![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by YoYoMe on November 15, 2003, at 22:55:51
It may be a scary notion, and they're certainly not for everyone, but has anyone noticed lately that it just may be so? I wonder. The only legitimate investigation into it that I could find says that of 7 very depressed people in a month trial, 6 got much better. One got worse. All 6 felt less fatigue and more vigor, and a couple said they felt "more normal." My own experience tells me they are a sure-fire quick jump start and mood elevator, though prescribing them would be crazy, as docs can't be sure that you won't forget your thinking cap and succumb to addiction, even with, say, ample brains and talent on loan from God. But for me, the feeling normal is more important than any fleeting euphoria. I know better than to chase that, and I know to be ever vigilant. Anyway, for this group, improvement happened fast - within one week - not slowly like most depression-fighting drugs. Two of the people in the trial went from very depressed to very happy in week one, and stayed that way for at least 2 years. That, among other things, “argues against this being a placebo response,” says the doc who did this study. He thinks maybe what’s broken in some of our brains when they get low on happiness has more to do with abnormalities in natural opioid neurotransmission than with serotonin. He claims dead people who’ve killed themselves have nine times more opioid receptors than dead people who haven’t! What do you make of that? Am I the only one noticing this?
Posted by rxnurse on November 16, 2003, at 20:03:58
In reply to Might Opiates in Moderation Fight Depresion?, posted by YoYoMe on November 15, 2003, at 22:55:51
I understand what you are trying to say here. I can say with experience, opiates generally do provide short term alleviation of depressive symptoms. However, they are only short term and the risks involved including dependency and addiction greatly outweigh the benefits of using them! Opiate addiction can happpen very rapidly with usage, no matter if your doctor is following your dosage carefully or not. In a short period of time the euphoric effects of the opioid will diminish, facilitating the need for a higher dosage. There starts the viscious circle that so many people get caught up in, many times unintentionally! With some people opiates create dysphoria, mimicking depressive symptoms. I don't see doctors ever prescribing opiates for depression. They are just too dangerous and addictive. However, who knows?????
Posted by bsj on November 23, 2003, at 21:09:26
In reply to Re: Might Opiates in Moderation Fight Depresion?, posted by rxnurse on November 16, 2003, at 20:03:58
I'll say straight up that I take Wellbutrin plus 10mg of hydrocodone twice a day; I went through the antidepressant mill for five years before finding out how well hydrocodone works (including a stint on Adderall; I had to quit it because
I started having panic attacks).As for addiction: amphetamine (Adderall) is also considered an addictive drug, and in the two years I took it I had no problems. My dose was upped slightly around the 18 month mark because tolerance does occur--as it does with _all_
medications. I've yet to notice any tolerance at all with the hydrocodone, though, and it's been several months so far. The only drawback is that
hydrocodone causes physical dependence--then again, so do SSRIs and Effexor (I ended up in the ER when I went off Paxil--they thought I was a junkie going through withdrawal until my psychiatrist showed up; Paxil withdrawal
is nasty in the extreme).For some people there may be a danger of psychological addiction, but in some
cases opiates are simply as last resort to help restore someone's life. Without hydrocodone, I'd probably be dead, and that's no exagerration. The drug works for me with a minimum of side effects. Any psychiatrist who'd be reluctatant
to prescribe opiates for a refractory case because of addiction worries should have
his license revoked and be run out of town on a rail. Then I guess even among psychiatists there are those who believe one is better dead than addicted; it's part of the modern-day drug mythology.
Posted by bsj on November 23, 2003, at 21:21:37
In reply to Might Opiates in Moderation Fight Depresion?, posted by YoYoMe on November 15, 2003, at 22:55:51
>All 6 felt less fatigue and more vigor, and a >couple said they felt "more normal."
