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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 56. This is the beginning of the thread.
Posted by Horned One on May 29, 2008, at 15:22:38
Can anyone lay their hands on the studies that showed buprenorphine was an effective antidepressant? I know they're probably in the bowels of PubMed somewhere, but I'm too depressed to sort them out right now (besides, it's much nicer to have someone else do it for me). I'm thinking of bringing them with me to my next appointment. I don't have much hope because I've been begging for an antidepressant since February, and the answer is still 'no'. My pdoc must surely be sadistic because he's putting me through Hell, and he knows it.
Anyway, I'm also seeing a new pdoc who happens to be an addiction specialist. I have more hope for him because he already agreed to long-term prescriptions for zopiclone (even though he's an addiction specialist), and he actually seems to listen to me.
The points I'm thinking of putting forward are:
* I'm addicted to OTC codeine products, and have been for a number of years. I could therefore be classed as 'opiate dependent' and thus a candidate for maintenence therapy. Although codeine is a weaker opiate than bupe, this is how we could write it on the official documentation.
* I've tried nearly every antidepressant going, and opiates are the only class of drugs that have consistently helped my mood.
* I have chronic fibromyalgia-like pain and what might be early onset arthritis, which is one of the motivating factors behind my codeine usage. A strong painkiller would therefore be most welcome, if not appropriate.
In any case, I think it's time they looked seriously at my opiate consumption. I'm hoping the new pdoc will be less resistant to the idea of using bupe for depression because he prescribes it every day anyway for much more serious addictions than mine, and also because he's a down-to-earth common sense sorta guy who doesn't blow the addiction potential of certain drugs out of proportion.
I hoping so hard that I'll be able to try this drug. Please help.
-Horny
(T.B.F.K.A.Q)
Posted by SLS on May 29, 2008, at 16:13:44
In reply to Does anyone have the original buprenorphine study?, posted by Horned One on May 29, 2008, at 15:22:38
1: J Clin Psychopharmacol. 1995 Feb;15(1):49-57.Click here to read Links
Buprenorphine treatment of refractory depression.
Bodkin JA, Zornberg GL, Lukas SE, Cole JO.McLean Hospital, Consolidated Department of Psychiatry, Harvard Medical School, Belmont, MA 02178, USA.
Opiates were used to treat major depression until the mid-1950s. The advent of opioids with mixed agonist-antagonist or partial agonist activity, with reduced dependence and abuse liabilities, has made possible the reevaluation of opioids for this indication. This is of potential importance for the population of depressed patients who are unresponsive to or intolerant of conventional antidepressant agents. Ten subjects with treatment-refractory, unipolar, nonpsychotic, major depression were treated with the opioid partial agonist buprenorphine in an open-label study. Three subjects were unable to tolerate more than two doses because of side effects including malaise, nausea, and dysphoria. The remaining seven completed 4 to 6 weeks of treatment and as a group showed clinically striking improvement in both subjective and objective measures of depression. Much of this improvement was observed by the end of 1 week of treatment and persisted throughout the trial. Four subjects achieved complete remission of symptoms by the end of the trial (Hamilton Rating Scale for Depression scores < or = 6), two were moderately improved, and one deteriorated. These findings suggest a possible role for buprenorphine in treating refractory depression.
PMID: 7714228 [PubMed - indexed for MEDLINE]
Posted by Bob on May 29, 2008, at 18:15:38
In reply to Re: Does anyone have the original buprenorphine st, posted by SLS on May 29, 2008, at 16:13:44
> 1: J Clin Psychopharmacol. 1995 Feb;15(1):49-57.Click here to read Links
> Buprenorphine treatment of refractory depression.
> Bodkin JA, Zornberg GL, Lukas SE, Cole JO.
>
> McLean Hospital, Consolidated Department of Psychiatry, Harvard Medical School, Belmont, MA 02178, USA.
>
> Opiates were used to treat major depression until the mid-1950s. The advent of opioids with mixed agonist-antagonist or partial agonist activity, with reduced dependence and abuse liabilities, has made possible the reevaluation of opioids for this indication. This is of potential importance for the population of depressed patients who are unresponsive to or intolerant of conventional antidepressant agents. Ten subjects with treatment-refractory, unipolar, nonpsychotic, major depression were treated with the opioid partial agonist buprenorphine in an open-label study. Three subjects were unable to tolerate more than two doses because of side effects including malaise, nausea, and dysphoria. The remaining seven completed 4 to 6 weeks of treatment and as a group showed clinically striking improvement in both subjective and objective measures of depression. Much of this improvement was observed by the end of 1 week of treatment and persisted throughout the trial. Four subjects achieved complete remission of symptoms by the end of the trial (Hamilton Rating Scale for Depression scores < or = 6), two were moderately improved, and one deteriorated. These findings suggest a possible role for buprenorphine in treating refractory depression.
