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PostPosted: Wed Oct 14, 2015 7:45 am 
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I posted a couple weeks ago I'm on 0.5mg buprenorphine for major depressive disorder. I'm prescribed 1mg/day but find that 0.5 is enough. I have serious depressive episodes with PMS, so for that week I go up to 0.75 mg.

I would like to hear from anyone on a very low dose for any reason. How long have you been on it?, how does it work for you?, etc.

Also, has anyone been on a low dose for an extended period of time and gone off? How was the detox?

Just an aside - I asked both the Sub doctors who have treated me their experience on tapering patients off. Both said that they only had a couple of patients who tapered all the way off, but they have patients that got down to ~1 mg and stayed there. When the first doctor told me that, I had no idea how significant a piece of information that was. I had no idea that bupe is prescribed for pain in microgram doses, and 1mg is still a very big dose.
This is probably a whole other topic, but I have spoken to 3 other Sub doctors as well, and there seems to be little experience getting patients off. The only Sub Dr. I know who has weaned a large number of patients off Sub is Dr. Junig - and he's a proponent of keeping people on!

Thanks for any input,
Lilly


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PostPosted: Wed Oct 14, 2015 7:53 pm 
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Hi Lilly,

The problem is that when people finally get through the process of stopping buprenorphine, the last thing they want to do is pay to see the doctor who used to prescribe it for them. I think that in my case, one difference is my use of email. All of my patients know my email address, and I encourage them to contact me for any problems that pop up... so some people continue to stay in touch even after stopping buprenorphine.

I am a proponent of long-term buprenorphine in that I do not agree with forced dose-reductions in stable (or unstable) patients. But I will assist any patient who wants off buprenorphine-- although I may let the person know that I don't AGREE with their plan to discontinue the medication.

I have talked about the things that I have come to see as positive indicators for staying off opioids: age over 30, a stable relationship with a partner, being employed, having hobbies, having non-using friends.... nothing that takes a rocket scientist to figure out! The other thing that helps, I think, is 'time on buprenorphine or methadone'-- i.e. time out of the cycle of using and craving. I see people doing well after being on maintenance for 3-5 years. There are over 8 studies now that show high relapse rates after only one year-- so obviously one year is not enough.

Lilly, your use of bupe for depression is interesting. Not sure if you're aware of Alkermes work on a buprenorphine-based med for depression... they combine bupe with a mu antagonist, which prevents the tolerance and withdrawal. The med is not yet approved, but I think that if it ever DOES get approved, there will be a great deal of interest in using other opioids for mood disorders.

One last note-- I agree with your comment about 1 mg being similar to 8 mg. Some patients seem to think that 4 mg is a small dose of buprenorphine-- but from a historical perspective, 4 mg of bupe is a LARGE dose. In early bupe/addition treatment, the French referred to bupe doses of 4-16 mg as 'HDB', i.e. 'high dose buprenorphine.' I think it is good to remember that... although that does NOT mean that the high doses are dangerous. It just means that above 4 mg, the ceiling effect makes dose irrelevant-- in most people anyway.


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PostPosted: Sun Oct 18, 2015 8:42 pm 
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Thank you for replying, Dr. Junig. You bring up some good points - I never would have thought of stopping contact with my Sub doc, as she's my psychiatrist and prescribes my AD's as well as provides better counseling than most of the therapists I've been to.

As far as your positive indicators for being successful off Sub, I have all of them, including having been on maintenance for over 3 years. I feel I have been successful in my ORT free recovery, but I have relapsed while in a major depressive episode - it's my Achilles heel.

I was hoping to get some takers on this thread, but I guess everyone is either at a higher dose, or is doing so well on a low dose that they're not looking for answers on a forum!

I'm trying to give it a fair try, but I feel kind of dysphoric on the low dose. Very stable, though - I had a major family crisis (cops showing up at my door kind of crisis, unlike anything I'd ever dealt with before). I was totally calm and almost emotionless. Which in this case was helpful, but overall is not how I want to be. (In fact being totally flat and emotionless is one of the reasons I decided to get off Sub almost 3 years ago).

Has anyone heard of, or been on the new med that TeeJay mentioned, Vortioxetine (an atypical AD)? I've pretty much given up on AD's but I guess part of me still holds out hope that one day I will find something where the side effects don't outweigh the benefits.

Maybe I'll ask this over in the buprenorphine and mood thread.


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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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