That's most certainly been my experience. I don't get high on hydrocodone--at least not what I'd consider to be high, though the drug certainly provides a noticable effect. As for the addiction boogeyman: it's more imagined than real; it's standard practice to use psychostimulants for refractory cases, and amphetamine and Ritalin have just as much abuse potientual as opiates do. (I was on Adderall, which is mixed isomers of dextroamphetamine, for two years.)
As for depression being caused by a malfunction in the opioid system: quite possible in some cases (it's highly unlikely that the bundle of symptoms we call "depression" is due to any single cause, which is why no single medication works for everyone). I can't really detect any qualitative difference between the suffering caused by physical pain and that of depression; depression--for me at least--is the suffering of physical pain without the physical sensation of pain. They seem to be one and the same thing.
Posted by YoYoMe on November 27, 2003, at 21:55:31
In reply to Re: Might Opiates in Moderation Fight Depresion?, posted by bsj on November 23, 2003, at 21:09:26
Well said, bsj. But I'm puzzled by your comment about "any psychiatrist reluctant to prescribe opiates for [depression]." I was under the impression that almost all psychiatrists were not only reluctant, but dead-set opposed. Now I have exactly three things with which to try in vain to persuade mine otherwise: (1) my experience, (2) your experience, and (3) this 1995 study by Dr. Bodkin. Do you know of any other less anectdotal persuaders? Dr. B's statistic on the huge number of opioid receptors in the brains of people who've killed themselves seems pretty dramatic, at least to a layman like me with no schooling in biochemistry, but some common sense and fondness for feeling normal.
Posted by MysticalMeds on November 28, 2003, at 16:07:53
In reply to Re: Might Opiates in Moderation Fight Depresion?, posted by bsj on November 23, 2003, at 21:09:26
bsj, does the same doctor who perscribes your wellbutrin give you the hydrocodone? what time of day do you take the 2 pills?
YoMeMe,
try http://opioids.com & www.biopsychiatry.com
there's no doubt in my mind that opium derivatives are the only way that a small percentage of people with depression will ever truly feel normal. As i am of limited means, i excercise daily, which releases endogenous opioids, equivalent (subjectively) to maybe 2 or 3 milligrams of hydrocodone.***********
In classical antiquity, Aristotle - admittedly not always the soundest authority on medical matters - classified pain as an emotion. Opium was a traditional remedy for melancholic depression; its efficacy is arguably superior to Prozac, though controlled clinical trials are lacking. In "animal models", opioids reverse the depressed behavior, learned helplessness and neuroendocrine responses associated with clinical depression. By contrast, opioid antagonists such as naloxone exacerbate them. To confuse matters further, sufferers of depression typically share an increased sensitivity to pain; and modern "antidepressants" can themselves act as "physical" painkillers. Conversely, mu-opioid receptor agonists offer both unsurpassed pain-relief and extraordinary emotional well-being; and delta-opioid agonists and enkephalinase inhibitors can function as antidepressants. There is clearly an intimate link between "physical" and "emotional" pain. In defiance of dualist metaphysics, the opioids tend to be best at banishing both.
Posted by bsj on November 28, 2003, at 22:57:30
In reply to Re: Might Opiates in Moderation Fight Depresion?, posted by MysticalMeds on November 28, 2003, at 16:07:53
"bsj, does the same doctor who perscribes your wellbutrin give you the hydrocodone? what time of day do you take the 2 pills?"
I'm between doctors at the moment, but using the WB script from the last one; I left him because he refused to consider hydrocodone. I usually take the first 10mgs of hydrocodone with the WB when I get up; and the second dose just before lunch.
Posted by bsj on November 28, 2003, at 23:03:51
In reply to Re: Might Opiates in Moderation Fight Depresion? » bsj, posted by YoYoMe on November 27, 2003, at 21:55:31
"I was under the impression that almost all psychiatrists were not only reluctant, but dead-set opposed."
Pyschiatry is a secular religion, complete with heresies. But there _are_ heretics, I'm sure; I hope to find one.
