![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 186 to 210 of 262. Go back in thread:
Posted by safire4hope on October 18, 2011, at 19:27:21
In reply to Re: opiates and major depression » safire4hope, posted by Chairman_MAO on October 18, 2011, at 12:07:42
My views are changing completely after reading and researching. I believed myself to be an addict just because I took a drug that helped my symptoms but "everyone else" said was illegal and "not right". I went for treatment because of all the trouble my self medicating was causing, and I now believe that I am not an addict, because I never "abused" any medication, but am only physically dependent which is something all people on certain meds have to deal with. Either be dependent or be depressed. If i have to choose I would choose dependent. I appreciate and agree with your statement of not caring what others think and only of your own well being. At this point I am ok with my depression and my "treatment for addiction" because I now know they are one in the same, but eventually I will have to deal with "what others think" when the doctors feel it is time for me to come off the suboxone. I only hope my own doctor or one I can locate will work with me and help me as much as possible. I don't ever want to be back in my "depressed" state again. It was not a pretty picture and cause my family a great deal of pain for a long time.
Posted by Chairman_MAO on October 18, 2011, at 20:33:47
In reply to Re: opiates and major depression » safire4hope, posted by CaptainAmerica1967 on October 18, 2011, at 18:54:54
> I've found success with buprenorphine because of it's kappa antagonist as everyone with depression has an overactive [... snip ...]
You found success with it because it is a mu-opioid agonist. You'd have just as much success with morphine. The kappa antagonist effect is good, but let's keep it real here.
Posted by sigismund on October 19, 2011, at 2:50:30
In reply to Re: opiates and major depression » CaptainAmerica1967, posted by Chairman_MAO on October 18, 2011, at 20:33:47
When compared with methadone I have heard people report some kind of elevation with bupe, once the changeover has been achieved.
But that is compared to methadone which is toxic enough.
Posted by CaptainAmerica1967 on October 19, 2011, at 8:29:28
In reply to Re: opiates and major depression » CaptainAmerica1967, posted by Chairman_MAO on October 18, 2011, at 20:33:47
Yes, I cannot deny that the opioid Mu receptor made me feel a little better but no more than any of the 100's of medications I've taken over the past 28 years of my life. I've tried tramadol and other Mu receptors meds and they only minimally helped as all meds have in my (TRD) treatment resistant depression /c anxiety and have had IV morphine after a car accident in 1986 from a seizure caused by high dose trazodone (1000 mg) that was very serious killing my Mother even after she told the psychiatrist I was having blank out spells, but he ignored my Mother's concern and said it was anxiety attacks causing me to faint and didn't believe trazodone could cause seizures even at a super high dose.
However, morphine did not make me feel like the buprenorphine. Pharmaceutical companies are working on several kappa antagonists and even addiction specialist, the head of NAABT, Richard Gracer, MD said depressed patients feel better on buprenorphine because of the kappa receptor antongism and believes that individuals /c depression have an impaired or overactive kappa system. Difference in treating refractory depression (TRD) vs opiate addiction is the dose SL tablets; TRD .5 mg - 4 mg QD vs addiction TX up to 20 mg of buprenorphine day. Gracer states that taking buprenorphine for depression isn't a weakness and is no different than patients who must take an antidepressant for a lifetime and shouldn't feel ashamed about that. I always told my depressed patients that it's no different that some of my diabetic patients that must remain on insulin for a lifetime.
I have developed osteoarthritis in the left knee from being an extreme athlete in trying to control my depression via endorphins, enkephalins release from extreme workouts all of these years and buprenorphine has a similar effect of calming my brain down after a hard workout and buprenorphine is indicated for osteoarthritis, but only the liquid injectable form which I refuse to take as injecting buprenorphine can really make one addictted and have severe withdrawal so I pay for the sublingual tablets off label 2 mg BID or $100 for 60 tablets, a months supply; Butrans patch by Purdue Pharma recently came out with their buprenorphine patch and is indicated for osteoarthritis pain but Medicare is denying it currently. The original buprenorphine study on TRD by Bodkin et al, used the liquid form but either used the buprenorphine liquid intranasally (60% bioavailability) or liquid sublingually (50% bioavailability) which is better than the sublingual tablets (40% bioavailabity) but the cost of the liquid is about 3x as much as the tablets and am not sure of the cost of the Butrans patch yet (50% bioavailabity).
I've had 70 ECT's when I was 18y/o-19y/o right /p high school graduation in '85 over a yr. period, tried over 100 medications since I was 16y/o in 1983, studied medicine as a PA to try to research TRD more on my own and have for years even prior to studying medicine in the early '90s and the MAOI type A antidepressants seem to work the best. Parnate is the best in my personal opinion at least for me with the comorbid depression with anxiety even though I took Nardil (has GABA inhibitor but mroe toxic to body) for 12yrs but Parnate has less side effects and boosts libdo, but I personally need clonazepam for the anxiety, for seizure prevention of high dose antidepressants in which I'm taking 100 mg of Parnate (high dose of trazodone, 1000 mg caused the seizure in 1986 and could have sued my psychiatrist but it wasn't going to bring back my Mother), and lastly need clonazepam for my REM sleep disorder; muscles aren't paralyzed during REM sleep, stage 5 as I sleepwalk, thrash, kick, punch-last girlfriend got a black eye-has made me hesitant towards longterm dating, talk all while sleeping and go directly into REM sleep instead of the 90 minutes it normally takes to go through the typical sleep phases-shoretned REM latency which is really more related to TRD. I just started taking Xyrem (known as GHB or sodium oxybate) for my REM sleep disorder which helps tremendously in getting at least 3-4 hours of sleep without before waking up as I used to sleep for one to two hours and wake up from thrashing, sleepwalking or talking in my sleep and Xyrem also helps /c the depression and anxiety.
