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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 15 to 39 of 39. Go back in thread:
Posted by flmm on April 6, 2007, at 10:35:37
In reply to Re: Best meds for anhedonia » falconman, posted by emme on April 6, 2007, at 7:17:25
Opiates are pain killers, plain and simple! If you are in pain they make you feel better. Are you in pain Declan?
Posted by falconman on April 6, 2007, at 12:40:03
In reply to Re: Best meds for anhedonia » falconman, posted by Quintal on April 6, 2007, at 7:12:06
To get 20-40mg codeine from OTC painkillers you would have to take loads of parecetamol/asprin too. This can't be good for you. An average co-codamol tablet contains codeine phosphate 8mg and paracetamol 500 mg.
would > For me OTC painkiller tablets containing small amounts (20-40mg) of codeine (not enough to get 'high' incidentally) have worked better for my depression/anhedonia/anxiety than any other pharmaceutical. I tend to build up tolerance after a few months of continuous use, then taper off to regain the effects. The tapering off is not at all unbearable because it's such a small dose, and I've just this week found that Mirapex (pramipexole) halts rebound anhedonia and helps physical/emotional pain. It feels very similar to the 'nodding' sensation of opiates i.e. no high or euphoria, just calm, peaceful contentment.
>
> Buprenorphine is the opiate most often prescribed for treatment resistant depression, but other here have been prescribed hydrocodone, methadone etc.
>
> Amisulpride at doses below 50mg is also helpful for dysthymia/anhedonia. They key linking all these drugs is that they are pro-dopamine.
>
> Q
Posted by falconman on April 6, 2007, at 13:25:06
In reply to Re: Best meds for anhedonia » falconman, posted by Quintal on April 6, 2007, at 7:12:06
Am I right in saying that ssri's and ssnri's decrease the effects of codeine?
Thanks
Posted by Quintal on April 6, 2007, at 14:57:50
In reply to Re: Best meds for anhedonia » Quintal, posted by falconman on April 6, 2007, at 12:40:03
No, you don't have to take more than the therapeutic dose of either paracetamol or ibuprofen to get 20-40mg of codeine, but it depends on the brand you use. I use Paramol which contains 7.46 mg dihydrocodeine. Dihydrocodeine is about 1.5x as potent as codeine, so you get roughly 22mg equivalent of codeine from the recommended two tablets if my math is correct. I sometimes add Nurofen Plus which contains 12.8mg codeine per tablet, so in total I can get the equivalent of roughly 47mg codeine from that cocktail if I take the two tablets of each brand.
It is safe to take paracetamol and ibuprofen together - I was started on this cocktail for pain control after being discharged from hospital. I'm sure there are risks to it, but probably no more so than with any other drug cocktail recommended here for anhedonia.
Yes, SSRIs are CYP2D6 inhibitors which can reduce or eliminate the effect of codeine because CYP2D6 converts codeine into morphine - the metabolite apparently responsible for most of the therapeutic effect.
Q
Posted by falconman on April 6, 2007, at 15:26:33
In reply to Re: Best meds for anhedonia » falconman, posted by Quintal on April 6, 2007, at 14:57:50
Posted by Declan on April 6, 2007, at 15:48:33
In reply to Re: Best meds for anhedonia, posted by flmm on April 6, 2007, at 10:35:37
>Opiates are pain killers, plain and simple! If you are in pain they make you feel better. Are you in pain Declan?<
Not so much now that I have read your post, but yes....surely everyone over a certain age is in pain?
I have a degenerative spinal condition (sounds good, that one) and arthritis (worse than you might think).
But physical pain is no harder to bear than the other sort.
Most people over 50 (I only pick that because I just squeeze over) are simply used to pain, don't you think?
Posted by flmm on April 6, 2007, at 16:05:34
In reply to Re: Best meds for anhedonia » flmm, posted by Declan on April 6, 2007, at 15:48:33
Well then Declan, you should take something for your "physical" pain! Mental pain is something entirely different than physical pain, no matter how you try to justify it. I blew out my back 5 years ago due to herniated disk, failed surgery etc. Been on those drugs, glad to be off. There is a difference between pain and the pain that requires opiates to treat! It's not just pain!
Posted by flmm on April 6, 2007, at 16:09:42
In reply to Re: Best meds for anhedonia, posted by flmm on April 6, 2007, at 16:05:34
By the way, telling people who are in need of help that opiates treat depression, is reckless and not true!
