![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 95. This is the beginning of the thread.
Posted by pseudoname on November 16, 2005, at 12:46:36
I finally got it! My sweet pdoc gave me a prescription for the opioid buprenorphine for my treatment-resistant unipolar depression. I'll take one 2mg sublingual Subutex tablet per day.
I've never used opioids or been addicted to anything. I'm not on any other meds, although I had been taking Adderall a couple times a week for really bad depression days.
Today I used just a 1/4 tablet because of all the opioid side-effect stories. That part of my tongue went slightly numb.
<anti-jinx> It probably won't work. </jinx>
Posted by Peter S. on November 17, 2005, at 1:22:04
In reply to buprenorphine trial !, posted by pseudoname on November 16, 2005, at 12:46:36
Keep us up do date! I would love to hear how it goes.
Best of luck
> I finally got it! My sweet pdoc gave me a prescription for the opioid buprenorphine for my treatment-resistant unipolar depression. I'll take one 2mg sublingual Subutex tablet per day.
>
> I've never used opioids or been addicted to anything. I'm not on any other meds, although I had been taking Adderall a couple times a week for really bad depression days.
>
> Today I used just a 1/4 tablet because of all the opioid side-effect stories. That part of my tongue went slightly numb.
>
> <anti-jinx> It probably won't work. </jinx>
Posted by pseudoname on November 17, 2005, at 6:37:10
In reply to Re: buprenorphine trial !, posted by Peter S. on November 17, 2005, at 1:22:04
> Keep us up do date!
Well, Day 1 was no fun, LOL:
1:00 PM – took 0.5 mg Subutex
2:00 very dizzy
3:00 bigtime nausea, face flushing, sweating. I walk like a drunk.
4:30 puked a bucketful
6:00 still dizzy, nauseous. Keep nodding off.
9:30 puked AGAIN
3:00 AM – finally fell asleepSome people say bupe helped their depression instantly. Elizabeth said 3 days for her. So far I'm not in the first category...
I could try an antiemetic for the puking, but antihistamines are very sedating for me and I have a HUGE social event tonight.
Posted by ed_uk on November 17, 2005, at 15:52:06
In reply to buprenorphine trial !, posted by pseudoname on November 16, 2005, at 12:46:36
Hi PN,
I guess your pdoc is not familiar with buprenorphine. 2mg/day is not a suitable starting dose for an opioid-naive individual. 0.2mg every 8 hours would be a suitable starting dose. Unfortunately, since bupe tablets are only used as a 'maintenance' treatment for opioid dependence in the US, low dose tablets are not available. In the UK, where bupe is additionally used as an analgesic, it comes as 0.2mg, 0.4mg, 2mg and 8mg tablets. The 0.2mg and 0.4mg tablets are not available in the US :-(
Nausea, vomiting, motion sickness, dizziness, drowsiness, flushing, sweating and itching/prickling (!) are all very common side effects if the initial dose is too high.
Here is what I recommend.......
1. Stop taking bupe, wait until the side effects disappear.
2. Start out by taking (about) 1/8th of a tablet + an antiemetic eg. cyclizine (Marezine) 50mg three times a day or prochlorperazine (Compazine) 5mg twice a day. Cyclizine is frequently an effective treatment for opioid-induced nausea/vomiting - it causes less sedation than most antihistamine antiemetics.
3. LIE DOWN! The majority of opioid side effects are greatly reduced by lying down. You'll feel a lot more nauseated if you walk about ...and A LOT more nauseated if you go for a ride in the car!
4. Be patient. Most of your current side effects are temporary, and will disappear shortly.
5. Titrate the dose carefully. Although bupe is generally given as a single daily dose in the treatment of opioid dependence, taking it in divided doses throughout the day is usually the best option when it's used as an analgesic ...and presumably when it's used to treat depression.
Kind regards
Ed
Posted by 4WD on November 17, 2005, at 22:00:23
In reply to Do not despair » pseudoname, posted by ed_uk on November 17, 2005, at 15:52:06
> Hi PN,
>
> I guess your pdoc is not familiar with buprenorphine. 2mg/day is not a suitable starting dose for an opioid-naive individual. 0.2mg every 8 hours would be a suitable starting dose. Unfortunately, since bupe tablets are only used as a 'maintenance' treatment for opioid dependence in the US, low dose tablets are not available. In the UK, where bupe is additionally used as an analgesic, it comes as 0.2mg, 0.4mg, 2mg and 8mg tablets. The 0.2mg and 0.4mg tablets are not available in the US :-(
>
> Nausea, vomiting, motion sickness, dizziness, drowsiness, flushing, sweating and itching/prickling (!) are all very common side effects if the initial dose is too high.
