Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
If prescribed antidepressants aren't working, it is probably because your pts are not trying out the large number of antidepressants available on the market. Each and everyone's body reacts differently from one another so one single type/brand won't make a difference for everyone. It's a process of trial and error basically,
I know that a GP doesn't have the psych training to be able to diagnose and treat mental illness accurately. For example, depression can mask as anxiety because they often occur simultaneously. Patients might see their doctor for depression but if the doctor took their time over several visits they might find there are also symptoms of another facet of the the mental illness that doesn't feel as bad as their depression like over-elation which feels good but is an equally damaging symptom. The proper dosing and types of non-narcotic medications can then be titrated.
Using opioids is a direct path to addiction. The miraculous results you describe is merely a numbing of symptoms but not treating the underlying cause of the malfunctioning of the brain and is not therapeutic. Patients who think they aren't addicted are unable to distinguish between the comfort and the damage, because, well, their brain has changed and they are addicted.
The body builds a tolerance fairly soon so more and more of the substance is needed to produce the results they demand.Check back with the co-worker patient and see if they have evolved into taking more than the 100 mg they started with.
While you may find fault with my observations over 40 yrs of experience-- after all, my data was not systematiclly collected nor statistically analyzed, but you apparently missed this article sited above https://www.bbrfoundation.org/conten...ant-depression ...Search "narcotics + depression" for an extensive compilation of the research on the subject.
Depression is highly correlated with altered serotonin & dopamine levels, and narcotics effect both, so it makes sense theoretically that they should work in depression, and the empirical evidence supports the practice.
The word "addicition" is thrown about carelessly in colloquial speech. It is scientifically defined as the situation where a drug exhibits tachphyllaxis (need to continually escalate doses to achieve the desired resonse AND sudden discontinuance of the drug induces a rebound phenomenon ("withdrawal syndrome"). The second of those critria is rarely seen with the mild narcotics. Death from over-dose from them (when used alone) is virtually non-existant.
Given the enourmous number of prescriptions for codeine or hydrocodone handed out each year, the rate of addiction to those is actually quite small.
It's not illegal to prescribe opioids in the US. But they're now prescribed only for a narrow set of circumstances. The same is true in Germany, from what I've read. German hospitals don't prescribe opioids for pain unless absolutely necessary. There are other ways to mitigate pain; massage in hospitals is now making a comeback, because it helps relieve pain, for example.
They've done evaluations of pain vs drugs using a reostatically controlled electrical shock stimulus. Subjects were asked to turn up the dial until it hurt, with and without narcotic-- Pain was reported at the same level on the dial for both conditions-- The subject just didn't suffer when under the influence of the drug. ("Yea, it hurts there. Far out, Man.")
Don't confuse pain ( a reflex arc ) with suffering (a cerebrally mediated emotion resulting from pain).
Lab electrical stimulus pain vs real life medicine, IMO don't necessarily correlate. I've been there with so many acute pain patients over the years, I couldn't know the numbers. Along with myself, friends and family. Narcotics usually, not always, reduce acute pain levels. Call it what you want, emotion or whatever. The medical point is to quickly alleviate patient suffering.
After my open heart surgery in 2002, 1/2 to 1 mg of IV dilaudid, and it was almost magical as the medicine quickly alleviated my intense sternal pain.
It's not illegal to prescribe opioids in the US. But they're now prescribed only for a narrow set of circumstances. The same is true in Germany, from what I've read. German hospitals don't prescribe opioids for pain unless absolutely necessary. There are other ways to mitigate pain; massage in hospitals is now making a comeback, because it helps relieve pain, for example.
There are many treatments and therapies for pain relief acute and chronic. But there is almost nothing better than a small IV dose of narcotic for intense acute pains. My wife can attest to this when the ski patrol/medics arrived at the scene where she inadvertently did a 3/4 front flip off a whoop-dee-doo right onto her pelvis, breaking in 3 places. Frikken LAST ski run of the YEAR!
The medical point is to quickly alleviate patient suffering.
.
Then we agree. I'm merely pointng out point of action and mechanisms.
The type of pain is also important-- NSAIDS have zero effect in treating pain caused by obstruction of a hollow viscus-- like kidney stone, biliary stone, intestinal obstruction, while they usually work better than narcotics for orthopedic or dental pain.
Maybe most import ant is that everybody is different and no textbook or best practices cookbook can substitute for tailoring the treatment to the pt by active trial and error.
I started work a few months ago and I have a manager who is really hardworking. She says that the secret to her success is using a low dose of OTC codeine (we live in Europe so it's legal) to stave off any anxiety she has as well as give her motivation. She takes about 100mg every few days.
It's working for her so far but I can't help but feel that she's headed down a dark path on harder opioids. I know there's a lot of misinformation about drugs in society but opioids seem to be the one drug that campaigns like DARE are really honest about and should be avoided long term.
