![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 20 to 44 of 62. Go back in thread:
Posted by dougb on March 31, 2001, at 12:00:23
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Mr. Scott on March 30, 2001, at 15:27:36
> Yes... See one of my doctors.. Last time I was in there he tried to get my to take MSContin (Morphine) or at the very least Vicodin..
>
> I don't know where your at (geography) but I understand Mass General has been trying a lot of this opiod depression stuff.Mr. Scott:
Thank you for your reply.Am in Texas, but if you would kindly give me your Dr.'s name and phone number, will contact.
Doug B
Posted by ShelliR on March 31, 2001, at 12:55:36
In reply to Re: ML Opiates and Treatment resistant Psychiatrists » Mr. Scott, posted by dougb on March 31, 2001, at 12:00:23
> > I don't know where your at (geography) but I understand Mass General has been trying a lot of this opiod depression stuff.
>
> Mr. Scott:
> Thank you for your reply.
>
> Am in Texas, but if you would kindly give me your Dr.'s name and phone number, will contact.
>
> Doug BDoug B, I'm completely confused. Are you also Mr. Scott?
Why would I give a stranger on the internet my Dr.'s name and number? I was interested in checking if there are studies on opiates at mass general. My post was directed to Mr. Scott. Why did you answer my post? You've completely lost me. ShelliR
Posted by Mr. Scott on April 1, 2001, at 11:30:28
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by ShelliR on March 30, 2001, at 21:04:47
> >
> > I don't know where your at (geography) but I understand Mass General has been trying a lot of this opiod depression stuff.
>
> Mr. Scott,
> Do you live in the Boston area? Do you know any more about exactly how mass general has been trying a lot "of this opiod depression stuff"? Are there controlled studies going on there? Thank you for any information. ShelliHi Shelli,
Actually No I live in Chicago. My Doc who is wishing to try Opioids told me that Mass General is the cutting edge facility working on the Opioid treatment of depression. I haven't even begun lokking into it yet, but When I find some info I will post.
mrscott
Posted by dougb on April 1, 2001, at 15:09:34
In reply to Re: ML Opiates and Treatment resistant Psychiatrists » dougb, posted by ShelliR on March 31, 2001, at 12:55:36
> Doug B, I'm completely confused. Are you also Mr. Scott?
No but there must be a good multiple personality joke here somewhere :-)
>
> Why would I give a stranger on the internet my Dr.'s name and number?
Of course you would not, there is a mix up here...
When i look back at the message thread, i see no message from me to you. Re-read the message in question and see if that does not clarify.As i am directing a message to you, you should see a subject line like this:
Re: Blah Blah > >SheliR
Sincerely
Doug B
Posted by Elizabeth on April 5, 2001, at 7:43:53
In reply to Re: ML Opiates and Treatment resistant Psychiatrists » Elizabeth, posted by ShelliR on March 30, 2001, at 21:00:29
> Hi Elizabeth. What is a delta antagonist? Also is buprenorphine "allowed" to be prescribed for depression? Thanks, Shelli
Hi Shelli. There are 3 different types of opioid receptors (that we know of at present, at least), named mu, kappa, and delta (there are also subtypes of these, e.g. mu-1 and mu-2, but let's not get into that). Activation of the mu receptor is responsible for most of the beneficial effects that opioids are known for. Kappa agonists (e.g., Stadol) also have some analgesic action, moreso for women than for men. The delta receptor may also have something to do with relieving pain, but it also seems to be involved in the development of tolerance. Most of the opioids currently marketed for pain are nonselective agonists at all three subtypes. There are a few exceptions, including buprenorphine (Buprenex), butorphanol (stadol), nalbuphine (Nubain), and pentazocine (Talwin).
Buprenorphine is officially labelled for pain, but it's perfectly legal for doctors to prescribe it for off-label uses including depression. (This applies in the U.S., other countries may have different rules.)
