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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 224 to 248 of 262. Go back in thread:
Posted by floatingbridge on October 27, 2011, at 9:29:14
In reply to Re: Looking into this » floatingbridge, posted by sigismund on October 24, 2011, at 14:48:43
>Rehmannia is Chinese and may possibly have something to do with endogenous steroid production. At any rate it is used for adrenal insufficiency (I think) and autoimmune diseases and fibro. I was told that Tian Wang Bu Xin Wan (of which it is an ingredient) would extend my life, which I took to be their polite way of saying they didn't like my chances at that point.
This is a formula I think they always give me. I need to go back. I also need to see my osteopath. He is amazing. And he only does soft tissue manipulation. He doesn't sell anything. I appreciate that. The psyiatrist who was alarmed because I said tramadol had a nice mood effect tried selling me all sorts of sh*t.
Btw, I entered (anonymously) the database for suboxone treatment. I said for fibromyalgia and that I was not taking any opoids or narcotics. I get these email messages from doctors that say things like, I have read your application and would be happy to help you with your dependency issues. It's very silly.
Posted by sigismund on October 27, 2011, at 10:20:05
In reply to Looked into this » sigismund, posted by floatingbridge on October 27, 2011, at 9:29:14
You'd have to be careful they didn't want to whack you onto a high dose.
Posted by europerep on October 27, 2011, at 10:33:41
In reply to Re: Looked into this » floatingbridge, posted by sigismund on October 27, 2011, at 10:20:05
> You'd have to be careful they didn't want to whack you onto a high dose.
Good point. In fact, even the 2mg Subutex are actually designated for opiate replacement therapy. Buprenorphine against pain starts at 0.2mg (Temgesic), and there is also an 0.4mg formulation (Temgesic forte). This is over here at least. Buprenorphine for depression can be a little higher than that, but for some people a dose around 1 mg is perfect. The Subutex 2mg can be split though, so they may be of use nonetheless.
Posted by floatingbridge on October 27, 2011, at 11:47:56
In reply to Re: Looked into this » sigismund, posted by europerep on October 27, 2011, at 10:33:41
As I read, I noticed that. I thought a 2mg starting dose would have some severe side-effects for me.
I have run into that name Temgesic here, so the States must have it.
The entire thing is on hold. I'm lucky to get gabapentin for pain at this point.
I have read two things. The first is there is supposed to be no escalation. The second, which I am not sure is true, it that I read instead of sensitizing the opoid receptors the active ingredient gives them a rest, or as one person put it, 'helps heal them'. I find this a little too good to be true myself.
Obviously, I don't know the scientific terms of this discussion....
Posted by sigismund on October 27, 2011, at 21:27:33
In reply to Re: Looked into this » europerep, posted by floatingbridge on October 27, 2011, at 11:47:56
> I read instead of sensitizing the opoid receptors the active ingredient gives them a rest, or as one person put it, 'helps heal them'. I find this a little too good to be true myself.
Just more ideology. What is the score? I forget. It is a partial agonist, an inverse antagonist or what? Anyway, after a certain point, the more you take the less it works. So the mu opiate recptors can't be maxed out, if that is what is meant.
Posted by floatingbridge on October 27, 2011, at 22:00:45
In reply to Re: Looked into this, posted by sigismund on October 27, 2011, at 21:27:33
>just more ideology
Yes, of course. Frankly, if that were the case, it should be put in the water like floride.
I really have no idea what it's about. You know much more than I do.
There is something about the way the chemical binds to the mu receptors--very tightly, so it knocks everything else out of the way. That is not the naloxone or whatever, it's the Bupe that does this.
Posted by sigismund on October 28, 2011, at 3:45:10
In reply to Re: Looked into this » sigismund, posted by floatingbridge on October 27, 2011, at 22:00:45
> Frankly, if that were the case, it should be put in the water like floride.
You make me laugh.
There this stuff about two things minimalising tolerance
1. memantine
2. That opiate antagonist thing that I have forgotten. often put in with bupe so if you inject it nothing happens in spite of the venotoxicity.
