opiates as antidepressants?

Has anyone heard anything else about this? I was browsing Google and found a couple different sites with articles about buprenorphine being used as an antidepressant. I've heard of opiates being used in the early 50's and before for depression and such, but is it possible that that may happen again? Buprenorphine is currently being used for withdrawal symptoms, like methadone is, but i've never heard of a doctor prescribing any kind of opiate for anxiety or depression within my lifetime. I wonder if this has any future? I mean, opiates would certainly make VERY effective antidepressants, however there would be two downsides that are obvious: tolerance and addiction. But with an opioid such as buprenorphine as an antidepressant, tolerance and addiction risks would be considerably minimized. I wonder if any stronger opiates will be used as antidepressants? codeine? morphine? oxycodone? Here i go dreaming again...Hmmm....

Check this out....
http://www.crazymeds.org/buprenex.html
http://www.dr-bob.org/babble/20030923/msgs/263124.html
http://www.talkaboutsupport.com/group/alt.support.depression/messages/1613955.html ----- lol...

It's an interesting concept... It's been suggested that some people might have endogenous opiate deficiencies and therefore would feel more normal under their influence, and that would cause high susceptability to addiction. I wonder if anyone's done any research to back this, though...if it is a problem, I'd guess that opiates would be as viable a fix for depression as SSRI's/SNRI's are, since the justification for that just seems to be, "Depressed people many times lack these neurotransmitters, so we might be able to help them by increasing the number of them in the brain."

Hell, I can take a completely unscientific guess that if you give almost anyone (whether they suffer from clinical depression or are just having a bad day) a decent dose of an opiate (assuming they have no experience/tolerance), they are going to feel a hell of a lot better.

It's kind of like the statement someone made regarding using stimulants for AD(H)D; stimulants have the ability to make everyone more focused and have been concentration, etc. I think it's very similar with opiates having a mood-lifting effect on anyone, regardless of whether they suffer from depression or not.

Yet, I still feel opiates could serve a role as effective antidepressants. But the main problem would be tolerance, which doesn't seem to occur with standard A/Ds, or at least not always or to the same extent as with opiates. So here's what I'm wondering...let's say you're using bupe as the A/D and you just keep increasing the dose as tolerance increases. Would the person eventually reach a point where they no longer need to increase the dose? For example, on Erowid, there's an article that says most addicts that had unlimited access to pharmaceutical diamorphine leveled out at some point (I think 2 grams/day was the highest).

Opiates made me very depressed after I got dependent on them. I guess my body slowed down endorphin production. It was horrible, and quitting was so hellish but I'm very glad I did it. I'm no longer depressed being off opiates.

I think this is a lousy idea.

There's definitely the risk of addiction and tolerance when considering using any kind of opiate as an anti-depressant, but there's that same risk with amphetamines being used for ADHD and such. Of course, the risk with opiates is probably far greater, but that depends on what opiate is being considered. I think bupe would be effective, with minimal risks involved, but something like fentanyl or hydromorphone...well, slightly more risky lol. Compare the use of an amphetamine like Aderall as a treatment for ADHD to the use of an opiate like codeine or morphine for depression: Aderall gives almost anybody extra energy and focus, whether they need the drug for medical reasons or not. However, opiates are the same way. So, in my opinion, the risks of abuse and addiction (physical or psychological) are nearly the same in both cases. With this in mind, i could see opiates being used as anti-depressants in the near future, whether they be ones such as buprenorphine and methadone or oxycodone and morphine sulphate. What do you guys think?

one more thing i forgot to mention....
Withdrawal: withdrawal would of course be a problem if patients were to stop using opiates immediately. But withdrawal is a potential problem with tons of drugs on the market currently anyhow, it's avoided by weening patients off of the medication, which would most likely be just as successful with opiates.
Consider how a methadone clinic works: Patients' doses are raised until they reach a point where they don't feel any more withdrawal symptoms. After the patient is stabilized, their dose is lowered until they are completely off the drug.
I don't really think opiates would add more problems to the world of pharmacology if they were to be used as anti-depressants. what do you think?

Some way of preventing tolerance would be ideal...but even slowing it down or limiting it somehow would be great. I read that taking low doses of an antagonist with opiates allows the user to still get pain relief yet slows (or prevents) tolerance (in an article about OxyTrex or something like that).

Say this agonist + small dose of antagonist theory works to limit tolerance:
Bupe is already a partial mu receptor agonist (and a kappa receptor antagonist) and therefore probably a better choice than a full agonist. Sometimes it contains the antagonist naloxone, but I believe that's just to prevent abuse (as it will cause withdrawa when IV'd, IM'd, or insufflated). So take bupe (a partial mu agonist), add a low dose of naltrexone (a longer lasting, orally active mu antagonist) and you would have an A/D that works well (at least I think it would be at least as effect as SSRIs) and you've added a way of reducing tolerance. Bupe has a "ceiling effect" around (usually around 16-32 mg) so their would be no benefit in raising the dose beyong that. The study with bupe that I read used less than 2 mg/day for almost all (maybe all), with one patient who continued treatment after the study and his dose had been very slowly titrated to 3.3 mg/day after about 2 years of starting treatment!!! A lot of depressed people go in and out of depression and don't necessarily ALWAYS need to be on medication. So it seems you could use bupe for a LONG time and probably never reach the "ceiling effect" due to the doses for depression seemingly being much lower than 16-32 (even after years of treatment) and you (and your doctor) could attempt to wean yourself off every year or so to see if you still need it or if you're temporarily "cured" from your depression. If you go off and become depressed some time in the future, you can go back on.