My depression is definitely an overactive brain as sleep deprivation works wonders for me (as do cold showers/baths) and calms my brain down (reduces glucose levels in the brain? Increases monoamines? Increases libido-increased dopamine?) but as soon as I get any amount of sleep, the depression/anxiety/hot flashes/difficulty concentrating returns.
Neurolgist Helen Mayberg of Emory Univeristy has shown that everyone with depression has certain parts of the brain that use too much glucose consumption-hyperactivity, areas around Broadmann's area 25 or the subgenual cingulate which controls serotonin transporters and controls the hypothalamus that in turn controls various mood areas of the brain like the amygdala. Additional studies with deep brain stimulation have shown that stimulating the white matter surrounding area 25 is just as effective in treating TRD and all of these areas are hyperactive to meaning too much glucose consumption is being used as shown on the PET Scan..
Posted by europerep on October 19, 2011, at 8:32:45
In reply to Re: opiates and major depression » CaptainAmerica1967, posted by Chairman_MAO on October 18, 2011, at 20:33:47
> You found success with it because it is a mu-opioid agonist. You'd have just as much success with morphine. The kappa antagonist effect is good, but let's keep it real here.
>Actually, buprenorphine is a partial mu-opioid agonist. Furthermore, research on kappa-antagonism shows its potential for treating depression, so this component of buprenorphine may well play a role. Lastly, buprenorphine's metabolite norbuprenorphine is a delta-agonist, which may as well contribute to buprenorphine's antidepressant potential.
Posted by Chairman_MAO on October 19, 2011, at 13:50:09
In reply to Re: opiates and major depression » Chairman_MAO, posted by europerep on October 19, 2011, at 8:32:45
>
> > You found success with it because it is a mu-opioid agonist. You'd have just as much success with morphine. The kappa antagonist effect is good, but let's keep it real here.
> >
>
> Actually, buprenorphine is a partial mu-opioid agonist. Furthermore, research on kappa-antagonism shows its potential for treating depression, so this component of buprenorphine may well play a role. Lastly, buprenorphine's metabolite norbuprenorphine is a delta-agonist, which may as well contribute to buprenorphine's antidepressant potential.
>Yes, I know it is a partial mu-opioid agonist, but you can get equipotent analgesia comparable to any other mu agonist so long as you don't go over buprenorphine's "ceiling", beyond which efficacy drops (but you already know this, I'm sure, because you bothered to "call me out" on its being a partial agonist). There is ample literature using conventional mu agonists to treat depression effectively.
I think that buprenorphine makes an excellent candidate for use as an antidepressant for many reasons--the number one reason being its safety in overdose. It has more than antidepressant potential, it _is_ an antidepressant. It's wonderful to have all of these hypothetical discussions about which receptor subtypes do what, but it's not very useful clinically. What matters is what works.
Posted by Chairman_MAO on October 19, 2011, at 14:09:38
In reply to Re: opiates and major depression » Chairman_MAO, posted by CaptainAmerica1967 on October 19, 2011, at 8:29:28
> Yes, I cannot deny that the opioid Mu receptor made me feel a little better but no more than any of the 100's of medications I've taken over the past 28 years of my life.
That is highly individualized, and not everyone feels that way (I am not speaking for myself here).
> However, morphine did not make me feel like the buprenorphine. Pharmaceutical companies are working on several kappa antagonists and even addiction specialist, the head of NAABT, Richard Gracer, MD said depressed patients feel better on buprenorphine because of the kappa receptor antongism and believes that individuals /c depression have an impaired or overactive kappa system.
Kappa antagonism is promising, but bootstrapping from psychopharmacology to some sort of pathophysiology is absurd. You can "believe" whatever about whatever you want in this field with virtually no evidence.
> Difference in treating refractory depression (TRD) vs opiate addiction is the dose SL tablets; TRD .5 mg - 4 mg QD vs addiction TX up to 20 mg of buprenorphine day.
That's funny, I got on it for depression and got the best effect at 4mg qid (sublingually of course), which is where, in most people, it seems to have the greatest analgesic effect. Taking it four times daily is different than taking it once or twice daily.
> Gracer states that taking buprenorphine for depression isn't a weakness and is no different than patients who must take an antidepressant for a lifetime and shouldn't feel ashamed about that.
I don't think that anyone should feel ashamed for using any drug for any reason unless there are negative consequences--especially if it has _positive_ results.
> I always told my depressed patients that it's no different that some of my diabetic patients that must remain on insulin for a lifetime.
That's a quaint narrative, but it belies reality. You know it doesn't work like insulin. I am really tired of http://en.wikipedia.org/wiki/Pharmacological_Calvinism
You could make it _metaphorically_ like taking insulin, but it is not like taking insulin.
>> I have developed osteoarthritis in the left knee from being an extreme athlete in trying to control my depression via endorphins, enkephalins release from extreme workouts all of these years and buprenorphine has a similar effect of calming my brain down after a hard workout
You mean calming your mind down?
