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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 41 to 65 of 73. Go back in thread:
Posted by bulldog2 on February 10, 2010, at 17:23:24
In reply to Re: Opioids for Depression, posted by kirbyw on February 9, 2010, at 23:12:53
> I think we are all missing something in this discussion.
>
> 1) I would agree that in the worst cases of endogenous depression where the person is acutely suicidal that opioids would probably be of use, but only until an anti-depressive could kick in.
>
> 2) The problem with the opioids is that you feel good "for no reason" This was very dangerous in my case, as instead of instigating behaviors that would improve my life, I was content to just sit around and "feel good," and this on a very small dose of Vicodin only about 1 or 2 pills per day.
> It took away that horrible depressed feeling and made me feel relaxed and confident. But the next morning I had to do it again, and the next afternoon etc. This was happening from last July until January 6th, the day that I took my last Vicodin.
>
> So there is some biochemical property of these artificial opioids that has a temporary effect, but doesn't stimulate any kind of permanent change in neurotransmitters. And it also gives you a false sense of well being. In extremes people on these drugs, feel great as we know, while they lose weight, lose their jobs, steal money from their families, etc.
>
> 3) Even worse, your mind/body creates symptoms which cause you to have cravings for the drug.
> These can be psychosomatic, in my case a sensation of shortness of breath, or my supposedly incapaciting prostate pain. Well, now that I am 33 days without Vicodin, the shortness of breath has almost completely disappeared. And the severe prostate pain when sitting is managed by 1 extra strength Tylenol.
> In fact, sometimes if I forget to take the Tylenol the pain seems minimal anyway. I have not to take more than 3 tylenols in any one day.
>
> Before, I always would be conscious of the pain, and would immediately take half a vicodin if i thought I would be sitting on a hard chair, or on a plane, or in a theater etc. for more than a few minutes. I took these pills for seven years. During that time certain aspects of my life went ok, but I was constantly feeling good on a low dose of Vicodin.
>
> When the time came for me to take steps to respond to some crises in my life, my response was to relax and take the Vicodin and more or less ignore the impending disaster. And those disasters led to my first severe depression in over 20 years. So then I was taking the Vicodin
> just get out of bed in the morning, to get something done etc. I was on Parnate, but I was feeling "too good". I was self medicating my depression with an opiate, and creating a sense of well being based on nothing.
>
> Only since I stopped the Vicodin have I returned to a point where I am trying to really solve my real life problems. I found a therapist, I am going to Narcotics Anonymous groups, and to another mental health support group, etc. I am much more active generally and this contributes to a sense of well being that I hope is far more significant for my life, than the "well being" I felt on the drug.
>
> As the crisis became worse, the use of Vicodin was, I feel, creating or at the very least enhancing the symptoms of depression, so as to
> "trick" me into taking some more Vicodin. Its hard to explain, but thats how I see.
>
> Now I am taking only Parnate, and I am do so many more things focused on improving my life than I was previously. I still feel bad on some days, I adjust the dosage of Parnate and can improve my mood rather quickly, although the higher the dose the more insomnia that I have. But that's a different issue.
>
> The term "self-medicating for depression" with drugs or alcohol is used all the time. It is actually a meaningless catch all phrase, until it is defined in terms of what is going on very specifically with a given individual.
>
> By the way, I had Vicodin cravings every day for the first week I stopped taking it. The depression was worse, even with Parnate, I had shortness of breath, pain in my chest, pain when sitting. Gradually this has diminished and now I just realize that these are symptoms of Vicodin withdrawl. In any case, if I really think they are "real" I can always go to the Doctor.
>
> Vicodin has a strong mind/body effect. Perhaps there should be an investigation into how to create a codeine based anti-depressant that will not have this effect. But I think that this may be almost impossible.
