Are opiates really a long term solution to psychiatric maladies?

[AlphaOdure]

I like your post Alpha, but probably not for reasons you'll enjoy - no offence is intended here....

why would anything you've said offend me? I think you just misinterpreted what I've said..

To begin with, Nixon's "war" against drugs had absolutely no positive effects - for all/any affected!

umm, that was my point

And agreed regard recognition of any form of mental disorders. This wasn't limited to the US, well I know for a fact Aust went through the same thing, there would have been others. And it's really is quite that even today in parts of the word "mental illness doesn't exist"

Didn't say otherwise.

you (I guess rightly-so) used certain terms such as "mood enhances", "anti-epileptics" and have seen these descriptor words use often elsewhere also...it can be seen that by using non-specific word to explain/describe a drug may lead to deleterious results

I used these terms b/c it was specifically asked "Does anyone know what specifically they were used for, when they were phased out, and what the exact stated reason was?"

I'm give example; there exist a number of noted, world excepted indications for oxycodone - with the obviously most prominent one being as an analgesic (for which most - general public - know) which of course aren't the only indications. However by marketing/pushing one use which essentially creates a stigma/judgements/opinions (which are basically not ones own due to all influences) where in the best scenario the GP informs the pt and they become educated and lose any issue they may have about having to use it for another purpose. And at the other end, the opinion of "oxycodone == analgesia" and they wont sway anyway may lead to possibly (said previous) pt not being offered/obtaining a modality which may in fact work!

Don't blame GP's... blame the FDA (and most every other western world's equivalent), which has approved oxycodone or other opiates/opioids for PAIN only.. the only exception being buprenorphine, which is approved for addiction.. obviously.

 

[AlphaOdure]

Tyrael, By the sheer volume, frequency, and tediousness of your recent posts, something tells me you're under the influence of some sort of stimulant; or perhaps some sort of entactogenic phenethylamine ...buut that's just a guess

 

[AlphaOdure]

Opioids are not worse than they crap they give psychiatric patients, on the contrary. SSRI withdrawal is FAR WORSE than opiate withdrawal. Also, you can COMPLETELY PREVENT opioid tolerance with several methods (co-administration with proglumide, low-dose naltrexone or memantine).

Don't be fooled, this is just another result of the war on drugs. Opioid tolerance exists because it dose-escalation is economically interesting to the big pharmas, because it can be completely prevented and even reversed.

That is the most IDIOTIC statement i've read in a while, for the reasons tyrael espoused above.

 

[tyrael]

Hey AlphaOdure, tbh I didnt think I had said anything offensive either, but some people can be a little precious! lol
.

Re "Nixon", yes I was agreeing, just adding to the topic!

Re people's attitudes (now verses before) toward mental health, again just putting my experiences/point of view across

Re the "terms" comment - it was more directed to this as why I didn't want to come across negatively! I just saw the post and thought it was an excellent example of what I was trying to say. Of course I used said terms, I wasn't implying anything negative more the fact that assumptions are made by people out there based on no more information then what has been told to them.

.....
Don't blame GP's... blame the FDA (and most every other western world's equivalent), which has approved oxycodone or other opiates/opioids for PAIN only.. the only exception being buprenorphine, which is approved for addiction.. obviously.

Definitely mate! basically my tl;dr and the point I was trying to make to others posting here was just because a drug, say oxy, is "only" an analgesic (in the eyes of the public and certain people) should most definitely not be the reason not to explore other indications (as said by posters previous).

I guess it could come across as me singling you out since I quoted a lot of your posts, but tbh it was because I agreed with it! :D

And finally fellow member AlphaOdure, don't assume to know me hehe Although tbh I am always tediousness (and by that I assume you mean detailed, well-written, knowledgeable and clearly eloquent? ) Sarcasm aside if I make the decision to post I do honestly attempt to write it, explain the OP's problem, not say or mention something without feeling I have a at least basic understanding (where unfortunately not all BLers make the same courtesy)

 

[tyrael]

That is the most IDIOTIC statement i've read in a while, for the reasons tyrael espoused above.

