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#375113 - 08/12/06 01:58 PM
Opiates for Severe Depression
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Trampy
GRAND Pooh-Bah
Registered: 04/02/02
Posts: 3176
Loc: Southwest U.S.
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This was moved from a thread about medical records which veered off into other topics.
faerie posted: Quote:
to say that SSRIs aren't dangerous is insane in my opinion. have you read the info on them? they have some serious issues that need to be addressed. yes, they are great for some, fairly decent for many, and an absolute disaster for some. opiates are the same way. btw, i don't use opiates for mental issues, but i don't judge those who do...it's not my place to do so. and fyi tylenol kills more people than opiates in any given year. yep the prices of the NROPs now are insane, last summer they were decent...i think NDS had brand name zydone for 90 pills for about $80...which was a decent price imo. nowadays you have to have some serious money to afford the NROPs, but they exist for a reason. in any case i just think that the snap judgements of people and the stereotyping is out of place. i mean seriously, have you all considered where you are at telling people that they are addicts, etc? this site is drugbuyers.com in case you've forgotten. do i feel like the govt needs to protect me from myself? no, i do not. if they really want to get to that level of protection take away alchohol...a much bigger problem for society than hydro. take away tobacco, which is a larger health risk not just for the person using the substance, but for those around them that are exposed. until then...i wish these blanket stereotypical judgements would not be made and i really think they are ridiculous on a site called drugbuyers.com...jmo~faerie
If they're gonna take away alcohol and tobacco, they might as well take away Tylenol too, because it kills more people than any other drug, prescription or OTC. And people won't be selling Tylenol on the black market.
I agree with you 100%, faerie! If someone thinks that SSRIs are always the answer for depression, they don't know anything about severe depression ... and they probably know very little about SSRIs. When the first SSRI was approved, Prozac, the labeled indication was only for "mild to moderate depression," not severe depression. Lilly could not prove that it was more effective than the "Gold Standard" of antidepressants at the time (and maybe still so), the tricyclic imipramine, so the FDA let Prozac be sold based on studies showing that Prozac was superior (with 95% confidence) to placebo for those with mild/moderate depression. Recent studies have confirmed the weak therapeutic effect of SSRIs, with one from a few years ago showing that taking a 30-minute walk every day was just as effective for mild/moderate depression as a randomly chosen SSRI at the recommended "standard" dose. Both "treatments" (walking and SSRIs) were slightly better than placebo ... which is not pooh-poohing them because placebo is much more effective for depression (and anxiety), than it is for, say, liver cancer.
(I joked once on-line that if someone could figure out a way to sell placebos for profit, they'd make a lot of money. It took only a few minutes for someone to reply that GNC already does it. The challenge is not profits, but achieving more than short-lived efficacy.)
It's funny that the SSRI manufacturers of drugs like Paxil (and the SSNRI Cymbalta), which are particularly hard to discontinue, do their best to discourage the term "withdrawal" in reference to the symptoms that often occur when a person becomes DEPENDENT on their drugs. Dependency is dependency. Those people became dependent on Paxil (or Cymbalta) and they find it difficult to stop taking it. What is the difference between them and someone who broke a leg and is discontinuing pain killers as it heals? Nothing, really, unless the person with the broken leg was abusing the pain killers and became addicted to them.
Now i've known of people "abusing" antipsychotics (e.g. Navane) to "numb their brain," and some people abuse Prozac (intranasally) because it is a stimulant, but i don't think anybody abuses Paxil. They designed the drug so that it is unpleasant.
It's totally ridiculous to think that opiates can not be used successfully as an alternative to ECT, VNS implant, or suicide for refractory depression. Opiates have been used for depression for 3000 years.
There are MANY peer-reviewed studies published since the 1970s showing the safety and efficacy of opiates for treatment of refractory depression. These are published in journals of science and medicine. One that stands out from the rest was a study where strong opiates were used with the subjects all having a history of previous self-medication (or "drug abuse") with opiates. The participants were closely monitored for compliance and their compliance was reported as 100%. The subjects were given hydromorphone, oxycodone, and hydrocodone. The study results showed safety and efficacy.