>
> Here is what I recommend.......
>
> 1. Stop taking bupe, wait until the side effects disappear.
>
> 2. Start out by taking (about) 1/8th of a tablet + an antiemetic eg. cyclizine (Marezine) 50mg three times a day or prochlorperazine (Compazine) 5mg twice a day. Cyclizine is frequently an effective treatment for opioid-induced nausea/vomiting - it causes less sedation than most antihistamine antiemetics.
>
> 3. LIE DOWN! The majority of opioid side effects are greatly reduced by lying down. You'll feel a lot more nauseated if you walk about ...and A LOT more nauseated if you go for a ride in the car!
>
> 4. Be patient. Most of your current side effects are temporary, and will disappear shortly.
>
> 5. Titrate the dose carefully. Although bupe is generally given as a single daily dose in the treatment of opioid dependence, taking it in divided doses throughout the day is usually the best option when it's used as an analgesic ...and presumably when it's used to treat depression.
>
> Kind regards
>
> Ed
Hi.As a former opioid abuser, (not to suggest you are or have or would, just that I've dealt with some of these issues) here are some tips to deal with the nausea. Drink ginger tea or eat fresh raw ginger or even ground ginger. As Ed, said, lie down. Don't do anything real active. When you feel a wave of nausea coming on, lie down and be as still as you possibly can. It will pass, along with the sweating, flushed feeling.
Finally, after you throw up, make yourself eat something right away. The nausea will be worse if your stomach is empty. Try something light and easily digestible. Something sweet will sometimes kick your stomach into gear and reduce nausea.
Good luck.
Marsha
Posted by pseudoname on November 19, 2005, at 16:47:59
In reply to Do not despair » pseudoname, posted by ed_uk on November 17, 2005, at 15:52:06
> I guess your pdoc is not familiar with buprenorphine.
For sure! Until 10 minutes before she wrote my script, she did not know she had the legal authority to prescribe bupe. (A common misperception in the States.)
But she is willing to try it when no others would, so I can certainly put up with a learning curve.
> 2mg/day is not a suitable starting dose for an opioid-naive...
I second that.
> Here is what I recommend....
In fact, pdoc asked me as we discussed the situation, "Well, what do your online sources say about it?" (!!) So she is using your recommendations as guidance. You international influence, you. She suggested Reglan (metoclopramide) to work against both the vomiting and the anticipated constipation, however.
I'm not supposed to try the bupe again until after I have my scheduled physical exam on Monday (and pick up the Reglan), but I took what I guesstimate is 0.1 mg today anyway because I'm impatient and it's the weekend (no driving or machinery-operating). Three hours later and I have no problems like I had with the "Day 1" dose – except slight dizziness for which I will lie down. :)
If my dosing is going to be consistently in the one-tenth-of-a-tablet range, I may need some advice on cutting & measuring tiny crumbs of brittle, oval-shaped pills.
Ed, thanks again for the detailed advice – which I'm printing to give to her in case she tries bupe with anyone else.
Posted by pseudoname on November 19, 2005, at 17:07:42
In reply to Re: Do not despair, posted by 4WD on November 17, 2005, at 22:00:23
Marsha,
Thanks very much for the advice.
> Drink ginger tea
I bought a box of ginger tea this morning so I'd be prepared for my second trial of bupe this afternoon!
> or eat fresh raw ginger or even ground ginger
This makes more sense than ginger ale (always suggested by the mothers in our family), which is sugar-loaded AND carbonated.
I took a much lower buprenorphine dose this time (0.1mg), and at 3 hours I think things are going much better. And thanks to these comments, I feel prepared to try increasing it over the next weeks, if need be.
Greatly appreciated.
Posted by ed_uk on November 19, 2005, at 21:14:05
In reply to Thanks!! » ed_uk, posted by pseudoname on November 19, 2005, at 16:47:59
Hi PN
>But she is willing to try it when no others would, so I can certainly put up with a learning curve.
