![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 83. This is the beginning of the thread.
Posted by Pacha on May 6, 2001, at 7:30:27
Lately i've been seeing a lot of talk about opiates being used successfully in treating depression.
I am unresponsive to all ssri and usual antidepressants. And would like to try one of the following: Tramadol, Darvon, Buprenorphine, Oxycontin, other ?
What are your views
Posted by Seraphim on May 6, 2001, at 10:29:46
In reply to Whats the best opiate for depression ?, posted by Pacha on May 6, 2001, at 7:30:27
> Lately i've been seeing a lot of talk about opiates being used successfully in treating depression.
>
> I am unresponsive to all ssri and usual antidepressants. And would like to try one of the following: Tramadol, Darvon, Buprenorphine, Oxycontin, other ?
>
> What are your viewsHi! Not to discourage you from trying, everyone is diferrent, but I have tried Darvon and Tramadol on and off for years and found only a fleeting benefit. I would also build up tolerance to the dosage very quickly. Personally, I think it works best if added to a lower dosage of a SSRI. Just my personal experimentations. The great things about them though is the lack of side effects for me. I didn't find them the least sedating, even at high doses, and except for a very mild feeling of dissociation, I felt pretty good.
Posted by JahL on May 6, 2001, at 11:49:09
In reply to Whats the best opiate for depression ?, posted by Pacha on May 6, 2001, at 7:30:27
> > I am unresponsive to all ssri and usual antidepressants.Me too.
> >And would like to try one of the following: Tramadol, Darvon, Buprenorphine, Oxycontin, other ?
I would like to know the experiences of others too. If that's all that's left you *gotta* at least consider it.
Hopefully this thread won't get hijacked by the anti-opiate brigade...
J.
Posted by dougb on May 6, 2001, at 16:39:57
In reply to Re: Whats the best opiate for depression ?, posted by JahL on May 6, 2001, at 11:49:09
>
> > > I am unresponsive to all ssri and usual antidepressants.
>
> Me too.-- Me three
> > >And would like to try one of the following: Tramadol, Darvon, Buprenorphine, Oxycontin, other ?
Darvon is working well for my as did Hydrocodone
>
> I would like to know the experiences of others too. If that's all that's left you *gotta* at least consider it.
>
--- If you do a search on dougb you will find a lot of posts that i have made, alternately search on = > Opi Opiate Opioid
Posted by shelliR on May 6, 2001, at 18:08:18
In reply to Whats the best opiate for depression ?, posted by Pacha on May 6, 2001, at 7:30:27
> Lately i've been seeing a lot of talk about opiates being used successfully in treating depression.
>Before I would try opiates for depression, I would definitely try MAOIs. Also, I think next month, the selegiline patch will be available, an MAOI that will (I believe) cause no food/drug interactions.
Have you tried an MAOI?
You have to really plan out taking opiates for depression. You don't want to start unless you have a way to continue, i.e., be able to keep getting prescriptions. Also, while opiates seem to have a good antidepressant effect for some; others they make feel dizzy and ill. And you should plan to have to increase your dose to continue the anti-depressant effects.As to the best, I don't know. I take small amounts of hydrocodone. I just e-mailed (Friday) questions to a doctor who participated in a study using buprenorphine, which if I understand correctly, is an opiate antagnonist which does not create a high but can help depression. Incidently, he is also part of the group which developed the selegiline patch--at McLean Hospital in Boston. His secretary suggested the e-mail; if I get any insight from him I'll share it.
I'm just amazed, however, how many people on this board say they have tried everything and have not tried nardil, parnate, or some of the reversable MAOIs. They are very different from all the other antidepressants and they did the job for me for fifteen years.
Shelli
Posted by kazoo on May 7, 2001, at 0:51:30
In reply to Re: Whats the best opiate for depression ? » Pacha, posted by shelliR on May 6, 2001, at 18:08:18
> > Lately i've been seeing a lot of talk about opiates being used successfully in treating depression.
