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Dr. Bob is Robert Hsiung, MD,
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Posted by Declan on February 22, 2007, at 17:51:40
In reply to Re: opiates for depression » Quintal, posted by FredPotter on February 21, 2007, at 22:10:02
Can tough love be far behind?
Posted by Declan on February 22, 2007, at 18:38:42
In reply to Re: opiates for depression, posted by kelv on February 21, 2007, at 23:35:07
I had a long term opiate addiction and stopped.
I also use an AD, even though it may not be quite a real one (bit suss, these psychotonics).Any treatment that comes anywhere near euphoria (suffering we can take for granted) will stir up feelings, but it isn't neccessary to have an emotional investment in the subject.
Posted by Phillipa on February 22, 2007, at 19:39:32
In reply to Re: opiates for depression, posted by flmm on February 21, 2007, at 21:11:37
flmm I broke my arm and was given percocet for pain. I only took one at night for the pain. But my husband noticed right away that I was laughing during the day and haven't in years. If I could get a scrip for percocet I'd take l nightly and feel good during the day. Was never high. I hate that feeling just want to relax and be me which I was when taking. Love Phillipa
Posted by Quintal on February 22, 2007, at 20:15:34
In reply to Re: opiates for depression, posted by linkadge on February 21, 2007, at 20:58:11
>Caffiene is an example of a stimulant drug which increases dopamine release much more in the frontal cortex than in the neucleus accumbens. While caffine is not patentable, it is probably the number one choice for ADHD for a number of undiagnosed.
Caffeine seems to mostly increase alertness and still isn't as effective as amphetamines though and it is less well tolerated at doses needed to have the desired effects; most people with ADHD seem to prefer amphetamines. Caffeine doesn't seem to be an impressive treatment for ADHD in spiders(!): http://en.wikipedia.org/wiki/Image:Caffeinated_spiderwebs.jpg
>Thats probably because straterra doesn't increase frontal cortex dopamine as much as it does frontal cortex noradrenaline. This drug doesn't make a lot of sense for ADHD since a number of studies indicate noradrenaline is hyperactive compared to dopamine in ADHD. (but thats beside the point)
That is the point I'm getting at link. This drug does make sense in theory because there have also been a number of studies that indicate a deficit in the nordrenergic systems of people with ADHD. Just as with dopamine, according to my textbook, there has been a noradrenaline deficit hypothesis in ADHD (it seems) whenever it has been convenient to market a new drug that operates via that mechanism.
>For starters we only really have Straterra, which as I mentioned above doesn't really increase frontal cortex dopamine so I wouldn't even use it as a comparitor.
That's the whole point I'm getting at link; you can increase attention span with drugs that act on neurotransmitters other than dopamine, yet they don't seem to be as good for treating the overall problem.
>Another consideration is that ADHD drugs can continue to work, long after the subjective high has subsided. Kids who take ritalin for years, are unlikely to be getting any buzz from it, but it still helps their attention.
You can say the same thing about benzos and point to people who have been taking them for decades and feel they are helping their anxiety long after the initial sedation and euphoria have faded. That might be true for some, but as studies suggest (in benzos for example), most are receiving little real benefit from the drugs at that point (hard though it is for them to believe). They have little more than placebo brought on by conditioning. I think a lot depends on the rate at which each person develops tolerance. For some it's rapid and the anxiety slaps them in the face and they have no choice but to admit the drug is no longer working. For others I suspect it's more insidious, creeping up over the years so gradually that they have time to adjust and develop coping mechanisms. In effect they've gradually withdrawn from the drug in the therapeutic sense, in that it is doing little to help the original problem, yet they are still dependent on it, but mostly to maintain equilibrium.
>Another argument that I would make is that many people who are trying drugs like strattera have already been primed to the reward of ritalin. As such, they are unlikely to find other drugs as effective.
Why would such drugs be any less effective for ADHD if the reward systems played no part in the therapeutic response? I seem to have put myself in the position of defending the 'ADHD drugs get you high' camp, which wasn't the intention I began with. I posted those comments about amphetamines because here in the UK you would certainly not be prescribed a stimulant for depression because tolerance to those effects develop quickly and they are notorious for precipitating particularly severe depressions on withdrawal. For those reasons amphetimes are considered inappropriate for treating depression here, and I'm inclined to agree. It seems unwise to give such drugs to people already prone to depression and mood swings for the risk of exacerbating the problem in the long run, whatever the temporary gain.
I was hoping to add some perspective on flmm's comments about opiates by highlighting the fact that some people here have been prescribed amphetamines for this purpose and no such objections are raised to this as they are with opiates. I've also noticed some people with chronic depression deciding that because they have poor concentration and trouble organising themselves they must have ADHD, and therefore need stims to treat this newly discovered co-morbid disorder. That seems a little dubious to me, hence my comments.
