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Question about PAWS... Refering to what Suboxdoc commented

Tue Dec 05, 2017 6:17 pm

Hello old friends. Instead of high jacking TeeJay's Sublocade thread, I figured I would just start a new one and ask Suboxdoc would he please elaborate on his theory about PAWS being an ill defined syndrome at best. And especially if he thinks, "at least some of the people labelled with PAWS are actually struggling with major depression caused by the detox", then could we possibly minimize this depression a great deal by getting on an antidepressant medication when we are tapering and after jumping off Suboxone. I'm certainly not trying to dispute anything Suboxdoc is saying but would just like to learn as much from him as I know this is his specialty. Also one last things... If that is so, what kind of antidepressant medication would likely be recommended? SSRI? I know there are several different types and would like to have a good idea which would be best, for your average person. Thanks for weighing in. Your forum friend, Angie

Re: Question about PAWS... Refering to what Suboxdoc commen

Tue Dec 05, 2017 11:41 pm

Or does anyone else have any thoughts on this?

Re: Question about PAWS... Refering to what Suboxdoc commen

Wed Dec 06, 2017 12:18 pm

Hey Angie! Hopefully Dr Junig will see this thread.

I had the worst depression coming off opiates and when I went to rehab I was miserable.... not wanting to be alive or eat for weeks miserable. I stayed like this for months til I relapsed. In rehab, my counselor threatened to discharge me because I wasn't eating. She even had all the ladies watching me to make sure I ate during our meals. When I'm upset or depressed I cannot eat. Anyway she kept saying 'it has been 3 weeks Jennifer and this shouldn't be caused by the opiates or ur detox because ur detox is over'. She literally had me thinking I was different and something was wrong with me.

As I was graduating the program she handed me a script for Prozac. I never filled it. I'm now wondering if I should have or if it would have made a difference with my depression. I'm absolutely convinced this whole thing was PAWS. The other ladies I was in rehab with didn't seem fazed at all, they were chasing guys, laughing, gaining weight and pretty normal acting but I was near dead inside. I didn't understand why my reaction to stopping was different. Now I realize (or at least I think) I had PAWS. After 6 months it was still hanging on and I couldn't take it anymore. I'm so grateful for buprenorphine because it takes that part away.

Great post Angie! So happy ur here!!

Re: Question about PAWS... Refering to what Suboxdoc commen

Wed Dec 06, 2017 2:59 pm

Thank you so much for your reply Jenn. I know that was some pretty debilitating depression you were experiencing because you have spoke of it many times. I too would ball up in a knot and wish for death when I was out of places to go to get my doc. Once when a pain clinic closed down, I just knew I was going to end up in a mental institution, this was before getting on Suboxone. But you make a good point, great point actually. SUBOXONE DOES INDEAD COVER/ TREAT THIS TYPE OF DEPRESSION. You know that's a biggie for me. I'm so grateful for Suboxone because there is no way in heck I can function while experiencing that intense of a depression. Just something else I need to take into consideration before planning out a taper and then setting a jumping off date. Will I be able to handle the depression and anxiety? I dang sure couldn't last time I attempted a taper and jump. Thanks Jenn for giving me something to think about. Your forum friend, Angie
Last edited by Bamagurl22 on Wed Dec 06, 2017 7:34 pm, edited 1 time in total.

Re: Question about PAWS... Refering to what Suboxdoc commen

Wed Dec 06, 2017 5:30 pm

Depression is one of my biggest issues now too. I didn't have depression prior to abusing drugs so I wouldnt be surprised if it's related to withdrawals. I was able to go from 8mg down to 1.75mg in 6 months, but then the depression hit and i needed to feel happy so on weekends started spiking up to 4mg and then back to 2mg during the week which has made it worse. I just can't handle being so sad and so so many regrets are swimming in my head all the time now. I can't get the past back and it's too late to change things. I was okay isolating when i had my best friend oxy keeping me company, and even on a high dose of subs being by myself didn't bother me. But now it's practically unbearable. I know i should go to meetings but I'm so stuck in this hole of nothingness.

need a happy pill that isn't an opioid, alcohol or food. Or is it just the nature of withdrawal that antidepressants don't work?

Re: Question about PAWS... Refering to what Suboxdoc commen

Thu Dec 07, 2017 8:47 am

Yes Angie, that depression left a lifelong fear in me, I'll never be able to forget that misery and it's the closest I've ever felt to not caring about if I lived or died. I remember when u were off buprenorphine when ur doctor left, I know u had a really hard time too. It's that kind of feeling that keeps me wondering if that would happen to me again.

Sylvia I understand and I hate to hear that ur not feeling so great. I have said this before but I honestly think that some ppl are more likely to suffer with depression coming off opiates than others and I've never figured out why. It's almost like cravings turns into depression and some ppl can't get past it even a year in. I don't understand it and I know it's hard for every addict but I think a percentage of us do have that dead inside depression........ or maybe some of us just don't deal with it as well as others and it's an issue like that, I really don't know but if an antidepressant would help that I'd definitely be willing to try it. Unfortunately I didn't try taking an antidepressant like maybe I should have.

Re: Question about PAWS... Refering to what Suboxdoc commen

Fri Dec 08, 2017 7:41 am

PAWS is an interesting thing. It seems to apply to recovering off all drugs of addiction, and the symptoms are similar for all of them. They are linked to psychiatric symptoms - mood lability (ups and downs that can last days), mood reactivity (being emotionally overwhelmed over seemingly little things), sleeping issues, motivation, anhedonia (seeming lack of pleasure derived from daily activity).

When coming off long-acting opioids like methadone and suboxone, subclinical acute withdrawal symptoms come into play in the early months. Intermittent / occasional bouts of sneezing, goosebumps, mild muscle aches can come and go and gradually improve over a few months.

