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Dr. Bob is Robert Hsiung, MD,
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Posted by med_empowered on February 20, 2007, at 2:07:04
In reply to Re: opiates for depression HELL NO, posted by Quintal on February 19, 2007, at 22:58:49
I think opiates can be a very, very good thing. High-doses for prolonged periods probably aren't fun, especially since chronic pain is often accompanied by mood and anxiety problems and psychosocial difficulties. Some more helpful docs give patients a stimulant (ritalin, provigil, an amphetamine) to help reduce lethargy. From what I've read (based on research done back when a doc could do this w/o fearing the DEA), such combos can work very, very well; the "speedball" combo tends to counteract sedation and depression and improve quality of life.
Anyway..that's beside the point...opiates have long been a solution, short- and long-term, to humankind's spells of misery and fits of despair. Based on my own experience, I hardly think any of these over-hyped miracle antidepressants will ever come close to matching the calming, soothing power of the opiates. And let's face it: the only reason these are considered "addictive drugs" is b/c no drug company has pushed through an overhyped med w/ opiate action for depression. The instant Pfizer or Eli Lilly or AstraZeneca take a break from pumping out "atypical" antipsychotics and offer up an opiate (one that, for 10-20 years, will be seen as "safe" and "less addictive" than cheaper drugs) for depression, p-docs all over will be spraying them on everyone for everything. And we'll all hear how terribly misinformed medicine was in the dark ages before they realized how beneficial opiates were, blah blah blah....
In the meantime, the best we can do is try to get docs to treat patients w/ mood issues with the same the same concern they're showing junkies. I think this really shows just how much the "mental patient" is disrespected and disregarded, even by the very profession that claims to serve us: drug addicts, a group traditionally seen as morally suspect, are entitled to better, more effective treatments than mental patients. Think about it.
((PS--I dont have a problem with people using/abusing drugs or those who wish to stop and end up labelled as "addicts" or "junkies"; my point is just that the "addict" has usually ranked pretty low on the social totem pole, and I think the way they are treated vs mental patients kind of shows that mental patients are still pretty much devalued and disregarded).
Posted by Crazy Horse on February 20, 2007, at 10:16:38
In reply to opiates for depression, posted by pearlcat on February 19, 2007, at 13:52:09
> Has anyone experienced that opiates seemed to help with depression,anxiety and add? I know it sounds crazy but it is true . I feel more motivated on these . I guess that is why they are addictive. Yet you cannot get them easily. But you can get crap like lamictal and effexor that can really screw you up! Too bad you cant get them on the internet!
Unfortunately they 'poop out' quickly do to tolerance. Otherwise they are great, i agree.
-Monte
Posted by Chairman_MAO on February 20, 2007, at 14:40:56
In reply to opiates for depression, posted by pearlcat on February 19, 2007, at 13:52:09
Try buprenorphine (Suboxone, Subutex, Buprenex). The doses required may be a lot more than 0.3mg qid, though (the "ceiling" dose is 32mg/day sublingually).
Buprenorphine for Depression: The Un-adoptable Orphan
Buprenorphine [BPN] in low (circa 0.3 mg qid) transmucosally (under the tongue or by nose drops) can be dramatically effective in cases of treatment for refractory depression. Its safety and efficacy are not secrets, yet it has received little study and currently receives little clinical use.
Early in BPN's history, Emrich et al (1982) found it a potent antidepressant in drug-refractory depressives. Sporadic supporting reports have appeared in the literature from time to time since then. Most recently, Bodkin et al (1995) reviewed the literature and reported an open trial of 10 cases to further document BPN's value as an antidepressant. When the drug works, it works quickly. Bodkin et al say they see results within several days. We have found that most patients experience benefits of an adequate dose within three hours. The only intolerable side effects are nausea and dysphoria. The effects are seen in 10% to 20% of patients and are quickly obvious....
We have personally treated five patients with BPN in whom the results were impressive. Three were more or less typical cases of depression who had failed adequate trials with various treatments, including, in one case, a thorough course of ECT. Of the two less typical patients, one was a case of panic disorder with onset in childhood and what could better be called dysthymia rather than typical depression.... All five patients were followed for several years while good results were maintained.
