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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by geeper16 on February 26, 2004, at 23:07:35
I just found this forum and I figured this would be the right place to express myself and my thoughts. Im 17 years old Ive always felt like there was something not right about the way i always feel. This feeling was not depression as a child but it was just of general social anxiety and very bad sensitivity to peoples comments and gestures as well as being a little insecure. At around 5 years old my dad tried to put me in baseball and the coach told me to move to the left a little when i was batting. This devastated me and i ran back crying to my parents car. This is one example of my lifelong emotional sensitivity. Of course I am no longer like that but even little things will bother me inside even though i know what is being said or gestured is not meant as a repremand or to hurt me. This thinking has led me never to persue school, sports, etc. Eventually I did go through a very bad depression as my home life got worse and worse from the circumstances that i created myself. Not shwoing up to classes, not finishing what i start, acting careless, slept all the time, etc, etc. Of course I am diagnosed with ADD and i am put on adderall. My condition improved as far as work, but I experienced a very strong high and a very bad crash at the end of the day. Along with the high's and lows it made my sensitivity to people even worse and it gave me extreme anxiety to the point where I couldnt even bare to walk into my school because of the fear of having a panic attack. All of this made my home life even worse because of the misunderstanding my parents have of me, thinking I am just careless and dont want to goto school. Yelling and screaming and my father constantly putting me down for not doing what I shuould have been doing threw me into a very bad depression where all i felt was guilt, pain, anxiety, and general emotional instability all day everyday to the point where i had to have homeschooling and counseling. I have alot of friends but when i was with them they would hae no idea what was going on because I would always act differently from what i felt. Although I am very self consious and always thinking to much. Ive never had any real longterm goals or asspirations. Well eventually after over 6 months of complete hell my depression subsided and I was doing a little better as far as being able to goto school. I got a job, i was alot more on the right track. But i still had general dysphoria and not alot of self esteem. Oneday I came across this little white pill, VICODIN. From the moment I tried it, I fell in love with it. I actually felt normal, like myself. My sensitivity to people was gone, it makes me extremely social. I was no longer lethargic, i get energy rather then loose energy from opiates as other people say it makes them tired. It makes me motivated, I can actually concentrate better and focus on things that are important rather then my foolish insecurities. Life just became better. I looked foward to work, school, anything as long as I had my vicodin. Now ive read that there are people that have endorphin deficiencies but i havnt read what exactly the symptoms of an endorphin deficiency are. I know that there are people who try vicodin, but why did I fall in love with vicodin the first time i tried it, why did it make me feel like myself and it makes other people feel like their drugged or wierd?. Im only guessing that I have a deficiency, but thats for you guys to guess and thats why Im writing this now. I have been on every antidepressent there is and all they have done for me is make me feel even more wierd and it made my thoughts even more out of the ordinary. Well to get back to my Vicodin, Its safe to say that I am pretty addicted, not surprisingly. I have just started attending a drug rehab center with counseling and I want to bring up my findings of Methadone for depression. I have tried Methadone before at 10mg and its a much cleaner and longer lasting feeling than vicodin gives me, although it gives me the same positive outlook. Im really considering bringing this up to my counselor and doctor but I am not sure if I want to become addicted to a drug thats more addictive than heroin. All I know is that even before my addiction with vicodin and even if the addiction does end, I wont feel right, Ill be back to my old depressed self, acheiving nothing and doing nothing. I am so amazingly emotionaly stable on opiates its a little scary. If I dont have a supply for the day which really only has to be as little as 3 10mg pills taken throughout the day at minimum I go back to my old unhappy self with withdrawals to top it off But now even with a good supply I try to limit myself as much as possible. I really cant go a day without Vicodin and I dont want to be dependant on this drug but at the same time I know if i stop it its gona make things better and not worse. Ive been taking vicodin everyday for almost a year. I am 100% positive that a daily dose even once a day of 10mg Methadone would be exactly what I need. Not only emotionaly but moneywise as well. Please post comments and suggestions, I need advice and information on opiate based antidepressants or antidepressant application. Im very happy I found this forum. This is just a rough draft of what i feel and its not edited so please excuse my grammar and write back. :-)
-Steve
Posted by jerrympls on February 26, 2004, at 23:33:34
In reply to Methadone for depression for me??, posted by geeper16 on February 26, 2004, at 23:07:35
Steve-
The use of opiates for depression is a reality. Vicodin does the same for me. Try to find an experienced psychopharmocologist and explain your experiences with opiates and/or see a psychiatrist at a university with a teaching hospital. They are putting me on opiates because nothing else works. There are treatments psychiatrists don't talk about. In fact, more and more studies are being done using opiates for those with severe depressions. The "Prozac Nation" is coming to an end because - as you can read on this board - those who have suffered too long on the wrong med have educated themselvves and have started to speak out and demand new and novel treatments. Seratonin is not the only neurohormone that causes depression.
