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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by ShelliR on April 11, 2001, at 20:03:37
Dr. Richelson,
Thanks for taking questions.
There are a few of us on this board who have been treated with small amounts of opiates to augment antidepressants for treatment resistant depression. Do you believe that some people are particularly responsive to the anti-depressant effects of opiates? In some cases (on this board) and on the internet in general, there are patients who have been treated with opiates (e.g., hydrocodone), and have found the same amount to continue to be effective for many years, and others who have had to increase because of tolerance. Do you know why that might be the case? What is your feeling about using opiates as part of treatment for depression, when no other drug combinations have succeeded in treating the depression? Do you think targeting opiate receptors will play any role in the development of future anti-depressant medications?
Posted by Dr. Bob on April 14, 2001, at 23:32:57
In reply to Richelson: use of opiates for depression, posted by ShelliR on April 11, 2001, at 20:03:37
> There are a few of us on this board who have been treated with small amounts of opiates to augment antidepressants for treatment resistant depression. Do you believe that some people are particularly responsive to the anti-depressant effects of opiates? In some cases (on this board) and on the internet in general, there are patients who have been treated with opiates (e.g., hydrocodone), and have found the same amount to continue to be effective for many years, and others who have had to increase because of tolerance. Do you know why that might be the case? What is your feeling about using opiates as part of treatment for depression, when no other drug combinations have succeeded in treating the depression? Do you think targeting opiate receptors will play any role in the development of future anti-depressant medications?
Long before the established antidepressants were available, opiates and opioids were used to treat depression. However, for various reasons today, I would not use this class of compounds to treat depression. The mechanisms of tolerance to a drug is very complex and not well understood for most drugs. Some mechanisms involve increased metabolism of the drug and adaptive changes at the cellular level. The theory about tolerance to opioids is that there are adaptive changes at the level of receptors for these compounds. Why tolerance would not develop in some patients, but not others is a mystery.
Posted by frizzaldizzal on June 15, 2006, at 13:49:22
In reply to Re: opiates for depression: Dr. Richelson responds, posted by Dr. Bob on April 14, 2001, at 23:32:57
I took hydrocodone for about 8 years. It was the only thing that would keep me from thinking about suicide. I never went up in the dose, all of the sudden was wasnt working like had been. The depression came back and I was very irritable. I took this med before they had diagnosed me with Bipolar II. I read in a John's Hopkin's University book about Bipolar that Bipolar depression is worse than regular. Since the doctors did not see that I was Bipolar they never put me on a mood stabilizer, and every antidepressant they put me on would quit working, so I always took the hydrocodone to help, even when I was on an antidepressant. I found it by accident. I had surgery and they put me on it, and I realized that it helped and that I was no longer thinking about suicide, so they let me stay on it.
Posted by pseudoname on June 18, 2006, at 17:17:13
In reply to Re: opiates for depression: Dr. Richelson responds, posted by frizzaldizzal on June 15, 2006, at 13:49:22
Thanks, frizzal, for finding this old post by Dr Bob.
Those were the good ol' days: when Bob also posted non-administratively on Babble!
I know that Dr Bob is not opposed to the spread of information about using buprenorphine for depression, and in fact encouraged me to put my links about it on his Babble Tips group at Yahoo.
I don't know if the typical opioid tolerance he was concerned about also occurs with buprenorphine. I have REDUCED my own dose significantly over the last 7 months without loss of effect, but who know what's actually going on physiologically. Maybe I was taking too much at first, or maybe I am in the non-tolerance subgroup, or maybe bupe is different enough that this is not a factor?
Posted by John45 on November 2, 2010, at 11:53:15
In reply to tolerance to buprenorphine. And thanks! » frizzaldizzal, posted by pseudoname on June 18, 2006, at 17:17:13
I TRULY believe that most people with depression, anxiety and OCD (especially men) find more relief with opiates because THAT is the target area in the brain that needs correcting. In other words, if you look at results, opiates and similar meds. are MUCH more effective in relieving depression than SSRIS or any other class of medication. Addiction and dependency IS an issue for some, but depression can be a FATAL disease. I just lost a close friend to suicide (HORRIBLE) who was on many meds and nothing helped. He tried a Vicodin once and said it made him feel sane and normal for the first time. Seriously. Let's continue this dialogue. IT IS SO IMPORTANT! Hugs....
Posted by ggggg123 on November 3, 2010, at 3:31:42
In reply to Re: tolerance to buprenorphine. And thanks! » pseudoname, posted by John45 on November 2, 2010, at 11:53:15
I took codeine when I got my jaw broke by a drunken yob in my teens, it was the best, and I repeat best drug I have ever tried. Good times lol, SSRI's are the opposite of mood lifters, they make you feel like crap. Personally I think things have to change. But I don't think pure opiods would make good longterm ad's, for one you can't function properly whilst taking them for two you may build tolerance and become dependant. But I do think the dopamine system is far under targeted, and ssri's are just scum, something that could be used to create a human, void of emotion and empathy, are they really good for society? they make you lose the will to live, where as prior to taking an ssri people with anxiety are anxious about death. They take the ssri, they feel terrible, they feel like a humanoid, what the idea is of completely neglecting the other neurotransmitters is beyond me, maybe its so the drugs can be marketed to the mass market, for huge profits, as they are safe* in immediate terms, they don't have any dangerous side effects and they won't cause addiction*, mania or tolerance, in theory they are ideal to dish out like sweeties, in reality they are very ineffective, and can ultimately make you feel worse. But that does'nt matter doctors believe the pharma reps, some patients are tricked into thinking they work and the rest is history, all the pharmaceutical companies are now mega rich!!!
Other ad's are also deeply flawed, in fact all the ones I've taken are pretty damn useless, useful drugs are banned, because people without clinical depression would want them, so we are left with the crap, the stuff that is very mediocre, the stuff that we have to put up with, because we have no choice, although it gives us relief from some anxiety, it turns us into hermits, it keeps us away from society and we turn into the forgotten people, we lack luster for life, we are emotionally and physically castrated, we are officially under the chemical cosh.
One drug that made me feel slightly better was mirtazapine, but that turns you into a fat walking sleep machine, and seems to always poop out. All my personal experience and opinion!!!!
This is the end of the thread.
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