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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by SLS on February 26, 2014, at 1:58:02
In reply to Re: Lou's response-blwnihndhawyn » Lou Pilder, posted by LostBoyinNC45 on February 25, 2014, at 12:16:19
> I have always been perplexed at how discussion of prescription opiate narcotics, prescribed "off label" for depression and anxiety...is tolerated at this forum
Do you embrace your freedom of speech to say such things? I do. Actually, it is my impression that it is more of a privilege than it is a civil right on Psycho-Babble. Whatever it may be, you are advocating for suppression of speech. LOL.
Why was Galileo Galilei not tolerated by the church for insisting that the sun was at the center of the solar system?
Off label?
You are no more a doctor to deem a treatment dangerous than others are to advocate it.
- Scott
Posted by 10derheart on February 26, 2014, at 1:58:03
In reply to Freedom of speech? Yeah, whatever. » LostBoyinNC45, posted by SLS on February 25, 2014, at 12:36:35
I agree completely. I was thinking of how to say it succinctly when I saw you'd already done that :-)
Free speech must be safeguarded wherever and whenever possible. Encouraging yet another gov't agency such as the DEA to contemplate squelching communications between individuals is a frightening, disheartening concept.
Posted by SLS on February 26, 2014, at 1:58:03
In reply to Re: Freedom of speech? Yeah, whatever. » SLS, posted by 10derheart on February 25, 2014, at 13:55:12
> I agree completely. I was thinking of how to say it succinctly when I saw you'd already done that :-)
You are so, so good for my ego.
:-)
I like it when you smile.
> Free speech must be safeguarded wherever and whenever possible. Encouraging yet another gov't agency such as the DEA to contemplate squelching communications between individuals is a frightening, disheartening concept.
- Scott
Posted by LostBoyinNC45 on February 26, 2014, at 1:58:04
In reply to Freedom of speech? Yeah, whatever. » LostBoyinNC45, posted by SLS on February 25, 2014, at 12:36:35
Scott,
It is a fact that opiate narcotics are not FDA approved for any psychiatric use. It is also a fact that to get bupe or morphine or other controlled, narcotic painkillers legally prescribed "off label" for psychiatric reasons, you normally must consult with an "expert" psychiatrist who advocates the use of such drugs in extremely drug resistant cases. Normally, that "expert" psychiatrist will be at a psychiatry department at a University teaching hospital where a lot of research is being conducted.
To let discussions go on here about these off label, highly scheduled and highly physically addictive drugs with serious legal consequences...is distasteful and foreseeably, dangerous.
As a concrete example I will use myself as an example. Over a decade ago, before I got on CPAP therapy, I was a very desperate individual who was a very sick man. I would browse this forum sometimes and other forums and various psychopharmacology websites I could find for any new info I could find on a prescription medication that might save my life and restore me to normal.
I read here many times about a "wonder drug" called "bupe." There were then and still are several "armchair Internet experts" here and elsewhere on the net who think "bupe" is the next best thing to sliced bread for clinical depression. Being a relative newbie and feeling sick as a dog and as I said, very desperate, I viewed these posts about "bupe" as authoritative. As maybe something that I should possibly look into for myself.
So I went to the psychiatrist I was seeing at the time and asked him about "bupe" and if it was a possibility. He became concerned acting and looking and said he does not prescribe "bupe" for depression and I noticed he wrote something down in my notes.
I went away not thinking very much about it, but years later when I got copies of my psychiatric records from that doctor, I noticed he had written down "drug seeking behavior for narcotics" in my psychiatric jacket. And that upset me a lot, because I have no history of any kind of substance abuse problems, just mental illness and sleep apnea.
Ive never even smoked a joint. Much less used any kind of narcotics, except as legally prescribed after major surgery such as after a tonsillectomy, after a knee surgery and once when I had a broken leg and injured knee.
I have wondered how many other psychiatric patients who have read this forum, naiive and not knowing "the big picture," have similarly done the same or similar.
Freedom of speech has its limits. It is illegal to shout "FIRE!!" in a crowded public place. I dont particularly care for the open and public discussion of some of the off label drugs that goes on this board and see it sort of as the same principle as shouting "FIRE!!!" in a crowded public place. Some of the details are obviously different, but it is foreseeable that if a severely ill person reads such discussion from "Internet experts" on a public forum, it could lead them to seek non FDA approved, off label prescription medications from physicians...whom do not want to get involved. And rightly so. And trash the patient on paper.
Narcotic addiction is one of the most difficult addictions to recover from and frequently results in the death of the individual. I dont know why "narcotics for depression" discussion is tolerated here.
