In my simplistic way of viewing depression and anxiety any kind of stimulating drug might be used to treat depression and any kind of depressant drug might be used to treat anxiety. For example, both Tramadol (chemically a opoid) and Wellbutrine (chemically an amphetamines) are both purported to have mildly simulating effects.

However depressants will tend to heighten depression and stimulants will tend to heighten anxiety. Unfortunately, many (most?) of those suffering from the one also suffers from the other. I read that they are very closely related fear-based sicknesses. Depression stems from the fear that something (often unidentifiable) presently is very wrong. Anxiety stems from the fear that something soon will be very wrong.

Another way to successfully treat just about any mental disease other than a psychosis in the short term is the use of just about any addicting drug including alcohol, barbiturates, narcotics, stimulants. Indeed this is part of current mainstream thinking that portrays addiction as initially occurring and to some extent continuing due to self medication of mental disorders.

Hence the mental disorder causes much discomfort and the euphoria of the drug alleviates the discomfort. There are of course numerous drawbacks to this approach, probably the least of which is that it only works short term. I don't believe that treating depression with a "pure opioid?" is good medicine.

The flip side to all this is that even short term relief of mental distress can in some cases be important to recovery. The person / patient can try on their new selves without the disease and so become more familiar to what the disease does to them in terms of “wrong thinking”. In the case of depression and anxiety “wrong thinking” can be characterized as any kind of negative thinking or thoughts that aren’t quite true and can lead to negative thinking.

Without this perspective the drug treatment is sort of “on its own” trying to lift the person out of depression. With some perspective the person can often self-correct his thinking thereby increasing his chances for getting out of the depression and staying out without the use of medicines.

r/P

I think what you're saying is there are no "good" drug treatments, that will cure depression and I agree. The Prozac I've started will increase my anxiety and without counseling or some other complimentary treatment, no drug can stand alone as a viable treatment, for depression or anxiety.

Those of us with TRD are in an even more precarious situation because most conventional treatments have already failed. Opioids or stimulants are merely a patch. However, so are all A/D, and for the severely depressed a patch may just get them through long enough to find an alternate, more conventional and long-term treatment option. Just 3 months ago I never would have considered opioid treatment. Given my present situation though, it would be incredibly arrogant of me to dismiss it, out of hand, after 20 years of failed conventional treatment.

I, and I think most TRD sufferers, have no intention of permanent drug therapy. I just want to be able to function at a higher level, then I am now so I can maintain some type of treatment... and life. Right now the disease makes either difficult and disparaging.

Oh, I cant....its not my doing...sigh.....

Careful with Prozacs and tramadols Pillar. I'm sure you know what to look out for. All the best.

My eyes are on the lookout for any signs of Seratonin Syndrome or seizure. I'm only taking 20mg/daily of Prozac and 200mg/daily of Tramadol, though. Should be safe but thanks for the heads up and kind words nephro.

i have been down both roads and i can tell you this much,
the the typical SSRI and similar meds will have zero to no positive effect if your seratonin levels are ok as they are.
If that is the case, then you wonder the halls of the misdiagnosed for months while the md with the psych degree patiently waits for you to come bouncing into his office bubbling over with joy....so he can close your file or put it in the "cured" pile or the under "successful" therapy file drawer.
there were times in the past when i was truely depressed over something. i believe that this is a natural state of the human mind when expectations have outrun reality. it happens.
i also know for a fact that you get past this naturally in time, or thru some conversaion that releases most sub-filed forms of depression like guilt or fear or other things, and you move forward comfortable with the fact that "its over" and you can move forward again. like grieving. its impossible to say everyone normally grieves for 17 days. everyone is different in how and how long they feel grief.

can a pill possibly help? maybe for some. for a few there may be a chemical imbalance or the need to capture the "happy" chemicals in the brain and hold them for interrogation. for most, it takes so long for that pill to have an effect that they get past the grief quite naturally and move on all by themselves, except now they have to wean themselves off this chemical.

for a few, cognitive therapy has benefits. getting re-programmed to respond to life in a different way. that can take years. so that often utilizes a pill or med to bridge the gap between what it IS and what should be.

