![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 43. This is the beginning of the thread.
Posted by clubfitter on August 11, 2007, at 19:42:25
Been diagnosed with Major Depressive Disorder and recently ended up in the hospital where I had to completely stop taking which were mild amounts of Percocet and Vicodin. I know opiates have been prescribed to treat depression but worry about the long term effects they may have with regard to how I feel....in particular withdrawal if i cant get them....i primarily use them for pain, but they always make me feel better too...Thx in advance!
Posted by linkadge on August 11, 2007, at 19:50:56
In reply to Vicodin and Percocet for Depression, posted by clubfitter on August 11, 2007, at 19:42:25
It depends. The real concerns are that you need to know yourself and how the meds affect you.
There is little problem with taking a steady dose of an opiate for depression if you believe it will continue to help alleviate symptoms long term.
Tollerance is always a possability, but it is not the rule.
If you have acess to a steady supply then you can always give it a try.
If you don't have acess to a steady supply or cannot gain approval with a doctor who would support you, or if you feel that you will built tollerance, then it may not be a good idea.
There are doctors who will consider doing a theraputic trial of an opiate for depression but I don't know who they are (it is unlikely they advertise such approaches)
Linkadge
Posted by clubfitter on August 11, 2007, at 20:09:19
In reply to Re: Vicodin and Percocet for Depression, posted by linkadge on August 11, 2007, at 19:50:56
I have the ability to attain them "aftermarket' and have a pretty steady supply for now and dont take a bunch..maybe one a day, two at the most...but i do run out im worried about sinking into the hole i was in which hospitalized me a few weeks back....
Posted by Quintal on August 11, 2007, at 20:59:57
In reply to Vicodin and Percocet for Depression, posted by clubfitter on August 11, 2007, at 19:42:25
I've used opiates to control depression and anxiety since quitting benzos over a year ago. I use the small amounts of codeine salts available in OTC codeine products here, which amount to ~50mg in total using high-strength brands. Tolerance to the 'mood elevating' properties of opiates can happen very quickly. This has happened to me, but I can regain some of the effects by withdrawing for a week or two to regain my tolerance.
As you know, some people here have been prescribed opiates for depression, but I've found people taking opiates for psychiatric purposes curiously resistant to the idea of tolerance and addiction, even when tolerance is obviously happening. It's just the result of the brain adapting in response to chronic expose to the drug, there's no moral judgment on the part of the opiate (one would hope). So I think you'll get plenty of frank, honest, advice about that, and what to do about it, on this forum: http://forum.opiophile.org/index.php?. That link leads to a message board which contains images that some might find disturbing. I know for some that will only pique curiosity even more...
I've found withdrawal symptoms to be quite mild from low doses of codeine/dihydrocodeine, and that dopamine agonists can suppress them: http://www.dr-bob.org/babble/20070730/msgs/773860.html
Q
Posted by clubfitter on August 11, 2007, at 23:29:14
In reply to Re: Vicodin and Percocet for Depression » clubfitter, posted by Quintal on August 11, 2007, at 20:59:57
i really dont abuse them..im sure youve heard that before...but rather i take a perc or a vic before i go running to mask some pain and give me energy...thats it...never take them at any other time....quit cold turkey about a month ago after being admitted but was feeling ultra depressed before i quit...is depression a withdrawal symptom when taking such small doses...?? most of the cases i read are people taking insane amounts...i do not....i already have MDD and dont want to worsen it should the pills run out you know?? thx Q
Posted by Phillipa on August 11, 2007, at 23:33:33
In reply to Re: Vicodin and Percocet for Depression)Quintal, posted by clubfitter on August 11, 2007, at 23:29:14
Some depressions respond to opiates wish I had access to a supply. One a day should be okay better than depression. Love Phillipa
Posted by Quintal on August 11, 2007, at 23:49:14
In reply to Re: Vicodin and Percocet for Depression)Quintal, posted by clubfitter on August 11, 2007, at 23:29:14
I wasn't implying that you were abusing them clubfitter, I just find the out-and-out addicts are more forthright about these things, and they have more experience. Depression is definitely a withdrawal symptom of opiates, even small doses. They're powerful antidepressants so it stands to reason. I think you find a similar thing with prescription antidepressants - the depression returns if you quit suddenly, but opiates being more immediate and more effective antidepressants the withdrawal is that much more immediate and powerful.
I don't know what the best thing would be, probably to try and cope without them, or use them p.r.n if possible.
