Hey there, pillar!

I've never, yet, actually come out of the closet here and admitted directly that I've been prescribed Suboxone for relieving my treatment-resistant depression. Because of a history of prior self-medication, the scrips all have the X waiver number, signifying that it's being used per label and consistent with the FDA guidelines on its prescription.

It's given to me by a very understanding PCP who has no problem with using it for TRD patients who find that it (and opioids in general) relieves their suffering. Because of who he is and where he works, I'm practically guaranteed lifetime maintenance where they're leaving it up to me to decide if I ever want to try a new round of conventional ADs again.

There has been no stigma expressed to me by anyone from this clinic or pharmacies filling the scrips.

As pointed out above by someone else, if I needed pure opiate agonists for acute pain, they would *not* induce withdrawals. The problem would be that a higher-than-usual pure-agonist dose would be required and my PCP has assured me that he would explain that need to anyone who needed to manage future acute pain. And, because the buprenorphine would be competing at the receptors with a pure agonist, the protocol is to titrate up the dose of the agonist after totally and immediately stopping the Suboxone for the entire duration of any needed acute pain treatment. When that acute pain treatment is no longer needed, then they'd induct me onto Suboxone again.

My biggest problem with this arrangement is that it ties me to this clinic and it greatly limits the number of countries I could relocate to. If I moved, it would be to a place with a lower cost of living than the U.S. While Temgesic might suffice at a lower buprenorphine dose due to the absence of naloxone, other black market options might be tempting due to their much lower cost.

If anyone gets tired of the rat race of chasing grey-market or black-market opiates, you can give Suboxone a try and if it relieves your depression you'll know it immediately.

Like the very first day! And then you can be on it for a few months before you reach the point of no return where you're hooked practically for life. A huge downside that anyone considering this path is that it's usually MUCH easier to quit a hydrocodone or oxycodone habit than it is to quit a Suboxone habit. The horrow stories of multi-year PAWS abound at heroin-detox.com.

After more than four years of being off and on it again and again, there are times when it seems to stop working, but then something good happens which lifts my mood from the severe funk and once again life seems like it's worth the trouble and suffering. Make no mistake. Suboxone is nothing like oxycodone or stronger where at least temporary happiness is guaranteed. The mood lift from Suboxone is more subtle; some people don't get any benefit from it except for relief from their opiate cravings.

Anyone wanting more info in private should PM me.

Thank you Trampy for your post. You have shared something I believe will benefit some if not many. You are very couragous in sharing your thoughts here. I was so happy to see you posting. Not because I know you but that you have a long history here and add so much perspective with your posts. Glad to see you back. I hope you share often. Best wishes...mmyp

Trampy! This is the best I've ever heard you sound! I am so happy for you that you found SOMETHING that eases your TRD.

You had suffered far too long. No one deserves that. Now that you have found something that helps, my money says you'll find a way to navigate the waters and find a place to live that will bring you the joy you deserve and an open minded medical community to assist you.

I wish you well.

glad you found something to help, TRD is a slow painful killer in my opinion. i have it as well and it truly has sucked the life right out of me.

Hello Grand Trampy,

Very nice post indeed. I do have quit a few questions but don't the need to rattle your PM basket. Generous to offer open Q&A discussions via PM. Here goes:

I'm considering use of buprenorphine.

All the contradictions that are provided with it seem to be focused on combinations with other depressants and associated chances of respiratory failure. That is, no mention of chemical incompatibility. I want to know more about the probable effects (good and bad) of combining buprenorphine with other drugs.

I have noticed that both buprenorphine and Tramadol our touted to the medical community simply as analgesics without mention of their opioid chemical structure and effects. Also, both are sometimes used in the treatment of depression similar to how narcotics were our first generation anti-depressants.

The other similarity I've noticed between two meds is that many claim that the withdrawal is from them is considerably worse than with a "pure opiod?". I can't see how that can be true. Neither hit your head anywhere near like a narcotic; Tramadol is not a controlled substance; and buprenorphine is used to treat narcotic addiction (why prescribe a drug that is more addicting than what you are trying to get off of?).