Posted by Declan on April 6, 2007, at 16:43:23
In reply to Re: Best meds for anhedonia, posted by flmm on April 6, 2007, at 16:09:42
It isn't that I want to tell people that so much as that I find the attitude of some people and governments to opiate addiction difficult to handle.
If you've had a herniated disc you know all about pain.
If you have bad nerve pain, even opiates won't help much.
Some pain can be endured. As I've got older my capacity to endure pain has risen (neccessarily).
Must go and do my back exercises.
Pilates has helped more than anything.
Posted by Quintal on April 6, 2007, at 17:03:18
In reply to Re: Best meds for anhedonia, posted by flmm on April 6, 2007, at 16:09:42
Based on my experiences I could say the opposite, that telling people who are in need of help that SSRIs treat depression, is reckless and not true!
As I said, low dose opiates have been the only thing that have really helped my depression/anhedonia/anxiety and left me feeling like a human being, not some sort of Clockwork Orange.
Q
Posted by flmm on April 6, 2007, at 18:38:50
In reply to Re: Best meds for anhedonia, posted by Quintal on April 6, 2007, at 17:03:18
Addiction is a constant rehersal of justifying drug abuse. Opiates are not antidepressants!
Posted by Quintal on April 6, 2007, at 19:29:19
In reply to Re: Best meds for anhedonia, posted by flmm on April 6, 2007, at 18:38:50
There's no justification with me flmm - I admit I'm an out and out abuser of pharmaceuticals. Opiates have proved to be superior antidepressants/anxiolytics. SSRIs have not. That's all I need to know.
Q
Posted by Declan on April 6, 2007, at 20:04:50
In reply to Re: Best meds for anhedonia » flmm, posted by Quintal on April 6, 2007, at 19:29:19
>I admit I'm an out and out abuser of pharmaceuticals. Opiates have proved to be superior antidepressants/anxiolytics. SSRIs have not<
Quintal
Does this mean you're in denial?
Posted by flmm on April 6, 2007, at 21:19:39
In reply to Re: Best meds for anhedonia » Quintal, posted by Declan on April 6, 2007, at 20:04:50
Just because you confuse addiction with an antidepressant effect, something most addicts do, does not mean antidepressants don't work! They do in a lot of people, me included. Also, just because antidepressants don't work in you, does not mean you are not addicted to a harmful,negative drug. I doubt you have any opiate receptors left in your brain, hence the continued need for opiates! Good luck.......................
Posted by psychobot5000 on April 6, 2007, at 21:32:53
In reply to Re: Best meds for anhedonia Declan,Quintal, posted by flmm on April 6, 2007, at 21:19:39
> Just because you confuse addiction with an antidepressant effect, something most addicts do, does not mean antidepressants don't work! They do in a lot of people, me included. Also, just because antidepressants don't work in you, does not mean you are not addicted to a harmful,negative drug. I doubt you have any opiate receptors left in your brain, hence the continued need for opiates! Good luck.......................
_____________
I heard a brief list of reasons given once, by a professor at Harvard Medical school, concerning why he sometimes uses opiates for difficult depression patients. Potential addiction was merely one of several disadvantages and advantages in comparison with more traditional drugs(and it can be managed by rotating various opiates, apparently).There's little actual evidence to back up this view, though. I believe various people, afraid of a society of drug abusers, have somewhat exaggerated the case.
I have never used opiates for depression--they made my stomach hurt the few times I was given them for pain. That said, there is good theory that supports using them in certain depressive patients, I am told. And they do have decades of history being used for depression, before we had MAO inhibitors, stimulants, tricyclics arrived. According to that doc, the treatment resistant people on this board are just the types for whom they ought to be potentially considered.
Best,
'Psychbot5000'
Posted by Quintal on April 6, 2007, at 21:36:11
In reply to Re: Best meds for anhedonia Declan,Quintal, posted by flmm on April 6, 2007, at 21:19:39
flmm, what perchance do you think could be happening to your serotonin receptors? I think linkadge might like to enlighten you on life after long-term SSRIs.
Q
Posted by flmm on April 6, 2007, at 21:43:19
In reply to Re: Best meds for anhedonia Declan,Quintal » flmm, posted by Quintal on April 6, 2007, at 21:36:11
SSRIs do not use up serotonin receptors! Also I know all about Linkadge. I really doubt SSRIs are the major contibutor of his problems, dispite his denials!
