Crazy Idea? (methadone for treatment-resistant depression)
SWIM and his friend came up with this the other night.
SWIM is wondering if people think this is a horrible idea. SWIM has depression, and takes heroin every couple of weeks because it's all he can afford and it helps greatly with depression. SWIM is not addicted to heroin, but might be if he had the cash. Since you can't get a heroin prescription, SWIM was thinking about going to a methadone clinic high, getting on Methadone, staying on that for as long as possible and then going to suboxone. Or perhaps right to suboxone. SWIM would do this purely for the anti-depressant effects of each, since no other medicine has worked so good.
Terrible idea?
You'd have to test positive for heroin/opiates at the very least. A lot of clinics also make you see a doc when you're in visable withdrawls before you get on. Not all make you get sick first but some do. Esp. the private clinics.
Just so you know, you'll build a tolerance to methadone quicker than you'd imagine. You won't be getting high anymore after a few weeks/month. Swim understands how you feel about wanting the high for it's antidepresant effects, it just won't last is all. You'll get strung out on a crazy dose of methadone (if you get on) and feel no effects after awhile and it will be impossible to get high on dope or pills or anything and you'll be right back in the same spot with the depression as before expect you also got a metha habit on your back too. It's just not a good idea.
Using opiates to treat depression/anxiety is a horrible cycle that so many people fall victim to but it never works out in the long run.
Wish I could help more...
Last edited by Moving Pictures; 25-09-2010 at 01:56.
Reason: sp
Certainly a very bad idea. So many people on methadone are hopelessly depressed my fiend included. Methadone just isn't a "feel good" drug, it's a horrible lethargic inducing drug with very little recreational effect in maintenance doses. Sure it can get you "high" but that's in one off or excessive doses and since it can take up to an hour for any effects to be apparent people can take too much in the first place, think they're not getting anything from it, take more and die.
Being on methadone is one of the worst (correction it's THEE worst) things in my life, i fucking hate it and now i have been forced to make daily trips to the chemist again i am reducing the dose to come off despite my better judgement that it might well be a bad idea.
Certainly a very bad idea. So many people on methadone are hopelessly depressed my fiend included. Methadone just isn't a "feel good" drug, it's a horrible lethargic inducing drug with very little recreational effect in maintenance doses. Sure it can get you "high" but that's in one off or excessive doses and since it can take up to an hour for any effects to be apparent people can take too much in the first place, think they're not getting anything from it, take more and die.
Being on methadone is one of the worst (correction it's THEE worst) things in my life, i fucking hate it and now i have been forced to make daily trips to the chemist again i am reducing the dose to come off despite my better judgement that it might well be a bad idea.
My friend asked me to post the following reply:
When I took only a 10mg pill. I was feeling good. Feeling like if I had one of these pills every day, this would be my Anti-D. But you think that's just from taking it the first time and since my body was not accustomed to it?
What about suboxone? I was also thinking of trying to get on that for anti-depressant effect. Or more accurately, from methadone to suboxone, but if I decide Methadone is not worth it then just to suboxone.
Last edited by MrG; 05-01-2011 at 13:07.
Reason: S.I.
Just out of curiosity, what other drugs/medicines did SWIY try to treat the depression with before deciding on heroin/opiates? The idea of opiates as anti-depressants strangely enough has never occurred to me, I guess because long-term use of them isn't necessarily a good thing for your system as far as I understand it. Using once or twice a week in order to life spirits can be great for depression, I used to do this (although not with opiates), but if you're considering taking methadone every day I have to believe there are better options. Unless you've tried them all, which I guess is what I'm asking.
Everyone my towel has ever spoken to about methadone has said "it will destroy you." He would not touch that with a barge pole.
Buprenorphine on the other hand he regards as something of a miracle drug. He went straight from H to bupre overnight and hasn't used H since. He, like SWIY, used heroin primarily for its anti-depressant qualities; and he then found that these were completely replicated by buprenorphine. He took buprenorphine for six months at very low financial cost (and zero other cost) and probably would have continued had he not run out of supply. As he did, he then successfully tapered off bupre but is considering going back to it in the future for the anti-d qualities.
