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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 43. Go back in thread:
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
Posted by mike lynch on August 13, 2007, at 20:53:02
In reply to Re: Vicodin and Percocet for Depression » linkadge, posted by Quintal on August 13, 2007, at 4:23:46
>so I'm curious, because I think I recognize some of the characteristic effects on thought processes.
>
> QLike what...about his post would suggest he was under the influence of marijuana? If that's what you're suggesting, Im very curious about this..
Posted by linkadge on August 13, 2007, at 21:38:57
In reply to Re: Vicodin and Percocet for Depression » linkadge, posted by Quintal on August 13, 2007, at 9:49:46
>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.
No offence taken. Only part of what I said was meant to be a direct response to previous threads. Some of what I was saying regarding opiates was just (again) some general information, perhaps for expanded discussion (?). I wouldn't say the information is necessarily irrelavant.
>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.
I suppose I should have clarified on that when you asked. You had made a few general totality type of statements. At one point you had said something allong the lines of "benzodiazapines cause significant cognitive impairment" instead of what I would see as a more accurate statement of "benzodiazapines can cause cognitive impairment". I was trying to say, that unless you can read the minds of every individual who takes benzodiazapines, it is impossable for you to know whether they are experiencing significant cognitive impairment. I was not trying to imply that you *acutually read minds*.
>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.
I'll try and make a responce there too to clarify.
>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.*For the record* I am currently not under the impression that I can read anybody's mind or that anybody is reading my mind, (or that anybody can read anybodies mind for that matter). I was simply using the expression.
>That combined with the fact that you had >disclosed you marijuana use to the board on >several previous occasions.
I have disclosed that I have smoked on previous occasions, although to my knowledge I have not had any delusions as a result. I am hoping I have not given the impression that I am a heavy user as nothing is farther from the truth.
>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.
Well, as much as ADHD may or may not be the case, I don't feel it is fair to diagnose online (as much as I appreciate the support). I am guilty of perhaps not being more clear in my wording, which I will try to rectify in the corresponding thread.
I don't much fit the borderline personality diagnosis (as far as I can tell), although a doctor would probably be best to consult about that. I don't think it has been seriously considered. My relationships (offline, the ones that exist) are fairly stable.
>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.
No problem at all.
Linkadge
Posted by Phillipa on August 13, 2007, at 21:51:46
In reply to Re: Vicodin and Percocet for Depression, posted by linkadge on August 13, 2007, at 21:38:57
I don't thing anyone can read minds as my own important relationships as well are offline and I'm not cognitivly impaired by benzos they relieve anxiety so I can function in our business. My therapist thinks I need a rheumatologist as my autoimmune sytem is out of wack along with the thyroid.
Posted by mike lynch on August 14, 2007, at 0:24:29
In reply to Re: Vicodin and Percocet for Depression, posted by linkadge on August 13, 2007, at 21:38:57
>Maybe you do have ADHD after all link? Maybe >it's >ADHD combined with some quasi-psychotic >personality traits - have you investigated the >BPD >common with that.
I think you're being really ridiculous and condescending.. *Psychotic??*, from an online post that seemed fairly reasonable to me? What is your grudge about?? You're the one who seems to making blind assumptions out of the blue, you're trying to diagnoze people over online!
Posted by Quintal on August 14, 2007, at 3:07:55
In reply to Re: Vicodin and Percocet for Depression, posted by mike lynch on August 14, 2007, at 0:24:29
Linkadge has asserted many times in the past that he has ADHD, and I'm pretty sure he has been prescribed Ritalin at one point, for whatever reason. Recently link reconsidered the diagnosis. That was what my comment regarding ADHD was based on. Linkadge's post above seemed very disorganized to me, showing what I thought could be signs of the typical divergent thought processes that occur under the influence of marijuana. I apologize for the confusion.
>*Psychotic??*, from an online post that seemed fairly reasonable to me?
I was referring to this post:
http://www.dr-bob.org/babble/20070808/msgs/775025.html
This is just one example, there are many more.
And also this comment by linkadge himself in one of the posts above, maybe you missed it?:
"I was placed on seroquel for hints of a psychotic thought process..."
>You're the one who seems to making blind assumptions out of the blue,
I am doing no such thing.
>you're trying to diagnoze people over online!
No I am not.
Q
Posted by Quintal on August 14, 2007, at 4:06:38
In reply to Re: Vicodin and Percocet for Depression, posted by linkadge on August 13, 2007, at 21:38:57
>No offence taken
I'm pleased to hear that. It's good that we can discuss these things openly without taking them personally.
>Some of what I was saying regarding opiates was just (again) some general information, perhaps for expanded discussion (?).
I wondered if it might be a form of distraction. I was confused by most of it to be honest, because it seemed to have little bearing on the central theme we were discussing, which I thought was tolerance. You see, no matter what mechanisms are behind the therapeutic response, the fact that most people do develop tolerance to opiates (and often very quickly) means that tolerance also develops to those esoteric mechanisms, if indeed they are behind the therapeutic response. So I wondered what your motive was for bringing them up.
I've seen less confident posters withdraw from debate with you on several occasions when presented with esoteric mechanisms like this, and I wondered if you might have learned that this could be a way of getting your opponent to back down, so that you could 'win' the debate, even if it became clear that your original assertions were on shaky ground.
>You had made a few general totality type of statements.
I think I may have omitted qualifiers like 'can' on occasion due to haste, rather than making absolute statements, because as I showed, and as we both agree, cognitive impairment and amnesia at therapeutic doses of benzodiazepines is very common. I think I did use the qualifier 'can' on several occasions but I thought you seemed to focus on the few times I omitted it.
