![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 23 to 47 of 164. Go back in thread:
Posted by Jim on April 12, 1999, at 19:02:34
In reply to Re: Refractory depression--naltrexone theories?, posted by Wayne R. on April 12, 1999, at 8:00:51
Wayne,
On your questions about who naltrexone
works for and why, I too am just an
interested (perhaps too interested!)
patient. I agree that most reports
(especially Lee Dante's) see it working
only as an augmentation strategy with
things like SSRIs (and also sometimes
tricyclics). But when I did some of my own
research on naltrexone use across
the board, I did find a bunch of places
in the alcholism & autism literature where
there was some question about whether it
might have an antidepressant effect in its
own right. This has not really been
formally researched so you're right to see
naltrexone as remaining basically an
augmentation strategy for the time being.
(My *theory* that I posted was basically
the best one that I as a non-specialist could
come up with!) If there are other people
that naltrexone has helped, I'd be interested
to see them come out of the woodwork too!
-Jim
Posted by Elaine on April 12, 1999, at 21:53:30
In reply to bipolar NOS - Elaine, posted by Elizabeth on April 12, 1999, at 8:38:39
It's the same thing - Not Otherwise Specified. Since not everything fits a clean diagnosis, they always have to leave an 'out'. In my case, I don't have mania, per se; my psychiatrist feels that the anger flashes I sometimes get fits into a bipolar dx, particular since, again, AD's haven't helped my bouts of depression as well as should. Since she tried several over the years and one characteristic of bipolar is not responding well or for very long to AD's...
I'm still not entirely convinced about the bipolar dx, but it's just a name as long as she knows what meds are helping. Again, though, I do not suffer from mania (although it might be nice just once, just for a little while?), so it really throws me into a strange category. I believe there is research about bipolar of a more dysthymic nature.
Is this anything you were looking for?
Posted by Elaine on April 12, 1999, at 22:02:04
In reply to Re: Dysthymia/Bipolar Depression (Elaine), posted by Nancy on April 12, 1999, at 16:40:45
My pdoc DID prescribe thyroid augmentation even though the doc's lab tests came back "Normal". She told me that a psych's range of "normal" can be different from a gp. I don't always know what helps, but she says it has. I guess I should consider myself fortunate that she doesn't simply go with the standard results.
Excuse me, did someone say "be careful you don't drink enough caffienated drinks"? I assume you mean "too much"? Does that apply to all thyroid meds? It seems I wake up sometimes with a pounding heart - (no, NOT anxiety or nightmares) - how long can the combination take before the side effect shows up? I never really thought about side effects with thyroid meds.
Posted by Elizabeth on April 13, 1999, at 1:40:28
In reply to Re: bipolar NOS - Elizabeth, posted by Elaine on April 12, 1999, at 21:53:30
Hi Elaine. Yup, that's the answer I was interested in. :-)
A diagnosis of bipolar without anything resembling manic or hypomanic episodes seems a bit odd to say the least. There is such a thing as dysphoric mania or hypomania, in which a person feels very irritable rather than euphoric. That doesn't sound like what you're describing, though.
I seem to recall reading an article somewhere or other about depression (unipolar) with "anger attacks" (similar to panic attacks, with the same kind of autonomic symptoms).
I've also heard of cases in which "rages" turned out to be complex partial seizures and were successfully treated with AEDs.
What sort of meds are you using, and are you having any luck?
Posted by Andrew on April 13, 1999, at 16:12:03
In reply to Dysthymia/Treatment Resistant Depressions, posted by JohnB. on April 8, 1999, at 23:24:43
It would be interesting to hear the personal experiences of those using Amisulpride to treat their dysthymia.
I've taken Amineptine for dysthymia, a general dopamine reuptake blocker, at a small dose for about 3 months with good results. I've had for as long as I can remember low mood and lack of drive. I had tried both Serzone and Buproprion (Wellbutrin). Neither medicine improved my mood however. The Amineptine gently provides me with drive. It is as if it helps provide the energy that allows me to care about and enjoy life. That has been my experience anyway.
Amineptine has had the minor side effect (at 50 mg./day) of making patterns 'dance' sometimes before my eyes, such as the pattern on a carpet in a dark hallway. When I had tried it at a higher dose it made the colors of some objects glow. Also, my thoughts became scattered and I felt irritable. So I don't take a higher dose.
I wonder if Amisulpride, since it targets only the D2-D3 receptors, has less of these side effects?
