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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by carlo on May 29, 2005, at 0:38:32
I have been sober in AA for 23 years. After 19 yrs. chemically free, I was diagnosed with depression and perscribed Paxil. After 6 weeks of hell, I woke up one day and the depression was gone for 4 years!(40mg. in the am). My doctor decided to try 25 mg. of CR twice a day. It didn't have the same kick so I started self adjusting the dose up and down and I gradually drifted back into depression. During the last 3 years I've had 4 surgeries(2 rotor cuff and 2 carpal tunnel)I was prescribed Vicodin each time for the pain(in spite of telling the doctors that I was an addict and afraid I would kick off my addiction). I was able to quit using the pills each time when the pain subsided and I never took more than prescribed. Secretly I thought the Paxil made me bulletproof and I no longer was an addict. I started "borrowing" Vikes from my wife to help me get things done around the house. I started feeling guilty about using narcotics and talking about recovery. I confessed to my sponser and he told me that I dodged a bullet and needed to stop self medicating. So I did for a week or two. Then came the insomnia and being tired at work. Then I stole ten Vikes from my wife and started taking 3 per day. Then I conned her into rationing me pills every day. I stole Percosets and Xanax from my sister. Can't shake the Obsession! Haven't used opiates for 2 days. Currently taking 30mg Paxil twice a day and started 18mg. Stratera a week ago. I can't get that good feeling back that Paxil gave me for 4 years. The Stratera was my doctors idea thinking that might help the Paxil. I think I need to get off the Paxil. Any feedback would be appreciated.
Posted by starlajay on May 30, 2005, at 8:18:18
In reply to depression and relapse, posted by carlo on May 29, 2005, at 0:38:32
All the addiction issues aside (not to give more weight one issue over another) here, I strongly, strongly, highly, emphatically recommend that you discontinue the use of Paxil based solely on the likelihood that you will become physiologically dependent on the drug. And with first hand knowledge of what the withdrawl from Paxil entails. I began taking it several years ago for panic disorder (started at 20mgs), now at 40mgs and about 5 panic-free years later, can not, no matter how hard I try and no matter what I do, can't kick the drug. I wanted to go off of it to figure out if my panic attacks were incidental, and found myself unable to drop below 20mgs without the severe and physical side-effects kicking into action. Even when I have tried tapering off extremely slowly (I took over a month to go from 25-20mgs) in the dosage, or replacing the Paxil for Zoloft, I can not avoid getting the side-effects. These side-effects are physical, for the most part. Although there are some emotional ones as well, but they are a pleasure in comparison to the physical pain I feel. It's really hard to try to explain just what it is that I feel when withdrawling from Paxil, but I'll try my best to explain. By the way, these symptoms begin within a couple hours after missing my daily dose as well, and do not subside for about four hours after taking the pill. First I feel dizzy. Like my brain engulfed water and although I've stopped moving, my brain is spinning freely inside my head which acts like the bowl of water. My vision then begins to "feel" like my eyes are serving as a film projector like from elementary or jr. high. But the film isn't working and is flapping around in my head. It begins to hurt to use my peripheral vision, and then I am feeling nauseated. Also, although I have never experienced vertigo, it am then feeling how I imagine that must feel. My movement, although to others it appears normal, then feels sporradic and disconnected and I get an unpleasant tingle sensation all over. I have a friend who has refered to that same tingle as a bunch of little shocks that are going on throughout his body. Emotionally, everything is intense, and all I can do is wait for the pill to kick in. When I tried to go from 25-20mgs, in addition to these feelings, I couldn't stop crying and I was tired from morning to night. Either I slept all day or was so tired but slept only a couple of hours at night. Well, my panic subsided but now there is a whole new problem for me to tackle. Also, in regards to any experience with Paxil and addiction, I have found it to be inneffective at helping me with my obsession/compulsion to use drugs. And have managed to find myself using illegal drugs as another source for medicating myself during this time on Paxil. I want to stress that during the few months when I really tried to ween myself under a physician's care, off of Paxil, I was not using or taking any other substances. Also, I want to note that I have never experienced anything such as this when discontinuing Prozac or Wellbutrine and don't consider myself to have an especially low threshold to pain either. Aside from Effexor (as I've heard similiar stories) consider anything else. A drug with a longer half-life than Paxil as well.
