![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by lew on December 11, 2004, at 16:50:22
I am looking for a doctor in Denver Colorado that would be open-minded and willing to try an alternative to the conventional AD, because I have been on ALL of them. I've experienced all the same side effects that I have been reading about on this website, which has been a Godsend for me. I'm not interested in abusing these medications. I feel truly that they are the only thing that help, make me feel "normal" and give me motivation. Please, someone out there help. I'm currently taking tramadol that I stumbled on by accident and realized it improved my mood significantly! It gave me hope after 8 years of fighting this horrible disease. I'm also on klonipin for anxiety and trazadone for sleep problems. I'm concerned about the tramadol because of the possibility of developing neuropathy. Although, I did make a phone call, out of the blue (literally) to Dr. Bodkin and he called me back!! He is such a great guy. He doesn't even know me and he called me back. I was amazed. Anyway, he asked how long I had been on the tramadol and I told him for about 1 year and he said if I hadn't developed neuropathy by now, my chances were pretty slim. That gave me some solace, but I feel I could be on a combo of opiate and AD (one that doesnt make me gain wt. or lose my sex drive, if that's possible with conventional AD) I feel I could be on a better medication that would be optimum for me. Does anyone have any thoughts on any of this, or a good combo of opiate and AD. My friends and family have noticed such a change in my motivation and attitude. It has been wonderful to feel really normal again. This was all brought on by an extreme trauma in my life, but I believe I am prone to depression from my mom's side. At this point, I'm almost willing to sacrifice my health just to feel normal. I guess I'm sounding pretty desperate because I am. And, I truly believe that the people on this sight will understand my desperation, as well as Dr. Bob. It was actually a pharmacist that gave me this idea, to get on line and ask for help. Is there anyone out there studying opiates for depression. I have even been told they are illegal to prescribe for depression in Colorado. My sister just attempted suicide on Halloween of this yr and the doctor told us she was within 3 minutes of dying!! She overdosed on Paxil!! How can these medicines be helping?!?!
Posted by linkadge on December 11, 2004, at 20:10:40
In reply to opiates for depression, posted by lew on December 11, 2004, at 16:50:22
Perhaps opiates plus and AD that effects opiates such as the TCA's
Linkadge
Posted by JackD on December 11, 2004, at 22:37:52
In reply to opiates for depression, posted by lew on December 11, 2004, at 16:50:22
Awesome, that's great you've found something that works. I just recently found "the right" combination as well and what I've been writing could pertain to you. Check out my previous posts. I just did a quick search for info about Tramadol and found that it is actually structurally similar to Effexor. That is soooo amazing. It's another peice to the jigsaw puzzle. Go to www.pubmed.com to look for more abstracts. Oh, so anyway, Namenda (Memantine HCL) prevents and even reverses opiate tolerance (in theory) so maybe you should ask your doctor if you can try it with the tramadol. Oh and be careful with Tramadol regarding serotonin syndrome!!!
Hot damn I'm soooooo psyched that I read your post... this is the second time in the past few weeks that I've just happened onto something like this. Someone should seriously start looking into all this. Effexor, Pain, Depression, Opioid System, Tolerance, Bipolar II, Memantine... and now Tramadol. Go, GO! Go out and tell the world!!!!
Oh I almost forgot, here:
"Effects of Chronic Tramadol on Pre- and Post-Synaptic Measures of Monoamine Function
by Hopwood SE, Owesson CA, Callado LF, McLaughlin DP, Stamford JA.
Academic Department of Anaesthesia and Intensive Care, St Bartholomew's and The Royal London School of Medicine and Dentistry,
Royal London Hospital, Whitechapel, UK.
