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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by pseudoname on June 15, 2006, at 13:09:03
Stan's question to me last week about whether I experienced "mental cloudiness" on buprenorphine/Subutex got me thinking. (Bupe is a mild opioid partial agonist/antagonist I take for depression.)
I told stan (http://www.dr-bob.org/babble/20060604/msgs/654443.html) that some slight mental "gauziness" never completely goes away, even though since starting at 3 mg/day in December I've reduced my bupe dose in recent months to 1 mg/day. Also, any immediate fluctuation up OR DOWN in the dose can seem to trigger minor cognitive problems. In the past week, I've had some experiences that highlighted those problems.
Taking 0.5 mg/day for 2 days (about 1/2 my regular dose), I went to a big family gathering. I couldn't remember the names of people I've known for years, including one of my cousins that I see about once a year. I'm usually bad with names, but I should've been able to handle that, especially when I'm kind of excited by the situation, which was a really nice gathering.
Also, I played chess and got horribly confused. Against one novice kid, I said, "If you move your knight here you can attack my queen." So he did. Then I moved some other piece, and he took my queen. I said, "I didn't see that!" He said, "You just told me to do it!"
This went on and on like my head was in molasses. I couldn't keep track of the pieces AT ALL. It was a bad trip.
The next day I took no bupe, and as luck would have it went to another family gathering (different branch). I remembered everyone's name, learned a couple new names, and had a lively conversation in which the other person complimented my alert observations. I needed to get and follow complicated directions to the house, and I felt like I was remembering them better than usual. But it was a much smaller gathering, so maybe I was more at ease. Oh yeah: and I also took a left-over Metadate capsule!
But poor mood and self-critical thoughts returned en mass and for days afterward I beat myself up over allegedly stupid things I said or did.
I stayed off bupe for 4 or 5 days, and I did feel clearer-headed, though I have no idea if my chess-playing faculties got any better. However, my mood, self-criticism, self-hatred, RESENTMENTS, hopelessness, and suicidality (at the starting-to-make-arrangements level) returned to pre-treatment levels.
This continued constantly over those days. I had even forgotten about the seemingly constant visual imagery I used to have that expressed my self-hatred. THAT came back, all too frequently.
Maybe all these things were just because I'm squeezing opioids out of my brain, eh? Maybe I'm fundamentally NOT depressed and I'm just re-adjusting to neurons without extra opioids? Maybe, except that this is where I usually was pre-buprenorphine. As my earlier Babbleometer scores (consistently around 53) and journals attest.
This morning, I woke feeling quite good (after a dream in which Tom Cruise was my pdoc! -- see Social). But as the minutes ticked on, thoughts started jam piling on me and I faced the "fact" that the only possible way to end my pain is to die.
In that frame of mind, I took 0.5 mg of bupe. About 90 minutes later, I no longer felt suicidal (at all) or resentful or self-hating, and I wasn't ruminating on self-criticism.
But I *do* feel slightly dopey.
I'm also not sure that I'm addressing all of the issues I was thinking of while OFF the buprenorphine. I noticed more cognitive threads then. I can follow one thread just fine on bupe, but I can't simultaneously keep track of multiple threads (like in chess). Looking in my journal, I think I had more ideas off bupe.
Sigh. What a trade-off.
Caffeine and/or Metadate (the stimulant methylphenidate) don't seem to have any effect combating buprenorphine's central gauziness or dopey cognition, although they can help around the edges. I haven't tried adding Adderall.
Maybe I'll experiment with even lower doses of buprenorphine to see if I can reduce the cognitive gauziness while retaining the AD effect. I may have to go back and use Larry's brilliant eye-dropper dosing technique to get very small doses a couple times a day.
You have no idea how much better the world looks to me today than it did yesterday, even if I am a little more stupid now.
Posted by Phillipa on June 15, 2006, at 20:39:23
In reply to buprenorphine and cognition, posted by pseudoname on June 15, 2006, at 13:09:03
Does it act an opiod in your body. Usually kind of help you feel good? Love Phillipa
Posted by pseudoname on June 16, 2006, at 9:42:48
In reply to Re: buprenorphine and cognition » pseudoname, posted by Phillipa on June 15, 2006, at 20:39:23
Hi, Phillipa.
> Does it act an opiod in your body. Usually kind of help you feel good?
