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Re: opiates and major depression Chairman_MAO

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..




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