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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Iansf on April 13, 2005, at 16:57:45
Morphine May Be Helpful in Refractory OCD
Reuters Health Information 2005. © 2005 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.NEW YORK (Reuters Health) Apr 04 - Some patients who have failed multiple drug trials for treatment of obsessive-compulsive disorder (OCD) may respond to a weekly dose of oral morphine, results of a small pilot study suggest.
Although serotonin reuptake inhibitors (SRIs) are approved for treatment of OCD, up to 40% of patients fail to respond to two or more trials of such drugs, Dr. Lorrin M. Koran and his associates explain in their paper, published in the March Journal of Clinical Psychiatry.
Other small trials have suggested a role for mu-opioid receptor agonists in patients with treatment-resistant OCD, since there is a high concentration of opioid receptors in the striatal system, an area thought to be important in the pathophysiology of OCD.
For their trial Dr. Koran's group enrolled 23 subjects with OCD who had failed two to six trials of SRIs; 11 of the subjects had also not responded to atypical antipsychotic drugs. Patients were assigned, in random order, to once-weekly oral morphine sulfate (first dose 30 mg, second dose 15 to 45 mg, depending on response), lorazepam (1 mg, then 0.5 to 2 mg), or placebo, for two weeks each.
Median scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) declined from 29 to 25 during the morphine trials, and to 27 in the lorazepam trials.
Seven of 23 subjects were deemed responders to morphine based on Y-BOCS score decreases of 25% or more. There were four subjects who responded to lorazepam.
Among those responding to morphine, the most noticeable effect began the day after taking the drug and lasted for 2 to 5 days. Subjects reported decreased frequency and persistence of obsessions and anxiety, as well as an increased ability to resist their compulsions.
The authors detected no euphoric effects or disinhibition after taking the drugs, although one subject later admitted to having abused hydrocodone for several years, which he said reduced his OCD symptoms.
"The response seen, its rapidity, and the relative tolerability of the treatment are encouraging and warrant larger and longer term studies" of morphine or other mu-receptor agonists for managing treatment-refractory OCD, the authors conclude.
J Clin Psychiatry 2005;66:353-359.
Posted by Phillipa on April 13, 2005, at 17:54:51
In reply to Morphine for OCD, posted by Iansf on April 13, 2005, at 16:57:45
So, are they going to give Morphine for OCD? Fondly, Phillipa
Posted by Iansf on April 13, 2005, at 19:25:43
In reply to Re: Morphine for OCD » Iansf, posted by Phillipa on April 13, 2005, at 17:54:51
> So, are they going to give Morphine for OCD? Fondly, Phillipa
If larger studies back this one up, I'm sure a few of the more risk-taking psychiatrists will give their clients the opportunity to try it. Actually, I doubt there's much risk of addiction in once-a-week oral dosing. Of course, I have no idea how a 25mg dose compares to typical morphine dosing. I'm guessing it's on the low side (or at least NOT on the high side), but I don't know.
John
Posted by Phillipa on April 13, 2005, at 19:53:51
In reply to Re: Morphine for OCD » Phillipa, posted by Iansf on April 13, 2005, at 19:25:43
If my memory serves me, I think this a large dose. I believe morphine is given in the l,2,5mg range. Of course by now they may have even more long acting morphine. They used to give CA pts MS contin, which is a pill and lasts quite a while. Fondly, Phillipa
Posted by paulbwell on April 13, 2005, at 20:07:28
In reply to Re: Morphine for OCD » Iansf, posted by Phillipa on April 13, 2005, at 19:53:51
> If my memory serves me, I think this a large dose. I believe morphine is given in the l,2,5mg range. Of course by now they may have even more long acting morphine. They used to give CA pts MS contin, which is a pill and lasts quite a while. Fondly, Phillipa
The more I read here and the various folks who take poppy juice products, the more I come to think of how increadible versatile Opi's are for almost every psych ailment, theres people using them medically here for
-Pain (obviously)
-Depression
-Anxiety (OCD being 1 of the Anx disorders)
-PTSD
-psychosesThey really seem to be a cure-all? which Docs typically don't like. They like different meds for different ails. Cure alls (which cross different branches of medicine) are seen as not medically specific enought.