>
> One final example: When I was hospitalized for a severe endogenous depression in 1982, before I had ever taken parnate, the psychoanalytically oriented Psychiatrist at the hospital decided to give me a "sodium pentathol interview" in order to dig into my childhood or whatever. For one hour, I was only semi-concious. I didn't recover any signficant childhood memories but I remember that I felt, normal for the first time in two years, that is to say the endogenous physical pain of the depression disappeared on the sodium pentathol interview. The Doctor thought that this was some kind of catharsis because I kept saying "I can feel. I feel normal" etc. etc. Well, about an hour after the interview was over, and the drug wore off, I felt exactly the same pain that I had been feeling before this experience. The physiological effects of the Pentathol wore off and that was the end of feeling good. Now if good old Dr. Freud had given me a small dose of Pentathol every hour or so, I probably could have continued to feel better, but I would have to have been hooked up to a sodium pentathol machine for the rest of my life. It was a different drug, parnate, (in a different hospital with a different Doctor) that got me out of the depression.
>
> I regret that I used Vicodin for almost seven years, even though I functioned adequately most of that time. The end result was as I have said a severe crisis and a relapse into endogenous depression.
>
> The Vicodin was orignally prescribed for the prostate pain when sitting. And I got letters from a pain clinic enabling me to continue to get Vicodin prescriptions from other Doctors. For all I know I could have gotten by on Tylenol the whole time.
>
> Rick in Costa rica.There may be a subset of depressives who have a shortage of endogenous opiates. They may not respond to standard ads and their opiate systems may never kick in and produce enough internal endorphins. That is why they need their opiate meds every day.
Posted by bulldog2 on February 10, 2010, at 17:27:36
In reply to Opioids for Depression: link for Sigi + all, posted by floatingbridge on February 10, 2010, at 16:09:18
They key is to give enough of the synthetic opiate to stimulate activity rather than a euphoric high where you bask in a good feeling. I was on percocet for four months for pain and when I took my perocet it also worked on my depression. I found myself doing more things and becoming more active. So how much you stimulate the receptor is key.
Posted by Cherry Carver on February 10, 2010, at 17:35:47
In reply to Opioids for Depression: link for Sigi + all, posted by floatingbridge on February 10, 2010, at 16:09:18
Great link!!!
This study reminds me of another study I read about in school (over 30 years ago now) in which the subjects' brains were exposed and probes were inserted that vividly brought back memories of happier times and beautiful music, among other things. The author said that this could be useful therapy for Altzheimer's patients or a way simply to alleviate depression in aging people. It always sounded like a great trip to me. Never heard about any follow-up to it, though--the risk of infection might have been too great, and the expense was probably tremendous.
> Do dopaminergic gene polymorphisms affect mesolimbic reward activation of music listening response? Therapeutic impact on Reward Deficiency Syndrome (RDS)
>
>
> http://www.medical-hypotheses.com/article/S0306-9877%2809%2900682-3/abstract
Posted by emmanuel98 on February 10, 2010, at 18:53:00
In reply to Re: Opioids for Depression, posted by bulldog2 on February 10, 2010, at 17:23:24
When I was in the hospital this summer, I suggested to the doctor that I try to maintain on suboxone (an opiate agonist-antagonist that can't be used to overdose). She was looking into it. As it turned out, parnate worked fine for me, so we didn't go down that road. It would have meant, probably, lifelong addiction.
Posted by floatingbridge on February 10, 2010, at 22:23:57
In reply to Re: Opioids for Depression: link for Sigi + all, posted by bulldog2 on February 10, 2010, at 17:27:36
Bulldog, that sounds like my experience; it at least sounds like what my pdoc was talking about (in unscientific terms, since I do not understand brain chemistry).
> They key is to give enough of the synthetic opiate to stimulate activity rather than a euphoric high where you bask in a good feeling. I was on percocet for four months for pain and when I took my perocet it also worked on my depression. I found myself doing more things and becoming more active. So how much you stimulate the receptor is key.
Posted by europerep on February 11, 2010, at 13:55:25
In reply to Re: Opioids for Depression, posted by emmanuel98 on February 10, 2010, at 18:53:00
> When I was in the hospital this summer, I suggested to the doctor that I try to maintain on suboxone (an opiate agonist-antagonist that can't be used to overdose). She was looking into it. As it turned out, parnate worked fine for me, so we didn't go down that road. It would have meant, probably, lifelong addiction.
hi emm98,
could you tell me which drugs or combinations you have taken before parnate, or before going to hospital? I kind of have to make the same decision, but the probability for MAOIs to work after many failed medications is quite low, so I do not really count on that option.. that's why I would like to know what you have tried before.. thanks!