It's the War on Drug Users which prevents doctors from prescribing treatments that could save many lives; opiate therapy costs peanuts and gives instant relief from the mental pain, while ECT destroys the brain, the VNS implant costs at least $20 K and requires surgery for implantation and it can take more than six months to give a benefit (a very long wait for a suicidally depressed person). Suicide is an irreversible and very cheap self-treatment for depression and it can be done painlessly, but, while it causes great pain to the person's survivors, it can give instant relief to the person suffering from severe depression.
Have you noticed the frequent use of the word "severe"? We've had a lot of words written about SSRIs used for what Peter Kramer called cosmetic psychopharmacology, where people are given SSRIs as "mood brighteners," like teeth whiteners. We've heard the story of someone who started taking Zoloft because of an emotional shock and he took it for 10 years and got up to 100 mg/day. SSRIs are handed out like candy and PCPs often think that they should be presribed to anyone who has a low mood or who complains of vague and undiagnosed physical discomfort. I'm not talking here about treatments for those patients and their SSRI prescriptions. No, that is an entirely different topic.
I'm talking about alternatives to suicide when a person is severely depressed for a long period and who has "been through the mill" of psychiatrists and tried many of their prescribed drugs, which all either had unacceptable side effects, had no benefit, or initially had a benefit but eventually pooped out.
I'm talking about people who grew up in a family where everyone suffered from either anxiety disorders or depression, or both, and this illness has been with them for as far back as they can remember. Imagine that such a person has been in psychotherapy for many years, on and off, and has sought treatment from a new psychiatrist every few years to try out some of the latest new poisons to see if they're better than the poisons available on the last go-round. After each new round of unsuccessful treatments, it will seem less likely to them that going through it all again with someone new will be any different from the past. That is the type of person for whom opiates should be available on at least a short-term basis.
If you do a cost-benefit analysis comparing short-term opiate therapy to the alternatives of 1) ECT, 2) VNS implant, and 3) suicide, the best choice is obvious. Yet, psychiatrists will almost universally insist on a person taking new drugs or higher doses of their existing (and insufficient) regimen. But past experience has shown that trying a new go-round is likely to be a waste of time and money, and the side effects from a new drug are often intolerable. So what is such a person to do if they can't afford or don't want to risk ECT or VNS? It seems there are three main options to choose from: 1) suffer through the misery, 2) suicide, or 3) self-medicate.
Doctors don't like it when they learn that a patient has self-medicated. They hate it, and their hatred can be so strong that the patient might feel that the doctor hates them. Despite strong evidence (Google "self-medication Khantzian") that mental illness causes substance abuse, and not the other way around, doctors will often tell a depressed patient who has self-medicated that it's their self-medication that causes their depression. Some doctors will say that (maybe even think it) despite medical records showing that their depression preceded by decades the patient's access to drugs such as opiates and benzodiazepines.
Medicine was the first profession to embrace the scientific method, but, in these cases, dogma trumps the evidence and trumps simple logic. Put it another way. If the person only recently began self-medicating with particular substances, but their depression existed for decades prior to their gaining access to those drugs, how can those drugs be responsible for the person's depression?
Even psychiatrists who specialize in treating substance abusers are loathe to admit that self-medication can be anything other than drug abuse. It would go against the dogma of the War on Drug Users (and put their medical license at risk) if that psychiatrist admitted that a person desperate for relief (who had been prescribed, say, more than ten different antidepressants from many different doctors with no benefit) made a good decision if they chose to use, say, opiates, as an alternative to suicide.
Before you judge a person, you should walk in their shoes. I think a big problem inherent in our medical system's treatment of people with severe depression is that the intense demands of medical school and intern/residency will screen out everyone who suffers severe UNIPOLAR depression since childhood. The psychiatrist Kay Jamison is a notable exception, but she is bipolar; and their manic energy can get them through to being a doctor, as she proved, but she wrote much more about being manic than about feeling depressed. Also, since severe depression runs in families, doctors are unlikely to have parents who suffer from severe depression. So i think that's why so many doctors don't understand that mental pain can be very similar to physical pain. All types of pain are relieved by opiates. Pain is pain. It should be no wonder that studies have shown comorbity of at least 50% for depression and substance abuse. If the doctors will only give out garbage, many will find an alternative.
