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Dr. Bob is Robert Hsiung, MD,
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Posted by Squiggles on November 8, 2005, at 7:21:46
In reply to Re: Tricyclics and anhedonia » Squiggles, posted by neuroman on November 7, 2005, at 22:37:06
Unfortunately, there is not much choice
right now for severe depression- it's either
the Tri way or the highway.Dopamine - yes i have heard it makes you
happy, but I don't know much about neurochemistry.Squiggles
Posted by neuroman on November 8, 2005, at 9:25:07
In reply to Re: Tricyclics and anhedonia, posted by Squiggles on November 8, 2005, at 7:21:46
Hi,
> Unfortunately, there is not much choice
> right now for severe depression- it's either
> the Tri way or the highway.I hear ya'. No doubt about it, it did help my depression. I wish I had taken a "cleaner" one like desiprimine. More importantly, I wish I had tapered off of it a lot more slowly, even though I did taper more slowly than they say is necessary. I felt physically horrendous for months after I stopped. I think the withdrawal caused some excitotoxic damage to my system. I've heard adding bupropion has helped some people taper off of some of the tricyclics more easily. Wish I had known that at the time...
> Dopamine - yes i have heard it makes you
> happy,Dopamine transmission increases in certain parts of the brain when we desire something or when we expect a reward or are having feelings of anticipation. If the desire is met or the reward attained than dopamine levels stay high and we feel good. If the desire is not met or the reward is not attained than dopamine levels drop off. We have a word for this..."frustration". This is a huge simplification of the process but it does make sense. At least to my screwed up brain. :-)
Paul
Posted by Squiggles on November 8, 2005, at 9:38:39
In reply to Re: Tricyclics and anhedonia, posted by neuroman on November 8, 2005, at 9:25:07
Paul,
Even with lithium, even with nicotine,
even with alcohol, even with sugar,
taken for a very long time, when you
stop certain changes take place.I have a theory about psychiatric drugs--
i think they change neural chemistry and maybe
even brain structure. I think Dr. Torrey might
agree with that. How much and how long
depends on many things. Reversing is also
a problem.I am posting Dr. Preskorn's site here in case
it may be of some help. Maybe you could write
to him - he looks like one the best, in the
States anyway:http://www.preskorn.com/columns/0003.html
Good luck,
Squiggles
Posted by neuroman on November 8, 2005, at 10:24:48
In reply to Re: Tricyclics and anhedonia, posted by Squiggles on November 8, 2005, at 9:38:39
Hi again,
I agree with everything you said. How a particular substance effects an individual depends on that person's biology. With me I've found that I've become very sensitive to meds that effect ion channels and/or the release of glutamate. (i.e. elavil, neurontin, lamictal) These meds seem to effect me at much lower doses than most people. And I have a horrible time tying to stop them. I think this reflects a possible sensitization of some part of my nervous system and I think this sensitization has to do with the NMDA receptor. I can't prove it yet but I'm trying. One way I'm going to attempt to address this is by raising my very low dopamine levels. Dopamine antagonizes the NMDA receptor, so in effect, low dopamine levels may be responsible for the "over-active" NMDA receptors. Anyway, it's become my life's mission to find a doctor to work with who is knowledgable in neuropsychopharmacology. Not an easy task.
By the way, thanks for the Preskorn tip. Not only have I visited the site, I've printed out his entire book. :-)
Paul
Posted by linkadge on November 8, 2005, at 13:43:21
In reply to Re: Tricyclics and anhedonia, posted by neuroman on November 8, 2005, at 10:24:48
Some of the smartest doctors who initially discovered the antidepressant effects of the TCA's likened their actions to the amphetamines.
When one is taking a drug based on supposed neurochemical abnormalities that may or may not exist, one runs the risk of creating neurochemical abnormaities that never existed.
Linkadge
Posted by Squiggles on November 8, 2005, at 14:29:14
In reply to Re: Tricyclics and anhedonia, posted by linkadge on November 8, 2005, at 13:43:21
> Some of the smartest doctors who initially discovered the antidepressant effects of the TCA's likened their actions to the amphetamines.
>
> When one is taking a drug based on supposed neurochemical abnormalities that may or may not exist, one runs the risk of creating neurochemical abnormaities that never existed.
>
> LinkadgeI don't doubt that neurochemical abnormalities
must exist in order to get abnormal mental
states - the question is *what* abnormalities
and if common to more than one mental derangement.Among the head injuries I have had in my life
(not many), two of them, which may have been
cerebrovascular, like encephalic hypertension
in withdrawal from a K when I was sweating for
a year and my head felt "on fire", and the recent
bang on the head concussion--i noticed two
interesting phenomena in both distinct cases:- depression (transient thank God)
- and a craving for citrus fruits which I hate.