and finally pain. someone put 2 & 2 together and discovered that pain travels along neuro pathways to the brain where it is interprited as pain. so why not try to reprogram the brain with the same chemicals that produce "happy smiley face" and use those drugs to fool the brain into ignoring the pain messages that are constant and never ending.
IN MANY cases this is an entirely realistic possibility !
it can work. it cannot ever totally replace conventional pain relief therapys, but it can be helpful/.

i fought and argued against this therapy for years....i refused to open my mind to the possible way that it might be helpful. finally i agreed after seeing a cymbalta commercial. somehow that made sense and i agreed. my Dr was thrilled that i was finally open to the idea so we went forward. and you know, it did work. it did take several weeks and the result was subtle but it was difinately there.
i simply did better while ON some form of depression med than i did when i was just on opiate therapy alone.
the BIG bummer was ending it. i stopped too fast because of an economical issue that would not allow me to buy that med anymore and i did not take it too seriously so i just quit and almost lost my mind for 2 weeks while i was trying to figure out why i was feeling like i had just got off a roller coaster... and i hate roller coasters.but i got a replacement that was lots cheaper and that smoothed things over. i will not say that cymbalta is better than another med, but to shuffle the brain chemistry a bit to reduce neuro pain has its benefits. i may never take cymbalta again, but as long as i have chronic pain, i WILL take some form of depression med not because i am depressed, but because the pain ends up in the same place and has the same results and these meds seem to help reduce that.
i just dont hurt quite as much when i add a med for depression to the mix.

good luck with your journey.

The wellbutrin is also known for causing seizures. You may have a ticking time bomb there. The wellbutrin I was on was determined to be the cause of my initial seizure and they've been present ever since, so be careful of that med too.

I agree with the others regarding eluded's post. I highly doubt they've been thru what Trampy has and Trampy is very very knowledgable (sp??) about TRD and others.

If Trampy said the sky would green, I'd believe it.

Right now I'm taking Tramadol, Prozac and Desipramine, all for TRD, and they seem to be helping slightly.

i take Tramadol for my TRD too and it works great for me. i try not too use it too much though because i build up a tolerance and its also quite an expensive drug.

anyway, i thought it was really dangerous to take Tramadol and antidepressants at the same tim is it not?

It can be, due to the fact that Tramadol works on Seratonin, not unlike most A/D. All my doses are fairly low though, 20mg Prozac during the day, 200mg Tramadol throughout the day and 50mg Desipramine at bedtime. Now if it was 40mg Prozac 2x/daily, 400mg Tramadol/daily and 150mg Desipramine/nightly... I would be at a very real risk of developing Seratonin Syndrome.

Here's a bad combo I had: Effexor 225mg., Wellbutrin, I forget the dosage, twice a day I know that and then Pharamin (sp?) Pharamin is for peri menopause but basically prozac I was told.

After 10 days I started getting sleep ALL THE TIME. I slept from friday night till sunday evening, no breaks or wakeups. I went to the doc after that and my doc's partner said it was SS.

So, when you try things, be sure to ask the doc or the pharmacist. I prefer the pharmacist after reading the handout.

"Let's be careful out there"

Here's a bad combo I had: Effexor 225mg., Wellbutrin, I forget the dosage, twice a day I know that and then Pharamin (sp?) Pharamin is for peri menopause but basically prozac I was told.

After 10 days I started getting sleep ALL THE TIME. I slept from friday night till sunday evening, no breaks or wakeups. I went to the doc after that and my doc's partner said it was SS.

So, when you try things, be sure to ask the doc or the pharmacist. I prefer the pharmacist after reading the handout.

"Let's be careful out there"

Yep, I did 225mg EffexorXR, 3mg Klonopin, 300mg Tramadol and 150mg Desipramine, about 1 year ago. I was feeling ill and went to the pharmacy to ask if any of the meds would cause sweating, agitation and insomnia. She told me, "Yes. ALL of them in combo", and to watch out for SS. Had she been my pharmacist she would have not filled the Tramadol and requested codeine or hydrocodone, for a pain med.

I wish she would have been my pharmacist... and she was a Walgreens pharmacist suggesting hydro!

Thanks all for adding to my understanding; I had not considered TRD cases. Depression is of course horrible and if someone finds a way to get some relief from it they will and should pursue it. And as mentioned, this is true of any kind of severe suffering such as that caused by pain. I read your struggles a new with both fascination and sadness.

r/P.