Posted by fuji on May 31, 2005, at 9:05:43
In reply to depression and relapse, posted by carlo on May 29, 2005, at 0:38:32
I have been sitting here thinking how to write and address my problem and just read Carlo's post. Holy mackerel. I am 20 years sober and got sober in AA. I have had several surgeries within that time and never had an opiate problem. The first surgery I was 2 years sober and wouldn't take any meds at all. Hip replacement I took oxycontin for 10 days and stopped. That was over 5 years ago and just recently in February had back surgery and have been taking opiates daily now since before surgery. I don't take a lot, I don't get high and for the most part I legitimately had been taking opiates. But it's time to stop and I don't want to, and I have physical withdrawal which I can't even believe on the amounts I take. I have been on Effexor 300mg & prozac for a long time but the depression seems to be unrelenting. Was prescribed adderal as an adjunct but never took it because of fear of taking those types of drugs. I would like to get 1 day clean off of opiates but I have pain so I can justify it. Problem also, when I go back to work, I work in a substance abuse facility as a counselor and can't go to work unless I am straight. My rules not the facility. I need to stop and I never thought it would be difficult because it was so easy after the other surgery. I guess the longer I take them legitimately or not, the harder it gets. I too can't sleep without either vicodin or percocet. This has to end.
fuji
Posted by carlo on June 1, 2005, at 12:16:27
In reply to Re: depression and relapse, posted by fuji on May 31, 2005, at 9:05:43
Fugi. We need to talk some more. I also worked in the rehab field as a counselor. I have been taking Paxil for depression for the last 4 years. I was very reluctant to take it because of my experiance with rehab and AA (no mood or mind altering drugs). However, when it finally started to work I felt better than ever. I even began to question if I was an addict. I secretly thought that I may have been misdiagnosed in rehab and that I should have been treated for depression rather than addiction! I had rotor cuff surgery 2 years ago and declined the Percoset prescription from the doctor(a big mistake on my part). I eventually had to take pain meds for about a month and quit without a problem. The next year, I had my other shoulder done and didn't hesitate taking the vicodin as prescribed. I also was able to quit without much discomfort. Over thhe last year my doctor changed my Paxil to Paxil CR. It was ok for awhile but within 3 months I wasn't feeling as good. At the doctors request I tried adjusting the dose but couldn't get the same feeling (I know now that I was experiancing SSRI discontinuation syndrome). Over the last year I had carpal tunnel surgery on both hands and took Vicodin for the pain. I found that the Vicodin also relieved the symptoms of the SSRI DS and I continued taking 3 or 4 per day to augment the Paxil. I've tried to quit several times but the psychological withdrawl is very unpleasant. Today I contacted a doctor that uses bupenephrine to detox from opiates. I don't know if this will work but I am considering trying it. Do you know anything about this drug? Also, I still have the depression to treat which means I have to wean off the Paxil (and Stratera which I've been taking for the last two weeks) and find a new drug that works. On top of all this I feel like a hypocrite going to AA meetings and sponsering people. Thanks for your reply. I hope you see this posting and please write back.
Posted by fuji on June 1, 2005, at 18:38:06
In reply to Re: depression and relapse » fuji, posted by carlo on June 1, 2005, at 12:16:27
I too have been considering contacting a doctor for bupenorphine to detox off of opiates. What kills me is that I don't take many at all and my body has become dependent on them. In the days of my addiction I stopped everything on my own, never went to Rehab and just went to AA. I never felt withdrawal from anything. Today I called my psychiatrist and asked him to call in Strattera for me. I have wanted to try it for a long time and decided I need something else. He wants me to take Adderall but I am really reluctant to take it. How did the strattera affect you? If you take bupenorphine and are continuing to take opiates, it will throw you into an immediate unpleasant withdrawal. Bupe is also a mild pain killer which is also one of the reasons I wanted to try it. I don't go to AA anymore but can certainly relate to feeling like a hypocrite at meetings. I at least have to be off of opiates during the day before I can return to work. All my other surgeries I would just stop taking the opiates or not take them to begin with. I really just got so tired of being in pain and suffering. I know as clear as anything that I am an addict and it gets me mad. I still believe that if I have pain I can take pain killers. I just have to be honest with myself about the pain. It took me a long time before I would go on antidepressants and at the time I had a therapist who refused to treat me unless I took them. I think they probably saved my life. Unfortunately, I want more than to just not want to kill myself. I have so much more in my life than I ever had before and yet the depression lurks just under the surface like a heavy weight on my chest.
fuji.
