![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 35 to 59 of 59. Go back in thread:
Posted by Phillipa on July 4, 2007, at 20:34:55
In reply to Re: Heroine as atnidepressant, posted by FredPotter on July 4, 2007, at 20:11:55
Methadone is being used by a girl who moved in with her family across the street supplied daily as she was an opiod addict and she's not even depressed anymore. I think she's also on seroquel? Please stop using the heroine. Here we have a show on TV called Intervention and the people using have horrible deterioration of their mind and bodies. Love Phillipa
Posted by FredPotter on July 4, 2007, at 23:41:21
In reply to Re: Heroine as atnidepressant, posted by Phillipa on July 4, 2007, at 20:34:55
I've tried methadone pills a few times. They seemed to lift depression and anxiety but only after about 3 hours, so perhaps I imagined it. You do hear of people who keep their heroin use under control and it keeps them free of pain and living a normal life, but I'm far too fond of euphoria to go anywhere near the stuff
Posted by revaaron on July 5, 2007, at 0:10:15
In reply to Re: Heroine as atnidepressant » Sigismund, posted by Babak on July 4, 2007, at 3:14:15
Babak, a couple of nutritional ideas- L-tyrosine or L-phenylalanine for dopamine production; D-phenylalanine to increase your brain's internal level of opiate (endorphins); and 5-HTP for serotonin. I would try them each seperately, each for at least a week, maybe each one in turn. They can all be taken safely together, but if you can figure out which one is helping the most it might give you some insight as to which neurotransmitters you've got out of whack. I can tell you that with doses of DL-phenylalanine I've gotten relief from opiate cravings.
All of these nutritional supplements have had relatively quick effects. If I'm suffering from serotonin deficiency-induced depression I feel the 5-HTP like a high that I start to feel after only 20 minutes. If I'm not, it just makes me a little sleepy. The DL-phenylalanine doesn't come on as quick, but I notice a definate difference in opiate-related desire and WD symptoms, as well as more energy. The L-tyrosine I felt in a more subtle way, but I could notice a difference in my energy levels within a couple days of dosing with it.
Just out of curiousity: are you disabled? Do you have a job?
Also what do you mean by "H doesn't actually cure my depression"? I mean, for folks with chronic depression nothing usually "cures" their depression- it just makes life livable. With others, being treated for 6 months is enough to bring them out of it.
What was being on a stimulant like for you, if you ever have been? Some have had a lot of luck with dextroamphetamine as an AD. When I've been on it for AD/HD it completely kills my desire to get high, even though I don't feel high on it. I've always had a huge interest in experimenting and reading about various drugs, but when I was on the opiates I also lost interest in other drugs in a very profound way, where even drinking or smoking weed in social situations evoked zero interest.
Posted by revaaron on July 5, 2007, at 0:23:33
In reply to Re: Heroine as atnidepressant, posted by FredPotter on July 4, 2007, at 23:41:21
> ...but I'm far too fond of euphoria to go
> anywhere near the stuffBut that's the truly insidious thing about using most opiates as an anything but a pain med, whether as a treatment for AD/HD, social anxiety, generalized anxiety or depression. The euphoria is great and incredibly helpful in a lot of ways. But even if you decide outright to give your life to opium, heroin, or whatever, even if you say "I like this so much, and it helps so much that it's worth being an addict for the rest of my life, if that's what it takes." Even if you make that choice and have an endless pure supply of opiate it still isn't going to work. After a while, the euphoria is gone. This has nothing to do with tolerance in the sense most folks think of it- you can increase your dose and you still won't be euphoric, until you've had too much and have the negative effects of a minor OD (sweating, extreme sedation, naseua, dizziness). The euphoria of opiates is the most enjoyable drug imaginable for some (including me), but after a year or two, it just doesn't work like it did at first. I'd be willing to pay a lot of money to somehow magically restore my opiate receptors to the state they were in 10 years ago. I'm not addicted to them now in anyway, and haven't had any for months. And before that, not for months again, but the last time I did have an opiate, months after the dose before that, I still didn't get anywhere near the euphoria of the first year or two I was using on a regular basis.
