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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by brynb on August 1, 2012, at 17:59:58
hi all,
while reading an earlier post, i realized that some synthetic opioids (like tramadol or methadone) are nmda antagonists (as is ketamine). i'm currently on 25mg of tramadol (initially started on 100mg), and my pdoc wants me to wean off of it over the next week or so just to see how i do without it. the weaning process has been painless thus far, but i'm getting nervous about being off of it completely as it was THE med that pulled me out of my last (horrific) depressive episode. (i'm also taking lexapro and lithium.)
he seems (reluctantly) open to giving it to me again if need be, but is very partial to subutex (which i've taken with good results, too) as he is an addiction specialist (i had substance abuse issues in the past) in addition to being a mood disorder specialist.
so, does anyone know if subutex, like tramadol, is an nmda antagonist? i though it might be in that it's a synthetic opioid and it worked for my depression in the past.
also, if my mood responds so positively to tramadol, what might that suggest regarding nmda antagonists and my biochemistry? or, are the positive responses to tramadol and subutex related to mu receptors/kappa receptors.
i don't understand enough about the science behind this to connect the dots, so any feedback at all is appreciated. (i want to be armed and ready with info next time i see my pdoc!)
thanks!
Posted by phidippus on August 2, 2012, at 21:15:51
In reply to NMDA Antagonists + Synthetic Opioids, posted by brynb on August 1, 2012, at 17:59:58
Subutex is not an NMDA antagonist.
Your mood responds to Tramadol because its aa potent antidepressant. Besides being an NMDA antagonist, Tramadol is an SNRI (seratonin-norepinephrine reuptake inhibitor). Subutex isn't going to work on all the levels Tramadol did, but it can still be a strong augmentation for the treatmeent of depression-I take 8 mg PRN tto smooth over rough days.
Another drug you may want to try out is Memantine. Since you seem to respond to NMDA antagonism, this drug may be helpful for you.
Please ask me any questions you may have-I want to help you be prepared for your PDOC.
Eric
Posted by brynb on August 3, 2012, at 7:18:01
In reply to Re: NMDA Antagonists + Synthetic Opioids » brynb, posted by phidippus on August 2, 2012, at 21:15:51
Hi Eric-
Thank you so much! Interesting about Subutex. It's been good for me in the past (though, like you said, not like Tramadol). I like the idea of using it as a prn (to cut the risk of dependence) if need be.
We'll see how I do off Tramadol. Hopefully I'll be ok w/ my combo of Lithium and Lexapro, but I need to be realistic and have a back-up plan. Oddly, I generally can't tolerate SNI's--I can't take Effexor or Cymbalta, and I can't tolerate many of the TCA's. I think it's the norepinephrine...maybe I do well with Tramadol as it's weak on norepinephrine? I took 100 mg of Tramadol when I was coming out of my last episode, but once stable with the Lithium, I did great on just 50mg of Tramadol. Is it possible that Tramadol (and Subutex, for that matter) work well because of their action on the mu and kappa receptors?
That's good to know about Memantine; I never tried it, but it sounds like it could be an option.
Thanks, Eric.
Posted by phidippus on August 3, 2012, at 22:41:11
In reply to Re: NMDA Antagonists + Synthetic Opioids » phidippus, posted by brynb on August 3, 2012, at 7:18:01
Tramadol is a weak mu/kappa agonist. ITss a much more powerful NMDA antagonist and really likes to hit those S/N receptors. You probably did ok with Tramadol's SNRI activity on account of its weak opioid effect.
What I find funny is people going off on Tramadol as being so causing of dependency. They don't realize how weak of an opiate Tramadol is. The idea of getting hooked on it makes me laugh.
Subutex is Bupernorphine with nalexone added. I prefer my Bup straight. Be careful with Subutex...As an opioid agonist its about 50 times stronger than morphine.