>and buprenorphine is indicated for osteoarthritis, but only the liquid injectable form which I refuse to take as injecting buprenorphine can really make one addictted and have severe withdrawal so I pay for the sublingual tablets off label 2 mg BID or $100 for 60 tablets,
Injection vs. sublingual administration is just a matter of convenience. The SL bioavailability is so poor, that is why the doses of the SL tablets is so high. This has nothing to do with "addiction".
> a months supply; Butrans patch by Purdue Pharma recently came out with their buprenorphine patch and is indicated for osteoarthritis pain but Medicare is denying it currently.
That's a shame.
> The original buprenorphine study on TRD by Bodkin et al, used the liquid form but either used the buprenorphine liquid intranasally (60% bioavailability) or liquid sublingually (50% bioavailability) which is better than the sublingual tablets (40% bioavailabity) but the cost of the liquid is about 3x as much as the tablets and am not sure of the cost of the Butrans patch yet (50% bioavailabity).
>The sublingual bioavailability varies, but for the tablets it is about 30%.
> I've had 70 ECT's when I was 18y/o-19y/o right /p high school graduation in '85 over a yr. period, tried over 100 medications since I was 16y/o in 1983, studied medicine as a PA to try to research TRD more on my own and have for years even prior to studying medicine in the early '90s and the MAOI type A antidepressants seem to work the best. Parnate is the best in my personal opinion at least for me with the comorbid depression with anxiety even though I took Nardil (has GABA inhibitor but mroe toxic to body) for 12yrs but Parnate has less side effects and boosts libdo, but I personally need clonazepam for the anxiety, for seizure prevention of high dose antidepressants in which I'm taking 100 mg of ParnateUnless you are epileptic, you're unlikely to get a seizure from 100mg/day of tranylcypromine. Plus, you don't use a benzo as a primary anticonvulsant--certainly not in seizure-prone people--because they lose effectiveness over time and as tolerance and dependence sets in, they become less useful in status epilepticus.
That is because MAOIs are the best antidepressants --at least among drugs labelled as such. Good dose for "high-dose" tranylcypromine is 1.5mg/kg/day or a max of 200mg/day. The major concern AFAIK is thrombocytopenia if you keep going higher plus inhibition of other enzymes. I think knocking out MAO-A and MAO-B produces a more robust effect; knocking out MAO-B has a cascade of effects from letting more trace amines (namely PEA) remain around.> (high dose of trazodone, 1000 mg caused the seizure in 1986 and could have sued my psychiatrist but it wasn't going to bring back my Mother),
1000mg? Insane. I'm sorry to hear that.
> and lastly need clonazepam for my REM sleep disorder; muscles aren't paralyzed during REM sleep, stage 5 as I sleepwalk, thrash, kick, punch-last girlfriend got a black eye-has made me hesitant towards longterm dating, talk all while sleeping and go directly into REM sleep instead of the 90 minutes it normally takes to go through the typical sleep phases-shoretned REM latency which is really more related to TRD. I just started taking Xyrem (known as GHB or sodium oxybate) for my REM sleep disorder which helps tremendously in getting at least 3-4 hours of sleep without before waking up as I used to sleep for one to two hours and wake up from thrashing, sleepwalking or talking in my sleep and Xyrem also helps /c the depression and anxiety.
GHB is good stuff. Really non-toxic, too.
>
> My depression is definitely an overactive brain as sleep deprivation works wonders for me (as do cold showers/baths) and calms my brain down (reduces glucose levels in the brain? Increases monoamines? Increases libido-increased dopamine?) but as soon as I get any amount of sleep, the depression/anxiety/hot flashes/difficulty concentrating returns.
>What is "overactive brain"?
> Neurolgist Helen Mayberg of Emory Univeristy has shown that everyone with depression has certain parts of the brain that use too much glucose consumption-hyperactivity, areas around Broadmann's area 25 or the subgenual cingulate which controls serotonin transporters and controls the hypothalamus that in turn controls various mood areas of the brain like the amygdala. Additional studies with deep brain stimulation have shown that stimulating the white matter surrounding area 25 is just as effective in treating TRD and all of these areas are hyperactive to meaning too much glucose consumption is being used as shown on the PET Scan..
Could you provide me with citations of these papers, please? I am interested.
Posted by safire4hope on October 19, 2011, at 16:22:10
In reply to Re: opiates and major depression » Chairman_MAO, posted by CaptainAmerica1967 on October 19, 2011, at 8:29:28
I am not a doctor, but taking in all that everyone is stating and what I've researched so far, I do believe that the buprenorphine is working "for me" with my depression and obviously a lot of others. I would never have found this out if not for "using" opiates for years to self medicate and eventually believing myself to be an "addict" (even though I only took up to 20mg a day depending on my depression symptoms) and going into treatment for addiction. I let everyone else's view of what was right and wrong eventually cause me to believe badly of myself when I should have went with my very first belief that the pills were helping my depression. The suboxone I am on now (about 4mg a day) is def. better than taking pain pills for my symptoms and obviously safer as I saw someone else post because of the cap, although I don't abuse my medication to get to the point of overdose. I was on Methadone at one point and that did help but I don't care for it. It isn't safe and they had me on a dose that was way too high and I was falling asleep at times. I thank everyone for their help/input and facts. It has helped me greatly in my effort to find an AD that works for me and given me info I can use when speaking with my doctor. Having said all that, I am sorry to hear of all the things you've had to go through in your journey to find "the right fit" for you, and to hear of your mother's passing in such a way. I am sorry for that, and pray for you. Thanks to all who read this who've given feedback in any kind. It has helped. I've always asked the question "If it works, why change it?" and I was overall correct in saying that, in my opinion.