Thanks, Pillar! You are extremely lucky to have such a doctor. All the negative reactions posted here seem to come from people who don't realize how close we can come to suicide.

I wrote earlier about Rearden Metal and his blog on this same subject: http://www.prohibitionkills.blogspot.com/

He used to post very actively at a message board for stock traders called elitetrader.com. He had 5000 posts there about stock trading and said he ran a hedge fund. I commented on his blog with a link back to this here thread, and I also sent him emails and PMs through elitetrader. There has been no reply from him. His posts have stopped. Take a look at that blog and tell me if you think he might be dead. His last entry was expressing regret that he had gone down the path of using opioids for his TRD instead of using low-dose naltrexone.

I was hoping a few years back to have the VNS implant from Cyberonics but Medicare won't pay for it and CYBX has stopped marketing it for TRD because, even if the device "really worked" (which is not clear), it would be unethical for them to conduct the type of double-blind placebo-controlled Phase 3 study to show safety and efficacy that the Medicare system is requiring before they'd pay for implanting the device to treat TRD.

It's 100% legal for a doctor to prescribe opioids for depression with an off-label Rx. Any doctor can legally prescribe Suboxone off-label whether or not they possess the X waiver number.

If a person has never experienced TRD, and has never grieved for someone who killed themself after a lifetime of misery caused by TRD, they can easily come to this thread and tell us that what we're doing is wrong. Unless they've bothered to read back at least a few pages, I won't reply.

Do you hear that, folks? If you want to throw in your 2 cents because you don't understand why someone with TRD would voluntarily become dependent on opioids for the rest of their life, go back and read all 20 pages of this thread. It's explained in great detail.

This thread is about a pharmaceutical practice that goes back 3000 years to the ancient Greeks using poppy extracts to treat melancholy. The oldest known written records describing its use for such are from Hippocrates: the "do no harm" guy. We don't know if if was used before that by the ancient Egyptians or Chinese.

If the Suboxone stops working I have only three options for getting relief from the suffering: 1) methadone klinik, 2) black-market garbage-grade diacetylmorphine, or 3) suicide.

Well said Trampy! TRD is not garden variety depression, like you may feel after a loss or break-up. It will not just go away or respond to most treatments. People should think of it as a "superbug", an anti-biotic resistant strain of bacteria, except this is an anti-depressant resistant depression.

I found a site with some links to various treatments http://depression.about.com/od/resistance/Treatment_Resistant_Depression.htm . For those out there unfamiliar with TRD, you can see what "options" are available for us. For those with TRD you may find something that seems interesting to you. I found the Deep Brain Stimulation very interesting, after seeing it on tv. I'm currently trolling local Medical Universities for clinical trials on TRD/Major Depression drugs and treatments. So far I've found several in my area. All anyone interested has to do is go to your local university websites, check for clinical trials or the Psychiatry Dept. Almost every major university will be conducting clinical trials. I'm lucky enough to live near University of Chicago, Northwestern and Loyola University - all have large Psych Depts. and are on the cutting edge of medicine.

Effexor made me horribly suicidal. Worse than any period of my life when I was completely unmedicated. Thus, I am now terrified of Cymbalta which, I hear, is very similar.

Yes, Pillar, you are indeed very lucky to be located where you are. I'm not so lucky. Although we have our fair share of clinical trials, they're all for drugs. Another thing they're currently looking at for TRD besides deep brain stimulation is magnetic stimulation. The VNS implant seems to have peaked and is no longer used much because Payors won't pay for it.

The ancient Greeks used a form of electrical stimulation for depression using electric eels and so I have acquired a few devices that create small currents for electrode clips which can be applied to my head or ears.

I also have a few light/sound brain wave entrainment devices starting with the "Paradise David" made in Canada which I bought back around 1990.

It was a very difficult decision to go on indefinite opioid maintenance because I don't believe I would be capable of enduring the PAWS of another Suboxone withdrawal.

The last time I went through that torture the PAWS lasted six months, but then, maybe thanks to Effexor (which no longer does me any good) I had a period of about six months of opiate-free happiness until a very traumatic even put me back in a serious funk and I began self-medicating again despite receiving intensive cognitive-behavioral therapy (CBT) at the time. It most definitely *is* harder to quit Suboxone than it is to quit a hydrodone or heroin habit.

