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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk on January 8, 2006, at 10:10:30
In reply to Re: Buprenorphine nasal spray!, posted by reefer on January 7, 2006, at 17:04:19
Hi Reefer!
>Do they mean 5% dextrose in a water solution?
Yes
Ed
Posted by reese7194 on January 9, 2006, at 8:54:47
In reply to Re: Buprenorphine nasal spray! » reefer, posted by ed_uk on January 8, 2006, at 10:10:30
hello everyone, i haven't had a chance to read all the posts. i remember years ago trying to find a doc who try buprenex here in nyc. that was when it was schedule five and all that b.s.
finally after going through hell i was finally put on opiods. i am curious if anyone has been on buprenex for an extended period of time and how there tolerance is.
the one side effect i have found with opiods is what i would call...it kind of does in a way what the stereotype of what lithium of anti-psychotics are supposed to do. it can / does dry my brain out. so it's not so wild and creatiive. which is good and terrible.
maybe i am just jaded and tired and this is the reason. it's hard to tell. i go on and off them quite a bit. curious what other people have noticed. thanks
reese
Posted by pseudoname on January 9, 2006, at 17:19:19
In reply to opioid motivation » Declan, posted by pseudoname on January 5, 2006, at 9:32:39
I've been on buprenorphine (Subutex) 3 mg/day for about 7 weeks for depression.
Last night, I had trouble breathing when I lay down to go to bed. It was as if I couldn't get enough oxygen through my nose, but there was no pain. So I breathed through my mouth. No better!
Every time I lay down this started over. Then it started happening while I was sitting up straight. Then it started happening whenever I THOUGHT about the subject of breathing and I got butterflies all through my abdomen, like a panic attack. (Which I've never had before.)
I figured it was asthma, which I've never had.
I got ZERO sleep last night. At 4:00 AM I took a walk; I was okay. Then I played a computer game and got absorbed in it and.... no breathing problems! Today troubled respiration came & went whenever I though about it & forgot about it. At one point I could only avoid what felt like suffocation by distracting myself playing with my cel phone's menus.
I went to my G.P. today about it, who listened to my chest & my heart & my history (all fine), read my blood O2 level (98%), ordered chest X-ray (not yet seen), etc. His determination? It's not asthma, not heart attack, not infection. It's probably due to the BUPRENORPHINE!
Bupe, like other opioids, *can* cause respiratory depression in overdose. (If you got too much opioids, you'd need to be on a ventilator till they were out of your system. I'm pretty sure there's no antidote.) He thinks it's likely that I may be sensitive to opioids, and that the bupe is screwing with various respiration control centers in my brain even at the low doses I'm taking.
So his advice: No more bupe until this is resolved and I speak again to my pdoc (who prescribed it).
My reaction: NOOOO!!!
Bupe is the ONLY antidepressant that has EVER worked for me. I've had hopeful outlooks on it that I have never had in all of my adult life! I care about other people as human beings now! My "How-are-you?"s are SINCERE on bupe!
It is not perfect and I need to learn more about maximizing its good effects (which are not constant but seem to be spreading), but it is as close as I've ever been to a miracle drug.
I can't lose it now. I *can't*.
Acute respiratory problems, however, are TERRIBLE. They are actually worse than depression. I cannot afford to keep having them. I'm really not looking forward to tonight since I'm still affected by this morning's bupe and I still have trouble breathing every time I think about it.
The G.P. offered no advice about tonight other than to try sleeping propped up with pillows and go to an E.R. if it gets dangerously bad.
I left a message with my pdoc, but it's not her style to return calls promptly. I see her next week Tuesday (8 days from now).
Posted by reefer on January 9, 2006, at 18:18:50
In reply to BAD NEWS!, posted by pseudoname on January 9, 2006, at 17:19:19
> I went to my G.P. today about it, who listened to my chest & my heart & my history (all fine), read my blood O2 level (98%), ordered chest X-ray (not yet seen), etc. His determination? It's not asthma, not heart attack, not infection. It's probably due to the BUPRENORPHINE!
>He might be right it's the buprenorphine. But he is wrong saying it's respiratory depression.
