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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Quintal on December 14, 2006, at 8:49:28
I took a tablet of Phenergan (promethazine) last night to help me sleep and I noticed today that my dose of codeine did not make me feel warm and happy as it usually does.
According to an article on Wikipedia promethazine is sometimes used to 'increase the effect' of opiates so that lower doses can be used - I presume they're referring to the analgesic effect there?
Any experiences/thoughts welcome.
Q
Posted by mattye on December 14, 2006, at 14:13:28
In reply to Do APs block the euphoric effects of opiates?, posted by Quintal on December 14, 2006, at 8:49:28
It is interesting that you brought this up, because I was wondering the same thing about SSRIs blocking the effect of opiates.
As a seasoned opiate abuser, I was surprised that when I took 5 40mg oxycontins, chewed up, (that's 200mgs!) I barely got high. I was drinking too! It had been weeks since I used an opiate drug, so I should have had no tolerance. My brother took one and got high as hell and was throwing up! I have always had some intrinsic tolerance towards opiates, but this was ridiculous! The only thing I could think of was that I had recently started on Lexapro about 2 months earlier. Perhaps the SSRI made some changes in my brain - dopamine depletion or something.
The other weird thing is that I am SUPER sensitive to stimulants. I hate them! I took one of my sister's adderall the other day and I wanted to scratch my eyes out. I think my brain is already wired too fast and speed just makes my thoughts feel out of control.
Posted by med_empowered on December 14, 2006, at 23:47:50
In reply to Re: Do APs block the euphoric effects of opiates?, posted by mattye on December 14, 2006, at 14:13:28
yeah, they do. Stelazine (trifluoperazine) is an old stand-by neuroleptic that's being studied for "preventing opiate addiction," presumably for long-term opiate patients. Its kind of adding insult to injury...first the patients have to deal with chronic pain and under-prescribing physicians, then they have to take neuroleptics to "prevent addiction".
Neuroleptics are brain disabling drugs that suck all the joy and color out of life, so it doesn't surprise me that they "prevent addiction". They also "prevent emotion" and "prevent individuality," so they seem to be good at "preventing" anything medical/psychiatric authorities might deem troublesome. Neuroleptic treatment is remarkably similar to various forms of lobotomy--the dopamine blocking causes similar frontal lobe deficits while the drug is being used. Not surprisingly, lobotomy and similar brain ravaging surgeries have been, and are being, used for opiate addiction...in China and Russia, these surgeries have been used with some success. In the West, I suppose more lip service is paid to "human rights," so instead of cutting up addict's brains, we treat every patient like a potential addict and drug them into oblivion accordingly.
Posted by SLS on December 15, 2006, at 6:03:27
In reply to Re: Do APs block the euphoric effects of opiates?, posted by med_empowered on December 14, 2006, at 23:47:50
> Neuroleptics are brain disabling drugs that suck all the joy and color out of life...
> ...They also "prevent emotion" and "prevent individuality,"
This has not been my experience with Zyprexa, Risperdal, or Abilify. I have been on Abilify for over 2 years. It has enhanced motivation and energy and has not dampened emotion at all. I'm not sure neuroleptics deserve such a generalization. Actually, I'm sure they don't.
- Scott
Posted by Quintal on December 15, 2006, at 10:43:11
In reply to Re: Do APs block the euphoric effects of opiates? » med_empowered, posted by SLS on December 15, 2006, at 6:03:27
I'm sure you know Abilify is slightly different in its action at D2 receptors than most other APs Scott. Personally, I couldn't tolerate the akathisia and insomnia it caused.
I think there was a thread about Zyprexa causing emotional numbness on here just the other day. I can't remember my own response to it clearly - a bit like a benzo from what little I do recall and with them I wasn't aware of how much my normal emotional responses had been distorted until I'd withdrawn from them for a few months. It was a horrible realization.
Seroquel certainly made me into the classic drugged zombie 'mental patient'. I was spaced out all the time, couldn't concentrate, drooled all over the place - not that I cared too much about that at the time though. It was such an extreme effort to stay awake. Like walking through glue.
Generally speaking from my personal experiences and observing a few friends who have been unfortunate enough to need them, and reading experiences of other people posted on the web I have come to the conclusion that *generally* the APs do what med_empowered claims. They tend to reduce motivation and will power, and the ability to enjoy life fully in the normal sense. There are always exceptions of course, but they are exceptions nevertheless.
