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Dr. Bob is Robert Hsiung, MD,
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Posted by sweetmarie on April 5, 2001, at 7:58:07
In reply to Re: Dysthymia/Treatment Resistant Depressions, posted by Nick on April 10, 1999, at 13:27:22
> > In November of last year a miracle happened which was the augmentation of Prozac with Naltrexone..... However, nobody has been able to give me a hint as to why this combination should work. Can anyone speculate about this? Wayne
>
> OK big guess coming up! There is cross - talk between Opiate systems and Noradrenergic systems - it MAY be (wild guess) that naltrexone operating through the opiate system somehow activates noradrenergic transmission, lifting mood. There you are, speculation!I suffer from treatment resistant Dysthymia, with an added major severe episode on top (`double depression`).
I recently saw a specialist in `difficult to treat depression`, who is starting me on a new med combination:
Venlafaxine (Efexor)/Mirtazapine (Zispin/Remeron)/Lamotragine (Lamictal)
Has anyone been on this combo (or has heard of it)?
With what results?
Cheers,
Anna
Posted by warrior on May 5, 2001, at 19:48:35
In reply to Re: Dysthymia/Treatment Resistant Depressions, posted by sweetmarie on April 5, 2001, at 7:58:07
> > > In November of last year a miracle happened which was the augmentation of Prozac with Naltrexone..... However, nobody has been able to give me a hint as to why this combination should work. Can anyone speculate about this? Wayne
> >
> > OK big guess coming up! There is cross - talk between Opiate systems and Noradrenergic systems - it MAY be (wild guess) that naltrexone operating through the opiate system somehow activates noradrenergic transmission, lifting mood. There you are, speculation!
>
> I suffer from treatment resistant Dysthymia, with an added major severe episode on top (`double depression`).
>
> I recently saw a specialist in `difficult to treat depression`, who is starting me on a new med combination:
>
> Venlafaxine (Efexor)/Mirtazapine (Zispin/Remeron)/Lamotragine (Lamictal)
>
> Has anyone been on this combo (or has heard of it)?
>
> With what results?
>
> Cheers,
>
> AnnaAnna,
How are you doing with your current medication regime? I too am "Dysthymic" and have been diagnosed as having possibly "Double Depression".
I am on Celexa 20 mg a day. I am also reading up on the latest to include Dr Burns, "Feeling Good" and whatever else I can get my hands on.
Best wishes.
Warrior
Posted by Dubya on May 5, 2001, at 23:40:11
In reply to Re: Dysthymia/Treatment Resistant Depressions, posted by warrior on May 5, 2001, at 19:48:35
I wish everybody luck against their battle with depression. I have been diagnosed with dysthmyia; although, I haven't mentioned to my 'shrink' that I have allergies. The allergies cause me to have swollen eyes and a runny nose every single day. Well, every single day until I took the anti depressants in Jan 2001. Until Mid Feb 2001, I had been taking Claritin/Clartin Extra and Flonase spray for the past 15 years (I'm 20 now). Since then, I was able to withdraw the allergy meds but, again, my allergies are flaring up again (MAY 2001-Spring in Toronto). I used to feel helpless b/c even with the allergy meds,I've tried so many meds to no success; I was still stuffed up. So from FEB-MAY 1st, 2001, I've been allergy free. Now I am taking allergy meds again. My allergy meds are over the counter (Claritin reg & extra) ones as recommended by my previous family doctor. I feel 'doomed' again. PErhaps, my allergies are partly responsible for my dysthmyia, in addition to social factors. Please suggest somebody if this makes sense?
Posted by ccass on May 6, 2001, at 9:21:59
In reply to Re: Dysthymia/Treatment Resistant Depressions, posted by Dubya on May 5, 2001, at 23:40:11
> I wish everybody luck against their battle with depression. I have been diagnosed with dysthmyia; although, I haven't mentioned to my 'shrink' that I have allergies. The allergies cause me to have swollen eyes and a runny nose every single day. Well, every single day until I took the anti depressants in Jan 2001. Until Mid Feb 2001, I had been taking Claritin/Clartin Extra and Flonase spray for the past 15 years (I'm 20 now). Since then, I was able to withdraw the allergy meds but, again, my allergies are flaring up again (MAY 2001-Spring in Toronto). I used to feel helpless b/c even with the allergy meds,I've tried so many meds to no success; I was still stuffed up. So from FEB-MAY 1st, 2001, I've been allergy free. Now I am taking allergy meds again. My allergy meds are over the counter (Claritin reg & extra) ones as recommended by my previous family doctor. I feel 'doomed' again. PErhaps, my allergies are partly responsible for my dysthmyia, in addition to social factors. Please suggest somebody if this makes sense?