Eric
Posted by brynb on August 4, 2012, at 2:29:27
In reply to Re: NMDA Antagonists + Synthetic Opioids » brynb, posted by phidippus on August 3, 2012, at 22:41:11
> Tramadol is a weak mu/kappa agonist. ITss a much more powerful NMDA antagonist and really likes to hit those S/N receptors. You probably did ok with Tramadol's SNRI activity on account of its weak opioid effect.
That makes sense...maybe that kind of mitigated the NRI properties? It also really helps leg and arm pain that I get that's not systemic, so basically it must be depression-related and psychosomatic.
>
> What I find funny is people going off on Tramadol as being so causing of dependency. They don't realize how weak of an opiate Tramadol is. The idea of getting hooked on it makes me laugh.
>Fortunately I haven't had any trouble tapering off of it--it's more a psychological thing (I'm really scared my mood's gonna plummet). But so far, so good.
I'm rather annoyed my pdoc is taking me off of it (for now). I never had to raise the dose, never got addicted to it (at least in the compulsive sense), and NEVER wanted to take more than prescribed. And I benefited from all of its effects on various neurotransmitters w/o the unbearable side effects of many other psych drugs.
> Subutex is Bupernorphine with nalexone added. I prefer my Bup straight.
I thought it was just Bup. Isn't it Suboxone that's mixed with Naloxone?
>Be careful with Subutex...As an opioid agonist its about 50 times stronger than morphine.
I knew it was a decent opioid agonist but didn't realize it was that strong! I've used it in the past to help me come off several things (even benzos at one point). I used the 2s & 8s, but at the time, during addiction, it didn't seem like much. However, I've been drug free (not including psych meds!) for a long time now, and my doc would give me a much smaller amount. (And I'm sure it would "feel" much more potent).
The funny thing is, my pdoc is so concerned w/ me getting dependent on both tram & bup, but truthfully, I don't see it as too much different than my dependency on ADs. It's not exactly a picnic coming off SRIs. And I've withdrawn from a lot of drugs, and IMO, benzos and ADs are some of the hardest!
Also, last time I had nitrous oxide at the dentist (say, 4 months ago), I freaked--total dissociation and horrible depression/anxiety for hours after. Isn't it an NMDA too?
-b
Posted by phidippus on August 4, 2012, at 7:05:35
In reply to Re: NMDA Antagonists + Synthetic Opioids » phidippus, posted by brynb on August 4, 2012, at 2:29:27
>It also really helps leg and arm pain that I get >that's not systemic, so basically it must be >depression-related and psychosomatic.
I wouldn't say that. The reuptake inhibition of seratonin and norepenephrine is part of Tramadol's pain fighting effects. Another SNRI, Cymbalta is approved to treat arthritis based on this mode of action.
I'm frustrated with your pdoc :) He should leave welll enough alone.
You're right, Subutex is just buprenorphine.
The effects of Nitrous oxide are veryy dose dependent and it is an NMDA antagonist. NMDA antagonist can cause dissociative states in high doses. Hell, PCP is an NMDA antagonist.
Eric
>
Posted by brynb on August 4, 2012, at 9:35:01
In reply to Re: NMDA Antagonists + Synthetic Opioids » brynb, posted by phidippus on August 4, 2012, at 7:05:35
> I'm frustrated with your pdoc :) He should leave welll enough alone.That's how I feel. I'm just trying to be compliant and listen to him--be a "good patient", ya know? If I don't like how I feel off the tramadol, I'm going to insist I go back on it, otherwise I'll get it through a different doc. Urgh!
Thanks, Eric :))
Posted by phidippus on August 4, 2012, at 23:35:08
In reply to Re: NMDA Antagonists + Synthetic Opioids, posted by brynb on August 4, 2012, at 9:35:01
There's nothing wrong with disagreeing with your pdoc. I argue with mine all the time. I aagree with you sstrongly about the Tramadol and I think you have the right to take it if it helps you so much.
Eric
Posted by brynb on August 5, 2012, at 8:50:32
In reply to Re: NMDA Antagonists + Synthetic Opioids » brynb, posted by phidippus on August 4, 2012, at 23:35:08
This is the end of the thread.
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