LOL she sounds pretty cool!
>She suggested Reglan (metoclopramide) to work against both the vomiting and the anticipated constipation, however.
Metoclopramide sometimes helps, but not always by any means. Anyway... you probably won't need an antiemetic provided that you initiate buprenorphine at a very low dose and increase gradually. Tolerance to the 'nauseating' effect of buprenorphine usually develops quite quickly. If an antiemetic *is* necessary and metoclopramide doesn't help, cyclizine might be effective. Haloperidol (eg 0.5mg three times a day prn) is another option. Fortunately, antiemetics are not usually necessary after the first five (or so) days of opioid treatment.
Metoclopramide and haloperidol sometimes cause akathisia (restlessness) and/or dystonia (abnormal muscle contractions - often affecting the mouth, tongue, face or neck). Such reactions can be treated with an anticholinergic drug or diphenhydramine (Benadryl) while you wait for the antiemetic to be excreted. Benadryl can be unpleasantly sedating - less sedating anticholinergics are preferable.
Cyclizine (Marezine) is a popular treatment for opioid-induced nausea in the UK but I don't think it's much used in the US. Although cyclizine can be sedating, it's not as bad as Benadryl! As far as I know, cyclizine (Marezine) is available without a precription in the US. It's approved for the treatment of motion sickness. The usual dose for opioid-induced nausea/vomiting is one 50mg tablet every 4-6 hours up to a maximum of four times a day.
I guess you could buy some cyclizine if metoclopramide doesn't help. Please check that cyclizine would be safe for you to take.......
http://health.yahoo.com/drug/d00858a1
>constipation
Buprenorphine is (apparantly) much less constipating than most opioids. It's quite possible that it won't make you constipated at all. Nevertheless, if constipation does occur, metoclopramide is (probably) not a suitable treatment. Mild constipation can be treated with a bulk-forming agent such as Metamucil. Severe opioid-induced constipation can be treated with a combination of a 'stimulant' laxative (such as bisacodyl) and an osmotic laxative (such as MiraLax). If severe constipation develops, long term (daily) use of laxatives will be necessary.
>Three hours later and I have no problems like I had with the "Day 1" dose – except slight dizziness for which I will lie down. :)
Please do - it works :-)
>If my dosing is going to be consistently in the one-tenth-of-a-tablet range........
You'll probably need a higher dose in time. 0.1mg is just a starting dose.
>I may need some advice on cutting & measuring tiny crumbs of brittle, oval-shaped pills.
Hmmmmmm, I haven't really thought about that. We have the 0.2mg tablets (Temgesic) in the UK so it's not really necessary. I suppose you could crush a tablet to form a powder and separate the powder into (approximately) equal piles. Not sure how you'd get the powder under your tongue though - could be messy ;-)
Kind regards
Ed
Posted by pseudoname on November 20, 2005, at 15:47:48
In reply to Re: Thanks!! » pseudoname, posted by ed_uk on November 19, 2005, at 21:14:05
Ed, thanks again for your comments.
Taking a smaller dose of bupe (just 0.1mg) has helped a lot. My target dose is uncertain. Therapeutic results are reported for nonabusers from 0.2mg to 6mg. The biggest study's average was 1.8mg.
> As far as I know, cyclizine (Marezine) is available without a precription in the US
Tomorrow I'm going to pick up some Marezine, which I had not realized was OTC. Even though things are going well now nausea-wise, as I increase the dose over the next week or two, that could change.
> check that cyclizine would be safe for you to take
The warning sheet looks okay.
(Also going to pick up some ginger as Marsha suggested... mostly because it sounds yummy!)
> Buprenorphine is (apparantly) much less constipating than most opioids
Elizabeth had enduring problems with it that way, so I guess that worried me. But on the reduced dose (circa 0.1 mg), so far no problem. In fact I think I'll hold off on buying the Reglan unless I actually develop constipation.
> Haloperidol...is another option
I'm shocked. Bad experience with Haldol, so I think I'll pass, LOL.
>> I may need some advice on cutting & measuring tiny crumbs...
I guess if I get the dose up to about 1.0 mg soon, that won't be a problem, but anything less will be pretty much guessing and inconsistent. I need a teeny tiny scoop.