>
> PMID: 7714228 [PubMed - indexed for MEDLINE]
If they achieved such fantastic results, then why is it not mentioned these days?
Posted by undopaminergic on May 29, 2008, at 22:43:56
In reply to Does anyone have the original buprenorphine study?, posted by Horned One on May 29, 2008, at 15:22:38
> Can anyone lay their hands on the studies that showed buprenorphine was an effective antidepressant?
>See the following web addresses - the first one is most authoritative, but I'm including the others in case the first one goes off-line:
http://64.233.183.104/search?q=cache:oCHVpMr4kT0J:www.journaladdictionmedicine.com/pt/re/adm/selectreference.htm
http://opium.poppies.org/index.php?showtopic=9033
http://www.drugbuyers.com/freeboard/showflat.php?Cat=0&Number=196682
http://balder.prohosting.com/~adhpage/bupe.html>
> * I'm addicted to OTC codeine products, and have been for a number of years. I could therefore be classed as 'opiate dependent' and thus a candidate for maintenence therapy. Although codeine is a weaker opiate than bupe, this is how we could write it on the official documentation.
>Buprenorphine (BUP) is stronger than codeine per unit of weight, but at typical starting doses of both drugs - codeine at 30 mg or less and BUP at 0.6 mg or less, codeine may actually be stronger in some respects.
>
> * I have chronic fibromyalgia-like pain and what might be early onset arthritis, which is one of the motivating factors behind my codeine usage. A strong painkiller would therefore be most welcome, if not appropriate.
>Ironically, it may be easier for you to acquire oxycodone or other opioids than bupernorhpine based on the above complaint by going to pain specialists or others who prescribe these drugs as a matter of routine.
Bob wrote:
> If they achieved such fantastic results, then why is it not mentioned these days?
>There are a number of reasons that I think are significant.
One reason is that the use of buprenorphine (BUP) for opiate substitution therapy for addicts has diverted attention from the use of BUP for other purposes, including pain and depression. Furthermore, the abuse of BUP, mainly as a result of its high availability in some locales, as well as the prevalence of prescribing it to known addicts, who are more liklely to abuse it, has given the drug negative attention and contributed to make it a lot more controversial than it was at the time when its use in depression was investigated and publicised.
I have reasons to believe that psychiatrists - or more accurately a subset of them - use opioids in their practice for the treatment of refractory cases a lot more often than one might be led to believe by the scarcity of published studies. This is of course due to the controversial nature of the subjects. Their use of opioids for psychiatic conditions is simply not something that doctors like to speak openly about.
Furthermore, not everyone responds well to opioids and it is usually possible to find alternative satisfactory treatments, including MAOIs, MAOIs with stimulants, and off-label uses of a number of drugs. As a result, the use of opioids in psychiatric disorders remain a relatively limited practice.
Posted by Phillipa on May 30, 2008, at 0:27:36
In reply to Re: Does anyone have the original buprenorphine study?, posted by undopaminergic on May 29, 2008, at 22:43:56
Just wanted to add that cymbalta helps with pain too. But even here they have Bupe clinics and inpatient facility. Phillipa
Posted by SLS on May 30, 2008, at 18:58:12
In reply to Re: Does anyone have the original buprenorphine st » SLS, posted by Bob on May 29, 2008, at 18:15:38
> If they achieved such fantastic results, then why is it not mentioned these days?
Maybe the results were not repeatable. Maybe no one was interested in repeating the study. I'm sure the idea of using an opioid as an antidepressant is not endorsed by the mainstream psychiatrist. Since we have seen that suboxone can indeed have a robust effect with some people, something is being overlooked by our researchers.
- Scott
Posted by Crotale on June 1, 2008, at 12:43:33
In reply to Re: Does anyone have the original buprenorphine st, posted by SLS on May 30, 2008, at 18:58:12
For an interesting discussion of why buprenorphine isn't used much today (and why drug companies are unlikely to seek approval for depression), see:
Callaway E.