> >
>
> Before I would try opiates for depression, I would definitely try MAOIs. Also, I think next month, the selegiline patch will be available, an MAOI that will (I believe) cause no food/drug interactions.
>
^^^^^^^^^^I agree with the above.
Opiates for depression? That's like a trans-orbital lobotomy for a headache. It just doesn't make any sense, but, then again, none of these drug combinations do, and I'm amazed (and baffled) as to how (and why) they do.
The only problem I see with using this genre of drug for depression is this: try convincing a doctor that you need DILAUDID for the "blues" and watch how fast you get kicked out of their office. Unless the doctor is totally dynamic (not to be confused with "insane"), I see little hope in getting a downer to help someone in a "downer" condition.
Remember, doctors use the PDR as their Bible, so unless you can rewrite the indications for the drugs you mention to include depression, you may want to consider shellR's good advice before being labled as one with "drug seeking behavior" (Gasp! Gasp!)
kazoo
Posted by kazoo on May 7, 2001, at 1:56:57
In reply to Re: Whats the best opiate? PACHA, posted by kazoo on May 7, 2001, at 0:51:30
As always, I'm having second thoughts about my previous post re. the use of opiates to relieve depression.
Conventional wisdom, as it is, dictates that opiates, and the synthetic narcotic analogs, are specifically and concisely indicated, via the PDR, for physical "pain" such as a toothache, bone fracture or cancer. With that being the case, one could say that depression is a form of mental anguish, and mental anguish is just as painful as physical pain. So it would follow, then, that opiates would be good for this painful mental anguish called depression. I realize that I'm mixing realities with metaphors, but I *can* understand why someone would use a narcotic to relieve the terrible anguish associated with depression. Morphine has this wonderful quality of not only relieving physical pain, but also providing a "lift" in spirits, whether from the absence of pain or the presence of those chemicals which induce this sense of well-being. So, if we did not use morphine to relieve physical pain, but used it for just this sense of "wellness," is this still a justifiable reason to use type of drug?
The logic (if any) skates on thin ice, and I'm flip-flopping back and forth, which I dislike doing.
I do know that one can build up a tolerance to opiates very quickly, and if you should need them for a terrible physical pain, such as a third degree burn, they don't work as well, if at all, so there goes the "justification."
Opiates may provide a "quick-fix" to relieve the despair in any mental state, and is this so wrong to do? Yes and no, and vice versa. However, the medical community doesn't view it this way, and it is through this very same medical community that any chance of changing their common, status-quo thinking is just as futile as asking the original question.
I'm stumped on this one.
(a flip-flopping, stumped) kazoo
Posted by Elizabeth on May 7, 2001, at 7:48:54
In reply to Re: Whats the best opiate for depression ? » Pacha, posted by shelliR on May 6, 2001, at 18:08:18
Of the ones you mentioned, buprenorphine or tramadol would be my choice.
Buprenorphine has the advantage that it can be combined safely with classic monoaminergic antidepressants, which is somewhat risky with Ultram (MAOIs, in particular, are absolutely contraindicated). A disadvantage is that there is no pill form available in the U.S. at this time. People in other countries who've tried the sublingual formulation -- known by the brand names Subutex and Temgesic -- say that it doesn't work very well by that route, which is consistent with my experience attempting to take Buprenex (the solution) sublingually. (Dr. Bodkin, the researcher Shelli mentions, confirmed that this has been his experience as well, BTW.)
Tramadol has the advantage that it is available in the U.S. in pill form (also it is not a controlled substance (YET), so you're more likely to be able to get a prescription for it). It may be toxic if you raise the dose too high.
Darvon is rather toxic and very weak. Oxycontin is very expensive, and oxycodone is more likely to produce tolerance rapidly than buprenorphine or Ultram.
Methadone might be a good choice, as it is extremely long-acting (so tolerance will develop relatively slowly). A disadvantage is that if you become unable to obtain it, the withdrawal syndrome is incredibly long-lasting (although not as intense as withdrawal from shorter-acting opioids).