Educate yourself. Be an effective patient. Don't give up. Refuse to live as just 'better."
Good luck
Jerry
Posted by Chairman_MAO on February 27, 2004, at 13:13:19
In reply to Methadone for depression for me??, posted by geeper16 on February 26, 2004, at 23:07:35
Opiates/opioids are the original and best antidepressants. In fact, the tradition of antidepressants that began with imipramine is more biopsychiatric sophistry than advance in treatment. Opioids are also much, much less toxic than the new drugs. People have been using opium poppy alkaloids for thousands of years. Aside from "dependence", there is virtually no risk save overdose, which is honestly almost impossible to do unless you're using it intraveinously (overdose is IMPOSSIBLE with buprenorphine). From your post, I believe you are taking appropriate antidepressant doses of the opioid. Unfortunately, I doubt--unless you have lots of money--you will ever find a doctor to prescribe schedule II drugs--ESPECIALLY opioids--for depression. You DO NOT want to take Vicodin long-term because of the other TOXIC painkiller in it.
Good luck with the methadone, but if you cannot get it, ask for buprenorphine. It might even be best to ask for buprenorphine first, because the dependence/withdrawl is negligable and it's not schedule II. If that fails, I'd ask for tramadol, which is less safe and less effective, but a fine antidepressant. You may want to consider asking your doctor about buprenorphine/tramadol (or a better opioid) + stimulant (preferably dextroamphetamine), under the guise of treating your ADD. Stimulates potentiate the analgesic and antidepressant effects of opioids and also attenuate some of their adverse effects.
Best wishes, and please, do let me know how it's going and if you need any more help getting what you need. I understand how frsutrating it can be spending years under the care of psychiatrists that simply won't "cut to the chase".
Posted by jerrympls on February 27, 2004, at 18:11:04
In reply to Re: Methadone for depression for me?? » geeper16, posted by Chairman_MAO on February 27, 2004, at 13:13:19
I totally agree with the Chairman. It's very difficult to find a doc to prescribe opiates. However - I see a RESIDENT at a teaching hospital at a Big Ten University - heavy on the research side of things - so they are not afraid to prescribe novel treatments when they see a real need for it.
I wish you the best...and if you need some article abstratcs regarding the use of opiates for depression to show your doc - I have some good ones I'd be happy to share.
Jerry
Posted by geeper16 on February 27, 2004, at 18:20:02
In reply to Re: Methadone for depression for me??, posted by jerrympls on February 27, 2004, at 18:11:04
Thank you for all your replys. This is a great forum. Yes If you could send me some articles I could show my doctor that would be great. Im going sometime this week ill let everyone know how it goes. I just hope the person i talk to is educated about these things. Thanks again.
-Steve
Posted by jerrympls on February 27, 2004, at 18:27:41
In reply to Re: Methadone for depression for me??, posted by geeper16 on February 27, 2004, at 18:20:02
> Thank you for all your replys. This is a great forum. Yes If you could send me some articles I could show my doctor that would be great. Im going sometime this week ill let everyone know how it goes. I just hope the person i talk to is educated about these things. Thanks again.
> -SteveSteve-
Here ya go:
USE OF OPIATES FOR TREATMENT RESISTANT DEPRESSION
1: J Clin Psychiatry. 2001 Mar;62(3):205-6.