FWIW, I've been taking 90mg of codeine every day (30mg TID) for 16 years, albeit not for pain, and I'm not headed down a dark path.
Or if I am, I must be walking very slowly down it.
Quote:
Originally Posted by AZgarden
Problem is the drugs wear off and you need more and more for the same effect. If its 100mg now, it might be 200mg in a few months.
It depends on the effect you're trying to achieve. I've been on the same dose for 16 years.
I started work a few months ago and I have a manager who is really hardworking. She says that the secret to her success is using a low dose of OTC codeine (we live in Europe so it's legal) to stave off any anxiety she has as well as give her motivation. She takes about 100mg every few days.
It's working for her so far but I can't help but feel that she's headed down a dark path on harder opioids. I know there's a lot of misinformation about drugs in society but opioids seem to be the one drug that campaigns like DARE are really honest about and should be avoided long term.
100 at a time every few days, or a smaller amount per day that adds up to 100 over a few days? I'm guessing the latter.
Quote:
Originally Posted by Parnassia
Without knowing anything else about this woman difficult to comment. She might have some type of chronic pain in the background. I would guess one way to "test" her theory or her dependence is to see what happens if she is deprived of her little "aid" for a period of time. After all, wellbeing isn't just physical, its psychological too. There are quite a few people who seem able to discipline themselves to stick to a given level of an addictive medication indefinitely.
It isn't one of the meds where a person should suddenly stop. It needs to be tapered down. I took Tylenol 3 for a time after an injury with my toe caused chronic pain. Tapering it off was a breeze.
Quote:
Originally Posted by guidoLaMoto
Unfortunatley, the prescribing of opiates has run into all sorts of political impediments here in The States.
The neurochemistry of pain and depression are interminged. I had many pts whose conventional meds for depression were inadequate in treating their depression, but who had miraculous improvement when taking codeine or hydrocodone, two extremely safe narcotics with low risk for addiction. Even small doses (once or twice a day) was extremely beneficial.
...and I have seen many pts who observe the same thing about narcotics and motiviation (lack of motivation is a cardinal symptom of depression)....Just like giving a stimulant to a hyperactive kid paradoxically slows them down, a narcotic, usually considered a sedative, may paradoxically stimulate depressed pts.
Thank ignorant lawyers once again for taking a good tool away from our tool kit.
The Sackler siblings in addition to the lawyers. I feel bad for people who have to contend with bad, chronic pain.
FWIW, I've been taking 90mg of codeine every day (30mg TID) for 16 years, albeit not for pain, and I'm not headed down a dark path.
Or if I am, I must be walking very slowly down it.
It depends on the effect you're trying to achieve. I've been on the same dose for 16 years.
If you live in the USA, I am amazed that you're getting a prescription for it, unless you are crossing the border.
Where I live, the anti-opioid campaign is so strong that those that are truly in need of pain relief do not receive it. Ironically, a opioid treatment clinic, aka methadone clinic, was sneaked into the community by the local government, defying the opposition from the community. They are calling it a "wellness center", as if you go there to do yoga. But, it's a very profitable venture for the group who financed it & "influenced" the local government in a closed-session meeting.
Using opioids for off label treatment isn't a good idea. There are other healthier treatments out there. I take a B-Complex vitamin plus extra B12...and some D3 - for depression and anxiety. It does work and there are no side effects for me. I've taken antidepressants and off label meds for depression....wasn't crazy about any of those mostly due to obnoxious side effects.
I also recently discovered the field of Anthroposophy from a friend who has been a student of this way of living, which includes health and spirituality. There are also doctors who are practitioners. From what I understand, these doctors are functional medicine doctors who practice medical care and holistic care, too. My friend has been using a doctor in her area, Michigan, and has been very happy with the care she is receiving. She had cervical cancer and had been getting advice from a surgeon. But she began seeing one of the anthroposophy doctors for treatment. When she went in for the surgery, they could find no cancer. Her surgeon was surprised, but told her, you need to continue whatever you've been doing. If this was 30-40 years ago, I would give one of these doctors a try for my depression. But I found my own treatment as I shared above. I try to stay away from doctors whose only cure is to write a prescription. I need more choices than that.
There are also groups that meet in differrent areas of the U.S. who look at all of the different areas that Antrhoposophy covers. They really aren't selling anything. They do a lot of educational cafes and meetings - with speakers - to help people find out exactly what type of help we can get for all sorts of things. This organization is affiliated with the Waldorf schools that I'll bet quite a few of you know about. You can also look this up on Wikipedia.
Last edited by 'M'; 06-18-2022 at 12:29 AM..
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
Without knowing anything else about this woman difficult to comment. She might have some type of chronic pain in the background. I would guess one way to "test" her theory or her dependence is to see what happens if she is deprived of her little "aid" for a period of time. After all, wellbeing isn't just physical, its psychological too. There are quite a few people who seem able to discipline themselves to stick to a given level of an addictive medication indefinitely.
