![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 21 to 45 of 95. Go back in thread:
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.
Posted by ed_uk on December 5, 2005, at 16:26:07
In reply to buprenorphine: Week 3, posted by pseudoname on December 3, 2005, at 20:46:34
Hi PN :-)
I'm so pleased to hear that bupe is helping! Please continue to post how you're doing :-)
>For the constipation, I'm doing Miralax, milk of magnesia (only 1 week, I know), lots of water, a high-fiber diet...
If you're on MiraLax, adding Milk of Magnesia probably isn't necessary. MiraLax and Milk of Magnesia are both osmotic laxatives: they work in the same way. Opioid-induced constipation usually requires a 'stimulant' laxative such as standardised senna extract, sodium picosulfate or bisacodyl. Don't be afraid of 'stimulant' laxatives. Despite the bad press they've received, few people run into problems with them. MiraLax + a stimulant laxative is an excellent combination.
Warm regards
Ed
Posted by pseudoname on December 5, 2005, at 17:09:46
In reply to Re: buprenorphine: Week 3 » pseudoname, posted by ed_uk on December 5, 2005, at 16:26:07
> MiraLax and Milk of Magnesia are both osmotic laxatives: they work in the same way.
I had wondered about that. I've actually now discontinued the MoM since I finally pooped 4 times yesterday and 4 times today. (YES, you all needed to know that!! LOL!!)
No need for the stimulants at this point.
Questions: When do you think I should try going without the Miralax? And when I do, should I taper down, using it every other day or using half as much, etc?
Thanks for your support of my opioid trial. As I get more experience, I'll post more about it. When I went skipped bupe for a day last week (my drug holiday), depression & ALL the old demons had returned by the 36-hour point.
Ed: I hope you're doing well!
Posted by ed_uk on December 6, 2005, at 14:03:38
In reply to laxatives, opioids » ed_uk, posted by pseudoname on December 5, 2005, at 17:09:46
Hi PN
>When do you think I should try going without the Miralax?
In all honesty.......... never! Tolerance to the constipating effect of opioids doesn't usually develop.
>.........should I taper down, using it every other day or using half as much, etc?
Aim for a dose of MiraLax which allows you to painlessly pass soft stools on a regular (!) basis ie. similar to your usual frequency in the unmedicated state.
>Ed: I hope you're doing well!
Not bad thank you :-) .......but I've got a mild virus :-(
Warm regards
Ed
Posted by pseudoname on December 6, 2005, at 16:23:15
In reply to Re: laxatives, opioids » pseudoname, posted by ed_uk on December 6, 2005, at 14:03:38
>> When do you think I should try going without the Miralax?
> In all honesty.......... never! Tolerance to the constipating effect of opioids doesn't usually develop.Thank you, Ed; this is good to know. I think Elizabeth was still complaining about this problem after more than a year.
I'll get my Miralax by the case, then. ;-)
Posted by bigcat on December 8, 2005, at 19:24:11
In reply to Re: laxatives, opioids » ed_uk, posted by pseudoname on December 6, 2005, at 16:23:15
Magnesium Citrate works wonders for me. Dulcolax, suppositories, and stool softeners don't help. A bottle of magnesium citrate (2$) gets the job done within hours.
Posted by pseudoname on December 8, 2005, at 20:24:09
In reply to MAGNESIUM CITRATE FOR CONSTIPATION » pseudoname, posted by bigcat on December 8, 2005, at 19:24:11
> Magnesium Citrate works wonders for me
Hey, thanks, Matt. At $2 a bottle (!) it's certainly worth a try. "Within hours"...! :o My Miralax seems to have paused a little at the moment. I should be able to get some mag cit tomorrow (and I'll have the afternoon free...).
Have you talked yet to your doc about buprenorphin? Or are you waiting to see if I crash to smithereens, LOL! It is consistently working for me on mood 40-90% (or better). This is from 0-15% on anything else. It is especially helping with thinking about certain "scary" thoughts: I can think about them now. It's worth it to me for that alone, constipation or not.
Take care.
Posted by bigcat on December 10, 2005, at 21:09:40
In reply to Thank you! » bigcat, posted by pseudoname on December 8, 2005, at 20:24:09
Hey There Psuedoname-
Your buprenorphine trial sounds like it is going very well, and I hope with time you will gain the confidence that it will continue to bring you relief. I was so pleased with what I read earlier, about you talking with your neighbor "like it was no big deal" and that it seemed very natural. It's amazing when something starts working how little things are no longer such monumental stresses. I particularly related to how you described your "usual" experience in such situations, replaying the encounter and obsessing about what she may be thinking of you for weeks afterwards.I also liked how you said that you could "rise above" your thought patterns and acknowledge truths, even hurtful truths, that you were blocked from adressing earlier. This is sometimes painful, but also very liberating, as truly "feeling" pain is an indication that your emotions are returning. And accepting, without attaching, to this pain is a sure sign of progress. This change in perspective indicates that your reality has changed. I am very happy for you and commend your relentless determination to find something that will make you better.
