![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 26 to 50 of 121. Go back in thread:
Posted by Elizabeth on November 19, 2001, at 13:13:29
In reply to Re: Morphine for depression., posted by paxvox on November 17, 2001, at 19:45:29
> OK, I'm dropping into this discussion late, though I have made other posts RE:opiates as mood stabilizers. I have had that effect from opiates. As opposed to the "normal" sedative effects, I actually get a rather smooth lift in mood. I guess one would suggest that is why some people become heroin addicts, though I see that as a more complex issue.
Addicts get f---ed up on heroin -- nodding, general indifference to just about everything, etc. It's usually sedating, if anything.
For me, opioids are stimulating. They don't make me feel indifferent at all; instead they *increase* the range of emotions that I can experience. I don't think that the antidepressant effects I get are the same thing people are experiencing when they get high on opioids (having had the opportunity to observe a few people in the "high" state < g >).
BTW, some of the literature suggests that they do have both AD and mood-stabilizing effects.
> However, I do not know of any main-stream Pdocs that would be handing out scripts for schedule II narcotics as pyschotherapeutic meds.
Buprenorphine isn't C-II, FWIW -- as a partial agonist, it's only C-V. But there certainly are plenty of doctors who have prescribed morphine, oxycodone, etc. as antidepressants for certain patients. Before amphetamine was discovered, opium was the *only* antidepressant.
-elizabeth
Posted by Elizabeth on November 19, 2001, at 16:54:20
In reply to Re: Morphine for depression. » paxvox, posted by shelliR on November 18, 2001, at 22:42:34
> There were accusations and attacks that those of us investigating narcotics were nothing but addicts in depressive disguise. It was
> not a very supportive time on this board.Dr. Bob did intervene, if you recall, and I think that, while the subject is alive and well on p-b, the people who were being abusive have calmed down or stopped posting on the subject.
> Anyway, you've asked a tough question. I completely lucked out, if you consider lucking out working with a doctor who sees me five minutes, won't return phone calls, and was making me come see him every other day.
The question that immediately arises in my mind is: how much does he charge you (per 5-minute session)?
> I was already using vicodin as an adjunct to my AD premenstrually, then my AD pooped out and nothing else seemed to work.
For me, opioids are very hard to use because of their side effects (*very* bad constipation, dry mouth, itching, amenorrhea, etc.) and also because they're so short-acting (well, most of them are, buprenorphine included), which can result in a lot of ups and downs in mood and energy level throughout the day. Although regular ADs by themselves were never adequate for me, I need to take one "in the background" to smooth things out.
A friend has been trying to convince me to try complicated combinations of ADs, but I haven't seen anything that gives me much hope for stuff like that. I'm considering trying Provigil again: the one time I tried it, I was taking Parnate and the combination was too activating, but it did help with my main residual depression symptoms (anhedonia, anergia, dulled concentration). And other than the jitters (nervousness, exaggerated startle response, exacerbation of tremor), I didn't notice any side effects from it. It didn't even cause much of a BP increase with the Parnate, and practically every other stimulant I tried with Parnate did, even in very small doses (like, 1.25 mg of Adderall).
> Buprenorpine has the most information on the board and is probably the easiest opiate to get from a doctor (and it still is not easy).
A problem with buprenorphine that makes it harder to get if you live in the USA is that the only formulation available is a solution for injection. It can be taken intranasally (that's what I do), but it's very inconvenient and the doctor will still have to entrust you with syringes. I got it from a doctor who I'd known for several years, who I'd seen regularly (not just 15 minutes once a month). Because I had always been honest and forthright with him and because he had known be for a long time, I think that he felt certain enough that I was a reliable person and that if I started having any troubles I would let him know about it.
Before making the decision to prescribe it to me, my pdoc spoke about it with Dr. Alexander Bodkin, a researcher at McLean (which is a teaching hospital affiliated with HMS) who he knew from residency. A couple of years earlier, my pdoc had sent me to Dr. Bodkin for a consultation because I was having trouble finding something that would work for me, and buprenorphine had first come up as a possible treatment for me during that session although I didn't try taking it until much later. Dr. Bodkin has quite a bit of familiarity with buprenorphine and its use in the treatment of depression; he was the primary author of a paper reporting the results of a small pilot study. (The paper, in case you're interested, is "Buprenorphine Treatment of Refractory Depression," by Dr. Bodkin, Gwen Zornberg, Scott Lukas, and Jonathan Cole. It was published in the Journal of Clinical Psychopharmacology, vol. 15 no. 1, pp. 49-57. A guy posted it on the web, at http://balder.prohosting.com/~adhpage/bupe.html.)
It probably also helped that my doctor was generally very experienced and had plenty of confidence in his own judgment and skill. He'd been involved in academic medicine for a long time before leaving to focus on his private practice, and he had been in charge of one of the general adult units at McLean, so he was very experienced not just with outpatients but with more severely ill inpatients. He had also already been treating another depressed outpatient with morphine (30 mg five times a day), and that patient had not abused the medication. So my doctor had plenty of firsthand experience that made him feel confident that it would be safe for him to try treating me with buprenorphine.
> Its selling point to pdocs is that there is a very small study study out of the McLean Harvard Group in Boston (It will come up if you do a search on Google, Yahoo, etc.). They are a very respected group within the psychopharmacology community.
