Opiod deficiency

[Laudaphun]

SWIM has a question he's seen posed on other forums... There are some who have been suggesting that depression can result from not only a "deficiency/over reuptake of serotonin, norepinephrine, or dopamine. Depression can also result from a deficiency /over reuptake of your endogenous opioids" Endrogenous opiods are endorphins, dynorphins, and enkephalins (our bodies naturally produced opiods).

In the past opiates have been used as anti-depressants, until they were replaced by more fine tuned substances. However there are people who claim that no traditional anti-depressant will help their depression (SSRI, MRI, SNRIs..). These people are saying that small doses of buprenorphine is the only thing that works for their depression. This is a concept that seems to be gaining popularity and people there are a lot of people who believe that there is actually a medical condition known as 'endogenous opiod deficiency'. Obviously chronic use of opiates would cause this type of deficiency, however what about people who take opiates for the first time and feel like they've found that something that has been missing all their life... an example given by MrJim in http://www.drugs-forum.com/forum/showthread.php?t=32115 Buprenorphine is already being used as an off label anti-depressent in a number of people by bold physicians in patients who have responded to no other traditional anti-depressent. Is this truely a legit condition and if so, could it be caused by a mother's use of opiates while pregnant as mentioned in the link just mentioned? SWIM believes himself that this is very likely a good possibility, however he'd like to get the opinion of people who are more familiar with psychology, pharmacology, medicine, etc. Do you think 'Endogenous Opiod Deficiency' is an actual medical condition, or do you think its just that most of these maintanence patients are just getting a little bit of euphoria from their medicine?

Reputation Comments on this post:

extremely interesting thread

[Ethyl]

Many drugs have been used to treat depression, most of them better than todays depressants.

Opiates, amphetamines, are the most euphoric, and they were really good in treating depression because of their effects as anyone here can understand.

But, some words...

The brain "functions" using chemical/electrical systems. Every part of one of those systems are connected to the other systems.

Personally i don't believe that much in the current amine theory for depression, especially because when you begin to use SSRI's and NSRI's they boost the amine levels since the first day, but only begin to function 2 to 3 weeks later, so that tells me that it aint the amine levels that caused the depression but something else linked to that change in amine levels. As each amine system connects to others chemicals systems, i tend to believe that the depression lift from SSRI's is indirect...
Swim would never use SSRI's, because they are nasty and indirect in Swie opinion. One think you should ask you doctor when they want to prescribe you SSRI's or NSRI's is: "Why it takes 2 or 3 weeks for them to function, if my serotonin/noradrenalin levels are boosted since the first days?" Your dr. will problably not be able to answer that....

Opiates are really good for depression, but only for a period of time, because most of the opiates nowadays tend to make you depressive if you take them for to long...
Depressed people will have less endorphin (endogenous substances with opiate like effects) levels in their bodys/brain. I can't point a study right now but i've read it somewhere credible. But if you treat depression with opioids you will be within some time (can be a lot) depressive and addicted to opioids too..

A possibility for "treating" depression with opioids maybe in the Kappa/Delta systems. But they seem complex and one seems to antagonize the other.

The better opioid like substances for working out depression in nowadays may be: buprenorphine, salvia divinorum, and maybe tramadol.

[MrJim]

What about methadone, ethyl? It has such a long lasting effect that if we choose to ignore it's severe addictive capabilities, maybe that could be one to add to the list of potentials?
SWIM thinks one of the problems with a proposed opioid treatment plan would be the same that they ran into when barbituites were all the presciptive rage... you just keep needing more to achieve the same effects.

[Ethyl]

Originally Posted by MrJim

What about methadone, ethyl? It has such a long lasting effect that if we choose to ignore it's severe addictive capabilities, maybe that could be one to add to the list of potentials?
SWIM thinks one of the problems with a proposed opioid treatment plan would be the same that they ran into when barbituites were all the presciptive rage... you just keep needing more to achieve the same effects.

Methadone because it lasts that long, tends to saturate the opioid receptors with daily use (specially at high doses, but with more time with low doses too) leading to a constant binding in there. With time methadone users tend to be bored because every moment is the same.. The high/feel good effect is the difference between the previous state of taking the substance and the after state. with methadone it tends to be no high with frequent use because the receptors are allways flooded..
And because of that long term high dose methadone users tend to be bored cause them don't feel their endogenous opioids.

Mathematical Equation:

High = (After state of mind) - (Previous state of mind)

Note: - is (minus)

[ojos_de_brujo]

Isn't the reason why opiates are effective as antidepressants in people who have suffered from opiate addiction (even unknowingly as a baby) that their body's ability to produce endogenous opioids is impaired due to regular administration of opiates?
Wouldn't our body become lazy (by lack of a scientific word) to produce opioids itself if much stronger opiates were taken for some time?
And wouldn't a developing foetus, when constantly administered opiates in it's bloodflow, somehow change the way his endogenous opioid system was build? There would be less reason (from a biological viewpoint) to have it finely tuned, if it constantly receives opiates.
Sorry if Swim is pointing out something too obvious.

Is Endogenous Opioid Deficiency a medical condition? In a way. Maybe it can be explained by using the image of tolerance. When using opiates, your tolerance will steadily go up, you'll need to use more to get the same effect. Reverse this, and you'll know why depression can get relief from opiates. Your opioid receptors are tuned to a large dose of opiates, what the body produces itself will not have the effect it should have. The opioid receptors will not set themselves back into the default position as easily as your tolerance does, they always remember what they were once set to. That will make use of opiates feel like 'coming home'.

Treating depression with opiates will have a paradoxal effect. In time it will make the deficiency bigger, Swim thinks. Not to speak of the other negative effects.
But that does not mean the idea of opioid deficiency isn't valid. Maybe, someday, something can be done with it.

[Laudaphun]

Originally Posted by ojos_de_brujo

Is Endogenous Opioid Deficiency a medical condition? In a way. Maybe it can be explained by using the image of tolerance. When using opiates, your tolerance will steadily go up, you'll need to use more to get the same effect. Reverse this, and you'll know why depression can get relief from opiates. Your opioid receptors are tuned to a large dose of opiates, what the body produces itself will not have the effect it should have. The opioid receptors will not set themselves back into the default position as easily as your tolerance does, they always remember what they were once set to. That will make use of opiates feel like 'coming home'.

I knew this is what a lot of people would immediately think when reading this, however, the argument for Endogenous Opiod Deficiency is that the reason for addiction in the first place was due to this as a pre-existing condition, or an opiod deficiency in the brain that was present before the person used the substance for the first time. I personally am undecided on the issue, until I see more studies. Buprenorphine is the main drug being argued as useful to treat this suggested condition. I've found a lot of recent studies on this, that show supporting information on this, however I've been reading them on sites the support the use of buprenorphine so they could be subject to some bias.