For me, at the doses I've tried it (up to 5 mg/day), buprenorphine doesn't produce any high or buzz. It doesn't even make me feel as good as caffeine can. Its benefit for me seems to be that those persistent, intense, hostile thoughts and feelings just stop.
(As they did this morning at *half* the dose I used yesterday!)
:-)Buprenorphine weakly activates some of the typical euphoric/analgesic opioid receptors, but it also BLOCKS kappa-opioid receptors that trigger dysphoria. I wonder if that kappa-blocking is mostly or entirely responsible for its antidepressant effect in me.
AFAIK, there are no selective kappa antagonists on the market yet, but I guess research is being done. I'd like to try them when they come out.
• “Kappa Opioid Antagonists: Past Successes and Future Prospects” by Matthew D Metcalf & Andrew Coop. AAPS Journal. 2005; 7(3): E704-E722 http://www.aapsj.org/view.asp?art=aapsj070371
Posted by pseudoname on June 17, 2006, at 6:41:37
In reply to buprenorphine and cognition, posted by pseudoname on June 15, 2006, at 13:09:03
I went back on buprenorphine Thursday at 0.5 mg/day with a complete return of benefit. (Thank g*d.)
Friday morning I tried 0.25 mg. That dose seemed to work exactly as well.
18 hours later, I took another 0.25 mg. This morning it's still working.
Do I feel "dopey"? I dunno. I guess I gotta get a computer chess game and start comparing my performance against my doses.
I wonder if 0.125 mg will also work??
Posted by pseudoname on June 19, 2006, at 12:11:45
In reply to reduced buprenorphine doses, posted by pseudoname on June 17, 2006, at 6:41:37
> I wonder if 0.125 mg will also work??
Experimenting with reduced doses, I tried 0.12 mg / day of buprenorphine. It had slight effect, but not enough. My resentful, hateful, and insanely self-critical thoughts still went disruptively through my head all day long.
Maybe if I get some good life successes under my belt, the reduced dose would be adequate then. Maybe with way more social support and establishing some rewarding, creative occupations, I won't have as much volume from the self-hatred spigot and won't need as much.
For now, it seems to have to be at least 0.2 mg q 18 h to get enough benefit. That's just on the edge of quelling the GOOD anxieties, however; the anxieties that can get you out of bed in the morning or motivate you to brush your teeth. My head is a bit clearer. (I've got to get a computer chess game!) It's a hope-filled edge. More to follow.
Posted by ed_uk on June 19, 2006, at 12:51:20
In reply to 0.12 mg did not work, posted by pseudoname on June 19, 2006, at 12:11:45
Hi PN :)
>0.12 mg did not work
When used to treat pain, the minimum dose is usually 0.2mg. I guess I'm not surprised that 0.1mg wasn't enough to treat your depression.
What dose are you going to take now? 0.2mg once or twice a day?
Regards
Ed
Posted by pseudoname on June 19, 2006, at 13:24:55
In reply to Re: 0.12 mg did not work » pseudoname, posted by ed_uk on June 19, 2006, at 12:51:20
Hi, Ed! It seems like a long time since I talked to you.
> When used to treat pain, the minimum dose is usually 0.2mg.
Thanks, I appreciate knowing that.
> What dose are you going to take now?
I'm going to take 0.2 – 0.25 mg once a day in the morning. If I'm awake when it stops working (about 18 hours later), I might take another pill then, even if it's late at night.
I'm also going to take regular holidays from it, which I hadn't done since March. If tolerance is a risk (Is it, with bupe?), I want to keep it in check as much as possible.
Bupe does not seem to help with much of my neurotic anxiety, not even at higher doses. But at the higher doses, I think it did dull some ordinary motivational impulses, which I can use beneficially to "overpower" my anxieties. I'm only putting this observation together now.
So, my anxieties are combatted better at the lower dose, as long as the depression & hostility are taken care of. Interesting.
It's a complex situation, and there's very little guidance. Thanks for all your input.
;-)
Posted by ed_uk on June 20, 2006, at 16:13:47
In reply to Re: 0.12 mg did not work » ed_uk, posted by pseudoname on June 19, 2006, at 13:24:55
Hi PN
>It seems like a long time since I talked to you.
