Whats your effective "antidepressant" dose?

Does buprenorphine treat depression? Is my depression from Suboxone? Will Suboxone treat bipolar? Will naltrexone or Vivitrol make me depressed?
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Re: Whats your effective "antidepressant" dose?

Post by rule62 » Mon Jun 11, 2018 7:25 pm

Hi Cory and welcome here. When I first got on Suboxone it was a similar story to yours. It took away all urges for just about everything. If I was still drinking it would have helped there too. Just the normal feeling of the medication was amazing.

Yes, there have been some small side effects that are consistent with any opiate derivative. But I've been on it since 2010 and have no desire to stop ever. What little problems it causes far outweigh its benefits. What it doesn't do is dull my senses or effect my happiness meter one bit. Just feel normal all the time.

We're very glad to hear you found recovery and are enjoying life once again.

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Re: Whats your effective "antidepressant" dose?

Post by docm2 » Tue Jun 12, 2018 12:45 pm

For years I have appreciated TJ's insights and posts. Especially what is happening 'down under.'
PAX

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Re: Whats your effective "antidepressant" dose?

Post by Cory » Thu Jun 14, 2018 9:23 am

Thanks everyone for welcoming me here. Some changes have occured in the past couple of weeks. I began to loose the antidepressant effect of the Sub. I have a feeling the dose is too high for that side of things. For addiction purposes it is still helpful. I suppose we all try at least once to get high from the Sub. I began adding a tab in the afternoon as a booster with positive effects but of course that left me short. Well then a good opportunity to see if my old friend codeine would level it off. In fact it did, slightly but no high. I'm content now to know that I really can't get high on this stuff but also that the codeine works a little if there is a WD concern but then also to know that I can't get high on opioids with the Sub flooding the receptors. I am an addict after all. I will have to confess to my Dr. all this. I'm not used to being honest with doctors. I'm a very good scammer. A con. That's not what I want in my life anymore so I will be upfront. I have a feeling he will suggest that I am not stable yet. I really felt that the booster dose in the afternoon was helpful and I can work with that. I understand the normalizing of behaviour by once daily dosing but I am not really at the place where I am ready to give up my drugs totatally. I just don't want to die from it. I dropped twice 2 months ago when the fentanyl in my meth syringe hit me. I have been using drugs since I was 15. I'm now 56. I really can't see and maybe don't really want to see or be totally off drugs. That may not be the road to good health. Again, it's a matter of safety. We will see if my opinion changes as my depression lifts. If it does.
My depression came back hard 10 days ago. I'm now as of today put myself on disability. Short term. My Psych is on board as are my friends and my GP. I have started lamotrigine day 4 now. I swear I can feel a positive lift already. I am a dedicated musician but I have not touched an instrument in months due to the depression. This has never happened in the past so I know that something is dramatically wrong. Maybe the time away from work and stress will allow me back to my 1st love. I live on the ocean in the PNW Canada. I have never seen a more beautiful place. I will try to hike and maybe go camping and indulge myself in the healing properties of the forest and nature.

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Re: Whats your effective "antidepressant" dose?

Post by jennjenn » Thu Jun 14, 2018 11:05 am

Cory the place you described where you live sounds amazing!!!! I could literally picture it. Take advantage of that!! How lucky are you to live in such a great place! My suggestion would be to just be honest with your doctor about running low and you slipped up because of that. Maybe see if your doctor will be willing to prescribe you a little higher of a dose. Get leveled out with your dose again and just do things like hiking and music. Give yourself time to adjust. Good luck!
Jennifer

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Re: Whats your effective "antidepressant" dose?

Post by Amy-Work In Progress » Thu Jun 14, 2018 2:23 pm

It is good that you are recognizing the possible motivations behind your actions. Keeping it real with yourself and others is important in recovery.

There is nothing wrong with harm reduction, but stay safe! You've had some close calls and I hope that keeps you on the straight and narrow. Let us know if you need help.

Amy
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Re: Whats your effective "antidepressant" dose?

Post by Ashlee » Mon Jun 18, 2018 2:20 pm

Cory,



How are you feeling now? Have you been to your doctor yet? I honestly got a little jealous when you said you live on the ocean in Northwest Canada... I can't even imagine how beautiful Mama Nature is on that side of this continent.

Cory, you are extremely strong for pulling through & making it this far! The fact that you are so honest with yourself is incredible. Being honest & upfront in regards to recovery is the only way that you'll be successful! You really are doing great & we're here for ya!


You mentioned that you're a musician... What instrument do you play? How do you feel while you're playing/writing music? What are your favorite genres? I find music to be like meditation for the soul. It moves you in ways (soulfully) that no pill or drink could ever do. Sorry for the rant!

Hope you're doing good today!


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Re: Whats your effective "antidepressant" dose?