Treatment of refractory major depression with tramadol monotherapy.
Shapira NA, Verduin ML, DeGraw JD.
Publication Types:
Case Reports
LetterPMID: 11305709 [PubMed - indexed for MEDLINE]
2: Aust N Z J Psychiatry. 2000 Dec;34(6):1032-3.
The efficacy of intramuscular tramadol as a rapid-onset antidepressant.
Spencer C.
Publication Types:
Case Reports
LetterPMID: 11127616 [PubMed - indexed for MEDLINE]
3: Am J Psychiatry. 1999 Dec;156(12):2017.
Treatment augmentation with opiates in severe and refractory major
depression.Stoll AL, Rueter S.
Publication Types:
Case Reports
LetterPMID: 10588427 [PubMed - indexed for MEDLINE]
4: J Clin Psychopharmacol. 1999 Aug;19(4):373-6.
Long-term codeine use is associated with depressive symptoms.
Romach MK, Sproule BA, Sellers EM, Somer G, Busto UE.
Department of Pharmacology, Faculty of Pharmacy, University of Toronto,
Centre
for Addictions and Mental Health, Ontario, Canada.
myroslava.romach@utoronto.caA community survey was conducted among long-term (>6 months) users
of codeine-containing products to characterize chronic use of these
extensively consumed medications. Respondents recruited through newspaper
advertisements completed a mailed questionnaire. Three hundred thirty-nine completed questionnaires were obtained, yielding a response rate of 70%. Codeine dependence/abuse as defined by DSM-IV criteria was present in 41% of
the respondents. Two thirds of the subjects had sought help for mental
health problems, most often depression (70%). Scores on the Symptom
Checklist-90 subscales were modestly elevated, particularly on the Depression subscale (1.2 +/- 0.9). Long-term codeine use is strongly associated with dependence. Depression and depressive symptoms are common. These data suggest that dysphoric mood states may be significant in maintaining long-term codeine use.PMID: 10440467 [PubMed - indexed for MEDLINE]
5: Biol Psychiatry. 1996 Jun 15;39(12):989-90.
Buprenorphine for depression: the un-adoptable orphan.
Callaway E.
Publication Types:
EditorialPMID: 8780832 [PubMed - indexed for MEDLINE]
6: Am J Psychiatry. 1996 Jun;153(6):843-4.
Mood alterations and tramadol.
Pinkofsky HB, Woodward RA, Reeves RR.
Publication Types:
Case Reports
LetterPMID: 8633712 [PubMed - indexed for MEDLINE]
7: J Am Osteopath Assoc. 1996 Mar;96(3):156.
Long-term narcotic use may complicate treatment for depression.
Tobe EH.
Publication Types:
LetterPMID: 8932590 [PubMed - indexed for MEDLINE]
8: Biomed Pharmacother. 1996;50(6-7):279-82.
Treatment of depressive syndromes in detoxified drug addicts: use of
methadone.Laqueille X, Bayle FJ, Spadone C, Jalfre V, Loo H.
Service Hospitalo-Universitaire de Sante Mentale et de Therapeutique,
Centre
Hospitalier Specialise Sainte-Anne, Paris, France.Depressive syndromes are very frequent in drug-addicted patients. Their
study is particularly difficult on account of the toxic intake which disturbs
the clinical analysis. Methadone has improved our understanding of these
pathologies. In fact, methadone permits treatment of some depressive
disorders typically linked to addiction, such as a motivational symptoms and
depressive mood following intoxication. It brings to the fore the other mood
disorders which are often associated with drug intake.Publication Types:
Review
Review, TutorialPMID: 8952868 [PubMed - indexed for MEDLINE]
9: J Clin Psychopharmacol. 1995 Feb;15(1):49-57.
Buprenorphine treatment of refractory depression.
Bodkin JA, Zornberg GL, Lukas SE, Cole JO.