Every drug has side effects, and, as a class, antidepressants may be only second (or third or fourth) only to chemotherapy drugs in the frequency and severity of their side effects. They are all "dirty drugs." Given that sex is considered the "Third Drive" it's absurd that so many doctors think that SSRI-induced destruction of a person's ability to have sex is a no-nevermind.
And no, it's not a felony to make these statements.
I don't think that a person who knows nothing about ECT and VNS (or suicide) as "remedies" for depression should be judging the extreme measures which can prevent suicide among those with chronic and severe depression. They should do some reading on ECT and how it has permanently damaged the minds of some very highly creative people (with depression incidence being associated with creativity). They should also read the (admittedly flaky) data on the efficacy of VNS at www.cyberonics.com, in addition to their (much better quality) data on treatment-resistant depression (TRD). If anyone still thinks that opiates should not even be considered for TRD after doing that reading, i'd be glad to debate the claim further.
P.S. I'll bet that most people here don't realize how recently in our history that what we now call "prescription drugs" required a prescription in order to be bought at a pharmacy. It was in 1951, with the passage of the federal Food, Drug, & Cosmetic Act creating the FDA that the federal government established a system for approving drugs for safety and efficacy, and limited their sale to prescription only by federal law. And then in 1970, even more controls were added with the CSA creating the DEA and inventing the concept of the Schedules of Controlled Substances. The sale of LSD, psylocybin, and mescaline were outlawed in the late 1960s, but there was no DEA to enforce the law. Before the CSA and DEA, there was a patchwork of laws banning or controlling the sale of marijuana and opiates with marijuana being controlled by the need to buy a tax stamp that was impossible to buy. There were (and still are) many absurdities in our country's efforts to control its populations use of psychoactive substances, which Siegel in his book Intoxication calls the "Fourth Drive" and shows many animals (often insects) seeking out psychoactive substances as "natural behavior." The War on Drug Users will have the same outcome as our prohibition of alcohol because, as Siegel makes clear in his excellent book: banning the sale of psychoactive drugs is no different from the government trying to ban or control people having sex. The drive to alter consciousness is deeply embedded in our nervous system. Some, like the Wall Street banker R. Gordon Wasson, went so far as to say that it was the use of psychedelic drugs by early humans that led to our development of spoken language as well as the concept of God.
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#375115 - 08/12/06 03:01 PM
Re: Opiates for Severe Depression
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JasonG
Pooh-Bah
Registered: 10/24/04
Posts: 1070
Loc: west/midwest
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I have genuine needs for opiate pain killing meds, which I am on, but I also have been diagnosed w/mild depression which SURPRISE, dissapates with opiod treatment. Yeah, a bottle of vikes costs an rx about 10 bucks, whereas the same amt of Lexapro(which my old pcp tried to get me on) etc is 5x that at least. So what do I do? Kill 2 birds (and maybe my liver) with one pill. The danger is the usual,.."I feel a little depressed, maybe I should wank an 80 mg oxy!" but properly administrated...(which we all do ,, rite?) I think it is a possible alternative. Good luck, cuz this is a dangerous playground. J
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#375117 - 08/12/06 03:35 PM
Re: Opiates for Severe Depression
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Grasshoppa
GRAND Pooh-Bah
Registered: 06/23/05
Posts: 4184
Loc: most Days, just laughing!
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scapes, They gave me Cymbalta to slow down my Headaches. I don't like or do well on SSRIs. Have tried many in the past for the same reason.
I was told this one would be different.
After reading here what members told me. I tossed them too.
No thanks....I will never try a SSRI'S again.