Posted by ShelliR on April 5, 2001, at 12:34:52
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Elizabeth on April 5, 2001, at 7:43:53
> > Hi Elizabeth. What is a delta antagonist? Also is buprenorphine "allowed" to be prescribed for depression? Thanks, Shelli
>
> Hi Shelli. There are 3 different types of opioid receptors (that we know of at present, at least), named mu, kappa, and delta (there are also subtypes of these, e.g. mu-1 and mu-2, but let's not get into that). Activation of the mu receptor is responsible for most of the beneficial effects that opioids are known for. Kappa agonists (e.g., Stadol) also have some analgesic action, moreso for women than for men. The delta receptor may also have something to do with relieving pain, but it also seems to be involved in the development of tolerance. Most of the opioids currently marketed for pain are nonselective agonists at all three subtypes. There are a few exceptions, including buprenorphine (Buprenex), butorphanol (stadol), nalbuphine (Nubain), and pentazocine (Talwin).
>
> Buprenorphine is officially labelled for pain, but it's perfectly legal for doctors to prescribe it for off-label uses including depression. (This applies in the U.S., other countries may have different rules.)Thanks Elizabeth for the information. I just went to a new pdoc yesterday and he approved my small amount to hydrocodeine (about 3.75mg per day). He says, however, he cannot prescribe it for me because you can not prescribe it for depression. Right now I am getting it from my gyn for premenstral pain.
When I read what you wrote I wondered if I should be talking about buprenorphine or some other form of opiate with my doctor. However, I don't believe he is much of a specialist in this and I am so grateful to find a pdoc who can accept that I take this, that I don't know if I want to push it any further.
Perhaps along the line it ought to be a neurologist I consult with? It seems the main reason you suggest not using codeine because of the higher risk of addiction which I have not experienced yet, after three years, but of course I cannot rule it out in the future. shelli
Posted by SLS on April 5, 2001, at 12:52:08
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Elizabeth on April 5, 2001, at 7:43:53
Hi Elizabeth.
It never ceases to amaze me the diversity of unconventional treatments appearing on Psycho-Babble. I started seeing a new doctor in September. Since he came highly recommended, I am hoping that he would be cognizant of and motivated to use some of these things. So far, he has not revealed any "exotic" treatments that he has alluded to. Right now, he is focusing on exploring a few combinations of standard antidepressants that I have not yet given a truly adequate trial. That's OK with me for now.
I told my doctor about the use of hydrocodone by people here and asked him how often it was used for depression, and if it exerted a true antidepressant effect. His answer was that he thought the perceived relief from depression using hydrocodone was a euphoriant effect no different from that which would be experienced by an otherwise healthy person.
I guess my question is this: Whose idea was it to try buprenorphine? If it was yours, how did you go about selling it to your doctor? Where did you get the idea from?
Thanks.
- Scott
Posted by Elizabeth on April 5, 2001, at 20:55:50
In reply to Re: ML Opiates and Treatment resistant Psychiatrists » Elizabeth, posted by ShelliR on April 5, 2001, at 12:34:52
> Thanks Elizabeth for the information. I just went to a new pdoc yesterday and he approved my small amount to hydrocodeine (about 3.75mg per day). He says, however, he cannot prescribe it for me because you can not prescribe it for depression. Right now I am getting it from my gyn for premenstral pain.
Hi. I think you probably mean either hydrocodone or dihydrocodeine, right? If your doctor is licensed in the U.S., I'm a little confused by his claim that he can't prescribe it for depression. He might not want to because it's an unusual use, but I don't know of any legal reason why he couldn't if he wanted to.
> When I read what you wrote I wondered if I should be talking about buprenorphine or some other form of opiate with my doctor. However, I don't believe he is much of a specialist in this and I am so grateful to find a pdoc who can accept that I take this, that I don't know if I want to push it any further.
I know, I sort of feel the same way, like I don't have a right to ask my doctor about alternatives to buprenorphine because he is already doing me a favour by prescribing that. This isn't true, of course -- we should feel like we can speak to our doctors freely, right? -- but it still feels awkward. (Personally I think the government shouldn't interfere so much with doctors' ability to make medical decisions.)
> Perhaps along the line it ought to be a neurologist I consult with? It seems the main reason you suggest not using codeine because of the higher risk of addiction which I have not experienced yet, after three years, but of course I cannot rule it out in the future. shelli
A neurologist won't treat depression (except maybe if it's related to a problem, such as epilepsy or stroke, that the neurologist is already treating), and almost certainly won't be willing to use unconventional treatments. The ideal person to see would be a pdoc who has experience with opiates (using them to treat patients, that is!). The only other thing I can think of would be maybe a pain specialist, since they tend to have more experience prescribing opiates than psychiatrists do.