Posted by alchemy on October 31, 2011, at 19:54:54
In reply to opiates and major depression, posted by androog on October 16, 2001, at 16:49:58
> I have suffered from depression for over 30 years and have tried about every antidepressant on the market to no avail. I've even had 17 sessions of ECT which left me with nothing more than a bad memory and a huge bill.
Tears are flowing with hearing about the 30 years of depression. I am about to turn 39 and I am almost at 30 years at well. I've had ECT, TMS, and meds galore. To be so close to 40 with no progression in any area, because it's a challenge to get through the day.
I support opiates being used for depression at a certain point. You definitely have reached that point.
I didn't feel anything from Percocet. Doesn't that have some opiate in it?
Posted by Chairman_MAO on October 31, 2011, at 20:59:05
In reply to Re: opiates and major depression » Chairman_MAO, posted by europerep on October 25, 2011, at 12:31:38
> > You are so snarky I really don't know how to respond. "Abuse potential"? You mean something that someone wants to take? No, buprenorphine is not Prozac. It is a much better drug with greater efficacy which has not been documented to induce dysphoric mania leading to suicides.
>
> Can you present any evidence for buprenorphine not having potentially severe side effects in psychiatric patients? I doubt it.
>
Which "side effects" (in pharmacology, there are only effect, "side effect" is a value judgement) would these be exactly? How am I supposed to prove a negative?> > Addiction? A vast majority of people that take narcotics do not develop an "addiction"--which in and of itself is a value judgement.
>
> Addiction is a quite valid concept, and concern over it is absolutely warranted. Your "vast majority of people" is pretty vague by the way.
>
http://peele.net/lib/moa3.html
http://www.globalizationofaddiction.ca/Two internationally recognized authorities. Enjoy.
> > Everyone has a right to drugs, period.
>
> That's a valid opinion, however, there is this thing called "reality". In reality, you need good reasons for giving opioids to patients (including pain patients). That too is warranted.
>
No, really, in reality there is thing called the "constitution", and with decisions such as Roe v. Wade and the abolition of slavery, I own my body. I decide what goes in it. If I am not harming anyone, leave me alone. If I harm someone, then punish me.> I'm not sure whether we're not talking past each other. I have tried both buprenorphine and more "typical" opioids for my TRD, and I am thankful for the open-mindedness of my doctor who prescribed me the latter (the buprenorphine thing was a little more complicated, but that's not relevant here). So I totally think these substances have a place in psychiatry. However, *precisely because* they have a place in psychiatry, they should be used with care.
All drugs should be used with care. The brute fact is that we know more about the long-term effects of opioid use than we do about SSRIs. They are generally benign.
> Nothing is worse than a legislative backlash after some ill-informed journalist writes an article about opioid prescribing behaviors, which then makes the situation even worse for those patients in need of these drugs.
Yeah, which is why we should be protected from these idiot legislators and our right to drugs restored.
Posted by floatingbridge on November 1, 2011, at 0:41:16
In reply to Re: opiates and major depression, posted by alchemy on October 31, 2011, at 19:54:54
Hi Alchemy,
I'm not sure. Yes, percocet is opiate based. Suboxone has buprenorphine which is semi-synthetic, so I think it works as a partial agonist. It may have other qualities too, that set it apart from an regular opiate. Maybe someone can comment on this.
I have heard that some people are not opiate responders. I don't know what that means regarding suboxone response or if your experience with percocet falls within that category.
I certainly am sorry you have endured depression this long.
Hugs to you.
Posted by CaptainAmerica1967 on November 1, 2011, at 4:48:31
In reply to Re: opiates and major depression, posted by alchemy on October 31, 2011, at 19:54:54
> > I have suffered from depression for over 30 years and have tried about every antidepressant on the market to no avail. I've even had 17 sessions of ECT which left me with nothing more than a bad memory and a huge bill.
>
> Tears are flowing with hearing about the 30 years of depression. I am about to turn 39 and I am almost at 30 years at well. I've had ECT, TMS, and meds galore. To be so close to 40 with no progression in any area, because it's a challenge to get through the day.
>
> I support opiates being used for depression at a certain point. You definitely have reached that point.