I've read Pramipexole, used to treat Parkinsons, has been shown in early trials to be effective for depression. It is described as either a D3 agonist or a D2-D3 agonist. Does anyone have experience with this medicine?
Posted by Nancy on April 13, 1999, at 16:57:45
In reply to Re: Dysthymia/Bipolar Depression (Elaine), posted by Danielle on April 12, 1999, at 17:37:10
Hi Danielle,
It's wonderful to hear that your are recieving proper treatment. It's terrible to look to a physician for help, but find ignorance instead.
:) Nancy
> > > > Recent augmentation of my treatments with T3 and T4 (to get the thyroid function into the upper-quartile range of "normal") have miraculously improved physiological responsiveness to AD and mood stabilizing meds.
> > > >
> > >
> > > Nancy - I'm delighted to hear thyroid augmentation was effective. It's a treatment that a lot of psychiatrists balk at.
> >
> > ***NO KIDDING!!! I went through hell and high water to get T-three and T4!!!!!!!!!!! In just the first 7 days of taking T-three, you will begin to feel more energetic. ??i have to spell out the word "three" because my keyboard just lost it's mind...the numeral three isn't working at the moment(33333...see?)...oh, well.
> >
> > Anyway, (oh, i love to tell my stories....Thank You!) my pdoc and gp were totally against using thyroid augmentation BECAUSE MY TEST RESULT CAME BACK "NORMAL". I finally began asking where on the range of "normal" was I???? GET THIS: Doctors say that your thyroid levels are normal, even when those levels are in the "low end of normal". Which, by the way, IS NOT sufficient thyroid level for treatment refractory patients!
> >
> > The pdoc who had read literature (even after graduating from med school) important for prescribing drugs for severly treatment resistive bipolar patients (like me), was the pdoc who ended my 18 months of agonizing and totally disabling depression.
> > :) ok next question (deep breath)
> >
> >
> > For my own education: how long did you have to wait for an effect, what doses of T3 and T4 were used, and did you get any side effects?
> >
> > ****Dosage begins at 0.05mgs/ A.M./ empty stomach. An ultra sensitive thyroid blood test is done two weeks later. Increase dosage by 0.05mgs, as before, until both T3three and T4 levels are in the upper-quartile of the "normal" range.
> >
> > Personally??? the doses of thyroid meds I take...T4 = 0.15mgs and T3three = 0.05mgs...at the present time
> >
> > Side Efeects??? be careful that you don't drink enough caffienated drinks to cause a pounding heart...you may have some flushing (turning a little pinkish) of your skin, rather than the pale sickly color of the skin when your thyroid is "low normal"...oh, also, you may feel a lot better than you ever have since this awful depression began!
> >
> >
> >
> > I've had people complain of hair loss as well as sweats and diarrhoea. Thanks, Nick
> >
> > Oh yea, the thyroid meds will make you feel warmer. Which is a great benefit to those of us who always felt cold all the time. Haven't noticed hair loss. But, I have very long, curly blonde hair. It would probably take a long time for me to notice much of my hair missing...hee hee hee :) Nancy
>
> Hi Nancy:
> Same for me, only I was also losing big globs of hair. Finally got hold of a endocrinologist - ob/gyn who said the others were silly, low end of normal wasn't normal for me! Ranges aren't absolutes.
> Danielle
Posted by Nancy on April 13, 1999, at 17:03:53
In reply to Re: Bipolar/Treatment Resistant Depressions/ECT!!!, posted by Elizabeth on April 12, 1999, at 9:11:33
> Nancy,
>
> I agree that ECT is a good choice in some emergencies, but I also seem to recall that some subtypes of depression don't respond well to it. Anyone know anything about this? (My recollection is that it was more effective in severe or delusional depression and less effective (or ineffective) in dysthymic or atypical depression.)
>
> I'd actually say that for resistant dysthymia, if there's a need for immediate results (which wasn't the impression I got from Elaine's post...Elaine, could you elaborate?), amphetamines (e.g., methylphenidate or d-amphetamine) might be a good thing to try, as they tend to work fast (when they do work).
>
> For long-term treatment of bipolar depression, the atypical antipsychotics are worth a try, as they seem to act as antidepressants in some people. (Not everybody, though.)Gee, ever hear of dyskinesia???? As far as ECT goes, it was the ONLY treatment that stopped my 18 month dibilitating bipolar depression. I should have had ECT after 6 months of treatment resistance.
You need to go back and read some of my posts and do some more research regarding this kind of illness.