Is this where one has to have some understanding of antagonists, receptors and alike?

This is a list of the meds or drug classes that I would like to know more about concerns & contradictions and potential (possible positive effects).

- stimulants / psychostimulants used in ADHD treatment; in particular Adderall and Ritalin

- Wellbutrin (rummered to be have a amphetamine-like chemical composition)

- narcotics & Tramadol

- SSRIs

- benzos

I'm more than willing to read up on them but would like to keep it at the drug effects level without going in too deep into receptor theory (although some would also be good) so also appreciate any good references.

Thanks Trampy for any help you can provide. r/P

The probably reasons why withdrawal from tramadol is described as being particularly include the fact that one metabolite of tramadol (known as M1) has 200 times the affinity at the mu-opioid receptor than the parent drug (basically speaking), hence the delayed onset of effect and relatively long half-life. But it is not the onset of effect that contributes to withdrawal symptoms; it is the offset.

Tramadol also has other mechanisms, which are supposed to contribute to its analgesic properties, including enhancement of serotonergic and adrenergic pathways. When the levels of serotonin and adrenalin (and possibly related) suddenly drop, as with tramadol withdrawal, this also makes the patient uncomfortable.

Thank You, kserah! This has been going on for years ever since I discovered by total accident that opioids relieve my TRD in a way that no other class of drugs has ever done. I've taken at last 20 different antidepressants over the years. Without exception, either their side effects are unacceptable, or they're ineffective, or they "poop out" within a year or two at most.

It's taking time, but more and more doctors and therapists are learning that there are people like me who have only found relief for their TRD with opioids.

Also, even though I'm not interested in trying Abilify, it makes me happy to see their TV ad that says something like "2 out of 3 people being treated with antidepressants still have symptoms of depression." They're countering the myth that all a person needs is to find the right AD and then they're magically cured. Not so!

Over all my time here and all my posts here about opioids for depression, I've only found one doctor (in HI) who was amenable to using Buprenex for TRD, but he would only do it if the patient moved there and went to his office every day for at least a month to have him administer the injections before he would even consider giving an Rx for its home use.

It took me five years to find a doctor who treats me with respect and who is now giving me four refills at a time for a 30-day supply, with office visits every three months and the pharmacy requesting refills from his office as needed, so they keep track of when new scrips are needed. It's long-term indefinite maintenance.

The longer I see him, the more refills he gives. Last scrip had four refills. That's telling the pharmacy I'm stable and on it for the long haul. I was only drug-tested once, after about three months. Because of my "history" it was a 17-panel drug test used for health care workers with opioid "problems." It was just once, but for everything in addition to the "usual suspects": e.g. Tramadol, fentanyl, methadone, propoxyphene, carisoprodol and even zolpidem. He never mentioned those test results, which were given me by the records dept. of the institution along with my bloodwork results.

If I moved away from here, I don't know what I would do, because it was so difficult and took so long to find this doctor. He works in a clinic where all the new doctors are *required* to have a waiver #, so even if he quit his job there, my records would support continued maintenance by whoever took over his cases, but finding a new clinic to continue the regimen would be a totally different story. And if it's outside the U.S., forget it!

Another thing to consider is the expense, because Medicare won't cover anything if living outside of the U.S.

And for anyone who thinks they can get their doctor to write Suboxone off-label for depression, think again, because your insurance probably won't cover it. And it's a VERY expensive drug!

There are no pat answers to any of your questions about those drugs. You need tio figure it out yourself if you rellay want to understand it. I highly recommend that you take the time to read up on opioid receptor chemistry, especially the scientific basis of the agonist/antagonist combination patented by Crain & Shen and which is reason for developing OxyTrex now in phase 3 trials. Ignore the stated dogma and know that *some* amount of the naloxone in Suboxone *IS* sublingually absorbed and that makes Suboxone a very different drug from Subutex.

None if that was even mentioned or explored in the (rushed through) clinical trials that supported approval of those two drugs in 2001 along with the framework for office-based treatment, waiver #s, etc. There are still NO DATA on how Suboxone is best discontinued or how it compares to methadone in safety and efficacy for their labeled uses.

