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PostPosted: Sat Feb 05, 2011 7:31 am 
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Hey guys,

I had a very interesting late December early January. It would have been very hard to type the whole thing out again, so I've pasted here a msg I dropped to the doc. I'm kinda desperate for answers.

Ideally I'd like to find someone else who's had similar experiences who can help me find a solution? But I get the feeling I'm one out in this complex mine-field.

Maybe someone will learn something? Or maybe it could pose as a warning for those who have bipolar and are thinking of going on anti-deps while on suboxone treatment.

Quote:
Dear Dr Junig,

I've been meaning to get in touch with you for some time on this topic, given your areas of expertise & hands on experience with opioid addiction.

7 years ago I was diagnosed with bipolar type 1, after suffering (or should I say, immensely enjoying) 3 manic episodes in my late teens and early 20's. I also started using heroin at the age of 17 after my first psychosis, in the "black hole" period of feeling lost as if the rug had just been pulled from under myself & my life ambitions.

Anyway, 3 years ago I started to put my heart and soul into trying to get clean. I tried many different methods - methadone, subutex, suboxone, 12 steps, long term rehab - each with varying success, at best 13 months abstinent with no drug replacement. Today I am on suboxone treatment, which I started in July of 2010, along with lithium & sodium valproate combination treatment to take the edge off my cycling mood.

The issue I'm hoping you could clarify has to do with my bipolar depression. These days, depression is the prevalent mood through which my illness manifests. Basically, I spend every waking minute in a grey, mild depression which makes it difficult to enjoy anything, and I often find myself avoiding social situations because of my cynical attitude (I feel like people wouldn't want to hang around me cos of my bleak outlook). Woe is me. What's the point of living. Blah blah blah.

Occasionally this mild depression dips really hard into a severe depression, and I start to consider doing bad things to myself. However, in these sad states the thought of using just makes me more depressed, so using really is the furthest thing from my mind.

Anyway, when this happens I toddle off to the psychiatrist, and explain to him how I'm feeling, as I did around xmas / new years 2010-11. And (of course) he prints me off a script for the latest fandagglin SNRI - Pristiq, basically because it's only the SNRI's that seem to work for me.

So I start taking these pills, and within 3-4 days I start to feel better. However, with this marked uplift in mood, really intense cravings to use heroin come back, even months after not using. It's as if all the negative consequences that will arise from relapse don't matter. I stop caring. I turn into some kind of hypomanic hedonistic short-sighted pleasure seeking machine. The fact that these anti-deps feel a little bit like amphetamines, and dilate my pupils, doesn't help either.

So, of course, just like in late December / early January of this year , I relapse. Now here's where things take a surprising turn. It seems like while I'm on these anti-deps (this time desvenlafaxine, previously venlafaxine, duloxetine, and to a lesser degree luvox), suboxone loses all its blockade effect. I can have a shot of heroin 2 hours after my dose of suboxone and still get high. I also discovered a nifty way to gauge how well the gear would work by [removed]...
By the mid January I was using every day again, though only once a day so the suboxone wouldn't precipitate withdrawal.

Fortunately I still had the presence of mind and sanity to see the pattern which had formed. I jumped off the pristiq (a rough ride in itself), and luckily within a day I lost all the desire to use. I haven't used since

Have you heard of this happening?

My question to you Dr, and I'm desperate for some kind of answer as this reaction has my docs bamboozled... Do you know of any way to treat bipolar depression that does not affect my recovery?

It seems that when they try to treat my bipolar, it messes with my addiction treatment, and when they treat my addiction, it messes with my bipolar.

Getting so sick of the wringer :|

I understand you get a lot of msgs, but I'd really appreciate it if you could shed some light on what I'm going through. Do I just have a unique metablism? Is there still a way medicine can help me?

Thanks.

T


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PostPosted: Sat Feb 05, 2011 8:36 am 
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Good to "see" you again, tearjerker. I'm so sorry to hear about the relapse and the challenges you've been facing. It sounds like you've been on a terrible roller coaster and when you try to address it, it just makes things harder. I respect your determination to find the right combination.

I'll let the doctor address your specific question about your response to these two meds. I did want to ask if your doctor has ever tried mood stabilizers with you - like lamictal or abilify? I have major depressive disorder, but many doctors over the years have tried to tell me I'm bipolar. My therapist and I feel that the label is just not important for me and treating my issues is the way to go. I used to have terrible moods swings, but since I've been on my latest cocktail of Celexa, Abilify, and Lamictal my life is finally stable. Next to zero mood swings and only rare bouts of depression. So I know what it's like to struggles with mood issues and trying to find the right combination of meds to treat it. You're not alone.

I really hope you can find a way to treat both of your diagnoses and can get some peace of mind soon. Please keep us posted and I'd love to hear what Dr. Junig has to say about it. Take care.

_________________
-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

-I'm only responsible for what I say, not for what you understand.


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PostPosted: Sat Feb 05, 2011 11:07 pm 
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Hey again Hatmaker,

Good to see your'e still doing your quick responses :) Thank you.

I was on Lamictal at one stage. I can't remember if it was Lamictal alone, or in combination with lithium. It was a number of years ago now. If I recall correctly, I felt that the benefits of lamotrigine didn't outweigh the money cost. In my country, lamotrigine isn't covered by our government PBS, so while I only pay $5 for a script of lithium, depakote (epilim), or tegretol, I had to pay $60 a month for lamictal. And given I didn't find it much more effective for ..me.. than lithium / epilim, I just stayed on the tried and true.

It's good to hear Cipramil is working for you. According to my subox prescribing doctor, many of his patients are on SSRI / SNRI medications and they don't interfere with their recovery at all. So I'm just a complex, annoying case. The only theory I can pull out is that anti-depressants easily flip me into a hypomanic state (and potentially even a full blown mania if I'm not on mood stabilisers), so I instinctively grab for anything to "bring me down", usually heroin.

At the moment I'm pinning a little bit of hope on a new anti-depressant, Agomelatine, which although isn't covered on the PBS, apparently it will be in the next few months. Given that it has a different mechanism, and it is taken at night, I'm hoping that I won't find it as mind altering and leave me as wired as the SNRI's. I'll let you know how I go.


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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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