I really don't think using opiates is the best way to treat depression at all, if you can find anything else that works, but I've tried all the standard things and then some and there just doesn't seem to be any alternative (except ECT, but I very much prefer to avoid that).
Posted by Elizabeth on April 5, 2001, at 21:23:17
In reply to Re: ML Opiates and Treatment resistant Psychiatrists » Elizabeth, posted by SLS on April 5, 2001, at 12:52:08
> It never ceases to amaze me the diversity of unconventional treatments appearing on Psycho-Babble.
Well, this isn't so unconventional. Opiates are really the first drugs that were used as ADs, dating back to ancient times.
> I started seeing a new doctor in September. Since he came highly recommended, I am hoping that he would be cognizant of and motivated to use some of these things. So far, he has not revealed any "exotic" treatments that he has alluded to.
I hope that if he does give you more of an idea of what he considers "exotic," you'll share his ideas with us!
> Right now, he is focusing on exploring a few combinations of standard antidepressants that I have not yet given a truly adequate trial. That's OK with me for now.
That's good. It makes sense for him to want to do that, and it also gives him a chance to get to know you. A doctor is more likely to feel comfortable prescribing controlled substances to a patient he knows pretty well.
> I told my doctor about the use of hydrocodone by people here and asked him how often it was used for depression, and if it exerted a true antidepressant effect. His answer was that he thought the perceived relief from depression using hydrocodone was a euphoriant effect no different from that which would be experienced by an otherwise healthy person.
I agree with part of what he's saying. Morphine and other opioid agonists are mood-elevating drugs, and they have this effect on nondepressed and depressed people alike. (They don't do it for everybody, BTW, so don't expect miracles.)
But as for the "euphoriant" part, I don't take a high enough dose to produce euphoria (if that's even possible with buprenorphine, something that's disputed). It doesn't feel like getting high, nor am I tempted to take more in order to try to get high.
I also think that some depressed people probably have problems that are particularly responsive to opiates and less responsive to monoaminergic ADs. One explanation might be a deficit of endogenous opioids (I have no doubt that this is oversimplified, if not outright wrong). Anyway, this is based on my own experience.
> I guess my question is this: Whose idea was it to try buprenorphine? If it was yours, how did you go about selling it to your doctor? Where did you get the idea from?
My pdoc isn't a specialist in psychopharmacology (he's actually a psychoanalyst), although I think he's still better than most psychopharmacologists < g >. So at one point, when it became clear that Nardil had stopped working, he sent me to a specialist, someone he knew from residency. The specialist happens to be a researcher who focuses on novel treatments for depression, and buprenorphine was one of the treatments he had experimented with (1). He mentioned it as a possibility because of some of the things I said about my symptoms, but he felt at the time that it would be worthwhile to try MAOIs again or consider tricyclics (which I've never been able to tolerate very well). Anyway, eventually my pdoc and I came to a point where I was doing having trouble functioning on a day-to-day basis and nothing seemed to be helping, so we decided to try buprenorphine. It appealed to me in particular because I was pretty sure it would work (based on past experiences with hydrocodone from my dentist I knew that I'm one of the people who feel better on opiates -- as I said, not everybody does), and it was something that would work pretty much immediately (it takes an hour rather than a month).
(1) Bodkin et al. Buprenorphine treatment of refractory depression. _Journal of Clinical Psychopharmacology_ 1995 Feb; 15(1):49-57.
Posted by SLS on April 6, 2001, at 8:08:38
In reply to opiates -- Scott, posted by Elizabeth on April 5, 2001, at 21:23:17
Elizabeth,
Thanks for taking the time to respond. You have cleared up quite a bit for
me. I am much more comfortable with the approach my doctor is taking. That
means a lot.Thanks again.
- Scott
> > I guess my question is this: Whose idea was it to try buprenorphine?