I realize that a lot of the old-timers who remember me as the only poster with the title of Oracle no longer come to this message board.

Back in the summer of 2005 (or 2006) I posted a serious cry for help here on DB because I needed to have more than just electronic communications with the people who were interested in my posts, by reaching out to people were concerned about me as a person, not just the (sometimes nasty) persona I had adopted here.

Well, thankfully, many here graciously trusted me that summer by giving me a way to contact them and just this morning I found a piece of paper with the phone numbers that several fellow posters had given me in my time of need. It's way too long a time elapsed for me to call any of those numbers, but I held on to them, mostly as a reminder that there were people here who genuinely cared about my welfare and were willing to lend me their ears.

I'm doing as much as I can to get local support, but it's very difficult for me to find people who can understand what I' facing. Only in the past two weeks I found a local chapter of the Nation Association of the Mentally Ill (NAMI) with a twice-weekly support group fuil of understanding people.

I also started posting on a message board devoted to an entirely different topic in the hope of finding someone of like mind who replied to my posts in such a thoughtful manner that the rest of the message board seemed afraid to say anything. It was like were were having a private conversation in public.

I'm trying to seek out people who I can share my thoughts with, because even professional counselors usually find it impossible to understand me or to trust that I'm being truthful with them (and to myself).

I promise to protect the privacy of anyone who contacts me, just as I protected our nation's secrets when I was entrusted with a high security clearance in my "former life" of working for the government. That clearance was handed in a long time ago, and I'll never again have a clearance, so nobody there cares who I am, or whether I'm making it all up.

I remember you Trampy.....fondly from a long time ago.....a much respect member.....I so wish I could contact you.....

The concern I had / have was not in the use of addictive drugs to treat depression but rather the use of depressant drugs to treat depression. I guess if it works then it works. But everything I knew about extended, or even short term, use of depressant drugs (primarily benzos, & barbiturates but including narcotics) is that they will (not might) cause severe depression. And not just during withdrawal as any addictive drug is apt to cause but during use / treatment of the drug. I sort of understand the use of the opioid Tramadol because of its unusual stimulant properties. But I have a hard time understanding how a drug that is almost characteristically defined as causing depression can be used to treat depression. Is this not a real concern?

Opioids alway cause some degree of *respiratory* depression, but in terms of affecting mood, the effects can range from euphoria at one end of the spectrum to dysphoria at the other end.

Also, I don't think anyone has been suggesting that using opioids as antidepressants is likely to help most depressed people. They may help a few people with Treatment Resistant Depression (Refractory Depression). Obviously, that is probably one of the last things a doctor might try after all other efforts have failed.

To help put things in more perspective, here is a quote from part of a clinical study in which opioids were given to people for depression:

"An intriguing possibility is raised by the marked response to opioid treatment of this group of chronically depressed patients who had been little helped by standard antidepressant drug therapy. Perhaps the pathophysiology of depression in a subgroup of patients is unrelated to abnormalities of central monoaminergic systems, but rather, results from dysfunction of the endogenous opioid system. This might account for the resistance to treatment with standard monoaminergic antidepressants in some patients. It is also consistent with the recent finding that the brains of depressed suicide victims show up to a nine-fold increase in the number of endogenous opioid receptors over age- and sex-matched controls postmortem. This finding suggests that opioid receptor up-regulation may be occurring in this very treatment-refractory population because of a deficit of endogenous opioid neurotransmitter availability."

So you can see, nobody is saying that opioids are a good choice for treating most cases depression. If they help depression at all, it is probably in only for very small group of people.

If you can't send PMs, I'll make up a disposable yahoo.com email and will post it here so you (or anyone else in yr situation) can email me there.

helptrampy-1@yahoo.com should now be working.

Well the admin......put a lock on it....I still dont know why? I have been asking ....no luck so far...Btw....they dont want me to talk about it on the board ....now iam afraid.....sorry admin.....but I needed to tell trampy....and wont talk about it again....

You can edit your last post to make it empty before the edit time expires. Admin: Please excuse Dawn. I take responsibilty for her post.

If the edit times runs out, you could report your own post to Moderator and ask them to delete it for you if you're not allowed to edit or delete your own posts. Is so, then please don't make it worse by posting that you can't delete your own posts.