Posted by Declan on June 1, 2005, at 19:43:06
In reply to Re: depression and relapse » fuji, posted by carlo on June 1, 2005, at 12:16:27
I haven't taken buprenorphine but people say that it is a fair bit less depressing than methadone. It should cover for the Vicodin since you're not taking much.
Declan
Posted by fuji on June 2, 2005, at 7:36:52
In reply to Re: depression and relapse, posted by Declan on June 1, 2005, at 19:43:06
You're probably right that it will cover the vicodin and not cause too much of a problem. Then comes the time to detox off the bupe. I had a client who was being detoxed off of narcotics with bupe by a doctor who didn't really know how to use it. She was so strung out on it she was in a wheelchair. She was completely incoherent and virtually out of it. She did know that she didn't want to go inpatient for treatment though. It was so scary to see her. Her breathing was so shallow her poor husband really had his work cut out for him.
Posted by carlo on June 2, 2005, at 8:59:09
In reply to Re: depression and relapse » Declan, posted by fuji on June 2, 2005, at 7:36:52
Talked with a doctor last night. The cost for treatment is $220.00 for the first visit then $100.00 per week plus the cost of the medicine and he does't take insurance. I can't afford it right now! I'm going to talk with my family doctor to see if he can prescribe it for me.
Posted by ed_uk on June 2, 2005, at 9:09:05
In reply to Re: depression and relapse, posted by fuji on May 31, 2005, at 9:05:43
>Then comes the time to detox off the bupe. I had a client who was being detoxed off of narcotics with bupe by a doctor who didn't really know how to use it.
'Detox' and 'narcotics' are terms used when referring to drug abuse. You said yourself that were were taking opioids for a legitimate medical reason. You may be physically dependent but you are not an opioid 'addict'. The language which you are using makes you sounds like an abuser.
>I work in a substance abuse facility as a counselor and can't go to work unless I am straight/clean........
>I have pain
>I don't get high.....but you are straight....aren't you? You are not abusing your medication.....are you? All this talk of getting straight/clean implies that you have been abusing your medication. This is the language of drug abuse. You said yourself that you were taking an opioid analgesic for the treatment of post-operative pain.
>I work in a substance abuse facility as a counselor........
>I have physical withdrawal.........Surely, as a counsellor, you are aware of the difference between pure physical dependence and a true 'addiction'??? Addiction is characterized by craving, misuse of a drug for its euphoric effects, compulsive drug use, getting intoxicated, using a drug as an 'escape', large amount of time spent consuming a drug, non-compliance with your doctors instructions, increasing the dose without a valid medical reason etc. Pure physical dependence (ie. withdrawal symptoms on discontinuation) is a *natural* consequence of long-term opioid use, it is not the same as an 'addiction'. Since you are 20 yrs sober, I can understand your concern RE addiction.........but please don't condemn yourself as an opioid addict unless you really are one.
If you want to withdraw from oxycodone, you could get a prescription for the oral solution and (very) gradually decrease the dose using an oral syringe. Other analgesics such as NSAIDs may be useful for the pain.
Kind regards,
Ed.
Posted by ed_uk on June 2, 2005, at 9:50:12
In reply to Re: depression and relapse, posted by fuji on May 31, 2005, at 9:05:43
Hi again,
>I at least have to be off of opiates during the day before I can return to work.........
So, you only take opioids at night?? If you really need to come off opioids, perhaps you could try taking a small dose of amitriptyline (Elavil) to help you sleep; amitriptyline is usually very sedating. Amitriptyline can also help to relieve pain. Prozac interacts with amitriptyline: it potentiates amitriptyline's effects by inhibiting its metabolism. Because of this, as little as 5mg (half a 10mg tablet) of amitriptyline (in the evening) might be helpful. *Large* doses of amitriptyline must not be combined with Prozac.
Kind regards,
Ed.
Posted by ed_uk on June 2, 2005, at 10:09:07
In reply to Re: depression and relapse, posted by fuji on June 1, 2005, at 18:38:06
>........*for the most part* I legitimately had been taking opiates..........
Have you been misusing opioids from time to time?? If you have, I can see why you want to stop. Perhaps it would be helpful to have your medication dispensed in small quantities.
>I really just got so tired of being in pain and suffering.
Chronic pain following back surgery is often a serious problem. If possible, consulting a pain specialist could be very useful. A pain specialist could provide a variety of non-opioid pain therapies and/or could carefully supervise long-term opioid treatment if there was no reasonable alternative. It sounds like your depression is quite bad at the moment, a different antidepressant might be helpful. I'm not the worlds' greatest fan of Strattera, a lot of people seem to find that it makes their depression worse. You could post on the main p-babble board and ask for suggestions RE further antidepressant treatment.
