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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 2 to 26 of 26. Go back in thread:
Posted by Brainbeard on December 30, 2010, at 16:43:24
In reply to Tramadol for TRD., posted by roscopeeco on December 30, 2010, at 15:33:50
From all the anecdotal evidence I have seen on the web, I come to these conclusions:
* tramadol appears to be a magnificent directly acting antidepressant for a lot of people
* this effect seems to dissipate with time, probably because of tolerance
* when the drug has stopped working, people want to stop taking it, to find that it has a withdrawal syndrome from hell.
Posted by roscopeeco on December 30, 2010, at 16:51:13
In reply to Tramadol - Or 'Hit It And Quit It', posted by Brainbeard on December 30, 2010, at 16:43:24
> From all the anecdotal evidence I have seen on the web, I come to these conclusions:
>
> * tramadol appears to be a magnificent directly acting antidepressant for a lot of people
>
> * this effect seems to dissipate with time, probably because of tolerance
>
> * when the drug has stopped working, people want to stop taking it, to find that it has a withdrawal syndrome from hell.I would take a drug dependence with great results over a suicidal depression. If you respond well to tramadol, you will respond well to medications like suboxone or subutex. I personally know two people who are on subutex for life at managable doses. They have yet to become tolerant to that medication. From what I have seen by people who take tramadol. if they feel they are building a tolerance they cycle down for a couple days. Some people just take one 200mg extended release tablet. In my desperate state I had a Dr. in my area ready to prescribe suboxone if need be.
Posted by Phillipa on December 30, 2010, at 21:36:01
In reply to Re: Tramadol - Or 'Hit It And Quit It', posted by roscopeeco on December 30, 2010, at 16:51:13
Seriously I correspond with two people on subtonex. One's New Years resolution to get off it and the other has also been trying desparatly for a long time to get off the pain. I know that meds like this help me also. But I don't think I go there as my pdoc said no to tramadol yet has no problem with benzos. Phillipa
Posted by floatingbridge on December 31, 2010, at 16:52:55
In reply to Re: Tramadol - Or 'Hit It And Quit It', posted by roscopeeco on December 30, 2010, at 16:51:13
> I would take a drug dependence with great results over a suicidal depression. If you respond well to tramadol, you will respond well to medications like suboxone or subutex. I personally know two people who are on subutex for life at managable doses. They have yet to become tolerant to that medication. From what I have seen by people who take tramadol. if they feel they are building a tolerance they cycle down for a couple days. Some people just take one 200mg extended release tablet. In
my desperate state I had a Dr. in my area ready to prescribe suboxone if need be.
>What is this suboxone people are talking about? I thought it was a detox med.
Anyways, I did add tramadol to my cocktail after waiting a heck of a long time. (I have chronic, weirdo, fibro-ish pain.) Wow, did I develop rapid tolerance. So it was not the answer I thought. I do take ultram 200mg daily as part of my cocktail. I have something going on with dopamine, opoids, whatever.
My 2¢ experience.
fb
Posted by Phillipa on December 31, 2010, at 19:59:35
In reply to Re: Tramadol for TRD » roscopeeco, posted by floatingbridge on December 31, 2010, at 16:52:55
FB it's for opiod detox and also is addicting. My FB friend is hooked on it. Horrible time. I just deleted a nursing article with warning about the addictive tendencies of tamadol. I will see if can find it. Phillipa
Posted by Phillipa on December 31, 2010, at 21:03:41
In reply to Re: Tramadol for TRD » roscopeeco, posted by floatingbridge on December 31, 2010, at 16:52:55
FB for you. Phillipa
Posted by roscopeeco on January 1, 2011, at 11:22:24
In reply to Re: Tramadol for TRD » roscopeeco, posted by floatingbridge on December 31, 2010, at 16:52:55
have something going on with dopamine, opoids, whatever.
>
> My 2¢ experience.
>
> fb
>
>
If this is the case you might want to start doing research on suboxone and subutex...Dr's have successfully treated treatment resistant cases with these meds. Unlike the ultram, you don't build a tolerance. Like I said before, I know two people on suboxone. It is a pretty unique drug and the subject of research by Harvard in treatment resistant cases.