Posted by europerep on October 20, 2011, at 15:30:27
In reply to Re: opiates and major depression » europerep, posted by Chairman_MAO on October 19, 2011, at 13:50:09
My point was simply this: pharmacology matters.
It matters when explaining to a doctor why giving buprenorphine to a patient with TRD is not like prescribing morphine, or for that matter, heroin. It matters when trying to point out why the risk-benefit ratio with buprenorphine is better than with oxycodone or hydromorphone. And lastly, it matters when looking at what future drug treatments could or should look like.
That's all I wanted to say.
Posted by CaptainAmerica1967 on October 20, 2011, at 17:52:15
In reply to Re: opiates and major depression, posted by sigismund on October 19, 2011, at 2:50:30
I just wanted to write this note down and wish pharmaceutical companies would take this note seriously:
By 2020, which is less than nine years away nearing eight, the second leading cause of death in the USA will be suicide and second only to heart disease and possibly the number one killer for women. This has been predicted by WHO (World Health Organization predicted this as far back as the late 1990's or early 2000's I believe).
Obviously not all suicides are caused by psychiatric diseases, but a large percent are; Others causes of suicide follow along reasons for individuals getting "reactive depression" such as death of a family member/loved one, loss of a job, divorce/breakup, longterm/lifelong chronic illness, and more which are tough enough situations but "in my opinion" don't compared to those who struggle from "daily, chronically treatment resistant depression" as I've had or have all of the above situations happen to me.
Maybe the economy is going to get really bad producing more financial hardships, divorces, loses of jobs/homes, the baby boomer ('46-'64) parents will die causing grief on their children or Social Security Disabilty will be taken away (fortunate that I saved enough money throughout my career hopefully to last a lifetime if SSD goes away or if I'm never fixed to feel confident enough to work again) by the Republicans or that's what Rick Perry wants as well as many other Republicans want to do, and this will place too much pressure or stress causing suicides to become number two or maybe it's just more genetics passed down with depression as the number of RX antidepressants have skyrocked throughout the past 10 years. I would have liked to have kids as it's only my Brother (he had a girl) and I remaining but I would never wish TRD on anyone if mine is indeed genetic (I was a 12pd baby boy and OBGYN may have damaged my temporal lobe-limbic system while trying to deliver me vaginally with too much pressure, force being placed with the foreceps on temporal lobes as I had blood on both side and still have a scar on my right temple; Neurologist gave me this hypothesis of depression as he had seen this happen quite a bit in his career prior to retiring) so I don't want children, but could always adopt.
I think the pharmaceuticals companies need to wake up and are too focused purely on the monoamine hypothesis of depression and wish they'd start focusing on other mechanisms. Prior to the first antidepressant developed in the 1950's which was discovered purely by chance when a MAOI drug used to treat tuberculosis was given to patients, the patients started feeling much better; (Other drugs are discovered this way, ie testing Viagra for heart disease, but found out Viagra worked for erectile dysfunction). Physicians used to prescribe morphine, or opiates and the opiates worked for everyone and not just a select percentage, but the fear of addiction lead to the downfall or replacement by antidepressant drugs.
Present day, upto about 45% of patients who take antidepressants don't respond or do respond but don't get completely better. Some patients may respond better to the older meds like MAOIs or tricylics as they block REM sleep better compared to the SSRI's, but probably not the SNRI but Parnate is the most potent REM blocker available (why it helps my REM sleep disorder too) and keeps the brain less active, or from being over active/hyperactive during REM sleep in which all patients with depression show this overactivity or too much glucose uptake or excessive cerebral blood flow shown on PET scans or SPECT imaging; both my pyschiatric and I believe deep brain stimulation for those with the most severe TRD will make ECT obsolete because DBS really works and hits the root cause of the depression, overactivity by stimulating the specific area every so often, it calms the brain just like DBS would for overactive brain conditions like Bipolar, ADHD, Parkinson's (DBS first used for), Anxiety, OCD, Anorexia Nervosa, Epilepsy (over and under active), hot flashes?, possibly Alheimer's whereas ECT just makes the patient have a seizure hoping that the brain corrects itself via various mechanisms. ECT didn't help me at all and probably made me feel worse as I hated the thought and feeling of being knocked out as it's a total different feeling than slowly drifting off to sleep which is a nice feeling and I felt groggy half the day from the anaesthetics and worn out.
So why do pharmaceutical companies keep coming out with tweaked or slightly changed medications like Effexor to Effexor XR to Pristiq which if the Effexor didn't work then why Effexor XR or Pristiq? Money is the reason because the company is extending the life of the medication from becoming generic and will sometimes make them into a liquid or patch therefore still extending the patent but this is not trying to necessarily really help the struggling depressed patient.