I started the Effexor recently and while I'm currently immersed in the depression, I have had a brief taste of remission upon starting the med, so I'm sticking with it for now. But stories like your Bupe trial are encouraging, reminding me that there are always still options available.
I see people like you and me as fighters, not labrats (I'd try the bupe in second, and wouldn't wait to see how your trial turned out before diving in). There is so much misinformation out there that hinders psychopharmacology, and the "whatever it takes" philosophy is one that we have both dedicated our lives to.
I swear by the Magnesium Citrate. It is the one constant I can rely on the alleviate what amounts to the most acute side effect I get from AD's. Hope it treats you equally as well.
-matt-
Posted by pseudoname on December 10, 2005, at 21:54:05
In reply to Re: Thank you! » pseudoname, posted by bigcat on December 10, 2005, at 21:09:40
Posted by ed_uk on December 14, 2005, at 16:19:17
In reply to What a great post to read. Thanks (nm) » bigcat, posted by pseudoname on December 10, 2005, at 21:54:05
Hi PN!
Hope things are going well :-)
How is your mood? What dose are you taking right now?
And I have to ask.......
How's the constipation and which laxatives/doses are you taking?!
Ed
Posted by pseudoname on December 15, 2005, at 13:39:23
In reply to Re: What a great post to read. Thanks » pseudoname, posted by ed_uk on December 14, 2005, at 16:19:17
> How is your mood? What dose are you taking right now?
My mood – on buprenorphine – is pretty good. I'd say bupe gives me 40-95% mood improvement every day. But another key benefit for my particular problem: when I accomplish something good in the course of a day, ON BUPE I don't freak out about it later. It's hard to explain, but bupe keeps that bizarre post-success panic away. Not even benzos did that for me.
That is what I've wanted for 10+ years.
I take 2 mg Subutex tablet early in the morning and about 1 mg about 1:00 PM. (Oh! Be right back.....) It takes 1-2 hours to get any mood/thought benefit. The first dose wears off after 4-8 hours, but the second dose can last into the night.
I've taken a few drug holidays (36-48 hrs without bupe), and the worst foul thoughts come back toward the end. Off bupe, I'm always semi-suicidal. The only physiological withdrawal symptom I've had so far is headache.
> How's the constipation and which laxatives/doses are you taking?!
LOL. My drug holidays were mostly for pooping, but constipation is a little less recently.
I bought the stimulant Dulcolax® (bisacodyl) at your encouragement and magnesium citrate (at Matt's suggestion). So far I haven't had to open either one. I also stocked up on wax suppositories, which aren't much help.I'm still taking 17g of Miralax every day. I haven't taken milk of magnesia in 2 weeks or so.
OTHER SIDE EFFECTS: My mental ability is better now. I can read books, which I couldn't do at first on bupe at all.
Two different times off bupe, I had absent-minded cognitive problems. I did little things on the computer that I never realized at all! A couple weird things like that. Definitely worth noting.
I still have no real drive or interests. Until a couple years ago, I had dreams & plans even when I was very depressed. Maybe I'm just getting old. Maybe another AD or some other drug on top of the bupe might work now? Maybe if I keep working, exposing myself to rewarding situations, etc, I'll start coming alive again.
Thanks for asking. Peace to you, Ed.
Posted by ed_uk on December 17, 2005, at 14:15:04
In reply to buprenorphine ongoing » ed_uk, posted by pseudoname on December 15, 2005, at 13:39:23
Hi PN :-)
Sorry for the delay in responding - my new internet connection is currently very tempremental, I'm not sure what's wrong. Most days I can't log on to the internet at all.
>It's hard to explain, but bupe keeps that bizarre post-success panic away.
Do you worry about the possibility of 'poop out'?
>I take 2 mg Subutex tablet early in the morning and about 1 mg about 1:00 PM. (Oh! Be right back.....) It takes 1-2 hours to get any mood/thought benefit. The first dose wears off after 4-8 hours, but the second dose can last into the night.
Perhaps you could get a more consistent effect by taking it in three divided doses - which is often necessary when it's used as an analgesic. What do you think? You could take 2mg when you wake up in the morning, 0.5mg four hours later and another 0.5mg after a further four hours.