It's not a mystery that concussions create
depression, nor strokes for that matter - why? It's not the same as a genetic
marker.As for the craving for citrus, darn if I know.
As Dr. Torrey has said, many diverse factors
from genetic to viral to bacterial to physical
to chemical can result in neurochemical
abnormalities. But in order to have depression,
perhaps the identical neurochemical abnormality
may exist. In analogous terms, you can have
suffer a bruise of the same intensity and the
same duration and call it b1, but the causes
may vary. It's still a bruise.Squiggles
>
>
>
>
Posted by neuroman on November 8, 2005, at 19:24:23
In reply to Re: Tricyclics and anhedonia, posted by linkadge on November 8, 2005, at 13:43:21
Hi,
>Some of the smartest doctors who initially
discovered the antidepressant effects of the
TCA's likened their actions to the
amphetamines.Interesting. I didn't know this.
>When one is taking a drug based on supposed neurochemical abnormalities that may or may not exist, one runs the risk of creating neurochemical abnormaities that never existed.
There is no doubt that elavil created problems for me that I didn't have prior to taking it. The problem that I have with a drug like elavil is that it does to many things. I'll never know which one of it's actions was helping me and which ones were hurting me. I can only make an educated guess based on my experiences with other medications, my family history, various tests that I've had (which may or may not be of any value), and my instincts, etc. But an educated guess is better than an uneducated guess. Right now I'm guessing that my problems have less to do with serotonin and more to do with dopamine and norepinephrine.
Paul
Posted by paulbwell on November 9, 2005, at 18:20:31
In reply to Re: Opiates for depression?, posted by Squiggles on November 6, 2005, at 11:11:02
> Hmm, that's interesting. So, I guess
> the chemical composition of opiates
> is not conducive to an anti-depressant
> effect, such as Lexapro, or others.
>
> SquigglesHydrocodone seems to help MANY people with, energy, interest, enthusthiasm, like Matt, here on these boards, who takes 5mgs Hycodan 4x daily-alomg with other meds.
Opiates CAN DEFINATELY assist short-medium term, depression.
Cheers
Posted by Squiggles on November 9, 2005, at 19:05:29
In reply to Re: Opiates for depression?, posted by paulbwell on November 9, 2005, at 18:20:31
Thanks Paulbwell,
What is short medium-term depression?
Squiggles
Posted by paulbwell on November 9, 2005, at 20:10:01
In reply to Re: Opiates for depression?, posted by Squiggles on November 9, 2005, at 19:05:29
> Thanks Paulbwell,
>
> What is short medium-term depression?
>
> Squiggles> Thanks Paulbwell,
>
> What is short, medium-term depression?
>
> SquigglesWeeks-Months? and IN SOME CASES YEARS-i know-unadvisable but????-ask the patient?
Cheers!
Posted by Squiggles on November 10, 2005, at 16:19:52
In reply to Re: Opiates for depression? » Squiggles, posted by paulbwell on November 9, 2005, at 20:10:01
If i were to give my friend advice
as to what to switch to, maybe this
drug would be good or something in its
class; because taking imipramine for
many years may actually start to wear
on the brain -- I think Dr. Preskorn has
some articles on the toxicity of imipramine --
maybe the toxicity increases with age and
time taken? Maybe, it's time for a change?Squiggles
Posted by paulbwell on November 10, 2005, at 22:50:11
In reply to Re: Opiates for depression?, posted by Squiggles on November 9, 2005, at 19:05:29
> Thanks Paulbwell,
>
> What is short medium-term depression?
>
> SquigglesI don't take Imipramine!
Cheers
Posted by jerrympls on November 10, 2005, at 23:27:51
In reply to Re: Opiates for depression?, posted by paulbwell on November 9, 2005, at 18:20:31
> > Hmm, that's interesting. So, I guess
> > the chemical composition of opiates
> > is not conducive to an anti-depressant
> > effect, such as Lexapro, or others.
> >
> > Squiggles
>
> Hydrocodone seems to help MANY people with, energy, interest, enthusthiasm, like Matt, here on these boards, who takes 5mgs Hycodan 4x daily-alomg with other meds.
>
> Opiates CAN DEFINATELY assist short-medium term, depression.
>
> CheersMy doc has me on HYCODAN, 5mg 4xdaily. I've been on it for a year - works great.