I hope to enter into a ketamine study ASAP but most likely early next year as I've been much better this past year on buprenorphine, "SUBUTEX" (not "SUBOXONE"), but still not 100% everyday and an hoping the ketamine will get me there or I'm able to start working out again, otherwise I'll try to get into a deep brain stimulation again, but was excluded twice because of one psychiatrist's mistake of giving me too much trazodone and having a medication induced seizure therefore excluding me from two DBS studies (Dallas, Emory-Mayberg at Emory) as they want patients with who've never had a seizure regardless of the reason (you can have a seizure by getting knocked over the head-knew a patient that had a seizure after a coconut fell out of a tree and hit him on the head) and I even spoke to Helen Mayberg (pioneer of DBS for TRD) regarding my situation and said I was an excellent candidate but the reviewing psychiatrist who does the inclusions/exclusions is very thorough, rigid with the rules of DBS for depression still being an investigational study.
Ketamine, from what I've read, increases brain derived neurotrophic factor (BDNF) or increases the synapses, synaptogensis. I know ketamine works as an antagonist of the glutamate NMDA receptor, a proposed mechanism for depression but have already tried meds like Namenda (Alheimer's and detxromethorphan, the newest being Nuedexta (indicated for a disease that makes individuals breakout into crying or laughing spells-pseudobulbar affect that has quinidine to elevate the detxromethorphan levels) even while on the Parnate (normally a psychiatrist or pharmacist wouldn't dare combine the two but after what TRD patient has tried everything, taking cautious risks by slowly adding a medication might be worth it but the med didn't have the desired effect either.
My goal is to conquer this as everyone's goal is an to write an autobiography in the hopes of saving individuals lives before 2020.
Best wishes to all!
Posted by SLS on October 20, 2011, at 18:47:41
In reply to Re: opiates and major depression, posted by CaptainAmerica1967 on October 20, 2011, at 17:52:15
Nice post.
I don't know if excessive neural activity in Brodman's Area 25 is the root cause of depressive illness or a consequence of it, but DBS works. Outside of this structure, brain activity (FDG uptake) is reduced almost globally as rendered in PET scans. One day soon, we will understand the functions of, and the relationships between, brain circuits.
I am not refuting the idea that overactivity in the subgenual cingulate might be the cause of depressive illness. I just haven't seen evidence that is accepted as being conclusive yet.
- Scott
Posted by JohnLA on October 20, 2011, at 23:29:42
In reply to Re: opiates and major depression, posted by CaptainAmerica1967 on October 20, 2011, at 17:52:15
capatain america-
like your post very much. but, over half a million die from cancer each year in this country. not sure where you got your info. even more from heart disease. suicide deaths i believe are a little over 30,000.
suicide is not even in the top 10 causes of death in the usa. i'm not trying to make lite of our conditions. it's just a little bothersome when inaccurate info is posted regarding depression.
maybe i misunderstood that part of your post?
regardless, like i said, i agree whole-heartedly w/the rest of your post.
john
Posted by CaptainAmerica1967 on October 21, 2011, at 4:05:10
In reply to Re: opiates and major depression, posted by JohnLA on October 20, 2011, at 23:29:42
I read that suicide would become the second killer in the USA back in the early 2000's I believe, but just search; suicide, 2020, WHO (World Health Organization). I know it stunned me to hear this way back then too, but WHO has an excellent track record however they come up with stats either from increasing results of death records (they know the true results like a pathologist does unlike the public) or some other means. You never hear about suicides (My neighbor lost his job two years ago, wrapped himself up in bubble plastic so blood wouldn't get all over and put a pistol to his head and shot himself dead-It was not published and he was a well known realtor but the family didn't want the stigma-his son killed himself two weeks earlier and likewise wasn't published) like you hear about deaths from heart attacks or at least not as much /c suicides because of the shame like stigma assocaited with it. There were 100's and more military individuals who have commited suicide while serving in the Afganistan or Iraq War. They didn't publish it though, but I know that there were countless numbers of individuals who took their own life (most PTSD) but the stigma attached with suicide especially a MARINE cannot be published as it would make us look weak. Find a friend of a friend who has been fighting over seas on the front zone and they'll tell you the truth about suicides but it's hush hush around the public.
The brain is so complex and no one might ever truly know the exact mechanism or there could be several reasons or mechanisms for various psychiatric disorders as we do know that environment and genetics have a role and in other disease too like heart disease. In Japan, heart disease is low (low risk genetically, lots of omega 3 fatty acids from seafood, over half the country or a very high number of individuals take CoQ10 as physicians recommend it?), and then the Japanese comes to America and then they start suffering from heart disease. Why?
Posted by CaptainAmerica1967 on October 21, 2011, at 15:40:57
In reply to Re: opiates and major depression » Chairman_MAO, posted by europerep on October 20, 2011, at 15:30:27
Yes, most physician look at you crazy if you suggested buprenorphine for TRD even some psychiatrists unless they have their specialized license to RX buprenorphine because they'd know about correlation or previous studies on bup. and mood
I just wished insurance companies would pay for buprenorphine, Subutex or Suboxone as off label like they do plenty of other drugs, ie, Inderal for migraines, trazodone as a hypnotic. I pay money for insurance (maybe I shouldn't buy part D for medicine, but I cannot buy any other insurance because TRD is a pre-existing condition so Medicare is all I can buy), and take 4 meds (Parnate, Klonopn, Subutex, Xyrem (Xyrem for REM sleep disorder), and the insurance company only pays for 1 (Parnate) with th rest denied.