(There are a lot of psychiatric research groups at various sites affiliated with Harvard. Take a look at http://www.hmcnet.harvard.edu/psych/redbook/)
This actually isn't much of a selling point to most doctors. If you can convince them to actually *read* the paper, though, they'll learn about some of the advantages buprenorphine has compared with other opioids, and this may convince them it's safe to prescribe. Because buprenorphine is only a partial agonist, there is a ceiling on its intrinsic effect. As a result, you can't get high on it. It's also virtually impossible to kill yourself by ODing on it (a legitimate concern that doctors may have about prescribing opioids to severely depressed patients). The article goes into some detail about the pharmacology of buprenorphine. This information, more than the results of the study, is liable to quell doctors' objections to prescribing buprenorphine as an antidepressant.
(I believe that a lot of the evil in the world arises out of ignorance, so spreading accurate information can be effective in combating evil.)
> I am on the east coast and am very uncomfortable in my position of knowing just one pdoc.
FWIW, I've been able to convince pdocs outside the tight-knit Harvard community (< g >) to prescribe it for me because I was already on it, after talking to the doctor who originally prescribed it (and, in some cases, Dr. Bodkin). Pdocs who might not be willing to *start* you on opioids can often be much more receptive to the idea of *continuing* you on them.
> He is not easy to get along with and I am always in fear that he'll cut me off if he gets angry at me and decides he doesn't want to work with me.
Can you talk to him about this? (Be diplomatic, of course -- like, leave out the part about his difficult personality, or at least try to put a less judgmental spin on it! :-} )
> Before I found him, I was going to research pain clinics and ask them if they would consider giving me opiates for pain, because my experience with vicodin was so positive.
Pain clinics are not all alike, but they have a general reputation for pushing people to agree to a "pain management" program (i.e., no medication -- "management" pretty much rules out "treatment"). Possibly a pain medicine specialist in private practice would be willing to help you, though. I think it would be nice if I could find someone like this to supervise my buprenorphine, because psychiatrists usually have no real experience with chronic opioid therapy.
> BTW, I have had to go up several times on oxycontin and it is still a question whether my body will finally get to a level and settle in so I don't have to go up and up and up. So there is the real possibility of developing an opiate habit. I guess you would have to decide how bad your depression is to take that chance.
I'd be much more worried about the possibility of one day having to "detox" if I were taking oxycodone, personally. Another advantage of buprenorphine is that the withdrawal symptoms are pretty mild, certainly not worse than what I experienced going off MAOIs! In contrast, oxycodone discontinuation could be extremely difficult.
-elizabeth
Posted by Elizabeth on November 19, 2001, at 17:03:56
In reply to Re: Morphine for depression. » shelliR, posted by SLS on November 19, 2001, at 10:59:55
> Do you think nausea or feeling wierd are predictors of non-response?
I know you're not asking me, but I decided to answer anyway. :-} Plenty of people who respond positively to opioids also get side effects. I couldn't start out at a fully-effective dose of buprenorphine (0.3 mg q. 4-6 hours) because it made me vomit. Also, I did feel sort of dizzy and lightheaded when I first started taking it.
> I found something on the Internet that described that most people using methadone for depression begin to experience improvements by the end of the first week. Some took two weeks.
Some feel their depression remitting after only a dose or two.
> At my last visit, I was happy to see that he was somewhat receptive to the possibility that opioids might be worth considering. I mentioned oxycodone and buprenorphine. I didn't know about methadone at the time.
Dr. Andy Stoll (yes, the OmegaBrite guy) published a letter in some journal in which he described a series of cases in which he and a colleague had successfully used oxycodone and oxymorphone to treat depression, including in some patients with histories of opioid abuse. (!) The cite is:
Stoll AL, Rueter S. Treatment augmentation with opiates in severe and refractory major depression. Am J Psychiatry 1999 Dec;156(12):2017.
HTH
-elizabeth
Posted by Elizabeth on November 19, 2001, at 17:12:19
In reply to Re: Methadone/opiates for depression-shelli, scott, posted by nightlight on November 19, 2001, at 8:05:31
> But, more pertinently, the only way I have gotten thru the past many years was thru the use of an opiate/barbiturate drug that I was prescribed for chronic pain from a herniated cervical disc.
Which drug was that (what were the active ingredients, that is -- the narcotic and the barbiturate)? Back/neck/shoulder pain is notoriously hard to treat. I have relatively minor back pain myself, and one nice bonus effect of the buprenorphine I take for my depression is that it does away with the back pain.
> I am now on a very low-dose narcotic, 60 mgs. stimulent, 2 mgs. klonopin and apotent muscle relaxer.
Again...which narcotic and which muscle relaxant, and what are the doses? (just curious)
> I haave only recently been diagnosed ADD w/endogenous depression,
Did the doctor call it "endogenous depression," or was the exact diagnosis something else. I'm curious because "endogenous depression" is an expression that's not used much anymore in psychiatry. Do you live in the USA?
> Stimulents are what I have needed all along, but, couldn't seem to convince docs why (another story).
For me, opioids act like I would expect stimulants to act!