Q
Posted by SLS on December 15, 2006, at 15:43:48
In reply to Re: Do APs block the euphoric effects of opiates? » SLS, posted by Quintal on December 15, 2006, at 10:43:11
> I'm sure you know Abilify is slightly different in its action at D2 receptors than most other APs Scott. Personally, I couldn't tolerate the akathisia and insomnia it caused.
>
> I think there was a thread about Zyprexa causing emotional numbness on here just the other day. I can't remember my own response to it clearly - a bit like a benzo from what little I do recall and with them I wasn't aware of how much my normal emotional responses had been distorted until I'd withdrawn from them for a few months. It was a horrible realization.
>
> Seroquel certainly made me into the classic drugged zombie 'mental patient'. I was spaced out all the time, couldn't concentrate, drooled all over the place - not that I cared too much about that at the time though. It was such an extreme effort to stay awake. Like walking through glue.
>
> Generally speaking from my personal experiences and observing a few friends who have been unfortunate enough to need them, and reading experiences of other people posted on the web I have come to the conclusion that *generally* the APs do what med_empowered claims. They tend to reduce motivation and will power, and the ability to enjoy life fully in the normal sense. There are always exceptions of course, but they are exceptions nevertheless.
I participate in a day program a few times a week where many of my 150 peers have been on APs for months and years. I don't see that these people are being affected in the ways you have generalized. I can't yet account for the differences in what we both have observed.
- Scott
Posted by Quintal on December 16, 2006, at 4:21:58
In reply to Re: Do APs block the euphoric effects of opiates? » Quintal, posted by SLS on December 15, 2006, at 15:43:48
>I participate in a day program a few times a week where many of my 150 peers have been on APs for months and years. I don't see that these people are being affected in the ways you have generalized.
>Really? A good portion of 150 people taking APs and not a single case of flattened affect, somnolence or impaired concentration? That's almost incredible!
Q
Posted by SLS on December 16, 2006, at 5:42:04
In reply to Re: Do APs block the euphoric effects of opiates? » SLS, posted by Quintal on December 16, 2006, at 4:21:58
> >I participate in a day program a few times a week where many of my 150 peers have been on APs for months and years. I don't see that these people are being affected in the ways you have generalized.
> >
>
> Really? A good portion of 150 people taking APs and not a single case of flattened affect, somnolence or impaired concentration? That's almost incredible!Thanks for including the qualifier "almost". Of course, I don't communicate intimately with everyone there, but I do speak with the majority. I'll make it a point to gather some more information. There have been some people who have complained of somnolence on Seroquel, but this often dissipates with time at higher dosages. Some people don't like the way they feel on Risperdal, especially at the beginning. This often depends on diagnosis, though. Schizophrenia and schizoaffective disorders seem to do better with it. It made me feel more depressed for the first few days (bipolar depression) and somewhat slowed down, but this resolved by the end of the first week. Zyprexa and Abilify are almost never a problem. Yes, there are some people who don't like the way they feel on neuroleptics, but the majority do not resemble the following depictions:
"Neuroleptics are brain disabling drugs that suck all the joy and color out of life,"
"They also "prevent emotion" and "prevent individuality,"
"Neuroleptic treatment is remarkably similar to various forms of lobotomy"
No theory. Just my opinion based upon observation and personal experience - just like you.
- Scott
Posted by Vale on December 16, 2006, at 14:02:39
In reply to Re: Do APs block the euphoric effects of opiates?, posted by med_empowered on December 14, 2006, at 23:47:50
>
> Neuroleptics are brain disabling drugs that suck all the joy and color out of life, so it doesn't surprise me that they "prevent addiction". They also "prevent emotion" and "prevent individuality," so they seem to be good at "preventing" anything medical/psychiatric authorities might deem troublesome. Neuroleptic treatment is remarkably similar to various forms of lobotomy--the dopamine blocking causes similar frontal lobe deficits while the drug is being used. Not surprisingly, lobotomy and similar brain ravaging surgeries have been, and are being, used for opiate addiction...in China and Russia, these surgeries have been used with some success. In the West, I suppose more lip service is paid to "human rights," so instead of cutting up addict's brains, we treat every patient like a potential addict and drug them into oblivion accordingly.