J Psychopharmacol 2001 Sep;15(3):147-53ABSTRACT
The atypical analgesic tramadol has strong structural similarities to the antidepressant venlafaxine and is a mixed noradrenaline (NA) and serotonin (5-HT) uptake inhibitor. Because tramadol has been found active in the forced swim test, a common predictor of antidepressant efficacy, we therefore examined the effects of chronic tramadol on various pre- and post-synaptic monoamine measures. Male Wistar rats (150-200 g) received tramadol (20 mg/kg i.p.) or vehicle for 21 days and were sacrificed 24 h after the last dose. Quantitative autoradiography revealed that specific frontocortical [3H]dihydroalprenolol and [3H]ketanserin binding was lower in the chronic tramadol group than controls (beta: 37+/-8 and 217+/-56 fmol/mg; 5-HT2A: 23+/-3 and 44+/-7 fmol/mg, respectively, p < 0.05). Chronic tramadol had no effect on the magnitude of electrically stimulated noradrenaline (NA) efflux or uptake in locus coeruleus (LC) slices. Although dexmedetomidine (10 nM) decreased LC NA efflux equally (by approximately 60%) in chronic tramadol and vehicle groups, desipramine (50 nM) increased LC NA efflux more in vehicle (to 164+/-7%) than tramadol-treated rats (144+/-6%; p < 0.05). Chronic tramadol had no effect on dorsal raphe (DRN) or median raphe (MRN) 5-HT efflux. However, 5-HT uptake in tramadol-treated rats was slower (p < 0.05) in MRN and nearly so (p = 0.055) in DRN. The selective 5-HT1A agonist 8-OH-DPAT reduced 5-HT efflux in both DRN and MRN. Its effect in DRN was greater in rats given chronic tramadol than in vehicle controls (54+/-2 versus 32+/-6% reduction in 5-HT efflux, respectively). In conclusion, we suggest that tramadol has many of the pre- and postsynaptic neurochemical features of a conventional antidepressant, as might be predicted from its pharmacology. "
Posted by lew on December 11, 2004, at 23:34:22
In reply to IMPORTANT INFORMATION FOR ALL, posted by JackD on December 11, 2004, at 22:37:52
I'm glad that you found my post insightful! Do you mind me asking what are your symptoms and what combo are you finding that works? I was aware of the pharmacology being similar to effexor, but that drug scares me. I'm in a line of work that I really have to watch my weight. What is seratonin syndrome? I've never heard of it.
Posted by lew on December 11, 2004, at 23:37:53
In reply to Re: opiates for depression, posted by linkadge on December 11, 2004, at 20:10:40
> Perhaps opiates plus and AD that effects opiates such as the TCA's
>
> Linkadge
Pardon my ignorance, but what are TCA's?
Posted by RetiredYoung on December 12, 2004, at 6:41:14
In reply to Re: opiates for depression, posted by lew on December 11, 2004, at 23:37:53
Posted by Larry Hoover on December 12, 2004, at 18:00:48
In reply to IMPORTANT INFORMATION FOR ALL, posted by JackD on December 11, 2004, at 22:37:52
> Awesome, that's great you've found something that works. I just recently found "the right" combination as well and what I've been writing could pertain to you. Check out my previous posts.
This was the only other post of yours I could find. Do you see where a URL might be useful?
> I just did a quick search for info about Tramadol and found that it is actually structurally similar to Effexor. That is soooo amazing. It's another peice to the jigsaw puzzle. Go to www.pubmed.com to look for more abstracts. Oh, so anyway, Namenda (Memantine HCL) prevents and even reverses opiate tolerance (in theory) so maybe you should ask your doctor if you can try it with the tramadol. Oh and be careful with Tramadol regarding serotonin syndrome!!!
One of the problems with long-term use of tramadol is how quickly tolerance develops. It would indeed by important to find a way to avoid tolerance, but I know of no one who has yet been successful in doing so.
> Hot damn I'm soooooo psyched that I read your post... this is the second time in the past few weeks that I've just happened onto something like this. Someone should seriously start looking into all this. Effexor, Pain, Depression, Opioid System, Tolerance, Bipolar II, Memantine... and now Tramadol. Go, GO! Go out and tell the world!!!!
>
> Oh I almost forgot, here:
>
> "Effects of Chronic Tramadol on Pre- and Post-Synaptic Measures of Monoamine FunctionThere's a very important detail in this abstract:
"Male Wistar rats (150-200 g) received tramadol (20 mg/kg i.p.)...."That would be similar to a human ingesting 1400 mg tramadol, more or less (assuming a mass of about 70 kg, or 150 lbs.).
It's pretty hard to derive human parallels from doses that are many times over the maximum human intake.
You may wish to search the archives here for others' experiences with tramadol. Not one person has ever had long-term success.