Given BPN's availability and demonstrated efficacy, why is it so rarely used in treating depression? Therein hangs a tale. Reckitt and Colman Pharmaceuticals, Inc. [R&C] received their NDA to market BPN as a parenteral analgesic more than a decade ago. It appears that their grand strategy was to get BPN approved as an over-the-counter analgesic. It does indeed have a remarkable safety profile. At high doses, it produces less respiratory depression and cognitive obtunding than morphine, perhaps due to its antagonist action....
Addiction and tolerance are not serious problems. Patients who abruptly stop the drug complain of fatigue, dysphoria, upset stomach, and sometimes piloerection. This pallid imitation of narcotic withdrawal is generally not associated with craving, and indeed patients do not usually associate their symptoms with having stopped the drug until they experience the relief occasioned by restarting their treatment. There are reports of the drug being abused, but then some substace abusers will abuse almost anything. We were told that San Quentin stopped using white scouring powder because substance-abusing inmates were injecting it into themselves!
One handicap BPN has had as an antidepressant was the absence of any interest in that application on the part of the manufacturer. The idea of selling BPN as an OTC analgesic was not an unreasonable one, but it did not lead R&C to pursue work on the psychotropic properties of their drug.
It appears tha BPN can be used much as methadone is used in maintaining opiate addicts. While doses of up to 32mg have been used, doses in the order of 6 to 12mg seem best. Compare this to the 0.15mg to 0.3mg doses that are effective in depression. Several studies have reported that BPN is indeed effective in treating opiate dependence, although less so than methadone (Kosten et al 1993 and Strain et al 1994). However, BPN's use in treating addicts, plus the ominous "-norphine" suffix in its name, have been even more of a deterrent to BPN's exploitation as an antidepressant than has R&C's narrow focus on its analgesic applications.
Comparing BPN with classic mu agonist opiates is unfair. BPN is a derivative of thebaine, which has partial mu agonist and kappa antagonist activities. As a partial agonist, it seems to act as a mu antagonist at higher doses, and this provides some protection against it being used in escalating doses by substance abusers. In addition, in low doses it produces minimal or no euphoria. We have a little packet of reprints to send out to pharmacists who call accusingly and question why we are prescribing such a "dangerous narcotic."...
We have continually been frustrated by the resounding lack of interest our colleagues have shown in BPN as an antidepressant. In spite of some promising pilot work, Veterans Administration workers treating post-traumatic stress disorder have declined to study BPN because so many of their clients are substance abusers, and BPN is "narcotic-like."
We discovered that someone had contracted with Cygnus, Inc. to develop a BPN patch. That was accomplished, but the contracting company dropped the project. The developed BPN patch now sits on their shelf. However, after a few cordial lunches, Cygnus indicated they would need a million dollars up front to reactivate production of the patch for a clinical trial. Small business grants are limited to $100,000 to start, so that would not get Cygnus back into the BPN patch business. Also, treatment-refractory depression does not sound like an appealing market to business types. We are not sure the market is so small, and it has been suggested that as many as 20-30% of depressed patients may be treatment-refractory. But certainly, for a single physician, patient accrual is slow. While the patent on BPN has run out, orphan drug status might allow a company to be protected against competition while it recoups its investment and more. But so far there is little interest from industry.
Academia has been similarly uninterested, but with better reason. It's too bad that substance abuse takes a hight priority than depression in congress, but then what is one to expect. And our wildest fantasy does not have the National Institutes of Mental Health approving the trial of such an oddball drug for treatment-refractory depression. In our mind's eye we can see the pink sheet: Reviewer No. 1 says: "We already know that BPN works in depression, so why do it again?", while reviewer No. 2 says: "It's too much of a long shot in these times of short money."...
Research is the art of the possible, and none of us these days can afford to espouse lost causes. But your local pharmacist can dispense BPN without a triplicate, and even supply a syringe and needle so the patient can withdraw the drug form the vial and squirt it under the tongue. You will find it in the Physician's Desk Reference under the trade name "Buprenex" injectable, 0.3mg/ml. So even if the orphan remains un-adoptable, you might want to try BPN on an occasional drug-refractory depressive, and so keep it alive, at least in the lore of those who do tertiary psychopharmacology.
Enoch Callaway
University of California-San Francisco
Tiburon, CA
References:Bodkin JL, Zornberg GL, Lucas SE, Cole JO. (1995): Buprenorphine treatment of refractory depression. Journal of Clinical Psychopharmacology, 16:49-57.
