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  • BDD Moderators: Keif’ Richards

bup starting dose for depression (opiate newbie)

D

doctordog

Bluelighter
Joined
Feb 13, 2011
Messages
118
So I obtained some Suboxone strips (8mg), which I plan on trying for my very treatment-resistant depression/anxiety. This is by no means a long-term plan: I am simply curious to know whether this will be a worthwhile avenue to pursue and thus might feel more confident presenting the idea to a psychiatrist.

I am an opiate virgin.. studies seem to dose in the 0.3-05.mg range.. however, since it's half-life is quite long, should I dose every other day to begin with?

One other question: I tried some codeine + paracetemol for pain recently, and actually felt far more clear-headed, motivated and energized, though it didn't surprise me, since I am prone to paradoxical reactions. I've read on here that certain Opiates are more likely to stimulate than others. Are such reactions common with buprenorphine? Anxiety is my biggest problem, so just want to be prepared for any adverse reactions.

Thanks guys
 
Curious, was this prescribed off label or are you taking matters into your own hands? Are you taking any other medications? Your starting dosage appears ok, I would stay towards the low end of the range,.25 mg. please note that bupe's onset is very slow, so it will take a few hours to take full effect. There is some information that suggests that certain opiates stimulate you more than others. I think more importantly it depends on your individual physiology. I tend to get amped up when I take moderate doses of opiods. As I increase the dose I come closer to nod-land.
 
I took matters into my own hands, though it's been 10 years of treatment-resistance, so feels warranted at this point.

I'm not taking anything else .. I'm having protracted withdrawal symptoms from low-dose Mirtazapine (stopped 4 weeks ago) such as restlessness, akathisia, anxiety, which haven't responded to anything and which I was hoping the bup might actually help.

The codeine stimulation (low doses, 8mg) was helpful for depression, but not anxiety, so not something I'd be looking for ideally.
 
I can completely relate, I have issues with both anxiety and depression. I think that is why I gravitated towards opiate use many years ago. I must admit, at first it was great, but I developed a nasty addiction. Years of messing around with opiates and benzos has made the anxiety and depression significantly worse. Tread lightly.
 
I believe opiates definitely help a ton for anxiety and depression. Just be careful they're super addictive for that reason. But yeah if you're opiate naive then you should get some positivr results from Bupe. I read there was a study somewhere where they were using Oxy to treat depression with extremely positive results.
 
Self medicating with Buprenorphine is the start of a slippery slope. I suffer from depression too so can appreciate that you get desperate at times and any solution seems a good solution.

Just try and keep yourself in check buddy, look after yourself and take it easy on the opioids.
 
I appreciate the concern and lack of judgement, guys.

I also understand the rationalization process, but anxiety is probably an understatement -- if I've been able to spend an hour a day out of the house over the past 2 years, that's lucky. I can never see friends anymore. I can't work, study, function, think. My waking life is basically just endless dissociation and terror created by obsessive-compulsive disorder. This definitely hasn't been a rash decision: I can't tolerate most drugs and psychiatry has kind of given up on me.

I will keep the dose as low as possible, and am aware of the potential risks involved. If it works, as I say, I will seek out a doctor to assist me. The good thing is I should know in a week or two, rather than having to wait 8+ weeks.
 
Groundhogdayagain said:
There is some information that suggests that certain opiates stimulate you more than others. I think more importantly it depends on your individual physiology. I tend to get amped up when I take moderate doses of opiods. As I increase the dose I come closer to nod-land.
Click to expand...

Do you tend to get amped up on moderate doses of most opioids, or just certain ones? I remember a post in the archives that said certain opioids are more likely to stimulate -- the 'codones I believe -- though I'm not sure if that includes codeine. I just found codeine too stimulating and have been wondering if response to one might predict response to others. The last thing I need is another paradoxical reaction to something.
 
Quick anecdotal evidence:

I had been off years of opiate use, culminating whiskey mg methadone everyday for a year (a great way to massively increase tolerance, far more than any common usage pattern, even a $100 a day heroin habit).

So -- off of the methadone and all opiates for 1 month after a 6 month taper my tolerance was down significantly, very very significantly. BUT, most proper would expect that I would still have some serious perma-tolerance...