McLean Hospital, Consolidated Department of Psychiatry, Harvard Medical
School,
Belmont, MA 02178, USA.Opiates were used to treat major depression until the mid-1950s. The
advent of opioids with mixed agonist-antagonist or partial agonist activity, with
reduced dependence and abuse liabilities, has made possible the reevaluation of
opioids for this indication. This is of potential importance for the population
of depressed patients who are unresponsive to or intolerant of
conventional antidepressant agents. Ten subjects with treatment-refractory,
unipolar, nonpsychotic, major depression were treated with the opioid partial
agonist buprenorphine in an open-label study. Three subjects were unable to
tolerate more than two doses because of side effects including malaise, nausea,
and dysphoria. The remaining seven completed 4 to 6 weeks of treatment and as
a group showed clinically striking improvement in both subjective and
objective measures of depression. Much of this improvement was observed by the end of 1 week of treatment and persisted throughout the trial. Four subjects
achieved complete remission of symptoms by the end of the trial (Hamilton Rating
Scale for Depression scores < or = 6), two were moderately improved, and
one deteriorated. These findings suggest a possible role for buprenorphine
in treating refractory depression.Publication Types:
Case Reports
Clinical TrialPMID: 7714228 [PubMed - indexed for MEDLINE]
10: J Subst Abuse Treat. 1990;7(1):51-4.
Depressive symptoms during buprenorphine treatment of opioid abusers.
Kosten TR, Morgan C, Kosten TA.
Department of Psychiatry, Yale University School of Medicine, New Haven,
CT.Among 40 opioid addicts treated as outpatients with sublingual
buprenorphine (2-8 mg daily) for a month, depressive symptoms significantly decreased in the 19 who were depressed at intake to treatment.PMID: 2313769 [PubMed - indexed for MEDLINE]
11: Int Clin Psychopharmacol. 1988 Jul;3(3):255-66.
Current and historical concepts of opiate treatment in psychiatric
disorders.Weber MM, Emrich HM.
Max-Planck-Institut fur Psychiatrie, Munchen, Federal Republic of
Germany.In recent years psychiatric research has rediscovered the theoretical
and clinical importance of opiates, especially for the understanding of
depressive disorders. However, opiate treatment is not a new therapeutic concept
in psychiatry. The use of opium for "melancholia" and "mania" may be traced to ancient classical medicine. After Paracelsus and Sydenham, the psychiatry of the German Romantic Era widely discussed therapeutic opium use with the Engelken family going on to develop a structured opium treatment of depression in the first half of the nineteenth century. Although the underlying scientific problems of psychiatric opium therapy were never solved, it gained an outstanding position as a practical treatment for over 100 years.Publication Types:
Historical ArticlePMID: 3153713 [PubMed - indexed for MEDLINE]
Posted by Festus on February 27, 2004, at 22:28:27
In reply to Re: Methadone for depression for me?? » geeper16, posted by jerrympls on February 27, 2004, at 18:27:41
In following the course to "educate"one,s self to Medication options for treatment of what ails one,there will always be a item or 2 that is worth a "second opinion",in your case,Steve,I will comment on the post that spoke of it "being nearly impossible to overdose on Opiates unless they were being injected"that I am without doubt ,positive the"Chairman"wrote the reply in honest sincerity and good-will to try to help you,and in no way am I saying any different,I just want to opine that MANY folks have died as a direct result of oral Opiate overdose.Please be careful,especially with Methadone.It has a very long half-life and if taken in bigger doses,maybe just experimenting,it can build up in your system to a quite toxic level.No disrespect of ANY kind was intended by this,only what I know to be true.
Festus
Posted by jack smith on February 27, 2004, at 23:59:55
In reply to Re: Methadone for depression for me?? » geeper16, posted by Chairman_MAO on February 27, 2004, at 13:13:19
> Opiates/opioids are the original and best antidepressants.
This may be true for a discrete class of people but I think this is an over-generalized statement. . . . .
> Aside from "dependence", there is virtually no risk save overdose, which is honestly almost impossible to do unless you're using it intraveinously (
There is a risk of overdose in oral opiates. I would agree it is greatly exagerated and definitely less than some AD's such as tricyclics. But the ssri's are clearly less of an overdose risk. . . .