That's the worst thing- when all you want is that high, but nothing in the world will be able to get it. No amount of money, no amount of drug, no potentiators, etc. Which basically means that you either keep wasting money and possibly your health (the opiates never negatively effected me outside of a weight gain from my metabolism being so slow and a poor libido and soft penis). I don't have a horror story about how I lost it all because of opiates. I've never watched a friend die. I don't have HIV or hep C. I never have been rushed to the hospital or had to rush a friend to the hospital. I've never put anything into my vein. I never hit "rock bottom," like a lot of heroin addicts do. I didn't lose anything but the drive to make love to my wife, thousands of dollars (cheap compared to heroin!) the motivation to keep fit, some mental wellbeing (made it dysphoric and depressed after a many years); it did give me sleep apnea and some depression/dysphoria. Not good things, but they're nothing compared to a the kinds of things street drug addicts go through.
What I tried to say before: the most insidious thing about opiates is that when the feeling they give you is what you want the most is when you longer get that feeling and have no way to get it back other than not using for a long time.
Posted by maria3667 on July 8, 2007, at 18:35:23
In reply to Re: Heroine as atnidepressant » FredPotter, posted by revaaron on July 5, 2007, at 0:23:33
Well,
Babak, where R U?
We are all trying to help you, but you seemed to have dissapeared of the surface of the earth?
Please give us a sign you are alright. I really hope you have taken notice of the sound advice many people have given you. You may not believe it, but there's loads out there WHO CARE FOR YOU !
Posted by deniseuk190466 on July 9, 2007, at 15:26:40
In reply to Heroine as atnidepressant, posted by Babak on July 3, 2007, at 19:15:27
Babak,
I feel for you I really do, you are just doing what you can at the moment to survive.
If you are interested in DBS for depression, they were supposed to be starting trials for this over a year ago in Bristol. It might be worthwhile your contacting them.
I could get you the email address if you are interested but you need to get a referral from a Doctor or psychiatrist.
Best Wishes. I hope you get the help you need soon.
Denise
Posted by F00TBALL on July 10, 2007, at 16:22:13
In reply to Re: Heroine as atnidepressant, posted by Phillipa on July 4, 2007, at 20:34:55
While I do not believe using an illegal substance is a particularly good way to treat depression, if you have decided to give that route a try, have you ever considering using Ecstasy instead of Heroin?
It is considered to be much safer, much less addictive, and IMO more effective then H. It's also a stimulant, so along with evaporating your depression, you'll have a lot more energy and motivation.Just a thought.
Posted by FredPotter on July 10, 2007, at 19:40:38
In reply to A different thought., posted by F00TBALL on July 10, 2007, at 16:22:13
> While I do not believe using an illegal substance is a particularly good way to treat depression, if you have decided to give that route a try, have you ever considering using Ecstasy instead of Heroin?
> It is considered to be much safer, much less addictive, and IMO more effective then H. It's also a stimulant, so along with evaporating your depression, you'll have a lot more energy and motivation.
>
> Just a thought.Until the serotonin crash gets you and you become more depressed than ever
Posted by revaaron on July 10, 2007, at 20:34:50
In reply to A different thought., posted by F00TBALL on July 10, 2007, at 16:22:13
First: Another random thought- probably not, considering what Babak has said about other opiates, but I think DLPA or just D-phenylalanine would be at least worth trying. Anyone know where to buy bulk DPA, not just overpriced capsules of the stuff?
On MDMA:
Good try, but I think that using MDMA would probably be a lot worse, at least in the recreational doses folks usually use and in typical usage patterns. MDMA can be pretty neurotoxic, where as most opiates used properly, are not all that bad for you, physically. Not saying physical addiction is a good thing, but MDMA and meth/dextro/levoamphetamine carry with them the possibility of both physical addiction and neurological damage, at least in typical abuse dosages.I've no doubt that MDMA can be a useful tool for therapy (like traditional psychedelics, Iboga, etc) when used once in a while, with or without someone in the role of therapist to guide a person through the experience.
MDMA is very far down on my list for 'off label' daily ADs. After using MDMA for a few days in a row its become a lot more like garden variety amphetamine than MDMA. I don't know if an SSRI or 5-HTP would keep this from happening, but still, it isn't a good idea. What'd be the point? Why not try dextroamphetamine or Desoxyn, both of which have proven efficacy and pretty good track record as ADs- and it's a lot more likely you could find some radical doc to prescribe them.
MDMA just isn't an every day sort of drug, even if you don't take safety or the possibility of permanent neurological damage into account. Not to mention the cost of MDMA, how relatively rare it still is in pills sold as "ecstacy" on the street, which can contain all sorts of other drugs, some of which might badly exacerbate a depressed person's condition.