It's kind of scary, but YES, just as heroin was sold by Bayer as a less addicting substitute for morphine addicts from the Civil War, everything I've seen suggests that Suboxone is *harder* to quit than pure agonists like oxycodone or heroin. Anyone considering Suboxone for TRD needs to look into that! I lookd into it and decided the alternatives to it were worse than a lifetime of (legal at least here) dependency.

Read up what Crain & Shen say about how low levels of opioid antagonists "sensitize" the mu receptors and potentiate analgesia while also reducing the severity of abstinence syndorme when the "mixed" opiate combo drug is discontinued.

My doctor is aware of the fact that when my depression becoms unbearable I will, of necessity, take some Tramadol and ibuprofen and they give me relief from the unbearable slumps caused by reading about the impending bankruptcy of America and possible totalitarian rule to control the insurrection that would be caused when most people lose their homes and have no jobs and no food.

He's OK with this but is not writing me any Tramadol scrips. He is aware that Tramadol was originally developed as an antidepressant.

Finding a medicine that "works" doesn't mean I'm happy all the time. Situational setbacks can often put me in a funk that lasts for weeks. Social support is ESSENTIAL!

If all I had for my TRD was the Suboxone, I'd probably be dead by now. It's been very difficult to find a psychotherapist because they're intimidated by me or scared of me. I recently decided that it was a total waste of $20/week for the copay on seeing a LISW therapist. Just last week was my first visit to a wonderful support group just a 7-minute drive from my house and they meet twice a week for 90-minute meetings and they also socialize outside of the meetings.

Very nice people! Much much better to go there twice a week than to drive ten miles to spend 50 minutes talking to someone who only smiles at the end when she runs my credit card for the $20 copay.

As some of you remember, I was spending a lot of time playing the stock market. Like many others last fall, I saw huge "unrealized depreciation" which caused a severe decline in my mood levels. I didn't sell at the bottom and the solar power stocks I bet on are now coming back strong in anticipation of huge and unprecedented spending of our monopoly money dollars by our next president. That massive creation of fake money makes it seem only a matter of time until the dollar becomes worthless, which should be good for precious metals like silver and gold.

It has been VERY DEPRESSING to read this book, which is by and large very accurate, and SHOCKING:
http://www.amazon.com/Web-Debt-Shocking-Sleight-Trapped/dp/0979560802

Everything there is consistent with Elgin Groseclose, who wrote the readily available
http://www.amazon.com/Money-Man-Survey-Monetary-Experience/dp/B000OHF8G0

Also managed to score a first edition in hardcover for $10 of Groseclose's American Money Machine: The Story of the Federal Reserve , which tells the story of how our U.S. dollars are created by private bankers when they make loans, not by the government. Students of American history should know that the debate over hard money verus fiat money goes back to the Founding Fathers.

It makes very interesting reading, but is very very scary.

Many former high-level government policymakers and Fed board members (the Fed a private entity of bankers) believe the U.S. will "go broke" as soon as 2009.

If things fall apart and there's mass insurrection when the federal and state/local governments can't pay the interest on their debts, the only way out seems to be armed insurrection per the Declaration of Independence.

Is anyone else here concerned that the U.S. economy is a vast Ponzi scheme and that we can't "print our way out of it." Zimbabwe is printing up money by the truckload and we're starting to do the same. Right now the dollar is still holding its strength because the entore world is competing to "beggar thy neighbor" by all of them debasing their currencies. Where will it end? Hyperinflation is the only way that all our bonds (government and private) can be paid off. Deafulting on bonds is bankruptcy.

It's happened before. Groseclose tells a very accurate history of how fiat money has always resulted in economic failure. What makes things different this time is that the world is now too interconnected to have just parts of the systems failing. It will all go.

Ellen Brown's new book Web of Debt is only $13.xx at Amazon. You don't need to know anything about economics to understand her arguments which are all supported by authoritative and well-footnoted quotations. Our paper money and the electrons in the computers which represent credits and debts are all creatd out of thin air ... by private bankers and not by our government. Most people don't know and don't care.