He recently wrote about all of this in a lot more detail in the heroin forum: post #15 of this thread
If SWIY does try buprenorphine, then:
1. Try to get subutex (pure buprenorphine) instead of suboxone (which also contains naloxone). Technically it should make no difference as long as one takes them sublingually as designed - i.e. does not IV them - but some people can apparently be sensitive to the naloxone, and the fewer substances one takes the better in general. It may not be possible to get subutex though.
2. If SWIY has no opiate tolerance - or even if he has a small one - be incredibly careful with the dose. The first dose should be in the region of 0.5 mg or even less. This might well make you quite high. DONT try to get that high again, because you won't (unless you wait some days/weeks, which would defeat the anti-d purpose) and you'll just escalate your dosage needlessly. To be clear: regular bupre usage will make SWIY feel good, just like SWIY hopes an anti-d will; but not normally "wow I'm high", except on the first occasion. That high is not possible to repeat from my towel's experience - once you've dosed once, you're tolerant to it and the high goes.
3. 0.5 mg/day is probably adequate to maintain the anti-d properties; or if necessary 1mg/day. More should almost certainly not be required. Dosing every day is also not necessarily required. To start with, try a 0.5 and then only take another 0.5 the next day if you are noticeably not feeling anything any more. Buprenorphine has a very long half life - up to 72 hours is possible. Alternatively, one might consider 1mg every two days instead of 0.5mg a day (that'd be easier to divide up, for example) - but again, not for the first dose or even for the first days. Ease into it.
4. Because of this, get 2mg pills if at all possible. It's much easier to divide a 2mg pill into quarters than an 8mg pill into 16ths - in fact the latter is basically impossible (without very accurate weighing scales) so one has to just break off a tiny bit. The smaller the better, one can always take another tiny bit if one doesn't feel anything (after a couple of hours.)
PS. I mention above how my towel went 'overnight' to bupre - this is true, but is not standard procedure; most people get precipitated withdrawal if they take buprenorphine while being dependent on another opiate. I don't believe that applies in the OPs case because he is not dependent, but just to mention this for others. Lots more info on that in the Buprenorphine forum.
When I took only a 10mg pill. I was feeling good. Feeling like if I had one of these pills every day, this would be my Anti-D. But you think that's just from taking it the first time and since my body was not accustomed to it?
What about suboxone? I was also thinking of trying to get on that for anti-depressant effect. Or more accurately, from methadone to suboxone, but if I decide Methadone is not worth it then just to suboxone.
Most definitely it was because it was a one off first time thing, like i said it only really works with one off (not every day) or excessive doses (someone on maintenance taking enough to kill an extended family). With buprenorphine (subutex/suboxone) it will be exactly the same.
My fiend has been on methadone so long that he doesn't want to even think about how long it's actually been. He has drank half litres of the shit before and it doesn't really do that much, it's difficult to explain. Maybe you'd think well that's because you take it every day, yes but that's exactly what someone would be doing if they get put on a methadone script for any reason.
Going on methadone will lead you down a dangerous path, it's actually a very strange way to get drawn in to this world.
Just out of curiosity, what other drugs/medicines did SWIY try to treat the depression with before deciding on heroin/opiates? The idea of opiates as anti-depressants strangely enough has never occurred to me, I guess because long-term use of them isn't necessarily a good thing for your system as far as I understand it. Using once or twice a week in order to life spirits can be great for depression, I used to do this (although not with opiates), but if you're considering taking methadone every day I have to believe there are better options. Unless you've tried them all, which I guess is what I'm asking.
SWIM has been on almost every anti-depressant there is. SWIM actually had his doctor say I don't know what to tell you. SWIM has treatment resistant depression.
Quote:
Originally Posted by Arthur Dent
Everyone my towel has ever spoken to about methadone has said "it will destroy you." He would not touch that with a barge pole.