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#375120 - 08/12/06 05:18 PM
Re: Opiates for Severe Depression
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tigersmom
GRAND Pooh-Bah
Registered: 07/20/05
Posts: 5072
Loc: Witchville
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Quote:
Well written as usual Trampy.There is one thing you said that really made me think...."mental illness causes substance abuse, not the other way around".Do you believe this to be true with ANY substance abuse?(alcohol,cigarettes)Just curious....-scapes
When Kurt Cobain killed himself, his heroin use was widely blamed for "causing" his suicide. I thought then and I think now that this is the type of bullshitte propaganda that we have been fed at least since the "War on Drugs" started. Anyone with any knowlege of Cobain's life...hell ANY severely depressed person's life...knows that such depression almost certainly predates opiate use.
Although you asked trampy specifically, I will say that in my opinion, all exteme behavior suggests self-medication for depression...this can include overeating, or undereating, alcohol, some forms of sexual behavior...even some forms of extreme religiosity...(just think of the sucide bombers in Palestine if you wish to consider a person so depressed and hopeless that they are willing to take not only their own life, but those of others...)
I don't know if opiates is the key to suicidal depression (it finally stopped working for Cobain obviously), but I do find that opiates can ease the mind of a depressed person and greatly inhance their productivity...I present myself as speciman A...LOL...
_________________________
I am neither Liberal, nor Conservative...I am RATIONAL
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#375123 - 08/12/06 08:09 PM
Re: Opiates for Severe Depression
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Trampy
GRAND Pooh-Bah
Registered: 04/02/02
Posts: 3176
Loc: Southwest U.S.
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Quote:
Well written as usual Trampy.There is one thing you said that really made me think...."mental illness causes substance abuse, not the other way around".Do you believe this to be true with ANY substance abuse?(alcohol,cigarettes)Just curious....-scapes
The post was about opiates and severe depression, not other drugs and other illnesses, but it's funny you should mention cigarettes because they are a drug that is harmful, but smoking is not considered "substance abuse," per se. Maybe it should. I remember seeing stories about health insurers that wouldn't pay anything for smoking cessation programs and treatments. I guess it shows that while drug use is universal, different societies have different taboos. Why is cigarette dependence not considered the same type of mental health problem as alcohol dependence? Probably because you can get "high" on alcohol but not so for cigarettes. It doesn't matter that tobacco kills more people than alcohol does. Alcohol gets people drunk. A month of bupropion and some counseling sessions is a lot cheaper than treating emphysema and lung cancer. And they'll pay thousands of dollars a year to keep someone on Suboxone for drug addiction, but they'd deny payment if a psychiatrist was brave enough to prescribe it off-label for depression even though medical reference books list depression as an off-label indication for Buprenex (the same drug, but injectable). Makes a lot of sense, huh?
Also, coffee is a drug. It's probably the most commonly used drug in the world. In the world markets for natural commodities (before the recent spike in metals prices), coffee was a clear second only to oil in the dollar volume of international trade. When taken in moderate doses, coffee may have some benefical effects on the vascular system that could be weighed against the teeth staining and occasional anxiety or insomnia (if taken late in the day) so that it's not clearly harmful. Many people involved in creative arts, especially writers (of both words and computer code) would not be very productive without coffee. But it can be abused if a person drinks 20 cups a day and on into the night, making them anxiety-prone insomniacs. Like any stimulant, excessive use (combined with lack of sleep) could make a person paranoid, though their paranoia would probably go away if they cut back on the stimulants and started to get good sleep.
Back to smoking, i think the answer is probably Yes to some extent with cigarettes, for one type of mental illness. Cigarettes are used by smokers to relieve anxiety (for a very short-lived relief). It's my understanding that smokers can become addicted very quickly because rebound anxiety can develop quickly. More certain, though, is the association between schizophrenia and cigarette smoking. I know a few people who have that mental illness and they ALL smoke cigarettes. I've also seen studies that found a smoking incidence of about 90% among people with schizophrenia, and there was some research showing that nicotine has a "normalizing" effect on brain function of schizophrenics ... so, yes, in the case of schizophrenics and smoking, there is a cause-and-effect relationship with their smoking being a form of self-medication which can make it almost impossible for them to quit. But, for the chicken-versus-egg question, it would be clearly absurd to think that smoking cigarettes causes schizophrenia. There is some work going on to develop a less addictive drug that affects nicotine receptors in order to help people quit smoking, and the association with schizophrenia is so well known that these drugs are probably being looked into as possible new treatments for schizophrenics.