Certain opioids, such as morphine and hydromorphone, are not well-absorbed orally and therefore probably not the best choice.
I agree with Shelli that if you haven't tried MAOIs, they are very much worth a go.
> Before I would try opiates for depression, I would definitely try MAOIs. Also, I think next month, the selegiline patch will be available, an MAOI that will (I believe) cause no food/drug interactions.
The selegiline patch can cause drug-drug interactions (e.g., with Sudafed or Demerol) but, because it bypasses the GI tract, it won't interact with foods. Shelli -- where did you hear that it will be available that soon? That'd be pretty neat.
> You have to really plan out taking opiates for depression. You don't want to start unless you have a way to continue, i.e., be able to keep getting prescriptions.
Yes. This is a disadvantage of full agonists in particular, because they have extremely intense withdrawal syndromes compared with partial agonists. People develop tolerance at different rates, and some experience seems to suggest that many who take opioids for depression can continue indefinitely on the same dose (my therapist, in particular, has found this to be the case on the few occasions when he has used morphine as an AD).
> I just e-mailed (Friday) questions to a doctor who participated in a study using buprenorphine, which if I understand correctly, is an opiate antagnonist which does not create a high but can help depression.
That would be Dr. Bodkin. It's true that buprenorphine does not create a high, but it is a partial agonist rather than an antagonist. (It is supposedly an antagonist at kappa opioid receptors, but I haven't actually seen any data to support this idea. Anyway, kappa agonists, such as Stadol, are apparently rather unpleasant for depressed people who respond to opioids; the mu receptor is probably the one responsible for their antidepressant effect.)
> Incidently, he is also part of the group which developed the selegiline patch--at McLean Hospital in Boston. His secretary suggested the e-mail; if I get any insight from him I'll share it.
McLean is in Belmont, actually. :-)
> I'm just amazed, however, how many people on this board say they have tried everything and have not tried nardil, parnate, or some of the reversable MAOIs. They are very different from all the other antidepressants and they did the job for me for fifteen years.
Yeah, they sure are (although I think that the reversible MAOIs are probably not as effective for people who've failed to respond to other ADs).
Shelli -- let me know what Dr. Bodkin says. I spoke to him a few days ago (about a referral) but he didn't have much time to talk so I refrained from asking him how his research was going.
Posted by shelliR on May 7, 2001, at 11:15:59
In reply to Re: Whats the best opiate for depression ?, posted by Elizabeth on May 7, 2001, at 7:48:54
Hi Elizabeth.I talked to Dr. Bodkin for about three minutes and he's the one who told me that the selegiline patch was due to come out. He said he'd talk to me again when he got back from being out of town, but so far no luck.
So I called Dr. Lukas (same hospital, same studies) and it was his secretary that told me to e-mail him. I asked him about opiates and also exactly when the patch was due out. IF I hear from him, I'll let you know what he says.
Do you think Bodkin is worth having a consultation with? (I'd have to come up from Washington, D.C.).
It seems, though, that the information you are giving me is probably the same that he would.I don't have anyone to try different optiates with me here. I will look up tramadol, because I don't know anything about it. But even if that's what Bodkin would recommend, I'm not sure he'd write me prescriptions (since I'd only be going for a consult), and my pdoc down here (who I never see--just renews my prescriptions) is okay with me taking a small dose of hydrocodone, but won't prescribe it.
So basically, I feel like I am my own pdoc now. Sometimes that feels scary and lonely, but at other times it is a relief not to hear all the time from my last pdoc how codeine is not an anti-depresssant, how I will become an addict etc. Your clarification on habituation vs addition led to my doing a lot of reading on the subject. Basically, I ended up feeling a lot better about the whole thing. So thanks.
One question I asked Dr. Lukus was, besides eliminating food interactions, if there was any anti-depressant advantage to the patch. Selegiline is a reversible MAOI, right? So I was curious to know how it compares to nardil or parnate orally in terms of anti-depressant value for treatment resistent depression. My guess is that I would not be a good candidate for it, but I'm curious what he will say, if I do indeed get an answer.
