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 Post subject: 2mg to 4mg?
PostPosted: Sat Mar 19, 2016 5:45 pm 
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I need help guys. I was prescribed suboxone for treatment resistant depression and at first it worked GREAT. It was a miracle. However swishing and crushing it and painting it around my mouth caused a swollen tongue. After my first week of doing this my doxtor had me stop and i had to just let it dissolve. I started feeling depressed again so went back to the painting and swishing, but the depression relief hasnt been the same since in the second week. All of the side effects also went away around this time. I went up to 2mg and got no side effects and no increased depression relief. Would going up to 4mg help get back that depression relief since its hitting the ceiling? Oh also I started out with .5mg.
Please help! Ive already tried and failed SSRI's, SNRI's, tricyclics, rTMS, ECT, and ketamine! This is the first thing that has worked in Forever!!! Also is there any truth in endorphin deficiency syndrome? Should i switch to naloxone? Thanks.


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 Post subject: Re: 2mg to 4mg?
PostPosted: Sat Mar 19, 2016 9:13 pm 
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Hey and welcome!

I'm on my phone so I apologise for being concise.

Sure a dose increase may temporarily provide you with more relief from depression, largely because of increased mu-agonism. Just be aware that this is the same affect that lends opioids to abuse. Ie there are plenty of people out there abusing heroin, fentanyl and oxy because it makes them feel less depressed.

It also makes sense that the antidepressant effects have worn off after a couple of weeks because that's how long it takes to build up a tolerance to mu-agonist effects. You could take more and feel better again, but you will likely find the same thing happening after another couple of weeks. Its effects will diminish, and you will face the same decision, and possibly want to increase to 6mg.

The ceiling effect is interesting. But in my opinion, all it means is eventually you will reach a point where increasing your dose further brings no increased effect.

As you can probably tell I'm not a big believer in the kappa antagonists effects. I think most people get relief from the mu agonist properties of Sub. As such this post is largely my opinion. I personally see the prescription of Suboxone for depression as no different to the "opium cures" of the early 1900s. Read up on it it's interesting.

If I had no history of opioid addiction, I'd sooner get ECT than take an opioid for depression. But that's just me. Maybe I've been scared off opioids due to 15 years of addiction.


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 Post subject: Re: 2mg to 4mg?
PostPosted: Sun Mar 20, 2016 12:31 am 
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But ive read a lot about people who are in a dose of suboxone for depression for years and dont need to increase their dose. I also read an post by dr junig that when ppl take suboxone for a long period of time that if anything their dose decreases over time that u dont have to keep decreasing it over time.
Should i try naltrexone? I tried and failed ECT.


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 Post subject: Re: 2mg to 4mg?
PostPosted: Mon Mar 21, 2016 2:47 am 
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I don't want to scare you off Suboxone. It may very well be the answer for you. All I know is that I still experience bouts of depression even if I'm on high doses of Suboxone.

I'm on Brintellix and have found it really useful for depression. It's got multiple modes of action. More than just an SSRI. However I find that when I don't take my full dose of lithium my depression returns, even while taking Brintellix. Have you tried lithium augmentation?


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 Post subject: Re: 2mg to 4mg?
PostPosted: Mon Mar 21, 2016 11:36 am 
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There are a couple of members here who use buprenorphine as well as an antidepressant to treat their resistant depression. For them it's the only thing that works. You might want to look in Buprenorphine and Mood for more posts on this subject.

Amy

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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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