I wonder if there have been studies on the long term effectiveness or danger of of using low dose MDMA for depression? Not bloody likely considering the legal status of MDMA.
Posted by F00TBALL on July 11, 2007, at 13:59:15
In reply to Re: A different thought., posted by revaaron on July 10, 2007, at 20:34:50
I'm going to have to disagree with you. Take a look at this comprehensive study published this year that ranked 20 different drugs from most dangerous to least dangerous.
http://observer.guardian.co.uk/uk_news/story/0,,2026205,00.html
The media has given Ecstasy a bad rap, but it's not nearly as dangerous as Heroin or most other illegal drugs.
Posted by kingcolon on July 11, 2007, at 14:08:00
In reply to Re: Heroine as atnidepressant » Squiggles, posted by Babak on July 4, 2007, at 9:01:37
> That is very interesting, I use opium on and off for over ten years and then I wanted to come off it but I kept getting this stomuch pain which wouldn't go away even after a year without opium. Finally it turned out to be related to my depression and had nothing to do with opium withdrawal as I kept telling the doctors. An increase in my Effexor dosage stopped the pain but by then I was hooked on Subutex which was hell to kick. It took a month to come off subutex.
> It was while I was on subutex that I developed this severe anhedonia. So I ma just wondering may be this anhedonia is related to Subutex & opiods which is a common withdrawal symptoms with heroine addicts but in my case it doesn't go away, not even a year after I came of Subutex and stayed clean of all opiods.
> My fear is that opiods, subutex included has permenantly changed my brain chemistry. But is this possible? Is there any documented case or evidence of such permenant change?
> It is this adhedonia which is cripling.
>
> Can anyone shed some light on this?I'm using Subutex (buprenorphine) for the past 2 months for depression (history of abuse of opioids as well). Although I see you felt you worsened on BUP, there is nothing in the literature that I can find supporting that BUP worsens or causes depression. That said, it's use in depression is mostly anecdotal. There needs to be more studies. My own reaction is that it is the only medication I've had to date that really seems to have gotten to the bottom of my anhedonia (apart from my previously abused opioids). I'd be interested in what dose you used to take--tiny doses of about 1-2 mg are effective in depression, but larger doses are necessary in actively opioid users.
You say you were "hooked" on Subutex, but there is absolutely no evidence that, taken orally in appropriate doses, it produces addiction (it DOES cause dependency with withdrawal but this is not the same as addiction). There is no euphoria anything like other opioids with it, used this way. It works on other opiate receptors besides the mu receptor, namely, the kappa receptor, and this is actively being studied for depression (kappa antagonist). It would be a shame if you incorrectly concluded you got worse on Subutex if it was really the underlying depression. Perhaps a short course of Subutex again would be helpful to see if you have no effect--if it is going to work, you should know in a week or so.
Posted by revaaron on July 11, 2007, at 15:08:39
In reply to Re: Heroine as atnidepressant, posted by kingcolon on July 11, 2007, at 14:08:00
I think it's a shame that the words for dependence are so fuzzy and inaccurate. Dependency vs addiction vs habituation; withdrawal vs stoppage syndrome, etc. It'd be nice if we had a strict vocab that folks knew and stuck with.
Don't get me wrong, bupe is quite unabusable compared to methadone (though not as unabusable as using loperamide as a maint med), but I've known my fair share of opiate users who still found a way to abuse bupe. The quality of 'high' might not be like heroin or morphine, but the usage patterns and intent were the same. Not saying everyone does this, but opiate have a knack at finding a way...
Posted by FredPotter on July 11, 2007, at 20:15:56
In reply to Re: A different thought., posted by F00TBALL on July 11, 2007, at 13:59:15
We have a drug in NZ called methamphetamine or "P". It's quite the most dangerous drug on the planet and yet amphetamines are stated on the list to be less dangerous than benzos. I therefore dismiss that list as ludicrous
Posted by revaaron on July 11, 2007, at 22:20:35
In reply to Re: A different thought., posted by F00TBALL on July 11, 2007, at 13:59:15
> I'm going to have to disagree with you. Take a
> look at this comprehensive study published this
> year that ranked 20 different drugs from most
> dangerous to least dangerous.
>
> http://observer.guardian.co.uk/uk_news/story/0,,2026205,00.htmlSorry, I don't buy it. This list sucks. It would be easier to critique if the criteria were listed. Sorry, but any list the 20 most dangerous drugs that has buprenorphine higher on the list of danger than solvents is *completely* without credibility.