Lar
Posted by lew on December 13, 2004, at 9:12:21
In reply to Re: IMPORTANT INFORMATION FOR ALL » JackD, posted by Larry Hoover on December 12, 2004, at 18:00:48
> > Awesome, that's great you've found something that works. I just recently found "the right" combination as well and what I've been writing could pertain to you. Check out my previous posts.
>
> This was the only other post of yours I could find. Do you see where a URL might be useful?
>
> > I just did a quick search for info about Tramadol and found that it is actually structurally similar to Effexor. That is soooo amazing. It's another peice to the jigsaw puzzle. Go to www.pubmed.com to look for more abstracts. Oh, so anyway, Namenda (Memantine HCL) prevents and even reverses opiate tolerance (in theory) so maybe you should ask your doctor if you can try it with the tramadol. Oh and be careful with Tramadol regarding serotonin syndrome!!!
>
> One of the problems with long-term use of tramadol is how quickly tolerance develops. It would indeed by important to find a way to avoid tolerance, but I know of no one who has yet been successful in doing so.
>
> > Hot damn I'm soooooo psyched that I read your post... this is the second time in the past few weeks that I've just happened onto something like this. Someone should seriously start looking into all this. Effexor, Pain, Depression, Opioid System, Tolerance, Bipolar II, Memantine... and now Tramadol. Go, GO! Go out and tell the world!!!!
> >
> > Oh I almost forgot, here:
> >
> > "Effects of Chronic Tramadol on Pre- and Post-Synaptic Measures of Monoamine Function
>
> There's a very important detail in this abstract:
>
> "Male Wistar rats (150-200 g) received tramadol (20 mg/kg i.p.)...."
>
> That would be similar to a human ingesting 1400 mg tramadol, more or less (assuming a mass of about 70 kg, or 150 lbs.).
>
> It's pretty hard to derive human parallels from doses that are many times over the maximum human intake.
>
> You may wish to search the archives here for others' experiences with tramadol. Not one person has ever had long-term success.
>
> Laryou may Wish to search my previous post. i am concerned about the use of tramadol, that is why i am inquiring about opiates. i have been treatment resistant to every AD. i found something that works (tramadol), but i believe there to be a better combo for me. regardless of what you say or think, i believe there is strong AD effects of tramadol. it might serve you well to look at the pharmacology abstracts. jackd was simply happy i found something that has helped (and i appreciate the support) and yes, it has saved my life.
lew
Posted by ed_uk on December 13, 2004, at 9:26:31
In reply to opiates for depression, posted by lew on December 11, 2004, at 16:50:22
Hi,
Here are some interesting case reports from the American Journal of Psychiatry.......
Treatment Augmentation With Opiates in Severe and Refractory Major Depression
ANDREW L. STOLL, M.D., and STEPHANIE RUETER, B.A.
Belmont, Mass.To the Editor: Substantial evidence supports the antidepressant efficacy of opiates (1). This report summarizes our open-label experience using the µ-opiate agonists oxycodone (Oxycontin/Oxynorm) or oxymorphone in patients with highly refractory and chronic major depression.
Mr. A was a 44-year-old man with severe and chronic depression. Numerous trials of antidepressants produced only limited benefit. Mr. A also had an extensive history of opiate abuse, and he noted that the only times he ever felt normal and not depressed was during opiate use. Because of the refractory nature of his depressive symptoms and his apparent self-medication with opiates, Mr. A was given a trial of oxycodone (Oxycontin) under strict supervision. After 18 months of oxycodone treatment (10 mg/day), Mr. A remained in his longest remission from depression without the emergence of opiate tolerance or abuse.
Ms. B was a 45-year-old woman with bipolar disorder and opiate abuse (in remission for 2 years). A trial with standard mood stabilizers had failed, and she had experienced mania with several standard antidepressant drugs. As with Mr. A, Ms. B reported feeling well only when taking opiates, particularly oxymorphone. Oxymorphone (8 mg/day) was thus cautiously added to ongoing lamotrigine therapy (as a mood stabilizer), and she remained well for a minimum of 20 months without drug tolerance or abuse.
Mr. C was a 43-year-old man with chronic major depression that was unresponsive to numerous antidepressants with and without augmentation. Detailed questioning revealed that he once experienced marked antidepressant effects from opiates that he received after a dental procedure. There was no history of opiate abuse, and a cautious trial of oxycodone was initiated. Mr. C experienced a dramatic and gratifying antidepressant response from oxycodone (10 mg t.i.d. for 9 months) without opiate tolerance or abuse.