Good Luck,
Nancy
Posted by Elaine on April 14, 1999, at 0:19:40
In reply to Re: bipolar NOS - Elaine, posted by Elizabeth on April 13, 1999, at 1:40:28
Hi, Elizabeth! The unipolar depression with "anger attacks" sounds interesting, although I'm not quite sure what an "anger attack" would be. I think possibly not. I will just sometimes have such a reaction to something that I have to do or say SOMETHING to release the tension. Nothing too drastic, though. It's just like jumping over an imaginary line, even when I shouldn't be feeling too much under attack or defensive. Anyway, I am on lithium, levoxyl (to boost thyroid, rx'd by pdoc) and, since December, gabapentin (Neurontin), due to a possible start of a depression. It's always hard to tell what helps a condition, or whether time has helped, but I haven't had a sudden, intense reaction in quite awhile, so possibly the meds have gradually helped. I am more prone to depression than the anger, as you might be able to tell from the meds, but it is nice not to feel I may jeopardize a job or something by an inappropriate reaction. Again, it is not like a rage or anything that severe, just an intense reaction where I almost feel removed from myself and I need to do or say SOMETHING to release the tension. I don't know if this makes sense at all...
How are you doing and have you found others who you can relate to, even though you are in the infamous "NOS" category?
Posted by Steve on April 14, 1999, at 3:29:09
In reply to Re: Refractory depression--naltrexone theories?, posted by Jim on April 12, 1999, at 19:02:34
The brain cleaves its opiates out of one big
peptide called ACTH, which is undersecreted in
some forms of depression. It is conceivable that
by blocking the mu opiate receptor you can trick
the brain into churning out more ACTH, and therefore
more opiates which do elevate mood.> Wayne,
> On your questions about who naltrexone
> works for and why, I too am just an
> interested (perhaps too interested!)
> patient. I agree that most reports
> (especially Lee Dante's) see it working
> only as an augmentation strategy with
> things like SSRIs (and also sometimes
> tricyclics). But when I did some of my own
> research on naltrexone use across
> the board, I did find a bunch of places
> in the alcholism & autism literature where
> there was some question about whether it
> might have an antidepressant effect in its
> own right. This has not really been
> formally researched so you're right to see
> naltrexone as remaining basically an
> augmentation strategy for the time being.
> (My *theory* that I posted was basically
> the best one that I as a non-specialist could
> come up with!) If there are other people
> that naltrexone has helped, I'd be interested
> to see them come out of the woodwork too!
> -Jim
Posted by Elizabeth on April 14, 1999, at 6:31:41
In reply to Re: Bipolar/Treatment Resistant Depressions/ECT!!!, posted by Nancy on April 13, 1999, at 17:03:53
> Gee, ever hear of dyskinesia???? As far as ECT goes, it was the ONLY treatment that stopped my 18 month dibilitating bipolar depression. I should have had ECT after 6 months of treatment resistance.
EPS don't occur at lower doses of the atypical antipsychotics (olanzapine probably better than risperidone). (Low doses are usually sufficient for nonpsychotic affective illness, as far as I can tell.)
I do read your posts and I'm sure that ECT was right for *you*, but I think you should be a little more conservative in recommending it to other people regardless of the form their illness takes. It's appropriate in some cases of very severe or refractory depression (or mania), but not for more minor affective illness, such as dysthymic depression. And as noted, it may not even work in some types of depression. It's an extreme measure, necessary in some cases but not a first-line treatment.
Posted by Jim on April 14, 1999, at 7:37:18
In reply to Re: Refractory depression--naltrexone theories?, posted by Steve on April 14, 1999, at 3:29:09
Steve wrote:
> The brain cleaves its opiates out of one big
> peptide called ACTH, which is undersecreted in
> some forms of depression. It is conceivable that
> by blocking the mu opiate receptor you can trick
> the brain into churning out more ACTH, and therefore
> more opiates which do elevate mood.