"Now I have exactly three things with which to try in vain to persuade mine otherwise: (1) my experience, (2) your experience, and (3) this 1995 study by Dr. Bodkin."
It's probably a waste of your time to try to persuade your doctor; it'd be like trying to get the Pope to reject transubstantiation. Evidence will not convince those who are opiophobic; opiophobia, like all phobias, is irrational and not subject to argument.
Posted by bsj on November 29, 2003, at 10:00:58
In reply to Re: Might Opiates in Moderation Fight Depresion?, posted by MysticalMeds on November 28, 2003, at 16:07:53
A short history of the medical use of opiates:
In the late 19th and early 20th centuries, not only could you buy opiates freely, but they were in practically every kind of medication
and remedy available. In a way, the excessive use of opiates in that era paved the way for modern opiophobia in the medical establishment;
opiophobia is a knee-jerk reaction to the very scattershot and disreputable medicine of the past, where heroin, e.g., was used to quiet (sometimes permanently) fussy infants.Opiates were used to treat some cases of depression up until the 1950s, when the first crude antidepressants became widely used. It was assumed then that ADs could completely replace all other medications for depression--which,
of course, wasn't true, but now doctors had an excuse not to use opiates: they could push the new ADs instead. Then the political and social developments of the next 20 years, Nixon's drug war in particular, would ensure that opiates
would never again see psychiatric use. Even today medical schools drill opiophobia into their students, so that not even pain patients who need the drugs get them in the necessary quantities. It's partly the fault of doctors and partly the fault of agencies like the DEA, who regularly yank the power to prescribe controlled substances from doctors (or threaten to yank; all it
takes is a bit of fear).The dogma of opiophobia goes something like this: opiates are powerfully addictive drugs that, if used in any quantities for an extended length of
time, will cause addiction and completely destroy the lives of those who take them. The distinction between physical dependence and psychological dependence is rarely taken into account; even though the two are very
different things, it's assumed that one goes hand in hand with the other--i.e., that psychological addiction is inevitable. This is the most dubious
part of the dogma, and flat out false; most chronic pain patients never have problems, e.g. Opiophobia ascribes to opiates powers that they don't have--viz, the power to turn any user into a hopeless slave. Does this happen? Sure.
Is it inevitable, or an excuse not to try opiates for refractory cases of depression? Absolutely not. I'd argue that stimulants are, on the whole,
far more dangerous drugs, yet their use in refractory cases is well established. The exclusion of opiates from the antidepressant arsenal is arbitrary and motivated primarily by political concerns, not medical ones.(On the subject or mental and physical pain: I can't discern any real qualitative difference between the two; the fact that we tend to think of them as separate things is a legacy of the Western mind-body distinction, going back to Descartes.)
Posted by rxnurse on December 3, 2003, at 16:22:26
In reply to Re: Might Opiates in Moderation Fight Depresion?, posted by bsj on November 29, 2003, at 10:00:58
BSJ:
I have a terrific idea for you that will solve your dilemma concerning your philosophy on opiates for antidepression treatment: go to medical school and become a pioneer for your cause! Maybe you could start a trend?
I spoke with several doctors at work last week and they all think using opiates for treating depression is unwarranted and dangerous. That opinion seems pretty unanimous. These are doctors who willingly prescribe patients narcotics for physical injury and pain, as well. I know several people who have had narcotics prescribed for post-operative pain over a couple of months who have gotten addicted, despite taking them as directed! It's a catch-22 situation, I guess??????
Posted by YoYoMe on December 3, 2003, at 23:01:05
In reply to Re: Might Opiates in Moderation Fight Depresion?, posted by rxnurse on December 3, 2003, at 16:22:26
Nice idea, RX Nurse. I don't know about B.S.J. but YoYoMe is way too O.L.D. for med school. I'll just hafta wonder, and stay tuned. Today NPR quoted June Dahl, professor of pharmacology at the University of Wisconsin, on the subject of what she calls "opiophobia, or the fear of causing addiction to opioids." Reasonable people still disagree over the wisdom of what's commonly taught, and what's commonly taught still deserves to be continually challenged, 'til we get this right. Meanwhile, has anyone thought of a theory of why dead people who've killed themselves have 9X more opioid receptors than regular dead people? And I wonder what science there is behind BSJ's perception that physical pain and psychic pain are of the same fabric?