This report describes three patients with chronic and refractory major depression who were treated with the µ-opiate agonists oxycodone or oxymorphone. All three patients experienced a sustained moderate to marked antidepressant effect from the opiates. The patients described a reduction in psychic pain and distress, much as they would describe the analgesic effects of opiates in treating nocioceptive pain.Two of the three patients described in this report were previous abusers of opiates. Although the clinical use of opiates in patients with a history of opiate addiction is usually contraindicated, in these cases there was a strong indication that they were self-medicating their mood disorders (2) with illicit opiates. None of the patients abused the opiates, developed tolerance, or started using other illicit substances.
We used oxycodone in three additional patients without histories of opiate abuse. In two of these three patients, oxycodone produced a similar sustained antidepressant effect. Two of these patients experienced mild-to-moderate constipation, and one experienced daytime drowsiness from the opiates. Opiates should be considered a reasonable option in carefully selected patients who are desperately ill with major depression that is refractory to standard therapies.
REFERENCES
Bodkin JA, Zornberg GL, Lukas SE, Cole JO: Buprenorphine treatment of refractory depression. J Clin Psychopharmacol 1994; 15:49–57
Khantzian EJ: Self-regulation and self-medication factors in alcoholism and the addictions: similarities and differences. Recent Dev Alcohol 1990; 8:255–271[Medline].................................................................................................................................................................
Use of the opioid buprenorphine in the treatment of depression......
J Clin Psychopharmacol. 1995 Feb;15(1):49-57.
Buprenorphine treatment of refractory depression.
Bodkin JA, Zornberg GL, Lukas SE, Cole JO.
McLean Hospital, Consolidated Department of Psychiatry, Harvard Medical School, Belmont, MA 02178, USA.
Opiates were used to treat major depression until the mid-1950s. The advent of opioids with mixed agonist-antagonist or partial agonist activity, with reduced dependence and abuse liabilities, has made possible the reevaluation of opioids for this indication. This is of potential importance for the population of depressed patients who are unresponsive to or intolerant of conventional antidepressant agents. Ten subjects with treatment-refractory, unipolar, nonpsychotic, major depression were treated with the opioid partial agonist buprenorphine in an open-label study. Three subjects were unable to tolerate more than two doses because of side effects including malaise, nausea, and dysphoria. The remaining seven completed 4 to 6 weeks of treatment and as a group showed clinically striking improvement in both subjective and objective measures of depression. Much of this improvement was observed by the end of 1 week of treatment and persisted throughout the trial. Four subjects achieved complete remission of symptoms by the end of the trial (Hamilton Rating Scale for Depression scores < or = 6), two were moderately improved, and one deteriorated. These findings suggest a possible role for buprenorphine in treating refractory depression.
Regards,
Ed.
Posted by Larry Hoover on December 13, 2004, at 14:41:57
In reply to Re: IMPORTANT INFORMATION FOR ALL, posted by lew on December 13, 2004, at 9:12:21
> you may Wish to search my previous post. i am concerned about the use of tramadol, that is why i am inquiring about opiates. i have been treatment resistant to every AD. i found something that works (tramadol), but i believe there to be a better combo for me. regardless of what you say or think, i believe there is strong AD effects of tramadol.
There is, but it never lasts long. If you've been achieving any lasting success, they ought to write a case report about your experience. There is nothing like it in the literature.
> it might serve you well to look at the pharmacology abstracts.
I've been on these boards for a long time. The subject has been fully researched by myself and others. You might want to check the posts by Ame Sans Vie, from 2003.
> jackd was simply happy i found something that has helped (and i appreciate the support) and yes, it has saved my life.
> lewI'm glad for you, but tramadol has never been shown to give a lasting positive result. And everybody who's tried it here, has said the same thing as well. It simply poops out.
