Posted by BarbaraCat on January 22, 2002, at 20:59:47
In reply to Re: problems getting buprenorphine » BarbaraCat, posted by Elizabeth on January 22, 2002, at 18:37:31
Thanks for your info, Elizabeth,
Actually, it was me who diagnosed myself as Bipolar II (for lack of anything else to call it, and my pdoc basically saying 'Gee, I dunno, might be, couldn't hurt to try.'). I've been cycling in and out of very severe depressions beginning in my early 20's and amping up to several episodes a year (I'm 50). I have mixed very melancholic vegetatives cycling to agitated, panic, bad, bad anxiety, insomnia, crying marathons, utter bleak despair. I've had classic hypomanic episodes (Oh God, I'd like some more of those, please) but most take the form of agitation, ruminative worry, fear, starting projects, never finishing. All this compounded by severe muscle pains that have been diagnosed as 'fibromyalgia' (and BTW, I had a Stephen King horror movie kind of childhood). I've been on all of the SSRI's and most of the 'novel' ones, buproprion, some TCAs, on and on.
No AD works longer than 2-3 months and all of the SSRI's have spun me into loco hyper states in the first few days. I like opiods cause they make me feel good. Simple as that. Currently I'm on 30 mg. Remeron and 200 mg lithium, titrating up slowly, and lots and lots of knock me out sleepers. I seem to be a classic 'AD's make me worse' case with extreme lability - brain inflammation would describe it best - and personally, I'm a big proponent of the viral theory. The lithium seems to be smoothing things out and I like it's neuroprotective and antiviral putative benefits. I wonder about the Bipolar II accuracy and if it's not just jumping on another bandwagon that provides new drug regimens, new hopes, but my symptoms have not been helped by the standard severe depression Rx. I also have many prolonged bouts of very happy, productive normalcy with delightful snippets of joy and wonder thrown in. So my awful times are not constant, but very randomly cyclical (isn't this the way malaria and other cyclical malaise type illnesses present?) -- Barbara
> Hi Barbara.
>
> > I've checked past posts, but couldn't find any details on why you've found bu-orphine helpful and what your regimen is. Could you give some info as to what it's treating, results, etc? Is it an opiod, or an antagonist?
>
> Buprenorphine is an opioid mixed agonist/antagonist. It's a partial agonist at the mu receptor (i.e., it activates the receptor, but less than a full agonist such as morphine would) and an antagonist at the kappa receptor. Like the full mu agonists, it's a controlled substance in the U.S., but unlike them, it's only Schedule V (minimal abuse potential). It's used in many countries for maintenance treatment of opioid dependence.
>
> I take 1 mL (= 0.3 mg) three times a day, in addition to 900 mg/day of Trileptal and 187.5 mg/day of Effexor XR (target dose of Effexor is 300 mg/day). I also take Xanax as needed. I have unipolar depression and a possible seizure disorder (hence the Trileptal).
>
> Buprenorphine helps with my mood, energy level, concentration, motivation, optimism, anxiety (including social anxiety), and anhedonia. The Effexor seems to be helping too; I think it is a good combination.
>
> > Also, if you could also answer a burning question - why do opiods have such an energizing effect, at least they do for me.
>
> I don't have an answer for that (they're activating for me, too), and I'm not sure anyone does. In general, opioids have mixed activating and sedating effects (they're not strictly inhibitory or excitatory), to varying degrees for different people. I could speculate about the neurochemical reasons for the variation, but it would just be speculation.
>
> > I've always heard of their sophorific effects, not the calm yet speedy one I get.
>
> "Calm yet speedy" -- that's exactly it. :-)
>
> -elizabeth
>
> p.s. You mentioned that you were recently diagnosed with Bipolar II disorder. There seems to be an epidemic of previously undiagnosed Bipolar II -- everybody is bipolar these days! Do you think the diagnosis is accurate in your case? (Just curious, no relevance to the discussion.)
poster:BarbaraCat
thread:4588
URL: http://www.dr-bob.org/babble/20020116/msgs/91145.html