Posted by roscopeeco on January 1, 2011, at 11:33:43
In reply to Re: Tramadol for TRD » floatingbridge, posted by Phillipa on December 31, 2010, at 19:59:35
> FB it's for opiod detox and also is addicting. My FB friend is hooked on it. Horrible time. I just deleted a nursing article with warning about the addictive tendencies of tamadol. I will see if can find it. Phillipa
It is obviously addicting, but there are many people on suboxone for treatment resistant depression. Unlike Ultram you don't have to keep dosing up to get the effects.
This is a good link of a guy who is using it for TRD. Within the thread there are a couple other links about others who are doing the same. The dosing for depression is 2mg or under, where the dosing for addiction withdrawal is around 16mg. The depression suffers never have to go up. We are talking about true TRD cases where people have been shocked and nothing helped. I don't think suicidal depression cares about having to take Suboxone for the rest of their life. The only people I know that complain about the withdrawals are those who never had depression in the first place and just want to get off the med for the sake of being med free.
http://www.addictionsurvivors.org/vbulletin/showthread.php?t=25542
Posted by roscopeeco on January 1, 2011, at 12:02:24
In reply to Re: Tramadol for TRD, posted by roscopeeco on January 1, 2011, at 11:33:43
Here is an abstract from Harvard in 1995 using buprenorphine as an antidepressant. Buprenorphine is suboxone without the naloxone. The mean half-life is 37 hours.
http://www.addictionsurvivors.org/vbulletin/showthread.php?t=25542
Posted by floatingbridge on January 1, 2011, at 14:49:06
In reply to Re: Tramadol for TRD, posted by roscopeeco on January 1, 2011, at 12:02:24
Roscopeeco, thanks for the links. I'll take a look.
Good new year to you!
fb
Posted by ed_uk2010 on January 1, 2011, at 17:52:16
In reply to Re: Tramadol for TRD, posted by roscopeeco on January 1, 2011, at 11:33:43
>The depression suffers never have to go up.
I think that remains to be seen. Buprenorphine is an experimental treatment for severe depression, not an established treatment.
All clinically used opioids have the potential to create dependence and withdrawal symptoms occur frequently when stopped. Buprenorphine may be less problematic than some of the others in this regard but it is still an opioid, and remains a controlled drug for a reason. In some areas, buprenorphine has established itself quite a reputation as a recreational drug.
Posted by Phillipa on January 1, 2011, at 18:20:52
In reply to Re: Tramadol for TRD, posted by ed_uk2010 on January 1, 2011, at 17:52:16
Ed that is what happened to an old poster here. PJ
Posted by bleauberry on January 2, 2011, at 7:41:04
In reply to Tramadol for TRD., posted by roscopeeco on December 30, 2010, at 15:33:50
At websites where patients randomly rate their med experiences, tramadol happens to be one of the best. The only others getting high scores are nardil and parnate. On a 1 to 5 scale, tramadol scores in the low 4's, along with nardil and parnate, where all other psych meds score low 3's or lower.
That said, at these same places you can find horrible stories of tramadol....bad reactions, withdrawals. Tolerance and addiction seem to be common, but can be accepted and managed depending on whether the med is working well or not. Addicted and well, or unaddicted and sick....that's the decision tree.
I was unfortunately one of the minority of people that did very bad with tramadol. It sent me into a a deep dark place within 2 days. Fortunately my experience is in the minority.
Tramadol can be magical. People have taken every other antidepressant on the planet with bad effect, and then found tramadol to be wonderful. Most of those people discovered it by accident during a pain reliever prescription.
Posted by Brainbeard on January 2, 2011, at 12:59:47
In reply to Re: Tramadol - Or 'Hit It And Quit It', posted by roscopeeco on December 30, 2010, at 16:51:13
If there´s anybody who´s been on tram for more than five years without the drug losing efficacy, I´d love to hear about it.
Posted by rogerk on January 8, 2011, at 16:01:42
In reply to Re: Tramadol - Or 'Hit It And Quit It', posted by Brainbeard on January 2, 2011, at 12:59:47
i am actually one of those horror stories, only took it once or twice, but it seems to have a stimulating effect on your brainstem. so therefore can cause seizures if u take it with an antidepressant.
i wasn't even taking it with an antidepressant, when i almost had a seizure.
Posted by floatingbridge on January 8, 2011, at 16:09:13
In reply to Re: Tramadol - Or 'Hit It And Quit It', posted by rogerk on January 8, 2011, at 16:01:42
Wow-- that's exactly what took so long for me to try it; my pdoc feared a possible seizure. I am so sorry!