Shelli
Posted by mikes on May 7, 2001, at 12:37:59
In reply to Re: Whats the best opiate for depression ?, posted by JahL on May 6, 2001, at 11:49:09
"anti-opiate brigade"....LMAO.
> Hopefully this thread won't get hijacked by the anti-opiate brigade...
>
> J.
Posted by JahL on May 7, 2001, at 12:50:47
In reply to Re: Whats the best opiate for depression ?, posted by mikes on May 7, 2001, at 12:37:59
> "anti-opiate brigade"....LMAO.
'Scuse my ignorance, but what does LMAO stand for?
Posted by JahL on May 7, 2001, at 12:53:42
In reply to Re: What? » mikes, posted by JahL on May 7, 2001, at 12:50:47
> > "anti-opiate brigade"....LMAO.
>
> 'Scuse my ignorance, but what does LMAO stand for?Laugh My Ass Off???
Posted by jimmygold70 on May 7, 2001, at 15:48:13
In reply to Whats the best opiate for depression ?, posted by Pacha on May 6, 2001, at 7:30:27
Pacha,
Did you try ECT ? (Electroconvulsive Therapy). That's more effective than most drugs.
Jimmy
> Lately i've been seeing a lot of talk about opiates being used successfully in treating depression.
>
> I am unresponsive to all ssri and usual antidepressants. And would like to try one of the following: Tramadol, Darvon, Buprenorphine, Oxycontin, other ?
>
> What are your views
Posted by mikes on May 7, 2001, at 21:56:53
In reply to Re: What? » JahL, posted by JahL on May 7, 2001, at 12:53:42
yes, laughing, to be exact. any idea what "SWIM" means? I've been trying to figure it out for months.
> > > "anti-opiate brigade"....LMAO.
> >
> > 'Scuse my ignorance, but what does LMAO stand for?
>
> Laugh My Ass Off???
Posted by mikes on May 7, 2001, at 22:07:50
In reply to Re: Whats the best opiate for depression ?, posted by jimmygold70 on May 7, 2001, at 15:48:13
The lengths you will go to to avoid a high...jeez. I wouldn't mind losing some of my memories, but why bother if opiates can do the job?
> Pacha,
>
> Did you try ECT ? (Electroconvulsive Therapy). That's more effective than most drugs.
>
> Jimmy
>
Posted by kazoo on May 8, 2001, at 1:01:09
In reply to Re: Whats the best opiate for depression ?, posted by jimmygold70 on May 7, 2001, at 15:48:13
> Did you try ECT ? (Electroconvulsive Therapy). That's more effective than most drugs.
> Jimmy^^^^^^^^^^
Jimmy, me lad, one does not "try" ECT like "trying" a new brand of toothpaste. ECT is serious business and I can't imagine any patient confronting their doctor with this idea. It's up to the doctor to evaluate you to determine if you are a candidate, not the other way around.As I have stated in previous posts about this subject, ECT is not a walk in the park, or something that can be performed willy-nilly at the Office on just anybody who walks in the door, much less requesting it. There are a series of steps and tests that are mandated by sound (and sane) medical practice, not to mention law, before ECT is to be even considered.
ECT is the last resort for mental illness. It is done usually in a hospital setting and when everything (and I mean EVERYTHING) else fails.
And as far as ECT's efficacy goes, the jury has been out for the longest time on this topic, and, quite frankly, I think it will always be out. This is the most troubling thing (for me) about ECT: the fact that there are still (after all these decades) so many questions and doubts about its effectivenss.
All other routes and alternatives should be and must be exhausted before this sort of thing is to be even considered. If you search the archives, you can find such alternatives.