Q
Posted by FredPotter on February 22, 2007, at 21:29:28
In reply to Re: opiates for depression, posted by Quintal on February 22, 2007, at 20:15:34
Quintal thanks for your observations on benzos. I was very reluctant to admit that the Xanax I'd been taking for years (and benzos in general for 42 years) wasn't working anymore. But not so long ago I surprised myself by saying to the Dr that "I believe they work, that's the point". My general anxiety isn't abated but as I haven't had a panic attack for years I believe it's because Xanax makes them impossible. But maybe I've just grown out panic attacks.
The truth can never hurt you, they say. Perhaps it can if you're undermining a robust placebo response
Fred
Posted by flmm on February 22, 2007, at 21:43:41
In reply to Re: opiates for depression » flmm, posted by kelv on February 22, 2007, at 0:26:34
Hey Kelv, that's quite an impressive list! I won't bother showing you mine. Needless to say, I have a little experience myself. Funny how niave you are, despite your impressive resume.......
Posted by Quintal on February 22, 2007, at 21:44:07
In reply to Re: opiates for depression » Quintal, posted by FredPotter on February 22, 2007, at 21:29:28
Thank you Fred. I don't want to spark another heated benzo debate, or go down that particular path right now. I was using the example of benzo tolerance because it's the one I'm most familiar with, but that might not apply to amphetamines. I don't know, but it might. I think it's possible.
Q
Posted by mattye on February 23, 2007, at 0:40:08
In reply to opiates for depression, posted by pearlcat on February 19, 2007, at 13:52:09
Yeah nothing works better than opiates! LOL! But that is exactly the problem. As a seasoned opiate abuser, I can say from experience that using potent opiates for depression is just wishful thinking. I don't know about bupe... but take any opiate for awhile and you will have withdrawls and depression.
I have developed a permanant tolerance to opiates. Even when I haven't done any opiates in months, it still takes about 10 percocets on an empty stomach to get me high. I barely feel hydrocodone anymore (that's Vicodin).
Seriously, though, don't take opiates unless you absolutely have to. They are addictive - especially for depressed people. I have a lifelong addiction to these drugs that I have only been abstain from for a few years at a time. They always come back to haunt me, especially when I relapse on my depression / anxiety. I have been clean from heroin for a long time, but I don't think I will ever be able to kick the pills. They do come in handy if I am in a deep black depression. Rips me right out but dumps me right back when the high wears off.
> Has anyone experienced that opiates seemed to help with depression,anxiety and add? I know it sounds crazy but it is true . I feel more motivated on these . I guess that is why they are addictive. Yet you cannot get them easily. But you can get crap like lamictal and effexor that can really screw you up! Too bad you cant get them on the internet!
Posted by yxibow on February 23, 2007, at 0:47:44
In reply to Re: opiates for depression » flmm, posted by Phillipa on February 22, 2007, at 19:39:32
> flmm I broke my arm and was given percocet for pain. I only took one at night for the pain. But my husband noticed right away that I was laughing during the day and haven't in years. If I could get a scrip for percocet I'd take l nightly and feel good during the day. Was never high. I hate that feeling just want to relax and be me which I was when taking. Love Phillipa
If you want to relax and be you, I'd suggest an occasional use of Kava. And no dime store version, one that actually lists kavalactone quantities on it because these things vary wildly. Yes, there are liver questions about it but if you use it like once or twice a week, its nothing more than Xanax but somewhat different. Don't take it with alcohol.
Posted by Declan on February 23, 2007, at 1:47:33
In reply to Re: I'm an addict, posted by mattye on February 23, 2007, at 0:40:08
Declan
Themeanreds
Quintalbut not Mattye.
Is that right?
Posted by Declan on February 23, 2007, at 1:55:51
In reply to Who is in denial?, posted by Declan on February 23, 2007, at 1:47:33
What about pearlcat? He sounded like he was in denial.
What about you Fred? Do you think you're in denial?
I take it as read that flmm is not.
How about Yxie?
What about you, PJ?
Posted by Declan on February 23, 2007, at 2:00:57
In reply to opiates for depression, posted by pearlcat on February 19, 2007, at 13:52:09
the people I've forgotten. This is a long thread.
Posted by Quintal on February 23, 2007, at 2:25:48
In reply to Who is in denial?, posted by Declan on February 23, 2007, at 1:47:33
>Seriously, though, don't take opiates unless you absolutely have to. They are addictive - especially for depressed people. I have a lifelong addiction to these drugs that I have only been abstain >from for a few years at a time. They always come back to haunt me, especially when I relapse on my depression / anxiety. I have been clean from heroin for a long time, but I don't think I will >ever be able to kick the pills. They do come in handy if I am in a deep black depression. Rips me right out but dumps me right back when the high wears off.
