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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 65 to 89 of 95. Go back in thread:
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.
Posted by reefer on January 20, 2006, at 0:02:33
In reply to anxiety / breathing problem update, posted by pseudoname on January 18, 2006, at 10:19:28
> 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.
>
Hi!Are you going to stop using buprenorphine completly now? And also have you felt any symptoms of withdrawal? I guess not since it's been 10 days and you say you aren't feeling depressed. The WD's from bupe are usually mild but can last pretty long compared to shorter acting opioids. Most people say it's over within 2 weeks. For me the wd's feel like a slight depression and mild fatigue but it is very easy to handle.
Posted by reefer on January 20, 2006, at 0:20:02
In reply to Re: Metadate for OCD » ed_uk, posted by pseudoname on January 19, 2006, at 18:44:06
> 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.
>
I take Concerta 54 mg/day. When i feel i have built a tolerance for it i switch to Modafinil(branded Modiodal here, Provigil in the USA) for a week then i go back to Concerta. They aren't causing any cross tolerance and even though i prefer the methylphenidate to the modafinil it's a pretty subtle difference for me actually. I also take Lexapro which i'm gonna switch to Cymbalta soon hopefully. Depending on how well Cymbalta works for me i might go off the bupe or if it works fine in comb i'll keep it. I also still have a small dose of klonopin left 0.5mg/day which i should have dropped long time ago but i just haven't felt like going through bdz wd's. I would very much like to be on only cymbalta and a stimulant(if needed) and maybe sometimes a xanax for very anxious days.Why did i just rabble my entire drug cocktail? I don't know. But now i did it anyway so i'll just post it, hehe.
Posted by pseudoname on January 20, 2006, at 7:59:22
In reply to Re: Metadate for OCD, posted by reefer on January 20, 2006, at 0:20:02
> Are you going to stop using buprenorphine completly now?
Well, depression started to come back on the last two days, so I took 1 mg of buprenorphine right as those familiar foul thoughts started. Within about 90 minutes, bupe had removed those thoughts competely. So I guess I'll keep it on stand-by, at the very least. I haven't really talked to my pdoc about using both bupe AND Metadate.
> And also have you felt any symptoms of withdrawal?
Nothing! I was only on 3 mg/day, and I've only been taking bupe for 9 weeks altogether, so maybe I haven't had enough yet to get physiologically dependent?
> When i feel i have built a tolerance for [Concerta] i switch to Modafinil for a week then i go back to Concerta. They aren't causing any cross tolerance
Thanks for reminding me of that strategy. I will mention it at my next pdoc appointment.
I just took my first 10-mg dose of Metadate-CD. Pdoc prescribed 30 mg, but I don't want to start that high.
> Why did i just rabble my entire drug cocktail?
Interesting & appreciated, reefer!
Posted by ed_uk on January 20, 2006, at 13:58:41
In reply to Re: Metadate for OCD » ed_uk, posted by pseudoname on January 19, 2006, at 18:44:06
Hi PN
Let us know how the methylphenidate works :)
Ed
Posted by reefer on January 22, 2006, at 17:06:16
In reply to Re: Buprenorphine nasal spray!, posted by reefer on January 7, 2006, at 8:30:50
I did try the spray a couple of times. It seems to be very acidic cause it burns badly and i start to bleed from both nostrils after a few minutes. And i usually dont get a bleed easily. I will make a new try by separating the non water soluble part of the tablet from the solution. So the next time i will dissolve a tablet in 4ml of 5% dextrose/DH2O solution and wait until the fillers fall to the bottom. I will then suck up the solution carefully using a syringe and a small cottonball or maybe a cigarette filter. I will then add up with more of the dextrose/water solution to make 8ml. I will post an update on this when i do it. Probably next week.
Posted by Declan on January 23, 2006, at 7:08:36
In reply to Buprenorphine nasal spray, update, posted by reefer on January 22, 2006, at 17:06:16
Hey Reefer
Bupe is supposed to be toxic to veins when injected. I wonder if this has any bearing on your nosebleeds.