Recreational drug users must know something about this. Maybe I'll post a question on the Substances board.
Posted by pseudoname on November 21, 2005, at 15:23:13
In reply to nausea / constipation....NOT! :-) » ed_uk, posted by pseudoname on November 20, 2005, at 15:47:48
> As far as I know, cyclizine (Marezine) is available without a precription in the US
It turns out Marezine is OTC-approved in the US, but no drug store or pharmacy in my area carries it. One pharmacist had to look it up because she'd never heard of it. She recommended meclizine (Bonine®) instead, which she takes for motion sickness. So I got some of that. I only took 1/2 a tablet of it (12.5mg), and it made me pretty drowsy. Fortunately, it was cheap.
Posted by ed_uk on November 21, 2005, at 15:34:11
In reply to Marezine, meclizine » pseudoname, posted by pseudoname on November 21, 2005, at 15:23:13
Hi PN
>She recommended meclizine (Bonine®) instead, which she takes for motion sickness. So I got some of that. I only took 1/2 a tablet of it (12.5mg), and it made me pretty drowsy.
Meclizine is quite similar to cyclizine. With both meds, the drowsiness tends to reduce after a few days. You might not need an antiemetic in a few days though!
Ed
Posted by ed_uk on November 21, 2005, at 15:41:10
In reply to nausea / constipation....NOT! :-) » ed_uk, posted by pseudoname on November 20, 2005, at 15:47:48
Hi PN,
>Taking a smaller dose of bupe (just 0.1mg) has helped a lot.
:-)
>My target dose is........
........whatever dose provides the best balance between efficacy and side effects for YOU! :-)
>Elizabeth had enduring problems with it that way, so I guess that worried me. But on the reduced dose (circa 0.1 mg), so far no problem. In fact I think I'll hold off on buying the Reglan unless I actually develop constipation.
I wouldn't recommend taking Reglan to treat constipation - it's unlikely to be effective and it generally causes more side effects than laxatives.
>I'm shocked. Bad experience with Haldol, so I think I'll pass, LOL.
What dose did you take? How did you find it? Haldol tends to be very unpleasant at high doses but tolerable at small doses - at least in the short term. Haldol is very similar to Compazine - a widely prescribed antiemetic and neuroleptic. Low doses are used to treat nausea/vomiting.
Kind regards
Ed
Posted by pseudoname on November 21, 2005, at 16:02:00
In reply to Re: nausea / constipation....NOT! :-) » pseudoname, posted by ed_uk on November 21, 2005, at 15:41:10
>> Bad experience with Haldol...
> What dose did you take?Don't remember the dose, but many moons ago, I was trying Haldol to treat depression (this was before atypical antipsychotics, I think). On the 2nd or 3rd day, I suddenly got very confused and set about knocking holes in the wall with my head. For several years we covered the biggest one up with a picture of Durham Cathedral.
The dose was probably increased too quickly. But I'm now permanently Haldol-averse.
Posted by ed_uk on November 21, 2005, at 16:52:26
In reply to Haldol aversion » ed_uk, posted by pseudoname on November 21, 2005, at 16:02:00
Hi PN
>On the 2nd or 3rd day, I suddenly got very confused and set about knocking holes in the wall with my head. For several years we covered the biggest one up with a picture of Durham Cathedral. The dose was probably increased too quickly. But I'm now permanently Haldol-averse.
Were you extremely restless? Couldn't stay still, had to keep moving? It could have been akathisia. The dose was probably much too high.
Haldol, Compazine and Reglan are all dopamine antagonists. Given your bad reaction to Haldol, I wouldn't recommend any of them!
Kind regards
Ed
Posted by pseudoname on November 23, 2005, at 19:43:41
In reply to Re: buprenorphine trial !, posted by Peter S. on November 17, 2005, at 1:22:04
This was my fifth day on buprenorphine (Subutex).
Day 1: 0.1mg
Day 2: 0.1
Day 3: 0.2
Day 4: 0.4
Day 5: 0.6Today I took about 0.2mg at 6 AM, noon, & 4 PM. (See http://www.dr-bob.org/babble/subs/20051106/msgs/580668.html for my dosing technique.)
