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PostPosted: Sun Feb 21, 2010 12:03 am 
To anyone who knows, preferably a doctor:

I take 4 to 6 mg of Suboxone per day, and that is non-negotiable. I have a 10+ year history of depression, and I've been through all of the SSRI's, SNRI's, Wellbutrin, and other modern antidepressents with not-very-much success. I suffer from atypical depression and social phobia, which are both well-known to best respond to MAOI's (Monoamine Oxidase Inhibitors). However, these type of AD's interact with tons of meds, including some narcotics. The main one (which is always a no-no) is meperidine (Demerol). I've never seen buprenorphine specifically listed as a contraindication. The four MAOI's available in the US that I'm considering are phenylzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), and Emsam (selegiline patch). Emsam specifically seems to have less interactions listed than the others, and when I checked it for interactions, no narcotic pain relievers were listed. On the down side, Emsam is considered the weakest of the four. Does anyone have any more info?

Much appreciated
j


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PostPosted: Fri Aug 28, 2015 3:54 pm 
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I am unsure, and definitely ask your doctors (medical and psych). I felt the urge to reply because I'm diagnosed with Panic Disorder and Severe Atypical Depression as well. Also Borderline. I tried to get on MAOIs for a couple years, after doing lots of research and finding out their rate of success. But, being that I did not/do not have insurance, couldn't get the medication I needed.

The free clinic doctors would never prescribe the MAOIs because of the high side effect profile, eating restriction, etc. and the fact that they aren't used much anymore... I will refrain from ranting about the quality of health care the poor receive in this country versus the wealthy, who can afford private doctors, and generally can find a way to get whatever meds they want....

so anyway, I was lucky enough to have VCU Health Services finally agree to prescribe the Emsam patch (was a student at the time). It was a very low starting dose, (6mg maybe?) because the doctors were so scared of MAOIs, and I felt absolutely no effect whatsoever (good or bad), so after a few months I had to switch to something that somewhat helped. My point here, is that the patch is very weak compared to the original pill forms, so I advice against it.

But I do think that old school MAOIs are a great idea and should be tried more today, especially for treatment resistant depression like we both suffer from.

Good luck, I hope you can do both suboxone and an MAOI at the same time and it helps you. Keep me updated : )


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PostPosted: Fri Aug 28, 2015 3:57 pm 
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sorry, just realized the original post was in 2010. so yeah.


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PostPosted: Fri Aug 28, 2015 5:42 pm 
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That doesn't mean the information isn't valuable! Do you find that suboxone helps with your mental disorders at all? You've probably done a lot of research in this area. I don't personally know much about MAOIs, although I just started a class in Psychopathology.

Has the new health care system helped you get insurance? I know it doesn't fix everything, but I hope that at least more people are being covered. Because you are absolutely correct about how poor people are treated versus wealthy people. I find it incredibly sad that we don't put value in taking care of the poor in this country, unless it's through religious organizations.

I hope you might post some more! It's obvious that you have knowledge you can share!

Amy

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PostPosted: Sat Aug 29, 2015 2:54 am 
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My doctor's always been apprehensive to prescribe me MAOI's because of their potentially serious interactions with drugs of addiction. I have a history of using meth, cocaine and opiates, and as such he's steered well clear of MAOI's. At one stage we discussed the possibility of going on Parnate, but opted instead to experiment with tricyclics, which turned out to basically be SNRI's with more side effects.

I'd be interested to see how you go, so whatever course you choose please stick around and keep us filled in. It may also be worth shooting Dr. Junig a question regarding this as it's very much his area of expertise.

At the moment I'm on lithium, zyprexa and Brintellix. The Brintellix has been pretty good. I much more "transparent" anti-depressant than the usual ones I'm prescribed (Pristiq / Effexor / Cymbalta). However I've always found I'm more prone to experience depressive symptoms while on Suboxone. I've recently been put back on Suboxone after having 2 years off it, and my mood has taken a bit of a hit as a result. But it's still better than using.


