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PostPosted: Wed Apr 18, 2012 9:43 am 
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Sigh....it amazes me how misinformed people are on this medication. Where would you get an idea like suboxone can't be prescribed off-label? Furthermore why post this without anything to back it up?

The purpose of this thread is to educate people who may be considering suboxone for depression treatment....I am not condoning it, nor am i saying its wrong....its my hope people can read this thread and know that yes it is possible....yes it can work....and you can do it without lying to the doctor about why you want to take it.

So please post accurately or from your own experience...not what you heard...or believe.

This excerpt is right from the buprenophine prescription writing guidelines....

If a buprenorphine prescription is written for an off-label use (i.e. not for opioid dependence), then no "X" number should appear on the prescription. Also, patients who are treated for off-label use are not considered to be part of the 30 or 100 patient limit.

the "X" refers to the X DEA number (which denotes buprenorphine prescriber status)

So there you have it...not only is it legal..BUT it also doesn't count toward their patient limit....hence why my doctor is seeing more then 100 patients right now.


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PostPosted: Wed Apr 18, 2012 12:55 pm 
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I'm not against Sub being prescribed for depression. I do feel that patients need to be aware of the risk of dependence, and its need to be weighed up carefully against the benefits. No doubt there are many people whose depression is so debilitating and life-threatening, that being opioid dependent or even addicted might be worth it to return some semblance of living.

As a person who's done the rounds of opioid dependence and depression treatments, IMO Sub for depression should be the avenue of last resort. If 6 montly rounds of ECT would have made me feel better, it'd likely have been less damaging for me than my years of opioid dependence.

It's just something that I think people need to be really cautious about. If enough doctors started toying with the idea, it wouldn't be long for RB to see an opportunity and start drumming up hype, if they haven't already.


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PostPosted: Thu Apr 19, 2012 1:39 am 
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Darken do you have a link to that Suboxone scripting guidelines? I'd like to print that out for my sub doctor. I know my subox doc thinks Sub can only be scripted for addiction, though he was willing (since I do use it for pain as well) to script the butrans patch to me and move me off his "100 list" and into the normal patient list. But I didn't want that cause the butrans patch is such a low dose.

Also I was just going off of my own understanding of the DATA act at
http://buprenorphine.samhsa.gov/titlexxxv.html
Which created the waiver in the old old law that says that opioid addicts are not allowed to be prescribed opioids for purposes of addiction treatment...and that suboxone is the ONLY medication the FDA has approved to be used under that act (though interestingly the act does say that class 3, 4, and 5 drugs are also allowed to be prescribed for purposes of opioid addiction...[but the FDA hasn't *approved* any others yet that I know of])

Also going by things like this, in the NJ prescribing guidelines:
"Buprenorphine is a partial agonist that is available for use solely by physicians certified in Addiction Medicine and those who have satisfied qualifications set-forth under the provisions of the Drug Addiction Treatment Act of 2000 (DATA 2000)."
http://www.nj.gov/humanservices/das/tre ... boxone.pdf
That has some other interesting stuff like how in NJ some doctors don't even have to abide by the 30/100 patient rule under certain conditions.

But anyway, that was my understanding of why it could not be scripted off-label. Obviously it can! Does a doctor need to be a certified sub doc to script it off-label or can ANY doc script it off-label?


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PostPosted: Thu Apr 19, 2012 2:00 am 
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Wanted to edit my post but didn't see a button to do so. Anyway this document clears it up. YES it can be prescribed off-label by any doctor with a C-III certification. Just as Darken said, they don't need to put their special Suboxone UIN on the label.
Here's the link:
http://www.naabt.org/links/dea_bup_for_pain_letter.pdf

Interesting and relevant quotes:
"The off-label use of the sublingual formulations of buprenorphine (Suboxone®/Subutex®) for the treatment of pain is not prohibited under DEA requirements. However, off-label use does pose a dilemma for pharmacists. Currently, there is no requirement under the DATA for a qualified practitioner to put the Unique Identification Number (UIN) on a prescription for Suboxone® or Subutex® for maintenance or detoxification treatment."

