Posted by pseudoname on June 15, 2006, at 13:09:03
Stan's question to me last week about whether I experienced "mental cloudiness" on buprenorphine/Subutex got me thinking. (Bupe is a mild opioid partial agonist/antagonist I take for depression.)
I told stan (http://www.dr-bob.org/babble/20060604/msgs/654443.html) that some slight mental "gauziness" never completely goes away, even though since starting at 3 mg/day in December I've reduced my bupe dose in recent months to 1 mg/day. Also, any immediate fluctuation up OR DOWN in the dose can seem to trigger minor cognitive problems. In the past week, I've had some experiences that highlighted those problems.
Taking 0.5 mg/day for 2 days (about 1/2 my regular dose), I went to a big family gathering. I couldn't remember the names of people I've known for years, including one of my cousins that I see about once a year. I'm usually bad with names, but I should've been able to handle that, especially when I'm kind of excited by the situation, which was a really nice gathering.
Also, I played chess and got horribly confused. Against one novice kid, I said, "If you move your knight here you can attack my queen." So he did. Then I moved some other piece, and he took my queen. I said, "I didn't see that!" He said, "You just told me to do it!"
This went on and on like my head was in molasses. I couldn't keep track of the pieces AT ALL. It was a bad trip.
The next day I took no bupe, and as luck would have it went to another family gathering (different branch). I remembered everyone's name, learned a couple new names, and had a lively conversation in which the other person complimented my alert observations. I needed to get and follow complicated directions to the house, and I felt like I was remembering them better than usual. But it was a much smaller gathering, so maybe I was more at ease. Oh yeah: and I also took a left-over Metadate capsule!
But poor mood and self-critical thoughts returned en mass and for days afterward I beat myself up over allegedly stupid things I said or did.
I stayed off bupe for 4 or 5 days, and I did feel clearer-headed, though I have no idea if my chess-playing faculties got any better. However, my mood, self-criticism, self-hatred, RESENTMENTS, hopelessness, and suicidality (at the starting-to-make-arrangements level) returned to pre-treatment levels.
This continued constantly over those days. I had even forgotten about the seemingly constant visual imagery I used to have that expressed my self-hatred. THAT came back, all too frequently.
Maybe all these things were just because I'm squeezing opioids out of my brain, eh? Maybe I'm fundamentally NOT depressed and I'm just re-adjusting to neurons without extra opioids? Maybe, except that this is where I usually was pre-buprenorphine. As my earlier Babbleometer scores (consistently around 53) and journals attest.
This morning, I woke feeling quite good (after a dream in which Tom Cruise was my pdoc! -- see Social). But as the minutes ticked on, thoughts started jam piling on me and I faced the "fact" that the only possible way to end my pain is to die.
In that frame of mind, I took 0.5 mg of bupe. About 90 minutes later, I no longer felt suicidal (at all) or resentful or self-hating, and I wasn't ruminating on self-criticism.
But I *do* feel slightly dopey.
I'm also not sure that I'm addressing all of the issues I was thinking of while OFF the buprenorphine. I noticed more cognitive threads then. I can follow one thread just fine on bupe, but I can't simultaneously keep track of multiple threads (like in chess). Looking in my journal, I think I had more ideas off bupe.
Sigh. What a trade-off.
Caffeine and/or Metadate (the stimulant methylphenidate) don't seem to have any effect combating buprenorphine's central gauziness or dopey cognition, although they can help around the edges. I haven't tried adding Adderall.
Maybe I'll experiment with even lower doses of buprenorphine to see if I can reduce the cognitive gauziness while retaining the AD effect. I may have to go back and use Larry's brilliant eye-dropper dosing technique to get very small doses a couple times a day.
You have no idea how much better the world looks to me today than it did yesterday, even if I am a little more stupid now.
poster:pseudoname
thread:657263
URL: http://www.dr-bob.org/babble/20060610/msgs/657263.html