Kind of sloppy and unorganized...just ask if you need any clarification...the bupe+naltrexone was just an idea to reduce tolerance; I feel bupe alone would be an effective A/D.

Opiates can only be used in pain management issues. Depression is related to serotonin deficiency whereas ADHD is norephedrine or dopamine deficiency. I am talking in medical language here as oppossed to word on the street. Whilst depressed people may benefit from taking an opiate, their motivation for doing so would have to be under the umbrella of pain management.

Smyth said:

Opiates can only be used in pain management issues. Depression is related to serotonin deficiency whereas ADHD is norephedrine or dopamine deficiency. I am talking in medical language here as oppossed to word on the street. Whilst depressed people may benefit from taking an opiate, their motivation for doing so would have to be under the umbrella of pain management.

Click to expand...

Wow you speak as if everything there is to know about depression is already known... we barely know anything about the mechanisms involved as there are MANY and they are COMPLEX. saying that depression is related to seretonin deficiency is gross oversimplification. it is NOT always related to seretonin deficiency. please do some more research before posting...

this topic has been discussed many times before, do a search.

Try going to the doctor and tell him you need opiates for your depression. He'll quite probably laugh in your face and write 'drug addict' all over your medical records.

did i say anything that implied that he should go to his doctor and tell him he needs opiates for his depression? was that even a response to my post or just some random crap you felt like saying? it really has NOTHING to do with what i posted.

the fact that opiates arent currently officially being prescribed for depression (though there are a few notable rare cases) is really due more to politics than actual medical reasons. ever heard of THE DRUG WAR?

have you heard of the study done using buprenorphine as treatment for refractory depression?

1. 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.

2. The drug war is two-fold. On one side you have the heros actually making the valuable drugs. On the other side there are the reckless criminals destroying them.

3. I have not heard too much about bupe although I did read one study where it was concluded that it did prove useful in the treatment of depressive illness. The report had been conducted on a case-to-case basis. The reader became aquainted with the patients and how the introduction of bupe had affected their lives. Generally positive results were reported. I suppose it is comforting to the reader to see this on a rather personal level, the same could not be said for SSRI's for example. But if you gave the patients levophanol I would expect them to enjoy that even more.

I think there is a fine line here between taking drugs to medicate an actual illness and taking them merely with the intention of getting oneself high. With opiates we need to weigh up the pros and cons for their usage. [It would be an appauling waste of space to do this for ALL drugs so we will concentrate on opiates here]. I actually cant be bothered to do this now as lists for this can no doubt be found elsewhere. My point is this though: Physical Addiction.

My point is this though: Physical Addiction.

Click to expand...

You mean, like I was to Effexor XR?

What?

Opiates lower serotonin production. I've read that somewhere credible, if you want proof go look for it yourself. I'll stick to what I said; opiates might be a short term antidepressant but they will eventually cause worse depression.

Smyth said:

1. 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.

Click to expand...

And SNRIs and SDRIs and benzos and whatever else they can get away with throwing at the problem.

It sounds like you don't know any more than anyone else and are just trying to make yourself sound clever.

In SNRI's and SDRI's do you know what the 'S' stands for? In SSRI's the same 'S' is for 'Selective'. Here though, it stands for 'Serotonin'. So serotonin is used in all of these drugs used to combat depression. Benzos are not used to treat depression. Maybe you thought that they were, but you are wrong. They are used to treat anxiety. Whilst in your mind depression and anxiety may be the same thing, in medical terminology they are definately not. You would have to be exceptionally unstable for the doctor to hand you benzos. Either that or he thinks your are old & wise enough to judge for yourself what the correct course of action is for you. I think you need to be careful because it looks to me like you are smearing the boundaries that separate the different catagories of mental illness.

I find that I feel slightly depressed and grumpy for a few days after one recreational dose of codeine. I use codeine maybe once every two weeks. Can't say I've noticed any anti-depressant effect after using lower dosages. I can't speak for any other opiates/opioids however...

Smyth said:

In SNRI's and SDRI's do you know what the 'S' stands for? In SSRI's the same 'S' is for 'Selective'. Here though, it stands for 'Serotonin'. So serotonin is used in all of these drugs used to combat depression. Benzos are not used to treat depression. Maybe you thought that they were, but you are wrong. They are used to treat anxiety. Whilst in your mind depression and anxiety may be the same thing, in medical terminology they are definately not. You would have to be exceptionally unstable for the doctor to hand you benzos. Either that or he thinks your are old & wise enough to judge for yourself what the correct course of action is for you. I think you need to be careful because it looks to me like you are smearing the boundaries that separate the different catagories of mental illness.

Click to expand...

No. Many anti-depressant medications work on dopamine or norepinephrine reuptake and not serotonin. (Reboxetine, bupropion, etc.)

In short, when someone is "depressed", one thing we try is boosting a neurotransmitter or two. Serotonin usually, today, but who knows what will be popular tomorrow.

Why? Because nobody really knows what "depression" is. You certainly don't.

I don't need to be "careful". I don't care to draw a boundary between depression and anxiety because I don't really think there is much of one. Maybe I'm wrong, but until this is conclusively determined, I will discuss how I like.

You are welcome to a different opinion, but, again, quit trying to make yourself look clever. Prick.

GFunk02 said:

Opiates lower serotonin production. I've read that somewhere credible, if you want proof go look for it yourself.

Click to expand...

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.