Buprenorphine for depression: the un-adoptable orphan.
Biol Psychiatry. 1996 Jun 15;39(12):989-90.Opioids can have some nasty side effects. I think fear of addiction is probably the chief reason, however. (Not saying this is necessarily a good reason.)
Crotale
Posted by bulldog2 on June 3, 2008, at 14:50:28
In reply to Re: Does anyone have the original buprenorphine st, posted by Crotale on June 1, 2008, at 12:43:33
> For an interesting discussion of why buprenorphine isn't used much today (and why drug companies are unlikely to seek approval for depression), see:
>
> Callaway E.
> Buprenorphine for depression: the un-adoptable orphan.
> Biol Psychiatry. 1996 Jun 15;39(12):989-90.
>
> Opioids can have some nasty side effects. I think fear of addiction is probably the chief reason, however. (Not saying this is necessarily a good reason.)
>
> CrotaleI'm not sure who it was on babble but he tried Buprenorphine and said it pooped out after about four weeks. So there might be tolerance issues involved.
Posted by okydoky on June 4, 2008, at 12:20:49
In reply to Re: Does anyone have the original buprenorphine st, posted by Crotale on June 1, 2008, at 12:43:33
Can anyone direct me to or tell me some kind of equivelent dose of Subutex to Oxycontin? To take for pain management. Or how one would go about making the change from one to the other?
oky
Posted by undopaminergic on June 5, 2008, at 13:10:33
In reply to Re: Does anyone have the original buprenorphine st, posted by okydoky on June 4, 2008, at 12:20:49
> Can anyone direct me to or tell me some kind of equivelent dose of Subutex to Oxycontin? To take for pain management. Or how one would go about making the change from one to the other?
>Various opioids differ to various extents, and so there may be no truly equivalent dose. However, some theoretical conversion factors have been published. For calculation of the approximate dose of buprenorphine required to replace oxycodone, start by determining the daily dose of morphine that corresponds to your daily dose of oxycodone. Then convert the daily dose of morphine to the equivalent dose of buprenorphine.
For example, if you take 20 mg oxycodone a day, multiply that by the conversion factor 2, and you get 40 mg moprhine.
Then convert the morphine dose using the generous conversion faction 0.04, which yields 1.6 mg of buprenorphine. This may be divided into the number of daily doses you wish to take. Generally 2-3 doses would be appropriate.
Posted by okydoky on June 6, 2008, at 12:00:07
In reply to Re: Does anyone have the original buprenorphine st, posted by undopaminergic on June 5, 2008, at 13:10:33
Thanks that is very helpful. I found somewhere and cannot find it again some conversion for Subutex. Any ideas? I figure the way things look I will probably find a doc who will prescribe or sell me a script so I am going to have to figure it all out myself. I did not want to do this alone but it looks like it is the only way.
oky
Posted by bulldog2 on June 8, 2008, at 15:48:43
In reply to Re: Does anyone have the original buprenorphine st » undopaminergic, posted by okydoky on June 6, 2008, at 12:00:07
> Thanks that is very helpful. I found somewhere and cannot find it again some conversion for Subutex. Any ideas? I figure the way things look I will probably find a doc who will prescribe or sell me a script so I am going to have to figure it all out myself. I did not want to do this alone but it looks like it is the only way.
>
> oky
HiWould appreciate your input on this. I use percodan now and than which isn't that often. But need about 20 -30 milligrams to get an ad response. thinking of trying bup. Would you have any idea what a good starting dose would be? Also what has your experience been with this opiate?
thanks
bulldog2
Posted by okydoky on June 8, 2008, at 16:05:44
In reply to Re: Does anyone have the original buprenorphine st, posted by bulldog2 on June 8, 2008, at 15:48:43
I think you will find some suggestion in the following thread:
http://www.dr-bob.org/babble/20080519/msgs/831180.html
I have not tried it yet and I have built up tolerence from years of oxycontin so it would be different.
Good luck,
oky
Posted by bulldog2 on June 14, 2008, at 14:40:15
In reply to Re: Does anyone have the original buprenorphine st » bulldog2, posted by okydoky on June 8, 2008, at 16:05:44
> I think you will find some suggestion in the following thread:
>
> http://www.dr-bob.org/babble/20080519/msgs/831180.html
>
> I have not tried it yet and I have built up tolerence from years of oxycontin so it would be different.