Eric AKA "LostBoyinNC"
> > I have always been perplexed at how discussion of prescription opiate narcotics, prescribed "off label" for depression and anxiety...is tolerated at this forum
>
> Do you embrace your freedom of speech to say such things? I do. Actually, it is my impression that it is more of a privilege than it is a civil right on Psycho-Babble. Whatever it may be, you are advocating for suppression of speech. LOL.
>
> Why was Galileo Galilei not tolerated by the church for insisting that the sun was at the center of the solar system?
>
> Off label?
>
> You are no more a doctor to deem a treatment dangerous than others are to advocate it.
>
>
> - Scott
>
>
>
Posted by LostBoyinNC45 on February 26, 2014, at 1:58:04
In reply to Re: Freedom of speech? Yeah, whatever. » SLS, posted by LostBoyinNC45 on February 25, 2014, at 14:40:36
Here is just one of hundreds, if not thousands of posts on psychobabble about the scheduled and controlled opioid "bupe" being used off label for depression. Talking about it like it is "just another drug" or something. LOL
You cant even legally drive on this drug or other narcotics. Ever had a DUI before?
http://www.dr-bob.org/babble/20060304/msgs/615934.html
Eric AKA "LostBoyinNC"
Posted by SLS on February 26, 2014, at 1:58:04
In reply to Re: Freedom of speech? Yeah, whatever. » LostBoyinNC45, posted by LostBoyinNC45 on February 25, 2014, at 15:12:37
> Ever had a DUI before?
Ever had a mental illness before?
- Scott
Posted by LostBoyinNC45 on February 26, 2014, at 1:58:05
In reply to Re: Freedom of speech? Yeah, whatever. » LostBoyinNC45, posted by SLS on February 25, 2014, at 15:49:19
Sure, I have depression and anxiety problems.
On the DUI question. I was being facetious and sarcastic. I was implying that if you take any prescription narcotic drug, even for a legal and FDA approved reason and go drive a car, there is a high probability you will end up with a DUI.
Then you still have the mental illness problem, are now physically dependent upon prescription narcotics (a growing problem here in the USA) AND lost your license for a year and are in trouble with the legal system? Whereas if you just stay with FDA anti-depressants or mood stabilizers for depression, its very unlikely you will get a DUI.
Eric AKA "LostBoyinNC"
> > Ever had a DUI before?
>
> Ever had a mental illness before?
>
>
> - Scott
Posted by sleepygirl2 on February 26, 2014, at 1:58:05
In reply to Re: Freedom of speech? Yeah, whatever. » SLS, posted by LostBoyinNC45 on February 25, 2014, at 14:40:36
You do have a very good point. Opiate addictions are horrible things.
Posted by Phillipa on February 26, 2014, at 9:57:13
In reply to Re: Freedom of speech? Yeah, whatever. » LostBoyinNC45, posted by sleepygirl2 on February 26, 2014, at 1:58:05
Very common but then many with illnesses physical need them for pain. Phillipa
Posted by SLS on February 26, 2014, at 13:12:49
In reply to Re: Freedom of speech? Yeah, whatever. » LostBoyinNC45, posted by sleepygirl2 on February 26, 2014, at 1:58:05
> You do have a very good point. Opiate addictions are horrible things.
Yes, they certainly are.
When used in heroin addiction, the administration of buprenorphine, especially when combined with naloxone (the Suboxone preparation), accomplishes two things. It prevents withdrawal from heroin (dependence) and reduces cravings (addiction). People can leave the house and not be tempted to take a trip downtown. The idea is to crossover from heroin to Suboxone and then taper the Suboxone with the goal of discontinuing it. There are other protocols for treating heroin addiction. These include abrupt discontinuation (abstinence) followed by enrollment in a 12-step program. I would not presume to decide for a heroin addict how he should treat his addiction. Suboxone works, though, and does not require the time commitment needed to work a 12-step program such as Narcotic Anonymous (NA). You can look on the FDA website for more information on the approved uses of buprenorphine.
As for off-label use of buprenorphine, there has not been very much scientific clinical investigation for its use in depression. However, I feel that there is enough so as to warrant further study. So does the NIH.
http://clinicaltrials.gov/show/NCT01407575
There is more extant material that supports the use of buprenorphine to treat TRD. You can find quite a bit using Google as a search engine.
Like many other drugs used in treating mental illness, there are risks and benefits to be weighed. Buprenorphine is a powerful, unpredictable, and dangerous drug to be used cautiously by patients capable of understanding the dangers of self-medication. The same thing can be said of MAOIs and TCAs.