>
>
Steve--
Actually, my unschooled hypothesis is somewhat different, though you're probably right to a certain extent. From what I've seen, however, most clinical efficacy of naltrexone seems to come from the opiate antagonism itself--one of the best supported examples of this might be in self-cutting patients, who are probably literally "addicted" to the endogenous opiates (endorphins) they can produce by hurting themselves. The same could be said for binge-eating and compulsive gambling patients, who have also apparently shown some good responses to naltrexone treatment. I suppose my underlying hypothesis here is that certain types of depression may have similar processes at work, even if they are not manifested in outright behaviors. (Opioids are produced in response to stress, and stress is both a causal factor and a feature of depression...) Naltrexone may help to extinguish these kinds of psychological / physiological" short circuits" that, like morphine addiction, flood the system with opiates and thereby downregulate (i.e., decrease the number of) the opoid receptors. A good part of naltrexone's efficacy may come from its ability, through antagonism, to help restore the receptor population to normal levels so that opioids can function more "normally" in the body once again, perhaps in some cases even at *lower* levels than before treatment. (The research I've seen is very inconclusive about what naltrexone does to endorphin blood levels.) Once again, all my spoutings here to be taken with a healthy adjunctive grain of salt, since they are basically those of an armchair neuropharmacologist!
Best,
Jim
Posted by Elizabeth on April 14, 1999, at 17:51:11
In reply to Re: bipolar NOS - Elizabeth, posted by Elaine on April 14, 1999, at 0:19:40
Hi Elaine.
I figured out where I heard about "anger attacks" in depression: some people at Mass. General have been researching the connection between anger attacks, depression, panic disorder, etc. for about a decade. The site listing current research is www.hmcnet.harvard.edu/psych/redbook.
Anyway, anger attacks are linked mainly with unipolar depression - not manic-depression or (despite some obvious similarities) panic disorder. You didn't mention whether you experience symptoms of autonomic arousal (rapid heartbeat or palpitations, sweating, nausea, difficulty breathing, etc.) during your "spells," but that's what distinguishes "anger attacks."
Anyway, irritability can occur in depression as well as mania. (I think it's only recognized "officially" in childhood depression, but there's no reason to suppose that adults couldn't show irritability as a symptom of depression too. Especially since, well, they do.)
I'm sort of startled by the idea that if you are depressed but don't seem to respond to antidepressants, you must be bipolar (even if you've never had a manic episode). Which antidepressants have you tried, and how is your current cocktail working out? (I'd never heard of Neurontin being used for depression as such, although I have seen its increasing popularity for use in anxiety disorders.) The name doesn't matter too much, as its main purpose is to communicate with other clinicians about you (e.g., if you're hospitalized, or if you move and need to get a new psychiatrist). (Well, that and to communicate with your insurance co. :-P) But given what you've said, "bipolar" seems like a misleading description.
I know of a number of people who, like me, seem to have "bipolar III" - informally, this designation is sometimes used to describe a syndrome of recurring major depression with one of: (1) antidepressant-induced manic or hypomanic symptoms; (2) family history of bipolar disorder; or (3) "hypomanic temperament." I think most people who develop mania or hypomania on antidepressants have milder symptoms than I did (I had a minor episode on Paxil and a severe mixed episode (psychotic) on Effexor). My depressions are pretty "classic," though.
Buprenorphine works pretty well for me, but it has a lot of side effects so I'm not sure I'd recommend it unless you've exhausted most of your other options.
Posted by Elizabeth on April 14, 1999, at 18:01:47
In reply to Re: Refractory depression--naltrexone theories?, posted by Jim on April 14, 1999, at 7:37:18
> Actually, my unschooled hypothesis is somewhat different, though you're probably right to a certain extent. From what I've seen, however, most clinical efficacy of naltrexone seems to come from the opiate antagonism itself--one of the best supported examples of this might be in self-cutting patients, who are probably literally "addicted" to the endogenous opiates (endorphins) they can produce by hurting themselves.
This jumped out at me because, from having talked to "cutters," I really do get the impression that cutting is addictive for them, that they have "urges" the same way that a substance addict has "cravings." (Maybe other forms of self-injury can be addictive as well, but it's curious how people seem to discover cutting independently *so* often)
A researcher I've spoken to who has some experience using opioids of various sorts for depression says that naltrexone by itself often causes dysphoria. It might be that naltrexone works specifically in the type of cases you list (impulse-control type disorders). (I won't presume to guess why it would cause relief sometimes and dysphoria other times, since I imagine I'd just be proved wrong. :-})
Posted by Elaine on April 15, 1999, at 0:04:24
In reply to Re: bipolar NOS - Elaine, posted by Elizabeth on April 14, 1999, at 17:51:11
Hi, Elizabeth! Thanks for the info, I'll check out the site.
If I am not bipolar, unipolar depression seems like a possibility. You're right, though, a name is just a name, although one always hopes that a correct dx leads to correct tx. I would not call my anger "irritability". At its worst, I shake with intensity, feel like my face is burning up, and start feeling like I'm losing touch with myself. It happens rarely.