The definition of "danger" used by this list is pretty skewed in some direction considering the kind of neurotoxicity that even non-habitual occasional solvent abuse carries.
> The media has given Ecstasy a bad rap, but it's
> not nearly as dangerous as Heroin or most other
> illegal drugs.The media gives *all* drugs (except tobacco and alcohol) a bad rap, I agree with that entirely.
However, if you think heroin is less dangerous than MDMA, then you've got some more research to do. It depends on what level you take it; as a impure street drug heroin is worse, but that has more to do with the dangers of injecting anything than heroin (or other opiates) as a drug. Pure heroin is safer, not neurotoxic, and while the addiction to opiates isn't a good thing, it is managed relatively easily. Not to down play the dangers of illicit IV drug use, but the idea of heroin being inherently a super-dangerous drug is based in the same kind of drug war propaganda you're asking me to ignore.
The dangers of heroin use would be almost entirely solved by the end of prohibition. The dangers of exist MDMA regardless of how pure your pills are. The danger of ODing on heroin is pretty low except when people mix it with other drugs, especially other downers like alcohol or benzos. The safe margin for MDMA is probably no worse, but the same risk of mixing it with other drugs is there.
However, none of that addresses much more practical issues I listed, to recap:
1. A reliable supply of actual MDMA dose is pretty hard to come by. Unless you are buddies with a chemist, your chances of having access to pure MDMA it next to nil.
Getting actual MDMA (not MD*, d-,l- or meth-amphetamine, ephedrine, DXM, LSD, 2C-*) is certainly possible, but there wouldn't be a thriving community around identifying what are actually in "ecstacy" pills. Knowing the amount of substance in the pill is next to impossible.
...and even if you had access to pharmaceutical grade MDMA:
2. Using MDMA for a few days in a row changes the user's subjective from the magic of MDMA to something closer to "speed." This effect is not uncommon amongst users using MDMA only once a week at parties.
3. Price. $60/day for pills that may or may not be MDMA?
Even most pro-MDMA sources acknowledge that MDMA use, let alone habitual/daily use carries with it a few serious risks, including neurotoxicity.
Sorry, but like I said, I don't buy it. I completely reject the erroneous mythology of psychedelic drug = good and euphoriant = bad that pervades so much of drug culture. It's half government propaganda and half feel good ignorance. Like I said before, taking MDMA a few times, even a once a month probably carries very little risk of damage if done so responsibly and safely. I do agree that some folks have derived great therapeutic value, allowing people to get over various mental blocks.
Using MDMA a few times and having it help you makes it a therapeutic not an antidepressant, which is a common trait among many psychedelic drug. Mescaline and S. divinorum have been used for this kind of positive change but I don't think you would call them "antidepressants."
If you actually know someone who has benefited from using MDMA as an regular-dosing antidepressant successfully, I'd be interested to hear more. What kind of dose do they use? How often?
Aaron
Posted by revaaron on July 11, 2007, at 22:45:08
In reply to Re: A different thought., posted by FredPotter on July 11, 2007, at 20:15:56
> We have a drug in NZ called methamphetamine or
> "P". It's quite the most dangerous drug on the
> planet and yet amphetamines are stated on the
> list to be less dangerous than benzos. I
> therefore dismiss that list as ludicrousIn theory, the difference between street drugs and safely used pharmaceuticals shouldn't be that great. In practice, the gap is extremely wide. Methamphetamine (Desoxyn (tm)) is actually one of the most effective and safe drugs for AD/HD around, well tolerated and with few side effects with most people.
But yeah, that list is completely bunk. Bupe being more dangerous than solvent abuse? I have no idea where you would even start on this. It's odd that it's so low on the list, below a drug like bupe that has probably the least abuse potential of any drugs on the list, let alone the damage that would come from therapeutic or recreational use. Bupe is probably the safest drug on that list, it shouldn't be on that list. Hell, Tylenol/APAP is a quite a bit worse for you than bupe. Solvents, at the other end of the spectrum, can cause brain damage the first time you use and are probably the most dangerous of the drugs on that list in a few ways to measure that.
I'd say methamphetamine is less dangerous than benzos if used as prescribed, and again less dangerous at lower levels of abuse. I've seen what lies at the end of the road of meth abuse, I have no illusions- we have a bad meth epidemic where I live (Midwestern US). The reasons for this are many, somewhat due to the specific effects of the drug but way more due to social and economic factors as well in the effects that prohibition cause (HIV, HepC).