Posted by emmanuel98 on February 11, 2010, at 19:55:01
In reply to Re: Opioids for Depression » emmanuel98, posted by europerep on February 11, 2010, at 13:55:25
I tried lexapro, cymbalta, lithium, lamictal, wellbutrin, seroquel and geodon and emsam without any effect. I used abilify and risperdal successfully but both caused massive weight gain. I tried ECT and that didn't help me at all. I was ready to throw in the towel.
Posted by floatingbridge on February 11, 2010, at 21:27:51
In reply to Re: Opioids for Depression, posted by emmanuel98 on February 11, 2010, at 19:55:01
Emsam failed? How long and at what dosages, may I ask?
So you are pleased with parnate? I'm glad to hear.
fb
europerep--good luck in your decision-making process!
> I tried lexapro, cymbalta, lithium, lamictal, wellbutrin, seroquel and geodon and emsam without any effect. I used abilify and risperdal successfully but both caused massive weight gain. I tried ECT and that didn't help me at all. I was ready to throw in the towel.
Posted by Sigismund on February 12, 2010, at 2:26:06
In reply to Re: Opioids for Depression » emmanuel98, posted by floatingbridge on February 11, 2010, at 21:27:51
>I was ready to throw in the towel.
I'm not surprised people do.
There's a lot of med trials with no real guide, or at any rate no certainty.
Posted by europerep on February 12, 2010, at 12:45:10
In reply to Re: Opioids for Depression » emmanuel98, posted by floatingbridge on February 11, 2010, at 21:27:51
> europerep--good luck in your decision-making process!
>thanks.. in fact your post a lil' earlier left me a little bit worried.. where you said that you responded well to opioid therapy, but your doc (and you yourself) said it was not the right thing for you.. I thought that, if I am going to try it, I'd "only" have to see whether it helps me without making me high/intoxicated/etc., and if it does, then I'd know I should pursue this option.. could you explain to me what were the reasons for the decision in your case?
thx!
Posted by floatingbridge on February 12, 2010, at 16:23:19
In reply to Re: Opioids for Depression » floatingbridge, posted by europerep on February 12, 2010, at 12:45:10
europerep,
I'm sorry my post provoked any worry. Opoid therapy was never suggested for me. I have other options to try, like maoi's, TMs, augmentations. My physical pain levels do not require it either. When I'm older, well, maybe, who knows, depending on what ailment develops as I age. However, my beloved pdoc, who I am blessed with, is older than myself, and odds are that he may not be in practice.
You may have more options left than you realize. I hope so. If you care to post,
I'm curious what symptoms you are addressing.Take care and hugs (if I may),
fb
med trials, chronic illnesses, like depression stink. Don't throw in the towel. Courage.
Posted by emmanuel98 on February 12, 2010, at 18:12:02
In reply to Re: Opioids for Depression » emmanuel98, posted by floatingbridge on February 11, 2010, at 21:27:51
I started on 6mg, then went up to 12mg. It had no effect on me at all. Parnate has been great. Complete remission of depression and minimal side effects.
> Emsam failed? How long and at what dosages, may I ask?
>
> So you are pleased with parnate? I'm glad to hear.
>
Posted by floatingbridge on February 12, 2010, at 18:17:49
In reply to Re: Opioids for Depression, posted by emmanuel98 on February 12, 2010, at 18:12:02
Thanks, emme98, and I am very happy for you!
:)
fb
Posted by Metafunj on February 12, 2010, at 19:07:49
In reply to Re: Opioids for Depression, posted by emmanuel98 on February 12, 2010, at 18:12:02
It's nice to hear a success story. There is hope! Good job!
Posted by europerep on February 14, 2010, at 14:36:41
In reply to Re: Opioids for Depression » europerep, posted by floatingbridge on February 12, 2010, at 16:23:19
> europerep,
>
> I'm sorry my post provoked any worry. Opoid therapy was never suggested for me. I have other options to try, like maoi's, TMs, augmentations. My physical pain levels do not require it either. When I'm older, well, maybe, who knows, depending on what ailment develops as I age. However, my beloved pdoc, who I am blessed with, is older than myself, and odds are that he may not be in practice.