Buprenorphine on the other hand he regards as something of a miracle drug. He went straight from H to bupre overnight and hasn't used H since. He, like SWIY, used heroin primarily for its anti-depressant qualities; and he then found that these were completely replicated by buprenorphine. He took buprenorphine for six months at very low financial cost (and zero other cost) and probably would have continued had he not run out of supply. As he did, he then successfully tapered off bupre but is considering going back to it in the future for the anti-d qualities.
He recently wrote about all of this in a lot more detail in the heroin forum: post #15 of this thread
If SWIY does try buprenorphine, then:
1. Try to get subutex (pure buprenorphine) instead of suboxone (which also contains naloxone). Technically it should make no difference as long as one takes them sublingually as designed - i.e. does not IV them - but some people can apparently be sensitive to the naloxone, and the fewer substances one takes the better in general. It may not be possible to get subutex though.
2. If SWIY has no opiate tolerance - or even if he has a small one - be incredibly careful with the dose. The first dose should be in the region of 0.5 mg or even less. This might well make you quite high. DONT try to get that high again, because you won't (unless you wait some days/weeks, which would defeat the anti-d purpose) and you'll just escalate your dosage needlessly. To be clear: regular bupre usage will make SWIY feel good, just like SWIY hopes an anti-d will; but not normally "wow I'm high", except on the first occasion. That high is not possible to repeat from my towel's experience - once you've dosed once, you're tolerant to it and the high goes.
3. 0.5 mg/day is probably adequate to maintain the anti-d properties; or if necessary 1mg/day. More should almost certainly not be required. Dosing every day is also not necessarily required. To start with, try a 0.5 and then only take another 0.5 the next day if you are noticeably not feeling anything any more. Buprenorphine has a very long half life - up to 72 hours is possible. Alternatively, one might consider 1mg every two days instead of 0.5mg a day (that'd be easier to divide up, for example) - but again, not for the first dose or even for the first days. Ease into it.
4. Because of this, get 2mg pills if at all possible. It's much easier to divide a 2mg pill into quarters than an 8mg pill into 16ths - in fact the latter is basically impossible (without very accurate weighing scales) so one has to just break off a tiny bit. The smaller the better, one can always take another tiny bit if one doesn't feel anything (after a couple of hours.)
PS. I mention above how my towel went 'overnight' to bupre - this is true, but is not standard procedure; most people get precipitated withdrawal if they take buprenorphine while being dependent on another opiate. I don't believe that applies in the OPs case because he is not dependent, but just to mention this for others. Lots more info on that in the Buprenorphine forum.
Thank you so much! SWIM read your other post too. The more research SWIM does the more SWIM finds people who usually praise Buprenorphine over Methadone. Since SWIM does not have an opiate dependence, do you know if there is any amount that would be too much, i.e. lethal? SWIM heard that there wasn't, but SWIM could have misunderstood what his friend was saying.
SWIM's therapist (of all people) gave SWIM the number of a suboxone doctor that she said she thought would be easy to get from. Do suboxone doctors make you test positive for heroin first like some Methadone clinics, or make you get sick like some Methadone clinics? The only thing SWIM has left to figure out is if SWIM needs to stock up on H (which SWIM doesn't have the money for) first and then go in to see the doctor, just do H once right before SWIM goes in, or if it doesn't matter at all. SWIM thinks it may be different between doctor's but you can't necessarily ask them that, and is deciding the best option with very little knowledge of how it works.
swiy just needs a tiny bit of h in their system to test positive. I think you should try exercising, eating better, and changing your lifestyle before you embark on this crazy idea, bro.
swiy just needs a tiny bit of h in their system to test positive. I think you should try exercising, eating better, and changing your lifestyle before you embark on this crazy idea, bro.
Not necessarily true. My friend Girlie, when starting Suboxone (from 2 separate doctors on 2 separate occasions), was not only required to have a positive on a drug screen for opiates (and that's IT - no cannabis, benzos, cocaine, whatever was allowed), and was required to appear at the doctor's office, in withdrawals, on induction day. In fact, the 2nd time, she apparently was told she wasn't in ENOUGH withdrawals, and to check back in an hour or two. *sheesh*
So, it depends very much upon the doctor/clinic one might be attending.