Everything in that paragraph suggests opiates are acting as reliable and powerful antidepressants, so where is the wishful thinking? In that tolerance will very likely develop and depression will return with a vengeance? In truth this is a very likely outcome with any conventional antidepressant. Everyone who has got to the point of considering an opiate will have experienced this already with conventional antidepressants. All of your pessimistic assertions apply equally to benzos, and as I said earlier in the thread, amphetamines. It seems to me that it is more the 'narcotic' label that colors our perception of what happens when opiates are used to treat depression.
There are augmentation strategies that can be used, as well as other drugs that limit, slow down, or prevent tolerance such as lamotrigine that can be taken concomitantly in the hope of prolonging the antidepressant response.
I'm not sure what it is I'm accused of being in denial of.
Q
Posted by yxibow on February 23, 2007, at 2:53:54
In reply to Hang on, posted by Declan on February 23, 2007, at 1:55:51
> What about pearlcat? He sounded like he was in denial.
>
> What about you Fred? Do you think you're in denial?
>
> I take it as read that flmm is not.
>
> How about Yxie?
>
> What about you, PJ?I'm not quite sure what I'm in denial of.
I have psychiatric pain that could use an occasional low grade opiate, possibly.
I take a fair amount of Valium for a rare Somatiform disorder and I don't trip the light fantastic on it. Its a necessary evil.There's nothing wrong with euphoria. Some psychiatrists associate it with abuse. And indeed abuse can be the pursuit of euphoria. But euphoria is not the pursuit of abuse. They're not opposing states.
For thousands of years we have pursued euphoria, discovering that spoiled grain and other compounds made us giddy. We brewed beer-like substances time immmemorial. And then religion came in and said, no. And then views changed again. And then modern times came, with prohibition and the like (US). And now its legal again, but regulated, and religion steps in, in some countries and areas to make things "dry". Alcohol. CH3COOH.
Other substances were discovered too, in ancient times, now many placed under the Controlled Substances Act C-I, because some of them are indeed quite dangerous in quantities.
But euphoria can also just be something very simple. The opposite of our pains, our depression. That in itself would be elating enough for me.
Posted by TheMeanReds on February 23, 2007, at 10:47:30
In reply to Re: Hang on » Declan, posted by yxibow on February 23, 2007, at 2:53:54
I think everyone would be on heroin, if it were still legal, if they 'kept' their dose very low, every day. But that doesnt seem to be the case. History has shown we are at the will of our 'hedonistic impairitive'.
Posted by mattye on February 23, 2007, at 12:53:05
In reply to Re: Who is in denial?, posted by Quintal on February 23, 2007, at 2:25:48
Good point Quintal,
I have actually been able to manage my opiate intake. Mostly because they are expensive and I refuse to do heroin anymore (which is much cheaper than pills. For pills, you are paying for guaranteed purity and dosage. Heroin is waaay too extreme and unpredictable).
I am sure they would be a more effective anti-depressant if I took them therepeutically instead of a means to get high. And actually, for me at least, coming off opiates usually makes me a little cranky, but they have never left me feeling more depressed than I was before I took them.
The reason I don't do stims (coke, speed, adderall) is that the high is too harsh and the comedown is HORRIBLE. I have never felt worse than when I have come down from these drugs. I find it interesting that some addicts have the exact opposite reaction. My theory is that my brain is probably overwired and overstimulated and overstressed to begin with I seek drugs that calm it down. People who seek out stimulants usually are looking for the thrill or rush.
You mentioned benzos too . . . which interestingly I do not find addictive at all and it is impossible to explain this to any doctor who knows my history. Klonopin is very effective for my anxiety and it does not get me high . . . just sleepy if I take too much. In fact, I just came off of it after taking it a month straight and I had no withdrawls or cravings. I think having a month free from anxiety allows me to confront situations that would normally freak me out. My brain learns how to deal with them without the stress and whatnot. When I am back in the situation and off the benzos . . . I have "learned" the more sane way to deal with the situation.
I wonder if the same theory would apply for opiates. Like an aggressive 2 week treatment with opiates to pull the patient out of severe depression while the SSRIs get a chance to stabilize. During people's opiate treatment, they could get aggressive therapy. The opiates would allow the person to open up and talk about the things distressing them . . . thereby processing through the negative thought cycle that feeds the depression and anxiety.
Makes me wonder why opiates and benzos are so controlled while they hand out adderall and ritalin like tic tacs to little kids. Weird. I believe it is our capitalistic culture which is more comfortable with people being focused and productive instead of mellow and subdued.