Ask your family doc to give you a prescription for nasacort, its a nasal spray that you take daily it has done wonders for me.
Posted by PattyG on May 6, 2001, at 9:43:23
In reply to Re: Dysthymia/Treatment Resistant Depressions, posted by Dubya on May 5, 2001, at 23:40:11
Wow! Can you post some info about the nasal spray for depression? I've not heard of it - is it new?
Posted by BarbaraCat on January 5, 2002, at 17:54:45
In reply to Re: opioid agonist/antagonist discussion mailing list, posted by JohnB. on April 22, 1999, at 1:32:05
Please add me to the opiate/naltrexone list. I'm having many questions about WHY an opiate antagonist would work? My history is extreme refractory depression. I'm currently on 45 mg. of Remeron, 100 mg lithium as augmentor. I'm not suicidal, but have no sense of inner joy that Wayne reports (bless you, Wayne and may you dance forever in this gift of grace). I always feel good with opioids (just a little, not a gluttonous amount), so much so that I get an energetic buzz, want to clean the house (get same burst of energy from the very occasional hit of marijuana, BTW). I also crash the next day and feel awful, as though I've used up my slim allotment of 'feel-good' chemicals. This says to me that there's a dump of dopamine going on. So why would an opioid antagonist create a similar effect? Also someone mentioned ACTH dump re dopamine. Would supplementation with an acetylcholinergic (phosphatidylcholine, lecithin, etc.) go down this pathway?
Posted by stjames on January 5, 2002, at 20:17:56
In reply to Re: opioid agonist/antagonist discussion mailing list, posted by BarbaraCat on January 5, 2002, at 17:54:45
Do a search for this list, I think it is on yahoo groups. You will have to subscribe from its homepage and not here.
james
Posted by Elizabeth on January 6, 2002, at 22:04:58
In reply to Re: opioid agonist/antagonist discussion mailing list, posted by stjames on January 5, 2002, at 20:17:56
> Do a search for this list, I think it is on yahoo groups. You will have to subscribe from its homepage and not here.
The list has been dead for a while, but if people are interested I can start it up again.
-elizabeth
Posted by christophrejmc on January 7, 2002, at 0:22:45
In reply to Re: opioid agonist/antagonist discussion mailing list » stjames, posted by Elizabeth on January 6, 2002, at 22:04:58
Posted by cisco on January 7, 2002, at 3:31:58
In reply to Re: opioid agonist/antagonist discussion mailing list » stjames, posted by Elizabeth on January 6, 2002, at 22:04:58
Elizabeth:
I am interested as well. I can't seem to get enough good, focused info re: opioids/depression.
-Cisco
Posted by BarbaraCat on January 7, 2002, at 15:19:23
In reply to Re: opioid agonist/antagonist discussion mailing list » stjames, posted by Elizabeth on January 6, 2002, at 22:04:58
> > Do a search for this list, I think it is on yahoo groups. You will have to subscribe from its homepage and not here.
>
> The list has been dead for a while, but if people are interested I can start it up again.
>
> -elizabethJust log onto yahoo.com and do a search? Not sure on just how to do this, so any clarification would be helpful. Yes, I think starting it up again would be of interest to at least a few of us out here.
Posted by Elizabeth on January 10, 2002, at 21:07:49
In reply to Re: opioid agonist/antagonist discussion mailing list, posted by BarbaraCat on January 7, 2002, at 15:19:23
The old group has been deactivated, but I've started a new one, this one on Yahoo!. The name of the group is opioids@yahoogroups.com. The home page is http://groups.yahoo.com/group/opioids. I believe you can request to join from the home page.
-elizabeth
Posted by reese scott on January 15, 2002, at 15:49:51
In reply to Re: opioid agonist/antagonist discussion mailing list » stjames, posted by Elizabeth on January 6, 2002, at 22:04:58
My psychiatrist will try buprenex but he wants to talk to another doc who prescribes it. He spoke with some doc at yale and he said no. He would prescribe it for depression. I have been on every med known to man and take seven or so now. i don't want ECT.
Elizabeth what should I do?