Methadone, otoh, just required a positive drug screen (and she could have other drugs in her system, though it wasn't recommended); she was NOT required to be in ANY withdrawals, let alone a certain amount of withdrawals, prior to her first (lowish) dose. However, the initial dose that a methadone clinic gives (Girlie's clinic starts @ 30mg) could right kill or get a reasonably opiate-naive person overly high.
She says she doesn't really recommend this route for antidepressant effects, not by a long shot. These docs are used to treating addicts, generally with large tolerances, and the amounts given (esp with methadone, having to be under supervised dosing) could cause some serious illness & dysphoria, if not, well, death.
And yes, people CAN die from buprenorphine overdose, as well as bupe ODs being hard to treat, as they are resistant to Naloxone.
Though not at all recommended either, couldn't the subject try kratom daily or something instead???!
Methadone isn't a 'bad drug', it just depends on who is using it and for what. If you have been a heroin addict for years, constantly on the search for money/gear, with no time for yourself or anyone else, then stabilising on methadone, no matter how high the dose, will be a dramatic improvement to your quality of life.
However, being tied down to a drug that you need to take daily in supervised conditions, and that in itself is an addictive opiate, that also causes many unwanted side-effects, would, to most people, be a dramatic knock to their quality of life.
It's all relative to the individual's situation.
As for using opiates for depression, - swim himself did this initially, it's how he became hooked on heroin.
Initially, i.e. for the first few months, (before addiction became severe), it was amazing, heroin was the perfect cure, the thing swim had been searching for.
Unfortunately however, opiates like heroin and methadone are not drugs which continually give the same kick. A dose that got swim high and happy in the first month of use would not even prevent him from getting sick by the third month. Very soon, regardless of how much money swiy spends, or how much they take, they will NOT be getting any positive effects other than simply not getting sick.
So to sum up, if swiy were to do this, he'd have a great month or two, but after 3/4 months, he'd be in the same mental space as he is now, except in the situation that he has to take a certain substance every day just to feel normal. - Which REALLY ties you down, and makes life so much duller. The addition of addiction also generally makes people far more depressed than before they used opiates.
So swiy'd almost certainly be even more depressed if he did this, and with a whole heap of other shit on his plate too.
Swim can't advise strongly enough against this! (Having done it himself).
In Swims opinion, you should only go to a Methadone clinic if you're wanting to stop other Opiates and are very serious about your recovery.
Methadone will not get you high once you start using it everyday.
Swim is on Methadone and it doesn't really help with the anti-depressant effect that most Opiates can.
This is mainly because it doesn't get you high.
It just makes Swim feel "normal", not crave other opiates, and function like a normal person would without having to figure out a way to get your fix everyday.
So if you're depressed when you feel "normal", than Methadone probably wont be the answer for you.
As for using opiates for depression, - swim himself did this initially, it's how he became hooked on heroin.
Initially, i.e. for the first few months, (before addiction became severe), it was amazing, heroin was the perfect cure, the thing swim had been searching for.
Unfortunately however, opiates like heroin and methadone are not drugs which continually give the same kick. A dose that got swim high and happy in the first month of use would not even prevent him from getting sick by the third month. Very soon, regardless of how much money swiy spends, or how much they take, they will NOT be getting any positive effects other than simply not getting sick.
So to sum up, if swiy were to do this, he'd have a great month or two, but after 3/4 months, he'd be in the same mental space as he is now, except in the situation that he has to take a certain substance every day just to feel normal. - Which REALLY ties you down, and makes life so much duller. The addition of addiction also generally makes people far more depressed than before they used opiates.
So swiy'd almost certainly be even more depressed if he did this, and with a whole heap of other shit on his plate too.
Swim can't advise strongly enough against this! (Having done it himself).
I have to sort of disagree with this.