My pdoc and therapist both seem to accept non-response to ADs as something that helps to confirm a bipolar diagnosis. And my therapist is not a ready believer of a bipolar diagnosis. I think I have also read that at various sites. I am prescribed ADs when the depression becomes significant, but I believe mostly to augment the mood stabilizers rather than act on their own. Neurontin (gabapentin) is the latest, or one of the latest, in the series of anti-seizure meds being used for mood disorders. So, it should help both depression AND anxiety. I would say I have classic depressions, but the other end of the bipolar spectrum is the part that remains the mystery. If I haven't said it before, I am on Lithium, Neurontin and levoxyl. They seem to be working, so quite possibly the Lithium (Neurontin is too recent an addition to tell) has helped over time to even out my moods, including preventing those anger "flashes". My pdoc, by the way, told me Neurontin is supposed to help delay reactions and allow more appropriate responses, including those being worked on in therapy. In other words, it helps give you time to think about and hopefully practice behaviors being worked on with a therapist.
I'm pretty comfortable in saying I'm not bipolar III. It would be pretty difficult to accept becoming bipolar as the result of medications, rather than something like a chemical imbalance. It somehow would seem "not fair". Is there recovery from that type of bipolar? Are you now primarily depressed, or are you still subject to mania, full blown or not?
Posted by Elizabeth on April 15, 1999, at 6:53:52
In reply to Re: bipolar NOS - Elizabeth, posted by Elaine on April 15, 1999, at 0:04:24
Hi Elaine.
What you describe does sound like it might be anger attacks. The feeling spacey, not all there, or "losing touch with myself" is called depersonalization and is another panic symptom.
I'm not sure whether or why Neurontin would help with depression (it certainly hasn't been shown to, although lithium has), but if it works for you, that is the important thing. (They really don't seem to know how it works, even more so than other psychotropic drugs!) I think I may have already asked this: which antidepressants have you tried?
I should have been more clear in explaining how I've heard "bipolar III" used: if you have a spontaneous manic episode, then it's not considered bipolar III anymore, but bipolar I (if it's a manic episode) or II (if it's a hypomanic episode). I have never had a spontaneous manic or hypomanic episode. Having mania on antidepressants doesn't necessarily make you bipolar in a strict sense (that is, you don't necessarily start having manic episodes without antidepressants afterwards), but it means that you need to watch out for mania in the future when taking antidepressants.
(BTW what makes you think that antiderpessant-induced mania is not caused by a "chemical imbalance," whatever that's supposed to mean?)
Posted by Jim on April 15, 1999, at 7:52:33
In reply to Re: Refractory depression--naltrexone theories?, posted by Elizabeth on April 14, 1999, at 18:01:47
Elizabeth,
You might be interested to hear that I've recently started to try low-dose naltrexone augmentation myself (atop the imipramine I've taken seemingly forever). I DID have some scary nightmares at the start and promptly quit, but was persuaded to try again at a still lower dose along with a bit of klonopin. The results this time (though still way too early to be conclusive) have been extremely encouraging, I'd even say unlike anything I've tried before. (Paradoxically, it's weird to just feel normal!) Naltrexone is clearly a very interesting med with complex opioid-mediated effects on both impulse and mood. Though I still can't be sure how it will work out with me (fingers are crossed), I reckon at least that it has some kind of future in helping to treat depression--especially in cases where some kind of opioid involvement is suspected (cravings, addictions, trauma history, etc.).
--JimElizabeth wrote:
> A researcher I've spoken to who has some experience using opioids of various sorts for depression says that naltrexone by itself often causes dysphoria. It might be that naltrexone works specifically in the type of cases you list (impulse-control type disorders). (I won't presume to guess why it would cause relief sometimes and dysphoria other times, since I imagine I'd just be proved wrong. :-})
Posted by Wayne R. on April 15, 1999, at 11:36:44
In reply to Re: Refractory depression--naltrexone, posted by Jim on April 15, 1999, at 7:52:33
Jim wrote:
>
I've recently started to try low-dose naltrexone augmentation myself (atop the imipramine I've taken seemingly forever). … The results this time (though still way too early to be conclusive) have been extremely encouraging, I'd even say unlike anything I've tried before. (Paradoxically, it's weird to just feel normal!)Jim, I will be so thrilled if you should duplicate my results! My wife commented this morning how she cannot believe how different I have become. I have a sense of wellbeing and optimism that I have never experienced. Rooting for you… Wayne
Posted by Jim on April 15, 1999, at 11:53:10
In reply to Re: Refractory depression--naltrexone, posted by Wayne R. on April 15, 1999, at 11:36:44
Much thanks, Wayne; I'm nervous but obviously hoping for the best... The amount of naltrexone I'm taking is almost ludicrously small by official standards: no more than 1/20th of a tablet every other day, perhaps 2mg! (Anything more hits me like a freight-train and becomes very unpleasant, though I was this way with SSRIs too.)