You see something very similar with street heroin and pharmaceutical opiates, including heroin. You could use be addicted to pharmaceutical heroin or morphine, use it every single day of your life, and have no worse for the wear other than the addiction itself. Again, I do not play down the ugliness of heroin withdrawal, but unlike alcohol or benzo withdrawal it won't kill you.
There are a lot of drugs on that list below heroin that can do irreversable damage to your body and/or mind regardless of how much harm reduction you practice, some of them can do this damage without being a regular user.
Aaron
Posted by FredPotter on July 11, 2007, at 23:16:44
In reply to Re: A different thought., posted by revaaron on July 11, 2007, at 22:45:08
When we consider the terrible harm and lack of control of alcohol in Australian aborigines and to a lesser extent amongst Maori, we (the Europeans who have only just arrived), should hang our heads in shame. Alcohol has never been a part of their culture so they find sensible use more difficult than European people. And the fuss we make about the use of Kava, which is so feeble compared to alcohol. Yet we introduced alcohol to the Polynesians and that was apparently OK
Posted by kingcolon on July 12, 2007, at 10:15:05
In reply to Re: Heroine as atnidepressant, posted by revaaron on July 11, 2007, at 15:08:39
> I think it's a shame that the words for dependence are so fuzzy and inaccurate. Dependency vs addiction vs habituation; withdrawal vs stoppage syndrome, etc. It'd be nice if we had a strict vocab that folks knew and stuck with.
>
> Don't get me wrong, bupe is quite unabusable compared to methadone (though not as unabusable as using loperamide as a maint med), but I've known my fair share of opiate users who still found a way to abuse bupe. The quality of 'high' might not be like heroin or morphine, but the usage patterns and intent were the same. Not saying everyone does this, but opiate have a knack at finding a way...A QUOTE FROM ARTICLE BELOW:
"....There are reports of the drug being abused, but then some substance abusers will abuse almost anything. We were told that San Quentin stopped using white scouring powder because substance-abusing inmates were injecting it into themselves!"
True, addicts do "find a way" to abuse!!! It's a shame we seem to have lost Babek since my post was to try to help him/her find an alternative to heroin as a treatment for his intractable depression with anhedonia. I got the impression that Babek was not looking for a "high" at all, but unfortunatey found he became addicted (craving the high)and thus got into a cycle of abuse that led nowhere good as far as the a way to treat his depression. I really think BUP is a way out for people who want to avoid the addictive effects of heroin or other opioids to deal with helping them with their basic problem of depression. As I said, it produces little if any euphoria or craving, and the evidence is very pro excellent antidepressant effects. A withdrawal syndrome pales in comparison to the benefits of treating the depression and can be managed much more easily since there is no reward of a high as one withdraws resulting in drawing one back into using again. And if the depression is under control, and one doesn't want to get high, one isn't likely to relapse into heroin or other opiate abuse.
Obviously, this applies to this type of problem only--not the typical opiate abuser.
But you're right that any opiate carries with it a risk of abuse (in BUP's case, almost entirely with IV use). Here's an article from a previous post that has a comment about the effects of BUP on depression, together with mention of fears of using it by the public in general, mostly based on the "intent" and "patterns of use" you mention in abusers. The quote above says it all. But let's not forget the sufferers from severe depression. It's been a life saver for me so far. I hope I don't become tolerant, but it seems that even that is unlikely with this drug. And for dual diagnosed people, BUP carries the distinct advantage that you really can't get a high any more easily by increasing the dose (celing effect).I'd be interested in re-focusing the topic to opiates for depression--especially for people's experiences with buprenorphine.
--------------------------------------------------------------------------------Buprenorphine for Treatment-Resistant Depression
Posted by Rudiger on June 25, 2001, at 17:47:12The following are excerpts from an editorial in the June 15th, 1996 issue of the journal Biological Psychiatry. The editorial outlines the (irrational) reasons buprenorphine is not used more often in cases of clinical depression that has not responded to every other available treatment.
Buprenorphine for Depression: The Un-adoptable Orphan
Buprenorphine [BPN] in low (circa 0.3 mg qid) transmucosally (under the tongue or by nose drops) can be dramatically effective in cases of treatment for refractory depression. Its safety and efficacy are not secrets, yet it has received little study and currently receives little clinical use.