If it was yours, how did you go about selling it to your doctor? Where did
you get the idea from?> My pdoc isn't a specialist in psychopharmacology (he's actually a
psychoanalyst), although I think he's still better than most
psychopharmacologists < g >. So at one point, when it became clear that
Nardil had stopped working, he sent me to a specialist, someone he knew
from residency. The specialist happens to be a researcher who focuses on
novel treatments for depression, and buprenorphine was one of the
treatments he had experimented with (1). He mentioned it as a possibility
because of some of the things I said about my symptoms, but he felt at the
time that it would be worthwhile to try MAOIs again or consider tricyclics
(which I've never been able to tolerate very well). Anyway, eventually my
pdoc and I came to a point where I was doing having trouble functioning on
a day-to-day basis and nothing seemed to be helping, so we decided to try
buprenorphine. It appealed to me in particular because I was pretty sure
it would work (based on past experiences with hydrocodone from my dentist
I knew that I'm one of the people who feel better on opiates -- as I said,
not everybody does), and it was something that would work pretty much
immediately (it takes an hour rather than a month).> (1) Bodkin et al. Buprenorphine treatment of refractory depression.
_Journal of Clinical Psychopharmacology_ 1995 Feb; 15(1):49-57.
Posted by dougb on April 6, 2001, at 16:14:15
In reply to opiates -- Shelli, posted by Elizabeth on April 5, 2001, at 20:55:50
> > approved my small amount to hydrocodeine (about 3.75mg per day).
Be carful that it does not come with a secondary analgesic that might have unwanted side effects.
One of the common combinations is Hydrocodone with acetaminophen.
Acetaminophen (Tylenol)is not good stuff to be taking for extended durations or elevated quantities where it is considered as poisonous:
http://www.lef.org/protocols/prtcl-001.shtml
> -- we should feel like we can speak to our doctors freely, right? -- but it still feels awkward.If your use is legitimate, why? Hydrocodone, according to RXlist.com is the fifth most prescribed rx in the country:
If you still feel squeemish about the subject, check out this page and it's excellent links for lots of good info and tips on dealing with your Dr.:
http://www.widomaker.com/~skipb/2ThePatient.html
It worked for me! My GP prescribed the Hydrocodone as requested.He brought up the subject of dependence, and i pointed out how I am already quite dependent on several AD's but am not really being helped by them
An $18.00 prescription is doing a lot more for me than hundreds for the Zoloft/Remeron/Atavan mix.
The treatment of choice for Depression since Hippocrates up until the 1950's has been one of the opiate class of drugs:
The Therapist/webmaster for the above site has some unorthodox points of view - maybe s\he is just ahead of her time.
> I really don't think using opiates is the best way to treat depression at all,
What is your unhappiness with your outside of the frequent dosing, you mentioned?
Doug B
Posted by ShelliR on April 6, 2001, at 18:49:31
In reply to Re: opiates -- Shelli » Elizabeth, posted by dougb on April 6, 2001, at 16:14:15
Doug and Elizabeth. Thanks so much for the information and support about taking opiates for depression.
Elizabeth, I very much agree that opiates are not the best choice for an antidepressant for most people.
I came to this board about a year ago, specifically asking about opiates because they seemed to be the only thing that relieved by depression at that point. I had taken them for two years without any increase. I had had a very successful run with nardil for many years, but finally last year, back to the depths again.
I had made the connection between opiates and lack of depression when I was given some for a muscle spasm in the center of my stomach, which took a while to be diagnosed as nothing internal. (Then a simple shot with a tiny bit of cortizone got rid of the pain).
In the last few years the combination of nardil and lamictal did work for me, but this last time I gained 15 lbs on the lamictal. (All while doing the treadmill,
weights, and watching my diet. And I lost it all within two weeks of going off of lamictal).It's was hard for my therapist or my pdoc to understand why being overweight was so awful to me. I am also diagnosed with a dissociative disorder, and things
to me do not always look like they do to other people, and I was developing a real adversion to my body.I think I tried about fifteen different combinations of nardil with something else, until I just refused to try anything else. I lost a lot of time this year to sleeping and
feeling disoriented and I felt enough!So I am extremely grateful to both of you for sharing that you also take opiates and it is approved by your doctors. Elizabeth, I did pick up along the way, that as
you said, not everyone has the same positive reaction to opiates and also there is a threshold over which I will feel nausea, instead of feeling good--normal.