Lar
Posted by JackD on December 13, 2004, at 18:50:01
In reply to Re: IMPORTANT INFORMATION FOR ALL » lew, posted by Larry Hoover on December 13, 2004, at 14:41:57
Oh, well thanks for the heads up Lar. I wasn't trying to promote tramadol. I was just getting excited at the connection that tramadol and effexor are so structurally similar and how that relates to my newfounnd success combining drugs with memantine. My doctor is working on writing up a case study actually, I'm really not bullshitting you, but who knows where he stands in the medical community. I'd be so disappointed if my experience became altogether overlooked and disregarded. Oh well, if I can help even one person get an idea that eventually helps them help themselves I'd be content... and by the way, I've been on this board for a long time too, and I don't recall ANYONE trying memantine with effexor and/or remeron.
Posted by j. backer on December 16, 2004, at 13:54:32
In reply to Re: IMPORTANT INFORMATION FOR ALL, posted by JackD on December 13, 2004, at 18:50:01
opoids for deppression, worked great for me when i was on them before. its the drug war thats prohibiting everyone from getting proper treatment. some people can do opoid treatment and some can't, but either way it should be a desician that big brother stays out of. honestly please write your statesman about stopping this war on prescription drugs. its hurting us all.
id rather see 1 person treated properly and 3 junkies who want to use than 0 people treated propely and 1 junky. (the other 2 junkys are alcoholics instead)stopping illict drug use is a novel utopian idea kinda like communism and world peace. its not ever going to happen with drugs being illegal the black market is 2 strong. i grew up in downtown cleveland in the midst of a crack epidemic. (that is now worse even with this "new" stronger plice "crackdown") 49 homicides last year! all "drug related"...."drug related"? like high on crack killed someone you didnt like???
no "drug related" like "black market" related, a black market created by prohibition. the profits are so high and they get higher when police crackdown more. the profits are so high these days that we will always have a black market. and the higher the "crackdown" the more corrupted and violent the market becomes. i dont know how far towards legalization we need, i just dont know. but i do know that there is a middle road between what we have and legalization that we as the people NEED drasticly. a solution that is in agreement to the constatution that promotes liberty and puts a stop to gastapo like police. iv been a victim to gastapo like police, police that serch you because you look like a drug addict . police that take your prescription medicine and dont give it back until your docter calls the station (beacuse your a drug addict and forged the script???). a government that locks you up for being part of a black market they diretly are responsable for. a black market people with drug problems must use if they want to get high and will use because you will NEVER stop someone who belives they "need" to get high.anyway im srry for this rant but i just lost a friend a couple nights ago. he was an 18 year old man who would have been a damn good carpanter but he was murdered. the police called it "drug realated" and added it to the cleveland homicide statistics. He was murdered in a drive by shooting. the murderers were rival gangs competeing for which streets they were going to push drugs on. and now he is a statistic that the federal government will use to show everyone how bad drugs are and why they need to be illegal, even though his deathy is a direct result of the black market created by prohibition.
Posted by lew on December 17, 2004, at 15:13:22
In reply to srry bout my rant..., posted by j. backer on December 16, 2004, at 13:54:32
> opoids for deppression, worked great for me when i was on them before. its the drug war thats prohibiting everyone from getting proper treatment. some people can do opoid treatment and some can't, but either way it should be a desician that big brother stays out of. honestly please write your statesman about stopping this war on prescription drugs. its hurting us all.
> id rather see 1 person treated properly and 3 junkies who want to use than 0 people treated propely and 1 junky. (the other 2 junkys are alcoholics instead)
>
> stopping illict drug use is a novel utopian idea kinda like communism and world peace. its not ever going to happen with drugs being illegal the black market is 2 strong. i grew up in downtown cleveland in the midst of a crack epidemic. (that is now worse even with this "new" stronger plice "crackdown") 49 homicides last year! all "drug related"...."drug related"? like high on crack killed someone you didnt like???
> no "drug related" like "black market" related, a black market created by prohibition. the profits are so high and they get higher when police crackdown more. the profits are so high these days that we will always have a black market. and the higher the "crackdown" the more corrupted and violent the market becomes. i dont know how far towards legalization we need, i just dont know. but i do know that there is a middle road between what we have and legalization that we as the people NEED drasticly. a solution that is in agreement to the constatution that promotes liberty and puts a stop to gastapo like police. iv been a victim to gastapo like police, police that serch you because you look like a drug addict . police that take your prescription medicine and dont give it back until your docter calls the station (beacuse your a drug addict and forged the script???). a government that locks you up for being part of a black market they diretly are responsable for. a black market people with drug problems must use if they want to get high and will use because you will NEVER stop someone who belives they "need" to get high.
