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Dr. Bob is Robert Hsiung, MD,
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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
Posted by pseudoname on January 25, 2006, at 7:46:07
In reply to Re: Metadate, posted by reefer on January 25, 2006, at 1:41:30
> It took a couple of weeks for me to get used to Concerta.
Did you get the clinical benefit right away, or did that take a while?
Posted by ed_uk on January 25, 2006, at 9:04:50
In reply to Metadate » ed_uk, posted by pseudoname on January 24, 2006, at 16:45:36
Hi PN
Perhaps you'd prefer standard methylphenidate rather than the controlled release version?
Ed
Posted by pseudoname on February 7, 2006, at 12:25:52
In reply to anxiety / breathing problem update, posted by pseudoname on January 18, 2006, at 10:19:28
I know some recreational drugs can end up making people feel more anxious. Is that true of opioids?
I was prescribed buprenorphine (Subutex) for depression and it worked! (Yea!) But after 6-8 weeks on it, I developed an anxiety problem where I felt I couldn't breathe.
My G.P. took me off the buprenorphine. About 2 weeks later, the anxiety problem had subsided. I've since taken smaller doses of the bupe because the depression returned. Now the anxiety/breathing problem has returned again.
There's NOT a strong correlation between me taking the bupe and becoming anxious, but there is a slight correlation.
Do you think bupe could cause anxiety or aggravate it? (I hope it's not that.)
Posted by ed_uk on February 7, 2006, at 13:32:55
In reply to do opioids make anyone anxious?, posted by pseudoname on February 7, 2006, at 12:25:52
Hi
>Do you think bupe could cause anxiety or aggravate it?
It's possible but I think it's more likely that you've developed an association in your mind between breathing problems and bupe. This may have occured due to your memories of previously having breathing problems while your were on bupe. As a result, taking bupe leads you to concentrate excessively on your breathing, therefore resulting in anxiety.
Regards
Ed
Posted by pseudoname on February 7, 2006, at 13:55:36
In reply to Re: do opioids make anyone anxious? » pseudoname, posted by ed_uk on February 7, 2006, at 13:32:55
> I think it's more likely that you've developed an association in your mind between breathing problems and bupe.
Thanks. The breathing problems follow my thought-content and situational problems *so* precisely that it's a little silly for me to be wondering about the bupe connection. But I sure appreciate being able to ask and having someone reply so quickly. That helps so much.
It occurs to me (again) that I could use my fear of further anxiety problems to get myself off my butt and take care of some of my worrisome situations. *That* would be making lemonade out of lemons...
(I hope you're well, Ed.)
Posted by ed_uk on February 7, 2006, at 14:26:57
In reply to Thanks » ed_uk, posted by pseudoname on February 7, 2006, at 13:55:36
Hi PN :)
>anxiety
Would it help to have a benzo on hand in case you start to feel panicky? I would recommend Valium or Xanax for 'prn' use. Ativan and Klonopin are also useful if you let a tablet dissolve in your mouth.
>I hope you're well, Ed
Not bad thank you :)
Ed
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