My shrink is very open but he is just to scared to give me the script for buprenex because he hasn't prescribed it before. This is awful. It's across the street, a schedule V and i can't get it without another doc's okay.
help
Posted by reese scott on January 15, 2002, at 16:16:03
i'm sorry to bother you but if you could please contact me at tanyagrover96@yahoo.com i would truly appreciate it.
i am not doing that well and it's been to many years now, my psychiatrist is very open to medication and will allow me to try buprenex but the doctor here in ny who was going to give me the script is no longer practicing
what should i do, he's willing to allow me to take it but he won't write a script. And all buprenex is doing is being tested for junk and i'm sitting here a block away from the pharmacy that has buprenex and it's just rotting whatever i have left. i don't want ect.
reese
thank you
Posted by reese scott on January 15, 2002, at 16:23:26
i'm sorry if the last post wasn't clear...
my psychiatrist is okay with me taking buprenex at this point there isn't much left to try. for whatever reason he feels uncomfortable to write the script himself so he wants another doc to do it.
not good
the first doc said yes but he isn't practicing. the doc at yale said no because it's addictive. this is so ridiculous. it's like i'd rather try something like buprenex then have my head shocked which is the only other option besides finding a study for transcranial magnet stimulation but even that is a long tiring event with the placebo group etc..
there must be a way to make my psychiatrist feel comfortable enough to write it. All he needs is an okay from another doc for some reason. Please help me if you can this is just ( fill in the blank) awful
thanks
Posted by MB on January 16, 2002, at 8:15:19
In reply to Elizabeth....please...., posted by reese scott on January 15, 2002, at 16:16:03
> i'm sorry to bother you but if you could please contact me at tanyagrover96@yahoo.com i would truly appreciate it.
>
> i am not doing that well and it's been to many years now, my psychiatrist is very open to medication and will allow me to try buprenex but the doctor here in ny who was going to give me the script is no longer practicing
>
> what should i do, he's willing to allow me to take it but he won't write a script. And all buprenex is doing is being tested for junk and i'm sitting here a block away from the pharmacy that has buprenex and it's just rotting whatever i have left. i don't want ect.
>
> reese
>
> thank you
Why can't the psychiatrist write the script? Psychiatrists are medical doctors right?
Posted by reese scott on January 16, 2002, at 11:38:51
In reply to Re: Elizabeth....please.... » reese scott, posted by MB on January 16, 2002, at 8:15:19
that's what is so frustration. His reasoning is that he has never prescribed it before and he wants to talk to doc who has. He even was going to send me to Yale to meet with someone there but that doctor told him he wouldn't prescribe it for depression. So at this point I think he see's it as a useless or dangerous medication which is even the more frustrating. the doctor at yale told him, who is running trials for bubrenorphine/naltraxone for opiate detox, which seems to be what they are tryiing to license it as. He wants to find someone who has used it for depression.
Plus I think he's scared of prescribing it for me because he also is an addiction specialist and is concerned that they might look into him, which i think is complete bull shit. I've even had my mother call him and tell him that she wants me on it but again he just back pedals. So at this point i'm screwed. He would rather i go in for ECT then take buprenex even for a trail run of two to four weeks. It makes me sick. There is one doctor he knows in new york who would prescribe it but he no longer is in practice.
It basically seems for whatever reason he doesn't feel comfortable taking responsibility with the script, cause he doesn't know much about it.
I've read many of your posts and you seem to be the most knowledgable. There is no other medication left for me to try. I currently take lithium, neurontin, celexa, clonzapam, adderall, which makes it even funnier since adderall and clonzapam are both "addictive"
He could just pick up the phone and call it in but he won't. I've brought all the information I've found on the internet about buprenex but it doesn't seems to help. And it's also not a great help that they've seemed to have given up on studying it for refractatory depression and gone straight for the clinical trials of detox.
Do you know of any recent studies?
Who I might talk to about find a doc in manhattan he could speak with?i'm sorry if i am being a nuissance but i've been dealing with this for the last ten years and countless hospitalizations and for the last years have been unable to even work.
This situation is f*&*&*& ridiculous. He just won't take responsibility.
I don't know what else to say. Thank you
Posted by IsoM on January 16, 2002, at 13:03:41
In reply to Re: Elizabeth....please...., posted by reese scott on January 16, 2002, at 11:38:51
Reese, I don't want to presume, but Dr. Bob is a psychiatrist, right? So why not e-mail Dr. Bob personally & ask him if he could send an e-mail to your pdoc to let him know about the med.