I have osteoarthritis so the insurance approved liquid buprenorphine in the vial, Buprenex and I was going to use it like in the study and put it in an intranasal bottle or put required drops underneath my tongue but the Buprenex Vials total amount required for 4 mg day for a month was 3X as expensive than Subutex 4 mg day/month and I even got Suboxone approved off label for 4 mgs day/month, but Suboxone with insurance payment was still more expensive than Subtex 4 mg day/month for me so I just pay $100 for the Subutex a month. Last spring, 6 months ago when I first started taking Subutex, it cost $70 for 4 mg/month. In several years, I wonder how much I'll be paying? The drug companies almost charge what they want as addicts cannot go witout buprenorphine. I tried going off and got really super depressed this summer and went right back on. Need to start exercising gradually again, and not try to be HEMAN in the gym with running, weights and total workout, but it was the hard workouts that gave me the endorphin antidepressant relieve but only lasted a couple of hours so I had to exercise 2-3X day for effectiveness.
Thanks for all the responses in my previous posts as we all learn from each other to help one another overcome our various problems; just waiting for the day when scientists can at least learn how to control moods completely even if they cannot fix the root cause. Most conventional medicine is treat the symptoms anyways unless you're taking an antibiotic for an infection.
Posted by Chairman_MAO on October 21, 2011, at 18:22:37
In reply to Re: opiates and major depression » Chairman_MAO, posted by europerep on October 20, 2011, at 15:30:27
> My point was simply this: pharmacology matters.
>
> It matters when explaining to a doctor why giving buprenorphine to a patient with TRD is not like prescribing morphine, or for that matter, heroin.It matters more to drug-warriors and their sycophants, as well as physicians, because they have to live in fear of having their careers destroyed for prescribing opioids. It is very much like prescribing morphine or heroin. It is a different drug with a different receptor binding profile, but the only thing that matters is how someone feels. If buprenorphine works better, great. If heroin or methadone works better, great.
>It matters when trying to point out why the risk-benefit ratio with buprenorphine is better than with oxycodone or hydromorphone. And lastly, it matters when looking at what future drug treatments could or should look like.
Risk to who? Overdose is difficult; TCAs are more dangerous.
>
> That's all I wanted to say.I don't mean to sound snarky, but drugs are drugs, the statist apparatus notwithstanding.
Posted by CaptainAmerica1967 on October 22, 2011, at 2:14:54
In reply to Re: opiates and major depression » europerep, posted by Chairman_MAO on October 21, 2011, at 18:22:37
I don't care if a medication is addicting (going off an antidepressant is extremely very harsh too) at this point in my life if it will make me functional as the 100's of other medications/Tx's (antidepressants, other psychiatric labeled and off-labeled meds, small dose patch testosterone, UK meds unavailable in the USA, ECT, acupunture, meditation, spiritual tx John of God in Brazil(crystal colored lights tx, blessed passionflower which is an MAOI herb, supposedly a spirit (physician) enter your body from John of God to your body to fix the underlying cause of DZ-felt good for two month afterword-placebo?), supplements- nutraceuticals, herbs, mega vitamin tx, etc) didn't help, but only sleep deprivation, cold water treatment, and physical exercise helped with MAOI Nardil at the time and I'm sure I'll be on an antidepressant the rest of my life anyways and have been since I was 16y/o except for a two year period when I exercised 4Xs a day for at least 1 hour at a time(7AM,12PM,5PM,10PM) which if one has a career is almost impossible, but I was a pharmaceutical medical science liaison for those two years and one can get away when they want from work being in the field. Working out 4X/day probably was tough overall on my joints hence I have osteoarthritis (OS) at 44y/o (started @40y/o when I had to stop working out and left career) and one generally doesn't start to see OS in patients until their 60's and beyond.
I'm going to try the Butrans (buprenorphine patch)5 mcg/hr = 5 mg Subutex as I'm currently taking 4 mg Subutex a day and insurance will cover Butrans indicated for chronic pain, but not Subutex as I'm not an addict although my Dad(29y/o)died from a heroin/speed injection overdose when I was 5y/o in 1972 which I probably suffered from PTSD as I cried constantly as a child for no reason but my relatives, Mother didn't know why I cried but seeing him drop dead in front of me for a child of 5y/o can be traumatic.
Maybe I had the tendency or lack of opioids if he was using heroin/speed at the point of my conception but family members so no as he was in great shape, hadn't lost muscle, perfomed well at work and it was after I was conceived when he had semi lay-offs in his career and he started injecting heroin /c speed and lost all of his muscle mass, became thin (250pds to 200pds).
If physicians would think about the aspect that someone with treatment resistant depression that's tried everything including ECT that hasn't responded then why not try a low dose of an opioid like buprenorphine if they have their specialized license to RX buprenorphine as not all do from what I understand? Again, unless the patient has deep brain stimulation device implant, they will be on medications the rest of their life anyways.
Best wishes to all
Posted by europerep on October 22, 2011, at 7:19:07
In reply to Re: opiates and major depression » europerep, posted by Chairman_MAO on October 21, 2011, at 18:22:37
> It matters more to drug-warriors and their sycophants, as well as physicians, because they have to live in fear of having their careers destroyed for prescribing opioids.
They can have their careers destroyed regardless of whether they can rationally explain in front of an investigative panel the reasons for giving buprenorphine to TRD patients.
> It is very much like prescribing morphine or heroin.