-elizabeth
Posted by SLS on November 19, 2001, at 17:53:01
In reply to Re: Morphine for depression. » SLS, posted by Elizabeth on November 19, 2001, at 17:03:56
Posted by nightlight on November 20, 2001, at 7:54:32
In reply to Re: Methadone/opiates for depression » nightlight, posted by Elizabeth on November 19, 2001, at 17:12:19
> > But, more pertinently, the only way I have gotten thru the past many years was thru the use of an opiate/barbiturate drug that I was prescribed for chronic pain from a herniated cervical disc.
>
> Which drug was that (what were the active ingredients, that is -- the narcotic and the barbiturate)? Back/neck/shoulder pain is notoriously hard to treat. I have relatively minor back pain myself, and one nice bonus effect of the buprenorphine I take for my depression is that it does away with the back pain.Elizabeth~
Will reply in more detail later-running late for pre-school drop-off and work...I used Fiorinal #3-a combo of codeine, butalbital, caffeine and aspirin. It was originally prescribed for persistent headaches. It also comes in an acetemenophen (sp) formula-Fioricette #3 and, both are available w/o the codeine.
I actually found the drug listed in a PDR, suggested it to a dr., who prescribed it for me, and I took it intermittently for 15 years.
More later.
nightlight
Posted by shelliR on November 20, 2001, at 12:14:24
In reply to Re: Methadone for depression. » judy1, posted by shelliR on November 18, 2001, at 20:41:53
Posted by JahL on November 20, 2001, at 17:36:47
In reply to Re: Morphine for depression. » JahL, posted by shelliR on November 13, 2001, at 10:43:20
> > Lamictal just about stops me from being an ex-Jah .
> well, that's pretty important. You're just a young lad, so holding on till the right thing helps is imperative. You find the right drug and you still have 80% of your life left to live and enjoy.I'd love to live to 130-odd but 60% is nearer the mark. And less of the 'young lad'... :-)
> When are your appointments?Next month sometime.
>Can you slip bupe or methadone into the conversation, somehow.
I'll do more than slip it into the conversation...I'm at the stage where I'm not bothered about offending the sensibilities of pdocs.
>How does this appointment stuff work? Do you see these specialists only once, or do they follow up until the problem is resolved?
If you make enough noise the NHS is obliged to continue treating you. However it is often the case that pdocs will tell you (or at least me) "there is nothing further I can do for you", at which point you get referred back to yr regular pdoc (again). Back to square one-stylee.
> BTW, remember sweet marie (Anna) who spent months ina UK hospital and was still pretty depressed when she got out. I think about her alot and hope she's okay.Yeah me too. I would refuse to go to hospital on grounds of principle (it's been offered a few times). NHS='One Flew Over The Cuckoo's Nest' whilst the private clinics seem to farm institutionalised types unable to function in the real world. Sad but true. I'm sure they're [the clinics] a haven for some tho'.
>Her experience is one of the reasons that I am letting myself get habituated to a narcotic.
Those that would criticise you have the luxury of not going thru what you are. Simple as that. You go girl! :-)> > Interestingly I tried Methadone recently. Initially it improved my mood & energy levels but seemed to lose affect after a few days. I didn't go too high (only about 5ml); I thought I'd find out more on this site before going any further. Like you tho', I'm hesitant to bring this up for fear of being jumped on by the Thought Police.
> How did you get methodone? (An answer is not required).Ask me no questions & I'll tell you no lies ;-)
> Let us know about your appointments. I hope these big-wigs can help you out.Thanx. Me too.
I'm v. pleased to hear that Methadone seems to be doing the trick; pls keep us all updated.
Best of luck,
J.
Posted by JahL on November 20, 2001, at 17:56:23
In reply to Re: Morphine for depression. » SLS, posted by Elizabeth on November 19, 2001, at 17:03:56
> Plenty of people who respond positively to opioids also get side effects. I couldn't start out at a fully-effective dose of buprenorphine (0.3 mg q. 4-6 hours) because it made me vomit. Also, I did feel sort of dizzy and lightheaded when I first started taking it.
> > I found something on the Internet that described that most people using methadone for depression begin to experience improvements by the end of the first week. Some took two weeks.
>
> Some feel their depression remitting after only a dose or two.Hi Elizabeth. Keep the posts comin'; I don't have to read any text books with you around :-)
I have a Q if you don't mind. I know it's all guess work but *what would you consider to be a therapeutic dose of Methadone for an opioid-naive individual*?
I tried around 5ml a few times recently. Interesting. A bit dreamy in a not unpleasant kinda way. Good sleep. Bad constipation :-(
I wanted to find out a bit more (ie about dose ramping/contraindications etc) before pursuing this any further. Any thoughts (by anyone) greatly appreciated...
Ta as always,
J.
Posted by Mair on November 20, 2001, at 21:28:36
In reply to Re: Methadone for depression (DOSES) » Elizabeth, posted by JahL on November 20, 2001, at 17:56:23
Posted by shelliR on November 21, 2001, at 9:17:39
In reply to Re: Methadone for depression (DOSES) » Elizabeth, posted by JahL on November 20, 2001, at 17:56:23
Hi Jah,
> I have a Q if you don't mind. I know it's all guess work but *what would you consider to be a therapeutic dose of Methadone for an opioid-naive individual*?