>
> anyway im srry for this rant but i just lost a friend a couple nights ago. he was an 18 year old man who would have been a damn good carpanter but he was murdered. the police called it "drug realated" and added it to the cleveland homicide statistics. He was murdered in a drive by shooting. the murderers were rival gangs competeing for which streets they were going to push drugs on. and now he is a statistic that the federal government will use to show everyone how bad drugs are and why they need to be illegal, even though his deathy is a direct result of the black market created by prohibition.
Jbacker-
You really made a lot of valid points. I'm quite impressed. It is so frustrating trying to get the proper meds, in my case the only thing that has worked form me, and get nailed by these "gestapo" like police. I'm sorry for your unfortunate run-in with them. The war against drugs really has done more harm than good. I believe they should be legalized (at least marijuana and opiate) and it would cut down on the crime. But, unfortunately, you get these fanatical people in office that don't have a clue and it makes it impossible for the rest of us who really need these meds. They have definitely saved my life and given me hope and a reason to live. I'm so sorry about your friend. What a waste. It makes no sense to me. Good productive people in our society, trying to make a difference and then something happens like what happened to your friend. It's terrible! I'm going to take your advice and write to a congressman or senate person and TRY to help them to understand what this is doing to innocent people out there. thanks for responding and you great input. I wish you all the best.
Posted by lew on December 17, 2004, at 15:24:59
In reply to Opioid analgesics in the treatment of depression » lew, posted by ed_uk on December 13, 2004, at 9:26:31
> Hi,
>
> Here are some interesting case reports from the American Journal of Psychiatry.......
>
> Treatment Augmentation With Opiates in Severe and Refractory Major Depression
> ANDREW L. STOLL, M.D., and STEPHANIE RUETER, B.A.
> Belmont, Mass.
>
> To the Editor: Substantial evidence supports the antidepressant efficacy of opiates (1). This report summarizes our open-label experience using the µ-opiate agonists oxycodone (Oxycontin/Oxynorm) or oxymorphone in patients with highly refractory and chronic major depression.
>
> Mr. A was a 44-year-old man with severe and chronic depression. Numerous trials of antidepressants produced only limited benefit. Mr. A also had an extensive history of opiate abuse, and he noted that the only times he ever felt normal and not depressed was during opiate use. Because of the refractory nature of his depressive symptoms and his apparent self-medication with opiates, Mr. A was given a trial of oxycodone (Oxycontin) under strict supervision. After 18 months of oxycodone treatment (10 mg/day), Mr. A remained in his longest remission from depression without the emergence of opiate tolerance or abuse.
>
> Ms. B was a 45-year-old woman with bipolar disorder and opiate abuse (in remission for 2 years). A trial with standard mood stabilizers had failed, and she had experienced mania with several standard antidepressant drugs. As with Mr. A, Ms. B reported feeling well only when taking opiates, particularly oxymorphone. Oxymorphone (8 mg/day) was thus cautiously added to ongoing lamotrigine therapy (as a mood stabilizer), and she remained well for a minimum of 20 months without drug tolerance or abuse.
>
> Mr. C was a 43-year-old man with chronic major depression that was unresponsive to numerous antidepressants with and without augmentation. Detailed questioning revealed that he once experienced marked antidepressant effects from opiates that he received after a dental procedure. There was no history of opiate abuse, and a cautious trial of oxycodone was initiated. Mr. C experienced a dramatic and gratifying antidepressant response from oxycodone (10 mg t.i.d. for 9 months) without opiate tolerance or abuse.
>
>
> This report describes three patients with chronic and refractory major depression who were treated with the µ-opiate agonists oxycodone or oxymorphone. All three patients experienced a sustained moderate to marked antidepressant effect from the opiates. The patients described a reduction in psychic pain and distress, much as they would describe the analgesic effects of opiates in treating nocioceptive pain.
>
> Two of the three patients described in this report were previous abusers of opiates. Although the clinical use of opiates in patients with a history of opiate addiction is usually contraindicated, in these cases there was a strong indication that they were self-medicating their mood disorders (2) with illicit opiates. None of the patients abused the opiates, developed tolerance, or started using other illicit substances.