Hydocodene can make me a bit high if I take too much, but so does alcohol, and yet I choose in general not to drink or overtake hydrocodone because I'd rather
be more grounded than high.Incidently, I also had a differerent reaction to valium than many people. It totally grounds me--I could be totally floating and not feeling my body from being
dissociative and I could always count on valium to bring me back. Friends of mine without dissociative disorders have the opposite reaction--it makes them sort of
spacey. Now valium also has a bad rap and doctors want to give me klonpin instead, but it doesn't have the same grounding effect for me.About doctors prescribing opiates: My gyn said that in the list of doctors that lose their licenses, the greatest number lose it due to overprescribing opiates. She
said doctors are very carefully watched re opiate prescriptions. She said she would be more comfortable giving me tylenal 3, but I really pushed for straight hydrocodone.She is a very down to earth woman and a really good doctor, so I am confused to have both of you say that there is no problem for doctors to prescribe optiates for depression.
Anyway, thanks for letting me go off, and thanks to both of you for your support and information.
Shelli
Posted by judy1 on April 6, 2001, at 21:05:20
In reply to Re: opiates Elizabeth, Doug- Long (Too long!), posted by ShelliR on April 6, 2001, at 18:49:31
Hi Shelli,
I'm happy to see the support you've gotten for your use of an opiate for an AD. I think I've mentioned my pdoc is willing to prescribe 'small amounts' as an AD or anxiety med- but he is most definitely in the minority. I also agree that people react differently to it, I was interested to read you have a dissociative disorder (like me) and I also respond well to hydrocodone. Just an aside, I get Norco 10/325 to keep the level of APAP down. While I agree with one of the posters that lying about pain isn't really a decent thing to do, I feel depression is a lot worse. take care, judy
Posted by ShelliR on April 6, 2001, at 22:23:06
In reply to Re: opiates Elizabeth, Doug- Long (Too long!) » ShelliR, posted by judy1 on April 6, 2001, at 21:05:20
< I get Norco 10/325 to keep the level of APAP down.Judy, what is APAP?
By the way, how are you doing? I remember you were getting involved in a new program, but I don't remember the name. Then recently you've been talking about staying out of the hospital. Did the program you were talking about not pan out? Are you feeling more stable? shelli
Posted by dougb on April 7, 2001, at 14:05:06
In reply to Re: opiates Elizabeth, Doug- Long (Too long!), posted by ShelliR on April 6, 2001, at 18:49:31
>
so I am confused to have both of you say that there is no problem for doctors to prescribe optiates for depression.Don't recall saying that there was no problem, like your gyn pointed out - there is a problem for her, there is also a possibility of dependency or worse, depending on pre-disposition and peresonal discipline.
Let us know how you are getting on with the Hydro
Doug B
Posted by judy1 on April 8, 2001, at 14:42:27
In reply to Re: opiates » judy1, posted by ShelliR on April 6, 2001, at 22:23:06
Hi Shelli,
Thank you for asking about me. APAP refers to acetaminophen which can cause liver damage if taken in excess. While vicodin has 500mg in each tab- if you take 2 every 4 hours (which is common) then you are pushing the envelope by ingesting 4 grams of acetominphen a day. It's not the hydrocodone that's the problem. The pharmaceutical companies do this because when a narcotic is in combo with another non-opiate analgesic it doesn't fall in the category where a triplicate has to be filled to prescribe. But it sounds like you are using such small doses, this doesn't apply to you. I did enter the STEP-BD program, but have not been consistant- probably due to the depression and SI going on. I'm pretty much relying on my therp. I hope you are well- judy
Posted by dougb on April 9, 2001, at 11:34:18
In reply to Re: opiates » judy1, posted by ShelliR on April 6, 2001, at 22:23:06
>
> < I get Norco 10/325 to keep the level of APAP down.
>
> Judy, what is APAP?
>Here is a good link, if you want more info:
http://www.lef.org/protocols/prtcl-001.shtml
Posted by ShelliR on April 9, 2001, at 13:13:34
In reply to Re: opiates » ShelliR, posted by dougb on April 9, 2001, at 11:34:18
> >
> > < I get Norco 10/325 to keep the level of APAP down.
> >
> > Judy, what is APAP?