"If a physician prescribes, dispenses or administers buprenorphine (Suboxone®/Subutex®) for the treatment of pain or for any other reason, a DEA registration is required because both products are Schedule III controlled substances. The DATA waiver specifically authorizes qualified practitioners to treat narcotic dependent patients, using FDA approved Schedule III-V narcotic controlled substances for maintenance and detoxification. The DATA waives the requirement for obtaining a separate DEA registration as a narcotic treatment program for physicians using the approved drugs for maintenance and detoxification; however, it does not apply to physicians using Suboxone® or Subutex® for the treatment of pain. A physician using Suboxone® or Subutex® for the treatment of pain would be required to register with DEA as practitioner with Schedule III privileges."

So from the first paragraph it clearly says it is not prohibited for pain -- and I think one could infer that it's not prohibited for depression either (making it relevant to this thread, I'm not wanting this to go off-topic in your log Darken), they just didn't think to address it the time this was written. The second paragraph is a bit confusing but I think what they are saying is that docs who get the DATA waiver ("subox docs") don't automatically get the authority to prescribe other C-III meds, and that a doc who prescribes it for pain needs a standard C-III DEA number. Some docs have both and those could do it for opioid dependence or for pain; and any doc with a C-III DEA number already (which is probably most MD's as that class includes Vicodin/Lortab) can go ahead and prescribe it for pain.

This is very interesting. I didn't know this and I will show my doc next time. What ISN'T clear is if a doc who has both the DATA waiver and C-III number could *move* a patient from their "100 limit" to the "pain/depression/off label" group.


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PostPosted: Thu Apr 19, 2012 7:53 am 
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My doctor has the DATA 2000 sub waiver, but he prescribes my sub for pain (actually writes it that way on the bottle). I'd bet that he's not counting me in his 30 (or 100) patients. Since I started seeing him initially, he's become our family doctor, so I'm sure he's moved me from a sub patient to an off-label patient that just gets family care from him. That's pretty much the scenario you're thinking of, isn't it?

Otherwise, I'd say you have a good grasp now on the whole prescribing sub off-label.

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PostPosted: Thu Apr 19, 2012 11:32 am 
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Darken wrote:
Hey Everyone,

Although I'm sure this has been touched on these boards before, I wanted to start a thread detailing my experiences with Suboxone as treatment for Depression only. Throughout the web you can find stories here and there of people getting on this medicine to treat their depression, but it's tough to say if they are true or not. I will use this thread to help anyone of thinking of pursuing this treatment option for themselves. This thread will be 100% honest with no embellishing of facts or attempts to make the med seem like something more then it is. This is only from my experience, your experience may certainly vary.

A brief backgroung on me. I suffer from depression (MDD) with suicidal ideation. I do not have anxiety at all. I was hospitalized 4 years ago after an attempt on my life. This is when the Anti Depreessant med merry-go-round started. I originally was put on the AD Wellbutrin which made me feel great for two days and then it disappeared...a tease of feeling 'normal' that never returned in years of taking the med. During this time I was also put on various AD's including Celexa, Lexapro, Zoloft, Pristiq, Remeron, Seroquel XR, Abilify and others...all which had more side effects to them, then any positive effects on my mood. For four years I followed my PDoc's recommendations for treatment, only interjecting medication choices at times to avoid nastier AD's like Paxil and Effexor. Late last year I decided enough was enough and visited my GP looking for new options...

At the time we tapered my off of the current combo which was Seroquel XR, Zoloft and Wellbutrin. Since Wellbutrin was the only med to help...if only a little we decided to try a stimulant (adderall) to see if that might be effective in giving me energy. Adderall was the second medicine to give me a few days of feeling really good...followed by a much diminished effect...Adderall was very effective in giving me energy and helping me complete tasks that would have otherwise been left unfinished.

Coming into 2012 and now knowing two meds that helped briefly..clearly Dopamine is my problem area. I knew about Suboxone for years in reading a few stories(very few) online about people who had the luck of having in prescribed for them...but who knows if they were telling the truth. I asked my GP if he could refer me to a Suboxone doctor....he seemed onboard with the idea but was unable to find colleagues who would prescibe it strictly for depression...they would only see you if you were an addict or in pain.

I went to suboxone's website and printed out a list of the 100 closest doctors to me who were able to prescribe it. Calling around was little help as the secretaries wouldn't talk to you if you were not addicted. So I hit the letter route...I sent out letters to doctors explaining that I was looking to have Suboxone prescribed for depression and what my reasons were. I received 8 replies to the numerous letters I sent out and only one actually responded in a way that let me know he read my letter and might help.