The nausea is gone. Dizziness is slight, but I'm not driving. Very slight increase in itchiness (or is that my imagination?). I nod off a little late in afternoon. No insomnia last night – quite the reverse.
As far as depression goes, I can tentatively say that bupe seems to be somewhat uplifting, I think. A few hard-to-describe cognitive/emotional areas seem noticeably improved, but it's WAY too early to say anything for sure. Except I can say for sure that I have NOT experienced "euphoria;" even caffeine gives a better buzz.
Posted by ed_uk on November 24, 2005, at 13:44:35
In reply to Update: bupe Day 5, posted by pseudoname on November 23, 2005, at 19:43:41
Hi PN :-)
>The nausea is gone.
Excellent, I didn't think it would be a problem with slow titration.
So how is bupe affecting your sleep?
Are you finding it constipating?
>As far as depression goes, I can tentatively say that bupe seems to be somewhat uplifting, I think.
:-)
>A few hard-to-describe cognitive/emotional areas seem noticeably improved, but it's WAY too early to say anything for sure.
I agree. I'm hopeful :-)
Kind regards
Ed
Posted by pseudoname on November 27, 2005, at 17:36:57
In reply to Re: buprenorphine trial !, posted by Peter S. on November 17, 2005, at 1:22:04
At this point, I have no buprenorphine benefits to report.
Day 6: 0.6 mg total, in divided doses
Day 7: 0.6
Day 8: 1.0
Day 9: 1.0
Day 10: 1.4On Day 6 in the evening, my diary says "I feel unusually good," and situations seemed manageable that would typically freak me out. But on Day 7 (Thanksgiving) & later, I was depressed & stressed as usual, and despite dose increases I now see no cognitive or mood benefit at all.
In all journal & Web reports of bupe-for-depression, it works quickly (0-3 days) if it works at all. Callaway said "most patients experience benefits of an adequate dose within three hours" !! So "an adequate dose" is the real question. The thing is, most of the responders got at least *some* benefit with lower doses than I'm already taking even if they needed higher doses for complete benefit. So I'm not hopeful. But I'll go to 3 mg/day for 3 days before giving up.
When I first take an increased dose and feel slightly dizzy, I also have some minor happy-feelings. But I'm disregarding those as non-therapeutic and part of the dizziness; they're like the brief mood-lift alcohol initially gives me. If they persisted that'd be great, but they don't even last as long as the dizziness.
Side effects: headaches come & go; mild itchiness; splotchy rash on my face. Constipation may be a problem. I haven't had to poop since yesterday morning, when it was pretty hard.
Posted by Declan on November 27, 2005, at 20:08:48
In reply to discouraged—bupe DAY 10, posted by pseudoname on November 27, 2005, at 17:36:57
Hi there
Why do you take bupe in divided doses throughout the day? Being a long acting drug, might a once a day doseage give you a small nice feeling? (That's what happens on methadone.) But maybe you want more out of it than a small nice feeling for 2 hours a day.
Or would you be glad to have even that?
Declan
Posted by pseudoname on November 28, 2005, at 9:50:51
In reply to Re: discouraged—bupe DAY 10, posted by Declan on November 27, 2005, at 20:08:48
Hey, Declan.
> Why do you take bupe in divided doses throughout the day?
This is a good question. My only reason was that other people said they did. Elizabeth took it 3 times a day. (And she had to lie on the floor and drip it into her nose.) A few others in the archives also. And the only 2 papers on bupe-for-depression used divided doses. Supposedly for addiction, bupe's effect is long-lasting; as an antidepressant, it wears off within 6 hours. I hadn't questioned it.
But this morning I took 1.8 mg, my highest dose yet, and I took it all at once. (Actually, I divided it over 2 hours just to make sure I wouldn't puke.) It kicked in. I had forgotten what bupe's relief felt like last week when I first went up to 0.6 mg.
But will it last??
> ...a small nice feeling for 2 hours a day. Or would you be glad to have even that?
I'll take what I can get, even 2 hours – if they could be reliable. This morning I've had 4 hours so far. I've decided that when it starts to wear off, I'll hit it again with about 0.5 mg and hope that my problem isn't rapid tolerance but just that I need a high dose. No one else has reported needing to take so much to get a response so soon after beginning with buprenorphine. I mean no one who was opioid-naive when starting treatment: former users go way higher (16 mg).