>
I started on 10mg of oxycontinue twice a day, when I was fairly opiate-naive, (except for small doses of vicodin). I probably would have started even lower, but the smallest pill is 10mg and it wore off after about
eight hours. I think methodone dosing is 1/3 or less of oxycontin, so I will predict starting dose to be at only about 5mg or 2 1/2 mg twice a day.The meth dose is supposed to last 24 hours, but I could feel a let down in the early evening when I took my second dose. I also woke up with a similar depression as with oxy and had the same pattern of waiting about an hour til it kicked in.
Shelli
Posted by shelliR on November 21, 2001, at 9:53:40
In reply to Re: Morphine for depression » shelliR, posted by Elizabeth on November 19, 2001, at 13:02:38
> > I'm sorry, I got so mixed up. It's methodone he's written the prescription for: methadone 10mg tabs; 4 tabs three times daily.
> That's a **lot** of methadone! Then again it might be the right amount, since you do have some tolerance from taking the oxycodone.
Unfortunately, I have a lot of tolerance, which I was not expecting. And although he wrote 3x a day, he told me to take it only twice. So total of 80mg.
I wouldn't mind taking 10-20mg before bed in order to not wake up depressed. I'm not sure why the effects are not lasting longer--it's supposed to be a 24 hour drug. (Of course oxy was supposed to be 12hr and it lasted 8; but this is an even larger discrepency.) I felt a let down (again in my chest) in the early evening--again after about 8 hours.>
> No, but I bet opioid combinations are often used to control pain for dying patients (cancer, etc.). But methadone binds very tightly to opioid receptors (like buprenorphine, only methadone is a full agonist), and as a result it tends to prevent other opioids from doing anything. (This makes it particularly useful for people with heroin dependence.)So if I'm ever injured or in great pain, they would have to give me more methadone? Oxy or morphine would not be at all effective while I'm on methadone?
>
>.... I suppose you could rationalize your use of it by saying that depression is just emotional pain (and honestly, I don't think that depressive pain and nociceptive pain are all that different).My depression absolutely feels like physical pain.
It's like a huge heavy weight pressing on my chest.
I am in therapy, but working on issues that don't feel related to that pain. More about dissociating, not being able to control bad feelings, etc.
It feels almost identical to my oxy dose; there's a tiny bit of high. Yesterday first I took 30mg and didn't feel as good as with my oxy dose, so I added 10mg. The pills are scored so probably should have started at 35mg twice a day. I am hoping to stay at this dose so I didn't want to start at 35 and have to ask my pdoc to raise to 40 so I would feel a little better. I was scared that I felt too good yesterday: (of course it was a beautiful 70 degree day here and I finally taking a break from work to plant bulbs). But at first on oxycontin I felt too high at the lowest dose, and then of course I got too used to them, and had to go up. My measure of how much to take is the pain/pressure in my chest. Its absence is all I am looking for.
When people are on methadone maintenance, do they generally become habituated to their dose and have to raise it (like my experience on oxycontin), or is it a more stable opiate?I hope you are doing well on your combo.
Shelli
Posted by shelliR on November 21, 2001, at 10:48:47
In reply to Re: Methadone/opiates for depression-shelli, scott, posted by nightlight on November 19, 2001, at 8:05:31
Hi Nightlight,
Sorry it took me so long to respond.> But, I couldn't use it daily, supply and side-effect problems. However, knowing that I wd. have a few days (maybe 8-9) that I wanted to rise from my bed helped me 'go on' & keep the faith that I wd. eventually find what was right for me.
I'm sorry that you have a problem around supply. You say you have two wonderful doctors, so I wonder why you are having a supply problem. Maybe this
is something you can work on with them; let them know. Advocate for yourself as much as possible.
You deserve more than 9 good days.I can't speak to the stimulent problem--why they are not prescribing, but hopefully you'll get that all resolved.
Good luck to you,
Shelli
Posted by Elizabeth on November 21, 2001, at 18:39:53
In reply to Re: Methadone/opiates for depression » Elizabeth, posted by nightlight on November 20, 2001, at 7:54:32
> I used Fiorinal #3-a combo of codeine, butalbital, caffeine and aspirin.
Oh, of course! I got Fioricet (the acetaminophen-containing version) for back pain once. Butalbital (the barbiturate ingredient) is one of only a couple barbiturates that are still used much (phenobarbital is also sometimes used as an anticonvulsant).
I tried taking Fioricet more recently (again, for back pain), but I got *really* depressed, which definitely hadn't happened before. My pdoc thought it might have been an interaction with the desipramine I'm taking.
Did you ever try plain codeine, and if so, do you think that Fiorinal w/codeine was any more or less effective (for pain or for depression) than codeine by itself?
-e
Posted by Elizabeth on November 21, 2001, at 19:25:39
In reply to Re: Methadone for depression. » shelliR, posted by JahL on November 20, 2001, at 17:36:47
> I'll do more than slip it into the conversation...I'm at the stage where I'm not bothered about offending the sensibilities of pdocs.
Hey, you're in the UK, aren't you? So you can get Temgesic? I'm sure I've mentioned before that US doctors are reluctant to prescribe injectable drugs to outpatients (especially psychiatric outpatients, regardless of whether there's any history of drug abuse).