I know! Good to talk to you again :)
>I'm also going to take regular holidays from it
How will you cope during your holidays? Some holiday :(
>If tolerance is a risk (Is it, with bupe?)
It's a possibility, that's all I can say. It certainly doesn't seem that you're showing any signs of tolerance at the moment, particularly given your large reduction in dose. It's looking good, very good.
Love
Ed
Posted by Declan on June 21, 2006, at 8:50:49
In reply to Re: 0.12 mg did not work » pseudoname, posted by ed_uk on June 20, 2006, at 16:13:47
When used for opiate substitution it's sometimes given three times a week, so I guess it's a long acting drug. Short holidays?
Declan
Posted by ed_uk on June 21, 2006, at 14:23:45
In reply to Re: 0.12 mg did not work, posted by Declan on June 21, 2006, at 8:50:49
Hi Dec
Buprenorphine is unusual. It is an extremely potent opioid ie. it is effective at very small doses compared with other opioids such as morphine. Buprenorphine is also unusual in that it acts as a partial agonist at opioid receptors ie. when it binds to an opioid receptor it stimulates it but not to the same degree as other opioids.
Buprenorphine binds very tightly to opioid receptors and has a long duration of action, much longer than most opioids (apart from methadone).
ShawnT at neurotransmitter.net provides some interesting information about buprenorphine....
'Buprenorphine is a partial agonist at mu opioid receptors and nociceptin/orphanin FQ (ORL1) receptors. It exhibits antagonist activity at kappa opioid receptors and delta opioid receptors, with less potent effects at the latter. The drug may also act as an antagonist at epsilon opioid receptors. Buprenorphine is an oripavine analgesic used to treat opioid addiction. Its active metabolite norbuprenorphine is a partial agonist at mu and kappa receptors and a full agonist at delta and ORL1 receptors.'
Buprenorphine appears to act mainly at mu opioid receptors. The relevance of its effect at kappa receptors is unclear: it appears to act as a partial agonist.
When injected, buprenorphine may resemble morphine and heroin in its effects. Sublingual and (particularly) transdermal administration would be expected to be less euphoric, possibly resembling oral morphine or codeine - except that bupe has a much longer duration of action.
Some people find opioids remarkably euphoric, whereas other people do not find them euphoric at all. In fact, some people become acutely (psychologically) distressed following the administration of an opioid.
Tolerance to opioids seems to be determined by genetic factors - some people develop rapid tolerance to opioid analgesia whereas other people do not appear to develop tolerance at all. A genetic test to determine the likelihood of tolerance would be extremely useful!
Ed
Posted by pseudoname on June 22, 2006, at 16:32:31
In reply to Re: 0.12 mg did not work, posted by Declan on June 21, 2006, at 8:50:49
> When used for opiate substitution it's sometimes given three times a week
I think they take much higher doses, like 8-16 mg/day compared to my current 0.2 mg.
Bupe has a half-life of about 36 hours, but of course that's from the blood, not the brain.
When I took 3 mg/day I did not notice withdrawal symptoms or much clinical rebound even after 2-3 days without it. Now I notice (mild) withdrawal 24 hours later. So I think the smaller 0.2 amount, while all that's clinically necessary in the short run, is clearing much faster.
When I go to bed, it's wearing off clinically, and when I wake up I have mild withdrawal symtoms until 90 minutes after I take my 0.2.
Right on the edge, that's me. ;-)
Posted by Declan on June 23, 2006, at 1:13:40
In reply to short holidays? » Declan, posted by pseudoname on June 22, 2006, at 16:32:31
Well clearly, I know what you mean about doses wearing off fairly quickly. (OTOH 10mg methadone at my current rate would perhaps last for 500 days.) I once said to someone on the program "How long till you needed more methadone?", and sensibly enough he said "sometimes I've needed more methadone an hour after I've taken it".
I imagine the people who are weaning off bupe are on smaller doses toward the end.
Declan
Posted by pseudoname on June 23, 2006, at 9:40:59
In reply to Bupe - a high potency partial agonist opioid » Declan, posted by ed_uk on June 21, 2006, at 14:23:45
Hi, Ed.
Thanks for that interesting abstract. I also thought it's interesting that it comes from India, which is one of the countries that has problems with black-market buprenorphine and smuggling. There's stuff in the news pretty regularly about it there.