The best reports come from those people in drug addiction peer support groups like NA. Often I hear from ex-opioid addicts, ex-cocaine / amphetamine addicts, and recovering alcoholics who claim things like it takes 2 years before your moods resemble that of a normal person. Prior to that point, people report feeling negative periods for no reason. These ups and downs can last for many days at a time. As PAWS progresses and improves, the period of time these bouts occur both gets extended, and the intensity subsides until the inexplicable mood shifts become unnoticeable.

There's also a lot of psychological recovery that's happening at the same time which can blur the lines between physiological PAWS and general psychological recovery from living a life dictated by getting and using more drugs. Things like re-learning how to function on a day-to-day basis, relating with others, regaining trust by loved ones etc.

Whether a person chooses to treat the depression in early recovery is an individual decision. I'd say it comes down to whether the symptoms prevent a person from functioning, or consistently lead to a person relapsing.

PAWS is not to be confused with psychiatric symptoms that might have existed prior to a person becoming addicted to drugs, which is not uncommon. Many people who turn to drugs of addiction have pre-existing psychiatric disorders, often undiagnosed, and they're often only discovered when a patient is exposed to medical professionals because of their addiction. It's also often hard to figure out exactly what's going on psychiatrically until a person stops taking drugs, because the side-effects of the drugs themselves mimic various psychiatric illnesses. ie cocaine, amphetamines and marijuana can all cause psychotic symptoms when used in excess. Long term opioid addiction is also heavily associated with depression.

Re: Question about PAWS... Refering to what Suboxdoc commen

Mon Dec 11, 2017 11:48 pm

I too am very sorry Sylvia is having this depression while trying to wean down on Suboxone. I know the feeling all to well from trying to wean down and jump after my Dr office closed down unexpectedly. Maybe she could talk to her Dr about prescribing an antidepressant for the time being. TeeJay thank you for writing that in-depth look into PAWS. I am learning that you have quite a bit of experience with Suboxone, PAWS and addiction and I personally appreciate your contributions to this forum. I am so grateful to have found another Suboxone Dr when I did because it didn't look like I was going to stay sober had I not but still I always have the thought in the back of my mind about this new Dr wanting me to be off Suboxone after being on it two years. And that messes with me real bad. Like every time I go to the Dr I will be dreading the appointment and worrying myself sick is this going to be the appointment where he wants me to start cutting back. And then when he doesn't cut me back I start worrying about does this Dr know how to even oversee a decent taper, they did just start prescribing Suboxone a couple of months before I started going there. That was one of the problems last time was I only did about a 3 month taper before jumping. Seriously, all this worrying is starting to affect my peace of mind. Sometimes I wonder would I be better off if I just started my taper now so that I would have sufficient time to do it properly. Anyway ironically I have an apt with my Suboxone Dr tomorrow morning so we will see how it goes. I hope everyone is doing well and Sylvia is feeling better. Will chime in tomorrow. Your forum friend, Angie

Re: Question about PAWS... Refering to what Suboxdoc commen

Tue Dec 12, 2017 12:26 pm

Jenn and Bama thank you for your concern and thoughts on depression. I have my good days and bad, it would be nice if I could escape the holiday music in the stores. But I know that New Years is close and once i get over the holiday bump it will be a lot better. I am going to ask about getting on an antidepressant at some point i just wanted to wait until i was off subs completely. I have no rational reason why i wanted to do that, it just seemed like the "right" thing to do. But the again nothing is ever rational in an addicts mind :D

Re: Question about PAWS... Refering to what Suboxdoc commen

Tue Dec 12, 2017 8:33 pm

Well hey there Sylvia! Your spirits seem to up a little more today than last time you commented. Yes this is a tricky time of the year because it has so many different meaning for people but mostly they all stem around family. Which can bring up terrible feelings of guilt on the addicts side. Hang in there Silvia and if you need to talk, I'm here... Well I went to the Dr today and everything is pretty much staying the same. Still prescribed one 8mg strip and day, even though last month I cut down to 4 mg a day. I did jump back up to 8 mg about 5 five days before going to my Suboxone dr. I know that probably isn't the healthiest thing to do, but I had to stock pile back a few and I have a pretty good bit. I believe if I do that one more month, I will be good as far as worrying about getting cut off or asked to wean down quickly. Who knows? This Dr might turn out to be like most the other Dr's and allow me to stay on them indefinitely. But he did make me sign a paper saying that I would only be on Subs for about two years. And when I first started going there, I asked about being on Suboxone indefinitely for pain and he said I would need to go to a pain clinic and get one of the bupe medications if I wanted to do that. Which I thought was weird. But yeah, I have been trucking along just fine at 4 mg. There were a couple days, about 10 days into the drop that I had to jump back up to 6 mg, but that was for only two days. Then right back to 4 mg. Not sure how I will feel taking the 4 mg after shooting back up to the 8 mg for 5 days before this Dr visit, but we will see. Goodnight friends :D Your forum friend, Angie

Re: Question about PAWS... Refering to what Suboxdoc commen

Thu Dec 14, 2017 6:48 am

Sylvia, Welcome to the forum. I have also struggled with depression for most of my life. The worst episode for me was almost two years after I discontinued pain meds and got on suboxone. I was already taking an antidepressant and seeing a therapist once every two weeks. My therapist called my psychiatrist and I was admitted to a partial day hospitalization program for mental health. Good news is that I currently have been depression free without any antidepressants or therapists for the last several years. I have managed to cultivate an attitude of gratitude that has been of great help. I am on a slow taper off suboxone and hope that I don't run into problems with depression when I am finally off suboxone entirely. Best of luck in dealing with the depression problems.