A little citing from an article on bupe:
Even high doses of buprenorphine--as much as 100 times the dose at which it produces analgesia--do not produce dangerous respiratory effects. "Respiratory depression caused by buprenorphine is not of clinical concern," says Segal, "which makes it an extremely attractive treatment alternative."
I can't diagnose you. But i would bet on that what happened to you was not respiratory depression. But it might very well be related to the buprenorphine.
Posted by pseudoname on January 9, 2006, at 19:00:55
In reply to Re: BAD NEWS!, posted by reefer on January 9, 2006, at 18:18:50
Thanks, reefer.
I Googled from your quote & got the article.
I think I agree with your analysis. The G.P. was just going by what his pocket PDA of drugs said, so he wants me to see my pdoc about it. But the pdoc doesn't know anything about buprenorphine either!! Sigh.
I was not expecting this complication.
Posted by reese7194 on January 9, 2006, at 19:27:40
In reply to Thanks re respiratory problem » reefer, posted by pseudoname on January 9, 2006, at 19:00:55
i am sure this won't help and i'm sure you have thought about it but i figured i should mention it anyway. have you ever had any anxiety attacks before? if by chance you haven't. you are very lucky. because that could be what it is. in a way i hope it is that. because that would makes things a lot easier to deal with because it would have no connection to the buprenorphine.
Posted by reefer on January 9, 2006, at 20:54:44
In reply to Re: Thanks re respiratory problem, posted by reese7194 on January 9, 2006, at 19:27:40
I didn't want to say it at first but i also strongly believe it's anxiety. I actually had a couple of panic attacks during the first months of my bupe use. I cannot say for sure there is a connection to it. I had the attacks before using buprenorphine also but they were under control and reappeard during buprenorphine use. Then they dissapeard again. I must ask, do you have some trouble with sleep from bupe? I did in the beginning and i think that the anxiety was secondary to my loss of restful sleep cause as soon as i got good sleep again i didn't have any more attacks. But it might or might not be related. I can't really say. Just a thought.
Posted by pseudoname on January 9, 2006, at 21:52:03
In reply to Re: Thanks re respiratory problem, posted by reefer on January 9, 2006, at 20:54:44
> i am sure this won't help
Reese, I disagree with you already ;-)
(These exchanges are a lot of help. I'm lost at sea.)> [anxiety attacks] could be what it is.
It clearly has a psychological component. If I even START to turn my inner cognitive eye toward ideas connected to breathing, then suddenly I can't get air and my abdomen goes all squirelly like someone gave me a shot of epi.
Just now my BP was 140/93 (pulse 60), when my guts felt like an adrenaline surge. It was 124/80 at the doc's today. 118/78 last month.
> in a way i hope it is that [anxiety attacks].
> because it would have no connection to the buprenorphineMaybe. Bupe (I'm making wild guesses) might be setting me up somehow for the anxiety attacks. My brain is changing a *lot* lately, take my word for it. I suppose this could be a bad side-effect. If it is, maybe it's temporary...
Maybe I could take the bupe (for depression) AND PAXIL or something like that (for the anxiety)?
I'll be off the bupe for the next couple days. If the problem clearly goes away, that will make the bupe look guilty.
> have you ever had any anxiety attacks before?
Nope, never. Lucky me.
The part of this that was like (or was) a panic attack was horrible. Worse than depression.
I'll check back in tomorrow. Hopefully, I'll be WELL-RESTED!
Posted by reese7194 on January 9, 2006, at 22:02:31
In reply to anxiety » reese7194 » reefer, posted by pseudoname on January 9, 2006, at 21:52:03
okay. look this is the deal. if you have been on this stuff for seven weeks you have a tremendous amount of pressure going on in your head every minute if not every second within that every minute which is stating in blaring letters
"AM I STILL FEELING BETTER!!!!"
