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PostPosted: Mon Apr 17, 2017 1:59 am 
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I started Suboxone a week ago and I haven't felt like myself at all since. I'm not really craving opiates when I'm on it but my desire to do anything is pretty much gone, I no longer enjoy any of the activities I used to do and I don't have the motivation or energy to even leave the house unless I absolutely have to. I feel really out of it, I have a lot of brain fog and my memory is shit. I can barely find the desire to eat. I heard a lot about this stuff being good for treatment resistant depression and I was really hoping it would benefit me but I seem to be back where I was before I started using, maybe worse. Is this just because I haven't been on it for long enough? I tried a smaller dose yesterday and I managed to go out for a few hours so maybe I just need to take less. I don't know what to do if this doesn't work for me, I can't take methadone either (I tried a couple times and it also made me feel awful and gave me a major panic attack, plus I'm a hypochondriac so I'd be worrying about my heart constantly) and I've already failed to get clean without medication 20 times. Did anyone else get depressed from it?


Last edited by beatrice on Mon Apr 17, 2017 2:30 am, edited 1 time in total.

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PostPosted: Mon Apr 17, 2017 2:06 am 
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Not typically, no. In fact, it often has the opposite effect.

We can't really tell you much without knowing how you inducted, how much you're being prescribed. What drugs you were on before and how much. Some numbers would help!

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PostPosted: Mon Apr 17, 2017 2:29 am 
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I was taking about 16 to 20mg of dilaudid daily. Sometimes I'd use other stuff like morphine or oxycodone. I always felt motivated and cheerful when I was on them, I was excited to do everything and felt really normal for the first time in my life when I started using. I had always been extremely depressed and never wanted to do anything but lay around and cry. People around me, especially my family would comment about how happy I seemed; nobody knew I was using opiates. I did that for a year and eventually I couldn't stop. I tried many times to quit on my own. I talked to my doctor about it and they put me on 8mg of suboxone, we waited 24 hours from my last dose of dilaudid and I didn't have severe withdrawal or anything after I took it, things actually went back to normal except the fact that I couldn't stay awake or even keep my eyes open. I went 3 days like that, just constantly passing out, unable to focus my vision etc. I cut down to 6mg a day and I'm able to stay awake now, but I still have no desire to get up, go out and do things, see my friends or even talk to my friends. My father says I seem like a zombie, and that's absolutely how I feel. I tried taking only 4mg today, and I'm still depressed but now my cravings are starting to come back.


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PostPosted: Mon Apr 17, 2017 11:07 am 
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Hey Beatrice!

I can't remember exactly but doesn't dilaudid come in like 4mg and 8mg.... something like that? Not long after my addiction started, my drug of choice was morphine and most addicts that abuse morphine usually use dilauded too, I did and I think it was 4-8mg. So if that's right (not totally sure it is) then 8mg doesn't seem like ur overly medicated for what ur tolerance was. But that's kind of what ur symptoms seem like..... the sleepiness and feeling foggy headed. I will say though, when I first started buprenorphine, I dealt with being sleepy a lot at first. I adjusted really well though and figured out that when I started getting sleepy, I just kept moving. I noticed if I sit still then I'd get sleepy but moving around doing stuff made it immediately go away. But regardless u will adjust imo and usually these symptoms will go away.

With suboxone, I didn't get all that energy that I got from when I was using, I just felt like my 'normal' self again. So u may be looking for that old energy rush that u used to feel on opiates. I do feel a tiny bit energized after I dose but nothing like when I was using.

I don't think u should be cutting ur dose bk so quickly because ur not giving urself enough time to adjust, it's only been a few days. Cutting urself down too low ur going to start experiencing cravings again.

I think u should just stop reducing ur dose and give urself some time to adjust to this medication. It's such an amazing life saving medicine, just try to give urself a little more time. I truly hope u start feeling better!!

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PostPosted: Mon Apr 17, 2017 3:07 pm 
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Hi Beatrice...

Sorry you're having such a hard time. Jenn is right to stress that it's so early. It sometimes takes
a while to adjust to this medication. Give it some time. Of course if you're feeling better and more energetic on a smaller dose...without feeling withdrawal symptoms or cravings...then perhaps you are on too high a dose. But if I read your post correctly at 4 you started getting clear signals it wasn't enough.

I was a poppy tea addict and I don't know how to assess the size of your habit. However Jenn's got plenty of experience so I'm sure she's giving you excellent advice.

By the way. your response to opiates sounds perfectly normal to me too. I was never happier, or more focused, or more energized than when high on DOC.