I don't know if I want to live in a world like this.

I'm just wondering, why do they push antidepresive so much when opiates do relief depression? Personally I think that antidepressants are worthless....

OMG, this is really an option????

I thought I was odd because opiates got me out of bed, cleaning the house, smiling, etc.

I've taken Prozac, Paxil, Zoloft, Wellbutrin, Abilify, Seroquel, Celexa, Cymbalta and Buspar. None of them "worked". I'm 38 and have suffered from chronic depression since age 9. I take Vicodin or Percocet for pain and it's like I'm a new person! Not groggy at ALL; the OPPOSITE, in fact.

This has me more than slightly intrigued! Any studies to back it up that I can present to my MD?

i tried wellbutrin, it put me to sleep, and that was only half a pill. id heard it was more of an upper and didnt make pple sleepy like most all the ssri's, but sure made it so i couldnt do a thing.

Tramadol is the best thing ive found, as it helps lift the depression to a level so i can move at least. it doesnt really take away the depression though. and there are times it wont help, and i still get the intense emotions sometimes, which i hate. i think adding provigil also helped me a bit, even when i had the chronic fatigue symptoms. both are suppose to be helpful with cfs ive read. but im still looking for something that helps relieve the sadness and looking backwards as i do, which is somewhat ocd i think, and somewhat what anyone would be doing in my situation. i really find increasing the dose of Tramadol a day doesnt improve me. i try to stay at 100mg a day or at my worst times up to 200mg.

ive read about temgsic just a bit, but isnt it a heavy duty opiate? i wonder how much one would have to take? or if thats an option at all for me. i had considered adding ritalin, as ive read it can have a pos effect with antidepressants in small doses. if i didnt have the Tramadol now, i doubt id still be alive. its helped me to keep fighting the fight at least. though as i say its not made me well, just cope better.

loohoo, ive read that Tramadol has been studied and used to help control ocd when other things had not worked. do you have ocd? i doubt for mdd that your doc will prescribe it unless he is thinks outside the box, not many do. your md would say it has abuse potential and suggest something more conventional. ive also tried about everything there is with no luck.

sorry if ive rambled on to much.

You're certainly not odd; they do that to most people.

I think that doctors know this. But for the life of me....why they dont use it? May be because its too easy and the drug companies will lose money ?,,,,,,, I also think that if it was in the PDR and said may be used for depression it would be used.....You think?

Oh, yeah, I think! Those doctors LOVE that PDR! It's their freakin' Bible!

I have to tell you all, it's such a relief to know that I'm not alone in this. I mean, I can see how doctors might think, "Oh, she's just drug-seeking," but I swear on the lives of my precious, beloved children that opiates have ALWAYS acted in an antidepressant fashion for me. It baffled me and I figured my body chemistry was just screwed up because my mother had addiction issues. Now I have to rethink the matter and consider the possibility that she got depression relief from them, too. (She's dead now, of cancer, so I can't ask her; you can bet that I would if she were still around.)

Oh, and I meant to say it's like I'm a DIFFERENT person (when I take Percocet or Vicodin). I just got a new computer - a teeny little notebook - and I'm still adjusting to the teeny little keys on the keyboard!

They do seem to work for depression, for a while. then, for whatever reason, it seems a lot of us hit a wall.

Oh, I forgot, I've also taken Depakote and Neurontin (they thought I was bipolar at one point; NOT!), Lexapro, Celexa... Yeah, probably just about all of the SSRIs... Even OTC herbal stuff like St John's Wort and SAM-E. I'm sure I've forgotten a couple, too. I'm desperate. I'd take rat poison in small doses if you could convince me it would eliminate the depression and occasional suicidal ideations... I just want to be "normal"... But God forbid I should risk physical dependency in exchange for functionality, eh?

Couldn't have said it better! Those first few months of being pain free, energy, focus, and feeling wonderful because you are not hurting so bad turn to terrible mood swings, depression and a higher tolerance. Still better than being in excruciating pain, but not the cureall for depression that many think it to be. Used long term it is quite the opposite!