Jerry
Posted by jerrympls on November 10, 2005, at 23:29:49
In reply to Re: Opiates for depression?, posted by flmm on November 6, 2005, at 10:49:13
> As someone who has taken opiates for over a year due to back pain, I can tell you they are not good for depression! As a matter of fact, I think they make it worse. Constant ups and downs. They make you bipolar!Yes there are times you feel great on them, like any street drug, but they can be very unpredictable in your reation. Sometimes you feel good, sometimes depressed, sometimes paranoid, etc. I only hope I can get off them someday and let Lexapro do it's job as the opiates clearly block the good effects of antidepressents. That's my 2 cents!
I'm on an opiate for my depression - hydrocodone. I take 5mg 4x daily. Sure it's not as smooth as one would like - but it sure helps my depression. Been on it for a year now and no tolerance.
Jerry
Posted by paulbwell on November 10, 2005, at 23:43:19
In reply to Re: Opiates for depression? » flmm, posted by jerrympls on November 10, 2005, at 23:29:49
> I'm on an opiate for my depression - hydrocodone. I take 5mg 4x daily. Sure it's not as smooth as one would like - but it sure helps my depression. Been on it for a year now and no tolerance.
>
> Jerry
>
>Great to hear Jer, hope it continues.
You provide a sound, reasoned, rational, voice in the use of Opi's in the use of mood disorders, and i wish you continued benefit. If only ALL Docs were not so closed minded.
Apparently Stims, of which you take Dex 15mg Spans? can potentiate Opi's? i wonder if you have found this?
Good luck dude, and good health!-you are an inspiration!
Cheers:)
Posted by jerrympls on November 10, 2005, at 23:59:59
In reply to Re: Opiates for depression? » jerrympls, posted by paulbwell on November 10, 2005, at 23:43:19
> > I'm on an opiate for my depression - hydrocodone. I take 5mg 4x daily. Sure it's not as smooth as one would like - but it sure helps my depression. Been on it for a year now and no tolerance.
> >
> > Jerry
> >
> >
>
> Great to hear Jer, hope it continues.
>
> You provide a sound, reasoned, rational, voice in the use of Opi's in the use of mood disorders, and i wish you continued benefit. If only ALL Docs were not so closed minded.
>
> Apparently Stims, of which you take Dex 15mg Spans? can potentiate Opi's? i wonder if you have found this?
>
> Good luck dude, and good health!-you are an inspiration!
>
> Cheers:)
>I keep telling my doc she should write a paper on my experience since it's been so positive. The more that doctor's publish about opiates helping depression can only help open many closed minded docs.
Actually, I have switched my stim to Adderall - which I find to help much better in the general mood dept. than Dexedrine. I take 20mg XR 3x daily and it (Adderall) works GREAT with the opiate. I only wish there were a longer acting form of hydrocodone.
Thanks for the well wishes! I appreciate it!
Jerry
Posted by paulbwell on November 11, 2005, at 0:11:57
In reply to Re: Opiates for depression? » paulbwell, posted by jerrympls on November 10, 2005, at 23:59:59
> I keep telling my doc she should write a paper on my experience since it's been so positive. The more that doctor's publish about opiates helping depression can only help open many closed minded docs.
>
> Actually, I have switched my stim to Adderall - which I find to help much better in the general mood dept. than Dexedrine. I take 20mg XR 3x daily and it (Adderall) works GREAT with the opiate. I only wish there were a longer acting form of hydrocodone.
>
> Thanks for the well wishes! I appreciate it!
>
> JerryGood to hear your doing well!
You prove all the nay-sayers wrong with their idea of folks needing ever increasing doses of Opis-and your Hycodan being stable for 1 year shows this! good for you!
So you switched from Dex to Adderall? perhaps you had become tolerant to dextroamphetamine only. Most say Dex works better? althought Adderall is popular.
I wonder how they differ? effects?
Cheers dude!!
Posted by jerrympls on November 11, 2005, at 0:19:40
In reply to Re: Opiates for depression? » jerrympls, posted by paulbwell on November 11, 2005, at 0:11:57
> > I keep telling my doc she should write a paper on my experience since it's been so positive. The more that doctor's publish about opiates helping depression can only help open many closed minded docs.
> >
> > Actually, I have switched my stim to Adderall - which I find to help much better in the general mood dept. than Dexedrine. I take 20mg XR 3x daily and it (Adderall) works GREAT with the opiate. I only wish there were a longer acting form of hydrocodone.
> >
> > Thanks for the well wishes! I appreciate it!
> >
> > Jerry
>
> Good to hear your doing well!
>
> You prove all the nay-sayers wrong with their idea of folks needing ever increasing doses of Opis-and your Hycodan being stable for 1 year shows this! good for you!