"IS THIS GOING TO GO AWAY!!!"
all sorts of f*cking sh*t like this plus whatever usually goes on. but just because you are feeling better.......that alone to me is the most obvious thing that is going on. come on man. how can there not be a complete and utter sense of terror. i'm not sure what your age is or how long you have been on meds and all that crap and it doesn't really matter.
but i think the idea of taking something like paxil is definetly the wrong direction. if anything i would just try to realize that it is possibly, and i say posssibly, anxiety. if this turns out to be it.
be grateful. because i think that is a pretty healthy reaction to feeling possibly better. because you don't know what is going to happen when you wake up each day. will it look the same. will it look like it did yesterday or like it did a few months back.
worse comes to worse have your doc give you some klonipin or something. and please don't worry that you are taking a benzo and an opiod antogonist it is not a big deal unless of course you have a history of abuse.... which i'm guessing you don't.
i hope that helps.
i'm glad it's helping.
Posted by Declan on January 10, 2006, at 0:29:52
In reply to Re: anxiety, posted by reese7194 on January 9, 2006, at 22:02:31
I'll bet it wasn't respiratory depression. If it was that you would have got it much earlier, and anyway (in my experience) respiratory depression is never a (subjective) problem to the person who is experiencing it.
I'd still be thinking of something like asthma, which comes in many shapes and sizes. If you had some Ventolin handy when it was happening...........Hey, let me tell you, this is it....I know 2 people who switched from methadone to bupe who ended up in hospital with asthma attacks. Whatever you call them, I'll bet that's it.
Declan
Posted by pseudoname on January 10, 2006, at 10:01:36
In reply to Re: anxiety, posted by reese7194 on January 9, 2006, at 22:02:31
Good morning! I slept well last night and got up without breathing problems. I couldn't even trigger them by pinching my nose. :D
> if you have been on this stuff for seven weeks you have a tremendous amount of pressure going on in your head every minute if not every second [...]
Well, you have hit on it.
I left out of my posts yesterday (and I didn't get a CHANCE to tell the doc) that because the buprenorphine has been working and I've been relieved from depression for the first time in DECADES...
I have a $h*+load of new pressures. In fact, earlier in the evening of the breathing problems, I was going through some of the most stressful hours of my life. This has happened a lot in recent weeks as I feel more hopeful and energetic and turn my attention to financial and personal problems that I've been letting slide for years.
My life is still in crisis, but I can't ignore the problems anymore like I did when depressed.
Hours before the breathing problems began, I was at crisis-level stress. I was thinking, "Even if I'm not depressed, I can't solve these problems! I'm doomed!"
THEN I thought of an old friend / businessman that I could ask for advice, and waves of relief went through me. I started thinking, "Hey, maybe this *can* be solved ....er, somehow."
THEN the breathing problems started.
I know, LOL: people are saying, "Why didn't you mention this before?!"
Posted by reese7194 on January 10, 2006, at 10:28:12
In reply to Re: anxiety » reese7194, posted by pseudoname on January 10, 2006, at 10:01:36
no man that makes sense that you wouldn't say anything. if you would have said something i wouldn't have thought of it possibly being anxiety. anxiety is the sneaky sh*t that you can't be to aware of hopefully. it's like the car keys that are in front of your face but you can't see them. you know?
it's just cool that you are feeling okay. and it's hard not to feel like or beat yourself up for having possibly something new to be upset about.
you know
Posted by pseudoname on January 10, 2006, at 10:53:52
In reply to Asthma, bupe, and respiratory depression, posted by Declan on January 10, 2006, at 0:29:52
> I know 2 people who switched from methadone to bupe who ended up in hospital with asthma attacks
That is very interesting.
I left out of my posts that Friday & Saturday I had experimented going by increasing my dose from 3 mg/day to 5 mg/day. Then back to 3 mg Sunday. Then the breathing problem was Sunday night.
ALSO: Because of my depression, my house has not been cleaned in years. It is an asthmatic horror with all the dust!
But the doc said the trouble I described just didn't fit asthma. He said my problem was not environmentally triggered and my O2 levels were fine. I didn't 100% understand his confidence, but he pretty much ruled out asthma. Also, I have had no problem quickly filling my lungs even when very panicked, if that matters. But as you say, asthma comes in many shapes & sizes.
> If you had some Ventolin handy when it was happening..........
I was hoping the doc would just give me an inhaler to try. What could it have hurt? Maybe I can borrow one.
With asthma in mind, yesterday morning (before the doc visit) I also washed all my bed linens, blankets, & pillows, started cleaning my room, and changed the furnace filter.