Q
Posted by Phillipa on August 12, 2007, at 0:05:39
In reply to Re: Vicodin and Percocet for Depression)Quintal » clubfitter, posted by Quintal on August 11, 2007, at 23:49:14
Well no benzos, no opiates, no SSRI's so the drug companies are out of business. Love Phillipa
Posted by linkadge on August 12, 2007, at 8:56:42
In reply to Re: Vicodin and Percocet for Depression » clubfitter, posted by Quintal on August 11, 2007, at 20:59:57
There are other effects that opiates have on the brain other than the direct effects of opiate receptor agonism. For instance, opiates appear to increase the activity of tryptophan hydroxylase for the duration of exposure. Its not that tollerance won't built to certain effects of the drug such as euphoria, but researchers don't as of yet fully inderstand the complexities of neurotransmitter systems affected to a degree necessary to conclude that those who claim a long term antidepressant effect are misguided.
Case studies have observed certain treatment resistant patients gaining relief of depression for more than a year with a steady dose (monotherapy).
Its about knowing how you respond.
**One size fits all in psychiatry went out a long time ago**
Linkadge
Posted by linkadge on August 12, 2007, at 9:09:41
In reply to Re: Vicodin and Percocet for Depression)Quintal » clubfitter, posted by Quintal on August 11, 2007, at 23:49:14
We are learning things about the way that drugs act that we didn't know 20 years ago. Who knew that marajuanna would contain substance that promote neurogenesis, or that act as potent antipsychotic compounds?
The antidepressant effect of many conventional depression drugs can be significantly reduced by blocking the effect these drugs have on the opiate system. The effect of the TCA's, some of the SSRI's, and even tianeptine, are dependant, at least in part on the opiate system.
While it is true that you are going to an overabundantly "down to earth" type of description of opiates from ex-users, you will similarly notice that the SSRI withdrawl can similarly sour the minds of ex. "believers".
SSRI's pooped out on me and had excrutiating withdrawl, so what gives?
Individual milage will always vary.
You may want to look into anti-tollerance compounds and strategies.
Linkadge
Posted by linkadge on August 12, 2007, at 11:37:34
In reply to Re: Vicodin and Percocet for Depression)Quintal, posted by linkadge on August 12, 2007, at 9:09:41
Posted by med_empowered on August 12, 2007, at 16:25:13
In reply to Re: Vicodin and Percocet for Depression, posted by linkadge on August 12, 2007, at 8:56:42
if you can get a supply. I imagine a doc would go for ultram (tramadol) before, say, Vicodin, but who knows. Buprenorphine (I think that may be misspelled) is apparently being used now and then for this kind of stuff. Its FDA approved for in-office treatment of opiate addiction. Basically, a doc can take a person with opiate misuse probs and either a)keep them on a stead dose of bupe indefinitely or b)give them bupe and then taper it, hoping there isn't a relapse of some sort. The drug mixes agonist and antagonist properties, so its supposedly pretty low on euphoria while still offering pain and depression relief. Docs need special licensure to RX it for addiction, but any doc can rx it for an off-label indication such as depression.
My guess is that shrinks would do that more often than normal docs, and shrinks who are licensed to do it as part of drug treatment would be more likely to rx it for depression than other docs, but that's just a guess.
Its a weird situation, though: if you end up getting addicted to opiates, you might be able to take Bupe forever. If you ask for a scrip for depression w/o any addiction, you may not get the prescription and might be considered a "drug seeker".Weird.
Posted by Quintal on August 12, 2007, at 17:05:15
In reply to Re: Vicodin and Percocet for Depression, posted by linkadge on August 12, 2007, at 8:56:42
Tolerance is simply the adaptation of neurotransmitter systems to chronic exposure of a drug. Quoting esoteric mechanisms will not alter the fact that tolerance to opiates is very common, the rule in fact, and can happen very quickly. Tolerance occurs with buprenorphine too.
Q
Posted by Phillipa on August 12, 2007, at 21:04:53
In reply to Re: Vicodin and Percocet for Depression, posted by Quintal on August 12, 2007, at 17:05:15
We have a bupe hospital here. It's also used for depression here. Love Phillipa that's where I live at least . And when first moved here one of the pdocs in the practice was the bupe doc. Don't need to be hospitalized to receive either it or methadone as the girl near me is on it.
Posted by Quintal on August 12, 2007, at 21:15:48
In reply to Re: Vicodin and Percocet for Depression, posted by Phillipa on August 12, 2007, at 21:04:53
Posted by linkadge on August 12, 2007, at 21:45:00
In reply to Re: Vicodin and Percocet for Depression, posted by Quintal on August 12, 2007, at 17:05:15
>Tolerance is simply the adaptation of >neurotransmitter systems to chronic exposure of >a drug.