Emrich HM, Vogt P, Herz. (1982): Possible antidepressive effects of opioids: action of buprenorphine. Annals of the New York Academy of Sciences, 398:108-112.
Kosten TR, Schottenfeld R, Ziedonis D, Falcioni J. (1993): Buprenorphine versus methadone maintenance in opioid dependence. J Nerv Mental Dis 181:358-364.
Strain EC, Stitzer ML, Liebson IA, Bigelow GE. (1994): Buprenorphine vs. methadone in the treatment of opioid-dependent cocaine users. Psychopharmacology 116:401-406.
Posted by Chairman_MAO on February 20, 2007, at 14:41:37
In reply to Re: opiates for depression HELL NO, posted by flmm on February 19, 2007, at 21:36:19
Those people need to be given amphetamine.
Posted by Larry Hoover on February 20, 2007, at 17:20:36
In reply to Re: opiates for depression HELL NO, posted by flmm on February 19, 2007, at 21:36:19
> Hate to spoil the fun! After awhile these drugs are quite damaging in depression and can make it much, much worse! But hey, like any addictive street drug, it's fun in the begining. I speak from experience from back injury, surgery etc. Most people in chronic pain would do just about anything to get off the flatlining, terrible existence of barely surviving on opiates!
Nothing like the voice of experience....
Unfortunately, I have to weigh in on this side, also.I don't think anything can compare with the black depression that can arise when the opiates fail. It could be three months. Three years. Maybe never, if you're lucky. But the body eventually can't function with them, and you go into withdrawal, even when on a stable dose. At least I can say it happens, because it happened to me.
Now, the idea of using buprenorphine might well be the exception to the rule, but that's because it is an exceptional opiate (thebiate?). I'd be willing to give that a shot, not only because of the antidepressant effect, but also the pain suppressing quality of the drug.
I just want to say, there is a dark side to opiates. I don't care how careful you are, the darkness can come.
Lar
Posted by Quintal on February 20, 2007, at 17:47:10
In reply to Re: opiates for depression HELL NO » flmm, posted by Larry Hoover on February 20, 2007, at 17:20:36
I agree up to a point Larry, as I'm in a similar position to the one you were in not so long ago, right now myself but with OTC analgesics containing codeine. The same thing happens to some people with conventional antidepressants though (and that happened to me too) so I don't think it's fair to rule out opiates because of that. I'm very interested in buprenorphine too and I would like to try it if I ever get the chance.
Q
Posted by Phillipa on February 20, 2007, at 18:28:12
In reply to Re: opiates for depression HELL NO, posted by Quintal on February 20, 2007, at 17:47:10
Me too. you know they have a detox facility here in Charlotte that uses bupe but you have to be an addict first. Love Phillipa
Posted by yxibow on February 20, 2007, at 20:21:07
In reply to Re: opiates for depression HELL NO » Quintal, posted by Phillipa on February 20, 2007, at 18:28:12
I'm considering a doctor consultation for small PRN amounts of bupenorphine for eye and psychiatric pain for my visual somatiform disorder.
What is the general sensation of bupenorphine vis a vis other opiates such as codeine, oxycontin, percocet, etc, considering it is only C-V, from someone who has taken it specifically for some sort of pain or other disorder. I know its use is generally for detox, but who knows.
-- tidings.
Posted by flmm on February 20, 2007, at 21:10:45
In reply to Re: opiates for depression HELL NO » flmm, posted by Larry Hoover on February 20, 2007, at 17:20:36
Thank you for your sane sense of reason Larry! I think people become desperate and think opiates will work long term, they do not! Also, when they "poop out" it is not like an ssri pooping out, where it just seems to not work as well. They crash and actually make you more depressed,even if not increasing the dose, which most people do. This is the continuous withdrawal I think you are refering to. It is not an antidepressant, it is merely chasing a high! Which is what most depressed people did when they were younger and did not understand why they wanted to be high. It's called self medicating, and the road goes bleak very soon! Good luck to those that can handle it..............
Posted by Declan on February 20, 2007, at 21:59:27
In reply to Re: opiates for depression HELL NO » flmm, posted by Larry Hoover on February 20, 2007, at 17:20:36
>I don't think anything can compare with the black depression that can arise when the opiates fail.<
Maybe if you are in physical pain? Opiates generally fail inasmuch as tolerance decreases the effect and something happens in the brain that makes dose escalation beside the point. Everyone I knew on methadone maintenance had low grade depression, but methadone is the worst opiate I know of.