>
> So you switched from Dex to Adderall? perhaps you had become tolerant to dextroamphetamine only. Most say Dex works better? althought Adderall is popular.
>
> I wonder how they differ? effects?
>
> Cheers dude!!I didn't grow tolerant to the dex. I switched mainly because Adderall helps reverse a lot of the sexual side effects from the Lexapro. For me, Dexedrine helps with energy and concentration mostly - whereas Adderall helps with those too but also gives a more "natural" feeling of well-being - and is smoother (well, the XR form anyway). Dexedrine is a little bit rough around the edges - but not by much. I used to have a lot of severe nighttime anxiety and rumination when my Dexedrine wore off - but not so with Adderall - another reason I like it.
Jerry :-)
Posted by paulbwell on November 11, 2005, at 0:28:29
In reply to Re: Opiates for depression? » paulbwell, posted by jerrympls on November 11, 2005, at 0:19:40
Hi Ya!
you seem to have blocked me from yr MSN? bring me back on man-we could talk n stuff?
YES?
Posted by jerrympls on November 11, 2005, at 0:31:10
In reply to Re: Opiates for depression?, posted by paulbwell on November 11, 2005, at 0:28:29
> Hi Ya!
>
> you seem to have blocked me from yr MSN? bring me back on man-we could talk n stuff?
>
> YES?I've blocked you? I haven't been on in a long time. Perhaps some other night - I'm dead tired - was driving all day today!
Posted by paulbwell on November 11, 2005, at 0:38:41
In reply to Re: Opiates for depression? » paulbwell, posted by jerrympls on November 11, 2005, at 0:31:10
>
> I've blocked you? I haven't been on in a long time. Perhaps some other night - I'm dead tired - was driving all day today!
>
OK dude-have a good rest.we'll chat later maybe?
i'm online
Posted by linkadge on November 13, 2005, at 9:35:57
In reply to Re: Opiates for depression?, posted by paulbwell on November 11, 2005, at 0:38:41
As positive as jerrympls's story is, there have been equally many (if not many more) people who have used opiates without sucess in treating mood disorders.
Most people who go to withdrawl clinics to stop opiate addictions are really suffering from an underlying mood disorder.
Sometimes tollerance to drugs does not appear in the form one might expect.
Different opiates have different rates of tollerance.
Linkadge
Posted by Squiggles on November 13, 2005, at 9:38:25
In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 9:35:57
Linkadge,
do you think that *some* opiates might
work on depression, but not on manic-depression
for example?Squiggles
Posted by jerrympls on November 13, 2005, at 11:28:57
In reply to Re: Opiates for depression?, posted by linkadge on November 13, 2005, at 9:35:57
> As positive as jerrympls's story is, there have been equally many (if not many more) people who have used opiates without sucess in treating mood disorders.
>
> Most people who go to withdrawl clinics to stop opiate addictions are really suffering from an underlying mood disorder.
>
> Sometimes tollerance to drugs does not appear in the form one might expect.
>
> Different opiates have different rates of tollerance.
>
>
>
> LinkadgeJust for the record - I've always said that opiate therapy is NOT a cure-all. I still have had some depressive episodes while on the hydrocodone. And I agree it's not something that would work for everyone.
Also - Do you have the research that lists the rate of tolerance for various opiates? I find it hard to believe that scientists know the exact time it takes for anyone taking opiates to develop tolerance. But I could be wrong. And what do you mean by saying sometimes tolerance to drugs does not appear in the form one might expect?
Sorry if I come across a bit defensive but I get the feeling - and correct me if I am wrong - that you are trying to negate my experience. All I can say is that opiate therapy works for me and works well - and that I am not the only one by a longshot. I haven't developed tolerance after a year - but that's not to say I will never develop tolerance. Also, I am not an addict (not that you said that) and never have had a problem with addiction to anything.
So I guess I'm lucky.
Posted by linkadge on November 13, 2005, at 17:47:39
In reply to Re: Opiates for depression?, posted by Squiggles on November 13, 2005, at 9:38:25
Opiates can profoundly, if only temporarily, help depression, and the depressive phase of bipolar disorder.
Their long term safety or efficacy however, has never been shown.
They work in depression, because they directly activate the pleasure centres of the brain, like all other agents of abuse, something that other antidepressants don't do.
Another consideration is that, while virtually all antidepressant compounds to date promote neurogenesis, the opiates do not, infact they tend to lead to brain atrophy.The neucleus accumbens has incredably effective homeostatic mechanisms.
If tollerance to the effects are slow, then it is highly likely that the withdrawl effects will be long lasting.
Linkadge
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Dr. Bob is Robert Hsiung, MD,
[email protected]
Script revised: February 4, 2008
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