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Could codeine be used as an antidepressant?

AnrBjotk

AnrBjotk

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Not in our real life, but in some alternate Burroughsian world...

I find it odd that suicidal patients are simply given a good dose morphine.
Yes, there is addiction to worry about, but hell, one gets addicted to SSRIs aswell, and with proper medical attention, the WDs could be handled easily.

Is there a fear of it leading to street drugs? Yes, but so does it when used to treat pain in hospitals. If you fracture...oh, let's say your back, real nasty like, you're given morphine, so why not with a fractured heart, or a damaged soul?

This might lead to: While not just give the depressent f*cker a joint aswell, but my point is simply: When I've been real low, I can never understand, why don't my doc just slip me a couple of codeine-pills? I mean, suicidal tendencies are, in most patients, fleeting, a 4 hour buzz could get the dullard through the time...

"The old nurse walks up to us and hands us half a grain of morphine, we call her mama, wouldn't you?" (Burroughs paraphrase)
 
The real issue with using opiates as antidepressants is that it's unsustainable in the long term, hence why it's really only used for pallative care. Once opiate dosages get past a certain point you get diminishig returns and it gets ever harder to titrate off to sobriety or an alternate medication.
 
sekio said:
The real issue with using opiates as antidepressants is that it's unsustainable in the long term, hence why it's really only used for pallative care. Once opiate dosages get past a certain point you get diminishig returns and it gets ever harder to titrate off to sobriety or an alternate medication.
Click to expand...

Yes, but for severely disturbed 'peoples', people on suicide watch; pop a subutex in under their tongue and bobs you uncle!
 
Giving suicidal people a potent, dangerous drug is somewhat hazardous. I read about a GP in the 70s who prescribed one of his patients Diconal for long-term refractory unipolar disorder. About 6 months in, the patient took a months supply & promptly died. The GP was struck off & imprisoned.

Nobody is going to be responsible for such a risky form of treatment, it's against the Hippocratic oath (first, do no harm).
 
fencamfamine said:
Giving suicidal people a potent, dangerous drug is somewhat hazardous. I read about a GP in the 70s who prescribed one of his patients Diconal for long-term refractory unipolar disorder. About 6 months in, the patient took a months supply & promptly died. The GP was struck off & imprisoned.

Nobody is going to be responsible for such a risky form of treatment, it's against the Hippocratic oath (first, do no harm).
Click to expand...

Well, the tricyclics are known for their toxicity as well, I'm pretty sure a months supply could be fatal with many of them as well.

Anyway, the topic itself - opioids are in my opinion the greatest anti-depressants and anxiolytics available. Its why I became an opioid user in the first place. Hydrocodone vastly improved my problems dealing with OCD, anxiety and depression. But as we all know they come with addiction, dependence, etc...

I think Buprenorphine deserves a place in psychiatric treatment though. I've used it not just for maintenance, but also as my primary anti-depressant/anxiolytic/anti-OCD med for 8+ years now. I firmly believe it should be an option for severely depressed patients who get no relief from traditional monoaminergic meds, even if they are not opioid-dependent.

As for what the OP is talking about - immediate relief in the case of suicidal patients, its something I've pondered as well, but the potential for "I want/need to feel that again" is probably much higher for depressed patients than it is for physical pain patients. That's just an assumption though.
 
Im not sure what country you are from, but in the US, morphine is very, very far from a first-line treatment for major depression with suicidal idealization. Morphine can actually one feel rather sad......I remember that last time I used heroin, I got emotional and bitchy.........

I'm still not 100% on the bupe for depression idea, but I welcome the idea for usage in treatment resistant major depression.

People get "depressed" generally in a situation/environmental context, and often.....should not be drugged. There are always exceptions. But people experiencing congenital major depression or major depression caused by a neurophysiological defect are very, very different patients than the housewife on Zoloft.

If you are "sad" about something...try to seriously deal with it or ride it before taking some of these rather nasty compounds, many of which have a "doomed" future (5-10 year rule it's sometimes called).......