> >
>
> Here is a good link, if you want more info:
> http://www.lef.org/protocols/prtcl-001.shtml
Doug, Thanks. It's a good link. Right now I'm taking a 1/2 pill maximum (3.75mg) of hydrocodone daily, so I don't think I have to worry at this point. But it's always good to have the information, especially about ways to counteract possible liver damage if I ever have to take a lot of Tylenol. Shelli
Posted by dougb on April 10, 2001, at 12:33:03
In reply to Re: opiates » dougb, posted by ShelliR on April 9, 2001, at 13:13:34
>Right now I'm taking a 1/2 pill maximum (3.75mg) of hydrocodone daily,
Are you gettting relief at this level of Hydro?
After 5 mo I'm up to 4-6 pills of Hydrocodone/APAP 5/500 (6'4", 340lb is probably a factor as well)
Just stepped up from 2-3 pills/day, which had pretty much pooped-out. I was very happy when the increased dosage started working again. Have seen so many meds work great for a while and then sliding back
Doug
Posted by ShelliR on April 10, 2001, at 13:01:24
In reply to Re: opiates » ShelliR, posted by dougb on April 10, 2001, at 12:33:03
> After 5 mo I'm up to 4-6 pills of Hydrocodone/APAP 5/500 (6'4", 340lb is probably a factor as well)
>
> Just stepped up from 2-3 pills/day, which had pretty much pooped-out. I was very happy when the increased dosage started working again. Have seen so many meds work great for a while and then sliding back
>
> DougDoug, when you first wrote you said,
< I have not abused this opiate, indeed
just one capsule was lasting me 2-4 days
as i was cutting it up into quarters..That was only a few weeks ago.
If I understand you correctly, you have increased your dose by almost 24x in just two weeks?
That is not at all good. Do you realize how much you are taking a day? Then when that is ineffective, you need to increase. You're developing tolerance and unless you stop you will just continue to keep going up. You mention your height and weight, yet a quarter pill was sufficient at the beginning, so this doesn't have to do with body type. This has to do with tolerance. Sorry, but I think you're looking at an addiction, Doug. (Can't you see that by the amount you're increasing?)
Yes, 3.75 mg is enough for me, and I don't take it every day. If I found myself going up past 7.5 mg per day, that would be it for me. I think my body chemistry is unusual (although not unique) in being able to stay at a low dose of codiene.Doug, I think you really need to find a good psychopharmacologist and get yourself to taper off the hydrocodone and on to an antidepressant and mood stablizer.
Do it soon. Your post really scares me because you don't seem to realize what is happening.
Shelli
Posted by ShelliR on April 10, 2001, at 13:11:00
In reply to Re: opiates » dougb, posted by ShelliR on April 10, 2001, at 13:01:24
p.s. Doug, I just looked though this thread and realized that it you who wrote about the hell of addition (heroin, I believe)? Is this for real? Are you really getting yourself immersed in an addiction again? Is your post a serious post? You wrote on March 30, "and now the ugly side." I'm really confused. Shelli
Posted by judy1 on April 10, 2001, at 18:44:09
In reply to Re: opiates » dougb, posted by ShelliR on April 10, 2001, at 13:01:24
Shelli,
You seem to be one of those patients that my pdoc tells me about- the ones he prescribes 1 10mg hydro pill/day and they take 1/2 in the am and the other in the pm. Apparently this has helped their primary complaint of treatment resistant panic/anxiety with secondary depression. Unfortunately my usage parallels Doug's, the development of tolerance (and at 130 pounds, I can't claim a weight factor here). I wonder if that is probably the more normal path of people who use opiates in treatment-resistant depression, but I imagine it's who you talk to. For my pdoc, I'm not the norm, for those specializing in substance abuse I probably am. In standard pain prescriptions, the dose is 1-2 (10mg hydo) every 4 hours, Doug certainly seems to be in that range. The euphoric feeling wears off quickly, if you chase that, I think that's when you get into trouble. I spent a year on ms contin (morphine) after a car accident, taking close to 200mg/day and was able to taper off under a doc's supervision (and that is a much, much more powerful drug), and while not exactly comfortable, it was outpatient and have had much worse experiences with other psychotropics. I didn't intend to get this detailed, I guess I don't see Doug in trouble (yet?) and hope he is honest with his pdoc. Take care, judy
Posted by ShelliR on April 10, 2001, at 22:14:39
In reply to Re: opiates » ShelliR, posted by judy1 on April 10, 2001, at 18:44:09
> In standard pain prescriptions, the dose is 1-2 (10mg hydo) every 4 hours, Doug certainly seems to be in that range..... I guess I don't see Doug in trouble (yet?) and hope he is honest with his pdoc. Take care, judy <
Judy, 1-2 every four hours may be the standard dose for pain, but unless I misunderstood, Doug is using it for his depression, not for pain now. I'm going to have to disagree with you; I think Doug, if not presently in trouble, is headed straight for trouble, especially with a history of addiction. To increase so fast in such a short of time is a sure sign of tolerance and dependence.