His practice was 50 miles away...but I made and appointment and the rest is history. In short if your looking for treatment with suboxone for depression it's not going to be easy to find a doc...but if your honest and do it legimately....a doctor can be found....I'm living proof. thanks for Reading so far..

My journal of starting the med will start shortly....



I haven't read further, but this is pretty interesting. I would like to know more about your experience. I have never heard of this being used before, though opiates do make people very happy, and back in the day , opium was used to treat depression types, and yes it was also abused-but a lot of shamans used it in treatments.


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PostPosted: Thu Apr 19, 2012 11:34 am 
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tearj3rker wrote:
I wish Sub worked as an anti-depressant for me, but I get depressed just as much on Sub as I did while I was abstinent. I think maybe it's because I'm tolerant to opioids now. When I first started using them, they were fucking fantastic anti-depressants that cured me of all my woes. Then I became tolerant to them, and now I'm dependent on opioids with no benefit. Damnit!



Hey, me too. It does seem to help a bit at first, maybe the new found hope in the beginning of things, but now life is just life and still very hard at times!


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PostPosted: Thu Apr 19, 2012 12:55 pm 
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Thanks everyone for the feedback and comments. I'm glad that we can somewhat clear the confusion a bit regarding the prescribing conditions for Suboxone. I've mentioned it before in my posts that my situation is not ideal by any means, and it wasn't easy to follow through with, but it can be done, legally and without lying to the doctor about why you want to try it.

It was challenging to find a doctor who was willing to try it for this off-label use, but they are out there...look for MD's or Psychiatric doctors as they will be more likely to have experience using it for depression.

I agree that it should be used as a later treatment option as opposed to first line treatment. You may have success with one of the plethora of AD meds out there...but if you don't respond well then I think Suboxone might be a better option then say ECT..or some of the other Hardcore meds...heck some of the AD meds out there cause 'wtihdrawls' that can be just as unpleasant as coming off some opiates. In my opinion shocking your brain seems a 'little' more harsh then potentially getting on an synthetic opiate...but that's just my opinion.

For me right here and right now it's been more effective by far then any other med I've tried....I'm hoping that by being on a low dose I will not become as tolerant to it over time...that is my biggest fear to be honest...if this doesn't work then I have no idea what might be next. For the moment though I am very glad I took the risk and tried it as it has totally changed my life for the better....I can only hope this will continue in the months and years ahead.


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PostPosted: Fri Apr 20, 2012 10:46 am 
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I got on sub for opiate addiction, but it made my depression go away completely since day 1. I have been on it 2 months now and depression still hasn't come back. Hoping it stays that way.

I was also very resistant to AD's. I tried 7 or 8 of them over the last decade and nothing worked. I didn't expect subs to effect my depression, but I'm glad they did. I have tapered down to 3mg/day now and have been there for the last couple weeks (started on 8mg).

And I agree about some of the side effects of AD's. I was on Remeron for quite a few months and the only reason I kept taking it was because it helped me sleep. But I lost my insurance, and it made me gain 15 lbs, so I had to get off. It took me months to get off...I was down to biting tiny crumbs off the pill each night, just so I could sleep. Without tapering I would stay up for 2-3 nights in a row sometimes and started hallucinating from lack of sleep.


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PostPosted: Fri Apr 20, 2012 2:14 pm 
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Thanks Taurus...

You know I still don't agree with the whole term 'treatment resistant'...Rather I think the treatment is faulty at best. It's true that opiates were used in the past for depression, but were largely done away with when the modern AD drugs started to come out...however the remission rate has never been lower on these 'new' medications. I feel the reason is there are to many variables then just focusing on Serotonin or to a lesser extent Norepinephrine....Dopamine seems to be more of an issue with me...but who can say?

Whatever the case for me the AD's were not doing anything but causing more problems...you mentioned Remeron...between that and Seroquel I wasn't sure I would ever be able to sleep without medication again. I NEVER had sleep issues before getting on either medication...slept great while on both...but coming off of them was a nightmare...I couldn't sleep right for weeks...and still don't sleep as well as I used to. I have Seroquel for nights that are really bad...but fortunately I have not had to use it lately. Despite taking Suboxone twice a day in the morning and night...I seem to be getting back to a normal sleep pattern.