Posted by bsj on December 4, 2003, at 15:22:54
In reply to Re: Might Opiates in Moderation Fight Depresion?, posted by rxnurse on December 3, 2003, at 16:22:26
"I have a terrific idea for you that will solve your dilemma concerning your philosophy on opiates for antidepression treatment: go to medical school and become a pioneer for your cause!"
No thanks; I have no desire to be a doctor. I have a career already; or the remains of one.
"I spoke with several doctors at work last week and they all think using opiates for treating depression is unwarranted and dangerous. That opinion seems pretty unanimous."They can believe what they like; but I know what works and what doesn't.
It's getting to the point where I don't care anymore. It's a fight every month just to get60 little pills of hydrocodone, and I'm getting tired of it all. I feel tortured and betrayed.
Posted by bsj on December 4, 2003, at 15:24:57
In reply to Re: Might Opiates in Moderation Fight Depresion?, posted by rxnurse on December 3, 2003, at 16:22:26
PS: Do you seriously think I could make it through med school in this condition? You may as well as someone in the middle of a heart-attack to run the Boston marathon.
Posted by bsj on December 4, 2003, at 19:05:36
In reply to Re: Might Opiates in Moderation Fight Depresion?, posted by bsj on December 4, 2003, at 15:24:57
Next time you see them, ask your doctor pals what they'd do for a case like mine. Keep feeding me their BS meds until I jumped out of a window? Just pretend I didn't exist? (I'm sure they'd love to do that, i.e., pretend cases like mine don't occur; and many probably do). Generally, I've found psychiatrists to be hard-headed know-it-alls who actually know far less than they think they do. Psychiatry is still barbaric, just a short step above leeches and drilling holes to let the demons out.
Posted by rxnurse on December 4, 2003, at 19:57:27
In reply to Re: Might Opiates in Moderation Fight Depresion?, posted by bsj on December 4, 2003, at 19:05:36
I have been talking with physicians in the ER; which include cardiologists, internists, neurologists, orthopaedists, and pediatricians. I haven't limited my questions to just psychiatrists. My personal psychiatrist has been a tremendous help to me, she has been willing to try many different approaches to combating my depressive symptoms. It's not really fair to generalize all of them as faulty!
Posted by bsj on December 4, 2003, at 20:11:37
In reply to Re: Might Opiates in Moderation Fight Depresion?, posted by rxnurse on December 4, 2003, at 19:57:27
"My personal psychiatrist has been a tremendous help to me, she has been willing to try many different approaches to combating my depressive symptoms."
That's really nice. I'm glad for you.
"It's not really fair to generalize all of them as faulty!"
I spoke of them GENERALLY; general comments may not apply to some particulars.
That people like me exist at all is a sign that they don't understand the problem very well. They're blind men fumbling in the dark, except they act like what they're doing is hard science. I suppose for people like me they'd fall back on the old reliable: lock me away in a dungeon where I couldn't hurt myself.
Posted by bsj on December 4, 2003, at 21:00:53
In reply to Re: Might Opiates in Moderation Fight Depresion?, posted by rxnurse on December 4, 2003, at 19:57:27
"I have been talking with physicians in the ER; which include cardiologists, internists, neurologists, orthopaedists, and pediatricians."
I'm sure they all have opinions; and they're worth about as much as you had to pay for them.
I should have had the fortune of living in the 19th century, before opiophobia set in on the medical profession; back then, you could buy as much opium as you needed at any corner druggist's shop. That's really the way it ought to be now, but our governments labor under the charming--but very mistaken--idea that they can battle the drug problem by restricting access to substances. The only reason I don't buy stuff on the street is because of all the additives and purity concerns. Even those misgivings may eventually fade, however.