I just happened to glance at the board and chose this thread. I am dealing with a severe respiratory condition that is in the end stages. Ironically, while opiates do cause some degree of respiratory depression, I have a letter from my doctor (appealing a Medicaid co-pay) that says:

"...Additionally it is well known that narcotic medications can diminish the sensation of dyspnea (or shortness of breath(SOB)is perceived to be difficulty of breathing or painful breathing that a patient is aware of). This medication (oxycodone) enables her to be more active with her current conditions."

Not only has it helped physically (the oxy treats a burning sensation throughout my body), but obviously it has helped psychologically. One cannot live 24/7 in pain and/or wondering if this day will be the last. I can't help but wonder what some people are thinking when they ask me if I'm not worried about addiction! If the condition is terminal, what difference does it make? The only reason I'm able to be on the board and type at the moment is because I just took double of what I was supposed to a half hour ago. I see the PM doc next week. I refuse to go to the hospital if it gets too bad. I much prefer to be in control here in my home, on my own terms.

kserah, I'm so very sorry to hear that you are near the end.

I applaud you for wanting to be at home instead of in a hospital, even if being at home might, theoretically, shorten your remaining life due to limitations on therapy. Being at home means you're not exposed to all the "super-bug" infections that pervade every hospital. So it could very well *lengthen* your life to be outside of the hospital.

A friend of mine recently died of Stage 4 colon cancer just 4 weeks after he was diagnosed with it after they were unable to perform a colonoscopy to figure out why his constipation was so severe.

He angrily "fired" the first oncologist who was assigned to him in hospital after they did the colestomy operation and made him a "bag man" as he called it. The reason he fired her was because she told him that he had at most six months to live and he should make the best of it. He didn't want to hear it. When I told him that the Avastin that he had insisted on receiving cost over $20 K it made him happy to hear that they were spending so much money on an indigent person.

Instead of going to a hospice and receiving as much opiates as he wanted, he insisted on aggressive chemo and radiation therapy, even though it already had metastized to many places in his liver, plus, the spinal growth of metastized colon cancer had rapidly grown so large that he was quickly rendered unable to walk.

He had always had weak lungs which led to pneumonia which he acquired in hospital, and which killed him in just 7 days.

He was my best friend here, and losing a good friend like that has made my depression much much worse.

Thank you, Trampy. That means so much coming from you. I am so glad I've hung around long enough to see the real you (I knew you were in there!)

I do believe strongly that to a large extent our power of belief controls our destiny. Last summer my fingernails started falling off and things were going downhill. I was very much ready to let go. What was the point of hanging around for that?

Then I learned that my son and his wife were going to have another child--a HUGE surprise since the first (born on Mother's Day in 2007) had taken so long to conceive. There was no way I was going to move over to the other side before she (yes--a little girl this time!) was born. Personally, I don't fear dying, but it's such a rigmarole for everyone else, not to mention the emotional impact it would have on my son just before the birth of his daughter. So I started scooping up the dreaded steroids (they are truly hell on earth) and hung on for the ride. I set little goals, like seeing Obama get sworn in (I made it!) and the little one is due in about 3-4 weeks. I will hold her, that's a given.

But I don't rule out miracles, either. Miracles being those things we don't understand. They happen. I know because I've had a couple. It could happen again. As much as I like to theorize, I know in my heart of hearts that it isn't all up to me. When it's my time--it is. All I really have control over is how I handle it. I turned things over to the Prime Creator some time ago (time as we mortals know it). My only request is that everything work out as harmoniously as possible for everyone involved.

It's my 'One Step' program. Faith.

Thanks Mark, that does clear things up for me. You are one smart newbie.

And kserah, I am so sorry. Even when there is nothing else, there is always hope. It is so true what you said about none of us knowing when it will be our time or any one elses time.

I believe that those who have less life make up for it by getting more out of the life they have.

r/P

I wish this was understood throughout the world. You should ask for, and be put on, whatever amount of opioid generously treats your pain, and it should be increased immediately when necessary, absolutely without hesitation.

You may wish to consider use of fentanyl lozenges for breakthrough pain also.

bamone5 you make some very odd statements, I'm guessing you are still in High School.