I just don't think it's quite that bad.
No worse than benzo addiction.
Oh dear, I've used the A word innapropriately again....someone can correct me.
Posted by Larry Hoover on February 20, 2007, at 22:07:39
In reply to Re: opiates for depression HELL NO, posted by Declan on February 20, 2007, at 21:59:27
> >I don't think anything can compare with the black depression that can arise when the opiates fail.<
>
> Maybe if you are in physical pain? Opiates generally fail inasmuch as tolerance decreases the effect and something happens in the brain that makes dose escalation beside the point.It may be particularly prominent with oxycodone, that black depression, but I've heard it from many people. Not just people who used it for pain, either. Anecdote, I know, but....I don't think this sort of thing gets published.
Lar
Posted by Quintal on February 20, 2007, at 22:14:30
In reply to Re: opiates for depression HELL NO, posted by flmm on February 20, 2007, at 21:10:45
>I think people become desperate and think opiates will work long term, they do not!
They work as long as any other antidepressant; sometimes a few days, sometimes a few weeks, sometimes a few months, sometimes a few years, and it is a such a wonderful release for the person when they do work for treatment resistant depressives. We are talking about people who have tried nearly everything in the book afterall, not as some faddy new remedy for treating everyday blues.
>Also, when they "poop out" it is not like an ssri pooping out, where it just seems to not work as well.
The flip side to this is that just like with opiates when the SSRI/SNRI poops out you often face not only returning depression and anxiety, but at the most inopportune time you have to endure a nasty withdrawal syndrome to boot.
>It is not an antidepressant, it is merely chasing a high!
How do you define 'antidepressant'? Anything that ameliorates depression is an antidepressant to my mind, but I would argue that opiates are, in truth, more authentic antidepressants than drugs like SSRIs that seem to exert their antidepressant effect most often by reducing the capacity to feel emotion.
>It's called self medicating, and the road goes bleak very soon!
It's not self-medicating if the opiate is prescribed by a doctor. The road of conventional antidepressants has gone blank for many people here already, that's why they are considering opiates.
>Good luck to those that can handle it..............
Thank you.
Q
Posted by Declan on February 20, 2007, at 22:30:58
In reply to Re: opiates for depression F*CK YEAH!, posted by Quintal on February 20, 2007, at 22:14:30
O yeah.
Some people are more responsible than others.
Some people worry about PR more than others.
Some people couldn't give a rats.
Posted by Quintal on February 20, 2007, at 22:42:02
In reply to Merely chasing a high, posted by Declan on February 20, 2007, at 22:30:58
...........doesn't bother me.
I've yet to find anything that works as an antidepressant for me that lacks abuse potential; i.e. gets me high to some extent. That's what I mean by true antidepressants being mood elevators rather than anaesthetics.
Q
Posted by Declan on February 20, 2007, at 22:44:50
In reply to Re: Merely chasing a high, posted by Quintal on February 20, 2007, at 22:42:02
Well yes.
The standards of the industry are such that we are meant to be grateful for feeling half dead, but bugger that.
Posted by Declan on February 21, 2007, at 0:59:00
In reply to Re: Merely chasing a high, posted by Declan on February 20, 2007, at 22:44:50
Opiates 'help many people, period! Are they perfect? NO! They make a significant difference in my, and many other people I know, lives. Anxiety and depression is a complex and difficult disease. The drugs can only do so much! Maybe some of you complainers should look at other ways to help yourself, and be grateful for the help available to us!'
Really, who knows?
Posted by Declan on February 21, 2007, at 1:04:49
In reply to Re: opiates for depression HELL NO » Declan, posted by Larry Hoover on February 20, 2007, at 22:07:39
Well, yes Larry.
Giving up methadone felt like this endless thing, terrible really, and I wouldn't wish it on anyone.
The cure is often worse than the disease, hey?
Posted by Quintal on February 21, 2007, at 6:35:53
In reply to Re: opiates for depression HELL NO, posted by flmm on February 20, 2007, at 21:10:45
Actually, if there's one class of drug notorious for rapid tolerance and the severe, suicidal depressions that follow withdrawal, it's the amphetamines. Yet I see many people here using them to treat depression and some spurious cases of ADHD. Relatively little fuss is made of this.