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PostPosted: Sat Aug 29, 2015 3:58 pm 
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Hey TeeJay,

Good to see you back and posting. Don't be such a stranger in the future.

r

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PostPosted: Tue Sep 01, 2015 2:24 am 
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Thanks Amy!

The new (federal) health care system has not helped me whatsoever, but this is because I am covered by Virginia state's "indigent care" and my GAP medicaid (strictly for SA and mental Health) covers all my psych meds!

Lots of people don't know about this, but GAP medicaid is for those with both a serious mental illness, and are in need financially. Only in VA that I know of though.

http://www.dmas.virginia.gov/Content_pgs/gap.aspx


As for Suboxone, I just decided to stop taking it on my own. I am currently getting one 8mg strip per day. I daily dose at a clinic, and the cost if free.

They want to bump me up to 16mg and at first I thought that was a good idea. But now I think the dose is too high at 8mg. I am sleeping way too much! I sleep all day lately and don't get anything done. I also feel more depressed, this I attribute to the suboxone and from the sleeping (lack of energy/motivation). I have now missed my dose 3 days in a row (because I slept too late).

I don't know why, but I don't feel like complete shit yet, so I'm gonna try to just quit "cold turkey."

When I was on 8mg of the Subutex pill I didn't have this happen though. I attribute it to the naloxone and slight difference in the two medications.


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PostPosted: Tue Sep 01, 2015 2:34 am 
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When I started on Subutex I felt it really helped my mental health issues, especially my social phobia/panic disorder, and just general daily anxiety. It has taken me months to get into a free clinic, so before I did't get a dose every day necessarily. Only when I could afford to buy it off the street.

Now that I am in a clinic, I am noticing increasing depression and loss of energy after only one month. I am waiting to talk to the doctor and see if he will reduce my dose to 6mg and see if that helps. I am sleeping so much and so depressed that I have no desire to dose my normal 8mg.

I also felt like I did better on Subutex. But my clinic doesn't have it. I know people do react differently to the two, and they are different medications if you get into the pharmacology of it. I hope to be able to find a doctor who will prescribe subutex and see if it helps. But I have been looking for months and haven't been able to find a doctor who takes medicaid. Of course.

Anybody had subutex work, after having these depressive side effects on the suboxone?


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PostPosted: Tue Sep 01, 2015 3:02 am 
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For heaven's sake, why don't you try lowering your dose before quitting completely? Do you have to take your dose right there in front of them? If so, ask the doc to take you down to 4mg and wait a week to see if you are stable on it.

Also, for people who are sensitive to the naloxone in suboxone, try spitting out the saliva after the suboxone is absorbed. Don't swallow it!

Please keep us posted!

Amy

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PostPosted: Sun Sep 06, 2015 9:14 am 
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I'd question whether the naloxone in Suboxone is the cause of your mood symptoms. The effect of the naloxone is really negligible. Even if it was absorbed to a small degree, most of it is out of the body within half an hour to an hour. It's incredibly short acting.

I too have mood issues on Suboxone, though I don't attribute it to the naloxone. There have been others on this board complaining of sleepiness, low mood, low libido etc. Years ago while I was on Suboxone (I had a couple of years off it in between) I had my testosterone levels checked, and they were in the clinically low range. When I went off Sub, the issues subsided, but it took a month or two to properly pick up again. Perhaps what's happening is more due to opioid induced endocrine (hormone) issues. Opioids are notorious for wreaking havoc with hormones. Buprenorphine to a lesser degree, but it's still not immune.

I also have bipolar, so am prone to periods of depression. This doesn't help things much either.

Many people here have reported these side effects diminish, if not disappear completely, on lower doses of Sub. Like Amy said, can't you seriously explore the possibility of reducing your dose? Jumping off 16mg impulsively sounds like a recipe for relapse.


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