Posted by Elizabeth on June 25, 2001, at 23:58:25
In reply to Re: more about Xanax and depression » Elizabeth, posted by paulk on June 16, 2001, at 15:07:23
> >That's true, although there is something called a "use patent" (which is why you still can't get generic Prozac in the US
>
> Tell me more – how much longer can they stretch it out with this?It's not clear. However long the FDA will continue accepting bribes, I guess. < g >
> >I'm not sure I understand the question. Orthostatic hypotension (slowed cardiovascular adaptation to changes in posture) is probably due to central activation of alpha-adrenergic receptors (which results from increased norepinephrine, which results from destruction of MAO).
>
> From what you said that would be a secondary effect – the primary effect of the drug would be the destruction of MAO. A secondary effect would be the increase in neuro transmitters....because one of their major metabolic pathways is cut off, right. (There are other enzymes, such as catechol-O-methyltransferase (COMT), that catalyse the metabolism of these neurotransmitters, but those are relatively minor. I did once speak to someone who'd tried using a COMT inhibitor for depression and ADD, but he wasn't impressed by it in comparison to the MAOIs.)
> I saw some lowering of my BP quite as soon as I took the med – I’m thinking it might be a primary effect?
It's (probably) a consequence of the increased neurotransmitter concentrations (norepinephrine in particular). It's not a "direct" effect in the sense you seem to mean, but it is observable after a single dose, as opposed to the AD effects which usually require chronic dosing (for at least a couple weeks, although my impression has been that many people find that MAOIs work faster than other ADs).
> >Addiction results from using large doses of a drug to get high. Anybody who's been taking Xanax for a long time will get withdrawal symptoms; that's not drug addiction, it's a normal reaction.
>
> Not sure I’m tracking you here – my father gave some of his terminal patients enough painkiller for them to become ‘physically addicted’ – in my mind if there are physical side effects from withdrawal one is physically addicted.I discussed this in another post:
http://www.dr-bob.org/babble/20010618/msgs/67768.html
"Addiction" is a really loaded word and can cause confusion since different people have different ideas of what it means.
> On the other hand, I would say there are lots of people who are psychologically addicted to coffee.
Caffeine causes a mild withdrawal syndrome -- fatigue, headaches, etc. I once heard somewhere that something like 80% of adult Americans are pharmacologically dependent on caffeine, though (in other words, they need their morning coffee).
> I would even call the fever I got discontinuing Effexor a physical addiction.
The presence of withdrawal symptoms is evidence of what you call "physical addiction," yes. (I personally don't like that term because "addiction" is such a loaded word, and because it implies that mental processes are somehow "nonphysical.)
Besides its moral/political overtones, "addiction" also implies a pathological condition, whereas withdrawal symptoms are normal consequences of discontinuing certain drugs after you've been using them regularly for a while. Almost anyone who takes morphine for a few weeks will experience some uncomfortable withdrawal signs and symptoms if they attempt to stop taking it, especially if they stop "cold turkey." Most people who take morphine for pain have no trouble staying off it after stopping it, once the initial withdrawal period has abated (assuming that the source of their pain was treated so that they no longer require an analgesic).
> I think I remember hearing a ‘modern’ definition about addiction being where one loses the ability do deny oneself the drug (I guess I might be addicted to food - some of the amino acids can make me feel much better - (unfortunatley they tend to be found in association with high fat content)).
That's the defining characteristic of "addiction," yes. If an "addict" goes too long without their drug of choice, he starts obsessing about it and experiencing intense cravings -- even if he doesn't experience withdrawal symptoms.
> My guess is that the different MAOIs must be knocking out different MAOs or they would all have the same effect other than their side effects.
Nope. Nardil and Parnate are both nonselective inhibitors of MAO. They do have other effects in addition to MAO inhibition, though: Nardil is also an inhibitor of GABA metabolism, while Parnate is *thought* to have some sort of dopaminergic effect (perhaps induction of dopamine release: Parnate is chemically extremely similar to amphetamine).
> >Demerol's pretty crappy anyway. They should use morphine. :-)
>
> Or heroin – it is supposed to be the best painkiller (there might be some new synthetics – I don’t know about).No, fentanyl (which isn't all that new) is probably a better analgesic. Heroin (diacetylmorphine) is really just a semisynthetic version of morphine. The acetyl groups cause it to be taken up into the CNS very rapidly if it's taken intravenously (heroin, if taken through other routes, is transformed into morphine before it makes it to the CNS).
> Back when heroin was used as a painkiller most folks had no problem becoming dependent on it.
Well, they often became dependent on it (often in the form of unlabeled patent remedies with names like "Mrs. Brown's Soothing Syrup"). But because they had unlimited access to it, they didn't have trouble functioning as a result of their dependence.
> It probably got its bad reputation because so many coming back from the war had been treated with it at one time.
I'm kind of embarrassed to say that I don't know which war you're referring to. < G > But anyway, like almost every illegal drug, heroin's bad reputation originated in racism -- it was the recreational drug of choice of many of those wild, creepy, dangerous (i.e., black) jazz musicians.
> If a different opiate had been popular for pain control at that time it would have earned the same ‘bad drug’ status.
A number of different opiates, including morphine and laudanum, were used widely as analgesics in the late 19th and early 20th centuries. They were used in a wide variety of "nervous disorders" (anxiety and depression -- laudanum could be said to be the original "mother's little helper") as well.
> (I suppose one could make some points about the half-life of some opiates makes them more addicting.)
Not the half-life: the rapid onset of action. Heroin "hits" extremely fast when injected into a vein. Oral heroin, on the other hand, is effectively the same as morphine (which isn't very orally active itself: oxycodone has much better bioavailability when taken by this route).
> Anyway – many people who were given large amounts of heroin for pain had no problems getting off the drug.
Of course they didn't. Neither do most people who take the strongest opioid analgesics -- fentanyl, hydromorphone (Dilaudid), oxymorphone (NuMorphan), etc. -- today. Try explaining this to a politician, though!
> I also, have had a run-in with opiates=bad when I had my second kidney stone.
Oh jeez. I never had those, but I know how painful they are. There seem to be a lot of doctors out there -- especially ER docs -- who hate getting duped so much that they'd rather leave people in agony than risk giving "narcotics" to an addict (because if these doctors felt they'd been had, their precious egos would suffer irreparable bruising).
-elizabeth
poster:Elizabeth
thread:65795
URL: http://www.dr-bob.org/babble/20010625/msgs/67903.html