It didn't really work how I wanted it too, anyways....
I read your signature. Are you being treated for pain as well as?
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Posted by roscopeeco on January 9, 2011, at 9:39:17
In reply to Re: Tramadol for TRD » roscopeeco, posted by floatingbridge on December 31, 2010, at 16:52:55
> > I would take a drug dependence with great results over a suicidal depression. If you respond well to tramadol, you will respond well to medications like suboxone or subutex. I personally know two people who are on subutex for life at managable doses. They have yet to become tolerant to that medication. From what I have seen by people who take tramadol. if they feel they are building a tolerance they cycle down for a couple days. Some people just take one 200mg extended release tablet. In
> my desperate state I had a Dr. in my area ready to prescribe suboxone if need be.
> >
>
> What is this suboxone people are talking about? I thought it was a detox med.
>
> Anyways, I did add tramadol to my cocktail after waiting a heck of a long time. (I have chronic, weirdo, fibro-ish pain.) Wow, did I develop rapid tolerance. So it was not the answer I thought. I do take ultram 200mg daily as part of my cocktail. I have something going on with dopamine, opoids, whatever.
>
> My 2¢ experience.
>
> fb
>
>tramadol and ultram is the same thing.
Posted by roscopeeco on January 9, 2011, at 9:42:55
In reply to Re: Tramadol for TRD, posted by ed_uk2010 on January 1, 2011, at 17:52:16
> >The depression suffers never have to go up.
>
> I think that remains to be seen. Buprenorphine is an experimental treatment for severe depression, not an established treatment.
>
> All clinically used opioids have the potential to create dependence and withdrawal symptoms occur frequently when stopped. Buprenorphine may be less problematic than some of the others in this regard but it is still an opioid, and remains a controlled drug for a reason. In some areas, buprenorphine has established itself quite a reputation as a recreational drug.
>
>
How many people do you know that use suboxone as a recreational drug. It has naxolone in it as well. Try crushing it up and putting in your body by IV. See what happens.
Posted by floatingbridge on January 9, 2011, at 13:26:40
In reply to Re: Tramadol for TRD...floating bridge, posted by roscopeeco on January 9, 2011, at 9:39:17
>Some people just take one 200mg extended release tablet.
That's what I do:
> >
> I do take ultram 200mg daily as part of my cocktail. I have something going on with dopamine, opoids, whatever.
> >
> > My 2¢ experience.
> >
> > fb> tramadol and ultram is the same thing.
Yes, you are correct. I often confuse tramadol, ultracet, and ultram. I'd need a heck of alot more Ultram than 200mg per day, and I'm not willing to escalate at the rate my tolerance with generic ultracet was building.In my experience, generic ultracet was more mood-positive; maybe like regular xanax and xanax cr.
fb
Posted by ed_uk2010 on January 9, 2011, at 14:24:31
In reply to Re: Tramadol for TRD, posted by roscopeeco on January 9, 2011, at 9:42:55
>How many people do you know that use suboxone as a recreational drug. It has naloxone in it as well.
Sublingual buprenorphine was a popular recreational drug in Scotland back when Temgesic was more widely prescribed.
I am aware that Suboxone contains naloxone, but that is only relevant when it is injected, it does not prevent dependence occurring with other routes of administration.
>Try crushing it up and putting in your body by IV. See what happens.
I'm not sure that comment was appropriate.
I'm not trying to say that buprenorphine doesn't have a role in TRD. What I'm saying is that if you or anyone else thinks that it is somehow exempt from addiction and dependence issues, they are wrong.
Posted by roscopeeco on January 9, 2011, at 18:36:53
In reply to Re: Tramadol for TRD » roscopeeco, posted by ed_uk2010 on January 9, 2011, at 14:24:31
> >How many people do you know that use suboxone as a recreational drug. It has naloxone in it as well.
>
> Sublingual buprenorphine was a popular recreational drug in Scotland back when Temgesic was more widely prescribed.
>
> I am aware that Suboxone contains naloxone, but that is only relevant when it is injected, it does not prevent dependence occurring with other routes of administration.
>
> >Try crushing it up and putting in your body by IV. See what happens.
>
> I'm not sure that comment was appropriate.