> If you make enough noise the NHS is obliged to continue treating you. However it is often the case that pdocs will tell you (or at least me) "there is nothing further I can do for you", at which point you get referred back to yr regular pdoc (again). Back to square one-stylee.
That's so irritating! You know that what they mean is, "There's nothing further that I'm *willing* to do for you."
> Yeah me too. I would refuse to go to hospital on grounds of principle (it's been offered a few times). NHS='One Flew Over The Cuckoo's Nest' whilst the private clinics seem to farm institutionalised types unable to function in the real world. Sad but true. I'm sure they're [the clinics] a haven for some tho'.
I'm not sure I get what you mean about the private hospitals. Can you rephrase/elaborate?
> Those that would criticise you have the luxury of not going thru what you are.
Isn't that true all too often?
> I don't have to read any text books with you around :-)
Thanks, I think! < g >
> I have a Q if you don't mind.
Of course I don't mind!
> I know it's all guess work but *what would you consider to be a therapeutic dose of Methadone for an opioid-naive individual*?
I don't know much about methadone -- it's used sometimes for pain, but far more for opioid dependence, and the latter always requires shockingly big doses. I happen to know an opioid-naive guy who tried 10 mg (orally) a while back and says he was "better than well" for a full day. (He was also puking his guts out.) The recommended dose for pain, according to the PDR, is 2.5-10 mg every 3-4 hours, so I was surprised that it lasted so long for him. On the other hand, when addicts are treated with it, they usually need only one dose a day. Confusing.
> I tried around 5ml a few times recently.
How many mg/mL?
> Interesting. A bit dreamy in a not unpleasant kinda way. Good sleep. Bad constipation :-(
Sleep? Opioids (not just bupe) keep me awake! The constipation is an unavoidable and heinous problem. Some people also say that methadone makes them sweat a lot. I think that the best opioid, in terms of ease of use and minimal side effects, is Duragesic, the transdermal fentanyl patch (although wearing a patch for three days, which is how long it's supposed to last, sounds like it could get pretty grody).
-elizabeth
Posted by Elizabeth on November 21, 2001, at 19:39:09
In reply to Re: Morphine for depression » Elizabeth, posted by shelliR on November 21, 2001, at 9:53:40
Shelli,
It sounds like you might need to take methadone three times a day. This is typical for pain patients, although MMT patients do generally just need it once a day. I don't know why this should be different, but it is.
Buprenorphine is shorter-acting than methadone, and I consistently wake up depressed, BTW. Since you can sleep on methadone, though, I think you'd have a better time if you took some at bedtime. Let your doctor know about the problems you've been having with dosing frequency -- it seems he's assuming that your needs will be similar to those of an addict, but they're not, obviously. I'm guessing that, in general, the way that you and I are using opioids is more similar to the way that pain patients use them.
> So if I'm ever injured or in great pain, they would have to give me more methadone? Oxy or morphine would not be at all effective while I'm on methadone?
A high enough dose of oxy or morphine would displace the methadone, but it would have to be *very* high.
> My depression absolutely feels like physical pain.
I feel the same, although I can't really relate to the "weight" analogy. Talk therapy doesn't relieve pain, of course.
> When people are on methadone maintenance, do they generally become habituated to their dose and have to raise it (like my experience on oxycontin), or is it a more stable opiate?
Eventually they reach a dose that they can stay at, although it's often very high. They don't feel anything from it except for relief of cravings and other withdrawal symptoms. If they need pain medication, their tolerance prevents normal doses of opioids from working, of course.
-elizabeth
Posted by judy1 on November 22, 2001, at 17:30:18
In reply to Re: Methadone for depression. » JahL, posted by Elizabeth on November 21, 2001, at 19:25:39
I think that the best opioid, in terms of ease of use and minimal side effects, is Duragesic, the transdermal fentanyl patch (although wearing a patch for three days, which is how long it's supposed to last, sounds like it could get pretty grody).
>
> -elizabeth-well I guess 'grody' ;-) isn't exactly the term I use- I just switch from upper arm to upper arm and it leaves behind some adhesive which is kind of fun to pick at. Still tapering down... judy
Posted by judy1 on November 22, 2001, at 17:34:26
In reply to Re: Methadone for depression. » judy1, posted by shelliR on November 18, 2001, at 20:41:53
Hi Shelli
I'm delighted it's working for you. Looking at January for the baby, maybe if I jump up and down I'll get the free diapers for a year :-)- judy
Posted by shelliR on November 23, 2001, at 0:12:47
In reply to Re: Morphine for depression. » shelliR, posted by SLS on November 19, 2001, at 10:59:55
>Hi Scott.
>
>
> How do you deal with the roller-coaster ride every day? It must be difficult to have your state of being be so immediately tethered to a drug? It's not like taking a regular antidepressant where you can miss a few doses or take it at your convenience without feeling significantly worse. I'd be grateful to take it and have it work, though. It must be emotionally taxing just the same.
