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PostPosted: Wed Jan 04, 2017 11:17 am 
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Below is an interesting bit of information I found in the Journal of Addictive Diseases. It appears both Buprenorphine and Methadone suppress stress hormones like cortisol, and they also normalize beta-endorphin levels. These are both huge benefits for the patient. Despite all the research I've done on MAT over the past few years, I had assumed that maintenance drugs (like short acting opiates) suppressed endorphin levels. Many people experience depression or inability to feel pleasure/enjoyment after coming off of opiates or MAT. I think I've even been told by professionals that ones's endorphin levels need to come back up to normal after being suppressed by synthetic opioids for so long. Apparently this isn't true with Methadone or Suboxone.


"Buprenorphine can suppress stress responsive hormones such as ACTH and cortisol when administered acutely to healthy controls.101 When stabilized methadone maintained patients were transitioned onto buprenorphine, basal levels of beta-endorphin remained normal.102 It appears that most stress responsive markers are normalized in buprenorphine maintained patients and that failure to normalize correlates with craving and relapse.103,104 Thus, as with methadone, the role of buprenorphine in the treatment of opiate addiction is not simply replacement of an illicitly used opiate for a medically supervised opiate but rather as a medication that corrects many of the neurobiological processes contributing to relapse."


Citation: Bart G. Maintenance Medication for Opiate Addiction: The Foundation of Recovery. Journal of addictive diseases. 2012;31(3):207-225. doi:10.1080/10550887.2012.694598.
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PostPosted: Wed Jan 04, 2017 12:00 pm 
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Hi Lillyval, Thank you so much for that valuable information. This does explain a lot! I am thinking that this is why so many, such as myself, feel that suboxone helps with depression. I was experiencing depression related to menopause and that is how I got into trouble with tramadol. I think this information can also help to explain about the dosing of suboxone. So many have said that less is more. It is so important for us all to listen to what our bodies are telling us. I can only speak for myself, but after years of popping handfuls of pills I lost the ability to be able to take the appropriate amount of anything that was pain relieving! Again, thank you for this very insightful post!


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PostPosted: Wed Jan 04, 2017 12:50 pm 
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Very grateful to have this valuable information. In the past when I've gotten off some damaging substance or other, I've always had some depression. Terrible sinking feelings that translate to.."OMG, what now? Just real life? Pass the razor blades please."

Almost none of that at all this time after 12 years of twice daily mega-doses of poppy tea. Normally that would be a major...some would say profound.... adjustment. But so far it's really been smooth sailing.


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PostPosted: Wed Jan 04, 2017 1:10 pm 
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Hi Lilly,

Thanks for taking the time to post that information. It's all good stuff.

How are you doing?

r

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PostPosted: Wed Jan 04, 2017 9:48 pm 
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I'll be honest, I'm struggling. After 3 days of being down to 1 Tramadol a day I started having mild WD's in the form of insomnia. So I'm holding steady at 1 until I adjust and then I'm going to cut the pill like we do when tapering Suboxone. I know it sounds crazy doing a long taper to come off of 150 mg of Tramadol when I used to take 400-700mg/day in active addiction. But I just can't handle going through being sick or not sleeping right now when I start my new job Monday.

I've been on my AD (Trintellix-vortioxetine) for almost 3 months now and it doesn't seem to be working. I think I've been in a depressive episode since Nov. when I started taking extra Tramadol. (The Tramadol wasn't the cause, it was the effect). It's not so bad that I can't get out of bed, but I'm just forcing myself to do what absolutely has to be done in a day. I'm seeing the psychiatrist Friday, but honestly there's really nothing left that she can offer me.


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PostPosted: Wed Jan 04, 2017 10:12 pm 
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Lilly,

Depression scares me as it runs in my family. I think of the many terrible things nature can inflict upon a person, depression has to be one of the worst. If I were depressed I don't think there's any way I could stay sober. Opiates definitely have the effect of improving my mood. I also have the sense subs were doing that when I was taking a higher daily dose (24 mg). I'm down to 6, and I'm not sure I feel the same thing. Hard to tease out what's real and what's imagined.


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PostPosted: Wed Jan 04, 2017 10:28 pm 
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If Suboxone helps keep you from using as well as helping your depression you might want to consider going back to a moderate dose (like 8-12mg) and just stay there for a while. Give yourself some stability before tapering off - just a suggestion.


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PostPosted: Thu Jan 05, 2017 6:45 am 
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Lilly

You might be right. My script is for 24 so I've got the option any time I want. I just want to give it a fair chance. I do have some concerns about surgery. Not anything specific at this point, but I'm an old coot of 65 so I'd say it's even money that I'll need some sort of operation at some point. If I were younger I wouldn't be so concerned.

But once I got a clue about the ceiling effect a few days after switching, it occurred to me I might be taking a whole lot of extra subs to no significant therapeutic effect. I'm 90 percent sure the difference in the way I've been feeling is psychosomatic as I'm very prone to that. Plus it's only been 2 days...as of this morning...since I slid down from 8. The 8 seemed fine by the way. Some slight difference from 24, but again, who knows? i'm very suggestible :D

I hope you feel better soon. I've a relative who's doing much better after ECT treatments. I'm certain you know all about those and perhaps have even tried at some point. I've read they're much, much safer these days, though of course as with anything like that, there are some who argue otherwise.

Good thoughts.
G.


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PostPosted: Fri Jan 06, 2017 11:13 pm 
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Lillyval wrote:
Below is an interesting bit of information I found in the Journal of Addictive Diseases. It appears both Buprenorphine and Methadone suppress stress hormones like cortisol, and they also normalize beta-endorphin levels. These are both huge benefits for the patient. Despite all the research I've done on MAT over the past few years, I had assumed that maintenance drugs (like short acting opiates) suppressed endorphin levels. Many people experience depression or inability to feel pleasure/enjoyment after coming off of opiates or MAT. I think I've even been told by professionals that ones's endorphin levels need to come back up to normal after being suppressed by synthetic opioids for so long. Apparently this isn't true with Methadone or Suboxone.


"Buprenorphine can suppress stress responsive hormones such as ACTH and cortisol when administered acutely to healthy controls.101 When stabilized methadone maintained patients were transitioned onto buprenorphine, basal levels of beta-endorphin remained normal.102 It appears that most stress responsive markers are normalized in buprenorphine maintained patients and that failure to normalize correlates with craving and relapse.103,104 Thus, as with methadone, the role of buprenorphine in the treatment of opiate addiction is not simply replacement of an illicitly used opiate for a medically supervised opiate but rather as a medication that corrects many of the neurobiological processes contributing to relapse."


Citation: Bart G. Maintenance Medication for Opiate Addiction: The Foundation of Recovery. Journal of addictive diseases. 2012;31(3):207-225. doi:10.1080/10550887.2012.694598.
MLA


Lilly, this makes complete sense!! I found an article that talks about how the frontal cortex is particularly susceptible to being impaired by stress hormones!

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907136/

This part of the brain is responsible for higher level thinking and guards against making impulsive decisions. So if buprenorphine is suppressing stress hormones, the frontal cortex is operating much more smoothly than when it is on their drug of choice. The brain science of addiction is just fascinating!!

I'm sorry to read that you're struggling, Lilly. The life of an addict is a constant struggle. Take care, and make sure you come here when you need to vent or complain. This is a safe space for doing so.

Amy

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