>
> I'm not trying to say that buprenorphine doesn't have a role in TRD. What I'm saying is that if you or anyone else thinks that it is somehow exempt from addiction and dependence issues, they are wrong.
>We are talking about TRD. Who cares about dependence. Have you reconciled the fact that TRD is going to need antidepressants for life. Isn't that a dependence as well. With cessation there are physical withdrawal symptoms as with a drug like suboxone. I don't get some people on this board. If the alternative therapy, that could actually help some, is "outside of the box" it is shot down just because of the qualities of dependence and addiction. Scare tactics aren't needed for people in search of freedom from a life of depression. The correct dosing in depression is under 2mg and not everyone becomes addicted nor has significant withdrawal symptoms from that dose. I am sure phillipa was talking about people who were on doses at 8 to 16mg with a prior opiate addiction. I am not addressing you in general. There is more supporting evidence that it can treat people with a fair percentage with TRD then the contrary. To not mention all possible therapies on a board like this is counterintuitive.
Posted by Phillipa on January 9, 2011, at 19:57:24
In reply to Re: Tramadol for TRD, posted by roscopeeco on January 9, 2011, at 18:36:53
Absolutely correct first to percocet then saw addictions specialists started the sub and it was abused also. Phillipa
Posted by ed_uk2010 on January 10, 2011, at 12:22:19
In reply to Re: Tramadol for TRD, posted by roscopeeco on January 9, 2011, at 18:36:53
Hi there,
>We are talking about TRD. Who cares about dependence.
Unfortunately, opioid dependence is frequently associated with tolerance. Dependence is also relevant to any case where withdrawal is clinically necessary, for example if adverse effects become problematic. Of course, withdrawal issues are by no means specific to buprenorphine.
>I don't get some people on this board. If the alternative therapy, that could actually help some, is "outside of the box" it is shot down just because of the qualities of dependence and addiction. Scare tactics aren't needed for people in search of freedom from a life of depression.
I don't recall any involvement with scare tactics :) I was simply responding to a couple of your statements, in particular that 'depression suffers never have to go up' on the dose, which is not an entirely reasonable thing to say. You would need a lot of supporting clinical evidence to make that claim. I have only known one person (well) on this board who took buprenorphine for depression. He did obtain benefit from it for a while. Sadly, the benefit was not sustained and his life ended in suicide. Please bear in mind that I am not a newbie, I have been posting on this board for many years.
>The correct dosing in depression is under 2mg.
I think it's difficult to say at present what the dosage should be, or what proportion of patients will experience a sustained response. It's still an experimental treatment - cautious flexibility is required on the part of the prescriber.
>and not everyone becomes addicted nor has significant withdrawal symptoms from that dose...
Indeed not. I wouldn't suggest that.
>To not mention all possible therapies on a board like this is counter-intuitive.
I agree entirely.
Posted by emmanuel98 on January 10, 2011, at 21:08:26
In reply to Re: Tramadol for TRD, posted by roscopeeco on January 9, 2011, at 18:36:53
When I was hospitalized the summer before last for severe depression, and before I started parnate, I asked to be put on suboxone. I had been addicted to opiates and they kept my depression at bay for five years. The p-doc was consulting about it. By then, I had finished the washout, started on parnate and felt good within 48 hours. So I'm glad I didn't end up on suboxone. I've been on it for opiate withdrawal in the past and it's a very powerful opiate, even if it can only be absorbed sublingually.
Posted by sukarno on January 16, 2011, at 4:47:14
In reply to Re: Tramadol for TRD » roscopeeco, posted by emmanuel98 on January 10, 2011, at 21:08:26
How about dronabinol (Marinol) prescribed off-label for TRD without psychotic features? It is C-III, but in reality very few people abuse it and from what I can tell the side effects are not very pleasant. That said, there are anecdotes about it helping TRD. Perhaps nabilone or Sativex (available in Canada) would help too?
I wouldn't recommend it for anyone with anxiety or psychosis. For unipolar depression resistant to SSRIs, TCAs, MAOIs, ECT, etc, it might be worth a try.
I'm not sure if doctors prescribe it off label, even if you were inpatient and closely monitored.
At least there are no severe withdrawal symptoms. Any withdrawal from cannabinoids is mild due to the long half-life and it can be tapered off gradually. Opioids can be tapered too, but they are more problematic IMHO.
This is the end of the thread.
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