I wonder what's going on in people for whom it's euphorogenic. Is it that their prioir opioid exposure has primed their brains? But it seems like that would make them *less* sensitive to it.
Is it that they're just naturally opioid sensitive people? But euphoria isn't reported as a common side-effect in Buprenex patients, many of whom would also presumably be naturally sensitive.
Euphoria wasn't reported by the opioid-naive patients in the tiny depression studies.
Nevertheless, I find the euphoria reports worrying unless they can be explained. Not for myself, but for bupe's chances for wider safe use and acceptance as a depression treatment.
> When injected, buprenorphine may resemble morphine and heroin in its effects.
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=9513799&query_hl=11&itool=pubmed_docsum
Posted by Declan on June 23, 2006, at 14:41:38
In reply to buprenorphine abuse » ed_uk, posted by pseudoname on June 23, 2006, at 9:40:59
But you know, PN, these days, for whatever reason, people will abuse lots of things. Heroin was OTC until 1968 (in small amounts) along with morphine and opium based cough medicines, and they were not really abused much before the early 60s. There has been a progressive ratcheting up of the abuse level and the restrictions. People will abuse even petrol; a special petrol (opal) has been prepared here that is supposed to be non-abusable. The only sense I can make of this as a long term trend is that we have moved from being a duty oriented culture to a consumer culture. Then society's problems were disorders relating to duty (lots of cruelty, not to speak of war dead); now they are disorders relating to consumption.
You think?
Declan
Posted by pulse on June 23, 2006, at 15:09:29
In reply to Re: buprenorphine abuse » pseudoname, posted by Declan on June 23, 2006, at 14:41:38
butting in:
< The only sense I can make of this as a long term trend is that we have moved from being a duty oriented culture to a consumer culture. >
snip
< now they are disorders relating to consumption. >
i wholeheartedly agree. only thing i've been able to come up with, also.
pulse
Posted by pseudoname on June 23, 2006, at 15:45:14
In reply to Re: buprenorphine abuse » pseudoname, posted by Declan on June 23, 2006, at 14:41:38
> You think?
In fact I'm delighted to say I disagree with almost everything you've just written.
> But you know, PN, these days, for whatever reason, people will abuse lots of things.
People may abuse many things, but that in itself doesn't say why buprenorphine is euphorogenic for some and not for others. Is it mostly or only those who've already used opioids to get high? That's my question.
> Heroin was OTC until 1968 (in small amounts) along with morphine and opium based cough medicines, and they were not really abused much before the early 60s.
I'm a little skeptical of the rather over-qualified "not really much" claim, but assuming it's true, I think the contrast results from now demanding more control over private experience than was expected in the past. In the past, people died early and expected to feel bad a lot for a variety of reasons in the meantime. We moderns expect to live long and think we MUST feel good a LOT for the duration, even if our children huff petrol in emulation.
> we have moved from being a duty oriented culture to a consumer culture.
Perhaps it's different where you live. Shrill duty-mongering is stridently screamed to exhaustion here these days by various people. And I personally don't see the 18th, 19th, or early 20th centuries as awash in feelings of duty, except as a marketed theme in times of military call-ups; and THAT is prominent and unquestioned in the media here now. A good reputation seemed more explicitly important then than now, but I think duty failed as both a broad, reliable motivator and a restraint, C S Forester notwithstanding. How many desperate social problems went unaddressed historically despite appeals to "duty".
Consumption, too, seems to me to be a continual part of American history forever. We have always been rapacious here, even when we didn't think about it morally.
No, I think it's a question of wanting to control our feelings toward an asymptomatic asymptote: increase good feelings and eliminate all bad feelings. That demanding expectation is a disease of progress, since on that front, unlike plentiful food & clothing & cars, we can't live up to our own standards. Yet.
(The "control agenda" is a theory of Steve Hayes, not original to me.)
Posted by Declan on June 23, 2006, at 16:14:38
In reply to The Control Agenda » Declan, posted by pseudoname on June 23, 2006, at 15:45:14
An asymptomatic asymptote? I'll have to have a think about all this. There is a line I liked from a Clough poem, I think it was
'we are so prone to these things with our terrible notions of duty'
One man's duty is another man's evil, of course. After only 4 hours sleep last night that's all I'm up to. I would really like a decent opiate other than methadone to send me to sleep for the rest of the day. Goodmorning to you.
