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Thread: SSRI's and Opiate/Opioids

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    SSRI's and Opiate/Opioids 
    #1
    Is there any interaction? I've heard that some ssri's inhibit the effects of Morphine and Codeine. Ever since I started Prozac treatment opiates haven't been enjoyable. Anyone have any expierence or knowledge on the subject? I've searched around and haven't found much.

    EDIT: found this on erowid.

    "Some drugs also interfere with cyp2d6. Prime among these are the SSRIs, with the exception of Zoloft (if I remember correctly). The most potent inhibitor is paroxetine (paxil), followed by fluoxetine (prozac). If you are taking an SSRI, you will probably experience a markedly decreased euphoria when using codeine. (Paxil has a half life of only 24hrs, so not taking it for a few days will do miracles; the half life of prozac is 7 days"

    Does anyone know how long after taking Fluoxetine (PROZAC) that your inhibitory effects of CYP2D6 Return to normal after long term use?

    Also, can anyone tell me if escitalopram (LEXAPRO) inhibits CYP2D6?

    Or just any information in general about the interaction of the CYP2d6 enzyme and antidepressants. Or the interaction between Prozac and Oxycodone.

    I feel much less Euphoria when taking Oxycontin with Prozac. I'm trying to calculate how long I need wait until I can feel the desired effects.

    Also I suffer chronic depression and anxiety and I'm trying to figure out an SSRI that mixes well with opiates.

    Any help is greatly appreciated.
    Last edited by vecktor; 07-08-2007 at 20:30.
     

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    #2
    Thats fuckin awesome not one single response, thanks guys. Shows that this site really lacks intelligent people trying to better their knowledge.

    EDIT: apolagize i'm pissed oxy won't get me off anymore
    Last edited by LegalizeOpiates; 09-08-2007 at 03:47.
     

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    #3
    Well your question isn't exactly that advanced, i found the answer on wikipedia (and the links on the wiki page to the SSRI drug data sheets) in 10 minutes...

    Yes Prozac inhibits CYP2D6, and so can be expected to reduce the effectiveness of drugs that are bioactivated by CYP2D6, such as oxycodone.

    The wash-out time for Prozac from the system can be up to 5 weeks as its active metabolites have a very long half life.

    Also it may well be that the effects of Prozac on your serotonin system have downstream effects that cause you to enjoy opiates less, certainly when i took Prozac i found that it made me totally emotionally flat, bad things didn't make me sad and good things didn't make me happy, and so i was very apathetic as theres no point in caring about stuff if whatever you do you just feel the same semi-happy way you always do....

    Citalopram (and escitalopram) is a weak inhibitor of CYP2D6 and so will probably also reduce the effectiveness of oxycodone, although probably not to the same extent as Prozac.

    Personally i thought SSRIs were pretty crap (having been on Prozac, Aropax, Cipramil and Zoloft before they finally agreed to try me on something that wasn't an SSRI), and bupropion (wellbutrin/zyban) was way more effective for depression, plus it shouldn't interfere with the effects of opiates in the same way.

    Anyway taking opiates probably won't be good for chronic depression, as most euphoric drugs seem to make depression worse over time, but that may not be true for everyone. If you want an opiate that goes well with depression then probably your best bet would be buprenorphine (subutex) as that has been shown to have antidepressant effects in its own right.
     

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    #4
    thanks man, yeah i was considering Bupropion i didn't think it would mix well with opiates for some reason.

    Fuckin prozac! i gotta wait 5 weeks before i can enjoy an oxy i knew it hadda long half life... but damn 5 weeks.

    yeah suboxone is great for depression, i just gotta convince my doc that.
     

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    #5
    do you think grape juice will help?
     

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    #6
    Grapefruit juice you mean? Maybe but grapefruit juice inhibits CYP3A4 which is the enzyme that converts oxycodone to the inactive noroxycodone, it won't make any more of the oxy get bioactivated, just stops the good stuff from getting metabolised so fast.

    Oh and on checking it seems that one of the metabolites of bupropion, hydroxybupropion is a CYP2D6 inhibitor as well, so maybe thats not such a good alternative to SSRIs if you want an antidepressant that won't stop your oxy from working! And i guess its not exactly the kind of thing you can ask your doctor about...

    Reboxetine or maybe venlafaxine might be good alternatives, it doesn't look like either of those inhibits CYP2D6 as far as i can see. Haven't tried either of them personally but i know people who have, and they said that those two were both pretty good antidepressants. Venlafaxine can have nasty side effects though and has bad withdrawal effects, so reboxetine might be your best bet.
    Last edited by mad_scientist; 09-08-2007 at 04:03.
     

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    #7
    Quote Originally Posted by mad_scientist
    Grapefruit juice you mean? Maybe but grapefruit juice inhibits CYP3A4 which is the enzyme that converts oxycodone to the inactive noroxycodone, it won't make any more of the oxy get bioactivated, just stops the good stuff from getting metabolised so fast.