Q
Posted by Larry Hoover on February 21, 2007, at 15:36:01
In reply to opiates for depression, posted by pearlcat on February 19, 2007, at 13:52:09
Here's a recent study showing significantly decreased µ-opioid binding in MDD. Hmmmm....
http://archpsyc.ama-assn.org/cgi/content/abstract/63/11/1199
I think this is why buprenorphine seems to be so effective? I'm not remembering things well right now, so if anyone knows for sure, I'd appreciate the confirmation.
Lar
Posted by linkadge on February 21, 2007, at 16:02:22
In reply to Re: opiates for depression, posted by Quintal on February 21, 2007, at 6:35:53
I don't think it is fair at all for somebody to say that anyone using opiates for depression is merely chasing a high.
We don't fully understand the biochemical abnormalities in depression.
I think it is completely possable, that opiates target some aspect of the affective process, while potentally causing euphoria as a side effect.
It is just like how drugs for ADHD are not treating ADHD *by* causing euphoria. Euphoria is simply a side effect. The theraputic effect is not due to dopamine release in the neucleus accumbens, but rather dopamine release in the frontal cortex.
Similarly, I think it is possable that opiates do something in addition to their abuse poetneial. There is a link, for instance between depression and pain. Opiates affect the activity of substance P for instance. Substance P inhibitors are being investigated as a means to treat depression without euphoria.
So to say that a person using opiates for depression is just trying to get high may not be entirely accurate as there may be two entirely separate procesess at work.
Linkadge
Posted by Quintal on February 21, 2007, at 17:45:07
In reply to Re: opiates for depression, posted by linkadge on February 21, 2007, at 16:02:22
>I don't think it is fair at all for somebody to say that anyone using opiates for depression is merely chasing a high.
I agree. I'm not sure to whom this post was directed, if anyone in particular, but I'll respond anyway........
>It is just like how drugs for ADHD are not treating ADHD *by* causing euphoria. Euphoria is simply a side effect. The theraputic effect is not due to dopamine release in the neucleus accumbens, but rather dopamine release in the frontal cortex.
I think it's hard to tell link, since there are no drugs that specifically release dopamine only in the frontal cortex (that I'm aware of) that could prove it conclusively. The performance of treatments for ADHD that operate selectively via the noradrenergic system, like Strattera seem less impressive than those that (perhaps incidentally) increase dopamine release in the nucleus accumbens. I think to some significant extent the increased efficiency and tolerability of amphetamines used to treat ADHD is due to increased desire and greater capacity to feel reward caused by release of dopamine in the nucleus accumbens, as well as increasing attention span and organisation etc, by releasing dopamine in the frontal cortex. I say this because again, drugs that increase attention span alone and cause little if any euphoria, like Strattera seem to be less effective (and less well tolerated) overall.
I really think a drug that's subjectively more pleasant in its effects will have more treatment responders, because more people will be willing to persevere for the full length of the trial even if the actual benefits aren't that good.
>Similarly, I think it is possable that opiates do something in addition to their abuse poetneial. There is a link, for instance between depression and pain. Opiates affect the activity of substance P for instance. Substance P inhibitors are being investigated as a means to treat depression without euphoria.
I'm sure you know opiates affect many chemicals in the brain link, most of the usual mood-altering culprits dopamine and serotonin for example, as well as any action on substance P. We already have a whole gamut of antidepressants that supposedly treat depression without causing euphoria. They seem to be less effective overall than those that do cause euphoria, especially for treatment resistant depressives, and that is what most of this debate has been about.
That reminds me, didn't the legendary Elizabeth of Buprenorphine disappear off babble radar right after announcing she was considering being a participant in a clinical trial for a substance P blocker? I wonder if she ever did attend? Ominous.
Q
Posted by pearlcat on February 21, 2007, at 20:40:39
In reply to Re: opiates for depression » pearlcat, posted by Larry Hoover on February 21, 2007, at 15:36:01
Sometimes I think it is all a plot by the Government! Maybe if they did not hang over docs heads about controlled drugs some of us could get better out there instead of going through years of hell to find out what works. I agree that you do build a tolerance to opiates. However because it can make you feel normal and then help you sleep soundly , maybe that is why people abuse them. Not to get high just to feel happy and motivated. At least that is what is does to me. But, instead you get crap like EFFEXOR and you gain weight, and have a terrible time coming off of it. Maybe to alleviate some of the withdrawel of effexor they should prescribe opiates!!!