Maybe I've overstepped my limits, but if I have, it's not with intention to interfere but help. You sound so desparate, it hurts.
> that's what is so frustration. His reasoning is that he has never prescribed it before and he wants to talk to doc who has. He even was going to send me to Yale to meet with someone there but that doctor told him he wouldn't prescribe it for depression. So at this point I think he see's it as a useless or dangerous medication which is even the more frustrating. the doctor at yale told him, who is running trials for bubrenorphine/naltraxone for opiate detox, which seems to be what they are tryiing to license it as. He wants to find someone who has used it for depression.
>
> Plus I think he's scared of prescribing it for me because he also is an addiction specialist and is concerned that they might look into him, which i think is complete bull shit. I've even had my mother call him and tell him that she wants me on it but again he just back pedals. So at this point i'm screwed. He would rather i go in for ECT then take buprenex even for a trail run of two to four weeks. It makes me sick. There is one doctor he knows in new york who would prescribe it but he no longer is in practice.
>
> It basically seems for whatever reason he doesn't feel comfortable taking responsibility with the script, cause he doesn't know much about it.
>
> I've read many of your posts and you seem to be the most knowledgable. There is no other medication left for me to try. I currently take lithium, neurontin, celexa, clonzapam, adderall, which makes it even funnier since adderall and clonzapam are both "addictive"
>
> He could just pick up the phone and call it in but he won't. I've brought all the information I've found on the internet about buprenex but it doesn't seems to help. And it's also not a great help that they've seemed to have given up on studying it for refractatory depression and gone straight for the clinical trials of detox.
>
> Do you know of any recent studies?
> Who I might talk to about find a doc in manhattan he could speak with?
>
> i'm sorry if i am being a nuissance but i've been dealing with this for the last ten years and countless hospitalizations and for the last years have been unable to even work.
>
> This situation is f*&*&*& ridiculous. He just won't take responsibility.
>
> I don't know what else to say. Thank you
Posted by Elizabeth on January 16, 2002, at 21:15:35
In reply to Elizabeth....please...., posted by reese scott on January 15, 2002, at 16:16:03
Hi. I'm sorry I missed your post -- I don't check P-B every day.
My suggestion for you would be to try and get a referral from the doctor who was going to give you the script, the one who's not practicing anymore. If he can't prescribe it for you but was willing to, he should be able to find someone who can prescribe it. I'm a little confused as to why he was going to prescribe it if he's not in practice anymore.
Also, did your pdoc give an explanation for why he won't write a script for the buprenorphine? It doesn't make sense to say it's just because he hasn't prescribed it before -- I mean, there has to be a first time for everything, right?
How did you find a pharmacy that carried Buprenex, BTW? Or did they order it for you?
The guy at Yale who claims buprenorphine is "addictive" is full of it. The FDA says it has less potential for abuse than even benzos, and for once I agree with them.
Your pdoc could try talking to Dr. Bodkin at Harvard, who has clinical research experience with buprenorphine as an antidepressant. He's seen firsthand that patients don't abuse it. (You can reach him by calling McLean Hospital (617 855 2000) and asking them to transfer you to his office.) Dr. Bodkin was the primary author of an article which your pdoc could read if he feels he doesn't know enough about buprenorphine -- the article also has a lot of references to other relevant sources.
That's really all the advice I can think of
-elizabeth
Posted by reese scott on January 17, 2002, at 0:22:34
In reply to Re: Prescription » reese scott, posted by IsoM on January 16, 2002, at 13:03:41
thank you so much, your words really touched me and you in no way over stepped your grounds, there aren't anymore.
my psych is such a whatever that he wants to have someone else be the first one to write a script for it.
but i will try to call bodkin, and i also have another number for dr. stoll i believe that is his name. he is at mclean as well.
i live in manhattan but my mother would be willing to fly me out to boston if that's what it takes. it's so pathetic but there is nothing i won't do. the alternatives are just beyond normal comprehension.
thank you so much
elizabethplease stay in touch
Posted by Elizabeth on January 18, 2002, at 10:08:12
In reply to Re: Prescription to elizabeth from reese » IsoM, posted by reese scott on January 17, 2002, at 0:22:34
Reese,
Dr. Stoll has used opioids to treat depression, although I'm not sure if he's used bupe. He has used full agonists like oxycodone (he wrote a letter to the American Journal of Psychiatry reporting on some cases where he did this successfully), so he would probably not have a problem with bupe. I'm not sure if he's still seeing patients, though (he's very into his research on omega-3 fatty acids), and he's pretty hard to reach.