>
> You may have more options left than you realize. I hope so. If you care to post,
> I'm curious what symptoms you are addressing.
>
> Take care and hugs (if I may),
>
> fb
>
> med trials, chronic illnesses, like depression stink. Don't throw in the towel. Courage.of course you may :)..
well, I do not have any physical pain (luckily), so from that point of view I don't need opioids, but maybe they could do something against my depression..the symptoms I have include difficulties to get up in the morning (or, with doses of venlafaxine lower than 600mg/d, the inability to do so before 1 or even 2p.m.); the incapability to get pleasure out of anything in life; a lack of motivation for everything that makes out my life, a disinterest in any kind of social activity (even if I am a rather calm person, I used to enjoy talking and "interacting" with others around me); a lack of, or an absence rather, of self-confidence, hope for the future, etc..(plus physical symptoms)...
I do know that I have only had a fraction of the medication available against depression, but the point is that, since the end of childhood (around 10yrs) I have either been anxious or, for the last eight years, depressed, and so much so that it has basically precluded any actual social life, let alone for once finding a girlfriend, etc.. and this is not because I'm somehow not capable of it, but because my depression is just f##king up my life.. and I have done psychotherapy etc., and it was good, but, there are limits to it, you know? I do not have time for trying another tricyclic, or another SSRI, etc.. I know that, trying opioids now, is kind of like, instead of following the regular road, I'll take a shortcut through a mine field, but I WILL be cautious.. and if the road is leading to that very minefield anyway, then I might as well skip the rest of the road.. hmm, I like metaphores ;)..
yeah, that's my situation right now.. and, to make things "worse" (or better, depends on the POV), I do have a small quantity of buprenorphine at hand (10 x 0.4mg), so that way I could check whether it does me good, or not.. and I guess I'll do so soon, but I'm scared of both if it doesn't help me, and if it does but I won't find a MD who accepts this treatment.. hmmm...
well, thanks for reading anyway :)..
you take care too.. cu
Posted by jedi on February 15, 2010, at 2:22:49
In reply to Re: Opioids for Depression » floatingbridge, posted by europerep on February 14, 2010, at 14:36:41
europerep,
Opioids do make my depression feel better in the short term. I have seen no long term success from anybody in this thread. If your depression is atypical with social anxiety disorder may I suggest Nardil with a long acting benzo. I use clonazepam. This is the only thing that has worked for me out of 45+ different combinations of antidepressants.Atypical Depression is defined as:
A. Mood reactivity (i.e., mood brightens in response to actual or potential positive events)
B. At least two of the following:
1. Significant weight gain or increase in appetite ("comfort eating")
2. Hypersomnia (sleeping too much, as opposed to the insomnia present in melancholic depression)
3. Leaden paralysis (i.e., heavy, leaden feelings in arms or legs)
4. Long-standing pattern of sensitivity to interpersonal rejection (not limited to episodes of mood disturbance; fits of rage, hysteria, aggression and irrational reactions) that results in significant social or occupational impairment.
Atypical depression is actually the most common type of depression. When Nardil works, it can be like flipping a switch. It is an amazing and powerful medication. The food restrictions are way overblown.
Good Luck,
Jedi
> I do know that I have only had a fraction of the medication available against depression, but the point is that, since the end of childhood (around 10yrs) I have either been anxious or, for the last eight years, depressed, and so much so that it has basically precluded any actual social life, let alone for once finding a girlfriend, etc.. and this is not because I'm somehow not capable of it, but because my depression is just f##king up my life.. and I have done psychotherapy etc., and it was good, but, there are limits to it, you know? I do not have time for trying another tricyclic, or another SSRI, etc.. I know that, trying opioids now, is kind of like, instead of following the regular road, I'll take a shortcut through a mine field, but I WILL be cautious.. and if the road is leading to that very minefield anyway, then I might as well skip the rest of the road.. hmm, I like metaphores ;)..
>
> yeah, that's my situation right now.. and, to make things "worse" (or better, depends on the POV), I do have a small quantity of buprenorphine at hand (10 x 0.4mg), so that way I could check whether it does me good, or not.. and I guess I'll do so soon, but I'm scared of both if it doesn't help me, and if it does but I won't find a MD who accepts this treatment.. hmmm...
