Posted by Deus_Abscondis on September 3, 2007, at 13:30:24
There has been some discussion on this board about antidepressant actions of opioids in particular buprenorphine.
Recently I had the opportunity to try a short course of oxycodone in the form of Oxycontin (10mg slow release) and Endone (5mg capsules).
It was a real eye opener.
I have long standing chronic pain and a long standing dysthymic/severe-major depression and generalised severe anxiety that can peak in agitated near psychotic states and have burned out on at least 4 occasions over the last 25 years - I'm 44 y.o.
I recently was diagnosed with ADHD, inattentive type and was prescribed dexamphetamine. It helps. I'm not convinced that my ADHD symptoms are 'primary' - hippocampal atrophy through prolonged stress may produce similar symptoms (?).
Anyway, oxycodone not only dissolved way my pain it also lifted my mood unlike any medication I have taken to date and this is in doses in 10-20mg range. I had expected the typical opioid mellow out effect (I received opioids for kidney stones in my early 20s and have used codeine/paracetamol). Rather than mellowing out I was surprised to feel stimulated. I have since found out that 'oxy' is known for this speedy quality although I haven't seen it written about in any research articles and have only heard about on two occasions (have you?). Nor was it simply 'speedyness' it melted away my brain fog and gave me a clarity of thought - more so than dex. The mood lift wasn't exactly euphoric more like a rosy outlook and a sense of inner robustness.
I've tried tricyclics and SSRIs. For the first two weeks of starting Prozac I felt energised and lifted (I was told this was a placebo effect as it takes at least 2 weeks to start working), this passed then it did very little except clamp my emotions (emotional blunting - this effected how I reacted to other people and badly interfered with a relationship I was in ). This clamping mixed with my apathy and melancholy and left me semi-zombie like and while helping me cope with a job finding another job was what I needed but never did at that time. Libido disappeared and erectile dysfunction worsened. I had to stop Prozac after several years of use as I developed 'out of the blue' a bad urticaria. My pdoc said it wasn't the prozac but it came and went on cessation and restarting prozac and I decided to quit it as it was doing more harm than good. I've tried Zoloft and Avanza to no effect. I haven't tried an MAOI or RIMA. With the treatment for this urticaria came another eye opener - this all happened before my oxycodone revelation. I was given the corticosteriod prednisolone.
Now I know the corticosteriods can cause mood swings. However, I was prescribed a ramped and tapered low dose regime. After taking the first dose my pain seemed to drain out of my body - even in places that I didn't think I had pain. I won't go into details about my pain but it is fibromyalgic - musculo-skeletal upper back and neck - that is consistent with osteoarthritic degeneration - there's more to it than that including these mysterious 'waves' where I feel like I've literally been poisoned. Not only did my pain subside I felt lifted - again unlike any anti-depressant I've ever taken. A physician put it down to the above mentioned mood swing that these drugs are known for. I'm not convinced and after reading about hypothalamic-pituitary-adrenal axis involvement in depression I am going to pursue some tests. I'm not prepared to take a corticosteriod on an ongoing basis as the side effects are probably too risky (?)
Anyway back to the opioids. Has anyone else with treatment resistant depression/dysthymia/ADHD ever tried oxycodone?
Do you think the effects I noticed are a typical 'high' associated with the drug?
Do you think that I would develop tolerance - even a low doses and that the psychogenic effects disappear? I used oxy for about a month and didn't notice any tolerance developing. I wonder if oxy has some nerve 'stabilising' effect. It intrigues me that I haven't developed a tolerance to dex.
Trying to get opioids prescribed for chronic pain in Australia is virtually impossible (even though there is good evidence to support their use - there are a few champions of this position but they are on the fringe and I have yet to find a doctor that would entertain the idea). If I mentioned the effects on my mood/ADHD I would almost certainly get laughed at and thrown out of the clinic. One doctor has refused to see me again simply for asking for opioid pain relief!
That there has been some research with buprenorphine and depression is encouraging but I wonder if the 'speedy' effect of oxycodone is working in my favour with attention problems or if simply not having pain interfere is allowing better attention.
In any case even if these medications are the only effective ones I've ever taken, and could allow me to have a functional life, I still don't think I could obtain them in Australia. Even if one medication helped me manage with pain and had the added benefit of fixing my depression/ADHD I doubt if I could find a compassionate doctor to even trial them. It is extremely frustrating as I feel like I'm running out of options and the prospect of 'surviving' is losing it's appeal
D
poster:Deus_Abscondis
thread:780553
URL: http://www.dr-bob.org/babble/20070831/msgs/780553.html