Alcohol is also used by some with anxiety and depression for self-medicatiom, but i think that non-alcoholics would prefer benzodiazepines and opiates (or amphetamines), respectively, if available. A person self-medicating with alcohol can very easily get caught in a vicious spiral of alcoholism where the alcohol consumption only makes their anxiety and/or depression worse, and they can become quickly dependent on it if all they have to relieve their despondency is more and more alcohol. Because of the brain damage caused by high alcohol consumption, it seems likely that alcohol would be an exception to the statement of cause versus effect--that is, it seems likely that alcoholism could actually cause mental illness from organic brain damage. The mental illness from alcohol could manifest as anxiety, paranoia, rage, depression, or dementia (for starters).
Edited by Trampy (08/12/06 08:42 PM)
_________________________
Vote Libertarian if you want freedom. If you're not part of the solution, you're part of the problem.
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#375127 - 08/13/06 02:19 AM
Re: Opiates for Severe Depression
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jskream
Veteran
Registered: 10/07/03
Posts: 603
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Quote:
using a depressant to change a lousy mood doesn't hold up to scrutiny. depressant to treat "depression"! perhaps for a handful, out of a bazillion, could that not lead to worsening consequences. perhaps,(i suspect), for none could that be effective in the end.
That's a semantic game. 'Depressant' isn't a medical term which refers to a medication/chemical which causes depression. It just means it slows down your central nervous system (respiratory depression is a side-effect of opiates).
Opiates can be euphoriants. Euphoria is the opposite of dysphoria and depression.
I love exploring this site for everything opiate-related, and if you follow the somewhat circuitous links, you'll find a lot of research regarding the effect of opiates on mood, and...well, the effect of opiates on just about everything. Excerpt:
Quote:
A significant minority of the population only feel truly well on opioids. In effect, they self-medicate, taking responsibility for their own mental health in defiance of medical orthodoxy.
It would indeed be extraordinary if - alone among the neurotransmitter systems of the brain - the endogenous opioid families were immune from dysfunction. Enkephalins are critical to "basal hedonic tone" i.e. whether we naturally feel happy or sad. Yet the therapeutic implications of a recognition that dysfunctional endogenous opioid systems underlie a spectrum of anxiety-disorders and depression are too radical - at present - for the medical establishment to contemplate. In consequence, the use of opioid-based pharmacotherapies for "psychological" pain is officially taboo. The unique efficacy of opioids in banishing mental distress is neglected. Their unrivalled efficacy in treating "physical" nociceptive pain is grudgingly accepted.
I also love reading The Hedonistic Imperative, part of Hedweb.com.
I think these links can help to facilitate discussion regarding medication, depression, psychological states, etc.
∙--J
p.s., this isn't one of my better thought-out posts, please excuse me but I just got back from seeing Sleater-Kinney's last concert ever. OT, any other S-K fans here?
_________________________
"...but I'm coming home, I'm comin home, to make it all right so dry your eyes...we think the same things at the same time, there are too many of us so you can't count..."
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#375129 - 08/13/06 08:24 AM
Re: Opiates for Severe Depression
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namesrgone
Enthusiast
Registered: 06/22/06
Posts: 274
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Quote:
Suicidal thoughts are what led to the Cymbalta going down the toilet.I do not suffer from depression, but when I take my pain meds I feel EXTRA un-depressed. 
I have to agree CP is depressing in itself. When I take my pain meds, my mood is MUCH better.