>
> I didn't feel anything from Percocet. Doesn't that have some opiate in it?You're lifelong history sounds similar to mine possibly; over 100 medications (labeled and off labeled, some non-FDA or UK approved meds) in my lifetime since this dreadful disease started when I was 16y/o and am currently 44y/o equals 28 years but feels like more as I used to use sleep deprivation two to three nights in a row a week while on Nardil by being on a super high dose (increases cortisol too) but as soon as I got any amount of REM sleep, back to the TRD ( I also have REM sleep disorder-muscles aren't paralyzed during REM sleep and like most depressed patients, fall into REM sleep too quickly-shortened REM latency, but the sleep deprivation made me feel completely normal for those days except being sleepy (my brain had to have calmed down from overactivity without recharging via REM sleep deprivation-same theory with Deep Brain Stimulation now that all depressed patients have overactive brain area's as shown on PET and SPECT SCANs and only with remission of depression does the brain calm down to being normal-instead of overactivity of blood flow/uptake of glucose; DBS by constantly stimulating certain areas of the brain like stimulants calm the ADHD patient, calm the overactive TRD patient's brain but after 15 years of sleep deprivation and several close calls of being in an accident, I gave it up.
The 70 ECT at the age of 18-19y/o in 1985-1986 didn't have any positive effect or help and I developed REM sleep disorder/behavior after all of the ECTS, but don't know if it caused it.I haven't been on psycho-babble for awhile until several weeks ago when I mentioned the positive effect buprenorphine for the refractory depressed patient, particularly the only kappa opioid antagonist in use and in my belief from readiing and in the minds of some other physicians, psychiatric researchers, believe that this is the reason behind bup (Subutex's) success with severe, chronic, daily treatment resistant depression even with anxiety. Bup calms the brain by blocking kappa receptors that seem to be overactive as stated by Richard Greer, M.D. of NAABT. Several pharmaceuticals being worked on as kappa opioid antagonist.
If you've been depressed that long like me, I'm willing to try almost anything that isn't going to kill me or severely damage me in any way. You'll take an antidepressant the rest of your life of some form so physicians or the FDA that get upset with psychiatrists that RX buprenorphine for depression is wrong. Would they rather you kill yourself or not have an active or productive live just because there's a potential for addiction with buprenorphine but a lot less than other opioids. I've tried tramadol and it didn't do much and morphine in the ER which made me feel better but not better like buprenorphine.
I'm surprised you tried TMS after having had ECT (unless you tried TMS first)as most psychiatrist or the ones I've spoken to like Ivan Goldberg, M.D. (Depression Central website) who only treats the toughest of all patients, says he tells his patient not to waste their money on TMS if they've already had ECT and ECT didn't help. Remember, some psychiatrist are business professionals too wanting to make tons of money and if they have spent money on a TMS machine/device (very expensive) and you walk into their office and tell them you've already tried ECT, they might say I think you stil should try the TMS device when I think it would be a waste of money.
My goal is finish my medical autobiography with tips that psychiatrist never mention including physical exercise, cold water-shower-bath therapy, sleep deprivation and some others and my whole experience and thoughts about the disease in a way to prevent suicide in the future as suicide (not all suicides from depression, but many are) according to the World Health Organization thinks it likely that suicide will be the number 2 killer second only to heart disease by the year 2020. Many suicides aren't reported and that's why it's not ranked higher currently, but that will change in the near future.
Best wishes in trying buprenorphine-Subutex if you plan to try it. 1995 Harvard Study by Bodkin and currently a clinicaltrials.org is studying the effects of bup in late life TRD (BUILD study?).
I'm waiting for a DBS study even though I've tried to get into two but was excluded because I had several seizure on 1000 mgs of trazodone or medication induced seizure, but will without that part out and that I had 70 ECT as the same psychiatrist did both and will always get excluded from a study as they want no other history of any neurological problems whether drug induced or having an actual disease.
Posted by SLS on November 1, 2011, at 5:40:40
In reply to Re: opiates and major depression, posted by CaptainAmerica1967 on November 1, 2011, at 4:48:31
Hi.
> Best wishes in trying buprenorphine-Subutex if you plan to try it. 1995 Harvard Study by Bodkin and currently a clinicaltrials.org is studying the effects of bup in late life TRD (BUILD study?)
Would you be able to post a link to the study?Thanks.