I think every individual reacts differently to drugs, and I think I understand now why my doctors were so concerned that I was taking hydocodone for depression. I got quite a shock when after two weeks ago saying he was taking 1/4 pill, Doug is up to five or six pills a day. Still, I will continue to take it, unless, as I said in my previous post, I start the pattern of going up. I also just started neuotin and am doing the omega 3 thing, so I am feeling more optimistic than I have in a long time, aside from the "permission" to use hydrocodone from my new psychiatrist.
I'm sorry Doug, I do think you are in (or headed for) trouble and I hope you take Judy's advice and talk to your doctor.
shelli
Posted by Elizabeth on April 11, 2001, at 9:36:09
In reply to Re: opiates » dougb, posted by ShelliR on April 10, 2001, at 13:01:24
> That is not at all good. Do you realize how much you are taking a day? Then when that is ineffective, you need to increase. You're developing tolerance and unless you stop you will just continue to keep going up. You mention your height and weight, yet a quarter pill was sufficient at the beginning, so this doesn't have to do with body type. This has to do with tolerance. Sorry, but I think you're looking at an addiction, Doug. (Can't you see that by the amount you're increasing?)
This is a common misunderstanding. Most pain patients who take opiates for any length of time will have to increase the dose. Different people develop tolerance at different rates. Some people who take opiates for depression (even full agonists, like hydrocodone, oxycodone, or morphine) do not have to raise the dose at all. But anyway, tolerance alone does not mean that a person is addicted. Addiction refers to compulsive drug use that results from intense psychological craving. It has little to do with the particular drug being used (although some drugs are much more addicting than others).
I didn't mean to say that there is no problem at all with prescribing opiates or that doctors will (or should) be willing to prescribe them for any patient, but rather that it is okay in some circumstances. Your doctor has to be comfortable with it, obviously. In my experience,
most doctors who are familiar with the use of opiates for depression are comfortable prescribing them in certain cases when people have severe depression and haven't responded to standard ADs.
Posted by dougb on April 11, 2001, at 13:03:26
In reply to Re: opiates » ShelliR, posted by Elizabeth on April 11, 2001, at 9:36:09
> > That is not at all good. Do you realize how much you are taking a day?
Elizabeth:
Thank you for your kind interest.The amount of codeine I'm taking currently is the perscription amount (for pain).
Has my body built up tolerance for codeine, yes, but I expected this.
My body has also built up a tolerance for Zoloft. There was a time when all my problems were solved (more or less) with a 50MG dose per day. Was up to 300MG. + a healthy dose of Remeron.
And i STILL felt like @#@#@!, the only thing that kept me from stopping these meds was that, that made me feel even _worse_.
That little 5 year 'experiment in Psychopharmacology' had ruined my life.
I fully admit that I am becomming dependent on the drug. That was a conscious decision.
But I have been dependent on AD's for years, and THEY DO NOT WORK. If you doubt that look all around you on this board, if they worked (or at least worked for us, here) most of us would not be here.
Morphine was commonly prescribed for alcoholism in this country at one time. And here was their rational:
Alcoholics, beat their wives, and engaged in all kinds of
self-destructive behavior resulting in broken homes, jail-time
etc etc.
So those chronic alcholics were treated with morphine and
Families were functional again, people went back to work and
stayed out of trouble....I do not intend to become addicted, but even a strong dependence on what for me has been practically a miricle drug, is far preferrable to a non-productive depressed existance.
I am working again, with enthusiasm and zeal. I have been in my little home office every day for months now, working on as many as 3 computer projects at a time!
I am spending quality moments with my family. They all tell me, that I am much better.
Addiction-dependence-tolerance are just words, I am not afraid of those words, I am only afraid of going back to where I was.....
Sincerely
Doug B
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