Posted by bsj on December 5, 2003, at 20:28:33
I'm up for some serious discussion of opiate therapy. Please check all drug war and political mythology at the door.
I firmly believe, with personal experience on my side, that depression in some people is caused wholly or partly by dysfunction of the innate
opioid systems. This makes perfect medical sense: it would be absurd to assume that the endorphin systems are immune to malfunction, when it's known that virtually all other brain systems are; and depression would logically be the result of malfunction in such systems. This point has rarely addressed in psychiatric literature, because pyschiatry is stuck in the monamine theory of depression. They probably won't get to any widely-accepted opiod theories for another decade at least.For those whose depression is rooted in opiod dysfunction, SSRIs and other mainstream antidepressants will have little or no effect: the right systems are not being targeted for rectification. It's like treating coronary heart disease with insulin. These people will take all the medications like they're supposed to, but won't get any better; according to clinical trials of antidepressants, this happens some 30% of the time (and out in the real world, response rates are even worse). These people can choke down a pharmacy full of antidepressants and not notice a single positive difference. But, lo, give them an opiate, and they suddenly start feeling like themselves again; they begin to feel normal. Notice the words I'm _not_ using: high, whacked out, unnaturally happy; no--they
start to feel normal.Given that there are no opiod-targeting antidepressants now (nor are there likely to be for some time), I feel a justified therapy for these cases are weaker opiates like codeine and hydrocodone[1]. Those are the only drugs available that target the systems which are likely malfunctioning and causing the depression. These are the only drugs which have a chance of saving these people.
Let's address the physical dependence and tolerance issues: all opiates cause physical dependence and tolerance; there's no way around it. (But so do many antidepressants.) But these phenomena can be migitaged and lessened by drug holidays. Opiate tolerance disappears in a large part after a period of abstinance--say, a week to ten days; two weeks at the most. My own
regimine is to take hydrocodone 10mg twice daily for four weeks and abstain for the following week; I don't take it one week out of every five. I certainly notice some of the classic withdrawal symptoms (anxiety, spaciness, return of
the depression), but I keep tranquilizers on hand and sleep the withdrawal away. Then, when I go back to taking hydrocodone, I notice that its effect is comparable to what it was when I first started taking it. If one can maintain this regimine, the threats of physical dependence and tolerance are severely lessened. I've managed to do it so far with little willpower; and so
I know there are others who can do it, too.I see no reason why therapy of this kind should not be tried with refractory cases of depression where all other resources have failed. The risk is no greater than with using psychostimulants like Ritalin or Dexedrine. The reasons against it are all political in nature, founded on ill-conceived notions of drug dependence and the addiction boogeyman (I've avoided this term so far because it has no clinical meaning).
[1] It would be nice if a drug manufacturer would come out with a codeine-only or hydrocodone-only pill. APAP, aspirin, et. all are unnecessary and themselves may bring risks. But there are methods for isolating the opiates from the other
ingredients; I have a chemistry background, and do this myself, but not everyone has the equipment or knowledge. I usually ground half a bottle of pills up at once (30 pills or so) and make a solution whose concentration is 2mg hydrocodone/ml. This way, one dose equals a 5ml dropper.
poster:bsj
thread:286967
URL: http://www.dr-bob.org/babble/subs/20031014/msgs/286967.html