>I was trying to say, that unless you can read the minds of every individual who takes benzodiazapines, it is impossable for you to know whether they are experiencing significant cognitive impairment.
I'm relieved to hear you don't think I really do have supernatural powers. I think I went to considerable length to explain my position, that a minority seem to be unaffected, yet you seemed to persist in finding sentences where, by accident, I had omitted the qualifier 'can', even where I had used sentences containing the qualifier 'can' in the same post. I found that quite challenging.
>Well, as much as ADHD may or may not be the case, I don't feel it is fair to diagnose online (as much as I appreciate the support)
I really wasn't trying to diagnose you link, but I remember you saying that you thought you had ADHD, and that you had been prescribed Ritalin at one point, but I can't remember why. Recently you seem to have changed you mind on the ADHD issue, and, because I noticed that your posts seemed quite disorganized, I thought that this might be a valid diagnosis after all.
>I don't much fit the borderline personality diagnosis (as far as I can tell)
I remember you querying it as an alternative to the bipolar diagnosis that you have often said you disagree with. Again this was just a suggestion, and of course I don't know you in real life so am in no position to diagnose.
>although a doctor would probably be best to consult about that.
Absolutely.
>No problem at all.
I'm pleased to see we can have an open discussion of conflict like this. It's very refreshing. I'm sorry for any misunderstanding and I hope we've gone some way to clearing things up.
Q
Posted by Quintal on August 14, 2007, at 4:24:26
In reply to Re: Vicodin and Percocet for Depression, posted by Phillipa on August 13, 2007, at 21:51:46
Posted by linkadge on August 14, 2007, at 9:31:48
In reply to Re: Vicodin and Percocet for Depression » linkadge, posted by Quintal on August 14, 2007, at 4:06:38
>I wondered if it might be a form of distraction. >I was confused by most of it to be honest, >because it seemed to have little bearing on the >central theme we were discussing, which I >thought was tolerance.
I thought the general theme was on "opaites and depression". Everything I said was within that topic.
>You see, no matter what mechanisms are behind >the therapeutic response, the fact that most >people do develop tolerance to opiates (and >often very quickly) means that tolerance also >develops to those esoteric mechanisms,
Not necessarily. You can easily develop tollerance to one effect of a drug yet not develop tollerance to another effect. "Nardil Euphoria" is a prime example. I am simply arguing that some people apparently do find that they can treat depression long term with opiates. Whenever refering to opiates for depression, people always begin to think of the junkie, or others trying to get high. There is a long history of using opiates to treat depression despite such tollerances. If everybody became a junkie in a week, I think this remedy would not have lasted quite so long.
Most doctors would agree that the painkilling properites of the opiates, and the euphoriant effects are two totally separate mechanisms.
Euphoria is not a prerequisite for analgesia.Along the same lines, there are researchers who believe that opiates effect on mood might be separable from the effect on depression. Like I mentioned the effects of opiates on neurotransmitter systems are diverse.
Consider the effects of ketamine. The current theories are that the euphoriant effects are indeed "side effects", and not responsable for the theraputic effect in clinical depression.
Will you develop tollerance to the euphoriant effects of ketamine? Probably. Does this mean we scrach Ketamine off our litst of potentially usefull drugs for depression? No.
Perhaps the reason you thought my comments were incoherant or off topic was because I failed to draw together my points.
My whole arugment is that you nor I am fully aware of the complexities of the neurobiological effects of opiates. "Stay away from them", may be a good rule of thumb it does not account for individual variences in long term responce.
>I've seen less confident posters withdraw from >debate with you on several occasions when >presented with esoteric mechanisms like this, >and I wondered if you might have learned that >this could be a way of getting your opponent to >back down, so that you could 'win' the debate, >even if it became clear that your original >assertions were on shaky ground.
I am not trying to introduce these mechanisms to "proove a point" or to "win". Like I said before, I am trying to open up discussion. This isn't about winning or loosing.
Do you think that I believe I have prooven anything here? Obviously I havn't proven anything at all. I'm not even trying to prove anything. My main reason for mentioning such "mechanisms" was to suggest that there may be mechanisms destinct from the euphoriant effects of the drugs which are responsable for some individuals ability to use the drugs to treat mood disoders semi-long term.
>I think I may have omitted qualifiers like 'can' >on occasion due to haste, rather than making >absolute statements, because as I showed, and as >we both agree, cognitive impairment and amnesia >at therapeutic doses of benzodiazepines is very >common.
Lets keep threads separate.
>yet you seemed to persist in finding sentences >where, by accident, I had omitted the >qualifier 'can', even where I had used sentences >containing the qualifier 'can' in the same post. >I found that quite challenging.
Sometimes it is necessary to be over clear (IMHO) online as text often does not convey the mood of the idea.
>I really wasn't trying to diagnose you link, but >I remember you saying that you thought you had >ADHD, and that you had been prescribed Ritalin >at one point, but I can't remember why. Recently >you seem to have changed you mind on the ADHD >issue, and, because I noticed that your posts >seemed quite disorganized, I thought that this >might be a valid diagnosis after all.
>I think I may have omitted qualifiers like 'can' >on occasion due to haste
I rest my case.
>I remember you querying it as an alternative to >the bipolar diagnosis that you have often said >you disagree with. Again this was just a >suggestion, and of course I don't know you in >real life so am in no position to diagnose.
No worries.
Linkadge
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