Kind regards,
Ed.
Posted by ed_uk on June 2, 2005, at 10:30:39
In reply to Re: depression and relapse » Declan, posted by fuji on June 2, 2005, at 7:36:52
I hope you don't mind me posting to you LOL! You said that you were taking a very low dose of an opioid. Which opioid(s) are you taking and at what dose?
What withdrawal symptoms do you have when you miss a dose?
It's sounds like you're suffering from insomnia. What do you think is causing your insomnia? Pain, depression, anxiety, withdrawal?
Ed.
Posted by Declan on June 2, 2005, at 17:23:25
In reply to Re: depression and relapse » Declan, posted by fuji on June 2, 2005, at 7:36:52
It's sure to be easier to withdraw from bupe than from methadone (not saying much), maybe not from Vicodin. Dunno what the half life is there. Most doctors, probably because they haven't done it themselves are insensitive in their reduction schedules. I'm on 1.25mg/d methadone and have taken some form of opioid nearly every day since 1975 or so. My pdr tells me the amount I'm on is a placebo, and its not at all. The last little bit......To stop I'd need a month long walking holiday somewhere.
Declan
Posted by ed_uk on June 2, 2005, at 18:18:33
In reply to Re: depression and relapse, posted by Declan on June 2, 2005, at 17:23:25
Hi Declan,
>The last little bit......
..........is the hardest to come off.
Regards,
Ed.
Posted by carlo on June 3, 2005, at 10:36:46
In reply to Re: depression and relapse » fuji, posted by ed_uk on June 2, 2005, at 10:09:07
Thanks Ed. I would like to stop taking Paxil since it is not working like it was but I'm afraid of the withdrawl and do not want to go through 6 weeks of pain waiting for the new meds to kick in.
Posted by fuji on June 6, 2005, at 5:28:21
In reply to Re: depression and relapse, posted by carlo on June 3, 2005, at 10:36:46
prozac helps the w/d from effexor and possibly could do the same for paxil. ask your doctor about it. the words used to describe addiction or dependence or craving are words. yes, there are medical difference but the point is for me, that I take medication when I don't have pain and whatever name I give that, it's not good for me. it gets muddied because sometimes there is pain and sometimes there is hardly any pain. once an addict, always an addict at this point it's a matter of degree. i can recognize the nasty little warning signs of addiction. i know that my response to pain and pain meds is different than someone who never had an addiction. i look at the opportunity to take pills even antidepressants as something to look forward to. i can't remember a time when i didn't feel that way. it's a matter of choosing what pills to take. for me antidepressants and motrin are ok drugs. vicodin & oxycodone not good unless there is pain involved and that's where the waters get muddied.
fuji
Posted by ed_uk on June 6, 2005, at 13:39:10
In reply to Re: depression and relapse, posted by fuji on June 6, 2005, at 5:28:21
Hi Fuji,
>.....the point is for me, that I take medication when I don't have pain and whatever name I give that, it's not good for me.......
OK, so how are you going to go about coming off the opioids??
What other meds have you tried for your pain?? Did they help? Any side effects?
Kind regards,
Ed.
Posted by fuji on June 6, 2005, at 17:03:39
In reply to Re: depression and relapse » fuji, posted by ed_uk on June 6, 2005, at 13:39:10
Knowing me, I will just stop. That's how I have done everything else and it will probably be what I do. I take 10 mg. percocets and 7.5 vicoprofen, usually 2 or 3 total. Sometimes if the pain is bad I throw in a 10mg oxycontin because they work nicely for pain and I don't feel them. I take them the way you are supposed to take them and don't abuse them at all. It's the other two that I screw around with. Because of the surgery I had I can not take as much motrin as I like and tylenol is useless. If necessary, I will contact a doctor who does the buprenorphine opiate detox but I am hoping to do it on my own. If I didn't have my history I would say there's nothing wrong with how I take them, but I do have my history and coupled with depression I need to be careful.
fuji
Posted by starlight on July 6, 2005, at 12:28:14
In reply to Re: depression and relapse, posted by fuji on May 31, 2005, at 9:05:43
I read your post and think you shouldn't be too hard on yourself. Most people can come off of the opiates when they're no longer in pain, but if you need them you need them. You can start to wean yourself slowly, but you shouldn't be putting all of this pressure on yourself to stop, in my opinion, that really only makes things worse.
starlight
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