Early in BPN's history, Emrich et al (1982) found it a potent antidepressant in drug-refractory depressives. Sporadic supporting reports have appeared in the literature from time to time since then. Most recently, Bodkin et al (1995) reviewed the literature and reported an open trial of 10 cases to further document BPN's value as an antidepressant. When the drug works, it works quickly. Bodkin et al say they see results within several days. We have found that most patients experience benefits of an adequate dose within three hours. The only intolerable side effects are nausea and dysphoria. The effects are seen in 10% to 20% of patients and are quickly obvious....
We have personally treated five patients with BPN in whom the results were impressive. Three were more or less typical cases of depression who had failed adequate trials with various treatments, including, in one case, a thorough course of ECT. Of the two less typical patients, one was a case of panic disorder with onset in childhood and what could better be called dysthymia rather than typical depression.... All five patients were followed for several years while good results were maintained.
Given BPN's availability and demonstrated efficacy, why is it so rarely used in treating depression? Therein hangs a tale. Reckitt and Colman Pharmaceuticals, Inc. [R&C] received their NDA to market BPN as a parenteral analgesic more than a decade ago. It appears that their grand strategy was to get BPN approved as an over-the-counter analgesic. It does indeed have a remarkable safety profile. At high doses, it produces less respiratory depression and cognitive obtunding than morphine, perhaps due to its antagonist action....
Addiction and tolerance are not serious problems. Patients who abruptly stop the drug complain of fatigue, dysphoria, upset stomach, and sometimes piloerection. This pallid imitation of narcotic withdrawal is generally not associated with craving, and indeed patients do not usually associate their symptoms with having stopped the drug until they experience the relief occasioned by restarting their treatment. There are reports of the drug being abused, but then some substace abusers will abuse almost anything. We were told that San Quentin stopped using white scouring powder because substance-abusing inmates were injecting it into themselves!
One handicap BPN has had as an antidepressant was the absence of any interest in that application on the part of the manufacturer. The idea of selling BPN as an OTC analgesic was not an unreasonable one, but it did not lead R&C to pursue work on the psychotropic properties of their drug.
It appears tha BPN can be used much as methadone is used in maintaining opiate addicts. While doses of up to 32mg have been used, doses in the order of 6 to 12mg seem best. Compare this to the 0.15mg to 0.3mg doses that are effective in depression. Several studies have reported that BPN is indeed effective in treating opiate dependence, although less so than methadone (Kosten et al 1993 and Strain et al 1994). However, BPN's use in treating addicts, plus the ominous "-norphine" suffix in its name, have been even more of a deterrent to BPN's exploitation as an antidepressant than has R&C's narrow focus on its analgesic applications.
Comparing BPN with classic mu agonist opiates is unfair. BPN is a derivative of thebaine, which has partial mu agonist and kappa antagonist activities. As a partial agonist, it seems to act as a mu antagonist at higher doses, and this provides some protection against it being used in escalating doses by substance abusers. In addition, in low doses it produces minimal or no euphoria. We have a little packet of reprints to send out to pharmacists who call accusingly and question why we are prescribing such a "dangerous narcotic."...
We have continually been frustrated by the resounding lack of interest our colleagues have shown in BPN as an antidepressant. In spite of some promising pilot work, Veterans Administration workers treating post-traumatic stress disorder have declined to study BPN because so many of their clients are substance abusers, and BPN is "narcotic-like."
We discovered that someone had contracted with Cygnus, Inc. to develop a BPN patch. That was accomplished, but the contracting company dropped the project. The developed BPN patch now sits on their shelf. However, after a few cordial lunches, Cygnus indicated they would need a million dollars up front to reactivate production of the patch for a clinical trial. Small business grants are limited to $100,000 to start, so that would not get Cygnus back into the BPN patch business. Also, treatment-refractory depression does not sound like an appealing market to business types. We are not sure the market is so small, and it has been suggested that as many as 20-30% of depressed patients may be treatment-refractory. But certainly, for a single physician, patient accrual is slow. While the patent on BPN has run out, orphan drug status might allow a company to be protected against competition while it recoups its investment and more. But so far there is little interest from industry.
Academia has been similarly uninterested, but with better reason. It's too bad that substance abuse takes a hight priority than depression in congress, but then what is one to expect. And our wildest fantasy does not have the National Institutes of Mental Health approving the trial of such an oddball drug for treatment-refractory depression. In our mind's eye we can see the pink sheet: Reviewer No. 1 says: "We already know that BPN works in depression, so why do it again?", while reviewer No. 2 says: "It's too much of a long shot in these times of short money."...