--JimWayne wrote:
> Jim, I will be so thrilled if you should duplicate my results! My wife commented this morning how she cannot believe how different I have become. I have a sense of wellbeing and optimism that I have never experienced. Rooting for you… Wayne
> Jim wrote:
> >
> I've recently started to try low-dose naltrexone augmentation myself (atop the imipramine I've taken seemingly forever). … The results this time (though still way too early to be conclusive) have been extremely encouraging, I'd even say unlike anything I've tried before. (Paradoxically, it's weird to just feel normal!)
>
Posted by Elizabeth on April 17, 1999, at 9:33:06
In reply to Re: Refractory depression--naltrexone, posted by Jim on April 15, 1999, at 11:53:10
Jim, I'm thrilled to hear that things are going so well for you. How long have you been taking the naltrexone?
Could you describe in more detail your reaction to the 25mg dose of naltrexone? I'm curious because you compared it to your response to SSRIs - some folks with panic disorder experience an "activation syndrome" if they start on normal doses of an SSRI (they have to start out at, say, 5mg of fluoxetine), and I'm wondering if this might be the same thing. (Dunno if this happens with other anxiety disorders.) (Did you try the start low/go slow strategy with SSRIs?)
BTW what are your diagnosis (-es?) and predominant symptoms?
I'm interested in particular because while I had a phenomenal response to buprenorphine, the side effects were just too much. (I'd hoped it would be better than morphine, but no such luck.) So I'm going back to Parnate, augmenting with lithium and possibly a tricyclic. I don't have impulse-control problems (eating disorders, substance abuse, self-injury, etc.) or poop-out issues (with Parnate, anyway) so I'm not sure if naltrexone would be right for me, but it would be useful to get a better idea of when it works for other people.
Best of luck to you.
Posted by Jim on April 17, 1999, at 12:35:50
In reply to Re: Refractory depression--naltrexone, posted by Elizabeth on April 17, 1999, at 9:33:06
Elizabeth,
Thanks for the support--it's been a wild week and I'm still waiting to see how things settle down if & when I can get a stable regimen going. As you might have heard, I cut short my first try with naltrexone augmentation after about 3 days. I had started with miniscule doses (around 5mg/day) given my general supersensitivity to meds, but even this proved too much--by the morning of day 3 I had some very serious dysphoria going and threw in the towel. Surprisingly, it was about three or four days LATER that I began to feel curiously better, though given my general mood lability II didn't make much of a connection at the time, especially as I had read that naltrexone's half-life was about 10 hours. (Turns out this is perhaps not entirely true--see below.)
Anyhow, I started again with still lower (!) doses last weekend--we're talking tiny chips, perhaps 2 or 3mg--and noticed a positive effect within hours. (I also added a speck of klonopin nightly at bedtime.) By mid-week, I felt an antidepressant effect truly unlike any I had ever felt before--alas, it was a bit *too* intense, if anything, and I find myself now trying to get things to level off a bit. (My response wasn't hypomanic, more of an excited Rip-Van-Winkle-like strangeness overlaid by surface calm...) What I've found out in my copious web research over the last few days is that naltrexone may have an effective half-life of far more than 10 hours, which may somewhat explain the unexpected dynamics.
In any case, I'm in an expectant wait-and-see mode right now. Like Wayne before me, I feel this has at least the *potential* to change my quality of life completely, but I'll need to figure out the dosage issues and do a lot of readjusting to get to that point. FYI, I am probably best categorized as a long-term "refractory dysthymic", with atypical depressive features, a touch of OCD, and serious food cravings. Personally, I am surprised that naltrexone is not yet being more widely used as an adjunctive therapy in refractory depression--I will echo Wayne in highly recommending the material from Dr. Lee Dante and others in the "tips" section of this site. Your positive reaction to Buprenorphine may be all the more reason to try an antagonist strategy that might actually get closer to the root of things.
Thanks again and best of luck back to you. I'll try to keep the list posted with my results. (And by the way, when I tried Prozac for a while I used to take less than 1/2 mg!)