I don't know why the posters in this group so casually suggest ECT as the golden way-out from drug-resistant depression. It is not.
kazoo
Posted by Elizabeth on May 9, 2001, at 15:07:05
In reply to Re: Whats the best opiate for depression ? » Elizabeth, posted by shelliR on May 7, 2001, at 11:15:59
> I talked to Dr. Bodkin for about three minutes and he's the one who told me that the selegiline patch was due to come out. He said he'd talk to me again when he got back from being out of town, but so far no luck.
Yeah, he's been super-busy lately (he's not even taking any new patients except experimental subjects). So he's hard to reach. I spoke to him for just a couple minutes becuase I needed a referral.
> So I called Dr. Lukas (same hospital, same studies) and it was his secretary that told me to e-mail him.
Scott Lukas? I know him! He teaches a class on substance dependence. I think he's actually a PhD -- a *real* pharmacologist. < g >
> I asked him about opiates and also exactly when the patch was due out. IF I hear from him, I'll let you know what he says.
More perspectives are always welcome!
> Do you think Bodkin is worth having a consultation with? (I'd have to come up from Washington, D.C.).
I don't know if he'd even have time to see you! He's quite busy, as you've noticed.
> I don't have anyone to try different optiates with me here. I will look up tramadol, because I don't know anything about it. But even if that's what Bodkin would recommend, I'm not sure he'd write me prescriptions (since I'd only be going for a consult), and my pdoc down here (who I never see--just renews my prescriptions) is okay with me taking a small dose of hydrocodone, but won't prescribe it.
The idea of a consultation is, you go see the consultant, and the consultant speaks to your regular psychiatrist and makes recommendations as to your treatment. Yes, given your situation, I think a consultation (with Bodkin or, if he's too busy, with another doctor -- I'm sure he can make a good referral) would be worthwhile.
> So basically, I feel like I am my own pdoc now.
I know...I've had that feeling many times...like, nobody's there to help me so I have to just do my best to help myself.
> Your clarification on habituation vs addition led to my doing a lot of reading on the subject. Basically, I ended up feeling a lot better about the whole thing. So thanks.
You're welcome! I'm glad it had the desired reuslt.
> One question I asked Dr. Lukus was, besides eliminating food interactions, if there was any anti-depressant advantage to the patch.
It's supposed to start working quite fast.
> Selegiline is a reversible MAOI, right?
No. It's an irreversible one, preferentially inhibiting type B (but becoming nonselective at higher doses).
> So I was curious to know how it compares to nardil or parnate orally in terms of anti-depressant value for treatment resistent depression. My guess is that I would not be a good candidate for it, but I'm curious what he will say, if I do indeed get an answer.
I did try high-dose oral selegiline (for 6 weeks or so), but the results were less than stellar. It made me jittery, that was about it. (Kind of like Wellbutrin.) Maybe I wasn't taking enough.
Elizabeth
Posted by Elizabeth on May 9, 2001, at 15:12:40
In reply to Re: Whats the best opiate for depression ?, posted by jimmygold70 on May 7, 2001, at 15:48:13
> Pacha,
>
> Did you try ECT ? (Electroconvulsive Therapy). That's more effective than most drugs.It's extremely effective for certain types of depression, mania, and catatonia. However, it's got serious risks; also, as I noted, it is only effective for certain very specific types of depression.
I have not tried ECT, even though I do have one of the types of (treatment-resistant) depression that are known to respond well to it. (The type of depression I have is called melancholic depession.) This was my personal choice, of course, but it was based on seriously weighing the risks and possible benefits of ECT verus alternatives.
Posted by shelliR on May 11, 2001, at 12:20:31
In reply to Re: Whats the best opiate for depression ? / ETC, posted by Elizabeth on May 9, 2001, at 15:12:40
Elizabeth. I talked to Dr. Bodkin briefly today, and I had it wrong about the selegiline patch. It's not due out for a year.
He will do a consultation, but will not proscribe codeine because of a prior law suit. But he definitely seems very knowledgeable and gave me the name of someone in my area, who he admits is probably "less creative" in prescribing for depression than he is.
