Posted by Chairman_MAO on January 26, 2004, at 16:55:24
In reply to Re: any other OCD drug other than SSRI? » rianny, posted by Ame Sans Vie on January 24, 2004, at 8:04:30
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> But then along came Ultram. :-) It's not currently a federally controlled substance (which means a doctor is much more likely to feel comfortable in prescribing it off-label for a mental disorder), it is (based on my subjective experience) about as potent milligram for milligram as codeine regarding its euphoriant/analgesic/anxiolytic effects, tolerance isn't nearly as common with Ultram as it is with other opioids (and a simple OTC cough suppressant and/or DL-phenylalanine can be taken to prevent tolerance completely in many cases), and the icing on the cake -- Ultram inhibits the reuptake of both serotonin and norepinephrine. Effexor achieves the same thing in the brain and it is now speculated that Ultram is more an "antidepressant in disguise" than anything else (though it is a great painkiller). Not only do Effexor and Ultram share these reuptake inhibition properties, but both activate opiate receptors (Ultram more so than Effexor, though).
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>Ultram is basically a "pro-drug" whose active metabolite is an opioid. Its maker likes to emphasize its "reuptake-blocking" properties in purporting a "dual" mechanism of action. This is "data-spinning" on a grand scale. Facts the manufacturer seems not to consider:
* Many other opiate/opioid drugs (methadone comes immediately to mind) block monoamine reuptake to varying degrees,
* AND ultram blocks monoamine reuptake with approx. 1/50th the potency of imipramine. The usual dose range of imipramine is 50-150mg; I strongly suspect the analgesia you'd experience with 1-3mg of imipramine would not be as profound as that induced by the water used to take the dose.Call me a simpleton, perhaps, but I don't see how tramadol is anything significant besides a weak mu agonist with a delayed onset of activity. Absurd DEA classifications aside, I doubt one could discriminate between a pinch of morphine and a "regular" dose of tramadol (aside from the morphine not having that extra seizure risk, etc.)
Insofar as its an "antidepressant in disguise", ALL opioids are antidepressants in disguise (you no doubt realize this :) ). Arguably, they are among the PROTOTYPICAL antidepressants. Was it Aristotle who said that there is no real distinction between physical and psychic pain? That the opioids act more or less indiscriminately on both seems to bear this assertion out.
Finally, it is worthy of mention that amphetamine (and other dopamine agonists such as bromocriptine and pramipexole) often work in "treatment-refractory" OCD (and depression).
Occam's razor (philosophy's 'K.I.S.S.'): Perhaps psychic distress simply responds well to a nice healthy buzz ...
poster:Chairman_MAO
thread:304743
URL: http://www.dr-bob.org/babble/20040122/msgs/305769.html