>
> Good luck,
>
> okyActually hard to determine. While I don't use often because i have no source still need about 25 milligrams of perc to get an ad response. That might be because i used on and off for years. So while I'm not addicted because I can be off for weeks I still need a hefty dose to get a response. I noticed urinary hesitation on perc I wonder if that is a problem on bupe?
Posted by Crotale on June 20, 2008, at 0:30:55
In reply to Re: Does anyone have the original buprenorphine study?, posted by undopaminergic on May 29, 2008, at 22:43:56
I've been taking Buprenex for depression since around 1998 (before it was approved for maintenance treatment of addiction in the US, where I live). At times I've had trouble getting a doctor to prescribe it since 2000. I won't say there is any *good* reason for this, but there's some presumption in the medical community that if it's used for maintenance treatment of addiction, then it must be addictive itself. In fact I haven't had issues with substance abuse the entire time I've been on buprenorphine.
Also, there has been some misinterpretation of the 2000 law that permits the use of Subutex and Suboxone for maintenance treatment of opioid dependence (the Drug Addiction Treatment Act of 2000 [DATA]). This law has *nothing* to do with the off-label use of buprenorphine to treat depression. It doesn't say that a psychiatrist has to have a waiver to prescribe buprenorphine for depression, *only* for addiction. The off-label use of buprenorphine for depression is perfectly legal. It does not require a waiver, nor should you see an addiction specialist or go to a methadone clinic or somesuch to get your depression treated. It is also perfectly legal to prescribe buprenorphine for pain. Indeed that is the approved use of Buprenex.
Here's a link to the site that explains the DATA:
http://buprenorphine.samhsa.gov/index.htmlCrotale
Posted by Crotale on June 20, 2008, at 0:49:31
In reply to Re: Does anyone have the original buprenorphine st, posted by bulldog2 on June 3, 2008, at 14:50:28
> I'm not sure who it was on babble but he tried Buprenorphine and said it pooped out after about four weeks. So there might be tolerance issues involved.
I've been taking it for around 10 years and it still works.
One of the problematic side fx is dry mouth, which can lead to dental problems. My dentist says he has encountered this in other patients on medications that have dry mouth as a side effect.
BTW, since I've had ECT, I've been able to cut back on the BUP. As a result, my last visit to the dentist had a better outcome than other recent visits.
Crotale
Posted by undopaminergic on June 20, 2008, at 17:42:23
In reply to Re: Does anyone have the original buprenorphine st, posted by Crotale on June 20, 2008, at 0:49:31
> > I'm not sure who it was on babble but he tried Buprenorphine and said it pooped out after about four weeks. So there might be tolerance issues involved.
>
> I've been taking it for around 10 years and it still works.
>
> One of the problematic side fx is dry mouth, which can lead to dental problems.
>I take BUP and other medications that contribute to the dryness of the mouth problem, so I've been trying out nicotine chewing gum recently. It seems to work, but I don't know yet if it works better than regular chewing gum (without nicotine).
Posted by Crotale on June 20, 2008, at 18:30:11
In reply to Re: Does anyone have the original buprenorphine st, posted by undopaminergic on June 20, 2008, at 17:42:23
> I take BUP and other medications that contribute to the dryness of the mouth problem, so I've been trying out nicotine chewing gum recently. It seems to work, but I don't know yet if it works better than regular chewing gum (without nicotine).
I'm not positive, but I don't think it would. The other type of cholinergic receptor (muscarinic) is the one that stimulates the salivary glands (the one that's blocked by TCAs like amitriptyline).
I chew regular sugar free gum. My dentist says to look for the type that has xylitol (e.g., Tylenol) rather than other artificial sweeteners because it's better for your teeth.
Posted by yxibow on June 23, 2008, at 2:10:16
In reply to Re: Does anyone have the original buprenorphine st » undopaminergic, posted by Crotale on June 20, 2008, at 18:30:11
> > I take BUP and other medications that contribute to the dryness of the mouth problem, so I've been trying out nicotine chewing gum recently. It seems to work, but I don't know yet if it works better than regular chewing gum (without nicotine).
>
> I'm not positive, but I don't think it would. The other type of cholinergic receptor (muscarinic) is the one that stimulates the salivary glands (the one that's blocked by TCAs like amitriptyline).