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#375130 - 08/13/06 08:59 AM
Re: Opiates for Severe Depression
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tigersmom
GRAND Pooh-Bah
Registered: 07/20/05
Posts: 5072
Loc: Witchville
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Quote:
"When Kurt Cobain killed himself, his heroin use was widely blamed for "causing" his suicide." (Quoted from above post)
Kurt had complained of severe stomach/abdominal pain for years, and had even written lyrics about it - squeezing and burning in his gut. I believe he may have had undiagnosed Crohn's disease, the symptoms of which I am familiar.
He obviously took heroin for pain relief, and his wife, Courtney, lamented later on that people should've left him alone about his heroin use, b/c it obviously made him feel better.
Clara
Hi clara...actually Cobain's Crohn's Disease had been diagnosed years earlier. I lived in Seattle when he killed himself...even went and had a look at the garage where he did it (from the street.) Anyway, believe me, the local news made a huge issue of his "heroin" use as triggering his suicide (no pun intended!) which I've always thought was bullpucky. Cobain had a long history of depression and as far back as high school predicted that he would die by suicide. The Heroin probably did ease his physical pain, but the continued pressures of fame, etc. undoubtly just got him into a space where he couldn't handle it anymore...I'm sure that repeated "interventions" with a group of people, including Ms Love, sitting around on a "knod" while telling Kurt that he had to "clean up" wasn't very helpful either...
_________________________
I am neither Liberal, nor Conservative...I am RATIONAL
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#375132 - 08/13/06 10:09 AM
Re: Opiates for Severe Depression
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Trampy
GRAND Pooh-Bah
Registered: 04/02/02
Posts: 3176
Loc: Southwest U.S.
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Quote:
i knew two people who took opiates and eventually ended up suiciding.
neither of them found any relief from depression with the meds they were perscribed for depresion. i dont believe they abused opiates but i also dont believe that any amount of opiates would have saved them from suicide.
It's great that so many of you here understand that i'm advocating opiates for depression only as a last resort before suicide. Given enough time and money, standard psychiatric drugs (combined with psychotherapy) will work for most people, but it won't work for everyone.
Cyberonics says that 10% of people with moderate-severe Major Depressive Disorder are not helped by psychiatric treatment. Opiates may not be the answer for all of them, but they would help many.
Anyway, i'm curious why you "dont believe that any amount of opiates would have saved them from suicide."
Being forced to become "self-medicating outlaws" has many harmful effects: 1) legal risks/fear and societal isolation, 2) unreliable supply, 3) medical risks and ostracization by doctors, and 4) greater monetary cost than legal drugs. Would they be alive if they didn't have those problems?
Those two people tried psychiatric treatments that gave no relief, but they apparently got at least partial relief from opiates and they seemed to be controlling their use. Maybe they would have suicided even if they could get their opiates from a doctor and pharmacy and have their mental (and physical) condition and their drug usage monitored. But maybe they could instead be alive and happy and productive. We'll never know.
Our society tells these people we're better off with them in prison or dead. Is that right? What if the only opiate they can afford is street heroin made of who knows what by whom and how? That's gotta take a big toll.
There's only one way i know of to get legal opiate treatment for depression as a last resort before suicide and that's methadone maintenance. The cost around here is $200/month (covered by Medicaid/Medicare) and it's a hassle to go in there almost every day in the beginning, but after two years of "clean urine" you only have to go in once a month unless they call for a surprise bottle count and urine test.
Another last-resort possibility for those with very good health insurance or are rich is the VNS implant. Cyberonics forecasted that if they could get their device implanted into 10% of the people who qualified for it, they'd eventually sell a billion dollars a year. At $10 K each, that's 100,000 implants a year, which seems very optimistic, but they've had about 10,000 people who wanted it in the first year after FDA approved it for TRD. With a battery life of 5-8 years, if they don't switch to rechargeable batteries they'd get a recurring income stream from people who it helped and who outlived the battery.
I think it's pathetic that doctors would rather destroy someone's brain with ECT or try to get the VNS implant into them rather than even try to prescribe opiates for their TRD. How many die because of this? We'll never know. Suicides have always been underreported.
Edited by Trampy (08/13/06 11:19 AM)
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