Very true. After a while, they seemed to throw me INTO a deep depression.

I so agree with all of this. I wish there were some studies I could bring in to my MD. There just doesn't seem to be anyone on the same page as I am (a person holding an RX pad anyway!) Keep us posted on this topic......I would love to go in with some "evidence" to prove that this is true and it is not in my "drug seeking" head. LOL!

There are a few studies. Here are a couple of references:

Bodkin JA, Zornberg GL, Lukas SE, Cole JO. Buprenorphine treatment of refractory depression. J Clin Psychopharmacol. 1995;15:49-57.

Exstein I, Pickar D, Gold MS, Gold PW, Pottash ALC, Sweeney DR, Ross RJ, Rebard R, Martin D, Goodwin FK. Methadone and morphine in depression. Psychopharmacol Bull 1981;17:29-33.

Thanks, Markh! I'll be looking those up.

Because antidepressant manufacturers invest SCADS of money in marketing and distribution (think about it; how many Vicodin commercials have you seen in magazines or on TV?) - they have to make that money back!!! Also, many of their products are NOT available in a generic form. It's all about the Almighty Dollar. (I've even heard that some pharmaceutical companies are offering MD's nice perks like cash bonuses and travel packages in exchange for prescribing their products!)

Many opiates, on the other hand, are 1) NOT expensive to make, 2) already known about, therefore extensive marketing isn't necessary and aggressive marketing/sales aren't necessary to recoup investments, and 3) carry a significant social stigma.

Many people aren't aware that antidepressant medications have the same level of unpleasant withdrawal effects that opiates do. Therefore, there's very little sympathy/empathy for people who are coming off of them rapidly. Add to that the reduced capacity for abuse (although I do know people who have misused them in a misguided attempt to get a buzz) and you're going to have continued, aggressive "pushing" of these suckers.

There are a number of reasons why antidepressants are so strongly encouraged but I think I covered the biggest ones.

I truly believe opiates while taken in small (prescribed) amounts can have an affect of euphoria in the mild sense of the word which in turn can treat symptons of depression. But the conundrum that the medical practioners face with this is how does one maintain that dosage in a realistic and safe manner? The answer is you can't!

Tolerance of the opiate begins to take its toll on ones intake. To get that "euphoric" feeling of well being, the dosage must continue to increase over time. So now a safe amount of opiate becomes doubled and tripled and we all know the outcome of too much of a good thing. Addiction! Side affects! In some cases liver disease! I truly beleive researchers are well aware of the benefits of opiates to not only control pain, but to enhance well being. The problem would be controlling the intake in a manner that would not bring tons of malpractice suits. Finally, morphine and its opiate cousins have always intrigued the medical field and have always been the focus of many debates in regards to treatment options since morphine was first introduced by Friedrich Sertürner in 1805. I would say opiates will continue to be the centerpiece for many more discussions for many more years to come.

For me they are worthless, too. And like i said, my doctor understands that Suboxone is the only antidepressant i want to be taking. But it took me five years to find such a doctor. And in going down this road it means FOREVER ... because each time i've take myself off Suboxone was harder than that last time. I first took Suboxone in 2005. Because it's a mixed agonist-antagonist, tolerance doesn't build as quickly as with pure agonists. But tolerance to it DOES develop! If I went up to the "maximum recomended" 3 tabs per day, the cost would be over $5 K per year.

The only legal alternative is methadone, which my doctor says causes many side effects worse than constipation and is much less convenient than getting a Suboxone scrip with 4 refills.

Also. There hasn't been much research on opioids for TRD, so it's not clear that they'd be a good choice for everyone with that often-fatal disease. It would be bad medicine to make someone opiate-dependent unless they already were.

So the combination of the legal restrctions and ethical restrictions would prevent most any doctor from giving you opioids for TRD unless you had already self-medicated with them and had a medical record showing that you had tried many ADs with no success, or success that went away with time.