In regards to Suboxone being a rather novel choice for an anti-depressant consider this: Alkermes Plc - a maker of CNS drugs is working on an experimental drug called ALKS 5461.. this drug targets opioid receptors in the brain. It combines buprenorphine, which stimulates the receptors and is used to treat opiate addiction, with ALKS 33, which has the opposite effect, making a non-addictive medicine that may treat depression. I don't know if this forum allows links, but I can PM you the story if interested.

I welcome anyone to post their Suboxone success or failure stories in regards to their depression....co-existing or otherwise. As I said it's not going to be for everyone, but for me right now it's a lifesaver.


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PostPosted: Sat Apr 21, 2012 9:27 pm 
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This ALKS thing looks interesting. I wish there were more info than just press releases. I'd like to know more about this ALKS 33, like what the molecule looks like and what its pharmacological profile is.


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PostPosted: Tue May 01, 2012 3:18 am 
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I was getting confused earlier. What I was thinking of was how the law states that Dr's can't prescribe narcotics to manage opiate addiction (with the exception of methadone clinics and now DATA). They can prescribe anything they want off -label EXCEPT that. The law is telling doctors how to practice medicine. This is an OLD law, I think it was part of the Harrison narcotic act around 1914 or so. Other countries don't have these laws -- in the UK a dr can prescribe opiates for whatever they want. Your GP in the UK an prescribe methadone, DHC, or even diacetyl-morphine AKA heroin to treat addiction. Anyway sorry to be getting off topic....
How you doing Darken?


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PostPosted: Fri May 25, 2012 12:20 pm 
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Hi Everyone,

Time for the two month update. I hope to keep the journal fresh and consistent to help anyone else considering this med for depression treatment.

My experience in relation to mood continues to be positive on Suboxone. The first 30 days or so were really like a honeymoon phase you can get on other medications. On .5 mg twice a day I could feel the dose each and every time...basically felt like a tame opiate...some itching....some euphoria, but overall the largest effect for me was the overall energy level and positive outlook I now seemed to have on life. Negative thoughts and thoughts of Suicide are gone and overall it has been more effective then any other AD I've ever tried.

After 30 days though the ability to 'feel' the med take effect went away. Don't get me wrong the positive mood effects were still there, but I no longer could feel the medication 'working' (no euphoria, no itching...etc) I think this tends to lead people who are taking it for non addiction reasons to believe the med is no longer working....when in fact it is still causing positive effects. So yeah moral of the story don't judge a drugs effectiveness based on whether you get a little buzzed from it or not.

Now for the bad part...I've never been able to increase my dose about .5 mg (strip) any attempt to do so causes me incredible nausea...my sub doc says it's fairly common when trying to 'increase' the dose as your body adjusts to the level your taking. I want to get to where I only take it once a day...I have no need to take the second dose other then to keep my body at the 1 mg level....it would be nice to only take 1mg once a day.

I also suffer from daily nausea that is light and variable on a daily basis....it's frustrating as the med has been so beneficial to my mood only to apparently cause a very annoying side effect that is hard to live with. I have meds to counteract this...but the whole idea of taking a med to cure a side effect from another med bothers me and my doctor.

So I will keep this thread alive...60 days in things are still going well mood-wise....obviously it would be nice to still 'feel' the drug working....but I'm not complaining as it's still doing the job better then any other AD I've tried.


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PostPosted: Sun May 27, 2012 10:31 pm 
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Hey Darken :)

Glad to hear things are settling down ...

It sounds like you're starting to develop a tolerance to Suboxone, and thus a tolerance to opioids. This is both good and bad. Good in that the negative effects of the drug decrease. Bad because the positive effects diminish as well. It's easy when that happens to desire to increase your dose, which is fine. But it's important to be aware that increasing dose does make it harder to come off Suboxone, and increases dependence. Also the same thing will happen eventually after your dose increase - ie tolerance will build, and you will desire another increase.

Even me at 12mg has noticed that since I bumped it back up, recently my tolerance has caught up and I've started to get mild withdrawal symptoms / chills leading in my next dose. I could increase further, but I know the same thing will happen, especially given I'm around the "ceiling" level, meaning that I'm near the point where any dose increase will have no increase in effect. Because of this I choose to make do, and not increase my dose further, despite some mild withdrawal effects (feeling cold, goosebumps yawning, cravings in the morning and evening).