>magnesium citrate
Mag citrate is an osmotic laxative - it works in the same way as MiraLax, you won't need to combine them. MiraLax is probably a bit safer than mag citrate though, which is why I recommended it.
Bisacodyl will be useful if your constipation worsens and an increased dose of MiraLax doesn't help.
>I'm still taking 17g of Miralax every day.
It is adequate at this dose? Any side effects?
>I still have no real drive or interests.
Ever tried nortriptyline?
>Maybe if I keep working, exposing myself to rewarding situations, etc, I'll start coming alive again.
I do believe you will :-)
Love
Ed
Posted by pseudoname on January 2, 2006, at 20:34:06
In reply to Re: buprenorphine ongoing » pseudoname, posted by ed_uk on December 17, 2005, at 14:15:04
> Will you post how you're doing on your bupe thread?
For those new to this thread: This is my 7th week on buprenorphine for unipolar treatment-resistant depression. Bupe is an opioid given to addicts, but I've never been addicted to anything. Its use as an AD is off-label and very uncommon. I first got benefit in my second week, when I titrated up to 1.8 mg. I've had "40-100% improvement" every day that I've taken it for the last month. Mild nausea and dizziness were a minor problem for the first few days.
CURRENT DOSE: 2-4 mg/day Subutex® sublingual tablets. Usually 1 mg at 6 AM, 1 PM, 5 PM.
> Perhaps you could get a more consistent effect by taking it in three divided doses - which is often necessary when it's used as an analgesic.
I was taking 2mg on waking, but spreading it out evenly (waking-noon-supper) seems best right now. The AD effect is definitely TEMPORARY.
But oddly, despite its short action, I feel no craving or urge or "neediness" for it. I've gone without it several times without withdrawal, just the same-old depression & foul thoughts returning. Because of bupe's nasty taste, I actually have to force myself to take it.
I think there's no craving because it takes so long to kick in — about 1 or 2 hours after dosing before my thoughts clear and my mood lifts. So the addictive part of the brain can't figure out the connection.
My longtime craving for caffeine is greatly reduced on bupe, as is caffeine's effect. And usually a 1/2-glass of wine will get me buzzed, but I had a full glass over Christmas (I know, I know) and found it had ZERO subjective effect. Is that because I'm already semi-bombed by bupe??
I'm less dopey now on bupe than a month ago, but I'm still a little. I'm hoping that will continue to dissipate.
When I've gone WITHOUT bupe for a day, however, I've had really strange memory lapses. I've done complex tasks that I later have no memory of. That is worth keeping an eye on.
> >I'm still taking 17g of Miralax every day.
>
> It is adequate at this dose? Any side effects?Constipation was a big problem for several weeks, despite Miralax and other treatments. But now I poop about every other day. Maybe every day: I'm not paying attention, happily. I'm not aware of any side effects to the Miralax.
I still carry meclizine (Bonine®) in case of nausea, but it's rare. However, my tummy on bupe is sensitive and doesn't like rich foods.
> Do you worry about the possibility of 'poop out'?
Yes. I suppose that's not entirely bad. That worry could get me off my butt to make improvements in my life while I've got the ability to do it.
• PERSONAL GROWTH •
I feel like I'm a lot different on bupe. Aren't I? ;-) I feel like people are treating me differently– clerks, strangers, family, Babblers. Probably it's the same as ever, I'm just seeing it differently. Or maybe I'm more chipper or relaxed or something and evoke different responses.I've gotten insights and personal-history realizations on bupe that had eluded years of psychoanalysis. I think they were just too scary! On bupe I can face things I couldn't before. This is a separate effect from the general mood-lifting.
But being braver and less depressed means that I now have to fix some things I'd rather avoid! My finances and other messes, for example. Maybe also applying to grad school (not just pretending to, LOL). Curing depression can lead to anxiety.
I posted 3 weeks ago that although not depressed "I still have no real drive or interests." Well, I have continued "coming alive" slightly on the bupe. Some interests/drives are gradually returning.
I posted a lot over on Books about my recent bupe-related "enlightenment". It's probably not worth repeating. It may not be worth reading, LOL. :-)
http://www.dr-bob.org/babble/books/20051228/msgs/594384.htmlThanks for your continued interest, Ed. Sending love & best wishes your way. And thanks to Marsha, Dec, Matt, Larry, Elizabeth (if you're there), and everyone else who's given me their ideas & support.