>
> well, thanks for reading anyway :)..
> you take care too.. cu
Posted by Cherry Carver on February 15, 2010, at 20:29:19
In reply to Re: Opioids for Depression » europerep, posted by jedi on February 15, 2010, at 2:22:49
Has anyone here actually been given opioids specifically for depression in the long term? Like you, I take Klonopin (clonazepam), and it was the only thing that worked for me as well, except for prior, brief experiences with some opiates.
I'm just asking out of curiosity, because I wonder if opioids would work on depression and anxiety long-term. I understand why doctors don't prescribe it (due to the incidence of abuse), but couldn't it be applied therapeutically if it were monitored carefully? After all, there are people who get high on benzos like Klonopin and Ativan (I don't get high on Klonopin--it just makes me feel normal). It makes me think about the relative cost of all these drugs and what the pharmaceutical companies' real motivation is.
The fact that Klonopin is now a street drug disturbs me tremendously, because it works so well for my panic. Now I have to worry that the DEA will ban it and I'll be forced to take something less effective and more harmful.
> europerep,
> Opioids do make my depression feel better in the short term. I have seen no long term success from anybody in this thread. If your depression is atypical with social anxiety disorder may I suggest Nardil with a long acting benzo. I use clonazepam. This is the only thing that has worked for me out of 45+ different combinations of antidepressants.
>
> Atypical Depression is defined as:
> A. Mood reactivity (i.e., mood brightens in response to actual or potential positive events)
> B. At least two of the following:
> 1. Significant weight gain or increase in appetite ("comfort eating")
> 2. Hypersomnia (sleeping too much, as opposed to the insomnia present in melancholic depression)
> 3. Leaden paralysis (i.e., heavy, leaden feelings in arms or legs)
> 4. Long-standing pattern of sensitivity to interpersonal rejection (not limited to episodes of mood disturbance; fits of rage, hysteria, aggression and irrational reactions) that results in significant social or occupational impairment.
> Atypical depression is actually the most common type of depression. When Nardil works, it can be like flipping a switch. It is an amazing and powerful medication. The food restrictions are way overblown.
> Good Luck,
> Jedi
>
>
Posted by Phillipa on February 15, 2010, at 21:25:00
In reply to Re: Opioids for Depression » jedi, posted by Cherry Carver on February 15, 2010, at 20:29:19
Cherry seriously I know no one that abuses benzos for pleasure just feeling normal. Love Phillipa
Posted by Cherry Carver on February 16, 2010, at 9:48:56
In reply to Re: Opioids for Depression » Cherry Carver, posted by Phillipa on February 15, 2010, at 21:25:00
Phillipa, please check out these sites, from the USA and UK respectively:
http://www.deadiversion.usdoj.gov/drugs_concern/benzo_1.htm
http://www.ixion.demon.co.uk/benzodiazepines.htm
> Cherry seriously I know no one that abuses benzos for pleasure just feeling normal. Love Phillipa
Posted by Phillipa on February 16, 2010, at 20:52:27
In reply to Re: Opioids for Depression » Phillipa, posted by Cherry Carver on February 16, 2010, at 9:48:56
Some might but not those using for simple relief of anxiety. 40 years later on the lowest doses ever. And not raising them. The pooped out. Phillipa
Posted by Cherry Carver on February 17, 2010, at 6:35:03
In reply to Re: Opioids for Depression » Cherry Carver, posted by Phillipa on February 16, 2010, at 20:52:27
*LOL* Tell me about it...I'm on 2 mgs of K and tomorrow I have to see a shrink so he can keep my sanity going. I'm praying he won't try to change what works for me. Love, Cherry
> Some might but not those using for simple relief of anxiety. 40 years later on the lowest doses ever. And not raising them. The pooped out. Phillipa
Posted by slw2 on February 17, 2010, at 10:59:55
In reply to Re: Opioids for Depression » Phillipa, posted by Cherry Carver on February 17, 2010, at 6:35:03
i'm new -- i posted over in alternative's because i thought opiates for mental issues would be alternative.
should i post here too? it was long, i hate eat space like that.
opiates are the only thing that worked for my son -- he's like a completely normal person on them. without them, he can't function because of the depression & anxiety -- none of the meds he's taken have really helped get to the core problem.
he developed an addiction and is now on suboxone -- it's great for the cravings & withdrawels. some days it even helps the depression/anxiety, but some days it doesn't.
his psychiatrist won't even discuss opiates as an option with him.
does anyone actually treat with opiates?
i'm still reading through the above posts -- so forgive me if the info is there.addiction scares me -- but i also don't want to automatically eliminate what might be his best hope of a normal life because of moral issues and other peoples opinions.