I'm thinking now that my problem is anxiety-related, but I'm not ruling anything out.
My dusty house may be putting my breathing right on the edge of asthma-like irritation. Maybe that's why *breathing* and not, say, chest pain, is where my anxiety is expressed? THAT makes a lot of sense to me.
Posted by reefer on January 10, 2006, at 12:59:48
In reply to Re: Asthma bupe » Declan, posted by pseudoname on January 10, 2006, at 10:53:52
> > If you had some Ventolin handy when it was happening..........
>
> I was hoping the doc would just give me an inhaler to try. What could it have hurt? Maybe I can borrow one.
>
Do NOT use an inhaler. As far as i know they are beta-adrenergic agonists. And that's like anxiety in a bottle. Since the doc checked your 02 blood levels and they were normal he was correct in ruling out asthma. If you get an inhaler, use it first after trying an anti anxiety med like a benzo.> With asthma in mind, yesterday morning (before the doc visit) I also washed all my bed linens, blankets, & pillows, started cleaning my room, and changed the furnace filter.
>
Good, at least you wont get buried in dust!> I'm thinking now that my problem is anxiety-related, but I'm not ruling anything out.
>
Get some Xanax, or Klonopin wafers. Because they are quick acting. As soon as you feel the breathing problems come on you(if they do), take 0.25 - 0.5 mg and lay down and do some kind of relaxion training. If after 30 minutes you feel fine then you can be pretty sure it is anxiety related.Also remember that while you are now taking a bupe holiday you might feel more depressed. If that happens use small "rescue" doses of bupe.
Posted by ed_uk on January 10, 2006, at 15:16:03
In reply to BAD NEWS!, posted by pseudoname on January 9, 2006, at 17:19:19
Hi PN :)
>Last night, I had trouble breathing when I lay down to go to bed. It was as if I couldn't get enough oxygen through my nose, but there was no pain. So I breathed through my mouth. No better!
Sounds like panic-anxiety.
>Then it started happening whenever I THOUGHT about the subject of breathing
This is practically diagnostic of anxiety. If you were suffering from acute asthma you would be continually breathless, it wouldn't disappear on distraction.
>respiratory depression
It wasn't respiratory depression. No doubt about it. Your symptoms don't even vaguely resemble respiratory depression!
>It's probably due to the BUPRENORPHINE!
If bupe was gonna cause panic-like symptoms it would probably have occured before now. Perhaps the dose reduction from 5mg to 3mg triggered anxiety? Your docs will inevitably be ultra-cautious because using bupe to treat depression is so unusual.
>If you got too much opioids, you'd need to be on a ventilator till they were out of your system. I'm pretty sure there's no antidote.
There is an antidote. It's called naloxone (Narcan). You won't need it though :)
>I can't lose it now. I *can't*.
You could try a sedative antihistamine to help you sleep. Atarax (max 100mg per dose) might help, you could take it as a single dose in the evening. You need to focus on the fact that however much is feels like you can't breathe, you CAN breathe. In fact, you were probably hyperventilating! Anxiety will never stop you from breathing, despite how awful it feels. Keep this in mind. It will reduce your anxiety and hence your breathlessness.
Love
Ed
Posted by reese7194 on January 10, 2006, at 17:32:44
In reply to Re: BAD NEWS! » pseudoname, posted by ed_uk on January 10, 2006, at 15:16:03
i have to say something here. now the difference of switching over from god knows how much methadone for how many years to bup is a very f*cking scary dangerous proposition which any doctor in good faith would tell you. methadone is the most f*cked up of all synthetic pain killers. that's why it's so easy to get. that's why the people who take it are generally from the lower class of life. you don't see people who are suffering in mansions taking methadone.
america has had a drug war for god knows how long on everything except methadone. i wonder why. i'm not against methadone. no way. i just find how it's distributed and how the people are treated that are on it to be pretty f*cked up. once you are on that sh*t you can't get off.
so for this guy to start taking bup for seven weeks and comparing it to someone who is switching from methadone which means they used to have i would imagine a pretty decent relationship with dop / heroin to be just a little differetn.
it wouldn't be strang for someone to have a seizure switching form meth to bup.
my point being that i find the comparison not weighed properly.
this guy is taking buprenorphine. that's like getting totally drunk one night and waking up and feeling sick and thinking you are going through dt's because the guy next to you who has been drinking for the last twenty years is going through dt's.bad analogy i know.
