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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by iforgotmypassword on September 16, 2005, at 22:58:16
Posted by SLS on September 17, 2005, at 15:17:20
In reply to effexor and remeron with opioid activity?, posted by iforgotmypassword on September 16, 2005, at 22:58:16
When operating properly, an opioid system in the brain helps regulate the state of the HPA axis by inhibiting the release of CRF when opioid receptors are stimulated, thereby preventing the synthesis of too much cortisol. In depression, this balance goes awry, leaving the HPA axis dysregulated. In the most severe of depressions where psychomotor retardation is prominent, the HPA axis seems to be most often hyperactive. A reduced opioid tone might contribute to this. The abstract you cited indicates that increasing the responsiveness of opioid receptors by certain antidepressants could reverse the HPA axis hyperactivity, thereby enhancing these drugs' effectiveness. The question is, how is this done? I have read that NE pathways might be the route by which these antidepressants modulate the opioid system. SSRI drugs might not be as robust here because they don't directly manipulate NE synapses. One must be careful, however, not to treat the vast complexity of the brain as simplistically as I have done here.
HPA = hypothalamus pituitary adrenal
CRF = corticotropin releasing factor (sometimes referred to as CRH)
NE = norepinephrine
SSRI = selective serotonin reuptake inhibitor
- Scott
Posted by lunesta on September 18, 2005, at 14:13:54
In reply to Re: effexor and remeron with opioid activity?, posted by SLS on September 17, 2005, at 15:17:20
low dose naltrexone might work here.
Posted by Chairman_MAO on September 22, 2005, at 10:27:26
In reply to Re: effexor and remeron with opioid activity?, posted by SLS on September 17, 2005, at 15:17:20
In the real world, these effects are not significant enough to help with your depression; have you not already given these drugs a trial? Theories can be intellectually tasty, but they don't help depression much unless the drugs work. :(
You need a mu agonist, plain and simple. Bupe will do the trick; full agonists are better. If you have the option, go with oxymorphone. Tt is the most mood-brightening opioid IMHO. I really believe in the MAOI+opioid combination. Another advantage of bupe is that it is a kappa antagonist, which confers antimanic and antipsychotic properties, AFAIK. In addition, because it is a partial agonist, it seems to have a "normalizing" effect on the endorphin system that the full agonists don't. That is, tolerance to its mood-brightening effects don't seem to wane as much as with full agonists, although if you are an outright opioid responder this may not happen with full agonists, either. Its withdrawal syndrome is a walk in the park compared to even SSRIs.
Posted by SLS on September 22, 2005, at 21:54:42
In reply to Re: effexor and remeron with opioid activity? » SLS, posted by Chairman_MAO on September 22, 2005, at 10:27:26
> Theories can be intellectually tasty, but they don't help depression much unless the drugs work. :(
Yup. Well said.
> You need a mu agonist, plain and simple. Bupe will do the trick; full agonists are better. If you have the option, go with oxymorphone. Tt is the most mood-brightening opioid IMHO. I really believe in the MAOI+opioid combination. Another advantage of bupe is that it is a kappa antagonist, which confers antimanic and antipsychotic properties, AFAIK. In addition, because it is a partial agonist, it seems to have a "normalizing" effect on the endorphin system that the full agonists don't. That is, tolerance to its mood-brightening effects don't seem to wane as much as with full agonists, although if you are an outright opioid responder this may not happen with full agonists, either. Its withdrawal syndrome is a walk in the park compared to even SSRIs.
I'll keep buprenorphine on my list of things to try. It's been on there for quite awhile, but I haven't placed it towards the top, mainly because I thought it would be difficult to convince my doctor to use it. As we move through trials, I think he will be more receptive to it.
- Scott
This is the end of the thread.
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