using opiates to beat anxiety and depression

[mrflowers00]

the real reason doctors don't prescribe opioid/opiates for anxiety and depression is because in the long run it'll make it worse

 

[tokenname]

i say this again...ime...now, I c & p :

Believes anti depressant makers/producers/distributers must be amazing magicians/illusionists....
How else could you get so rich w/o a useful product or skill?


~token

 

[likeakite]

A Doctor could prescribe Suboxone for depression and Tramadol too. But...there addictive

 

[RobotRipping]

I completely agree Alex000, great post.

i have anxiety and panic attacks, sometimes depression and other anxiety related issues like DP and DR.

I've tried all sorts of things but opiates + therapy are what ended up helping the most. As long as i can keep my opiate dependence sustainable then i don't see myself running into any issues. Even if i have to quit opiates, i've made enough positive changes in my life while on them that things will be different this time around. Can't say the same for benzos as they ended up causing most of the problems in the first place. SSRI's didn't work for me either, except for giving me more anxiety and suicidal ideation.

 

[mrflowers00]

the therapeutic dose will rise and rise and rise leading to doctors saying enough is enough then is when you will feel way worse than before you started don't get me wrong i love opiate/opioid drugs and the do help with depression and anxiety as well as my pain but after almost 10 years on them the largest dose any doctor has felt comfortable prescribing me only last me a week at most... thank god for subutex

 

[alkap555]

Alex000:

Why should physical pain be treated with opiates, but not mental pain? Is one more serious than the other? Should be just throw chronic pain patients on Cymbalta, or maybe Lyrica, and say that's all even if it does not help? No. In psychiatry, opiates could be used carefully at certain rx'd doses (like anyother drug) to treat mental illness, if it were warranted. Self-medicating can be counterproductive, but proper opiate therapy overseen by a medical professional could be quite efficacious in bringing relief to mental illness

There are several issues with the use of opioids in the treatment of psychiatric disorders. A major difference between treating chronic pain and anxiety, for example, is that pain patients typically use just enough to control their pain. Generally speaking, the dose at which analgesia is attained is below that of inducing euphoria, especially once some degree of tolerance has set in. As a former pain pt myself, I recall that 20mg of oxycodone would effectively treat my pain, but to get a buzz, I would require somewhere closer to 40mg.

And a large portion (if not the majority) of substance abusers and addicts initially began taking their drug of choice to self-medicate their anxiety/depression. Thus it seems far more likely that sufferer's of anxiety/depression will drift into the realm of dose escalation, abuse and dependence than those treating physical pain. In fact, the statistical data support this, with a recent meta-analysis reporting that only 3.27% of chronic pain patients develop addictions and patterns of abuse (addiction does not equal physical dependence). Source: http://www.ncbi.nlm.nih.gov/pubmed/18489635

IMO the single largest obstacle is something you mention:

"In psychiatry, opiates could be used carefully at certain rx'd doses"

In theory this sounds great, but how would a psychiatrist ensure that their patients are not increasing dose (and subsequently their tolerance) and drifting away from a carefully planned treatment protocol and into "getting high" territory? The only way I could see this working would be to follow a methadone treatment regimen, where doses are handed out on a day-to-day basis.

Bottom line, opioids are just too damn fun and rewarding for many people (especially those with psychiatric illness) to control their use, (MUCH) more so than with benzos. In the short-term, sure they seem like wonder-drugs, but the chance of abuse and addiction is just too damn high to justify their use.

I am hopeful that more subtle (and less addicting) treatment modalities for the pharmacologic modulation of endogenous opioidergic transmission will be developed. One novel method may very well involve inhibiting enkephalinase/endorphinase, the enzymes responsible for endogenous opioid-peptide degradation. Check out some literature on enkephalinase inhibitors--I think they might have real promise for the treatment of physical and psychological pain:

http://www.ncbi.nlm.nih.gov/pubmed/17227231

 

[Chococat]

Dope sick from cymbalta

I took cymbalta for about four months, I switched from celexa. I never felt any improvement so my doctor and I decided to take me off of it. I weened myself off just as I was told, 30mg a day to 20 mg a day for a month and then 10mg a day for a month. It has been almost a week since I have taken cymbalta. I have had severe dizziness, so much so that I can not drive or even walk sometimes. Turning my head is a task that I cannot seem to do slowly enough. The dizziness has also caused me to throw up violently and immediately after eating and of course, loose my appetite.

I have never been actually dope sick and I know it is much worse than this. What I can say is that getting off this anti-depressant has been extremely depressing to the point of suicidal thoughts and a over all feeling of hopelessness. Mind you I am still on 75mg of Lamictal and 20mg of Latuda (a new drug for bipolar depression) a day.

I have also found that the only time I can function and think properly is under the use of opiates. This has been true before I ever tried Cymbalta. I have never felt physical withdrawal from opiates. When I do them, I snort 30mg at once. Considering I have been on and off of them for 3 years, I think that is low.

The profit margin in opiates is nearly nothing when compared to modern SSRIs. They have already demonized opiates to an extent that it cant really be undone. Any accidents that occur while it is in the patient's system will make good news stories. The withdrawal effects of modern ssris are hidden from the public, and polls of physicians show that they may not be any better informed than the average person. Look at the below sales figures for SSRIs, which can't even be proven effective for anyone except those with most severe from of depression, and even then the data isn't real encouraging.

http://discovermagazine.com/2008/oct/10-are-antidepressant-drugs-actually-worth-taking More prescriptions are dispensed for antidepressants—232.7 million nationwide in 2007—than for drugs of any other type, according to the data firm, IMS Health. U.S. sales of antidepressants totaled $11.9 billion in 2007, IMS Health reports.