Posted by Festus on December 4, 2003, at 22:51:52
In reply to Re: Might Opiates in Moderation Fight Depresion?, posted by bsj on December 4, 2003, at 21:00:53
I was wondering you have ever tried Marijuana for your depression?I don,t mean to ask goofy questions or you don,t even need to answer it,I was just thinking that there are many people who do use it for depression,as it is an Opiate derivitive,but I knew this couple that moved to one of the states where it,s no big deal to have it or use it.They grow theirs for nearly nothing and it keeps them happy.Just a thought.Festus
Posted by bsj on December 4, 2003, at 23:10:23
In reply to Re: Might Opiates in Moderation Fight Depresion?, posted by Festus on December 4, 2003, at 22:51:52
"I was wondering you have ever tried Marijuana for your depression?"
No. I've smoked pot only a handful of times, and it caused panic consistently. Besides, my job--what little I do of it anymore--requires a sharp mind; being stoned would make it impossible.
"as it is an Opiate derivitive"
No, it's not. The active ingredient in marijuana is THC; opiates derive wholly are partly from papaver somniferum. Two completely different plants.
"They grow theirs for nearly nothing and it keeps them happy.Just a thought."
I _have_ considered growing my own opium poppies and making something akin to laudanum. I have the chemistry background to do it. Trouble is, it would hard to maintain a supply in the winter, and I'd probably end up getting busted. You can't do anything these days without Big Brother watching.
My best bet would be to hook up with someone who robs pharmacies. I'd never do it myself, but I'd certainly give business to someone who did. I've managed to maintain a somewhat steady supply via online pharmacies, but the time is quickly coming when the DEA will put a stop to that. When that happens, I'll proably wind up either killing myself or switching to something you can readily buy on the street.
Posted by bsj on December 5, 2003, at 11:13:35
In reply to Re: Might Opiates in Moderation Fight Depresion?, posted by Festus on December 4, 2003, at 22:51:52
Just a little further explanation to Festus:
I know you're trying to help, but the jobs I hold would not allow me to be stoned everyday. I make most of my money as a sound engineer, recording music groups; it's actually a more physical job that you'd think--placing and adjusting mics, contorting myself to slip a mic between a couple a couple drums, etc. I'm also a writer, at which I make less money. It's only been the past few months that I've managed to write anything, after spending the previous 18 months in hell (after having to break off the Adderall). Hydrocodone doesn't dull my senses or intellect the way mairjuana does; I'm sure it works for people who don't have jobs like mine, but it's of no use to me.
Posted by MysticalMeds on December 5, 2003, at 19:38:26
In reply to Re: Might Opiates in Moderation Fight Depresion?, posted by bsj on December 5, 2003, at 11:13:35
BSJ,
have you every tried methadone, buprenorphin or LAAM? doctors may be much more willing to perscribe these for you as it is less heretical and they are designed for opiate maintenance dosing, which it sounds like you are interested in rather than trying to chase some sort of high. they would be more available if you would like to be honest. if you want to be less honest there are always pain clinics you can visit to get the stuff. hydrocodone has a pretty short half-life though, and i'm suprised that you're able to take one when you wake up and at lunch and are able to get through the whole day. if you're truly just taking 20mg/day its a pretty reasonable dose and probably practical to obtain.
i share a lot of your frustration and resentment with the difficulty of obtaining drugs. the ones i'm after are not controlled by the DEA but are pricey and its hard to find a way to make things work. creating them from scratch is always a possibility worth investigating. i wish you luck - let me know how things go for you
Posted by bsj on December 5, 2003, at 20:42:38
In reply to Re: Might Opiates in Moderation Fight Depresion?, posted by MysticalMeds on December 5, 2003, at 19:38:26
"have you every tried methadone, buprenorphin or LAAM? doctors may be much more willing to perscribe these for you as it is less heretical and they are designed for opiate maintenance dosing, which it sounds like you are interested in rather than trying to chase some sort of high. they would be more available if you would like to be honest."