Jim
Elizabeth wrote:
>
> ... Could you describe in more detail your reaction to the 25mg dose of naltrexone? I'm curious because you compared it to your response to SSRIs - some folks with panic disorder experience an "activation syndrome" if they start on normal doses of an SSRI (they have to start out at, say, 5mg of fluoxetine), and I'm wondering if this might be the same thing. (Dunno if this happens with other anxiety disorders.) (Did you try the start low/go slow strategy with SSRIs?)
>
> BTW what are your diagnosis (-es?) and predominant symptoms?
>
> I'm interested in particular because while I had a phenomenal response to buprenorphine, the side effects were just too much. (I'd hoped it would be better than morphine, but no such luck.) So I'm going back to Parnate, augmenting with lithium and possibly a tricyclic. I don't have impulse-control problems (eating disorders, substance abuse, self-injury, etc.) or poop-out issues (with Parnate, anyway) so I'm not sure if naltrexone would be right for me, but it would be useful to get a better idea of when it works for other people.
>
> Best of luck to you.
Posted by Elizabeth on April 19, 1999, at 2:50:40
In reply to Re: Refractory depression--naltrexone, posted by Jim on April 17, 1999, at 12:35:50
Hi Jim. I did ask my doctor about ReVia, and he, as well as the consultant who originally recommended the buprenorphine, didn't seem to think it was such a hot idea. I would be interested to find out if anyone has a good idea of how opioid agonist responders fare on the pure antagonists, though.
To anyone who's tried naltrexone, what sort of side effects did it have (and do you happen to know of any other common ones)? Given that I'm probably doomed to polypharmacy, I'd like to keep that sort of thing to a minimum.
Back to Jim - your symptoms sound pretty much dissimilar to mine, which is discouraging. I have pretty much classic episodic melancholia, and panic disorder (which seems pretty easy to treat and as such isn't a big concern for me these days). No significant atypical features except for occasional bouts of social phobia, and as noted, no impulse-related symptoms. (In particular, despite having experimented with drugs and alcohol quite a lot in college, I've never had problems with addiction.) I've had depressions since adolescence (now nearly 23), and they've grown closer together and more severe over time. When depressed I tend to have early-morning insomnia (where I wake up feeling like sh*t), pronounced feelings of self-reproach and guilty ruminations, loss of pleasure, motivation, and interest, fatigue and feelings of being "slowed down," and appetite loss. I've also been battling chronic pain and sleep problems for quite a while.
I was under the impression that naltrexone is rather long-acting, actually, and that q.o.d. dosing suffices for many. I could be thinking of something else, though.
Posted by Jim on April 19, 1999, at 4:39:41
In reply to Re: Refractory depression--naltrexone, posted by Elizabeth on April 19, 1999, at 2:50:40
Hi Elizabeth,
I don't want to sound like a naltrexone pusher--I'm having enough of a time trying to get it stabilized with me... (I'm apparently as supersensitive to it as to SSRIs, which is a disappointment.) I will say, however, that I have tended to really "enjoy" the effects of prescribed opiates in the past (e.g., I absolutely savored the demerol from my last tooth extraction); this is one of the reasons I was originally interested in buprenex, too. I agree that our symptoms are not totally similar, especially when it comes to food cravings, but I've also had anxiety-panic and definitely social phobia (along with a couple major depressive episodes). Naltrexone duration is supposedly a function of dosage (hence the various dosing schedules), but it seems that its course of antagonism at receptors is not fully understood yet.
Best, Jim> Hi Jim. I did ask my doctor about ReVia, and he, as well as the consultant who originally recommended the buprenorphine, didn't seem to think it was such a hot idea. I would be interested to find out if anyone has a good idea of how opioid agonist responders fare on the pure antagonists, though.
>
> To anyone who's tried naltrexone, what sort of side effects did it have (and do you happen to know of any other common ones)? Given that I'm probably doomed to polypharmacy, I'd like to keep that sort of thing to a minimum.
>
> Back to Jim - your symptoms sound pretty much dissimilar to mine, which is discouraging. I have pretty much classic episodic melancholia, and panic disorder (which seems pretty easy to treat and as such isn't a big concern for me these days). No significant atypical features except for occasional bouts of social phobia, and as noted, no impulse-related symptoms. (In particular, despite having experimented with drugs and alcohol quite a lot in college, I've never had problems with addiction.) I've had depressions since adolescence (now nearly 23), and they've grown closer together and more severe over time. When depressed I tend to have early-morning insomnia (where I wake up feeling like sh*t), pronounced feelings of self-reproach and guilty ruminations, loss of pleasure, motivation, and interest, fatigue and feelings of being "slowed down," and appetite loss. I've also been battling chronic pain and sleep problems for quite a while.
