opiates as antidepressants?

[TheTruth]

Current medical terminology states that depressive illness is primarily caused by serotonin deficiency. I neither agree nor disagree with this statement. However SSRI's are and will continue to be prescribed on this basis.

WRONG. Current medical "terminology" states that depressive illness is caused by MANY COMPLEX factors and does NOT have a single "primary cause" which you seem to believe is "serotonin deficiency." Let's not forget that very little is known about the true causes of depression. Also we don't truly understand WHY SSRI-type drugs actually help those suffering from depression.

Like I said MANY times before in responses to your posts, PLEASE stop posting about subjects that you don't understand very well. It's especially problematic when you use a tone that implies you have extensive knowledge of the subject and that your statement is correct without a doubt.

 

[Smyth]

This Reboxetine must be quite obscure material. Besides it is a NARI not a SNRI. As for Bupropion that is a special exception to the rule. So who is being the smart alek now? It is not used in the UK, just like Reboxetine was rejected in the US. Last I heard, it was getting used to treat nicotine addiction. I dont even know what Bupropion is tagged as, but it is not an SDRI. The argument I presented you in the above post with was based on the information you handed me. You just came across as being thoughtless and vague, basically I thought you were a rude dick.

 

[TheTruth]

Perhaps if you stopped spreading misinformation and misrepresenting yourself as an expert on various topics people wouldn't be so "rude" to you.

Bupropion is currently being used very frequently in the US for DEPRESSION as well as nicotine addiction and it is quite effective in treating both of those problems. It has a different side-effect profile that many people prefer over SSRI's.

snakjaw made a good post, perhaps if you weren't so close-minded and ignorant you'd actually learn something.

 

[Smyth]

My knowledge of the subject is from the experiences I have had with my doctor. It is not based on what I 'reckon', it is based on the terminology that has been in place over the past 10 years of my life. Doctors were prescribing me SSRI's for my depression and extremely resistant to hand out opiates for genuine pain (let alone depression), maybe this will change. However in todays world these ideas would still be considered quite radical by the general public. My expert voice was coming straight out the mouth of what my doctor had taught me and how I had personally been treated for these ailments. Again this has nothing to do with what I 'reckon', I was speaking from experience.

 

[Dope_User]

Just FYI:

Selective Serotonin and Norepinephrine Reuptake Inhibitors: Effexor and Cymbalta

Selective Norepinephrine Reuptake Inhibitors: Strattera, Reboxetine

Selective Dopamine Reuptake Inhibitors: Wellbutrin (technically mechanism of action is "unknown" but many consider it an SDRI)

 

[Gaz_hmmmm]

Benzos are not used to treat depression.

They sometimes are used as a combo with SSRI's. especially when someone is beggining SSRI's for the first few weeks!

 

[TheTruth]

yep, benzos are also combined with SSRI's when the patient experiences anxiety and/or insomnia as side-effects from the SSRI

 

[iloveoxycontin]

NRIs and SRIs

This forum isn't made for posts like this. Please dont make statements if you cant back them up due to your laziness. Only a fool will take your word for it just because you claim to have read it "somewhere credible." If you want to be taken seriously dont say shit like "go look for it yourself" and instead provide citations, ESPECIALLY when making claims that are potentially controversial. Thank you.

--good advice, i think EVERYONE needs to take it.

To help solve the confusion about which anti-depressant meds fall under which category, I've listed the below info:

"Reboxetine is a selective noradrenaline reuptake inhibitor --the first in its class to be marketed."
- http://www.reboxetine.com/reboxnew.html
As far as the difference between SSRIs and NRIs (aka SNRIs or SNARIs or NARIs), there isn't much of one. SSRIs work on increasing the amount of serotonin in your brain by selectively inhibiting the reuptake receptors. NRIs work about the same, except they inhibit the reuptake receptors for noradrenaline.
Noradrenaline and serotonin are BOTH involved in depression, along with dopamine (all of which are neurotransmitters and monoamines). The primary cause of depression has not been placed on the lack of one neurotransmitter in particular. There are different theories as to what causes depression, because "nobody really knows what causes depression"(1). The most popular theory, is obviously that the brain is lacking levels of a monoamine neorotransmitter (or many), such as serotonin, noradrenaline, or dopamine, "this is called the 'monoamine theory' of depression"(1).
1 - http://www.abc.net.au/health/depression/cause.htm
Now, considering the monoamine theory of depression, lack of dopamine is significantly involved with the cause of depression. "As opiates increase dopamine transmission"(2), they work parallel to SRIs and NRIs, in a way.
2 - http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=12654507&dopt=Abstract