There's just not enough published experience with it. Maybe the fact that bupe only worked with about 50% of TRD people in those studies is that they didn't try enough right away.
You gotta do what you gotta do.
Posted by ed_uk on November 28, 2005, at 13:14:32
In reply to divided doses » Declan, posted by pseudoname on November 28, 2005, at 9:50:51
Hi PN
>You gotta do what you gotta do.
Keep experimenting PN. There aren't any guidelines on what dose is likely to be appropriate for the treatment of depression.
>This morning I've had 4 hours so far.
How long did it last?
Have you tried any other opioids btw?
Ed
Posted by ed_uk on November 28, 2005, at 16:20:44
In reply to discouraged—bupe DAY 10, posted by pseudoname on November 27, 2005, at 17:36:57
Hi PN :-)
>On Day 6 in the evening, my diary says "I feel unusually good," and situations seemed manageable that would typically freak me out. But on Day 7 (Thanksgiving) & later, I was depressed & stressed as usual, and despite dose increases I now see no cognitive or mood benefit at all.
Tolerance? Perhaps. I'm hoping that you'll reach a dose where the benefit is maintained :-)
>Constipation may be a problem. I haven't had to poop since yesterday morning, when it was pretty hard.
Hard stools = time for a dose of MiraLax? Probably. If left untreated, opioid-induced constipation may necessitate the use of suppositories and enemas.
Warm regards
Ed
Posted by pseudoname on November 29, 2005, at 14:58:31
In reply to divided doses » Declan, posted by pseudoname on November 28, 2005, at 9:50:51
In many ways a complete failure in an antidepressant trial is easier to take than benefit-followed-by-loss-of-benefit. The "Flowers for Algernon" thing.
Day 11 was 1.8 mg AM; it brought a remarkable level of relief from depression. When it started to wear off later in the day, another 0.5 mg brought flat-out REMISSION.
Day 12 (today), I had to go to 2 mg before my acidic thoughts even receded. Not a lot of benefit. This afternoon I took *another* 0.5 mg trying to get the relief I had yesterday but.....
[…later…]
When I started to compose this post an hour ago, things were not good. But I guess that last 0.5 mg kicked in a few minutes ago – about 1 hr 40 min after I took it. I've noticed this with me & bupe: it takes almost 2 hours for a dose to affect me (except for dizziness, which comes on fast).So all my bitter resentful paragraphs get crumpled & tossed. And now, since I'm feeling that it's possible, I have to go outside & get a little work done before it gets dark! I'll comment more tonight.
THANKS to everyone for your ongoing interest & support. I'll reply to your specific posts tonight.
Posted by pseudoname on November 29, 2005, at 22:24:12
In reply to Re: buprenorphine trial !, posted by Peter S. on November 17, 2005, at 1:22:04
Ed asked,
> Hard stools = time for a dose of MiraLax?My pdoc agreed with you, Ed. So far no action. I also added milk of magnesia, and I already eat a high-fiber diet.
> Have you tried any other opioids btw?
I was given morphine injection once for an injury. I felt momentarily (t<3 sec) buzzy, similar to my initial effect from alcohol, but it went away quickly and wasn't a feeling I'd seek out to repeat. But it was *some* psychoactive response however slight...
¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯
Saw my pdoc today, who refused to set an upper limit on my buprenorphine dose. She said there is no basis. I told her the GP I saw for my physical last week had no problem with me taking an opioid for depression. Pdoc said, "Well, no; it's no skin off his nose if you sue ME."
I gave her printouts of Ed's, Larry's & Marsha's advice. She said she was now considering another TRD patient who'd tried everything; I told her to START WITH A #%*$@ing LOWER DOSE.Today (even before I saw pdoc) I was discouraged again about my bupe response. After what amounted to FULL REMISSION yesterday (if "remission" can last just 8 hours), this morning's 40% lift on the same dose seemed like failure. Of course, two weeks ago I would've killed for 40% improvement!