It's not that I think mickey is completely false, and I surely don't want to discount the personal experience of his friend that he shares here, but there is no reason to assume that this scenario is universally valid for everyone in that situation, i.e. everyone suffering from treatment-resistant depression.
First of all, there have been scientific works confirming the utility of buprenorphine in depression, and, although they are of course very limited in number (as well as in the size of the treated population) and are not methodologically perfect, they should not be as readily dismissed as they are by the overwhelming bulk of psychiatrists. It's true that opioids, including buprenorphine, are not the answer to treatment-resistant depression as it was hoped when those works came out, there are people who have experienced long-lasting remission from low to moderate doses of buprenorphine. Even if the chances for someone with resistant depression to profit from buprenorphine are slim, any patient will agree that even the slimmest chance of treating their depression will be worth a shot. And, if buprenorphine was to be helpful for a given patient, it would show after single administration (at a sufficient dose), so there would be no risk to develop dependance before knowing whether the treatment was doing good. Thus, until there is no longer a such thing as treatment resistancy in depression, opioids should have a role in psychiatric care, even if only as a fifth-line treatment so to speak.
That being said, the idea to get a buprenorphine prescription through faking opioid addiction is problematic of course - my friend Bobbin has been there . Unfortunately, it didn't work for him, so he dropped the treatment later on, but he's still glad he did it. Had he not done it, he would probably still be searching for a psychiatrist sufficiently familiar with treatment options for resistant depression, who would be willing to give it a try. As for the idea to try buprenorphine (or methadone) because heroin was useful in his depression: I'm not sure whether that works that way. Buprenorphine is quite different from heroin in terms of mode of action (partial µ-agonist, kappa-antagonist). My friend has not tried heroin, but from what he has read, it seems incredibly difficult to him to make the distinction between a heroin high and remission from depression. So, the fact that heroin provides relief from depression is, I think, not to say that the cure to one's depression will necessarily be with an opioid. But, again, in treatment-resistant depression, even the slimmest chance is worth exploring.
And, from a different perspective, even getting buprenorphine through faking addiction is probably a better way to treat oneself than through heroin. Again, from what my friend has read, it would seem that, even for a healthy person, it's terribly difficult to resist the temptation to do it regularly, and he doesn't even want to imagine how difficult it must be for someone suffering from depression.
Having said all that, and seeing that the thread is already a couple of weeks old: how did fromthatshow's friend decide to go on? I.e., did he try out his "crazy idea"?
Your friend should be ashamed of himself suggesting someone go and get themselves addicted to an opiod or opiate. SWIM really has to wonder if the previous posts were made by employees of pharmaceutical firms rather than ex-junkies' friends! Methadone is the biggest scam ever perpetrated upon junkies in the history of junk! IMO, it's only for those who deep down think they may (or definitely) want to return to the real deal at some point in the not too distant future - relapse rates are a joke. Otherwise, it's just kicking the can down the road Read the posted horror stories - there are many right here on DF. For most it is a last resort - and rightly so. Please seek guidance from real junkies before making the decision to become a slave to a substance no one has ever been completely satisfied with. Keep searching for something else or someone will live to regret it. Want to end up a depressed junky? REALLY?
Your friend should be ashamed of himself suggesting someone go and get themselves addicted to an opiod or opiate.
Are you referring to me here? If a treatment provides relief from severe depression - again, I think methadone is not a potential candidate, but buprenorphine is - then this would fully warrant being "addicted" to it. Just like for chronic pain patients. Obviously, this is pretty dangerous territory, and the prescribing psychiatrist must keep a close eye on his patients (possibly including random drug tests), but a depressed patient will more than gladly accept this in exchange for remission.
Prescribing methadone/buprenorphine for opioid maintenance just has nothing at all to do with prescribing it in depression, except for the substance of course. The context is radically different. I understand people's horror at the idea, but are you just as shocked about people getting opioids for physical pain? If not, then I think your horror is due to the fact that you cannot relate to the mental suffering of severe, resistant depression.
Last edited by C.D.rose; 12-11-2010 at 22:27.