Personally, I would like to see as many tools made available as possible. Buprenorphine is not an ideal drug, but might be necessary to give a small subset of patients with TRD an opportunity to function independently and enjoy life.
I think we should continue to talk about the use of buprenorphine for depression here on Psycho-Babble.
Not so simple.
- Scott
Posted by SLS on February 26, 2014, at 21:02:54
In reply to Re: Buprenorphine - Freedom of speech - Why not? » SLS, posted by LostBoyinNC45 on February 26, 2014, at 16:00:25
> A bunch of people refuse to acknowledge mental illness because of the lack of science behind it.
I am not terribly concerned with the ignorance extant in this particular bunch of people unless they are in a position to exert deleterious effects on the pursuit of improvement in the lives of the mentally ill.
I disagree with your supposition that there is a lack of science in the study of mental illness. I have been researching the medical literature since 1983. I have watched it evolve over time. In my estimation, modern scientific research into mental illnesses was in place by the late 1960s, and has grown exponentially. You can gain an appreciation for this by using Medline as a timeline.
The following link will search the Medline database for occurrences of the terms "major depressive disorder" or "major depression".
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed&form=4&term="major+depressive+disorder"+OR+"major+depression"&dispmax=100
It might be interesting to jump ahead to the last page to appreciate how great were the efforts to study mental illness scientifically in the 1950s.
Hopefully, the link will work properly.
Enjoy.
- Scott
Posted by SLS on February 26, 2014, at 21:06:35
In reply to Re: Buprenorphine - Freedom of speech - Why not? » LostBoyinNC45, posted by SLS on February 26, 2014, at 21:02:54
> > A bunch of people refuse to acknowledge mental illness because of the lack of science behind it.
>
> I am not terribly concerned with the ignorance extant in this particular bunch of people unless they are in a position to exert deleterious effects on the pursuit of improvement in the lives of the mentally ill.
>
> I disagree with your supposition that there is a lack of science in the study of mental illness. I have been researching the medical literature since 1983. I have watched it evolve over time. In my estimation, modern scientific research into mental illnesses was in place by the late 1960s, and has grown exponentially. You can gain an appreciation for this by using Medline as a timeline.
>
> The following link will search the Medline database for occurrences of the terms "major depressive disorder" or "major depression".
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed&form=4&term="major+depressive+disorder"+OR+"major+depression"&dispmax=100
>
> It might be interesting to jump ahead to the last page to appreciate how great were the efforts to study mental illness scientifically in the 1950s.
>
> Hopefully, the link will work properly.Nope.
Let's try this:
-----------------------------------------------
-----------------------------------------------
- Scott
Posted by Lou Pilder on February 27, 2014, at 19:44:33
In reply to Re: Buprenorphine - Freedom of speech - Why not? » LostBoyinNC45, posted by SLS on February 26, 2014, at 21:02:54
> > A bunch of people refuse to acknowledge mental illness because of the lack of science behind it.
>
> I am not terribly concerned with the ignorance extant in this particular bunch of people unless they are in a position to exert deleterious effects on the pursuit of improvement in the lives of the mentally ill.
>
> I disagree with your supposition that there is a lack of science in the study of mental illness. I have been researching the medical literature since 1983. I have watched it evolve over time. In my estimation, modern scientific research into mental illnesses was in place by the late 1960s, and has grown exponentially. You can gain an appreciation for this by using Medline as a timeline.
>
> The following link will search the Medline database for occurrences of the terms "major depressive disorder" or "major depression".
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed&form=4&term="major+depressive+disorder"+OR+"major+depression"&dispmax=100
>
> It might be interesting to jump ahead to the last page to appreciate how great were the efforts to study mental illness scientifically in the 1950s.
>
> Hopefully, the link will work properly.
>
> Enjoy.
>
>
> - ScottFriends,
It is written here,[...modern scientific research into mental illness was in place by the late 1960s...].
But what is the foundation of that research? Do you know and where it came from? Let us hear from a psychiatrist concerning as to if you have a chemical imbalance, which is a foundation of research into mental health...
Lou
To see this video:
A. Pull up Google
B. Type in:
[youtube, ARZ2Wv2BoFs ]
Posted by Phillipa on February 27, 2014, at 20:12:18
In reply to Re: Buprenorphine - Freedom of speech - Why not? » SLS, posted by LostBoyinNC45 on February 26, 2014, at 13:52:22
We at one time had an addictions board on babble and many of these drugs were discussed. One babbler that still talk to got hooked with a back fracture to opiods and then went on sub to get rid of that addiction so they have their place on babble. Phillipa
This is the end of the thread.
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