So, I had some buprenorphine pills I had never used during my methadone taper and detox.

I take literally 0.25 mg of powder suboxone intranasally and get really really strong effects ie scratching and up all night doing so.

So... if .25 mg did that to me, I strongly suggest you start with. 25 mg sublingual which is about half as strong as snorting.

Or, you can use half that, ie 1/8th of a milligram .125mg, and mix it with a little whiskey ie 1 ml or a little less aka a couple drops in a spoon and put that under your tongue. It's about as strong as snorting when put in an alcoholic solution.

Snorting is just bad for your mucus membranes and potentially your lungs, psychological potentially damaging if it feels less like medicine and more like drug abuse, and no more potent.

Also -- I feel bupe is definitely more stimulating than most opiates like morphine oxy hydro and heroin. Only one that seems close to me is oxymorphone although that money is a gorilla and bupe is a bonobo lol.

Also, I think bupe is great for general and social anxiety but for panic disorder I'm not sure how helpful it is. Possibly makes it worse for some people I think.

Alsox3 bupe addiction is nasty because of that Half-Life. Must heroin users take little breaks and go thru a little withdrawal that reduces tolerance and dependence. Bupe is just nonstop opiate receptor stimulation.

Finally, there is some evidence that a SINGLE dose of morphine (I imagine this may also apply to costume and heroin since they are metabolized into morphine) can stop OCD for a full week in some individuals. I believe it was a dose of something like 60 mg morphine. This is definitely achievable from poppy seed tea, or a CWE of over the counter codeine.

Finally... feelings of pain and anxiety are relative. You may simply be psyching yourself out in the sense that by using issues you may be creating a BIGGER problem than the one you are solving.

Try cognitive behavioral therapy first. And several different types of exercise routines. And fish oil. And MAGNESIUM, an absorbable form, not magnesium oxide. How great would it be too have your anxiety solved and not need drugs?

Stay safe. I got addicted to buprenorphine because it was so cheap and constantly available due to the fact that a tiny fraction of those strips was all I needed every day. Then, when heroin became super available I got addicted to that again... So, exercise extreme caution. There is evidence that recovering from opioid addiction is something that takes the brain years too physically recover from entirely...
 
Ps the stimulation from opiates IMO is very much unrelated too the anxiety causing stimulation of caffeine speed Coke etc
 
It's something to consider, especially if this has really been treatment-resistant for 10 years. A few years ago when I was anxious to the point of not being able (or desiring), to leave the house much my psychiatrist agreed to prescribe me methadone off-label for anxiety, since with just 1 10mg pill I was good for the whole day anxiety-wise. Not that I recommend methadone, this was before Suboxone became more widely available, but for a short-term trial long half-life opioids can be an option. Again, this is best as just occasional treatment as well, you're not going to benefit by taking it every day and becoming dependent-it'll only be effective if you can take a non-intoxicating dose that helps you interact with others.
 
Felonious Monk said:
It's something to consider, especially if this has really been treatment-resistant for 10 years. A few years ago when I was anxious to the point of not being able (or desiring), to leave the house much my psychiatrist agreed to prescribe me methadone off-label for anxiety, since with just 1 10mg pill I was good for the whole day anxiety-wise. Not that I recommend methadone, this was before Suboxone became more widely available, but for a short-term trial long half-life opioids can be an option. Again, this is best as just occasional treatment as well, you're not going to benefit by taking it every day and becoming dependent-it'll only be effective if you can take a non-intoxicating dose that helps you interact with others.
Click to expand...

I agree with the principles in this. I've switched from using Benzodiazepines/SSRI's for anxiety and now use opioids, generally a good dose of Dihydrocodeine is far, far more effective than something like Xanax for my anxiety.

Have you looked into Agomelatine/Valdoxan for treatment-resistant depression? I just couldn't tolerate SSRI's/SNRI's any longer so switched over in July and I experienced huge improvements in mood within just 2 weeks. Admittedly it's not helped so much for my anxiety but for my depression it's really been a blessing. Zero side effects too. Just maybe something for you to think about if you've not already.
 