Reason: correction
SWIM and his friend came up with this the other night.
The first line in the OP was the direct reference. My Junky Philosopher Amigo stands behind everything else in my post, though. Like that suggesting someone use a highly addictive, tolerance building substance off-label (at best Methadone barely works for what's ON the label) for something as serious as depression without exhausting every other possibility could lead to potentially life-threatening consequences. The person may be desperate but obviously also does not know what they are asking to get themselves into. MJPA must insist the OP be made aware- that's all.
Re: Crazy Idea? (methadone for treatment-resistant depression)
Just so everybody knows, the OP actually did go through with this and faked an addiction to get on suboxone. He has another thread about this where myself and another member encouraged him not to do this but he still did. We asked him to update the thread with how it was going but he has yet to do so. Anyone who has had an opiate addiction knows that tolerance kicks in and you stop getting high at a certain point or have to use huge doses to get high. This is why I don't think opiates will work for depression. The treatment of depression is dependant on the user getting high. If they can't get high anymore, the treatment will stop working. My friend knows that when he has a maintenance addiction (using solely to keep from getting sick), he still experiences depression and regular worries. Ask anyone who's been on the cup for a long time, all it will do is keep you well unless you keep upping the dose (which is impossible for bupe. as it has a ceiling of 32 mg before it ceases to cause further effects which is why people addicted on it cannot overdose). In the OP's defense, he has apparently tried many, many other treatments for his depression that weren't successful.
Re: Crazy Idea? (methadone for treatment-resistant depression)
Quote:
Originally Posted by MovingPictures
The treatment of depression is dependant on the user getting high.
Where do you take that from? I don't think one can generalize like this. Does treating physical pain depend on the patient get high? So why would it do so for depression?
I think the problem is that people imagine depression to be just another point on the regular, healthy mood continuum that everybody out there has. It really isn't. Depression is a serious disease, and in fact I am profoundly disappointed with the fact that it's still called a mood disorder. Besides the dozens of actual, physical symptoms, it's not about mood, but about being able to experience mood.
I can totally understand that people who have known the one side of opioids may shudder at the thought of using that side of them to treat depression, but that's just not what buprenorphine in depression is about. I'll post a link later with case reports, including a former opioid addict who went on buprenorphine (around 2-3mg) and had, at the point of the paper being written, been in remission for more than a year, including undergoing randomly scheduled drug tests to rule out any self-medication.
Last edited by C.D.rose; 13-11-2010 at 16:03.
Reason: wording
Re: Crazy Idea? (methadone for treatment-resistant depression)
SWIM thinks that methadone best antidepressant too. SWIM saw people who dancing without music after shooting it, not like mindless dances, like man, pretty oldie man, slides down from stairs and keep walking doing small dancing moving just cos everything so f..ing good. SWIM also might do something like this. SWIM found that mood increases a lot after shooting and SWIM smart enough to not wait for WDs before shooting so mood increases not cos WDs are gone. Thats like mood first then buzz.
Too bad that methadone on it's own is depressant as any other opiate, strong depressant. Yes, mood increases but one day 'treatment' should come to the end and then... Depression hard, too hard, add here usual post-methadone weakness at least for 6 months, insomnia... BDs to correct some post effects... Drugs to correct BD's post effects... Too expensive for physical and mental health. IMHO better give another chance to meds called antidepressants: result appears not that fast as with opiates but it's complications not that hard.
&rew added 9 Minutes and 26 Seconds later...
Depression is a serious problem and should be treated by medics as soon as possible before patient does something really stupid. Some patients just ignore problem and keep suffering till the of they's days while it could be healed.
Last edited by &rew; 13-11-2010 at 15:25.
Reason: Automerged Doublepost
Re: Crazy Idea? (methadone for treatment-resistant depression)
Quote:
Originally Posted by C.D.rose
Where do you take that from? I cannot disagree strongly enough with this kind of generalization. Does treating physical pain depend on the patient get high? So why would it do so for depression?