>
> Actually a lot of what you say here is untrue,
Firstly it's a blanket statement, that lumps all the A.P's together. Low doses of certain A.P's act as disinhibitors and reduce blunted affect states.
( Sulperide, Amisulpride) Correct doses of traditional A.P's suit many patients,they actually reduce stereotype behavior while sheilding them from stress and allowing better ability to concentrate on things. Have you ever been in the company of someone dosed up to their eyeballs with Heroin, they're not exactly the life and soul of the party either.It all boils down to what suits the individual and at the ideal dosage. In any event though, they should be reserved for serious illness, opiate addiction doesn't qualify, unless it's associated with pychosis.
Posted by Quintal on December 16, 2006, at 18:26:22
In reply to Re: Do APs block the euphoric effects of opiates?, posted by Vale on December 16, 2006, at 14:02:39
>Low doses of certain A.P's act as disinhibitors and reduce blunted affect states.
(Sulperide, Amisulpride).That statement could be slighty misleading because low doses of amisulpride and sulpiride (the two are closely related) have the *opposite* effect on D2 receptors to other APs. They are agonists at low doses and work in a similar way to cabergoline et al. D2 agonists can cause hallucinations and other psychotic behaviour so they are not used at low doses for the same purposes as other APs (to manage psychosis, subdue aggressive behaviour etc). There has been suggestion of their use in cocaine detox. Much of this implies that conventional APs are powerful dysphoriants.
>Correct doses of traditional A.P's suit many patients,they actually reduce stereotype behaviour while sheilding them from stress and allowing better ability to concentrate on things.
It's true that low dose benzos at least can appear to give the illusion of increased concentration (I've experienced this myself) as the person becomes less preoccupied with his/her internal worries and pays more attention to the outside world. It wasn't until I withdrew from these drugs that I realised just how much my normal responses had really been impaired though. It seems unlikely that a person's concentration on APs would be better than their concentration than while they are stable and unmedicated though.
>Have you ever been in the company of someone dosed up to their eyeballs with Heroin, they're not exactly the life and soul of the party either.
Ah, you're talking about sociability there and that's not what we are referring to. Obviously someone is going to be more sociable on APs, well, less anti-social at least, than someone who is actively psychotic. It is the typical dysphoric effect of APs and the way they negate the subjective sensation of euphoria and well-being produced by opiates that was the original topic of the thread.
>It all boils down to what suits the individual and at the ideal dosage. In any event though, they should be reserved for serious illness, opiate addiction doesn't qualify, unless it's associated with psychosis.
I agree.
Q
Posted by Vale on December 17, 2006, at 7:02:42
In reply to Re: Do APs block the euphoric effects of opiates? » Vale, posted by Quintal on December 16, 2006, at 18:26:22
Hi
I know that sulperide and amisulpride are closley realted. I've swallowed enough of them to be aware of that fact. Actually the subjective effects are different from the dopamine agonists you mention.
There is a definite "neuroleptic flavour" ( for want of a better definition) about them, even at low dose.And they are prescibed throughout the dose range for negative/positive symptoms of schizophrenia.
It's true to say that drugs like Haloperidol, are distintcly dysphoric for the majority of users, (myself incl.) there are nevertheless traditional A.P's which are indicated for milder depressive states ie. Thioridazine ( I hated it though)To get back to the original thread, Do A.P.'s block the euphoric effects of opiates?
I would hazard the answer, Yes and no,
Over the past 6 years I've been an occasional user of opium, smoked or as a tea. The euphoriant effects are by no means consistant for me, half the time when used on it's own, an actual dysphoria is evident. In order to achieve more consistancy I combine it with a low dose 25mg of Hydroxycin ( Atarax) a Piperazine, not too far removed from the classic neuroleptics. This has the effect of A/ potentiation of the Opiate euphoric effects. B/ Prolongation of those effects
C/ Reduction of the Histamine liberating side effects of Morphine. In other words a good buzz.
Posted by Quintal on December 17, 2006, at 9:03:24
In reply to Re: Do APs block the euphoric effects of opiates?, posted by Vale on December 17, 2006, at 7:02:42
>There is a definite "neuroleptic flavour" ( for want of a better definition) about them, even at low dose.And they are prescibed throughout the dose range for negative/positive symptoms of schizophrenia.