Declan
Posted by Declan on June 23, 2006, at 20:28:00
In reply to The Control Agenda » Declan, posted by pseudoname on June 23, 2006, at 15:45:14
The only mixed agonist/antagonist I've taken is Fortral (pentazocine), which ranked above codeine and dihydrocodeine and below everything else. My guess as to whether bupe is euphoragenic or not to the opiate naive or experienced (what a tangle that is)......probably better for those who've never tried opiates? This is leaving to one side the relief in the difficulty of acquisition.
Well, I simply made that up, that thing about OTC narcotics not being abused before the early 60s, so you are right to be sceptical. The pattern of abuse would have been more isolated perhaps, and more well behaved. Society was more conformist and ordered then? (OTOH I didn't make that up about opium being sold in Greengrocers in the UK before whenever....I read it in Auberon Waugh's column in The Spectator 25 years ago)
Still, you would agree, if narcotics were available OTC now, the situation would be uncontrollable? So there is some kind of difference.Take the pattern of mental illnesses. I assume there really were cases of hysteria and catatonia, which seem to indicate the only withdrawal possible from pointless and compelling duty. (Maybe not?) The heirarchies of God, Church, King, landed families, fathers etc were more intact. (When we were kids one of the things we talked about was what to be when you grew up. Saint was at the top, and then King, Archbishop of Canterbury (no Pope for us), Prime Minister.)
All the terrible things of the C20 used duty as a motivator. Noone really enjoyed DOING those things, but they seem to have believed it was neccessary. (I think we're just batty)
The effort to control all bad feeligs and increase good ones will be self defeating, surely, resulting in more misery. All spiritual and psychological systems emphasise acceptance. You reckon?
Declan
Posted by pseudoname on June 23, 2006, at 22:38:47
In reply to Coherance comes slowly » pseudoname, posted by Declan on June 23, 2006, at 20:28:00
[the *trig* is one word in the 3rd-to-last graph]
> ......probably better for those who've never tried opiates? This is leaving to one side the relief in the difficulty of acquisition.
Ha! Ironic, eh?
> Still, you would agree, if narcotics were available OTC now, the situation would be uncontrollable?
It would not be good. I don't think it would've been good in 1953, either. They took all those narcotic ingredients out for some reason.
> So there is some kind of difference.
Maybe it's just improved means of production and distribution of illicit addictives? You've made me want to read more about that history. I've seen a good recent book about it, but I'll have to hunt it down.
> The heirarchies of God, Church, King, landed families, fathers etc were more intact.
I think your experience was quite different on this axis than mine. I don't know if an American of any age could say anything like that. Even extrapolating for "King".
Do you feel this sense of duty now?
> All the terrible things of the C20 used duty as a motivator.
I disagree. The twentieth century had a wide variety of terrible things and many other motivations: power, greed, power, money (as a conditioned reinforcer apart from greed), moral superiority, safety, bigotry, hunger, power, aesthetics, indifference (if that counts), even peace, love, and good intentions.
But perhaps you see all these infused with duty. I don't. I do feel duty, but I can't imagine applying it outside my family and for friends who I love as much as family. No one outside that circle could ever have told me what my duty was or that it applied to anyone else. I remember some trying, and their efforts were like pebbles bouncing off concrete.
> All spiritual and psychological systems emphasise acceptance. You reckon?
Disagreeing with you twice in one post seems like posing. But… well… *some* do, in part; that's very true.
I mentioned Forester because I'm entering my circadian Hornblower period. (It alternates every 3 or 4 years with John le Carré and there's nothing I can do about it.) I mention it again because the contrast between my life and an early 19th century sailor's life is astounding. Mine's 100 times richer & safer; it's longer with better food and dental care. Yet I feel that they lived their brief lives with much less moral sitting around. Their philosophy was just as keen or dull as ours, but they had more data from abutting death and dismemberment to base their a prioris on.
I imagine they didn't wait as much for better opportunities. Or feelings.
This is simply a question of degree. They took opium, too.
Bedtime here in BFE. ;-)
Posted by Declan on June 24, 2006, at 3:10:55
In reply to duty and death (trig) » Declan, posted by pseudoname on June 23, 2006, at 22:38:47
I think my brother's idea was that he would be Prime Minister and I would be a saint (but saints can't have been top of the tree then?)