Well, sometimes the adaptive changes that take place with certain drugs is actually related to the theraputic effect. The brain adapts to chronic SSRI treatment by reducing the number of postsynaptic serotonin receptors. Despite this adaptive responce however, many individuals continue to attain a theraputic effect.
Sometimes euphoria is a side effect of conventional antidepressant treatment too. Nardil can induce temporary euphoria, as can Parnate. Euphoria with these drugs is a side effect and unrelated to the long term theraputic effect.
There have indeed been studies of opiate treatment for depression. Many times such studies end without reaching the same conclusions that are followed in common practice.
Some recent research has suggested that morphine is as effective as imipramine for endogenious melancholic depression, and that a theraputic effect can be maintained untill treatment ends.
Some researchers have noticed that opiates produce the same, long term alterations in EEG measures (ie EEG slowing) that occur during sucessfull TCA treatment which persists until treatment ceases.
As mentioned in previous posts, opiates effect neurotransmitter systems in ways that are not completely understood as of yet. Opiates appear to increase the activity of tryptophan hydroxylase, as well as altering levels of monoamine oxidase B. Their effects on tryptophan hydroxylase appear to be long term in nature. Opiates also appear to affect the glutate transporter, which may be a theraputic mechanism of certain SSRI's and hypericum.
Opiates can reduce stress induced anhedonia in animal models, as well as reducing stress induced hyperactivity of HPA axis function. They increase serotonin levels in the neucleus accumbens as do other antidepressant treatments.
As mentioned by another poster, opiate withdrawl can be prevented by d2 receptor modulation. Sucessfull treatment with either SSRI's or TCA's is generally though to be dependant on upregulation of limbic d2 receptor affinity. Sucessfull treatment with SSRI's or TCA's can be blocked by preventing this upregulation.
The behavioral effects of the opiates can also be blocked by d2 receptor modulation indicating that a similar theraputic end target exits for both treatments.
Clearly, it is not rational to squelch the possablity of a theraputic effect of the opiates seing as we cannot, as of yet, completely quantify their mechanism of action.
Looking purely from a standpoint of abuse, opiate use is probably a dead end. There are, however, many drugs of abuse for which tollerance to a theraputic effect is not always the rule.
Drugs such as amphetamines, or ritalin can be easily abused and tollerance often develops to the euphoric effects. Used in children with ADHD however, the drugs can be used for extended periods of time long after the euphoriant effects have subsided.
Tolerance to euphoric effects of many drugs would appear to be the rule, but as many authors have suggested, there may infact be mechanisms of activity of the opiates (such as with the stimulants in ADHD), that are affecting some critical aspect of the affective process.
Linkadge
Posted by Quintal on August 12, 2007, at 22:25:40
In reply to Re: Vicodin and Percocet for Depression, posted by linkadge on August 12, 2007, at 21:45:00
>Clearly, it is not rational to squelch the possablity of a theraputic effect of the opiates seing as we cannot, as of yet, completely quantify their mechanism of action.
I am not squelching the therapeutic effects of opiates, in fact I depend on them to keep me well and functioning. So that would be a non-sequitur. I am saying that tolerance to the 'mood elevating' (therefore therapeutic in this case) effect of opiates is very common, and often happens very quickly, regardless of the underlying mechanism(s), whatever they may be.
I have tried Ashwagandha and lamotrigine as tolerance-reducing agents with little success. Ashwagandha seemed to dull the 'therapeutic response' and did little to prevent tolerance. Lamotrigine gave me a nasty rash the last time I tried it and and made me too ill to continue, so I don't know how effective that may be long-term in my own case, but I would recommend anyone considering using opiates long-term to talk it over with their doctor.
Q
Posted by Sigismund on August 13, 2007, at 4:12:02
In reply to Re: Vicodin and Percocet for Depression, posted by linkadge on August 12, 2007, at 21:45:00
>Some recent research has suggested that morphine is as effective as imipramine for endogenious melancholic depression
Much better, no question, at least for a bit.
>and that a therapeutic effect can be maintained until treatment ends.Maybe.
Posted by Quintal on August 13, 2007, at 4:23:46
In reply to Re: Vicodin and Percocet for Depression, posted by linkadge on August 12, 2007, at 21:45:00
>Who knew that marajuanna would contain substance that promote neurogenesis, or that act as potent antipsychotic compounds?