I love the hypocrisy in America, where we say meth is the biggest danger to our kids, yet we can't get enough amphetamines to keep them legally doped up in class.

http://www.nationalmethcenter.org/STATISTICS_Threatmap.html "States where meth is the biggest problem according to law enforcement"

http://www.reuters.com/article/2012/01/01/us-adhd-adderall-shortage-idUSTRE80009E20120101 18 million prescriptions for adderall each year, DEA not dealing enough dope to big pharma to fill them all.

http://www.udel.edu/chemo/teaching/CHEM465/SitesF02/Prop26b/ritalin consumption.html "US produces and consumes more than 80% of the worlds methylphenidate"

 

[Princess_Poppy]

all these posts are so lengthy! guess people are passionate about this anywho...

ill keep it short and sweet. i agree with folks saying the fallout from opiates make it a mute point. i suffer from psychiatric issues and some of my worst times have been in a period of wd. and you are bound to become ADDICTED. leveling up as ppl mentioned. there will be a day when u end up in wd and it could be enuf to throw someone of the deep end...

 

[Felonious Monk]

There's a lot of good back and forth in this thread, which makes even more clear than this has to be up the psychiatrist carefully evaluating each patient.

I was once prescribed Methadone for anxiety. I'd be working with a psychiatrist for a while and had been the through the gambit of benzos, at high doses, and they really just weren't doing anything for me, besides getting me more dependent on nothing.

I was honest with my counselor--I told her I occasionally used opiates to help with my anxiety, since I felt they really melted it away, as opposed to just masking it. I was honest with her and told her I only took them ~3 times a week. I was also honest with what substances I'd taken (a range), but made clear in telling her that Methadone was most effective for my anxiety while at the same time explaining how I felt it was the least addictive used in this manner. I'd also taken out the time to research the very minimal literature on the subjective of opiate treatment for severe chronic GAD/SAD/social anxiety/panic attacks.
She ended up giving me a script of 30x10mg, which we agreed I'd try to take 2-3 times a week, with a max of 4. I had an appt for 3 weeks ahead and agreed to bring my bottle back so we could check my progress.

 

[Feelin-u4ia]

So here's the bare bones of it, opiates would be the BEST medication ever for anxiety and depression. But two factors, 1 tolerance would end up getting so high to keep the anxiety away 2 straight up hardcore physical/mental addiction would happen.

 

[Psychedelic Jay]

This is a brick wall waiting to be ran into.

It is a short term try to solving a long term problem.

 

[mossyman]

I think we are buying into BigPharma, the FDA, and medicine as it is today a bit too much, and ignoring some undeniable benefits opiates could provide to help treat mental illness. Some of you are saying that relying on drugs for "happiness" is just not effective, yet you advocate SSRI's and benzos, both of which are psychotropic, and both of which can cause serious dependence? There are several flaws with this point of view, and I refuse to defend how medicine is being practiced today as how it should be practiced always. I won't defend indications of this drug or that, and say they cannot be used for something other than what they were FDA approved. All of this is so narrow-minded and restrictive. Black and white thinking just does not apply with how medicine should be practiced.

But, back to opiates themselves for the treatment of mental illness. There are questions that could be posed such as should they be used for opiate-addiction in maintenance therapy (psychiatric) or should they be used to treat pain conditions without organic cause such as fibromyalgia? Where does one draw the line? But, even that is really unimportant in why opiates should be used for mental illness such as depression or anxiety, for example. Opiates are, really, wonder-drugs for so many symptoms. Alone, natural/semi-synthetic opiates are not toxic to the body, and are frequently used for CHRONIC pain management. Why should physical pain be treated with opiates, but not mental pain? Is one more serious than the other? Should be just throw chronic pain patients on Cymbalta, or maybe Lyrica, and say that's all even if it does not help? No. In psychiatry, opiates could be used carefully at certain rx'd doses (like anyother drug) to treat mental illness, if it were warranted. Self-medicating can be counterproductive, but proper opiate therapy overseen by a medical professional could be quite efficacious in bringing relief to mental illness. Opiates are wonderful analgesics, and do relieve pain of any kind, not discriminating. They simply make one more comfortable. They are also euphoriants, but why is this bad in every case? They help to stimulate, allowing for longer periods of activity with increased frequency w/o discomfort, as well as relaxing and sedating, allowing for good and comfortable sleep. Take a severly depressed individual, who has not responded to a variety of anti-depressants, and even responded poorly to ECT. What do we do? Allow the individual to suffer in his pain or relieve it?

There needs to be understood the difference between dependence and addiction. Many chronic pain patients use their opiates as prescribed w/o any addiction, but with significant relief. There is no reason the same would not hold true. Chronic dosing will lead to dependence, of course, but so will most any anti-depressant and benzos, of course.

This. People with severe depression and anxiety should not just be left to suffer when they have tried all available treatments. You wouldn't do it to someone in physical pain, you wouldn't even do it to a dog! Its grossly unfair when there are treatments available. There is a risk of addiction but that needs to be managed. Most people would take them as prescribed just like chronic pain patients.

 

[mossyman]

the real reason doctors don't prescribe opioid/opiates for anxiety and depression is because in the long run it'll make it worse

In the long run we are all dead! For the patient who is chronically depressed and anxious and only wants to die, then even a few years of wellness on low dose opiates is a gift from God.