Posted by pseudoname on January 3, 2006, at 13:00:01
In reply to buprenorphine WEEK 7 » ed_uk, posted by pseudoname on January 2, 2006, at 20:34:06
I forgot to add two things:
•1• (From weeks ago)
> > I still have no real drive or interests.
> Ever tried nortriptyline?I tried Pamelor and Nardil 18 years ago, without any benefit. I'm open to adding a regular AD, such as an MAOI, to the bupe at some point in the future. But interests have been gradually returning on their own.
Does nortriptyline specifically help foster interest?
•2• I have no sex drive or interest. Absolutely none. Less than zero. I don't even remember what an erection felt like. Men and women look equally uninteresting, clothed and unclothed, to me. I don't even miss it, that's how Gone it is.
Posted by ed_uk on January 3, 2006, at 15:03:01
In reply to buprenorphine WEEK 7 » ed_uk, posted by pseudoname on January 2, 2006, at 20:34:06
Hi PN
>I first got benefit in my second week, when I titrated up to 1.8 mg.
It's interesting that the benefit was quite delayed. SLS (Scott) would be interested. I think he once tried an opioid for a few days but it didn't help.
>But oddly, despite its short action, I feel no craving or urge or "neediness" for it.
I guess you just feel normal on it - not 'high'.
>Because of bupe's nasty taste
Is it bitter?
>And usually a 1/2-glass of wine will get me buzzed, but I had a full glass over Christmas (I know, I know) and found it had ZERO subjective effect. Is that because I'm already semi-bombed by bupe??
You can drink a bit of alcohol on bupe (provided that you don't drive or anything!) One shouldn't drink alcohol during the first 7 (or so) days of opioid treatment or while the dose is being increased.
It's interesting that the alcohol didn't give you a buzz.......naltrexone (an opioid antagonist) is used as an aid to the treatment of alcohol dependence.
>When I've gone WITHOUT bupe for a day, however, I've had really strange memory lapses. I've done complex tasks that I later have no memory of. That is worth keeping an eye on.
Interesting. Makes me think of state-dependent memory.
>I feel like I'm a lot different on bupe. Aren't I? ;-)
You do seem a lot happier :)
>But being braver and less depressed means that I now have to fix some things I'd rather avoid! My finances and other messes, for example.
It's interesting that bupe seems to be increasing your motivation. Opiophobes often talk of people becoming apathetic on opioids.
Love
Ed
Posted by pseudoname on January 4, 2006, at 10:26:03
In reply to Re: buprenorphine WEEK 7 » pseudoname, posted by ed_uk on January 3, 2006, at 15:03:01
> > I first got benefit in my second week, when I titrated up to 1.8 mg.
>
> It's interesting that the benefit was quite delayed.I guess I worded that poorly. Starting with 0.1 mg on the first day, it took me about ten days, increasing the dose gradually due to side effects, to get to 1.8 mg. But on the very first day that I took a 1.8 mg dose, I got the benefit in about two hours.
It took Elizabeth 3 days to get the benefit, but I'm not sure how long it took her to titrate up to her therapeutic dose-level.
> Is it bitter?
It is bitter — bitter!
> > When I've gone WITHOUT bupe for a day, however, I've had really strange memory lapses.
>
> Interesting. Makes me think of state-dependent memory.Well, I never had any recovery of the memory on bupe or off, so I don't think we can call it state-dependent. Just forgotten! :-)
Hmmm. But that is not a bad thing to keep in mind if I have to study for any tests: make sure my buprenorphine level is the same when studying as when taking the test.
> It's interesting that bupe seems to be increasing your motivation.
(Chuckle.) I don't want to overstate that! I'm still pretty lazy, but... humm.... yes, actually I guess my motivation is increasing! I was experiencing it more as feeling like I *had* to do stuff now, but that surely is "motivation", even if it feels burdensome.
What would I do without Babblers to help me think these things through?
> Opiophobes often talk of people becoming apathetic on opioids.
Somebody posted that she reacts to tramadol (Ultram®) like it's an amphetamine. It makes her run around cleaning her house and so on. I haven't had that experience yet.
Posted by reefer on January 4, 2006, at 17:47:40
In reply to Re: buprenorphine WEEK 7 » ed_uk, posted by pseudoname on January 4, 2006, at 10:26:03
> > Opiophobes often talk of people becoming apathetic on opioids.
>
This is true for all of the full agonists. In this bupe is very different. It makes me motivated to do things to, and a lot of people report this.> Somebody posted that she reacts to tramadol (Ultram®) like it's an amphetamine. It makes her run around cleaning her house and so on. I haven't had that experience yet.