I think one likely cause of your lethargy...although it sounds like more than that too...is depression. That also seems normal to me. One really gains the world when successfully switched over to buprenorphine but it's a loss at the same time. Even though by that time the drugs are likely not working that well anymore, it's perfectly normal to miss what had essentially been a dear friend over a long period of time.

Of course by the time you're ready to throw in the towel, that friend had well and truly turned on you. But it's hard to forget the good times.
If you feel adequately covered with 6 mg/s I would stay there for a while and see how I do over the next few days...

Keep posting! We're all here to help.

Best wishes,
Godfrey


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PostPosted: Mon Apr 17, 2017 7:34 pm 
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Sorry Beatrice, I went to bed before I could answer you.

This is what I'm hearing you say. You were always depressed and laying around crying before you started on opioids. Opioids made you feel much less depressed and everyone noticed. Since going on suboxone you are always tired and you are feeling depressed and unmotivated. Your family is noticing.

There may be something about your brain chemistry (low levels of natural dopamine?) that is only reversed on a full agonist opioid (like oxy, dilaudid, morphine, methadone, etc.) Buprenorphine, the ingredient in suboxone, is a partial agonist at the mu receptor in the brain. Therefore its effects are a bit different. So being on a partial agonist opioid may not give you that same happy, peppy feeling you had on other opioids.

In other words, you might be back where you were, when you were depressed all of the time. It seems to me that you need a good psychiatrist to help you treat both the addiction and the depression. Suboxone is not causing depression. It is just not relieving your already occurring depression.

I hope you can find some help with this. The sedation effect should ease up as your body gets used to the medication. The depression, however, may very well be more complicated. I wish you well as you figure this out.

Amy

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PostPosted: Mon Apr 17, 2017 8:08 pm 
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I thought I replied, but I must have lost the post...

Understand that there is very little difference between the effects of oxycodone, morphine, and hydromorphone (Dilaudid). Differences in potency create the different subjective experiences, much more than any other differences between drugs.

Also, understand that most of us had similar effects after taking opioids. That's why they are so addictive! We all felt more sociable, motivated, and cheerful on them, at least at first. But eventually those positive effects ALWAYS go away. There is no way to keep those positive effects going indefinitely, including by taking buprenorphine.

12 mg of Dilaudid is about as potent as 40 mg oxycodone, so your tolerance is not real high. The sedation and 'fog' from buprenorphine is likely being caused by the higher potency of that drug.

Buprenorphine or Suboxone is given in lower doses for pain. But the higher doses used for addiction are not intended to be titrated the way you are trying to do it. For these purposes, people are either ON or OFF buprenorphine, because if ON, they need to stay at a blood level higher than the ceiling threshold. If they try to take a lower dose, that doesn't stay above that threshold, they will have cravings and maybe withdrawal symptoms.

It appears to me that buprenorphine is not the right approach, given your tolerance. I have a blog post about whether to start buprenorphine in patients addicted to Vicodin, and those principles apply here: http://suboxonetalkzone.com/hydrocodone-vicodin-addiction-and-buprenorphine/

Whether to use buprenorphine for depression is a controversial issue; I wouldn't prescribe it for that purpose, but some doctors might. But beyond that issue, buprenorphine has an effect that is best-tailored for those with higher opioid tolerance than someone taking 12 mg of hydromorphone per day. Your choices are to either stop the buprenorphine, and find another approach, OR to stay on it and stay safe, until your tolerance increases-- which will take a couple weeks. If you stay on buprenorphine you should avoid other respiratory depressants, avoid driving, and recognize that you are 'impaired', at least until your tolerance adjusts to buprenorphine. That usually occurs over a few days, and maybe a few weeks.

The question, though, is whether your depression will be reduced by buprenorphine at that point. My best answer is 'I don't think so'. I say that because your expectations are WAY too high. You are thinking about the way you felt when taking oxycodone, morphine, or Dilaudid-- probably memories from before those medications began to turn on you. NOTHING can compete with THOSE memories-- at least not all the time! You may have a good day now and then when everything is going well, or when all of the misery from opioid dependence seems to be fading away... but a day or a week later, life will enter in again, with all of life's miseries. Someone you love will decide to love someone else, or a great employer will find a different favored employee. That beautiful sunny day will give way to rain. Of course on the other hand, you can read every one of these sentences in the opposite orders, and see that good times will return.

But happiness 'on demand' is never possible. Not for any of us. That's nature's intent; her way of keeping us dependent on each other, which is the ultimate reward in the long run.