>
> We used oxycodone in three additional patients without histories of opiate abuse. In two of these three patients, oxycodone produced a similar sustained antidepressant effect. Two of these patients experienced mild-to-moderate constipation, and one experienced daytime drowsiness from the opiates. Opiates should be considered a reasonable option in carefully selected patients who are desperately ill with major depression that is refractory to standard therapies.
>
> REFERENCES
>
>
> Bodkin JA, Zornberg GL, Lukas SE, Cole JO: Buprenorphine treatment of refractory depression. J Clin Psychopharmacol 1994; 15:49–57
> Khantzian EJ: Self-regulation and self-medication factors in alcoholism and the addictions: similarities and differences. Recent Dev Alcohol 1990; 8:255–271[Medline]
>
> .................................................................................................................................................................
>
> Use of the opioid buprenorphine in the treatment of depression......
>
> J Clin Psychopharmacol. 1995 Feb;15(1):49-57.
>
> Buprenorphine treatment of refractory depression.
>
> Bodkin JA, Zornberg GL, Lukas SE, Cole JO.
>
> McLean Hospital, Consolidated Department of Psychiatry, Harvard Medical School, Belmont, MA 02178, USA.
>
> Opiates were used to treat major depression until the mid-1950s. The advent of opioids with mixed agonist-antagonist or partial agonist activity, with reduced dependence and abuse liabilities, has made possible the reevaluation of opioids for this indication. This is of potential importance for the population of depressed patients who are unresponsive to or intolerant of conventional antidepressant agents. Ten subjects with treatment-refractory, unipolar, nonpsychotic, major depression were treated with the opioid partial agonist buprenorphine in an open-label study. Three subjects were unable to tolerate more than two doses because of side effects including malaise, nausea, and dysphoria. The remaining seven completed 4 to 6 weeks of treatment and as a group showed clinically striking improvement in both subjective and objective measures of depression. Much of this improvement was observed by the end of 1 week of treatment and persisted throughout the trial. Four subjects achieved complete remission of symptoms by the end of the trial (Hamilton Rating Scale for Depression scores < or = 6), two were moderately improved, and one deteriorated. These findings suggest a possible role for buprenorphine in treating refractory depression.
>
> Regards,
> Ed.
>
>Ed -
Thanks so much for the info. very insightful and helpful.
Posted by lew on December 18, 2004, at 9:52:38
In reply to Re: Opioid analgesics in the treatment of depressi, posted by lew on December 17, 2004, at 15:24:59
I am looking for a TCA to go with my opiate therapy treatment. Someone on this sight posted that TCA's were a good combo to use with opiates. Which one is the best? with the least side effects, weight gain, loss of libido, etc.
Posted by paulbwell on December 19, 2004, at 17:13:41
In reply to Re: Opioid analgesics in the treatment of depressi, posted by lew on December 18, 2004, at 9:52:38
> I am looking for a TCA to go with my opiate therapy treatment. Someone on this sight posted that TCA's were a good combo to use with opiates. Which one is the best? with the least side effects, weight gain, loss of libido, etc.
Hi lew,
I have taken a TCA for 2 months now. I use Codeine for its acute acting anti- depressant anti-anxiety effects, it sometimes works very well, quite frankly better than many ADs or benzo's i,ve taken, something akin to a combo of both, in a synegestic manner.
I dont know where you live, but in Australia, the UK, New Zealand, theres an OTC product that contains a reasonable amount of codeine in it, which is easily separated from its other compound. Since starting this TCA i've found Codeine somewhat less effective than before, (althought according to the PDR this TCA apparently potentiates Opiates, Benzos??) but other Opiates-Opiodes which dont have to be metabalised into 10% morphine (such as Codeine), may be different. I,v tried Codeine (200-300-400mgs) with 20-30mgs Valium or 2-6 mgs Clonazapam and have at times, experienced acute psychic relief, where stress, anxiety, being replaced with a warm, calm, every-things ok type feeling, reminesant of childhood.
So yes all the 1990s theories of lack of Seretonin being the cause of depression, i think it's just as likely *some folks* do have abnormal Endorphin function, as alluded to in the above posts, where these people becoming well, with controlled Opiate-Opiode therapy bringing about excellent response.
Cheers
Good Health
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