The roller-coaster ride is only once a day in the morning and I think that would have been finally disappeared. In the beginning oxycontin stimulated me too much to take it at night at all, and then I woke up with horrible depression. Once I had gotten myself up to 1/2 dose at bedtime the magnitude of the depression was lower. I think eventually I could have tolerated a full dose at night and the morning roller coaster would be allievated. The afternoon dose had some overlap, so it was not noticable.I think that methodone may be different in this respect. Once it gets into my body after a few days, it is supposed to last longer, so I may stil have enough of my evening dose still in me to avoid the depression.
As much as I hate waking up depressed in the morning and having to wait for an hour with the depression, I do have to admit that every morning, I had the most wonderful feeling flow through me during the transition. But I am aware that the change in my body is totally connected to a drug (as you stated "tethered to a drug"). This is a bit unsettling, but probably similar to the feeling of waking up with anxiety and waiting for a benzo to work. It is not, as you pointed out, similar to taking a AD,where is easily able to escape taking notice of the cause and effect (depression/pill/lack of depression)
> Do you think nausea or feeling wierd are predictors of non-response? I found something on the Internet that described that most people using methadone for depression begin to experience improvements by the end of the first week. Some took two weeks.Do you remember where you found that on the internet?
I think Elizabeth has more experience with this since she did have to adjust to buprenorphine, while I did not have to adjust at all to vicidin or oxycontin. I loved them both from the first time. .Today was different than yesterday with the methadone--I think although I took the same dose, it may have been too much. I don't feel as good, and I am having difficulty focusing. When I say didn't feel as good, I am not talking about depression, that is gone, but my body doesn't feel as well, and I may try to go down in dose tomrrow. I have to be somewhat more patient; this is a new drug for me. And yes, Elizabeth might be correct concerning a possible need to adjust and that one bad day is not enough to tell.
>
>
> At my last visit, I was happy to see that he was somewhat receptive to the possibility that opioids might be worth considering. I mentioned oxycodone and buprenorphine. I didn't know about methadone at the time.Receptive enough to let you give it a try, or is he still pretty far away from that? If you want to try it you might want to push harder so you can figure out if this guy might really go in that direction. Also, it is still best to stay on an anti-depressant with an opiate to avoid the dramatic ups and downs if possible, and potentially ly cut down on tolerance. (I'm not sure about that one).
Take care,
Shelli
>
>
Posted by SLS on November 23, 2001, at 8:09:48
In reply to Re: Morphine for depression. » SLS, posted by shelliR on November 23, 2001, at 0:12:47
Hi Shelli.
I bet you were more than just pleasantly surprised that methadone quickly picked up where oxycodone left off. No major disruptions in your life. I know that exercising patience is a difficult feat to perform, but I think you'll find your proper dosage quickly.
> > At my last visit, I was happy to see that he was somewhat receptive to the possibility that opioids might be worth considering. I mentioned oxycodone and buprenorphine. I didn't know about methadone at the time.
> Receptive enough to let you give it a try, or is he still pretty far away from that?
I don't think he would be receptive to making an opioid my next trial.
> If you want to try it you might want to push harder so you can figure out if this guy might really go in that direction.
I see him on Monday. Maybe I'll just ask him point-blank if he'd prescribe methadone or some other opioid within the next six months if I were not sufficiently improved by that time. I am truly grateful - as I am sure lots of other people are - that you have allowed us to watch you as you make adjustments to your treatment regime. Thanks.
> Also, it is still best to stay on an anti-depressant with an opiate to avoid the dramatic ups and downs if possible, and potentially ly cut down on tolerance. (I'm not sure about that one).
Did Lamictal smooth-out your mood shifts while you were taking oxycodone? How much Lamictal were you taking?
Keeping my fingers crossed for you... It looks like you're going to have a real Happy New Year afterall. ;-)
- Scott
Posted by nightlight on November 23, 2001, at 8:39:27
In reply to Re: Methadone/opiates for depression-shelli, scott » nightlight, posted by shelliR on November 21, 2001, at 10:48:47
> Hi Nightlight,
>
>
> Sorry it took me so long to respond.
>
>
>
> > But, I couldn't use it daily, supply and side-effect problems. However, knowing that I wd. have a few days (maybe 8-9) that I wanted to rise from my bed helped me 'go on' & keep the faith that I wd. eventually find what was right for me.
>
> I'm sorry that you have a problem around supply. You say you have two wonderful doctors, so I wonder why you are having a supply problem. Maybe this
> is something you can work on with them; let them know. Advocate for yourself as much as possible.
> You deserve more than 9 good days.
>
> I can't speak to the stimulent problem--why they are not prescribing, but hopefully you'll get that all resolved.
>
> Good luck to you,
>
> ShelliHi Shelli~
Couldn't use it daily also due to the fact that side-effects were bothersome-the itchies, dry skin, &....the dreaded constipation.Plus, altho great for pain, and they helped my depression, they did not help my ADD enough (naturally). And, my body/stomach eventually just
said, No More Fiorinal/codeine. They began to make me feel worse.I went into a bad pain flare (supposedly fibro) & I have herniated discs, a bad one at cervical area, so I saw a new doc (referred by my g.p.). He put me on Soma (carisoprodal) and plain old Darvocette 100's. Plus, I take a beta-blocker and klonopin (generic) form. This has been best for my pain. The Soma was key here. A good muscle relaxer (& very few work for me) makes all the difference when one has FMS/ chronic myofascial pain (which is my biggest bug-a-boo, pain-wise, I believe).