>
> I chew regular sugar free gum. My dentist says to look for the type that has xylitol (e.g., Tylenol) rather than other artificial sweeteners because it's better for your teeth.
n.b. xylitol is NOT Tylenol.
Not that people would mistake a possibly dangerous acetaminophen pill for a sugar alcohol I hope.Others would be mannitol, sorbitol, erythritol, maltitol, and lactitol.
They have a laxative effect if used more than sparingly.
Posted by Neal on September 13, 2008, at 1:47:12
In reply to Re: Does anyone have the original buprenorphine st » Crotale, posted by yxibow on June 23, 2008, at 2:10:16
I have taken Suboxone 8mgs/day for the last 2 years for unipolar depression. Opioids were just about the only things in a doctor's kit for "melancholia" from 10,000BCE until about 1950, so I thought I'd give it a try, Bush drug hysteria notwithstanding.
I found that it worked quite well when taken with other ADs. It helps with sleep, chronic pain, and anxiety espessially.
The main reason it's legal is that there's no "rush" from injecting and it's of course only a partial agonist. So it's used primarily for drug addiction.
I think there's a population of depressed people who could be helped by this drug, but the general drug hysteria generated in this country makes it hard for doctors to provide it for depression if they feel they're laying their license on the line.
Some people on this board are claiming that they got their docs to write scripts, but I found it hard, at least two years ago. Maybe things are changing for the better.
Posted by Quintal on September 13, 2008, at 11:11:18
In reply to Re: Does anyone have the original buprenorphine st, posted by Neal on September 13, 2008, at 1:47:12
I asked my pdoc for Suboxone last month and he wasn't sure at all, so he asked his collegues for advice. Both the professor and the addiction specialist he wrote to said there is no scientific evidence that opiates are of any benefit in mood disorders, except for the very limited studies I brought in from PubMed. They're right about the lack of evidence, but as you say, it has been known since the dawn of time that opaites are effective antidepressants.
Q
Posted by okydoky on September 13, 2008, at 23:11:41
In reply to Re: Does anyone have the original buprenorphine st » Neal, posted by Quintal on September 13, 2008, at 11:11:18
I spoke with my doctor two days ago. He said he just did not know how to prescribe it but had no problem besides that. I spoke with the manufacturer who said if he called they would inform him as to dose and anything else he wanted as it pertains to pain. I emailed him all the from my insurence and teh phone number of teh manufacturer in hopes when I show up on Monday he will write a script.
Does anyone know it Suboxone is nessisarily better for depression than other opiates? My insurence only covers 270mg over a "rolling" 75 days so if he does prescribe it we will have to write them so he can write for more. I take 60mg oxycontin for pain now. The manufacturer said the average dose is between 4 and 24mg a day??? The equivelent dose I found was 4.8mg a day but I know it is not always the same.
Well high to all. My computer is working again. Not sure if that is a good thing:-)
oky
Posted by Quintal on September 14, 2008, at 9:03:50
In reply to Re: Does anyone have the original buprenorphine st, posted by okydoky on September 13, 2008, at 23:11:41
That's great news oky, let me know how it goes. People have said that bupe is better for depression because it blocks kappa receptors, which can lower mood apparently.
Q
Posted by okydoky on September 14, 2008, at 12:54:43
In reply to Re: Does anyone have the original buprenorphine st » okydoky, posted by Quintal on September 14, 2008, at 9:03:50
Cross your fingers for me that he makes the call to Reckitt Benckiser and they provide th prescribing information to him. Seems he is being lazy these days. What I found was 4.8mg equivalent to 60mg oxycontin a day but how would I take it? Rhetorical:-)
Thanks
oky
Posted by okydoky on September 19, 2008, at 15:32:41
In reply to Re: Does anyone have the original buprenorphine st, posted by okydoky on September 14, 2008, at 12:54:43
My doc prescribed the Suboxone for me but just told me to take it how I was supposed to and figure out how much I need. First day I went into a little withdrawal second too. Seems okay now but it is not as good for pain. I've been pretty messed up. I still had to take Lyrica with it so the pain is taken care of but my depression is worsened. Start some instill for my bladder today hoping that will take care of this flare and i can stop the Lyrica. I just cannot know how much Suboxone I need without the Lyrica. He will need to write the insurance company because they only cover 3.6mg a day. Makes no sense to me. Oh well I think I will try to go to sleep now and escape once again. Wish I had more positive news :-0
oky
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