My advice? Take buprenorphine, but don't expect anything from it. If you do your part of the equation and make efforts to avoid opioids, you will have the chance for a better life than you would have taking opioids. Also, stick around! There are many interesting, kind people who use this forum, who enjoy sharing their journey with others. And when the next struggling newcomer comes along, you'll be here to help show him/her the way.


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PostPosted: Mon Apr 17, 2017 8:24 pm 
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Beatrice, just to let you know, suboxdoc is the real deal and the psychiatrist who founded this forum. If anyone else's answer contradicts his answer, definitely rely on his advice before anyone else's (like mine). I thought that buprenorphine might have less effect on depression because it is a partial, instead of full agonist. But Dr. Junig doesn't say anything like that in his post, so I could be wrong even though I was giving you my truthful opinion. I hope we're helping you!

Amy

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PostPosted: Tue Apr 18, 2017 12:32 pm 
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I appreciate that, Amy, but we may just be looking at different things. I think you are correct-- that a full agonist is going to get those dopamine reward pathways cranked up more powerfully than a partial agonist like buprenorphine... so I agree with you, that the potency of agonists accounts for the greater cheerfulness on those meds-- at least temporarily.

My comments about buprenorphine and depression were in regard to how someone may respond on it long term- after tolerance has developed, and 'after the thrill is gone' (trivia question: Artist? Album? Best memory when that song was on the radio?)


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PostPosted: Tue Apr 18, 2017 12:44 pm 
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Regarding comments about Beatrice's tolerance being too low for bupe....

That makes sense of course and would explain a great deal. And yet at 4 mg she was starting to have WD
symptoms and a return of cravings.

It's a bit of a conundrum, no? More likely I'm missing something.....


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PostPosted: Wed Apr 19, 2017 5:33 am 
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As I stated I was taking around 20mg a day, but I could take 16 and manage alright. I'm cutting back to 4mg now on the suboxone and that doesn't seem to be too sedating, I don't notice anything from it really, and I didn't get any major withdrawal symptoms although I had a few mild ones, and for some reason I get hypersensitivity more than anything and I always get brutal headaches and stomach pains (I had to go to the ER once because I thought I had internal bleeding, they did a scope and it turns out there's nothing wrong with me. The main thing I get from withdrawal is hyperalgesia). I'm probably going to try to taper off it. I'm still miserable but honestly I was before I even started abusing drugs. I decided to try the suboxone partly because I couldn't seem to stop using the pills, and partly because I was hoping I wouldn't end up as severely depressed as I was before. The main reason I quit was because I used them in some dangerous ways a couple times and did things I told myself I wasn't going to and I felt like I was losing control of it, not to mention that it wasn't sustainable. I don't know if I'm gonna stay clean forever, but I'm going to try and hopefully I can find something that will help me enjoy life a little that isn't just drugs.


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PostPosted: Wed Apr 19, 2017 7:47 pm 
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I've felt a bit better yesterday and today, I've been taking 6mg a day now and I've been able to go out and do some things. I'm not falling asleep all the time. Problem is my doctor isn't happy about me taking 6 and wants me to go to 12mg. I can't imagine that I'll be able to function on that and if I'm not having any cravings why would they want to increase it? I told them I feel better when I take less.


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PostPosted: Sun Apr 30, 2017 7:49 am 
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Some doctors can be quite naive as to the potency of buprenorphine in comparison to low doses of agonists. 12 or 16mg of Suboxone is a relatively significant dose, and coming from the tolerance you had to Dilaudid, may leave you more dependent on opioids than you were before starting Sub treatment.

I'd negotiate with your doctor about the dosage you want. Make sure you voice your needs. In the long run you will be better off.

Just my opinion. I am not a doctor, but I have seen many people on Sub over the years. When I first went on buprenorphine I was using heroin maybe once a week maximum. 4mg of Sub a day made my eyes droopy and put me on a "nod". When my doctor saw me a week later she dropped me down to 2mg, and that was fine. However when I reduced to 1mg and jumped off, I experienced more withdrawal than I ever did during my weekend "chipping" of heroin. So in that regard I experienced more dependence by my first round of Sub than I did using the heroin.

Mind you, I could have died from that weekend heroin use which Sub arrested for 6 months. You never know what could have been.

The other thing is, it sounds like you have been grappling with significant depression over your life. Suboxone, in ..my.. experience, doesn't do much to curb my periods of depression. It works for a lot of people as an antidepressant, but not others.


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