Zoloft once worked for me .. but only for two years. And then i went 6 months without any opioids but a very stressful event brought my depression back with a vengeance and then i started self-medicating again.

I found out by accident that opioids work for me ... and then it took 5 years for me to find a doctor who believed me and by that time i had made myself "eligible" by establishing a record of ... ahem .. being eligible. Long-term opioid maintenance will probably be for the rest of my life .. no matter how long that is. I've quit Suboxone several times in the past 5 years because the doctors giving it to me earlier didn't believe in long-term maintenance. The last time i quit it, the PAWS lasted for more than 6 months before I found my current doctor who gave me a scrip that put me out of my misery instantly.

And i've written on this thread about being kicked out of a psychiatrist's office during an intake evaluation that he ended after 30 minutes of the scheduled "hour" session. He kicked me out as a "opiate seeker" when all i was doing was seeking relief from suffering.

Opioids may work for some of us, but i would not advise anyone to become dependent on them unless their only major alternative was suicide.

P.S. Dawn, could you turn on your PMs for a bit so i can send you my email addy?

the whole problem with opiates and depression is that their effect may be wonderful, but its a false sense of wellbeing. the dose has to be increased continually. the patient then gets the physical dependence that will always turn to the psycological dependence. bottom line, numbing yourself emotionally is what opiates do and that is a very short term fix for a long term problem. learning to cope is a much better way to deal with the depression that comes from lifes let downs. the treatment of just a couple pills a day to chase the bad mood away has never worked without good consistant counseling.
learning to deny depression is something that has to be taught to those that have fallen victim to it. depression feeds upon itself, so there is no end in sight without professional help and that MUST include some form of F2F therapy as well as an SSRI to help stabiulize the brain chemistry.

What you are saying may be very well be good advice for the vast majority of people with depression. However, it could be that there is a small sub-population of people with depression who have a disfunction with the endogenous endorphin axis, rather than the serotonin axis, or at least such has been speculuated by some researchers.

I would also point out this article regading SSRIs:

"Antidepressants Don't Work, Says Study
Tuesday February 26, 2008
Antidepressants work no better than a placebo for most patients, according to a new study which is the first ever to include unpublished data in its analysis.

The new study, led by Irving Kirsch from the Department of Psychology at the University of Hull, examined both published and unpublished clinical trials submitted to gain licensing for the popular drugs Prozac (fluoxetine), Effexor (venlafaxine) and Paxil (paroxetine).

What Kirsch's team found was shocking. When the unpublished trials were included in the analysis, the drugs performed little better than placebo, suggesting that the drug makers had cherry-picked the best results to make their drugs appear more effective that they really are.

"Given these results there seems little reason to prescribe antidepressant medication to any but the most severely depressed patients, unless alternative treatments have failed," said Kirsch. "The difference in improvement between patients taking placebos and patients taking antidepressants is not very great."

Kirsch further stated that the study "raises serious issues that need to be addressed surrounding drug licensing and how drug trial data is reported."

A related article was recently published in the New England Journal of Medicine which reported a strong bias against publishing studies with unfavorable outcomes.

Kirsch's study appears in the journal PLoS (Public Library of Science) Medicine."

The fact that tianeptine is said to work probably explains why SSRIs often don't. It would be interesting to see what happens if/when it reaches the US.

i never heard of "opiates" being prescribed for depression alone.but i am taking "ritalin",my doc said it is prescribed for stubborn cases of depression,when nothing else seems to work.its effects are also imediate,not three weeks to a month like most antidepressants.

Here's a link http://balder.prohosting.com/~adhpage/bupe.html . Now you've heard of it . "Stubborn depression" or TRD does not, by nature, respond to traditional treatments. Those of us that are experiencing this are willing to try just about anything.

Right now I'm taking Tramadol, Prozac and Desipramine, all for TRD, and they seem to be helping slightly. But my doc and I are open to anything from opioids to stimulants to brain surgery (electrodes installed into the brain). TRD is the most painful and debilitating condition I have ever faced. I'd trade this for sciatica or the pinched nerve in my neck, any day.