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PostPosted: Mon Feb 13, 2017 3:16 am 
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Hi just wondered if the dosage when used for anxiety/ depression is different from a maintenance dose. I am on 24mg and alternating days with 16mg looking to get the dose down as low as possible. I was initially on 32mg and prescribed off labell for long term methamphetamine use with heroin, fent and any other strong opiates for the come down. It has kept me clean except for a few drinks since my first dose of suboxone.
The main reason or one of the many i guess i sarted on suboxone was the devastating affect anxiety was having on me and the result for me is i have not had that level of anxiety since starting on suboxone.
I was aware of the trials re suboxone being used as an anti depressant/ anxiety med but have not heard or read info regarding doses so would appreciate any info.
Cheers M


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PostPosted: Mon Feb 13, 2017 8:17 am 
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I'm aware that buprenorphine has a reputation for effectiveness in regards to depression, but I've not heard of it being used for anxiety. However I will say I felt the best...I have anxiety issues as well... when I was at
16 mg/s or above. (now down to 8 ). I can't say I felt like my anxiety was directly reduced, but I just somehow felt comfortably supported by scads of bupe. Dr. Junig tells us that for many...most?...people, full receptor saturation doesn't take place until doses of 16 mg/s.

Dr. J also says that 16 is the number you want to be at to be sure or as sure as you can be, that you'll be safely unbothered by cravings. This is well above the ceiling effect (the point where more bupe doesn't do much if anything in terms of opiate effects) so it's a bit of a paradox.

Others will likely be by. Perhaps Dr. Junig or Doc.


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PostPosted: Mon Feb 13, 2017 5:11 pm 
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There are no evidence based guidelines for Buprenorphine being used for anxiety/depression, nor do I anticipate any being added in the near future.
I look for the effective dose that manages cravings and allows for maximum function. It might be 4 mg a day or 20 mg a day. If there is a positive effect on their depression or anxiety we (meaning both of us) are pleased. I don't try to tweak the dose to see if we can effect their affect. Psych pun intended.


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PostPosted: Mon Feb 13, 2017 7:33 pm 
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Thankyou Godfrey and Docm2 i will keep on with the plan.


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PostPosted: Wed Feb 15, 2017 11:37 pm 
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I have the same opinion-- exactly, to be honest. I try to be consistent but I've probably written inconsistent things over time... but my thoughts on saturation are that there is a difference between 'full saturation' shown in lab studies vs. the full effects of clinical buprenorphine. As docm2 wrote, I have patients who seem to be 'fully saturated' from a clinical standpoint at doses as low as 2 mg buprenorphine per day. Those patients would claim that higher doses do nothing to increase the opioid effects that they can detect. I have never prescribed more than 24 mg per day, but I realize that some docs prescribe 32 mg, and even more. My opinion is that doses higher than 16 mg rarely increase opioid stimulation. i could be wrong, but I think many patients, especially early in treatment, THINK they need more than they really need.

But as docm2 wrote, I don't anticipate any FDA recommendations for anxiety or meth treatment, and I don't anticipate any increase in dosing recommendations for any indication. Understand that buprenorphine is really a 'microgram drug', with potency similar to fentanyl (but with a ceiling effect that makes it much safer than fentanyi). The milligram doses used for addiction, in many ways, are 'supra-maximal' doses-- and are qualitatively different than the microgram doses used for pain treatment in Butrans or Belbucca, for example.

Some addiction docs would say that the anxiety you are experiencing actually represents cravings. It is hard to see buprenorphine as an 'anti-anxiety' medication, as the depressant effects go away, almost entirely, with tolerance. Unlike benzos, buprenorphine does not block memory or concentration. But if you do get some anxiety relief, that's a helpful side effect!


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PostPosted: Thu Feb 16, 2017 5:54 am 
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Thanks for your reply Doc, i hear what you are saying about suboxone and its impact on anxiety and that the benefit i am getting is collateral. I am suprised and sorry to hear that there are no plans to help other meth addicts, I know my doctor here has a number of meth addicted patients on suboxone and is replicating my experience.


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PostPosted: Fri Mar 24, 2017 1:04 pm 
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My biggest problem with quitting CD turkey of opiates was the anxiety it was last for 3 to 4 days I couldn't take it anymore I mean I literally didn't eat or sleep and I repeat did not eat or sleep I might have dosed off for 30 mins here and there but the anxiety woke me right back up. That's a horrible feeling and would not wish it on anyone. I would pace my living room back and forth cuz I felt like it was so overwhelmi h i jus wanted it out of.my body I would yell at my boyfriend and literally jus tried to avoid my teenagers cuz it wasn't there fault and didn't want to yell at them. If it wasn't for the anxiety withdrawal I would have jus quit cold turkey. But I codbt take it anymore and would jus go buy opiates of the streets. So a question I have is that is there any prescribed meds that could help me with the anxiety withdrawal. Before I was on subutex my doctor didn't know I jus told him it was my anxiety off the roof and gave me several different meds Nd nothing worked. Now him knowing and telling him that sometimes towards super time I start to feel my anxiety kicking in and has given me the same and some different meds but notho g seems to work. So is there such thing as a med that would take my anxiety away if i quit my subutex. I know I can do it I did it for ways but my anxiety starting kicking in along with the hotflashes and sweating, that I can handle but the anxiety I cant


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PostPosted: Fri Mar 24, 2017 3:14 pm 
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Hi Lindy,

Might be a dumb question, but have you tried benzos? I can't imagine that Xanax ..assuming you've got
no tolerance to speak of, wouldn't cover your anxiety. Still it's hard to imagine you haven't at least tried these drugs.

I hate Xanax and the whole fam damly of benzos, but if you were talking about a very short time I would
say that's what they were made for.

But it's not going to be a short time if you're quitting subs CT. I'm sorry, I don't know any of your details.
Are you currently tapering at all? Are you currently on full opiates, or subs?


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Dr. Jeffrey Junig, M.D., Ph.D.

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