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Dr. Bob is Robert Hsiung, MD,
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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
Posted by Quintal on September 19, 2008, at 16:19:48
In reply to Re: Does anyone have the original buprenorphine st, posted by okydoky on September 19, 2008, at 15:32:41
I'm sorry this isn't working for you oky. I suppose you can't take another opiate for flareups when you're on Suboxone. Do you think you'll need to go back to your old pain meds? Keep us updated. Sleep well.
Q
Posted by okydoky on September 20, 2008, at 14:30:45
In reply to Re: Does anyone have the original buprenorphine st » okydoky, posted by Quintal on September 19, 2008, at 16:19:48
No I cannot take another opiate while I am on Suboxone. I did have breakthrough pain the past two days so I just took 1mg around 8 hours after my first dose each day so far.. I am supposed to be doing physical therapy but yesterday I received a letter from the insurance denying payment. I had the wrong doc send the script so maybe I can fix this easily. I wanted to start that and daily instills and what is called DMSO instills weekly with the Suboxone giving it the best chance to work and getting out of this flare up The Suboxone does not dissolve very well, it takes around 45 minutes. I remember when I took Fentora this way it dissolved in a few minutes. Does anyone else have this problem? If I swallow it my understanding is the amount I swallow will not be available in my body as a medicine. My mind is in such a fog from the Lyrica.. Just wriring this email is a huge effort. I am trying to make sense, please give me some leeway :-)
I need to take the Suboxone when I am not in a flare to evaluate its efficacy and its efficacy with Amineptine or Parnate.
My plan was to take Suboxone with one of these antidepressants to see if one worked with it instead of with a full agonist as my pain med. As the Suboxone does not work completely I have added Naproxen. When I took 4mg the first day it suppressed my breathing too much. Ill have to work with it. This would be okay if the antidepressant works with it. Lots of variables right now. Like I cannot take the Naproxen long term as it irritates my stomach. Its only been three days so I need to be patient.
I have noticed that I feel more raw on the Suboxone as opposed to Oxycontin or Morphine.Im just blabbering on and on now.
Thanks all for the support. This is difficult. I have been having suicidal ideation for a few months now. I was hoping trying this would give me hope. Oh well. Patience!
oky
Posted by Quintal on September 20, 2008, at 16:22:06
In reply to Re: Does anyone have the original buprenorphine st, posted by okydoky on September 20, 2008, at 14:30:45
>I have noticed that I feel more raw on the Suboxone as opposed to Oxycontin or Morphine.
This isn't good. I wonder if you're still feeling some sort of withdrawal effects? I switched from codeine to tramadol last week and I had a similar feeling. Tramadol just wasn't hitting 'the place'. I've had the same problem when switching between other drugs of the same class. It should get better in a few weeks if bupe is going to work for you. It may be that morphine and oxy are better painkillers and antidepressants than bupe. Are you able to go back to the ones that work if this trial doesn't work out?
>I need to take the Suboxone when I am not in a flare to evaluate its efficacy and its efficacy with Amineptine or Parnate.
I you can get this flare under control soon. The instills sound very painful.. I don't know how you manage it. Do you have a supply of amineptine? It's something I've always wanted to try. Hopefully the ADs will help with pain control.
>The Suboxone does not dissolve very well, it takes around 45 minutes. I remember when I took Fentora this way it dissolved in a few minutes. Does anyone else have this problem? If I swallow it my understanding is the amount I swallow will not be available in my body as a medicine.
Is it like a wafer or a tablet? There was someone who used to take it up her nose, but I think she was using a lquid form. I don't know whether that's still available, but I think there's a patch that might make things easier. I know it would be too much trouble with the insurance company to switch perparation though. I don't think bupe is absorbed very well from the stomach so what you swallow won't have much effect. You can't go for 45 minutes without accidentally swallowing some, so I wonder if this might be reducing the dose you actually absorb? Is there anything you can do to the tablet to make it dissolve quicker such as crushing or grinding it (I don't know whether that is a good idea, just adding suggestions).
People here are always willing to give their support but you need RL backup for when you have these suicidal thoughts. Is there a T or a pdoc you can contact when you're feeling like this? It sounds as though your depression isn't being well managed at the moment. Are you getting continuity of care from all your doctrs? You seem to have more than one and I wonder if they communicate properly. How soon can you start the ADs, and which one will you choose?
Take care
Q
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