Then, I met a great psychologist 2 months ago who sent me to a great shrink and I have been on Adderall (a stim, finally!!!). It brought me out of the deep depression I was in late summer. We are playing w/stim doses, but life is looking better now, and, finally, I have a ray of HOPE...
I'm also on low-dose Zoloft (50mgs.). The Add. was 30 mgs. 2x's a day, but I think I need some tweaking. I will be trying dexedrine this week, if plans progress as they should.nightlight
Posted by nightlight on November 23, 2001, at 8:55:12
In reply to Fiorinal and Fioricet » nightlight, posted by Elizabeth on November 21, 2001, at 18:39:53
> > I used Fiorinal #3-a combo of codeine, butalbital, caffeine and aspirin.
>
> Oh, of course! I got Fioricet (the acetaminophen-containing version) for back pain once. Butalbital (the barbiturate ingredient) is one of only a couple barbiturates that are still used much (phenobarbital is also sometimes used as an anticonvulsant).
>
Elizabeth,
Yes, ya just don't see those bottles of seconal, nembutal, tuinal, etc..... the way u used too! (In the med cabinets of friends parents, grandparents, etc). No "Return to the Valley of the Dolls" for this generation of the perpetually medicated.
> I tried taking Fioricet more recently (again, for back pain), but I got *really* depressed, which definitely hadn't happened before. My pdoc thought it might have been an interaction with the desipramine I'm taking.
>
> Did you ever try plain codeine, and if so, do you think that Fiorinal w/codeine was any more or less effective (for pain or for depression) than codeine by itself?
>
> -ePlain codeine did nothing for my depression, nor did any of the other many painkillers I have used in search of relief from intense cervical pain. Not even the beloved Vicodins from which I have known so many to find tremendous depression relief. ONLY the F#3's for me.
So, I figure, I realy needed the barbiturate for anxiety, and the codeine for 'synergy'. Now, if I had ever taken some other type of opioid/opiate combined with a barbiturate, the effect might have been equally efficacious.
nightlight
Posted by nightlight on November 23, 2001, at 9:06:29
In reply to Re: Methadone/opiates for depression » nightlight, posted by Elizabeth on November 19, 2001, at 17:12:19
>
> > I am now on a very low-dose narcotic, 60 mgs. stimulent, 2 mgs. klonopin and apotent muscle relaxer.
>
> Again...which narcotic and which muscle relaxant, and what are the doses? (just curious)
>
> > I haave only recently been diagnosed ADD w/endogenous depression,
>
> Did the doctor call it "endogenous depression," or was the exact diagnosis something else. I'm curious because "endogenous depression" is an expression that's not used much anymore in psychiatry. Do you live in the USA?
>
> > Stimulents are what I have needed all along, but, couldn't seem to convince docs why (another story).
>
> For me, opioids act like I would expect stimulants to act!
>
> -elizabethDear Elizabeth~
Present regimen:
Darvocette 100-2x's a day
clonazepam 1mg a.m-1mg pm
carisoprodal 350 mgs. prn daily
propanolol 40 mgs. 2 x's a day
Zoloft 50 mgs. nightly
Adderall 30 mgs. a.m. and mid-dayWill answer more about diagnoses later, it's still a bit fuzzy, my therp is not big on labeling, & I am a bit of a 'mix'.
But, pdoc said ADD straight out, altho that may have been in order to get me on the stims I needed immediately and out of the dark hole I was mired in at the time.
More later~
nightlight
Posted by nightlight on November 23, 2001, at 16:33:45
In reply to Re: Methadone/opiates for depression » Elizabeth, posted by nightlight on November 23, 2001, at 9:06:29
Elizabeth~
Darvocette 100-2x's a day
clonazepam 2mgs a day usually am & pm, as needed
propanolol 80mgs a day, 40 in the am the rest prn
carisoprodal 350mgs *3* x's a day, also prn, but usually take at least 2.(Soma-muscle relaxer)
These are rx'd by my g.p.for chronic pain, and I can play with the dosages, depending upon need, up to these designated dosages. Darvocette is a lightweight narcotic, and would not be sufficient in an acute pain phase. But, for now, while pain is on lower end of the scale, I can deal with this small dosage of actual narcotic painkiller..
My pdoc has prescribed:
Adderall (mixed amphetamine salts)30 mgs. 2x's a day
Zoloft 50 mgs nightlyHe is aware of my other meds, of course. I saw him Wed. and mentioned I was STILL fairly useless, brainwise and physically after 2p.m.
So, he is switching me to dexedrine, in 5 mg. tabs, so I can dose more often, as needed, accordingly, and titrate as needed. Don't know what the difference will be, but, for me, the Adderall was a definite improvement, but maybe too subtle. I could take 20-30 mgs. an hour before getting up in the morning, and still sleep thru the alarm sometimes! Now I have 2 alarms.
I had tried ritalin in the past, but HATED it. It did not stimulate anything in me except irritable agitation which lasted about 45 minutes and then I needed a nap & that was only at max daily dosing, otherwise, I was just mean and tired at lower dosing.> > > I am now on a very low-dose narcotic, 60 mgs. stimulent, 2 mgs. klonopin and apotent muscle relaxer.