Exceptions also occur, Phenelzine is a good drug and has been around for a while...........but again, this is not first line treatment for minor "melancholia".......
 
AnrBjotk, such therapy would be a road to nowhere. I once got severly depressed; I used various opiates for months, got withdrawn and relapsed many times. Though now I'm clean, I feel like every thing in the world lost sense, like I'm still dependent to the drug, even not being an addict anymore. As this was my way to cure myself, I wouldn't wish such a treatment to anyone, really.
 
Hangman said:
AnrBjotk, such therapy would be a road to nowhere. I once got severly depressed; I used various opiates for months, got withdrawn and relapsed many times. Though now I'm clean, I feel like every thing in the world lost sense, like I'm still dependent to the drug, even not being an addict anymore. As this was my way to cure myself, I wouldn't wish such a treatment to anyone, really.
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Later on I shall find the documents I have lying around about the experiments with opiates for depression conducted in the fifties. They DID in fact work wonders, especially for people(s) like meself, that do not respond well to common antidepressants.
Of course, I've abused opiates meself, and it made things much worse. What I'm trying to get at, is that within controlled environments, with the right kind of opiates, they do work out. My main interest is with using them as a last-resort to people on suicide watch. But I also believe it could be carried furher. Not high doses, but small, small, doses, enough to lift you up a little, help you focus and give you mental energy, should be fine...
As you are aware, LSD was used to treat neurosis and depression for some time in the sixites (in of course, small pre-hallucination doses)

I hope we can get past the moralistic ideas of, the only drugs we can give people are drugs that don't work too well...
There is a reason, and I keep coming back to this, why so many people are willing to give away everything for a taste of these drugs (acid, opiates, amphetamines), they WORK!
"Drug-fiends" dont live their lives in such a way cause they enjoy running from the police or being poor, they do it because it makes life bareable. (Of course, eventually, it becomes little more than avoiding withdrawal, but UP to that point, the use was a way of getting into a state of mind, where everything was just right, however they are... A zen-like, contemplative state)

I have a similar discussion that has being going in for some months now on drugs-forum, where another wonderful poster, has contributed with some precautionary rules that might be used; For instance the patients being tested for three months, every week, to make sure the patient is NOT an addict and just trying to score, urine tests being made during the treatment, to ensure that the patient have no traces of other opiates in them, and also testing to make sure the patient is only taking the allotted dose...

I will be back sharpish with these documents, as I believe you'll find them interesting. It is important not to get confuses; Just because a drug is illegal, doesnt mean it is useless, in fact, most narcotics are illegal simply because they work too well. It is simply arbitrary, in a sense, why some are illegal, while others, like sugar or nicotine, are legal... Keep that in mind.

Now... where did I lay those documents....
 
One of the main reasons SSRI drugs were developed was because they have high intrinsic safety in case of overdose. Tricyclics are not used as front-line treatment any more.

OLR1 modulators may be a worthwhile path to follow but not MOR agonists.
 
the only opioid i ever found usefull for depression was a once daily in the morning dose of tramadol (150mg) that i took every day for a year. it worked very well

but there is a difference between a morning dose of tramadol and taking it continuously. i wasn't experiencing a tolerance build up that was noteworthy.

codeine and morphine can make you feel a bit down and moody, plus tolerance skyrockets rapidly
 
ive been taking 120 - 240 mg of codeine daily for two months for a wrist injury.

I wouldnt recomend it. Its totally killed my sex drive and has made me depressed.
Although the depression could have been bought on by being in horrible pain all the
the time. Dunno
 
fencamfamine said:
Nobody is going to be responsible for such a risky form of treatment, it's against the Hippocratic oath (first, do no harm).
Click to expand...

I'm not sure I agree with this. How exactly did that doctor in the example break the hippocratic oath? Unless he told the person taking a month supply at once was safe, which I'm sure s/he didn't, then it's not their fault. The guy could've easily taken a months supply of Prozac (or whatever) and killed himself. Seems like a logical fallacy to me.