Shelli
Posted by dougb on May 11, 2001, at 17:05:54
In reply to Re: Whats the best opiate? PACHA, posted by kazoo on May 7, 2001, at 0:51:30
> Opiates for depression? That's like a trans-orbital lobotomy for a headache. It just doesn't make any sense, but, then again, none of these drug combinations do, and I'm amazed (and baffled) as to how (and why) they do.
Are you a doctor? or how do you arrive at above supposition?
> Remember, doctors use the PDR as their Bible, so unless you can rewrite the indications for the drugs you mention to include depression,My GP told me that he prescribes 'off-label' every day, He says that many off label uses of meds do not make it into the PDR due to economic reasons
>you may want to consider shellR's good advice before being labled as one with "drug seeking behavior" (Gasp! Gasp!)
Do you mean, withdrawal, constantly seeking better alternatives, inability to get off of meds, constant increase of dosage and rapidly acquired tolerance?
Posted by kazoo on May 12, 2001, at 0:13:38
In reply to Re: Whats... and Drug Seeking Behavior » kazoo, posted by dougb on May 11, 2001, at 17:05:54
> Are you a doctor? or how do you arrive at above supposition?
^^^^^^^^^^^^^^^^^^^^^^^^
A definition is needed here:An "opiate" is any set of various SEDATIVE narcotics which dulls the senses and induces relaxation or torpor; inducing sleep or sedation; soporific; causing dullness or apathy; deadening.
Pay particular attention to the word "deadening" then ask yourself how "deadening" the senses can, or would, lift someone from depression, which does a fine job of deadening the senses on its own.
If you thought unconventionally, you may fool yourself into believeing that the soporific effect may "lessen" the doldrums of depression, but that's not a judicious or wise approach given the addictive nature of the opiate family.
Over dinner the other night, I asked a psychiatrist from the Yale Psychiatric Clinic (YPI) whether he would prescribe an "opiate" to relieve depression. Without looking up, he said "No, that's ludicrous." I then asked him, "Even if the patient requested this giving sound reasons?" And his answer was "*Especially* if the patient requested this, reasons or not, it's just NOT DONE."
> My GP told me that he prescribes 'off-label' every day, He says that many off label uses of meds do not make it into the PDR due to economic reasons
^^^^^^^^^^^^^^^^^^^^^^^^^
What drugs are you talking about? Using RETIN-A as an anti-wrinkle cream instead of its indicated use for 'acne vulgaris'? You don't say which drugs he does this with? I've yet to encounter a doctor who does this, so you must be one of the lucky ones who has a doctor who does this sort of off-beat thing. How lucky can you get?
> Do you mean, withdrawal, constantly seeking better alternatives, inability to get off of meds, constant increase of dosage and rapidly acquired tolerance?
^^^^^^^^^^^^^
Does the term "doctor shopping" mean anything to you? Those ADDICTED to optiates have to CHASE FOR DOPE via DOCTOR SHOPPING and with the right amount of cash, there are plenty of them out there more than willing to oblige the hopelessly addicted, BUT DEPRESSED (!), individual.Opitates are not used for depression. To even think such a thing is an insult to the medical profession.
I will tell you one other thing: if you do get optiates to treat your so-called depression, and then you're shut off, you will experience the REAL depression you faked to begin with to get them. So who's fooling whom here? Not me.
kazoo
Posted by SalArmy4me on May 12, 2001, at 0:28:47
In reply to Re: Whats... and Drug Seeking Behavior, posted by kazoo on May 12, 2001, at 0:13:38
I'm willing to bet that the people endorsing opiates for depression have not tried every more convential treatment for depression.
I maintain that if one writes a list of psychotropic medications one has taken, I can always find 10 other viable and legitimate medications to try.
--The Salvation Army A.R.C. Command: Changing the world, one life at a time.