I still want to be a saint, but I have become progressively more perverse as I have learned to express myself.
Declan
Posted by pseudoname on June 24, 2006, at 9:15:33
In reply to short holidays? » Declan, posted by pseudoname on June 22, 2006, at 16:32:31
Well, I'm sticking with my plan to take regular buprenorphine holidays. I took 0.2 mg yesterday morning and today I've taken none. I have no clear withdrawal symptoms yet (30 hours post-dose), my cognition seems just fine, and although my mood is not quite as "vital" (?) as the last several days, I'm not quite depressed. I'm still planning for the future and various chores & tasks seem do-able, not impossible.
The lack of withdrawal symptoms suggests to me that I've been building up my bupe levels over the last several days, despite my very low doses.
Posted by pseudoname on June 25, 2006, at 11:03:14
In reply to buprenorphine holiday today, posted by pseudoname on June 24, 2006, at 9:15:33
Instead of going without buprenorphine for the planned 48 hours I only made it to 44. I was awake and feeling indescribably agitated at 2 AM, so I went ahead and took 0.2 mg, which I was going to take at 6 AM.
Some cranky mood stuff came back while off it, but not much. Next time I'm going to schedule the holiday so the 36-hour point is when I go to sleep, and I can be busy & awake as withdrawal starts. Assuming it follows the same pattern next time. Sigh.
The AD benefit came back at full force on resumption.
Posted by ed_uk on June 25, 2006, at 17:03:02
In reply to buprenorphine abuse » ed_uk, posted by pseudoname on June 23, 2006, at 9:40:59
Hi PN
>I wonder what's going on in people for whom it's euphorogenic. Is it that their prioir opioid exposure has primed their brains?
As an opioid, I expect many people would find buprenorphine quite euphoric. Not everyone finds opioids euphoric by any means......but some do, and I imagine this also applies to buprenorphine.
Kind regards
Ed
Posted by Phillipa on June 25, 2006, at 17:25:33
In reply to Buprenorphine » pseudoname, posted by ed_uk on June 25, 2006, at 17:03:02
One percocet at betime for the broken elbow the next day I just felt good not high. Love PJ
o
Posted by pseudoname on July 7, 2006, at 14:10:32
In reply to buprenorphine and cognition, posted by pseudoname on June 15, 2006, at 13:09:03
I've found that after being at 0.25 mg/day of buprenorphine (Subutex®) for depression for a couple days, I can take 0.12 mg/day for a couple days without any loss of clinical benefit. But if I start fresh after a holiday at 0.12 mg, it's not enough.
Also, the 0.12 mg seems to wear off noticeably about 9 hours later, and I can wake the next morning with that familiar horror-level depression. It can be a struggle then even to put the bupe in my mouth from my bedside table.
I don't notice any withdrawal symptoms, however, when going to 0.12, even 8 hours after the clinical effect has worn off. Interesting.
The cognitive dopiness that crept on me at my previous higher doses seems to come back a little if I continue for several days at 0.25, but I still haven't tested it with chess games.
I continue to have broader ranges of emotion at these lower doses, including things like compassion, interest, and sadness, that were absent when I was in untreated depression and less pronounced when I was at 1-3 mg/day. I recover very quickly now from being annoyed and without having to suppress lingering bile. I also notice a difficult-to-describe sort of "self-satisfaction" — not (I hope) in a heartless, narcissistic sense, but as an "Oh-yeah-this-is-me" recognition. You are who you are, which is not an idea I could embrace when depressed and wasn't so much aware of when I was at the higher doses.
I have a few remaining pretty serious behavioral problems, mostly neurotic interpersonal fears and avoiding situations like those in which I was abusively frustrated as a child. Those seem unaffected by the opioid, except that I'm much more objectively aware of them now. I'm tackling them by myself with a variety of therapy techniques. I've had only incremental success so far, but that's still some improvement, and I'm pretty happy and hopeful about my prospects.
(To recap, I've gone from 3 mg/day of buprenorphine in January, to 1 in March, to 0.5 and then 0.2 last month. Now between 0.25 and 0.1 mg/day.)
[Buprenorphine for depression links at http://health.groups.yahoo.com/group/psycho-babble-tips/links/buprenorphine_for_de_001146748536/ ]
This is the end of the thread.
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