Posted by emmanuel98 on February 17, 2010, at 19:02:18
In reply to Re: Opioids for Depression, posted by slw2 on February 17, 2010, at 10:59:55
I never heard of anyone actually treating with opiates. The FDA monitors docs, the drugs are addictive and you build tolerance fast. They work for depression though.
>
> does anyone actually treat with opiates?
> i'm still reading through the above posts -- so forgive me if the info is there.
>
> addiction scares me -- but i also don't want to automatically eliminate what might be his best hope of a normal life because of moral issues and other peoples opinions.
Posted by Cherry Carver on February 17, 2010, at 19:22:19
In reply to Re: Opioids for Depression, posted by slw2 on February 17, 2010, at 10:59:55
What I'm going to say may sound controversial, but I think the concept of "addiction" is becoming really overblown. It is, after all, a multi-million dollar industry.
Everybody here who takes ADs is addicted to their medication. We have no other choice, and if we stop taking these meds, most of us will suffer lengthy, nightmarish withdrawal and then return to the miserable way we were before we were medicated.
My heart goes out to you and your son. Opiates obviously do help alleviate depression. The fact that no doctor will prescribe them (in the USA at least; I am not familiar with international law) is because of unbelievably stringent DEA regulations. This is a country where some doctors deny morphine to terminal cancer patients because they fear the patients will become addicted!!!
Needless to say, I think the law ought to be changed where psychiatric disorders are concerned. Opiates work as well as any of the garbage I've been on for severe panic. However, the US government seems more and more prone to offer medication with side effects as extreme as "death events."
So, I'm in full agreement with you. Opiates used to be prescribed for depression and anxiety, and I think they should be considered for that purpose again. I don't think their side effect of "addiction" should worry people any more than it does with medications like the one I'm taking.
> i'm new -- i posted over in alternative's because i thought opiates for mental issues would be alternative.
>
> should i post here too? it was long, i hate eat space like that.
>
> opiates are the only thing that worked for my son -- he's like a completely normal person on them. without them, he can't function because of the depression & anxiety -- none of the meds he's taken have really helped get to the core problem.
>
> he developed an addiction and is now on suboxone -- it's great for the cravings & withdrawels. some days it even helps the depression/anxiety, but some days it doesn't.
>
> his psychiatrist won't even discuss opiates as an option with him.
>
> does anyone actually treat with opiates?
> i'm still reading through the above posts -- so forgive me if the info is there.
>
> addiction scares me -- but i also don't want to automatically eliminate what might be his best hope of a normal life because of moral issues and other peoples opinions.
Posted by floatingbridge on February 17, 2010, at 20:03:59
In reply to Re: Opioids for Depression, posted by slw2 on February 17, 2010, at 10:59:55
Sales,
Welcome here, regardless of the awful situation that brings you here.
Low dose morphine treatment is approved for OCD. Your son's history of addiction may complicate this, I don't know.
What do the rehab psychiatrists have to say about his depression? Contrary to popular belief, and as you undoubtedly know, most addictions occur because
someone has been self-treating a real illness, albeit an often undiagnosised. I'm wondering if his pdoc is onboard with treatment resistant depression in recovering addicts--they must have urgent special needs as a population.If you think you can get a better pdoc for
your son, maybe that might help.In your list of meds, has your son tried MAOI inhibitors. Nardil helps many with the symptoms you describe. There are other. MAOI'S as well. Therapy may not be effective until his symptoms are under control and he's feeling more comfortable.
Google morphine +OCD.
Disclaimer: I'm only a person with depression, with no authority to offer anything but personal advice and support.
Good luck to you! Be strong!
fb
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