I'm not saying that opiates, SRIs, and NRIs are the same thing, because they are not. But, I believe that opiates could be just as effective (if not more so) in treating depression as SRIs, such as fluoxetine, or NRIs, such as reboxetine.

 

[LIVE4EVER]

I must be one of those folks who would benefit from an opiate as an antidepressant. It seems to be a cure-all for everything. I have been on every type of SSRI, SNRI, etc. and have found no relief in them. If I take even a low dose, (to me a low dose is 20mg) of hydrocodone, all of my psychological issues disappear. I have social anxiety and the hydro makes me more outgoing and relaxed. And I'm certainly not depressed. I have more energy and generally a better outlook on life. I'm even more empathetic. If they can somehow rid the tolerance problem, it may help those who are already resistant to SSRI therapy. JMHO.

 

[Dependence03]

What type of Antidepressant is Remeron (Mitrazipine)? Its not an ssri, I'm positive of that, but do any of you guys know? I currently take it, and would like to know more about it, and what neurotransmitters it acts on.

 

[iloveoxycontin]

What type of Antidepressant is Remeron (Mitrazipine)? Its not an ssri, I'm positive of that, but do any of you guys know? I currently take it, and would like to know more about it, and what neurotransmitters it acts on.

Remeron (mirtazapine) is a noradrenergic and selective serotonergic antidepressant, increasing levels of norepinephrine and serotonin in the brain while inhibiting the H1 histamine receptor (which can cause hunger and sleepiness) and another recepter which i can't remember right now. Remeron is unique because the onset of the drug is alot faster than SSRIs and has a lot less crazy side effects than SSRIs and SNRIs. Remeron has also been studied for use for sleep disorders, i'm guessing partly because it can make you tired, but i've also heard it improves sleep quality as well.
Hope I've helped! Theres some sites below with more info...

EDIT: I was prescribed to Remeron once as a anti-depressant and for insomnia, in combination with an amphetamine to keep me awake during the day, i actually did like the combination, but sometimes i'd get cravings for candy and shit, it was like having the munchies or sumtin. Just thto id add that.

http://www.organon.com/products/mental/Remeron.asp?ComponentID=10139&SourcePageID=9643

http://www.crazymeds.org/remeron.html

http://www.rxlist.com/cgi/generic/mirtaz.htm

 

[nuke]

What?

I was on effexor 3 ish months, quit cold turkey, withdrawl was much worse than I'd ever experienced with cigarettes...Dizziness, tactile hallucinations, nausea, no appetite. The odd thing is sometimes I still get effexor vertigo (same thing that happened when I quit XR but never happened to me before) sometimes even though I've been off for a while...whatever.

 

[opiatekrzy]

lol the reason people think opiates can be used for depression is because it is a DRUG, just like any other drug that can be abused, it takes the mental pain away we suffer as people, thats why so many people use drugs

 

[iloveoxycontin]

I've never seemed to have any kind of withdrawals like that from anti-depressants I've been on, and I was on Effexor for a few months, too. That's strange.
Everyone knows that drugs can be abused and take away mental suffering, I was trying to shed light on some BENEFICIAL uses of opiates as anti-depressants
of course, i thoroughly enjoy recreational use :-D

 

[HobbyIsBowling]

yep, benzos are also combined with SSRI's when the patient experiences anxiety and/or insomnia as side-effects from the SSRI

You gotta love the medical community - treat the side effects of one drug with another. Maybe they should then give them amphetamines because the benzos make them groggy in the morning... I just think it's a dangerous way to go about things, but yes it does happen.