Posted by Phillipa on April 13, 2005, at 21:20:08
In reply to Re: Morphine for OCD, posted by paulbwell on April 13, 2005, at 20:07:28
I guess the pdocs don't like it if someone feels good. You know that more pdocs comitt suicide than any others,and a lot get into psych because they have problems they are trying to solve. And why are they so afraid of these meds and benzos if they are not abused. They have no problem using psych meds for nonapproved useage, and tons of addictive Ad's which for some reason they refuse to believe they are addictive. Again those promos from the drug companies. Fondly, Phillipa
Posted by paulbwell on April 13, 2005, at 21:26:43
In reply to Re: Morphine for OCD » paulbwell, posted by Phillipa on April 13, 2005, at 21:20:08
yup, PsyDocs highest suicide rate-I,ve heard that to, and 50% of em' are on psy meds too!
I wonder what they would prescribe themselves?
Opi's? mmmmmm
Posted by Phillipa on April 13, 2005, at 22:45:54
In reply to Re: Morphine for OCD- » Phillipa, posted by paulbwell on April 13, 2005, at 21:26:43
I wonder. The old pdoc of mine, who is under investigation, told me once that he tried all the meds before Rxing them. I don't believe him. He used to work at 3 hospitals, the jail, nursing homes, 3 offices in three different parts of the state. He claimed he drank a lot of coffee. I'll bet it was something else. No one has that much energy. Fondly, Phillipa
Posted by paulbwell on April 14, 2005, at 0:18:20
In reply to Re: Morphine for OCD- » paulbwell, posted by Phillipa on April 13, 2005, at 22:45:54
No one has that much energy. Fondly, Phillipa
Depends on what kinda coffee he drank (took)
did he offer you coffee?
Cheers
Posted by jerrympls on April 14, 2005, at 1:20:04
In reply to Morphine for OCD, posted by Iansf on April 13, 2005, at 16:57:45
See- opiates can be effective for mental illness. I'm going to show this to my pdoc - although I don't have OCD I think he'll find it interesting and a bit reassuring since I'm taking hydrocodone for my depression.
Thanks for the post!
Posted by ed_uk on April 14, 2005, at 10:38:44
In reply to Re: Morphine for OCD » Iansf, posted by Phillipa on April 13, 2005, at 19:53:51
Morphine dosage requirements are EXTREMELY variable! For the treatment of chronic severe pain, some people do well on less than 5mg (by mouth) every four hours, other people might need 1000mg every four hours! Morphine does not have a maximum dose. Low doses must be given initially to avoid causing respiratory depression. Very profound tolerance rapidly develops to the respiratory depressant effects of morphine.
Rarely, patients need unusually high doses of morphine......
'A 66-year-old white woman diagnosed with metastatic pancreatic carcinoma required hospital admission for pain control after receiving five different chemotherapy regimens. Morphine 2 mg/h i.v. was initiated and the dosage was titrated upward to a total of 6613 mg/d by hospital day 16'
Ed.
Posted by ed_uk on April 14, 2005, at 12:33:46
In reply to Severe pain: very high doses of morphine, posted by ed_uk on April 14, 2005, at 10:38:44
Morphine- a versatile analgesic
In the treatment of severe pain, there is no 'standard' dose of oral morphine. Doses have ranged from 2.5 mg to over 2500 mg of morphine sulfate every 4 hours, although most patients need less than 100 mg every 4 hours.
Ed.
Posted by Paulbwell on April 15, 2005, at 17:56:50
In reply to Re: Severe pain: dose of morphine, posted by ed_uk on April 14, 2005, at 12:33:46
Posted by ed_uk on April 16, 2005, at 14:36:56
In reply to Do you read 'The lancet' (nm) » ed_uk, posted by Paulbwell on April 15, 2005, at 17:56:50
LOL, actually no!
Ed.
This is the end of the thread.
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