Posted by Elizabeth on May 7, 2001, at 7:48:54
In reply to Re: Whats the best opiate for depression ? » Pacha, posted by shelliR on May 6, 2001, at 18:08:18
Of the ones you mentioned, buprenorphine or tramadol would be my choice.
Buprenorphine has the advantage that it can be combined safely with classic monoaminergic antidepressants, which is somewhat risky with Ultram (MAOIs, in particular, are absolutely contraindicated). A disadvantage is that there is no pill form available in the U.S. at this time. People in other countries who've tried the sublingual formulation -- known by the brand names Subutex and Temgesic -- say that it doesn't work very well by that route, which is consistent with my experience attempting to take Buprenex (the solution) sublingually. (Dr. Bodkin, the researcher Shelli mentions, confirmed that this has been his experience as well, BTW.)
Tramadol has the advantage that it is available in the U.S. in pill form (also it is not a controlled substance (YET), so you're more likely to be able to get a prescription for it). It may be toxic if you raise the dose too high.
Darvon is rather toxic and very weak. Oxycontin is very expensive, and oxycodone is more likely to produce tolerance rapidly than buprenorphine or Ultram.
Methadone might be a good choice, as it is extremely long-acting (so tolerance will develop relatively slowly). A disadvantage is that if you become unable to obtain it, the withdrawal syndrome is incredibly long-lasting (although not as intense as withdrawal from shorter-acting opioids).
Certain opioids, such as morphine and hydromorphone, are not well-absorbed orally and therefore probably not the best choice.
I agree with Shelli that if you haven't tried MAOIs, they are very much worth a go.
> Before I would try opiates for depression, I would definitely try MAOIs. Also, I think next month, the selegiline patch will be available, an MAOI that will (I believe) cause no food/drug interactions.
The selegiline patch can cause drug-drug interactions (e.g., with Sudafed or Demerol) but, because it bypasses the GI tract, it won't interact with foods. Shelli -- where did you hear that it will be available that soon? That'd be pretty neat.
> You have to really plan out taking opiates for depression. You don't want to start unless you have a way to continue, i.e., be able to keep getting prescriptions.
Yes. This is a disadvantage of full agonists in particular, because they have extremely intense withdrawal syndromes compared with partial agonists. People develop tolerance at different rates, and some experience seems to suggest that many who take opioids for depression can continue indefinitely on the same dose (my therapist, in particular, has found this to be the case on the few occasions when he has used morphine as an AD).
> I just e-mailed (Friday) questions to a doctor who participated in a study using buprenorphine, which if I understand correctly, is an opiate antagnonist which does not create a high but can help depression.
That would be Dr. Bodkin. It's true that buprenorphine does not create a high, but it is a partial agonist rather than an antagonist. (It is supposedly an antagonist at kappa opioid receptors, but I haven't actually seen any data to support this idea. Anyway, kappa agonists, such as Stadol, are apparently rather unpleasant for depressed people who respond to opioids; the mu receptor is probably the one responsible for their antidepressant effect.)
> Incidently, he is also part of the group which developed the selegiline patch--at McLean Hospital in Boston. His secretary suggested the e-mail; if I get any insight from him I'll share it.
McLean is in Belmont, actually. :-)
> I'm just amazed, however, how many people on this board say they have tried everything and have not tried nardil, parnate, or some of the reversable MAOIs. They are very different from all the other antidepressants and they did the job for me for fifteen years.
Yeah, they sure are (although I think that the reversible MAOIs are probably not as effective for people who've failed to respond to other ADs).
Shelli -- let me know what Dr. Bodkin says. I spoke to him a few days ago (about a referral) but he didn't have much time to talk so I refrained from asking him how his research was going.
poster:Elizabeth
thread:61760
URL: http://www.dr-bob.org/babble/20010507/msgs/61853.html