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Elizabeth-re opiates: Buprenorphine for depression Chuckie

Posted by Aurora on October 30, 2003, at 22:36:22

In reply to Re: elizabeth about dosing on opiates/ anyone, posted by Chuckie on October 30, 2003, at 15:10:05

Dear Chuckie and "reese1" (posted on October 24, 2002 "elizabeth about dosing on opiates/anyone")

I'm a new member and can share new information on buprenorphine. It is now available in sublingual tablet form, under the trade name of Suboxone (a 4:1 combination of buprenorphine and naloxone). Naloxone has no clinical effect when taken sublingually as directed--but if made into solution and injected, it induces immediate painful opiate withdrawal. Naloxone was added to prevent diversion to the street as a cash drug, and has been very successful in these first 9 months, according to the DEA.

A wealth of information is available on the government's website: www.buprenorphine.samhsa.gov including a "Physician Locator". Also, you can call 1-877-SUBOXONE and clinical staff will answer your questions.

The FDA's indication is for treatment of opioid dependence, so you may need to educate your physician regarding treatment for depression with the clinical article's in Chuckie's posting of 10/30/03. A University of California psychiatrist (director of that UC's Dept. of Psychiatry), said he anticipates their greatest use of Suboxone will be for treatment of depression, not opioid dependence or pain (other possible uses). He had read the 1996 editorial published in "Biological Psychiatry", entitled "Buprenorphine for Depression: The Un-adoptable Orphan", which Chuckie included in his 10/30/03 posting. He said buprenorphine apparently has a very fast onset of AD action (2-4 hours) and with insurance companies' pressure for fast discharges from the hospital, it could be helpful both to patients (faster relief) and insurance companies (shorter hospital stays). He would then taper patients off buprenorphine (Suboxone) after a few weeks when their conventional AD had time to take effect.

The tablets come in 2 mg and 8 mg and it's once-a-day dosing (half-life ranges from 37-92 hours). It's probably too early to know what the average dosing is for depression (range is 4-32 mg for opioid dependence). Bottom line is: dose to effect. As a partial mu opioid agonist, buprenorpohine has a ceiling effect: taken alone, overdosing will not result in respiratory lethality, unlike full opioid agonists.

Another psychiatrist has successfully treated two patients with treatment resistant depression using Suboxone. They had tried everything. Nothing had worked. They had very fast results with Suboxone and have been on it about three months.

Obviously there is no one medication for everyone. Suboxone is working from some, and it's helpful to have another option when there are patients who haven't received relief from existing medications, or who have had incomplete response with an AD.

I hope this may be helpful to some. In any case, never give up your search for a successful treatment. As long as there's life, there's hope. We have to care enough about ourselves to keep trying. After decades of struggling with major depression, I met a pdoc I trusted and finally agreed to try ADs (since exercizing alone wasn't enough). It took trials on five ADs before I found the one right for me, and two years later, I needed to add Provigil for energy. It's a whole new life. I feel grateful and blessed--definitely worth the long journey.

Sending wishes for your healing,

Aurora


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poster:Aurora thread:84007
URL: http://www.dr-bob.org/babble/20031030/msgs/275130.html