Posted by Quintal on April 6, 2007, at 21:55:38
In reply to Re: Best meds for anhedonia Declan,Quintal, posted by flmm on April 6, 2007, at 21:43:19
Actually SSRIs do downregulate serotonin receptors when used daily for long periods of time. Besides, I've plenty of experience with other drugs of abuse, namely benzos. I used to have a major Klonopin habit taking as much as 20mg/day at one point. I've now been benzo free for nine months and am pretty much at the point I was before starting benzos. It seems the receptors usually recover once the drug has been withdrawn. It's the same for opiates.
Q
Posted by KayeBaby on April 6, 2007, at 22:44:19
In reply to Re: Best meds for anhedonia, posted by flmm on April 6, 2007, at 18:38:50
> Addiction is a constant rehersal of justifying drug abuse. Opiates are not antidepressants!
Whether or not it is true that opiates (or SSRI's) are antidepressants is pretty subjective.
For some people they are. How can you argue that Quintal is not getting an AD effect from opiates? He states that he is.
Conventional wisdom regards opiates to be too problematic to be widely used as antidepressants.
I have experienced depressing effects from typical antidepressants and this goes against conventional wisdom too.If our brains followed the rules properly most of us wouldn't be here searching.
Kaye
Posted by Declan on April 7, 2007, at 2:41:33
In reply to Re: Best meds for anhedonia, posted by KayeBaby on April 6, 2007, at 22:44:19
>Opiates are not antidepressants!
So there's depression, and then there's antidepressants.
Very neat and tidy.
As far as I can see that's a language thing.
Posted by gardenergirl on April 7, 2007, at 10:08:36
In reply to Re: Best meds for anhedonia, posted by flmm on April 6, 2007, at 16:09:42
> By the way, telling people who are in need of help that opiates treat depression, is reckless and not true!
Please don't post anything that could lead others to feel accused or put down, and please don't exaggerate or overgeneralize. You've been asked before to be civil, so now I am blocking you from posting. I've asked Dr. Bob to determine the duration of the block.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
http://www.dr-bob.org/babble/faq.html#enforce
Follow-ups regarding these issues should directed to the Administration board and should, of course, be civil. Dr. Bob has oversight over deputy decisions. Thus, you can always appeal this decision to him, and he may choose a different action.Namaste
gg, acting as deputy
Posted by gardenergirl on April 7, 2007, at 10:12:30
In reply to Re: Best meds for anhedonia, posted by Quintal on April 6, 2007, at 17:03:18
> Based on my experiences I could say the opposite, that telling people who are in need of help that SSRIs treat depression, is reckless and not true!
Please don't post anything that could lead others to feel accused or put down, and please don't exaggerate or overgeneralize, even in response to a similar post. You've been asked before to be civil, so now I am blocking you from posting for two weeks.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
http://www.dr-bob.org/babble/faq.html#enforce
Follow-ups regarding these issues should directed to the Administration board and should, of course, be civil. Dr. Bob has oversight over deputy decisions. Thus, you can always appeal this decision to him, and he may choose a different action.Namaste
gg, acting as deputy
Posted by gardenergirl on April 7, 2007, at 22:20:10
In reply to Blocked for two weeks » Quintal, posted by gardenergirl on April 7, 2007, at 10:12:30
I can understand how the block length might be confusing. Here is the calculation Dr. Bob usually includes in his block posts:
previous block: 1 week
period of time since previous block: 2.5 weeks
uncivil toward a particular individual or group: no
particularly uncivil: no
different type of incivility: no
clearly didn't understand PBC/previous block and made effort to reply: no
provoked: yes
uncivil in multiple posts at same time: no
already archived: no
If we take 2.5 weeks, divide by 10, and round, that's a reduction of 0 weeks. If we apply that to his previous block, that's 1 - 0 = 1 week. And if we double that, that's 2 weeks.Namaste
gg
Posted by JerryPharmStudent on April 8, 2007, at 22:53:10
In reply to Re: Best meds for anhedonia » falconman, posted by Quintal on April 6, 2007, at 7:12:06
My psych has had me on hydrocodone for TRD for 3 years. It's ht eonly thing that has worked.
Posted by Phillipa on April 9, 2007, at 19:05:10
In reply to Re: Best meds for anhedonia, posted by JerryPharmStudent on April 8, 2007, at 22:53:10
Jerry I understand as when I had the broken arm one percocet at night and I was laughing. But no pdoc would ever give me an opiod. And it was suggested to me that I might be an opiod responder. Love Phillipa
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