*sigh* Although I like your comment Alpha, I gave him (maybe too much? lol!) benefit of the doubt and "attempted" to answer (after trying to decipher).

 

[THC2LSD]

Propoxyphene is rough on the cardiovascular system & heart in general, but not b/c of its opioidergic action... b/c of its effects as a local anesthetic & a sodium channel blocker, it affects QRS intervals (and subsequent QT intervals). And this particular action isn't shared by methadone or levacetylmethadol to my knowledge, & i've read a lot on both of these drugs over the years... But feel free to correct me w/ sources if they're sodium channel blockers. And relative to other full agonists, methadone & levacetylmethadol, aren't shown to have that much of a difference on the cardiovascular system.

Your right that the bad heart related side effects mostly don't come from mu agonism. Methadone( http://www.ncbi.nlm.nih.gov/pubmed/12820821) , LAAM and propoxyphene, all have some local anesthetic effects, but the QT prolongation is from their action on the potassium channel, particularly hERG. Propoxyphene also works on the potassium channels, http://www.ncbi.nlm.nih.gov/pubmed/10690289 . Methadone's not too bad at under 200mg for most people, but LAAM can caused heart problems at therapeutic doses.

LAAM was withdrawn from the market for heart problems. Kind of sad because 2-3x a week dosing would be convent for some and maybe easier to taper off, good because it probably might have less euphoria than methadone and slowly metabolizes into something stronger and would probably causes ODs.

Even with the usually small risk of heart problems, methadone is the lesser evil compared to abusing street drugs. You're far more likely to die from an OD.

Levomethadone is more potent and has less of an effect on the heart. I think they should use L-methadone for at risk patient. Fuck I think for those requiring high doses they should seriously consider diamorphine or hydromorphone maintenance therapy. None of this is likely to happen soon in the USA.

My theory is a social mania as a result of those strings of deaths supposedly related to methadone use here in the US

My theory for the ODs is a combination of noobs underestimating it strength(many mistakenly think that because it's for detox it's weak), taking more before it fully kicks in, and users mixing with other it downers and uppers.

And yes, tolerance has a lot to do with this effect (well, w/ QT interval prolongation that is) in opioids in general. Its related to respiratory depression, at least to some extent.

QT interval prolongation has almost nothing to do with respiratory depression or tolerance. I assume that if someone's taking 200mg+ of methadone they have a tolerance.

And to get back on top, it'd make sense that an NMDA antagonistic or monoamine reuptake inhibiting opioid might have anti-depressant effects, since drugs of those classes have been shown to have antidepressant effects.

Buprenorphine and cyclazocine have been shown in some studies to have an antidepressant effect. Have they been compared to full mu agonists? I guess it could be argued that full mu agonist are a really fast acting antidepressant:D. Considering some of the drugs and procedures they use for depression, perhaps if someone's suffering from severe unrelenting depression opioids might be an option.

 

[negrogesic]

Don't blame GP's... blame the FDA (and most every other western world's equivalent), which has approved oxycodone or other opiates/opioids for PAIN only.. the only exception being buprenorphine, which is approved for addiction.. obviously.

^^^This is indeed a reality.....

Ultimately, the issue in this thread does not pertain to whether an opioid with some degree of MOR affinity ('narcotic') can be used in the treatment of depression, because they can be used for this purpose. Further, there are cases in which they may even prove more efficacious than existing drugs officially indicated for depression (ie, trazodone), and even other cases in which their use may be appropriate.

Nonetheless, currently available opioids (again, those with MOR affinities relevant to this discussion) are generally not appropriate in the treatment of depression.

If psychiatry was my practice, I would feel relatively comfortable prescribing drugs similar to lefetamine for unique cases. But.....I don't practice psychiatry, and drugs similar to lefetamine are currently unavailable or 'out-of-bounds' due to control status.

 

[MeDieViL]

If addiction issues can be prevented yes, for the tolerance issues a protocol with a nmda antagonist could be the solution.