Are you kidding? If I told a doctor I wanted methadone for depression, he'd pat me on the head and send me away with a script for Paxil. Doctors don't prescribe methadone for opiate maintainence in the U.S.; that's illegal. There are specially-licensed places only that can dispense methadone to addicts.
"if you want to be less honest there are always pain clinics you can visit to get the stuff."
I've been doing that, as well as ordering online. The pain clinc thing takes a while, though. I was in a car accident about a year ago, and gave them that as the excuse for my Terrible Lower Back Pain. They check you out first; that was three weeks ago. They said I would have to wait 3-6 weeks to get the ok.
"hydrocodone has a pretty short half-life though, and i'm suprised that you're able to take one when you wake up and at lunch and are able to get through the whole day."
I do short days--never more than 8 hours (which is step up from sleeping 23 hours out of every 24). I've been fallow, vegetating, for 18 months; and I'm easing back into my life. Once I start doing 12 and 14 hour days again, I may have to start taking 10mg three times a day. We'll see.
"if you're truly just taking 20mg/day its a pretty reasonable dose and probably practical to obtain."You'd be surprised. The DEA has shut down all but one reliable online pharmacy that deals in opiates. And their doctor can be capricious. The way I see it, it's only a matter of time before THEY get shut down, too. Then the pain clinic is my only hope--that, or street heroin.
"i share a lot of your frustration and resentment with the difficulty of obtaining drugs. the ones i'm after are not controlled by the DEA but are pricey and its hard to find a way to make things work."
Money's no problem with me. I should hire someone to fly me to Mexico, stock up on a year's supply of hydro, and then fly it back over the border. Of course, knowing me, I'd get caught.
BTW, what drug are you after?
"creating them from scratch is always a possibility worth investigating."
I'm too afraid to try the poppy-growing thing. I'd get caught. Then I'd have to find some recipes for laudanum and tone them down a bit--to hear de Quincy describe it, you'd think he was flying. And that would be too much.
Posted by btnd on December 6, 2003, at 7:48:58
In reply to Re: Might Opiates in Moderation Fight Depresion?, posted by bsj on December 5, 2003, at 20:42:38
Have you tried it? It worked for my depression before I started using Amisulpride.
Posted by bsj on December 6, 2003, at 8:11:52
In reply to BSJ: what about Ultram - opioid agonist/antagonist, posted by btnd on December 6, 2003, at 7:48:58
Starting six months ago, I tried several opiate products, Ultram being one of them. It was the easiest to get. It made me feel very bizarre--uncomfortable in my own skin, spacey, distinctly unpleasant. Later, I read that it caused withdrawal symptoms in longtime opiate addicts, likely due to their lower endorphin levels. Given that I suspect my depression is due to endorphin dysfunction, this makes perfect sense; I am, more or less, like a longterm opiate addict, except, until I started taking hydrocodone later, I'd never took opiates in any quantity. I'd love to be able to compare my brainscan with that of, say, a heroin addict in withdrawal, and see what the similarities might be.
Posted by bsj on December 6, 2003, at 8:23:34
In reply to BSJ: what about Ultram - opioid agonist/antagonist, posted by btnd on December 6, 2003, at 7:48:58
Addendum:
I'm on one of my hydrocodone holidays at the moment, starting yesterday. Last dose was 17hrs24min ago. It's worst at about the 48-hour mark; but a couple bars of Xanax work wonders. This is so I don't develop tolerance. I won't start taking it again until next Friday (and when I do start back, it'll have the same effect as it did the first time; got to give those mu and kappa receptors time to re-adjust). It's a tradeoff, but compromises are necessary; and this way I can still take the drug and be productive MOST of the time.
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