>
> I was under the impression that naltrexone is rather long-acting, actually, and that q.o.d. dosing suffices for many. I could be thinking of something else, though.
Posted by paul on April 19, 1999, at 10:01:37
In reply to Re: Refractory depression--naltrexone, posted by Jim on April 19, 1999, at 4:39:41
Please put me on your "mailing list" for info on opioid agonists/antagonists in the treatment of depression, dysthymia, etc. It seems that if opioid agonists, whose primary mechanism of action is typically associated with (short-term) euphoria (often listed as a "side effect" in medical texts), then it should follow that antagonists would have no mood-elevating effects whatsoever.
I am fascinated with the seemingly paradoxical effects of antagonists, I would be interested in joining this discussion. I'm also interested in the effects of mixed agonists/antagonists.
Thanks.
Posted by paul on April 19, 1999, at 10:22:43
In reply to naltrexone, posted by paul on April 19, 1999, at 10:01:37
> Please put me on your "mailing list" for info on opioid agonists/antagonists in the treatment of depression, dysthymia, etc. It seems that if opioid agonists, whose primary mechanism of action is typically associated with (short-term) euphoria (often listed as a "side effect" in medical texts), then it should follow that antagonists would have no mood-elevating effects whatsoever.
>
> I am fascinated with the seemingly paradoxical effects of antagonists, I would be interested in joining this discussion. I'm also interested in the effects of mixed agonists/antagonists.
>
> Thanks.I posted the above message before I read the hypotheses/theories that preceded it. Very interesting. Is the idea of naltrexone as an adjunct to SSRI's new in the psychiatric community? In other words, is the average psychiatrist familiar with such treatment? Also, is this augmentation particularly useful in those with a propensity to abuse (oral only) opioids, such as hydrocodone? I take Zoloft and while I don't have a serious problem, I do have an affinity for things that attach to my opioid receptors.
Posted by Victoria on April 19, 1999, at 15:06:55
In reply to Re: Refractory depression--naltrexone, posted by Elizabeth on April 19, 1999, at 2:50:40
Elizabeth, Your symptoms sound very much like mine (except no panic disorder). The reference you made to chronic pain and sleep problems makes me think of my recent diagnosis of fibromyalgia (did we exchange posts on this a while ago)? Anyway, I'm currently doing much better on a combination of trazadone and serzone at night, and fairly agressive thyroid and hormone replacement (estrogen and testosterone--I'm older than you are). The more I learn about both depression and fibromyalgia, the more I believe they are related problems with brain chemistry. You might want to take a look at "Betrayal By the Brain" by Jay Goldstein, MD. One interesting overlap is that he claims to have a lot of success with fibromyalgia with neurontin and pindolol (among other things, he's got about 30 meds he works with). And lately I've been seeing more about both of those drugs as anti-depressants or augmenters of anti-depressants. I'm going to see Dr. Goldstein next month, so if I get good results, I'll let you know.
> Hi Jim. I did ask my doctor about ReVia, and he, as well as the consultant who originally recommended the buprenorphine, didn't seem to think it was such a hot idea. I would be interested to find out if anyone has a good idea of how opioid agonist responders fare on the pure antagonists, though.
>
> To anyone who's tried naltrexone, what sort of side effects did it have (and do you happen to know of any other common ones)? Given that I'm probably doomed to polypharmacy, I'd like to keep that sort of thing to a minimum.
>
> Back to Jim - your symptoms sound pretty much dissimilar to mine, which is discouraging. I have pretty much classic episodic melancholia, and panic disorder (which seems pretty easy to treat and as such isn't a big concern for me these days). No significant atypical features except for occasional bouts of social phobia, and as noted, no impulse-related symptoms. (In particular, despite having experimented with drugs and alcohol quite a lot in college, I've never had problems with addiction.) I've had depressions since adolescence (now nearly 23), and they've grown closer together and more severe over time. When depressed I tend to have early-morning insomnia (where I wake up feeling like sh*t), pronounced feelings of self-reproach and guilty ruminations, loss of pleasure, motivation, and interest, fatigue and feelings of being "slowed down," and appetite loss. I've also been battling chronic pain and sleep problems for quite a while.
>
> I was under the impression that naltrexone is rather long-acting, actually, and that q.o.d. dosing suffices for many. I could be thinking of something else, though.
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