Not according to the people who have done research on this for years and years. I trust them more than internet people.
> Risk to who? Overdose is difficult; TCAs are more dangerous.
Ever heard of that pesky addiction thing? Buprenorphine is a drug with abuse potential, like all other opiates. (The hypocrisy about giving Adderall to anyone with ADHD but not giving buprenorphine to TRD patients is a different story.) I agree that a risk-benefit assessment for bupe in TRD can be positive, but buprenorphine is not Prozac.
Posted by CaptainAmerica1967 on October 22, 2011, at 9:28:04
In reply to opiates and major depression, posted by androog on October 16, 2001, at 16:49:58
Go to the website The National Alliance Of Advocates For Buprenorphine or NAABT.org.
A psychiatrist needs a special DEA to RX buprenorphine and not all treat addiction even though you are looking for buprenorphine for refractory or treatment resistant depression.
The President, Richard Gracer, MD, even agrees that buprenorphine is very helpful in refractory depresed patients and quote said, "I believe that kappa overactivation may be an important cause of depression in many persons with substane abuse as well as the general population, even without the extra stimulation of opiate withdrawal."
"Most of these patients did not have a normal kappa system."
"I believe that these folks are taking the drug as an antidepressant and are not addicted to opiates anymore than othe depressed patients are addicted to Prozac. They need to continue the medication to treat their depression."
Posted by europerep on October 22, 2011, at 10:23:49
In reply to Re: opiates and major depression, posted by CaptainAmerica1967 on October 22, 2011, at 9:28:04
A psychiatrist in the USA needs a SAMHSA waiver if he or she wants to prescribe buprenorphine *as an opiate replacement*. Any psychiatrist (or physician) who can prescribe narcotics (that group contains almost all regular physicians) can prescribe buprenorphine off-label, for example for TRD.
Posted by CaptainAmerica1967 on October 22, 2011, at 13:30:37
In reply to Re: opiates and major depression » CaptainAmerica1967, posted by europerep on October 22, 2011, at 10:23:49
androog - there's a second answer. Hope you find one.
Posted by kirbyw on October 22, 2011, at 22:54:27
In reply to Re: opiates and major depression, posted by CaptainAmerica1967 on October 22, 2011, at 13:30:37
I have previously posted that vicodin gives me a lift when I am in a depressive episode. Even a small dose such as half of a 5/500 will give me a big lift for 6-8 hours. The problem is that I don't have a steady supply guaranteed, so I am saving the Vicodin from my last rx, in case of a serious episode. My regular meds are parnate, lithium and 2.5 mg of zyprexa. Since adding zyprexa I have put on 10 pounds, which I don't like at all. I can't determine if the zyprexa is helping or not.
Posted by CaptainAmerica1967 on October 23, 2011, at 3:39:45
In reply to Re: opiates and major depression, posted by kirbyw on October 22, 2011, at 22:54:27
> I have previously posted that vicodin gives me a lift when I am in a depressive episode. Even a small dose such as half of a 5/500 will give me a big lift for 6-8 hours. The problem is that I don't have a steady supply guaranteed, so I am saving the Vicodin from my last rx, in case of a serious episode. My regular meds are parnate, lithium and 2.5 mg of zyprexa. Since adding zyprexa I have put on 10 pounds, which I don't like at all. I can't determine if the zyprexa is helping or not.
Why don't you ask your physician straight out for Viocodin if it helps? Life is too short to have it wasted on being depression all of your life or at least that's how I feel. If you've had depression all of your life, you'll be on an antidepressant most likely the rest of your life which are also tough in withdrawal themselves. Some individuals the atypical antipsychotics work well, but they make me severely depressed and I've tried all of them for a good lenght of time. I even tried Amisulpride which in low doses is suppose to work as an antidepressant and anxiolytic, but all made me very tired, fatigued, and sleepy, depressed. Lithium I tried many times, but never felt anytime from it really although it's suppose to be a good prophylactic against depression/anxiety and increases brain derived nerve growth factor; I just worried about my kidney because of excessive workout session (sweating and ions) so whenever I tried it I used Lithium Orotate which is much more bioavailable supposedly and therefore can be used on less smaller of a dose, not sure as conflicting reports. It's over the counter.
Maybe print off a study for your physician like the Bodkin 1995 (Havard Study) or Richard Gracer, MD,President of National Alliance of Advocates for Buprenorphine Treatment, NAABT.ORG that wrote an article in March 2007 in the NAABT newletter educationg phyisician on the potential treatment of opioids (smaller doses than addiction) in general but more buprenorphine as it is currently the most potent longest acting kappa antagoinst which he thinks anyone with addiction or depression has a faulty mechanism in general of overactive kappa receptors leading to overactivity of the brain, There's even currently a clinicaltrials.org study for buprenorphine going on called "Buprenorphine For Late-Life Treatment Resistant Depression (BUILD)" where Reckitt Benckiser, Inc., the original developer of liquid buprenorphine who supplied bup. for the Harvard Bodkin 1995 study are supplying the liquid buprenorphine for this study so I wonder if this company, RB, is going to try to market a new form of buprenorphine indicated for treatment resistant depression. Again, liquid bup. given either intranally or squirted underneath the tongue in liquid like the original Bodkin study. Intranasally would be a new form if patented as companies come out with a liquid, chewable, long lasting/extended release or patch forms to hold onto patent to make more money so lets hope RB have plans on marketing bup to TRD patients with indication.