So then I increased today's total to 2.5 mg – and went over the Significant Crest. That's a definite point below/before which moods go up & down, variously better & worse – but everything is ALWAYS saturated with depression, and rancid, fiendish thoughts are always at least touching my consciousness. After the Significant Crest (which I've now gone over twice), things are just things, not tinted by anything, and the rancid thoughts completely VANISHED. I was free! When over the Significant Crest my moods have been neutral, fine, quiet, or pleasant and happy, but not joyous or even enthusiastic. I enjoy the other people I meet without needing their approval or imagining their thoughts about me. No euphoria, hypomania, or extra energy. This neutral peaceful freedom is worth constipation, if that's what it takes. It is worth a COLOSTOMY, compared to my everyday life for the last 22 years.
I assume there are others who are/will be reading this thread to weigh bupe for themselves. I guess that's one advantage for me in trying something hard-to-get: a fantasy of civic duty to TRDs everywhere will keep me on track to doing the trial fully, despite setbacks and tolerance.
Posted by ed_uk on November 30, 2005, at 15:18:28
In reply to the Significant Crest, posted by pseudoname on November 29, 2005, at 22:24:12
Hi PN
>My pdoc agreed with you, Ed. So far no action. I also added milk of magnesia, and I already eat a high-fiber diet.
Milk of magnesia is fine for short-term use but isn't the best laxative to use on long-term basis. Magnesium intoxication and other electrolyte imbalances might occur. Other laxatives are available which are safer in the long term.
>Saw my pdoc today, who refused to set an upper limit on my buprenorphine dose. She said there is no basis.
In the UK, the maximum approved dose for the treatment of opioid dependence is 32mg/day. 16mg/day is a fairly 'standard' maintenance dose - but many people take less.
>This neutral peaceful freedom is worth constipation, if that's what it takes. It is worth a COLOSTOMY, compared to my everyday life for the last 22 years.
LOL, you certainly won't be needing a colostomy ;-) How is the milk of magnesia working?
>I assume there are others who are/will be reading this thread to weigh bupe for themselves. I guess that's one advantage for me in trying something hard-to-get: a fantasy of civic duty to TRDs everywhere will keep me on track to doing the trial fully, despite setbacks and tolerance.
Think of yourself as a pioneer.
Kind regards
Ed
Posted by pseudoname on December 3, 2005, at 20:46:34
In reply to Re: the Significant Crest » pseudoname, posted by ed_uk on November 30, 2005, at 15:18:28
I've been on buprenorphine for depression for 2½ weeks. I'm now at 2-3 mg/day, which is WORKING(!) and tolerable but not scot-free. I'm cautiously optimistic.
I took a drug holiday Thursday for various reasons, but mostly so that I could POOP. It was an ordeal. For the constipation, I'm doing Miralax, milk of magnesia (only 1 week, I know), lots of water, a high-fiber diet... Wax suppositories don't quite seem to reach the problem, but I stocked up on 'em just in case. I haven't pooped again in the last 48 hours.
MOOD & COGNITION:
Buprenorphine helps me a lot. It varies unpredictably from about 40% to 100% relief, but I hope I will recognize what level I'm getting as each day goes on and maybe figure out how to optimize that degree of relief to improve my life that day. That's I can't have 90+% every day!It only works for 4-10 hourse at a time. It's still quite possible that tolerance to the good effect will set in, and bupe will poop out.
But this week I have seen what my thoughts are like without the depressive poison I've lived with for over 20 years. During one period of bupe's 100% effectiveness, for example, I spoke with a neighbor, and for once I wasn't imagining what she thought about me. I just talked to her. I enjoyed her company, but I didn't need for her to like me.
I can't convey how huge this difference is for me. Typically, 80% of my brain would be overheating with relentless, panicky ruminations in that situation and for 3 years after it. This time, they were just..... not there.
Also on bupe, when I thought about my childhood or my parents, I instantly realized things that I'd never noticed before. Despite years of psychoanalysis and obsessive psychologizing, I had never realized, for example, "I have a problem with my mother."
I'd actually done everything I could to step around this observation. If pressed in just the right way, after another 20 years I might've admitted that I was avoiding some issues there. But the other day, on bupe, it was as plain as day. I saw how that problem's framework goes through my whole adult history. I simply saw it instantly, without fear or sweating. Without evasion.
This was not recovered memory, catharsis, buried emotions, or "working through." It was buprenorphine. I was amazed.
Bupe is, for me, FOR NOW, a magic pill.
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Dr. Bob is Robert Hsiung, MD,
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