaks down endorphins and enkephalins, raising levels of those substances in our brains, and the L-isomer primary goes on to form thyroid hormone, tyrosine, dopamine, norepinephrine, epinephrine and alpha-phenylethylamine. Plain DPA is available if you don't want the stimulating element of LPA. <
Yes, please, refer me to the post, or I'll see if I can turn it up in a search. Cuz I have no idea what you just said there.
> Sure -- this is something that is actually just now catching on in pain clinics. An opioid (usually morphine) is prescribed along with a small dose of naltrexone; the morphine's action isn't inhibited and tolerance build-up is often very much delayed. <
Cool, I'll add that to my information arsenal. Thanks.
> I believe that the antagonists don't actually begin to block binding of exogenous opioid agonists when taken orally except at doses somewhat larger than those used for tolerance prevention. But that raises the question, "how do they work at such low doses then"? I'll have to look into it, lol. <
I think I get it. I've been reading much the same stuff as you, I think, but apparently with less comprehension.
> Also, the dextromethorphan I mentioned would probably be less expensive to use than naltrexone (I have no clue how much naltrexone costs; DXM is OTC at less than $20 for a month's supply. And probably is more effective. A morphine/dextromethorphan product called MorphiDex is being studied now, with good results. <Well, I'd just as soon stick with good old generic hydrocodone, if I can use antagonists to help prevent 'problems' and make my Doc feel more secure. Anything that has a brand name and/or is being tested, is probably beyond my budget.
> Just curious, do you just see a GP -- not a psychiatrist? <
Long story, but yes. I haven't seen a mental health professional in at least ten years. I saw way too many of them prior to that.
At least my GP listens to me and tries to help, for the most part. I'm just worried about how much help he'll be with this, and I'm worried cuz he's getting old and might retire or die.
Hey, thanks for the info and the moral support. I am so glad to have found this place.
Posted by Aurora on November 1, 2003, at 21:39:48
In reply to Re: elizabeth about dosing on opiates/ anyone » Chuckie, posted by Ame Sans Vie on October 31, 2003, at 14:45:25
Ame sans Vie and Chuckie
Just a quick note to let you know that with Suboxone and Subutex, off-label prescribing does NOT require the physician to have a special X DEA number. The X (which reflects that the physician is either (1) addiction certified or (2) has taken an 8 hour buprenorphine course and that both (1) and (2) have sent in a notification form to CSAT, certifying they are qualified to prescribe Suboxone/Subutex, that they understand there is currently a 30-patient limit, and that they can refer patients for counseling. Off-label prescription for pain and depression (or whatever else a physician may want to prescribe it for) does not carry any requirement. These medications are Schedule III, so no triplicate is required.
Posted by Aurora on November 1, 2003, at 21:49:43
In reply to Drug Seekers Unite? Anonymous? » Chuckie, posted by femlite on October 31, 2003, at 11:33:49
> I thought Id hop in here as one who started seeking treatment for depression also as a result of expereiencing depression free days under pain managment treatment.
>
> I have finally and acutally been called a "DRUG SEEKER" by my last pdoc (over the phone).
> What exactly is a drug seeker?
>
> When someone is in pain, be it mental, or physical, how has it become stigmatized to seek relief. I have never abused (taken more than prescribed) any medication Ive been given.
>
> Feeling abused and looking for feed back :{Hi, Femlite
Physicians and health professionals are taught to be aware of patients who request addictive medications for symptoms which they show no clear evidence and for doses beyond which is normally therapeutic. "Drug seeking" is common behavior of addicts. That is why addicts also approach multiple physicians to secure multiple prescriptions of the same medication. Pharmacists, too, are aware of and see this behavior, and will often alert the physicians, who will then discontinue the Rx's or make sure only one of them is Rxing.
Your case sounds like an over-generalizing physician who does not really know you. One thought is to find out who is an addiction specialist in your community--they may actually be more inclined to Rx for you, because they will see you are not an addict. -- Hang in there....
Posted by Aurora on November 1, 2003, at 21:54:15
In reply to Re: elizabeth about dosing on opiates/ anyone, posted by Ame Sans Vie on October 31, 2003, at 7:57:51
Ame sans Vie and Chuckie
Just a quick note to let you know that with Suboxone and Subutex, off-label prescribing does NOT require the physician to have a special X DEA number. The X (which reflects that the physician is either (1) addiction certified or (2) has taken an 8 hour buprenorphine course and that both (1) and (2) have sent in a notification form to CSAT, certifying they are qualified to prescribe Suboxone/Subutex, that they understand there is currently a 30-patient limit, and that they can refer patients for counseling. Off-label prescription for pain and depression (or whatever else a physician may want to prescribe it for) does not carry any requirement. These medications are Schedule III, so no triplicate is required.
aurora
Posted by femlite on November 2, 2003, at 0:28:28
In reply to Re: Drug Seekers Unite? Anonymous? » femlite, posted by Aurora on November 1, 2003, at 21:49:43
I can appreciate the slowness with which the Phsyicisan and health professional Indudstry move to adopt more accurate public policy.
Who can keep up with media and Pharm. compnies racing to market each new drug for curing all and to sell.
Suddenly the guy sitting on the john, reading his readers digest goes off the next day to get me some uh....The terminology needs to be updated
May be we could call drug abusers, drug abusers, and seekers; those still looking for the right pyschiatrist!> Your case sounds like an over-generalizing physician who does not really know you. One thought is to find out who is an addiction specialist in your community--they may actually be more inclined to Rx for you, because they will see you are not an addict. -- Hang in there....
Done that- been there-that was worse
but thanks for the good word
Posted by Chuckie on November 2, 2003, at 11:17:12
In reply to Re: Drug Seekers Unite? Anonymous? » Aurora, posted by femlite on November 2, 2003, at 0:28:28
> > Your case sounds like an over-generalizing physician who does not really know you. One thought is to find out who is an addiction specialist in your community--they may actually be more inclined to Rx for you, because they will see you are not an addict. -- Hang in there....
>
> Done that- been there-that was worseWhat happened, if I may ask? I was considering the same thing, as I'm in a good-sized city far from my GP. I don't have a clue how to find a Doc around here but I figured there must be plenty addicts and so plenty addiction specialists.
I'm also considering the flip side. Since so many folks have accidently found relief from depression while being treated for pain, I was thinking that someone who deals in pain treatment has maybe gotten a clue.
Posted by Aurora on November 2, 2003, at 22:01:03
In reply to Re: Drug Seekers Unite? Anonymous? femlite, posted by Chuckie on November 2, 2003, at 11:17:12
> > > Your case sounds like an over-generalizing physician who does not really know you. One thought is to find out who is an addiction specialist in your community--they may actually be more inclined to Rx for you, because they will see you are not an addict. -- Hang in there....
> >
> > Done that- been there-that was worse
>
> What happened, if I may ask? I was considering the same thing, as I'm in a good-sized city far from my GP. I don't have a clue how to find a Doc around here but I figured there must be plenty addicts and so plenty addiction specialists.
>
> I'm also considering the flip side. Since so many folks have accidently found relief from depression while being treated for pain, I was thinking that someone who deals in pain treatment has maybe gotten a clue.
>All the pain docs I've met refer out to pdocs for depression. If you live in a University city, they will be aware of research dealing with new options, as well as "old" options, like opiates for depression...another source perhaps worth checking out.
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