I tend to get amped up on moderate doses of all opiates (including bupe), perhaps some more so than others. I think you are correct doctordog, the ones derived from thebaine (oxycodone, hydrocodone) tend to be a bit more stimulating.

DyinISuss brings up a really good point. The extremely long half life of bupe will possibly cause an accumulation in your system. For example, if you take .25mg daily (every 24 hours) and the half life is at least 36 hours, well I think you see the point.

I wish you all the best, I know how debilitating depression can be. Please be true to thy self. As others have mentioned, the cure can be worse than the bite.
 
Yes, I suppose this enters into a grey area, since I am trialing a substance that may have some euphorigenic effects. However, it's not like I'm proposing something completely unconventional e.g. asking for tips on IV'ing low-dose heroin to ward off anxiety. Buprenorphine has been examined -- albeit in small trials -- in treatment-resistant depression and anxiety, and there is even a trial on OCD conducted last year. And again, this will be short-term -- 2-3 weeks max -- at a low dose <1mg.

There are reports on dr-bob from people who remained on a low dose for depression without developing tolerance; missing a dose seemed to produce mild withdrawal symptoms. I am quite content with the risk. I am not exaggerating when I say that anxiety has rendered me completely disabled for the past 4 years and robbed me of everything.

@DyinISuss, yes, I've tried a plethora of natural supplements and was in cognitive behavioural therapy on and off for 4 years, until I could no longer afford it. I also did psychodynamic therapy for 2 years. Therapy will not make a dent when your anxiety is crippling.

@Rybee, I have some Agomelatine sample packs, but just can't see it helping severe anxiety and evidence seems weak in that regard.

@Groundhogday, yes, I am aware of the half-life, which is why I asked if perhaps it might be a good idea to dose every second day to begin with.

Thank you for your help, everybody.

Final question -- probably stupid, but want to be cautious ..

I know from research that Suboxone should only be started *during* opiate withdrawal, and complications can arise if it's taken too early.

Does the same apply to any other substances? e.g. I never use benzos, but took 45mg of Oxazepam to sleep tonight so I can feel refreshed tomorrow (averaging 2-3 hours otherwise) .. there will no doubt be a rebound (I get it with short-acting benzos). Is it okay to take my first Suboxone dose when I wake up regardless?
 
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Suboxone should only be taken during withdrawals because it contains and opiate blocker that would basically rip the opiates from the receptors causing immediate and intense withdrawals. Benzos won't affect that but, I would be very careful because over time opiates will make your anxiety and depression far worse. For awhile opiates worked amazing for my depression and anxiety but eventually brought it to a new unbearable level of intensity that would only cease from detoxing from opiates. the initial anxiety will still be there but will be far more easy to handle than in the throws of addiction. it's a very slippery slope hard to escape,after 5 years of addiction and numerous detoxes and rehab I have yet to be able to resist the tantalizing call of opiates for long then a few months knowing very well what will happen when I start up again
 
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Taking when you wake up may make you a little drowsier than if you wait an hour. Both because you might still have a little of the benzo in your system, but also because if you start sedating yourself before you're fully awake it dampens the whole day (for me at least).

Because of the long half-life and risk of dependency, you might consider only taking it every other day, or only on days you really need it.
 
Being strung out on suboxone is not fun. I suggest exhausting all other resources before going to buprenorphine. You will end up fucking yourself and up making yourself more depressed than when you started.
 
I took 0.25mg sublingually yesterday. I felt somewhat sedated but calmer for about 6 hours. No noticeably effects on mood otherwise. Then I started to become nauseous, which grew overwhelming .. I felt closer to a state of withdrawal -- shaky, feverish etc.

Two complicating factors: a) the strips expired 2 months ago, though I read that shouldn't be an issue? b) I had been using small amounts of codeine (6-12mg) for about 3 days, and last took it 3 days prior.. any chance it could've still been in my system?
 
I don't think the expiration matters, especially since it was relatively recent. Also, I don't think it's precipitated wd, you barely took any codeine. Did you take in the am on an empty stomach. Sometimes opiates in the am, plus no food, plus opiate naivety equals nausea.
 
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