>I'm curious about the 'neuroleptic flavour' you talk about. Amisulpride felt nothing like any other AP I've taken - it felt very similar to the other dopamine agonists to me. It made me feel light and energetic - even euphoric at the beginning. I seemed much more alert and mentally sharp. The negative side effects I normally associate across the spectrum of APs are heavy sedation, mental slowing/cognitive impairment, vacant facial expression/zoning out etc, anhedonia/dysphoria, akathisia/restlessness, parkinsonism, dystonia and other EPS. None of these were a problem for me with amisulpride in doses of 50mg and below, and I didn't notice any problems at 150mg either - it just seemed to lose its energising effect.
I know the boyfriend of my friend who has schizophrenia was unwisely prescribed amisulpride with flupentixol to overcome the dysthymia he was having and they caused a severe manic episode. He had not had this problem with flupentixol alone even though it is known to provoke mania in susceptible people. This suggests to me that amisulpride does have quite a different flavour to the other neuroleptics which usually suppress mania.
>In order to achieve more consistency I combine it with a low dose 25mg of Hydroxycin ( Atarax) a Piperazine, not too far removed from the classic neuroleptics. This has the effect of A/ potentiation of the Opiate euphoric effects. B/ Prolongation of those effects
>Hydroxyzine is not an antipsychotic and can't be compared to them for this purpose. Some antipsychotics are piperazine derivatives but piperazine derivatives vary as widely as Viagra, pesticides and cattle wormers which are clearly not antipsychotics. The piperazines, particularly BZD, MCPP and TFMPP are being used in 'Pep Pills' here in the UK (and are rapidly being outlawed) as they are powerful stimulants and are marketed as legal harm-reduction amphetamine and ecstasy alternatives.
I've heard of people using antihistamines to enhance to opiate high. I sometimes use diphenhydramine (Nytol One-a-night/Benadryl) for this purpose and to reduce the itching. Atarax is not often used here and can be hard to obtain. I once asked my GP for some as a non-benzodiazepine anxiolytic and she refused because the BNF discourages it for some reason.
Q
Posted by Vale on December 17, 2006, at 15:54:26
In reply to Re: Do APs block the euphoric effects of opiates?, posted by Quintal on December 17, 2006, at 9:03:24
>Hello Quintal
>
> I'm curious about the 'neuroleptic flavour' you talk about. Amisulpride felt nothing like any other AP I've taken - it felt very similar to the other dopamine agonists to me. It made me feel light and energetic - even euphoric at the beginning. I seemed much more alert and mentally sharp. The negative side effects I normally associate across the spectrum of APs are heavy sedation, mental slowing/cognitive impairment, vacant facial expression/zoning out etc, anhedonia/dysphoria, akathisia/restlessness, parkinsonism, dystonia and other EPS. None of these were a problem for me with amisulpride in doses of 50mg and below, and I didn't notice any problems at 150mg either - it just seemed to lose its energising effect.Yes, it makes most people energized and alert, me too, I'm talking about a hard to define perception of how things are perceived under it's influence, rather than distinct side effect profiles like you mention.For me that perception comes closest to an A.P. rather then a dopamine agonist. It's not a dopamine agonist anyway, though it's reputed preferential pre-synaptic blocking mechanism at low dosage may contribute to the initial activating effects.
>>
>
>
> Hydroxyzine is not an antipsychotic and can't be compared to them for this purpose. Some antipsychotics are piperazine derivatives but piperazine derivatives vary as widely as Viagra, pesticides and cattle wormers which are clearly not antipsychotics. The piperazines, particularly BZD, MCPP and TFMPP are being used in 'Pep Pills' here in the UK (and are rapidly being outlawed) as they are powerful stimulants and are marketed as legal harm-reduction amphetamine and ecstasy alternatives.Hydroxycine in it's subjective effects can quite definitely be compared to A.P's.( sedation, and the who cares feeling), It may also cause similar side effects, notably EPS and tardive dyskinesia.
Though granted, it's use in clinical practice, is mainly for pre and post operative sedation, and as an antihistamine.( we are a long way from pep pills and cattle dewormer with this one)
If we go back in time to the early 50's, the first authentic A.P. chlorpromazine was an offshoot of an antihistamine experiment. (The Tri-cyclic A.D.'s are further tweaked relatives of this group of compounds)Thanks for the stimulating interchange,
A Merry Christmas and a Happy drug free new year.Vale
>
>
This is the end of the thread.
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