Posted by Declan on January 11, 2006, at 0:30:44
In reply to Re: BAD NEWS!, posted by reese7194 on January 10, 2006, at 17:32:44
Well Reese, I dunno. Far be it from me to sing the praises of methadone. But I do wonder if those 2 people would have had the asthma type response if they had 'simply' been withdrawing from methadone. Therefore I wonder about some bupe type connection. I agree with you 100% about methadone.
Declan
Posted by Declan on January 11, 2006, at 17:04:46
In reply to Re: BAD NEWS!, posted by reese7194 on January 10, 2006, at 17:32:44
You are right about methadone, not just the pharmacology but also the sociology, IMO. I'd like to be able to put that better, but sociology will have to do.
Declan
Posted by pseudoname on January 18, 2006, at 10:19:28
In reply to Re: BAD NEWS! » pseudoname, posted by ed_uk on January 10, 2006, at 15:16:03
About 10 days ago, I had breathing problems at night. My GP said I was physiologically fine, but took me off the buprenorphine opioid I was taking for depression, thinking it might be the cause.
We (Babblers, me, my pdoc) think the problem was anxiety and NOT the buprenorphine at all. I think the anxiety was brought on by the lifting depression.
I've been off the bupe for 10 days, and the breathing problem has continued. However, the depression has NOT returned! Not once. That is stunning. I seem to have flipped from being depressed to being anxious. I think the anxiety was always there, just neatly suppressed by depression.
My pdoc now seeks to treat me for anxiety and OCD-spectrum symptoms, which I now realize I have always had, bigtime. Despite not being depressed, I still have vague, bizarre anxieties that make many normal behaviors impossible. A lot of this was just covered up by the overwhelming depression.
To start, she prescribed Metadate CD. The original Ritalin worked well but briefly for me a decade ago, but the after-crash was terrible and tolerance developed quickly. Maybe this newer methylphenidate release will be better. Maybe if now it doesn't have to overcome the depression as well as the OCD-like anxieties, I won't have to use as high a dose or develop tolerance so quickly??
The breathing troubles are more mild and mostly at night, but I've been losing a fair amount of sleep. Ed suggested antihistamines for sleep, but since I know they only work for a few days for me and on them I wake up exactly 4 hours after falling asleep, I'm saving them for more urgent situations. It's good to know they're there.
Interestingly, a chest X-ray ordered by the GP showed "nodularity in both apices" probably from "previous granulomatous disease exposure". I'll probably follow up with a pulmonologist.
Based on my experience, I encourage anyone to consider buprenorphine (Subutex) for treatment-resistant depression, if you can get it and use it carefully.
Posted by ed_uk on January 18, 2006, at 15:45:48
In reply to anxiety / breathing problem update, posted by pseudoname on January 18, 2006, at 10:19:28
Hi PN
>My pdoc now seeks to treat me for anxiety and OCD-spectrum symptoms
>To start, she prescribed Metadate CDMethylphenidate seems like a very unusual choice given the circumstances. Why did she choose to prescribe it?
Regards
Ed
Posted by pseudoname on January 18, 2006, at 17:13:25
In reply to Re: anxiety / breathing problem update » pseudoname, posted by ed_uk on January 18, 2006, at 15:45:48
Hi, Ed!
> Methylphenidate seems like a very unusual choice given the circumstances. Why did she choose to prescribe it?
Even when the buprenorphine was effective against the depression and I was feeling good & hopeful, I still could not bring myself to do many necessary tasks, like fix my leaky plumbing or fill out legal paperwork or get a haircut.
The tasks in question are mostly non-challenging stuff I've done before and I want them done. But I'm confronted with a bizarre inability to do them. I thought that would go away when the depression went away, but it didn't. My pdoc said such symptoms were related to OCD (super-perfectionism & irrational fears of humiliation & so on).
We talked about various OCD and anti-anxiety drugs, but nothing she said really seemed to narrow it down for me, until she said that the methylphenidate might help with getting over the bizarre inhibitions and DOING the tasks.