    Oh and on checking it seems that one of the metabolites of bupropion, hydroxybupropion is a CYP2D6 inhibitor as well, so maybe thats not such a good alternative to SSRIs if you want an antidepressant that won't stop your oxy from working! And i guess its not exactly the kind of thing you can ask your doctor about...
    madscientist, do you think SSRI's or Wellbutrin would have any positive or negative affects while going thru opiate withdrawal based upon the facts you mention?
     

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    #8
    Not sure about that, never been much of an opiate user myself. Probably best to post a question about it in Other Drugs as i bet there will be people on there that have been through WDs while on SSRIs or Wellbutrin...
     

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    #9
    oxycodone does not need to be "bioactivated" (whatever that is supposed to mean). If you are refering to its conversion to oxymorphone the amount is so miniscule that it has absolutely no bearing on a subjective feeling of being high.

    Either your tolerance has outdone your dosage or the emotional flatness of SSRI's have lessened the enjoyment you get from opiates. Or perhaps they are working and a mild opiate high is not such a huge shift in consciousness for a person who is no longer chronically depressed and anxious.

    Inhibiting the above mentioned enzymes should actually potentiate oxycodone. Codeine is the only exception because it must first be metabolically converted to morphine before it will exert and effect and blocking those enzymes will prevent that conversion.
     

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    #10
    Bluelight Crew fastandbulbous's Avatar
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    Inhibiting the above mentioned enzymes should actually potentiate oxycodone. Codeine is the only exception because it must first be metabolically converted to morphine before it will exert and effect and blocking those enzymes will prevent that conversion.
    Inhibiting only CYP3A4 does not prevent conversion of morphine to codeine (N-demethylation), it's CYP2D6 that's responsible for the O-demethylation
     

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    #11
    Quote Originally Posted by LegalizeOpiates

    yeah suboxone is great for depression, i just gotta convince my doc that.

    Hah, good luck with that. Tell us how it goes.
     

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    #12
    Man it just sucks not being able to get that feeling anymore, bummer.


    Here's my theory as to why i can't get the same effect i used to.

    I used to be a daily user of oxy heroine morphine... whatever. i quit for about 6 months with rehab and all that AA bullshit,

    now i think my physical tollerence and mental tollerence aren't agreeing with each other.

    i still need about 80mg to get off mentally, but i don't think my body can physically process that much at one time anymore.


    Sooo maybe i need to work my dose up to get my physical tollerence back to speed?


    so what's happening is i'm doing about 40-60 mgs with no offect and i'm getting sick and either puking or it just isn't getting absorbed my stomach is just attacking it like it's a virus or something... Does that make any sense?
     

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    #13
    heh
     

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    #14
    Temporary Ban ChemicalSmiles's Avatar
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    im glad im on wellbutrin,,,,,
     

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    #15
    not to preach of course but it may be a sign that you should move on from your opiate use

    to be fair though and more constructive to your apparent desire a remedy may be to try another mode of administration such as insufflation or *gasp* plugging


    you may as such be able to achieve th head you desire without the neg sides and at a lower dose


    Quote Originally Posted by LegalizeOpiates
    Man it just sucks not being able to get that feeling anymore, bummer.


    Here's my theory as to why i can't get the same effect i used to.

    I used to be a daily user of oxy heroine morphine... whatever. i quit for about 6 months with rehab and all that AA bullshit,

    now i think my physical tollerence and mental tollerence aren't agreeing with each other.

    i still need about 80mg to get off mentally, but i don't think my body can physically process that much at one time anymore.


    Sooo maybe i need to work my dose up to get my physical tollerence back to speed?


    so what's happening is i'm doing about 40-60 mgs with no offect and i'm getting sick and either puking or it just isn't getting absorbed my stomach is just attacking it like it's a virus or something... Does that make any sense?
     

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    #16
    Bluelighter starfarer's Avatar
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    I dont want to mount a high horse either but *for those reading this post 3 years on* I would not recommend plugging or insufflating. SSRIs do attenuate opiates due to the reasons explored above, the best thing to do is to evaluate which will be more beneficial in the long run and stick with that. Both SSRIs and opiates are addictive, its a question of personal biology
     

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    #17
    Bluelighter King Hop Head's Avatar
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    Personally I find SSRIa potentiate the non codeine opiates. On Poppy tea, find if I took my dose of Paroxetine (Paxil/ Seroxat) or Citalopram (Ciprimil/ Clelexa) the sedative effects were enhanced.

    Also find SSRIs attenuate the mental aspects of withdrawal to some extent.

    Have been on SSRIs solidly from January 2001(Fluoxetine> Paroxetine> Fluoxetine> Paroxetine> Fluoxetine> Citalopram, and now considering going back on Paroxetine).

    For Opiods was using Kratom or Poppy tea recreationally from April 2006, then became dependant in January 2010.

    Regards

    Alan
     

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