> >
> > Again...which narcotic and which muscle relaxant, and what are the doses? (just curious)
> >
> > > I haave only recently been diagnosed ADD w/endogenous depression,> > Did the doctor call it "endogenous depression," or was the exact diagnosis something else. I'm curious because "endogenous depression" is an expression that's not used much anymore in psychiatry. Do you live in the USA?
e.~
Yes, 'endogenous', simply, I believe, to let me know that he believed that there was something off-balance in my physical chemistry and had been, for a very long time. He knew that my previous pdoc thought I was experiencing 'situational' depression and dysfunction and that, even tho no A-D's were working for me, (or ever had, in the many years of drug trials), I'd get better when my environment became less stressful.(My father had recently died of a sudden heart attack and my mom was diagnosed w/organic brain syndrome soon after-I was her caregiver and I had a 4-yr old running around-she was a 40th birthday surprise-my only child-and the backpain situation which had forced me to quit work, leaving all financial responsibility to my husband, etc, etc....). It was a plateload, but so is life, and I was depressed when everything around me had been close to perfect. Former p-doc was downright belligerent.I had been ill for years, but just had not been able to convince him of that. I quit him after 6 months. That was one yr. ago.
I've only seen my present therapist twice. But, we covered a lot of ground. He is perceptive, kind, insightful, *happy* and very intelligent, in an unassuming way-a pleasure to 'visit'.
I'm supposed to see him every 3 wks., but the NYC disaster and another event have interfered w/our seeing each other more often.
He says, at this time, no clear-cut diagnosis, except depression, anxiety and God knows what else.
But, was optimistic about the future, as am I.Interestingly, I have found out that propoxyphene, the narcotic componenent of darvocette, is a potentiator of amphetamine. I guess even drugs can get a little help from their friends! (However, this is a characteristic that can be quite dangerous in some situations..)
> > > Stimulents are what I have needed all along, but, couldn't seem to convince docs why (another story).
> >
> > For me, opioids act like I would expect stimulants to act!
> >
> > -elizabethYES! That is how the F#3 affected me, not a downer, but a depression lifter and motivator to work. I could concentrate better and get things accomplished.
nightlight
ps: yes, I do live in the good ol' U. S. of A.
>
> Dear Elizabeth~
>
> Present regimen:
>
> Darvocette 100-2x's a day
> clonazepam 1mg a.m-1mg pm
> carisoprodal 350 mgs. prn daily
> propanolol 40 mgs. 2 x's a day
> Zoloft 50 mgs. nightly
> Adderall 30 mgs. a.m. and mid-day
>
> Will answer more about diagnoses later, it's still a bit fuzzy, my therp is not big on labeling, & I am a bit of a 'mix'.
>
> But, pdoc said ADD straight out, altho that may have been in order to get me on the stims I needed immediately and out of the dark hole I was mired in at the time.
>
> More later~
> nightlight
Posted by Elizabeth on November 23, 2001, at 19:40:05
In reply to Re: Fiorinal and Fioricet, posted by nightlight on November 23, 2001, at 8:55:12
> Yes, ya just don't see those bottles of seconal, nembutal, tuinal, etc..... the way u used too!
I'm afraid that was before my time!
> Plain codeine did nothing for my depression, nor did any of the other many painkillers I have used in search of relief from intense cervical pain. Not even the beloved Vicodins from which I have known so many to find tremendous depression relief. ONLY the F#3's for me.
That's weird. Did you ever take Fiorinal (or Fioricet) without the codiene?
> Darvocette 100-2x's a day
Propoxyphene, the main ingredient in Darvocet, is a *really* weak synthetic opioid. ("Darvocet" is how it's spelled, BTW. The "-cet" ending just means it has Tylenol (aCETaminophen) in it, as with Fioricet -- plain propoxyphene is Darvon.) Propoxyphene is pretty comparable to codeine, in terms of how well it relieves pain, I think (the doses are different, of course).
> carisoprodal 350 mgs. prn daily
Soma is a good muscle relaxant (although not "potent"). I tried this one for back pain ("myofascial pain syndrome") as well as Fioricet; the Soma worked much more reliably.
> propanolol 40 mgs. 2 x's a day
What's this one supposed to be for? I don't think I've ever heard of beta-blockers being used for pain (twice-a-day dosing of propranolol is pretty unusual too).
> Yes, 'endogenous', simply, I believe, to let me know that he believed that there was something off-balance in my physical chemistry and had been, for a very long time. He knew that my previous pdoc thought I was experiencing 'situational' depression and dysfunction and that, even tho no A-D's were working for me, (or ever had, in the many years of drug trials), I'd get better when my environment became less stressful.
Ah. The expression "endogenous depression" is used more in the UK and some other places than here, but the UK definition is different from what your pdoc meant (they use it to mean what DSM-IV calls "major depression with melancholic features" -- helpful to know if you're ever reading European psychiatric literature).
I don't think it's very useful to say that a case of depression is "situational" or "non-situational" since "situational" depression often responds to meds and "non-situational" depression can be very hard to treat (with meds or otherwise). Also the distinction isn't always that clear. (IMO, it usually isn't clear at all.)
-elizabeth
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