I think that opiates can be a good alternative but only for those who have really failed "traditional" AD treatment. Right now, I use an opiate, Norco (somewhat illicitly), to augment my AD regime from time to time.
JACK
Posted by Chairman_MAO on February 28, 2004, at 8:18:40
In reply to Re: Methadone for depression for me??, posted by Festus on February 27, 2004, at 22:28:27
I should have been clearer by what I meant by "overdose risk", and that is UNINTENTIONAL overdose (and I foolishly forgot to mention that methadone is perhaps the worst in this regard for the reason you stated), the kind that gets the most bad publicity--and happens most often with IV use. I missed the obvious due to my overzealous desire to remind people that, as another poster mentioned, the opiates are not even as "dangerous" as the TCAs are in overdose. I'm glad you corrected me, as I feel irresponsible.
Also, if someone wants to kill/poison themselves, do they not have a RIGHT to? I'm not saying that it is MORAL to kill oneself, but it is not up to others to decide what is moral for another when only themselves are concerned. I'm going to get flamed for this, but I have my [libertarian] principles ...
As a depressive, there have been many times where I've strongly desired to end my life. I would tell my therapist that if I had a certain, painless way to do it, I would do it. But if I had an IV with loads of Nembutal and Heroin in it and all I had to do was push the button, I do not know that I would have. Deep down inside I'm not sure that I could ever consider suicide a viable solution to depression. However, some would say that I simply wasn't depressed enough, and this may be true.
If one isn't directly trying to kill themselves or medicate themselves into oblivion, prescription opiates are not any more dangerous than many other classes of drugs. There are no precautions put in place to prevent depressive people from obtaining all sorts of drugs/chemicals that they could off themselves with. The only ones our government seems to care about are the ones that get you high.
After all, psychostimulants ARE virtually impossible to fatally overdose on (have a better therapeutic index), intentionally or unintentionally, and yet TCAs are dispensed way more freely. And mentioning marijuana here is a moot point ...
I'm assuming the poster asking about 10mg methadone/day doesn't WANT to kill himself/herself, but rather live in a different state of mind.
Also, kids doing things such as playing around with scraping the time-release coating off of [the now discontinued] 180mg tablets of OxyContin do not count here either, because OxyContin should be available--time release or not--at the corner store with instructions on how to use it safely. Of course, if one bought Paregoric at the Vitamin Shoppe, this would be even less of a danger.
If opiates are so incredibly "dangerous", how did people manage to use them, mostly without incident, for thousands of years?
Perhaps my rant is meaningless, but it comes down to this fact: some people that engage in reckless behavior will die. This shouldn't prevent people from being able to improve their quality of life.
Posted by Festus on February 28, 2004, at 23:40:19
In reply to Re: Methadone for depression for me?? » Festus, posted by Chairman_MAO on February 28, 2004, at 8:18:40
One thing to remember,concerning the historical use of Opiates,is the fact that a truly"lethal"form of an Opiate derivative was not even available to overdose on until Morphine was first synthesized.That was back in the Civil War days,just in time to meet the needs of the severely wounded thousands of men who were a product of that war.So profuse was the need and availability of the Morphine,that,literally,thousands of soldiers became addicts after it was over.This by-product of that terrible time was known widely as"the Soldiers Disease".Anyway,so much for the history lesson,but it makes for some interesting reading if you look up the origins and follow the history of these early pain-meds and how they evolved into what they later became.Festus
Posted by geeper16 on February 29, 2004, at 13:46:39
In reply to Re: Methadone for depression for me??, posted by Festus on February 28, 2004, at 23:40:19
Thanks again for the replys. My appointment isnt until next week and im going to bring up methadone. Theres one thing i wanted to ask about but forgot. Ive been reading about DLPA its an amino acid thats supposed to increase the level of endorphins in your body. Therefor enhancing mood, energy, etc, and serving as an effective painkiller. Its nonaddictive and i was wondering if anyone has ever used this supplement or knows anything about it. Im thinking about getting it in hopes that it will raise my endorphin levels and help me through the minor withdrawels i get when stopping vicodin and possibly even mimic some of the attrctive effects that vicodin and other opiates give me. Of course Im not going to expect any intense euphoria, but an overall lift in mood, energy and concentration that opiates give me would make DLPA the supplement for me. Ive also read that it works by preventing opiates from leaving your body or reabsorbing, therefor its also effective in enhancing and prolonging the effects of painkillers, and preventing people from developing tolerance to them. Please feel free to comment.