I was concerned that a stimulant could make the anxiety-related breathing problems worse, but she said her anxious OCD patients who were given Ritalin/Metadate did not have worse anxiety on it.
With that reassurance, I went along with it because I had had some good (but brief) results long ago with Ritalin.
> Methylphenidate seems like a very unusual choice given the circumstances.
Do you mean because it's so soon after the anxiety/breathing problem?
Posted by 4WD on January 18, 2006, at 21:54:24
In reply to anxiety / breathing problem update, posted by pseudoname on January 18, 2006, at 10:19:28
> About 10 days ago, I had breathing problems at night. My GP said I was physiologically fine, but took me off the buprenorphine opioid I was taking for depression, thinking it might be the cause.
>
> We (Babblers, me, my pdoc) think the problem was anxiety and NOT the buprenorphine at all. I think the anxiety was brought on by the lifting depression.
>
> I've been off the bupe for 10 days, and the breathing problem has continued. However, the depression has NOT returned! Not once. That is stunning. I seem to have flipped from being depressed to being anxious. I think the anxiety was always there, just neatly suppressed by depression.
>
> My pdoc now seeks to treat me for anxiety and OCD-spectrum symptoms, which I now realize I have always had, bigtime. Despite not being depressed, I still have vague, bizarre anxieties that make many normal behaviors impossible. A lot of this was just covered up by the overwhelming depression.
>
> To start, she prescribed Metadate CD. The original Ritalin worked well but briefly for me a decade ago, but the after-crash was terrible and tolerance developed quickly. Maybe this newer methylphenidate release will be better. Maybe if now it doesn't have to overcome the depression as well as the OCD-like anxieties, I won't have to use as high a dose or develop tolerance so quickly??
>
> The breathing troubles are more mild and mostly at night, but I've been losing a fair amount of sleep. Ed suggested antihistamines for sleep, but since I know they only work for a few days for me and on them I wake up exactly 4 hours after falling asleep, I'm saving them for more urgent situations. It's good to know they're there.
>
> Interestingly, a chest X-ray ordered by the GP showed "nodularity in both apices" probably from "previous granulomatous disease exposure". I'll probably follow up with a pulmonologist.
>
> Based on my experience, I encourage anyone to consider buprenorphine (Subutex) for treatment-resistant depression, if you can get it and use it carefully.
Have you been tested for sarcoidosis? Can cause breathing problems (especially if your chest xray shows nodules). I think it can cause some mood issues as well.Marsha
Posted by pseudoname on January 19, 2006, at 7:15:27
In reply to Re: anxiety / breathing problem update » pseudoname, posted by 4WD on January 18, 2006, at 21:54:24
> Have you been tested for sarcoidosis?
My pdoc mentioned that, too.
I haven't had a biopsy. I realize now that a lot of the questions the GP was first asking me had to do with sarcoidosis. I don't think I have any other symptoms at this time.
After my follow-up X-ray next month, I'm going to see a pulmonologist, and I'll definitely ask him about it.
> Marsha
Nice to talk to you again.
Posted by ed_uk on January 19, 2006, at 14:48:34
In reply to Metadate for OCD » ed_uk, posted by pseudoname on January 18, 2006, at 17:13:25
Hi PN
>Do you mean because it's so soon after the anxiety/breathing problem?
I just meant that methylphenidate can sometimes aggravate anxiety. How are you finding it? Hopefully it will help you to get things done :)
Ed
Posted by pseudoname on January 19, 2006, at 18:44:06
In reply to Re: Metadate for OCD » pseudoname, posted by ed_uk on January 19, 2006, at 14:48:34
> ...methylphenidate can sometimes aggravate anxiety. How are you finding it?
I haven't taken it yet. I guess I'm a little nervous about it. Yesterday I started getting the familiar depressive thoughts / feelings again for the first time in weeks, so I popped 1 mg of buprenorphine. It took care of them very well, I'm happy to say, but I wonder if my recent stable good mood is actually a delicate balance that the stimulant could throw out of whack.
But I'm going to try 10 or 15 mg of Metadate tomorrow morning, unless I chicken out again. <chuckle>
Thanks for your good wishes. I hope you're well, Ed.
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