I am hoping that I won't need buprenorphine, but I guess I should start working on my doctor now to try to get him to change his mind. He doesn't want to use it on me.
- Scott
Posted by europerep on November 1, 2011, at 13:39:29
In reply to Re: opiates and major depression » europerep, posted by Chairman_MAO on October 31, 2011, at 20:59:05
> Which "side effects" (in pharmacology, there are only effect, "side effect" is a value judgement) would these be exactly? How am I supposed to prove a negative?
Well, how about "dysphoric mania leading to suicides"? You seem to feel quite strongly about that one. Can you point to any study that says that buprenorphine treatment in TRD bears no risk of dysphoric mania leading to suicide? No, because there are no such studies. Until such types of studies are done, buprenorphine has to be considered an experimental treatment to be administered with caution.
> http://peele.net/lib/moa3.html
> http://www.globalizationofaddiction.ca/
>
> Two internationally recognized authorities. Enjoy.Really? That are your sources? Seriously?
> No, really, in reality there is thing called the "constitution", and with decisions such as Roe v. Wade and the abolition of slavery, I own my body. I decide what goes in it. If I am not harming anyone, leave me alone. If I harm someone, then punish me.
Another alternative reality. I don't really know anyone, other than internet people, who think that the constitution enshrines the right to buy any drug you want to get.
I'll consider this discussion over though. If you believe to be denied a fundamental right, sue. Oh no wait, all those judges and justices out there are just paid by people who want to make you take SSRIs for the rest of your life.
Posted by CaptainAmerica1967 on November 2, 2011, at 11:28:30
In reply to Re: opiates and major depression » CaptainAmerica1967, posted by SLS on November 1, 2011, at 5:40:40
> Hi.
>
> > Best wishes in trying buprenorphine-Subutex if you plan to try it. 1995 Harvard Study by Bodkin and currently a clinicaltrials.org is studying the effects of bup in late life TRD (BUILD study?)
>
>
> Would you be able to post a link to the study?
>
> Thanks.
>
> I am hoping that I won't need buprenorphine, but I guess I should start working on my doctor now to try to get him to change his mind. He doesn't want to use it on me.
>
>
> - Scott
--------------------------------------------------There are actually two studies with buprenorphine going on; the current clinical trial on late life TRD (Build) and one that hasn't started yet (BUO-TRD) both in Pittsburg, PA
http://clinicaltrials.gov/ct2/show/NCT01071538
http://clinicaltrials.gov/ct2/show/NCT01407575I can no longer find the original Bodken 1995 Harvard Study using "liquid buprenorphine" which is 50% more bioavailable squirting under the tongue with the max dose in the study 2mg/d compared to sublingual tablet (Sutuex) with a max dose of eqivalent to 4mg/day.
I end up paying cash even with insurance for the Subutex or about $100 a month but if you're an addict, I think nearly 100% is covered which isn't right because many meds are used off label; Inderal (propanolol) for mirgraine, trazodone as a hypnotic or Tricyclic Antidepressant (Anti-Cholinergic effect) to prevent enuresis or bedwetting, but the last two are only classified as antidepressant.
I have osteoarthritis and the lowest dose of the new Buprenorphine patch (Butrans) is 5mcg/micrograms per hour or eqivalent to 5mg of Subutex-bupreneorphine, 1 more mg than I'd normally be taken but at least I wouldn't be forking out $100 of my own each month.
The Suboxone has the anti-addiction medication naloxone mixed with the buprenorphine at a 4:1 ratio (bup to nal) which may or may not help the addiction process (very doubleful as I worked as a clinical pharmaceutical consultant and I know the tricks pharmaceutical companies play once a medication goes generic and when Subutex went generic, they can out with Suboxone which isn't better than Subutex but several times more expensive, but I actually got my insurance to cover the Suboxone instead of the Subutex, but I know why; the cost of Suboxone was about 3-4x that of regular buprenorphine and Suboxone even more expensive with insurnace coverage so I opted to stay on Subutex but hope to get Burans patch which should be covered for me but my psychiatrist has been hesitant to go to it either thinking it's not as effective or the 1mg more of buprenorphine. I'm thinking more cash in my pocket and maybe even feeling better wtih 5mg of bup.