Declan
Posted by ed_uk on January 23, 2006, at 12:53:15
In reply to Buprenorphine nasal spray, update, posted by reefer on January 22, 2006, at 17:06:16
Sorry it didn't work out. Look forward to hearing about your next experiment!
Ed
Posted by pseudoname on January 23, 2006, at 22:39:36
In reply to Subutex withdrawal etc » reefer, posted by pseudoname on January 20, 2006, at 7:59:22
A few days ago, I posted:
> > And also have you felt any symptoms of withdrawal?
>
> Nothing!Well, for a couple days after that I got rapidly alternating chills & sweats; very uncomfortable. On Sunday, I took 1 mg buprenorphine because I was getting foul depressive thoughts, and VOILA — the chills & sweats went away.
Chills came back again this evening, so I took 1 mg bupe just for that purpose, and they went away again. So it seems to be withdrawal.
It's odd: I went 10 days cold turkey off bupe without withdrawal symptoms, then I took a couple bupes and a few days later started getting withdrawal symptoms.
(BTW: My anxiety / breathing problems *seem* to have subsided now.)
Posted by ed_uk on January 24, 2006, at 15:05:00
In reply to Re: Subutex withdrawal etc (revised), posted by pseudoname on January 23, 2006, at 22:39:36
Hi PN
How are you finding the methylphenidate?
Ed
Posted by pseudoname on January 24, 2006, at 16:45:36
In reply to Re: Subutex withdrawal etc (revised) » pseudoname, posted by ed_uk on January 24, 2006, at 15:05:00
> How are you finding the methylphenidate?
Hi, Ed. Thanks for asking.
I've taken it only twice (30mg Metadate CD) so far. It had no noticeable good cognitive / motivational effects. That's surprising to me, because 10 years ago, Ritalin had remarkable (but brief) "light-a-fire-under-my-butt" effects.
However, both times I took the Metadate, I got ZERO hours of sleep that night. I had taken it early in the morning.
Fortunately, it didn't increase any anxiety or bring back my breathing problems.
I'll keep trying it when I can risk a sleepless night, but I'm starting to wish I hadn't bought the whole $80 bottle! =0
Posted by reefer on January 25, 2006, at 1:41:30
In reply to Metadate » ed_uk, posted by pseudoname on January 24, 2006, at 16:45:36
It took a couple of weeks for me to get used to Concerta. At first i couldn't tolerate 18 mg. Made me sleepless at night and very anxious during the day. Now i can take 54 mg, and it makes me calmer after about 1 - 2 hours, but makes me very jittery after about 9 - 10 hours. I guess that's when it's leaving my body. So maybe if you take it a couple of days without holiday days you'll find it better.
Posted by reefer on January 25, 2006, at 1:59:23
In reply to Re: Subutex withdrawal etc (revised), posted by pseudoname on January 23, 2006, at 22:39:36
> A few days ago, I posted:
>
> > > And also have you felt any symptoms of withdrawal?
> >
> > Nothing!
>
> Well, for a couple days after that I got rapidly alternating chills & sweats; very uncomfortable. On Sunday, I took 1 mg buprenorphine because I was getting foul depressive thoughts, and VOILA — the chills & sweats went away.
>
> Chills came back again this evening, so I took 1 mg bupe just for that purpose, and they went away again. So it seems to be withdrawal.
>What you need to do to not get w/d is to take as little bupe as possible to keep you w/d free. When you feel it coming on take 0.2 mg and if after 90 minutes you still aren't comfortable take 0.1 - 0.2 more. This will get you a smooth landing.
Posted by reefer on January 25, 2006, at 2:01:44
In reply to Re: Buprenorphine nasal spray, update » reefer, posted by Declan on January 23, 2006, at 7:08:36
> Hey Reefer
> Bupe is supposed to be toxic to veins when injected. I wonder if this has any bearing on your nosebleeds.
> DeclanHow can it be toxic to veins? Buprenex can be used for i.v. injection, can't it?
Posted by Declan on January 25, 2006, at 5:53:53
In reply to Re: Buprenorphine nasal spray, update, posted by reefer on January 25, 2006, at 2:01:44
Well ummm, I'm just quoting my pharmacist actually, who said it was venotoxic. I don't actually know anything about it.
Declan
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