Posted by pearlcat on February 21, 2007, at 20:48:19
In reply to Re: opiates for depression, posted by linkadge on February 21, 2007, at 16:02:22
Thank you!!! It IS NOT about chasing a high. Its about getting through life and enjoying it with this illness or illnesses. And if it were to work than why not try it, research it more instead of slamming it and assuming that those of us that it helps are drug addicts.
Posted by linkadge on February 21, 2007, at 20:58:11
In reply to Re: opiates for depression, posted by Quintal on February 21, 2007, at 17:45:07
>I think it's hard to tell link, since there are >no drugs that specifically release dopamine only >in the frontal cortex (that I'm aware of) that >could prove it conclusively.
Caffiene is an example of a stimulant drug which increases dopamine release much more in the frontal cortex than in the neucleus accumbens. While caffine is not patentable, it is probably the number one choice for ADHD for a number of undiagnosed.
But, my point was that there are plenty of drugs that are eupohriants (ie NAA dopamine release) wich are not effective for ADHD. So, the effect of ritalin is not simply due to euphoria.
Just like, for a while people thought the mood effects of amphetamines were inseperable from the weight loss properties. Amphetamine derivitives like fenfluramine however seem to proove this assumption wrong.
>The performance of treatments for ADHD that >operate selectively via the noradrenergic >system, like Strattera seem less impressive than >those that (perhaps incidentally) increase >dopamine release in the nucleus accumbens.
Thats probably because straterra doesn't increase frontal cortex dopamine as much as it does frontal cortex noradrenaline. This drug doesn't make a lot of sense for ADHD since a number of studies indicate noradrenaline is hyperactive compared to dopamine in ADHD. (but thats beside the point)
>I think to some significant extent the increased >efficiency and tolerability of amphetamines used >to treat ADHD is due to increased desire and >greater capacity to feel reward caused by >release of dopamine in the nucleus accumbens, as >well as increasing attention span and >organisation etc, by releasing dopamine in the >frontal cortex. I say this because again, drugs >that increase attention span alone and cause >little if any euphoria, like Strattera seem to >be less effective (and less well tolerated) >overall.
Well, I'd like to comment. For starters we only really have Straterra, which as I mentioned above doesn't really increase frontal cortex dopamine so I wouldn't even use it as a comparitor. Certain supplements like omega-3 have utility in ADHD. The 0-3 fatty acids increase frontal cortex dopamine, but do not directly activate the reward systems. So, I'd say we need more drugs in order to fully know for sure.
Another argument that I would make is that many people who are trying drugs like strattera have already been primed to the reward of ritalin. As such, they are unlikely to find other drugs as effective.
Only time, and more test drugs will fully determine whether activating the reward systms is actually necessary for ADHD drug effect. One would also need to ascertain wheather the reward system in ADHD is actually dysfunctional, because we do know that long term stimulant treatment can make the reward systems dysfunctional.
Another consideration is that ADHD drugs can continue to work, long after the subjective high has subsided.
Kids who take ritalin for years, are unlikely to be getting any buzz from it, but it still helps their attention.
>I really think a drug that's subjectively more >pleasant in its effects will have more treatment >responders, because more people will be willing >to persevere for the full length of the trial >even if the actual benefits aren't that good.That is certainly true.
>We already have a whole gamut of antidepressants >that supposedly treat depression without causing >euphoria. They seem to be less effective overall >than those that do cause euphoria, especially >for treatment resistant depressives, and that is >what most of this debate has been about.I agree. But, all I am saying is that with some of these drugs, even the ones that cause euphoria, there may still be undetermined mechanisms of theraputic action that could be unrelated to euphoric properties. The neucleus accumens quickly adapts to chemical alterations, so I would argue that if a long term theraputic response is attained, then there is likely something else going on.
Linkadge
Posted by flmm on February 21, 2007, at 21:11:37
In reply to Re: opiates for depression, posted by pearlcat on February 21, 2007, at 20:48:19
Declan,Quintal, you are both in total denial! Yes, something that gets you high can be considered an antidepressant. That is not how ssri meds work. That's probably why a lot of people don't like them. The dreaded "poop out" everyone speaks about here, is merely the leveling out of the medication. You guys think the high should last forever!
Good luck and party on dudes...........
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Dr. Bob is Robert Hsiung, MD,
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