 

[fastandbulbous]

Actually aprazolam (xanax) does have antidepressant qualities on its own, unlike the rest of the benzos. I can't remember the mechanism of action, but the bit about it having antidepressant actions stuck in my mind.

Not that a doctor will prescribe it for depression though, purely because of benzo addiction.


As far as non-serotonin based antidepressants go, there's amineptine and nomifensine. Amineptine is a dopamine reuptake inhibitor, but is almost unavailable due to FDA pressure on other countries (it has a small abuse potential), and nomifensine never made it past the phase 3 trials (again, I think because of abuse potential)

Mirtazepine is also a alpha-2 autoreceptor antagonist, if I remember correctly (will confirm when I find the book I read it in). the alpha-2 receptor is the negative feedback brake that limits the amount of noradrenaline released. It's sedative, despite that, because it also has antihistamine and anticholinergic activity as well (a jack of all trades!)

 

[Dependence03]

What are yall's thoughts about mirtazepine? I've been on it for about 4 months now, and it seems to work A LOT better than SSRI's or Buproprion(wellbutrin/zyban). It seems to act on lots of transmitters, which in my case has helped my depression. I dose at night, and it also helps me sleep. However, I have gained 40 lbs. since I started Remeron, but that could also be attributed to the Methadone and lack of activity, horrible diet. Anyways, just wondering what others thought about mirtazepine that have used it before. %)

 

[Dependence03]

*bump*, someone has got to have been on mirtazepine before, or is on it now...and answer some of my questions, and comments. Please??

 

[Dope_User]

Dependence03, please don't bump threads. But to answer your question, every antidepressant will effect every person differently. While it seems Remeron (mirtazepine) has woked wonders for you (glad to hear it), it's not right for everyone...myself being one of those people. I also gained a lot of weight while on Remeron (about 20 pounds in just over a month). I was on 15 mg/day (taken 1-2 hours before sleep) which I believe is the lowest available dose. I also suffered from severe insomnia so it sounded like a good option (since I'd tried a couple SSRIs with some success, but unbearable side effects). I can't even comment on the antidepressant effects of the Remeron because it just made me sleep...about 12-16 hours a day. Even when I was actually awake, I was incredibly groggy and "hungover" all the time. Needless to say, I stopped taking it after realizing the extremely excessive sedative effects persisted (my doc and I were hoping the sedative effect would lessen after some time).

As far as opiates as a treatment for depression, I have one major issue with that - tolerance and dependence. Due to this, it seems like the dose would constantly have to be increased to keep the same A/D effects and the patient would become physical (and perhaps psychologically addicted). If this were preventable, I believe opiates could prove to be very effective for otherwise treatment-resistant depression...although I don't think opiates should ever be used as a "first line" treatment for depression. Possibly using something like bupe, which is a partial agonist/antagonist, along with a low dose antagonist (i.e. naltrexone). I suggest this because bupe is already suspected to have antidepressant properties, it is only a partial agonist/antagonist with a ceiling effect (therefore possibly decreasing tolerance/dependence), and experimental evidence seems to suggest that adding a low dose antagonist (i.e. naltrexone) can help reduce, or even prevent, opiate tolerance. I believe a pharmaceutical company is even coming out with such a product, called OxyTrex IIRC. It's a combination of oxycodone and a low dose antagonist (don't recall which one). As of now, a major advantage of traditional antidepressants, including SSRIs, is that they do not have the issues of tolerance or dependence. Some will beg to differ with that, but in my personal experience, I have NEVER experienced any type of tolerance or dependence to any of the A/Ds I've taken...including Cymbalta, which I am currently on and is effective - it has remained effect for quite some time and the same dose, 60 mg/day.

 

[ayjay]

There is stuff I've read on the self-medication hypothesis that suggests that some people choose to use opiates to combat depression - I'll post 'em when I find 'em again (researchers to check out are Edward J. Khantzian and David F. Duncan). It seems to work well in the short term - but not in the long term. This could be due to external factors involved in managing a habit, AND/OR possibly due to change in levels of activity of different opiate receptors. The mu-receptor causes euphoria - the kappa-receptor dysphoria; hence maybe over time the kappa-receptor becomes more activated??!!!