Research is the art of the possible, and none of us these days can afford to espouse lost causes. But your local pharmacist can dispense BPN without a triplicate, and even supply a syringe and needle so the patient can withdraw the drug form the vial and squirt it under the tongue. You will find it in the Physician's Desk Reference under the trade name "Buprenex" injectable, 0.3mg/ml. So even if the orphan remains un-adoptable, you might want to try BPN on an occasional drug-refractory depressive, and so keep it alive, at least in the lore of those who do tertiary psychopharmacology.
Enoch Callaway
University of California-San Francisco
Tiburon, CA
References:Bodkin JL, Zornberg GL, Lucas SE, Cole JO. (1995): Buprenorphine treatment of refractory depression. Journal of Clinical Psychopharmacology, 16:49-57.
Emrich HM, Vogt P, Herz. (1982): Possible antidepressive effects of opioids: action of buprenorphine. Annals of the New York Academy of Sciences, 398:108-112.
Kosten TR, Schottenfeld R, Ziedonis D, Falcioni J. (1993): Buprenorphine versus methadone maintenance in opioid dependence. J Nerv Mental Dis 181:358-364.
Strain EC, Stitzer ML, Liebson IA, Bigelow GE. (1994): Buprenorphine vs. methadone in the treatment of opioid-dependent cocaine users. Psychopharmacology 116:401-406.
--------------------------------------------------------------------------------
Posted by Sigismund on July 12, 2007, at 17:00:22
In reply to Re: Heroine as atnidepressant, posted by revaaron on July 11, 2007, at 15:08:39
>It'd be nice if we had a strict vocab that folks knew and stuck with.
It changes.
Addiction(1970)=Dependence(2007)
Posted by F00TBALL on July 12, 2007, at 20:06:43
In reply to Re: A different thought. » F00TBALL, posted by revaaron on July 11, 2007, at 22:20:35
"1. A reliable supply of actual MDMA dose is pretty hard to come by. Unless you are buddies with a chemist, your chances of having access to pure MDMA it next to nil."
Only if you buy it from some random guy. If you have a good drug dealer it's not difficult at all to get pure ecstasy.
"Getting actual MDMA (not MD*, d-,l- or meth-amphetamine, ephedrine, DXM, LSD, 2C-*) is certainly possible, but there wouldn't be a thriving community around identifying what are actually in "ecstacy" pills. Knowing the amount of substance in the pill is next to impossible."
Again, not if you buy it from a reliable dealer.
"2. Using MDMA for a few days in a row changes the user's subjective from the magic of MDMA to something closer to "speed." This effect is not uncommon amongst users using MDMA only once a week at parties."
While I do not deny that may be the case with some people, I know several people who have taken several hundred XTC pills in their lifetime, with absolutely no reduction in effects.
"3. Price. $60/day for pills that may or may not be MDMA?"I don't know where you live, but I've never seen it for more then $15. Usually it's no more then $10.
"Even most pro-MDMA sources acknowledge that MDMA use, let alone habitual/daily use carries with it a few serious risks, including neurotoxicity."
There is absolutely no conclusive evidence in regards to long-term damage caused by ecstasy usage.
The only report I have seen that claimed ecstasy caused severe brain damage was retracted when it was discovered the ecstasy had accidentally been switched with methamphetamine.http://en.wikipedia.org/wiki/Retracted_article_on_neurotoxicity_of_ecstasy
Here's a study that found only insignificant differences in the brain chemistry of heavy MDMA users.
http://maps.org/research/mdma/litupdates/human/comparisons/03.03/buchert2003.html
Posted by Babak on July 13, 2007, at 3:39:47
In reply to Re: Heroine as atnidepressant, posted by maria3667 on July 8, 2007, at 18:35:23
I am still here.
I was back in a state of vegitation as I tried to come off opiates for while. This is what happens everytime. I become a cripple I just sit on the sofa in front of the T.V. whithout even watching it. As I go throught withdrawal which is nothing compared to a sense of anhedonia. Stop eating or contacting the outside world drifting in and out of sleep full of dreams. I feel annxious and feelinf like having a bad cold. I become crippled with anhedonia and this continues until I get really fed up or I have to attend to somehing or other which can not be delayed or put to one side or ignored and then I have to sum up some sort energy to actucally get hold of some heroin and take it and do what ever I have to to and then go back to vegitation, because I really don't want to get more hooked than I am already.