Posted by floatingbridge on October 23, 2011, at 8:24:43
In reply to Re: opiates and major depression » Aurora, posted by safire4hope on October 18, 2011, at 7:29:01
Hi Safire,
I have TRD and chronic pain. I respond fabulously well to tramadol and hydrocodine, though experienced gradual escalation. Does suboxone or bupererephrone (sp) escalate over time? If so I would probably skip. If not, I am very interested,
Is there a website to see if there is a dispensing doctor in my area? I can't say I have an addictive past. I would need t o present as TRD and chronic pain and as a very favorable
responder. Thank you.
Posted by uncouth on October 23, 2011, at 8:56:58
In reply to Re: opiates and major depression » safire4hope, posted by floatingbridge on October 23, 2011, at 8:24:43
I'm glad this thread is going. I have been looking into bupe. myself over the past few months. And I think I actually ordered some a long long time ago when I was in the worst of my horrible depression, suicidal, in 2009, when ECT didn't work. But I'm not sure I ever used them...
Anyway, I am in the process of contacting a few doctors in my area. I am not expecting much at all but will let you know at the minimum what they say.
I am wondering though, does anyone know the biology behind the opioid receptors in relationship to the other theories about depression? I mean, I get that opioids modulate pain and pleasure, but that's not the only thing wrong in depression. How does kappa antagonism, or mu agonism, or whatever, relate to the other theories behind depression or bipolar depression such as:
- monamine hypothesis
- glutamate overactivity at NMDA receptors
- increased oxidative stress and dendridit atrophy
- stress-related hippocampal atrophy
- sleep
= hormonal imbalance
- ketamine's rapid impact on depressionI mean I get that there is not one master key to fit the lock, but it seems crazy that bupe is working for even the sickest patients, who must be in a ton of pain, and seemingly fully resolving all the other symptoms. Is that true? Is it helping motivation, pleasure, positive affect, instead of just helping numb negative affect?
What are the hypotheses for the more dynamic effects that opioids have in the brain in terms of end results and neurogenesis, monamine regulation, etc....or perhaps the feelings of pleasure and numbing of pain sort of make life worth living again, and the normal parts of life that we all need to feel good are more easily attainable when one is not in a state of severe pain or severe angst or emptiness or existential despair, etc.
All I know is that when I was at my sickest, in 2009, when ECT didnt work and I wanted to die, and was actively making plans to kill myself, it is totally unconsciousable that I wasn't given opioids at that time if they could have helped. Unfortunately I wans't int eh right mind to think about that.
Uncouth
Posted by CaptainAmerica1967 on October 23, 2011, at 10:53:40
In reply to Re: opiates and major depression - Question, posted by uncouth on October 23, 2011, at 8:56:58
The biology or mechanism of action of bup being the longest and most potent kappa antagonist that has an blocking effect on the overactivity of the brain and seems to calm it down do to chronic stress. The prefrontal cortex and the limbic system, the nucleus accumbens is part of the pleasure center(dopamine)and seems to not be normal (overactive) in both addicted patient and depressed patients according to Richard Gracer, MD of The National Alliance Of Advocates For Buprenorphine Treatment or NAABT.org. I've heard that kappa antagonist also block dynorphin which is the opposite of endorphins and makes individual feel kind of lousy, and not euphoric. I personally feel buprenorphine has more anti-anxiety effect that any of the benzodiazepines.
So much of this was already covered in the below post that I will repost them; hopefully that's allowed here.
...
keeping opioid prescribers out of trouble pseudoname 11/10/05
Re: opiates and major depression Nieko 7/19/08
Re: keeping opioid prescribers out of trouble Crotale 7/21/08
Re: opiates and major depression » androog maree 7/22/08
Re: opiates and major depression Crotale 7/25/08
Re: opiates and major depression Crotale 7/25/08
Re: opiates and major depression » maree Nieko 8/27/08
Re: opiates and major depression » Aurora safire4hope 10/18/11
Re: opiates and major depression » safire4hope Chairman_MAO 10/18/11
Re: opiates and major depression » Chairman_MAO safire4hope 10/18/11
Re: opiates and major depression » safire4hope Chairman_MAO 10/18/11
Re: opiates and major depression » safire4hope CaptainAmerica1967 10/18/11
Re: opiates and major depression » Chairman_MAO safire4hope 10/18/11
Re: opiates and major depression » CaptainAmerica1967 Chairman_MAO 10/18/11
Re: opiates and major depression sigismund 10/19/11
Re: opiates and major depression » Chairman_MAO CaptainAmerica1967 10/19/11
Re: opiates and major depression » Chairman_MAO europerep 10/19/11
Re: opiates and major depression » europerep Chairman_MAO 10/19/11
Re: opiates and major depression » CaptainAmerica1967 Chairman_MAO 10/19/11
Re: opiates and major depression » CaptainAmerica1967 safire4hope 10/19/11
Re: opiates and major depression » Chairman_MAO europerep 10/20/11
Re: opiates and major depression CaptainAmerica1967 10/20/11
Re: opiates and major depression » CaptainAmerica1967 SLS 10/20/11
Re: opiates and major depression JohnLA 10/20/11
Re: opiates and major depression CaptainAmerica1967 10/21/11
Re: opiates and major depression - Question uncouth 10/23/11
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