Matty
> >Seriously, though, don't take opiates unless you absolutely have to. They are addictive - especially for depressed people. I have a lifelong addiction to these drugs that I have only been abstain >from for a few years at a time. They always come back to haunt me, especially when I relapse on my depression / anxiety. I have been clean from heroin for a long time, but I don't think I will >ever be able to kick the pills. They do come in handy if I am in a deep black depression. Rips me right out but dumps me right back when the high wears off.
>
> Everything in that paragraph suggests opiates are acting as reliable and powerful antidepressants, so where is the wishful thinking? In that tolerance will very likely develop and depression will return with a vengeance? In truth this is a very likely outcome with any conventional antidepressant. Everyone who has got to the point of considering an opiate will have experienced this already with conventional antidepressants. All of your pessimistic assertions apply equally to benzos, and as I said earlier in the thread, amphetamines. It seems to me that it is more the 'narcotic' label that colors our perception of what happens when opiates are used to treat depression.
>
> There are augmentation strategies that can be used, as well as other drugs that limit, slow down, or prevent tolerance such as lamotrigine that can be taken concomitantly in the hope of prolonging the antidepressant response.
>
> I'm not sure what it is I'm accused of being in denial of.
>
> Q
Posted by mattye on February 23, 2007, at 13:01:27
In reply to Who is in denial?, posted by Declan on February 23, 2007, at 1:47:33
Not sure what you meant by this. I never said anyone was in denial. I am in no position to judge if someone is in denial, nor do I care. I probably am in denial to some extent myself, but I don't care about that either. You need a certain amount of denial to make it through life. Im no exception.
> Declan
> Themeanreds
> Quintal
>
> but not Mattye.
>
> Is that right?
Posted by pearlcat on February 23, 2007, at 16:46:57
In reply to Hang on, posted by Declan on February 23, 2007, at 1:55:51
I AM A ADDICT! But for so long I have been judged on that and I have just now figured out why I like narcotics. It was not because I wanted to abuse them or get "high" Its because it truly helped with my depression. I cannot get the meds of my choice but I dont think anyone can. I just wanted to know if their was anyone else out there that had the same theory. And no I am not in denial I was hoping that someone could direct me in a route to take with my meds. I have tried everything (AD) under the sun . I am tired of being put on this and put on that till they figure it out. I see a Phsyc that is part of a drug rehab center, solely for the reason that I did not want to be put on anything that I could abuse.....ie....amphetimines. I went that route and my husband thought I had lost my mind. It is like it triggered OCD. Oh well....in a perfect world I guess we could all be happy if we called the shots.
pearlcat
Posted by Declan on February 23, 2007, at 18:50:40
In reply to Re: Who is in denial?, posted by mattye on February 23, 2007, at 13:01:27
No Matt, you never said anyone was in denial. That was flmm, who said Quintal and I were.
Special thanks to you, flmm. You have given me days of delight with only a little affront.How often can you say that?
Posted by Declan on February 23, 2007, at 19:09:33
In reply to Re: Hang on, posted by pearlcat on February 23, 2007, at 16:46:57
Have you considered tianeptine?
It is OK with recovering alcoholics, which suggests something.
And it's been good for me, in recovery too (as we say these days).
Posted by flmm on February 23, 2007, at 21:24:22
In reply to Re: Who is in denial?, posted by Declan on February 23, 2007, at 18:50:40
No thanx needed Declan. That's what i'm here for! Party on dude..............Enjoy the trip!
Posted by flmm on February 23, 2007, at 21:27:03
In reply to Re: Who is in denial? Declan, posted by flmm on February 23, 2007, at 21:24:22
Oh, by the way. Funny how Heroin addicts are popping up on this thread! Heroin is a great an
antidepressant also!
Posted by Quintal on February 23, 2007, at 21:33:51
In reply to Re: Who is in denial? Declan, posted by flmm on February 23, 2007, at 21:27:03
>Oh, by the way. Funny how Heroin addicts are popping up on this thread!
There are no Heroin addicts on this thread.
>Heroin is a great an
antidepressant also!Yes, being an opiate of course.
Q
Posted by Declan on February 24, 2007, at 0:57:27
In reply to Re: Who is in denial? Declan, posted by flmm on February 23, 2007, at 21:24:22
If only (I could)
You have no idea about my life. It's all green tea and healthy food and in bed before 9pm.
No opiates for me.
(But neither do I wish to be congratulated for giving them up.)
For me there is no moral dimension to the opiate thing.
But then I don't live in the US.
Posted by flmm on February 24, 2007, at 9:43:36
In reply to Party on dude » flmm, posted by Declan on February 24, 2007, at 0:57:27
Why would you not take opiates if they were such great antidepressants?!
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