I know I am loosing control over my addiction and the same amount of heroine is not enough to lift me out of the vegitative state that I am in even though I use it one or twice a week. when I really have to actually do something.
I am in a real state and the doctors don't seem to appreciate the terrible state that I am in.
I am supposed to go in for VNS but the way NHS works in this country god knows how long that is going to be and I am not even sure if it will have any effect. BY the way does any one know if VNS helps anhedonia or not.
I am at a loss and wished I could be hospitalised and had some one else taking decisions for me.
I have lost the strength or will power to try any more. I have tried all the medications on the market. I live alone and I just can't take care of myself anymore. I don't remember when I had a bath or a shower last time. I don't even remeber when I left the house last time. What can I say, I should really kill myself but for some reason I don't feel suicidal.
I know I am ramblinmg but I just don't know what to do any more. The only reason I have managed to write these line is that some one brough me some heroine last night. But I didn't take it last night hoping that I would take it today so that I can summon up the will power to take a shower today.
God help me
Posted by Babak on July 13, 2007, at 3:51:34
In reply to Re: A different thought., posted by FredPotter on July 10, 2007, at 19:40:38
Thanks for suggestion and I have thought of it but I am on SSRI and MDMA pr Ecstasy won't have any effect on me apart from giving me a head ache which I have tried several times.
Thanks anywat
Posted by revaaron on July 13, 2007, at 10:19:02
In reply to Re: A different thought. » FredPotter, posted by Babak on July 13, 2007, at 3:51:34
Good to see you back!
Man, after the epic battle FredPotter and I were in... I can't help but find this humorous as hell.
OK, back to our regularily scheduled program!
Posted by FredPotter on July 15, 2007, at 15:52:54
In reply to Re: A different thought. » FredPotter, posted by Babak on July 13, 2007, at 3:51:34
Babak I know everyone says this, but have you tried Nardil? I have suffered my own peculiar version of depression, derealisation and extreme anxiety for 43 years and I've tried everything. Only recently did I convince a Dr to try this old drug, but after 6.5 weeks - a fairly rough ride - it worked and has continued to work for over 3 months. That's the best response of any drug. To think I could have been given it all those years ago! Yes I put on weight and my genitals have a purely excretory function. But it's worth it; I'm getting on in years. Anhedonia I found to be one of the worst features of depression as I'm naturally a passionately interested person - in virtually everything. When anhedonia strikes I feel very frightened as it makes me feel cut off from life and a black pit opens up inside me.
I don't know whether opiates would help during the burning in period, I imagine it would. Nardil and heroin affect different receptors, but I'm not knowledgeable enough to say it would be harmless
best
Fred
Posted by rvanson on July 19, 2007, at 0:57:54
In reply to Re: Heroine as atnidepressant, posted by polarbear206 on July 3, 2007, at 20:37:30
>
> Can you give a more detailed history of the onset of your symptoms and age. How different are they from 4 years ago? Do you see a psychiatrist? What are all of the meds you have tried? You are playing with fire using Heroine!!!!!!!!!
Why is that?Many people self-medicate for depressive symptoms with alcohol and marijuana every day and night.
If the heroine helps to make life more pleasant I can easily see why Babak would resort to using H to make things more bearable.
Posted by revaaron on July 20, 2007, at 15:48:11
In reply to Re: Heroine as atnidepressant, posted by rvanson on July 19, 2007, at 0:57:54
> Why is that?
Oh, I don't know- perhaps because Babak asked a question and this information would be pretty darn useful in providing more useful help?
> If the heroine helps to make life more pleasant I can easily
> see why Babak would resort to using H to make things more
> bearable.BTW, it's heroin.
"Do what feels good, baby!" I've no problem with drugs, but as someone who has seen some negative consequences from regular, long-term opiate use I can safely say that there are risks. And no, I'm not talking about the after-school special or NA sobstory variety. More like what I saw from safe, responsible opiate use, with accurate dosing, etc. It's like any drug- there are side effects.
The fact that it's an illicit street drug that is often shot, cut with various rubbish, and because you usually don't know quite what you're getting presents a whole new stable of problems that have nothing to do with heroin as a drug.
Sorry, but if someone asked a question about the long term sustainability of treatment using any random legal pharmaceutical you'd get a lot of similar replies- it's good for this, but these are the consequences. Isn't that the point of this board?
"What? The Prozac is killing your libido? Screw it, take it!"
RevAaron
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.