I got Buprenex (injectable liquid bup) covered as I have osteoarthritic pain and any physician can RX it without a triplicate, vial of buprenorphine for injection which mens you'd really become addicted, but like the Harvard study I would just squirt bup underneath my tongue or use intranasally (more bioavailable) but to get close to the dose of Harvard study of 2mg, I would have had to buy so many vials that it was 3-4x the cost of Subutex tablet equal 4mg of the tablet buprenorphine (Subutex) used sublingually with insurnace still and that's why I stay with the 2mg of Subutex twice a day which equals the max of the Harvard liquid bup. The only problems that all psychiatrist have is that the darn FDA will not recognize opioid as valid treatment for refractory depression, but believe just like herbal or integrative medicine that the view will change over the years.
Posted by JahL on November 2, 2011, at 14:10:48
In reply to Re: opiates and major depression » CaptainAmerica1967, posted by SLS on November 1, 2011, at 5:40:40
> I am hoping that I won't need buprenorphine, but I guess I should start working on my doctor now to try to get him to change his mind. He doesn't want to use it on me.
>
>
> - ScottHey Scott.
I haven't posted here in a few years so I'm a little vague on your current situation. Can I ask what your experiences of opiates are, if any? I ask because the description you give of your illness resonates with my own like no other I have read here - and I first started posting back in '99! Like yourself, I have trialled 60, maybe 70 'meds', with only sporadic and muted success. However, codeine excepted, every opiate I have ever tried has brought about a swift and tolerable improvement. My problem is that here in the UK the more potent opiates - which I believe might bring about something resembling full remission - are not available. Anyway, feel free to interrogate me if you think it could be of any help :)
Best wishes,
J
Posted by SLS on November 2, 2011, at 14:31:09
In reply to Re: opiates and major depression » SLS, posted by JahL on November 2, 2011, at 14:10:48
Hey JahL!
It has been a long time. When I saw your name, it brought a smile to my face and triggered a few distant memories.
I am just about out the door, so I'll write more later. I just wanted to say hi.
Be well.
- Scott
Posted by europerep on November 2, 2011, at 15:15:49
In reply to Re: opiates and major depression, posted by CaptainAmerica1967 on November 2, 2011, at 11:28:30
Thanks for posting that link, I wasn't aware of that new study to be done in Pittsburgh. I wish it were bigger in terms of patients participating, but a placebo-controlled study sure is a step in the right direction.
Again, thanks for that...
Posted by Chairman_MAO on November 3, 2011, at 19:38:25
In reply to Re: opiates and major depression » Chairman_MAO, posted by europerep on November 1, 2011, at 13:39:29
Then you obviously don't know very many people who have read the constitution or know about the history of prohibition.
Bruce Alexander and Stanton Peele are two very reputable sources.
http://en.wikipedia.org/wiki/Rat_Park
On what basis do you think alcohol prohibition was overturned? I mean, really, it's not my fault that you haven't met any people in real life that don't know about drug policy.
Posted by europerep on November 4, 2011, at 9:45:53
In reply to Re: opiates and major depression » europerep, posted by Chairman_MAO on November 3, 2011, at 19:38:25
So you accept those studies that say what you want them to say and dismiss all others?
The point is, we are starting from different premises. You want the doctors who stand between patients and narcotics to be gone - I want them to be better.
Anyhow, good luck with that "addiction isn't real" thing. (Yes, this is a straw man argument, but your argument is almost equally absurd.)
Posted by CaptainAmerica1967 on November 4, 2011, at 10:09:01
In reply to Re: opiates and major depression » CaptainAmerica1967, posted by europerep on November 2, 2011, at 15:15:49
> Thanks for posting that link, I wasn't aware of that new study to be done in Pittsburgh. I wish it were bigger in terms of patients participating, but a placebo-controlled study sure is a step in the right direction.
>
> Again, thanks for that...
----------------------------------You're welcome. I'd just like to see the pharmaceutical companies branch out on their R&D like buprenorphine or other mechanism of actions instead of just "tweaking current drug formulas as opposed to developing new classes of molecules". http://www.dana.org/media/detail.aspx?id=5392
Beyond those of us with resistant disorders, there are those 40% of patients that don't respond at all to anything even though they might not be as deeply depressed
Posted by Chairman_MAO on November 10, 2011, at 5:45:36
In reply to Re: opiates and major depression » Chairman_MAO, posted by europerep on November 4, 2011, at 9:45:53
> So you accept those studies that say what you want them to say and dismiss all others?