>
Tramadol has potent effects on NA, and this is why some people become speedy on it. It is a very weak opioid, different studies give different info but it's inbetween 1/10 and 1/100 the potency of codeine(which is about 1/10 or less the potency of morphine).
Posted by Declan on January 5, 2006, at 2:05:03
In reply to Re: buprenorphine WEEK 7, posted by reefer on January 4, 2006, at 17:47:40
I think if opiate doses are not excessive, and if the opiate is not too toxic (methadone) then motivation will likely be increased. I have heard it said of bupe, but maybe this is by comparison to methadone, that it is very clear mentally and not depressing. But I did some gardening on codeine, and I talked to strangers in the street on morphine (over the years). These positive motivating effects definately diminish over time, part of which I put down to methadone's toxicity, and partly to changes in oneself, maybe opiate receptors.
Declan
Posted by pseudoname on January 5, 2006, at 9:32:39
In reply to Re: buprenorphine WEEK 7, posted by Declan on January 5, 2006, at 2:05:03
I'm going to experiment with increasing my buprenorphine dose slightly (like from 3 mg/day to 4.5) to see if the "motivation" angle might improve more.
Despite these improvements:
•general mood
•activity level
•I brush my teeth every day now, no problem (big change)
•I feel I "have to" do stuff (which is an improvement over complete lethargy/disinterest),...there's a lot of room for further improvement. I'm not *doing* the stuff I feel I have to do.
Since there's no guidelines and I'm "a pioneer" like Ed says, ;-) I need to experiment.
Posted by York on January 5, 2006, at 13:12:02
In reply to buprenorphine WEEK 7 » ed_uk, posted by pseudoname on January 2, 2006, at 20:34:06
I have had refractory depression for 20 years and have tried avery SSRI available. I found info on the internet about Bupe and wanted to try it. No MD would give it to me. I went to visit family in TX and decided to go to Mexico and get some Temgesic 0.2mg SL. I got 2 weeks worth and that was the best 2 weeks of my life. I felt emotions that I never experienced before. From happy, sad, mad, balanced, and so many more. I have always had anxiety and that is usually my only emotion. I was able to make decisions based on real emotions and not by anxiety.
Anyway, fast forward 2 months. Went to 5 different MD's and all turned me down. I finally went to a MD who is Suboxone certified and told him I was a Vicodin addict. He gave me Suboxone 8mg's x 30 pills. With the Temgesic I was taking 0.3mg every 4 hours with a total daily doe of 1.2 mgs. I am not doing as good on the Suboxone but still 50% better than usual. I find it hard to cut the pills in small doses. I could be taking from 0.2 to 0.7 mg at a time. Sometimes I feel very good and at other times feel like my old self.
A couple of question.
1- I know the Suboxone is not pure Bupe because it has Naloxone in it and as long as it is taking SL the Naloxone "should" have no affect. What are your feeling on this?
2- Do you have any suggestions on what I should do to try and get the dosages more accurate as far as splitting the pills?I no this is the medicine for me at this time. Hopefully there will be other meds made in the future that will be easier to take or not addicting but after years of horrible depression/anxiety and tons of diffeent meds, I know this works for me.
Posted by reefer on January 5, 2006, at 13:17:54
In reply to opioid motivation » Declan, posted by pseudoname on January 5, 2006, at 9:32:39
> I'm going to experiment with increasing my buprenorphine dose slightly (like from 3 mg/day to 4.5) to see if the "motivation" angle might improve more.
>
For me taking 8 mg s.c inj. makes no difference at all compared to taking 4 mg s.c inj. I would very much like to try going much much higher. Like between 16 and 32 mg i just can't afford to waste my expensive hard to obtain Subutex. There is something that seems to work VERY much better than upping the dose. And that is spreading the dose as much as possible. Taking 4 mg in the morning will make me fine for 3 - 4 hours, just like 1 mg will. But taking 1 mg every 4 hours is a whole other story. This will make me feel fine pretty much all day long. So same total dose spread out is a whole other story than all at once. And this makes me think i really would like to get the patches instead. Since they release a low, stable and constant dose during the entire time it is working: between 72 hours and 7 days depending on the patch if i understand this correctly. I'm not sure if the patches deliver enough though. I think the 40 mg 72 hour patches delivered 70ug per hour. That is 280ug parenteral bupe during 4 hours. Should equal around 400ug SL. And the dose i like best is 0.5 mg every 4 hours. So this might very well be near perfect. There is also the possibility to add another patch if a higher dose would be needed.Anyway until i can get my hands on patches i will try and make a nose spray which i will administer every hour. I will report on how that works.
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