I take that from personal experience. Opiates for pain work even after the high is gone but anyone that has been on them long term knows you have to up the dose even to keep killing the pain due to tolerance. I've heard bupe is different than traditional opiates in that it itself had AD properities, effects on serotonin or something. I don't know if this is true or not because I've seen people on it go back to regular opiates because they were not getting high and had to feel their depression/worries. I'd be willing to look at research saying otherwise but from what I've seen, it isn't effective in treating depression longer term.
Quote:
SWIM thinks that methadone best antidepressant too. SWIM saw people who dancing without music after shooting it, not like mindless dances, like man, pretty oldie man, slides down from stairs and keep walking doing small dancing moving just cos everything so f..ing good. SWIM also might do something like this. SWIM found that mood increases a lot after shooting and SWIM smart enough to not wait for WDs before shooting so mood increases not cos WDs are gone. Thats like mood first then buzz.
&Rew, you are describing the high. Of course the high will get rid of depression. I think the debate now is if opiates in and of themselves produce any AD effect even without a high. For an addict, I think the relief that they got their fix and they know they won't be sick will cause a good feeling but if the person is used to taking a maintenance dose everyday, they won't have the worry of getting sick and will not longer feel relief from it. There's people out there with prescription for very strong opiates that are just a misreable as the rest of us.
It's my feeling that once the high is gone, the AD effects are gone too. I mean, if someone is in physical pain and is depressed due to the pain, yes, they would be rid of the depression simply because they were out of pain, high or not. I just don't think this is the case for addicts or people with classical depression.
Last edited by Moving Pictures; 13-11-2010 at 15:58.
Reason: edit
Re: Crazy Idea? (methadone for treatment-resistant depression)
As I just saw, The Honorable Richi already uploaded the file I was going to upload:
Quote:
J Clin Psychopharmacol. 1995 Feb;15(1):49-57.
Buprenorphine treatment of refractory depression.
by Bodkin JA, Zornberg GL, Lukas SE, Cole JO.
of McLean Hospital, Consolidated Department of Psychiatry, Harvard Medical School, Belmont, MA 02178, USA. http://www.drugs-forum.com/forum/loc...20&linkid=9149
As far as I know, buprenorphine doesn't act serotonergic though. The main focus when discussing its antidepressant properties is on its partial µ-agonism and its kappa-antagonism. However, my hypothesis is that these properties are at least partly due to the delta-agonism exerted by its metabolite, norbuprenorphine. One of the researchers who wrote this study, and who I contacted to share this thought, that is based on my friend Bobbin's experiences with buprenorphine in depression, said this hypothesis was "an interesting idea" that he "never thought about".
Last edited by C.D.rose; 13-11-2010 at 17:25.
Reason: personal comment
Re: Crazy Idea? (methadone for treatment-resistant depression)
I read the study (which someone really should clean up since it's a block of text and near impossible to read) and didn't see much that changed my mind. It still appears the effects are dependant on the high since all but one of the "successful" patients needed several increases in dose. I didn't see any real long-term follow up either. Also the low success rate doesn't help much either. Tbh, I think classic ADs have a higher success rate though I don't have any numbers.
This is something to be looked into, sure, but since this study was done in 1995 and fifteen years later, nothing more has come of it, I'm skeptical that it's effective long term.
To call this study a success based on one patient's experience is false. Especailly as seeing how most of the patients had inital improvement but subsequently fell right back into depression. I think that says a lot about opiate's use in treating depression.
It also seems one must be seriously, seriously depressed to become part of these studies.
Re: Crazy Idea? (methadone for treatment-resistant depression)
Quote:
Originally Posted by MovingPictures
(which someone really should clean up since it's a block of text and near impossible to read)
Now that's a legitimate criticism. I didn't take a look at the format, I assumed it was a regular pdf. I don't know if it's possible, but I'll ask whether the file can be replaced (I have the actual document as a pdf).
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and didn't see much that changed my mind. It still appears the effects are dependant on the high since all but one of the "successful" patients needed several increases in dose.