>
How many studies, exactly, do you want me to cite? Those were just two researchers. What studies are you citing? We're talking about something conceptual here; you have to start there first before one even begins to look at studies. What do you want me to demonstrate?> The point is, we are starting from different premises. You want the doctors who stand between patients and narcotics to be gone - I want them to be better.
>No, I don't want doctors to be gone. I want people to consult with doctors because they want to, not because they have to. That would have the effect of making doctors be better because they'd have to be in order to make money. You can be a professor of pharmacology at a medical school and know more than most doctors about drugs, and yet you need a permission slip to buy one. That doesn't make a bit of sense to me whatsoever, especially given that we're able to buy cigarettes and alcohol at the corner store.
> Anyhow, good luck with that "addiction isn't real" thing. (Yes, this is a straw man argument, but your argument is almost equally absurd.)
Posted by psychobot5000 on November 14, 2011, at 15:08:11
In reply to Re: opiates and major depression » europerep, posted by Chairman_MAO on November 10, 2011, at 5:45:36
Europerp: throughout this conversation I find your responses to the very helpful and knowledgeable Chairman_MAO to be rather haughty and ungentlemanly (or unladylike?). I don't see the need for any of it.
As for some questions earlier about buprenorphine's pharmacology, I don't think I saw them answered. I will attempt to do so. It's a partial agonist of mu-opioid receptors (meaning it only partway activates those receptors once it binds, so there's a lower 'ceiling' to its effect, no matter how many receptors it binds to), but has -very- -high- affinity for those receptors, so, yes, it attaches to them strongly and can displace some other medications. It's also, if I remember correctly, a kappa-opioid antagonist, but I'm skeptical about how important that is to its mood benefits.
I have been prescribed suboxone for TRD, and a quarter of a 2mg (so .5mg buprenorphine plus whatever nalaxone was in it) pill bowled me over. I'd recommend starting from .2mg and building from there.
Also, for that matter: there was confusion, above, about the second ingredient in suboxone is. It's nalaxone, the opiate antagonist used to prevent abuse by injection, not nalTREXone, the opiate antagonist used for various other things, including, I've heard, preventing tolerance.
Posted by SLS on November 15, 2011, at 6:52:28
In reply to Re: opiates and major depression » SLS, posted by JahL on November 2, 2011, at 14:10:48
> > I am hoping that I won't need buprenorphine, but I guess I should start working on my doctor now to try to get him to change his mind. He doesn't want to use it on me.
> I haven't posted here in a few years so I'm a little vague on your current situation. Can I ask what your experiences of opiates are, if any?
I have no experience with opiates.
> I ask because the description you give of your illness resonates with my own like no other I have read here - and I first started posting back in '99! Like yourself, I have trialled 60, maybe 70 'meds', with only sporadic and muted success.
I really don't know what keeps us going.
> However, codeine excepted, every opiate I have ever tried has brought about a swift and tolerable improvement.
Which opiate did you think was best?
Thanks, JahL
- Scott
Posted by Chairman_MAO on November 15, 2011, at 6:59:49
In reply to Re: opiates and major depression » JahL, posted by SLS on November 15, 2011, at 6:52:28
http://en.wikipedia.org/wiki/JDTic
Holds a lot of promise.
Posted by europerep on November 15, 2011, at 18:07:12
In reply to Re: buprenorph dosage and pharmacology, posted by psychobot5000 on November 14, 2011, at 15:08:11
> Europerp: throughout this conversation I find your responses to the very helpful and knowledgeable Chairman_MAO to be rather haughty and ungentlemanly (or unladylike?). I don't see the need for any of it.
>Well, if you want criticize me for being disrespectful, you might start by writing my name correctly maybe?
Besides that though, my point is simply that raging an internet war against psychiatrists who don't say "hey, take some tramadol" upon being told that a first trial of fluoxetine wasn't successful, is pointless. It's just not gonna solve anyone's problems.
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