Linkadge, were you smoking marijuana before, or even while, you composed your last post? I know you've said you use it regularly for its antidepressant and tranquillizing properties before, so I'm curious, because I think I recognize some of the characteristic effects on thought processes.
Q
Posted by linkadge on August 13, 2007, at 8:36:08
In reply to Re: Vicodin and Percocet for Depression » linkadge, posted by Quintal on August 12, 2007, at 22:25:40
>therefore therapeutic in this case) effect of >opiates is very common, and often happens very >quickly, regardless of the underlying mechanism>(s), whatever they may be.
I can accept "very common".
Linkadge
Posted by linkadge on August 13, 2007, at 8:38:02
In reply to Re: Vicodin and Percocet for Depression, posted by Sigismund on August 13, 2007, at 4:12:02
>>and that a therapeutic effect can be maintained >>until treatment ends.
>Maybe
These were simply the conclusions of this particular study I am trying to locate at the moment.The babble archives is probably loaded on this topic.
Linkadge
Posted by linkadge on August 13, 2007, at 8:54:31
In reply to Re: Vicodin and Percocet for Depression » linkadge, posted by Quintal on August 13, 2007, at 4:23:46
>Linkadge, were you smoking marijuana before, or >even while, you composed your last post? I know >you've said you use it regularly for its >antidepressant and tranquillizing properties >before, so I'm curious, because I think I >recognize some of the characteristic effects on >thought processes.
To be completely honest, I am clean as a whistle and have been for a while. I don't use it regularly, only occasionally.
I am (genuinly) interested though in what aspect of my though process seems to indicate marajuanna usage?
Is it my over liberal view of regarding the safety of marajuanna and or opiates? Sometimes I just like to play the devils advocate. Give me a month and I may be arguing the other side of the coin.
But seriously though, I'd really be interested if you expand on this assertion though (even by babblemail).
(I was placed on seroquel for hints of a psychotic thought process although even my doctor admits he can't clearly put his finger on anything, or that antipsychotics really did anything to reduce it. I think we agreed it was a personality trait, although not conclusivly.)
Take Care.
Linkadge
Posted by Quintal on August 13, 2007, at 9:49:46
In reply to Re: Vicodin and Percocet for Depression, posted by linkadge on August 13, 2007, at 8:54:31
>Is it my over liberal view of regarding the safety of marajuanna and or opiates?
Definitely not. I'm very liberal in my views on these substances, and benzos too, though you may not believe me on that. See below for an explanation. I like to think though, that I have a realistic appraisal of their limitations.
>Sometimes I just like to play the devils advocate. Give me a month and I may be arguing the other side of the coin.
I see that, and I do it too. I think it encourages interesting and vigorous debate, so I have no problem with it so long as we all keep it civil and try not to take it personally. I find an attitude of openness is most helpful when doing this.
>I am (genuinly) interested though in what aspect of my though process seems to indicate marajuanna usage?
Well okay, link. Since you asked, and know that this is not an attack on you, I'll tell you why I thought you might be smoking marijuana. It's because on a number of threads I've noticed you tend to bring up a great deal of what I consider to be irrelevant material, as if your thoughts go off on a tangent. Also, I think you made some comments, and I'm thinking about the one where you said I had said I could read minds here, that seem to me borderline psychotic at times. They seem to come completely out of the blue, and I've been quite shocked, and concerned by what I've read. If you go through this and the benzo thread I think you'll see what I mean. This is what happens to my own thought patterns, and nearly everyone else I know while under the influence of marijuana. So that's why I thought you might be smoking it. That combined with the fact that you had disclosed you marijuana use to the board on several previous occasions.
Maybe you do have ADHD after all link? Maybe it's ADHD combined with some quasi-psychotic personality traits - have you investigated the BPD diagnosis? I think quasi-psychotic episodes are common with that. Many people have these traits, most definitely myself, and I find they can be managed if you gain enough self-awareness and insight into your thought processes. This is probably a good first step in doing that. I apologize if this has made you feel uncomfortable, accused or embarrassed in any way. My intentions were pure.
Q
Posted by Quintal on August 13, 2007, at 12:45:32
In reply to Re: Vicodin and Percocet for Depression » linkadge, posted by Quintal on August 13, 2007, at 9:49:46
Here is a link to the benzo thread in question: http://www.dr-bob.org/babble/20070730/msgs/774284.html
Q
Posted by Phillipa on August 13, 2007, at 20:04:34
In reply to Re: Vicodin and Percocet for Depression, posted by Quintal on August 13, 2007, at 12:45:32
I personally feel that what Link does in private is his business. And how did benzos return? Love Phillipa
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.