Yes, of course doses have to be increased initially until reaching the target dose, just like with any other any antidepressant out there. ADs aren't started at the target dose, and especially not when it's ADs with a notorious side-effect profile. The point is that, once at the target dose (which were single digit amounts of buprenorphine, which is notorious for being hardly if at all euphoric in many people who take it), for those who profited from it, effects remained stable.
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I didn't see any real long-term follow up either. Also the low success rate doesn't help much either.
Well, more than two years of remission at the point of the article being written is as good as long-term follow up gets in psychiatry. True, the low success rate is what I referred to as why buprenorphine isn't the wonder drug for depression, but a person with severe TRD has a right to try a relatively harmless drug (relative to the disease itself, which has staggering rates of suicide), even if chances are slim to improve on it.
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Tbh, I think classic ADs have a higher success rate though I don't have any numbers.
Of course, but the point is: these people have had regular antidepressants (hence the term 'refractory depression'), as well as ECT in many cases, and they failed to improve on any of them. The choice for them was not to take buprenorpine or another antidepressant, but to take buprenorphine or, well, accept the disease as it is.
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This is something to be looked into, sure, but since this study was done in 1995 and fifteen years later, nothing more has come of it, I'm skeptical that it's effective long term.
It's not true that nothing has come out of it. I can give you other references, as well as anecdotal stories, of successes on buprenorphine, but that doesn't change the general fact that is expressed in this paper. Also, the fact that not one antidepressant that has been developped in the past 15 years actually targets opioids, and yet here we are still with TRD being a significant problem in depression treatment (it accounts for more than half of depression-related health care expenses), shows that alternative methods of treatment have to be explored. Ketamine appears to be much more promising, but until selective NMDA antagonists are actually out, we're stuck in the same situation as 15 years ago, so the paper has lost none of its value.
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To call this study a success based on one patient's experience is false. Especailly as seeing how most of the patients had inital improvement but subsequently fell right back into depression. I think that says a lot about opiate's use in treating depression.
There was only a detailed description of a subset of the ten patients involved. The fact that one in ten patients achieved long-lasting remission is already a success in treating patients with TRD.
Re: Crazy Idea? (methadone for treatment-resistant depression)
Going on Methadone when you don't have a true opiate dependency is a bad idea. The type of high it procedures doesn't out-weight the physical addiction that comes with it. The idea of Methadone is getting yourself to a optimal maintenance level when a patient has a opiate dependency. Building tolerance and reaching a plateau happens fairly quickly and depending on the clinic there are limits of dosage, some as low as 90mgs and as high as 220mgs. (Note: I know of a clinic in Waukegan, IL that goes up to 600mgs a day,they charge an extra $10 dollars per 100mgs after 200mgs. They allow patients with that high of a dosage to split there dose to 2-3 times a day. Clearly patients are selling the excess Methadone because a person would be a Zombie on 600mgs per day.)
SWIM has been on 180mg's for about 3years and just recently started decreasing. SWIM hasn't felt a good high since the first 6 months at the clinic, though SWIM has noticed if I do take my methadone first thing in the morning or wait a few hours after the 24hour mark, it will produce euphoria for up to two hours following that SWIM just feels normal.
The fact is with Methadone at the end of the day it's about "feeling normal", but now you'll be stuck with an addiction that is much worse then Heroin. Unless you have a habit you can't afford and don't have time to go through the withdrawal process because of work then Methadone is a excellent choice but to have no physical addiction and go to the Clinic on purpose just to get "High" is just not smart and possibly deadly.
Note: SWIM knew a friend of a friend who went to a Methadone Clinic, whom didn't have a opiate tolerance. The clinic didn't perform a drug test and started the patient on 30mgs. The patient went home, went to sleep and never woke up again. The patient had a fatal overdose.
Methadone is much stronger then the average person thinks.
. Unfortunately, it didn't work for him, so he dropped the treatment later on, but he's still glad he did it. Had he not done it, he would probably still be searching for a psychiatrist sufficiently familiar with 