Take care.


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PostPosted: Mon May 28, 2012 12:17 am 
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Darken wrote:
overall the largest effect for me was the overall energy level and positive outlook I now seemed to have on life. Negative thoughts and thoughts of Suicide are gone and overall it has been more effective then any other AD I've ever tried.


Darken, just fyi, Suboxone is still working for my depression too. I started taking it for addiction, but remained on it because it helped alleviate my depression and gave me a much more positive outlook on life as well (in addition to controlling my cravings). My whole approach to life and attitude each day now is different than it was before subs, and people in my life can tell.

I'm glad this approach has worked for you so far. No other AD helped me in the past either. I know it's very frustrating trying one med after another, waiting 4-6 weeks every time to see if they are going to work, only to be disappointed in the end.


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PostPosted: Tue May 29, 2012 10:00 pm 
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It is allowable for doctors to prescribe all sorts of controlled substances off-label. Darken's experience of being prescribed stimulants for depression is a good example. As far as I know, amphetamine and the like are indicated for ADD and marketed otherwise only for appetite control and shift-work sleep disorders. Treatment-resistant depression is an off-label use, albeit perfectly acceptable and medically sound. Benzos like Valium and Xanax are another example. These are indicated for seizure control and panic disorder or general anxiety disorder, but in reality are given to just about everyone under the sun who asks for them (often specifically) from many psychiatrists. "Mommy's Little Helpers" and all that business. I don't see why opiates should be any different. Hell, tons of people have to take Percocet for the rest of their lives or live with unbearable pain!

Certainly buprenorphine should not and will not ever become a first-line depression drug, but it should be available to someone for whom regular antidepressant therapy has failed repeatedly. Given the nature of true diagnosed major depressive disorder with it's attendant misery and very real risk of eventual death by suicide, buprenorphine has the potential to save and transform lives for such an indication. And if a medically-managed dependence on an opioid occurs, then I chalk that up to another unpleasant but acceptable side-effect.

Bunny


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PostPosted: Tue May 29, 2012 11:07 pm 
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VERY well said, bunnyman. Agreed!

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PostPosted: Sat Dec 29, 2012 4:30 pm 
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Hi Everyone,

As I was doing my 'mental' year in review it occurred to me I never properly updated this blog. I'm sorry for anyone who was following and curious as to the end results. In short I am no longer on Suboxone and therefore didn't feel I had anything to add to the forum anymore but didn't realize I didn't list a final update.

I really had high hopes for the medication and fought tooth and nail to stay on it despite literally never knowing how I was going to physically feel on a daily basis. In the end I just could not take the daily nausea and no amount of anti-nausea medication was able to quell the nausea no matter what. I can honestly say I've never been so sick in my life as I was while on the Suboxone and it wasn't worth the positive mental effects it appeared to deliver.

I'm happy I went to the lengths I did to give it a try, but in the end there is a reason why this drug exists and treating depression is not one of them. As some others have posted it's a nice side effect to have if it helps with your depression, but to seek it as a direct medication to treating depression would be a mistake in my opinion. I learned the hard way hopefully others out there can learn from my mistakes.

Good luck to everyone out there on Suboxone for it's intended use, I admire you all for conquering your addictions.

Darken


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PostPosted: Sat Dec 29, 2012 5:47 pm 
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Thanks for the update, Darken. One thing you didn't mention was are you treating your depression now? And, if so, what are you using and is it working for you?
I am taking Sub for addiction, but I also have MDD. I am planning on going off Sub due to its side effects, but I am well aware that it treats my depression. When I go off I will be back on the AD merry go round. Any new insights you might have on treating depression would be welcome.
Thanks,
Lilly


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 Post subject: Hello Lilly ...
PostPosted: Tue Jan 01, 2013 5:36 pm 
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I am sure the only reason I take Suboxone is because of my bi polarism .... I've already been on the AD merry go round .. I,ve stopped trying to get off Suboxone.. I now believe all the tramadol I took prior to my spinal fusion basically stopped all by bipolar bullshit ... Now Suboxone does ... Darken , I fully respect your decisions , brains become re - wired with long term opiate dependence or addictions ... I believe this is a very important topic , the real cause a lot of a lot of opiate misuse .


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