Posted by shelliR on May 12, 2001, at 14:46:33
In reply to Oy Vey: Opiates » kazoo, posted by SalArmy4me on May 12, 2001, at 0:28:47
One of the main reasons I use this board is to both pick up information on new depression treatments AND to discuss my use of opiates to control my depression. I have gotten both support, suggestions, and warnings concerning various opiates. I have also gotten insight into the difference between tolerance and addiction.
I have been to the best known psychopharmagologists in my area (a large eastern city). My psychiatrist is aware that I am using opiates to combat my depression; (I am not keeping secrets from my pdoc.) He agrees that I have tried enough drug combinations in the past few years that a respite is in order.
I also have strongly recommended MAOIs for people who have treatment resistent depression, before they enter into the opiate world. I think MAOIs can help people when all other meds have failed. And I try to help others realize that starting opiates to help depression has to be a well-thought out plan, and will not be successful for everyone, perhaps not even for most people.
That having been said, it is becoming increasingly tiresome to try to exchange information re opiates on this board among the posters who feel the necessity of sharing their own pedestrian outrage of such treatment for depression. I suppose all that can be done is to ignore your posts and not get into a defense of opiate use.
But I did want to say to you, that before you offer us your unsolicited consultations, perhaps if you read through the threads you will find that most of the posters using opiates to treat depression ...
have been to many doctors--doctors expert in treating medication resistent depression; Physicians who just might have more information than your MD father, or your MD mother, or the MD sitting next to you at a dinner party.
have tried many many medications and many combinations of medications over many years;
are using opiates WITH the knowledge of our
psychiatrists.and,
do not recommend that all depressed persons should use opiates as a treatment.It seems to me that most of you don't even read the whole thread before you rush in to save our opiate souls.
Shelli
Posted by SalArmy4me on May 12, 2001, at 18:25:20
In reply to Re: Opiates for depression, posted by shelliR on May 12, 2001, at 14:46:33
Here's what Dr. Richelson, one of Dr. Bob's colleagues wrote about opiates in depression:
"Long before the established antidepressants were available, opiates and opioids were used to treat depression. However, for various reasons today, I would not use this class of compounds to treat depression. The mechanisms of tolerance to a drug is very complex and not well understood for most drugs. Some mechanisms involve increased metabolism of the drug and adaptive changes at the cellular level. The theory about tolerance to opioids is that there are adaptive changes at the level of receptors for these compounds. Why tolerance would not develop in some patients, but not others is a mystery." --http://www.dr-bob.org/babble/20010411/msgs/59892.html
Here's what you wrote pertaining to a doctor who wouldn't prescribe opiates for depression:
"Elizabeth. I talked to Dr. Bodkin briefly today...He will do a consultation, but will not proscribe codeine because of a prior _law suit_{!}."Here's what the facts say:
•As many as 900,000 Americans are dependent on
heroin or other illicit opioids.
*3-8% of opiate users die of trauma or overdose.
Posted by Elizabeth on May 12, 2001, at 19:57:44
In reply to Re: Whats the best opiate for depression ? / ETC » Elizabeth, posted by shelliR on May 11, 2001, at 12:20:31
> He will do a consultation, but will not proscribe codeine because of a prior law suit. But he definitely seems very knowledgeable and gave me the name of someone in my area, who he admits is probably "less creative" in prescribing for depression than he is.
He is very knowledgeable; I think the world of him. He also knows a lot of people -- he referred me to a young pdoc who was a student of his. (I've only seen the guy once so far but he seems very bright, and I trust Dr. Bodkin's assessment of him.)
Codeine isn't the best choice for an AD anyway, IMO -- if you need a full agonist, a longer-acting one with fewer adverse effects relative to desired effects would be preferable.
I've heard many stories of people suing their doctors over some pretty absurd things. Dr. Bodkin takes particular risks in that he is willing to work with patients who may be personality-disordered (which often is associated with a tendency to blame other people for one's problems -- e.g., a patient misuses or overdoses on medication, then blames the doctor). I take Dr. B's willingness to work with these "difficult" patients as a sign of exceptional compassion.
-elizabeth
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