I think doctors are much more hesitant to prescribe an opiates/-oids for depression to cover their ass and avoid medical malpractice lawsuits, than they are of breaking the hippocratic oath. In fact, I think one could make a convincing argument that a doctor who is willing to try atypical treatments for atypical depression is MORE interested in the patients well-being than the doctor who just prescribes the same shit to everyone regardless of what the results are.

Maybe I'm jaded by my experience with doc's being afraid go give me something I needed because they're afraid it could come back to bite them on the arse. I understand why they do, however- that doesn't make it any easier when you're depressed and all they wanna give you is a limp-dick ssri pills (or whatever) when you've tried them ad nauseum with no positive results. It's this mindset that keeps my doctor from actually helping me and leads me to find relief elsewhere.

/rant :)
 
^Well, the doctor in question was struck off & imprisoned for it, so it was taken quite seriously. While older versions of the hippocratic oath actually state

'I will not give a lethal drug if I am asked'

the newer one states

'I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.'

When studies discovered that opioids didn't treat depression very well & there were clearly other, safer drugs (or indeed other forms of treatment) available... this appears to me to be overtreatment. The GMC certainly thought so. The GP defended himself by saying it WAS required, but a psychiatric order is what would have been expected of him.

I will dig out the article so you can read it.
 
^Good points well made.

I think the serotonin hypothesis is pretty outdated & suspect even the triple-reuptake inhibitors will not be an answer. Depression covers so many different things & it appears that drugs in general are less effective that CBT or other therapy. I only mention CBT because of it's current vogue. It's a 'one size fits all' approach so whoever is paying for the treatment likes it but the patient often does not.

Animal models are very limited in this field as far as I can see but it's pretty difficult to test new models on anything else. I guess that one day there may be depressed computers & we can model on them ;)
 
The effect of Codeine only lasts for around 5 hours, and even then the euphoria is only 1-2 hours long. Far too temporary for an anti-depressant, if anyone does come to use codeine as one they'll get addicted. And there are better safer anti-depressants out there. Using codeine would be no different from using alcohol as an anti-depressant.
 
^^^
Hobhead-
sounds like what a doctor would say. Just 'no'. No reason. Just no. 'It sounds to me like it shouldn't work, therefore it wouldn't work and we shouldn't try it period.'

I don't agree with the logic that because it's a depressant we couldn't use it for depression. Depressant doesn't mean it makes you sad or something. Depressant often produce euphoria as a side effect. If we called 'em 'euphorants' would you think it's okay to try them for depression?
 
^Your point being? ;) :)

Depression is a long-term illness & it's important that a drug doesn't produce tolerance (and certainly not dependence). I realize that there is a heated argument over the long-term effects of some SSRIs but it really cannot be compared with the effects of opioid withdrawal syndrome.

As you said, opioids are no better than alcohol. It just pushes back the symptoms by a few hours.
 
Actually, I'd like to make.a special mention specifically for tramadol, which I have found to be a pretty effective antidepressant, if taken at regular and reasonable doses (not as needed for stress - this will only build tolerance quickly and negate the long term effectiveness, at least in my anecdotal experiences with the drug).

As aformentioned, someone took tramadol at 150mg a day for a year without significant tolerance issues. This works if you are not looking for complete narcotizing doses to remain effective that long. For antidepressant effects, this does work effectively for much longer than you would expect from an opiate. The downsides include loss of the mild stimulation from norepinephrine effects after three or four months (replaced by typical opiate anhedonia - fix with caffeine and exercise), and of course the withdrawls can be tough if you don't taper.

Of course, if you need to stay on an addictive substance for a year to be happy, maybe the time would be better spent finding more permanent solutions for one's moods. I would only use tramadol for short term management of depression, maybe three months or so.
 
All I feel about this is when I was using alot of Poppyseedtea, Id be able to drink it, and have the energy to do projects. Otherwise Id just not have energy or especially not want to do anything becuase of pain sensitivity issues.
 
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