Best of luck to you! You seem very persistent so I think that you will find a way to get the help you need.
-elizabeth
Posted by BarbaraCat on January 18, 2002, at 11:54:44
In reply to Re: problems getting buprenorphine » reese scott, posted by Elizabeth on January 16, 2002, at 21:15:35
Elizabeth,
I've checked past posts, but couldn't find any details on why you've found bu-orphine helpful and what your regimen is. Could you give some info as to what it's treating, results, etc? Is it an opiod, or an antagonist? It would be very helpful. Also, if you could also answer a burning question - why do opiods have such an energizing effect, at least they do for me. I've always heard of their sophorific effects, not the calm yet speedy one I get. Thanks. -- Barbara
Posted by Zo on January 22, 2002, at 4:20:42
In reply to Re: problems getting buprenorphine » Elizabeth, posted by BarbaraCat on January 18, 2002, at 11:54:44
BarbaraCat, Sounds almost like the effect the so-called stimulants, Dexedrine and Adderall have on me. But I wonder if it differs in that I felt very centered on Bupe. Of course I soon became deeply, deeply manic, but that was me, and my bipolar II was unmedicated at the time. I wonder if there are biochemical parallels.
Zo
Posted by BarbaraCat on January 22, 2002, at 13:11:11
In reply to Re: She's baaa-ck! È BarbaraCat, posted by Zo on January 22, 2002, at 4:20:42
Zo,
I'm beginning to think after all these years of being diagnosed as severe unipolar with periodic agitation that I am REALLY bipolar-II. That's why no ADs have ever maintained the effect, I get panic attacks when I first start, and 'speed' has a paradoxically calming effect on me. Gotta figure these things out for ourselves, it seems.
-- Barbara> BarbaraCat, Sounds almost like the effect the so-called stimulants, Dexedrine and Adderall have on me. But I wonder if it differs in that I felt very centered on Bupe. Of course I soon became deeply, deeply manic, but that was me, and my bipolar II was unmedicated at the time. I wonder if there are biochemical parallels.
>
> Zo
Posted by Elizabeth on January 22, 2002, at 18:37:31
In reply to Re: problems getting buprenorphine » Elizabeth, posted by BarbaraCat on January 18, 2002, at 11:54:44
Hi Barbara.
> I've checked past posts, but couldn't find any details on why you've found bu-orphine helpful and what your regimen is. Could you give some info as to what it's treating, results, etc? Is it an opiod, or an antagonist?
Buprenorphine is an opioid mixed agonist/antagonist. It's a partial agonist at the mu receptor (i.e., it activates the receptor, but less than a full agonist such as morphine would) and an antagonist at the kappa receptor. Like the full mu agonists, it's a controlled substance in the U.S., but unlike them, it's only Schedule V (minimal abuse potential). It's used in many countries for maintenance treatment of opioid dependence.
I take 1 mL (= 0.3 mg) three times a day, in addition to 900 mg/day of Trileptal and 187.5 mg/day of Effexor XR (target dose of Effexor is 300 mg/day). I also take Xanax as needed. I have unipolar depression and a possible seizure disorder (hence the Trileptal).
Buprenorphine helps with my mood, energy level, concentration, motivation, optimism, anxiety (including social anxiety), and anhedonia. The Effexor seems to be helping too; I think it is a good combination.
> Also, if you could also answer a burning question - why do opiods have such an energizing effect, at least they do for me.
I don't have an answer for that (they're activating for me, too), and I'm not sure anyone does. In general, opioids have mixed activating and sedating effects (they're not strictly inhibitory or excitatory), to varying degrees for different people. I could speculate about the neurochemical reasons for the variation, but it would just be speculation.
> I've always heard of their sophorific effects, not the calm yet speedy one I get.
"Calm yet speedy" -- that's exactly it. :-)
-elizabeth
p.s. You mentioned that you were recently diagnosed with Bipolar II disorder. There seems to be an epidemic of previously undiagnosed Bipolar II -- everybody is bipolar these days! Do you think the diagnosis is accurate in your case? (Just curious, no relevance to the discussion.)
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