Posted by Kristi on January 25, 2002, at 1:05:49
In reply to Re: opioids » christophrejmc, posted by Elizabeth on January 24, 2002, at 12:47:08
Hi. I'm just curious...... you mentioned ultram is associated with seizures? I've been on it for a while, just wondering what you know. Thanks in advance, Kristi
> > Is there any reason why buprenorphine would be a better choice for depression than the other opiates?
>
> There are several, which are discussed in the Bodkin et al. article. The following factors make buprenorphine a better choice than a full agonist.
>
> - less toxicity in overdose
> - little or no potential for abuse or addiction
> - much milder withdrawal symptoms
> - lacks Ultram's potential for precipitating seizures
> - action lasts longer than most opioids
>
> > Strangely, it's easier for me to get schedule IIs than the lesser controlled opiates (legally, btw).
>
> Buprenorphine in particular, or less controlled opioids in general (e.g., Stadol, Talwin, Nubain, etc.)? Doctors often shy away from buprenorphine because it's only available (in the U.S.) in an injectable formulation.
>
> > I know that some people have had good responses from morphine/oxycodone/methadone, but I'd rather not mess with anything potentially "addictive."
>
> I think that's reasonable. IMO, it's a good idea to try buprenorphine first, and move on to full agonists (probably MS Contin, OxyContin, or Duragesic) only if buprenorphine benefits you, but (1) the effect of buprenorphine is not sufficient, and you need something "stronger;" or (2) you are unable to tolerate buprenorphine. (Fentanyl is probably the most tolerable of the opioids, although it's probably a bad idea to ask your doctor for it.) I don't think it's worthwhile to try full agonists if buprenorphine doesn't help at all, although it's generally worth trying different doses -- sometimes higher doses may work better, but sometimes you may actually find *lower* doses more effective. In general, because the side effects of opioids can be pretty harsh, I'd advise starting at a low-end dose. (I started at 0.5 mL t.i.d.)
>
> > Are there any other mixed agonists that are worth trying (and that don't require IV/IM injection)? Thanks for any information.
>
> Probably not. You might try Stadol (butorphanol), a kappa agonist/mu antagonist, especially if you're one of those people who feel worse on opioids (most people have at least tried codeine or hydrocodone at some point, so you're liable to have some idea how they affect you). But usually depressed people feel worse on kappa agonists. There was another drug on the market called Dalgan (dezocine) with a pharmacological profile similar to that of buprenorphine, but I think that dezocine is no longer available. (IIRC, Dalgan was an injection-only drug too, anyway.)
>
> HTH
>
> -elizabeth
poster:Kristi
thread:4588
URL: http://www.dr-bob.org/babble/20020124/msgs/91501.html