-Steve
Posted by green hornet on March 2, 2004, at 12:39:25
In reply to Re: Methadone for depression for me??, posted by jerrympls on February 27, 2004, at 18:11:04
Hello,
I am new to this forum and this posting really hit home. I have been on every antidepressant known to humans for the last twenty years, and even with the ones that worked (Wellbutrin and Celexa) the effects eventually wore off.
Two months ago I developed a cyst on my knee that hurt like blazes( I also had torn cartiledge and a torn acl.) So my family doctor put me on the smaller Vicoden for pain. I had the surgery three weeks ago and the surgeon put me on the stronger Vicoden afterwards. The thing is -- while the Vicoden did relieve my pain, it also lifted my depression!! I have one more refill (for 45 tabs). I only have to take two a day and the stuff works like nothing else. I do not abuse it. So -- do I present this to my family doctor? I no longer see a psychiatrist and the family doctor monitors my meds. He (the family guy) is VERY young and very good quite understanding and willing to listen to input. However I was an alcoholic until 24 years ago and he knows this. What are my chances of convincing someone of the fact that this stuff works for depression? Could I also get ahold of the articles somebody referred to??
Thanks for listening, all help will be greatly appreciated.
green hornet
Posted by Maicoguy on March 2, 2004, at 18:28:53
In reply to Re: Methadone for depression for me??, posted by geeper16 on February 27, 2004, at 18:20:02
Just found this thread. I have some experience with this so here goes... First the good stuff.
Having been on antidepressants for 10 years now I can tell you that methadone was a Godsend for me. (Or so I thought) I found it quite by accident when a friend who is in pain managment gave me some. I took all my depression symptoms away in 1 hour. This was stunning since all the normal antidepressant drugs only made life survivable but not "better". I accually felt like everyone else...able to cope with everyday problems and find some purpose in life. I asked my Doc about this and he had never known about using methadone for depression. He consulted someone and gave me a script for 10mg/day. It felt like I had my life back! I was able to get a job and work all day with no fatigue. This wasn't a "high" kind of drug, it simply gave me a mood boost that no anti depressant could do. The Doc couldn't believe it ether as I went through about 10 different medications with no success.
Now the other side...
I went on this for about 6 months with no problems then I noticed that 10mg wasn't working as well as before. I went to 15mg and all was well for a few weeks then the same thing happened. I noticed I was sweating alot more than before and seemed to be slightly short of breath. Unfortunatly for me I had stopped taking my normal A/D a few weeks before since I was sure that this drug was the answer. The old feelings started coming back unless I increased the dose. I told this to my Doc and he told me to slowly decrease the meth. to get off it as he was worried now about a possible addiction. Well I can tell you I went through two weeks of hell. My depression came back 10 fold as I had no A/Ds in my system. The withdrawal symptoms for methadone are horrible. I almost ended up in the Psych ward with that one. It was the worst experience of my life. It took about 3 months to get back to what was "normal" depression.
Lessons learned...
Will I ever take this drug again?...I really don't know. Nothing has made me feel better like this. But like anything else there's a price to pay. I've since read that methadone does some kind of damage to the bone marrow if used for long periods of time. More research needs to be done with synthetic opiates and how they work on the nervous system regarding depression. I've since went on to other treatments including trans-cranial stimulation.
My advice...
Please look into all the facts before trying this option and don't just stop the regular anti depressant treatment while on the meth. Do I think this is a valuable path to take?...it depends on the person and how really bad the depression is. If I were suicidal, this would be my first choice but it's no "cure".
This is the end of the thread.
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