Post by River9 » Tue Sep 04, 2018 5:30 pm

Greetings to all. Here I am still stuck at 3mg. My goal when I started the taper process in early June was to get down to my lowest effective dose. I've had a couple of problems with pain here and there but it has evened out after a few days. However, the biggest problem is depression. It is unrelenting. I've suffered with it my whole life on and off, but sometimes I am getting scary depressed. These crazy thoughts pop into my head like I am stupid, people don't like me, and I always feel like I don't have long to live. And now it's getting me in my dreams. I can't even escape it when I am sleeping. Can anyone tell me the dose around which the antidepressant is most effective. Is it at the higher doses or the lower doses? I have seen over and over on this board that less is more. And I am not giving up on the less part. I am thinking about going on an anti-depressant in hopes that I will be able to get my dose lower. I also saw on this sight that Bupe is generally used in <1mg. So that's what I want. If less than 1mg is what is usually used for pain than I want to be at less than 1mg. Anything above that for me just reassures me that I am a failure. :(
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Re: Whats your effective "antidepressant" dose?

Post by Amy-Work In Progress » Wed Sep 05, 2018 10:32 am

River, you are not a failure! That is your depression talking. You recognize how destructive your depression is in other areas of your life. You need to think about the messages you are receiving from your depression about success/failure.

Taking buprenorphine for addiction and/or pain is very individual. What if you metabolize buprenorphine more quickly than others who are at <1mg? Would it then make sense to put some arbitrary limit on how much buprenorphine YOU should be taking??? Of course not! You are shooting for the lowest effective dose, and if that is 3mg for you, it's 3mg.

It's ridiculous to let your depression determine how much medication you should be on. That is like saying, "Ok, forget my rational mind. I'm going to let my opioid addiction dictate what I should be doing!" Does that make any sense? Then why let another mental health disorder take the reins?

If you were advising a friend or relative on what their dose should be, would you tell them to set an arbitrary amount below 1mg because anything above that would be a failure? No. You would tell them to find their lowest effective dose. You would make sure that they make a decision that is correct for THEM, not the rest of the world.

I don't know what the best dose is for alleviating depressive symptoms, in part because it's so individual. Plus, I'm sorry to say that buprenorphine is not a cure for all cases of treatment resistant depression. I think it would be a good idea for you to see a therapist who is skilled in cognitive behavioral therapy or solution-focused brief therapy. Although long-term therapy can be beneficial for some, you can get a lot of improvement through a more limited amount of sessions as well.

Depression makes you look at the world through a harsh lens, but you can learn to shift perspectives and understand that there are other ways of viewing your problems.

Amy
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Re: Whats your effective "antidepressant" dose?

Post by TeeJay » Mon Apr 15, 2019 7:00 am

Ashlee wrote:Teejay...

You have me curious now, why do you say that?
It's a bit of a delayed response. But in my experience, my depression has been quite independent of my dose of buprenorphine. Because of that, I don't really subscribe to the idea of buprenorphine being an effective antidepressant for me, at least not for my depression which is bipolar in origin. It does however have many other benefits in terms of craving management, blockade and the often understated but life-saving benefit that it maintains a moderate opioid tolerance.

There have been periods where I've had stability where I've managed to come off maintenance completely. And getting off maintenance is a pretty big achievement for anyone. So maybe just being proud of myself for being opioid free during those periods had a strong antidepressant effect. Or maybe it was the other way around. Having a period of relative stability free from mental health symptoms, especially depression, allowed me to come off maintenance in the first place.

Depression is really complex and no doubt has different origins for different people, and thus different treatment approaches are required. So any comments I make re buprenorphine's supposed antidepressant effects are speaking for myself only.

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Re: Whats your effective "antidepressant" dose?

Post by TeeJay » Mon Apr 15, 2019 7:12 am

River9 wrote:Greetings to all. Here I am still stuck at 3mg. My goal when I started the taper process in early June was to get down to my lowest effective dose. I've had a couple of problems with pain here and there but it has evened out after a few days. However, the biggest problem is depression. It is unrelenting. I've suffered with it my whole life on and off, but sometimes I am getting scary depressed. These crazy thoughts pop into my head like I am stupid, people don't like me, and I always feel like I don't have long to live. And now it's getting me in my dreams. I can't even escape it when I am sleeping. Can anyone tell me the dose around which the antidepressant is most effective. Is it at the higher doses or the lower doses? I have seen over and over on this board that less is more. And I am not giving up on the less part. I am thinking about going on an anti-depressant in hopes that I will be able to get my dose lower. I also saw on this sight that Bupe is generally used in <1mg. So that's what I want. If less than 1mg is what is usually used for pain than I want to be at less than 1mg. Anything above that for me just reassures me that I am a failure. :(
I personally don't think it's a good time to reduce your dose if your mental health isn't sound. Depression is a symptom of reducing off opioids, so if you're already feeling as such, reducing further will only make it worse.

As for the notion that bupe is generally used < 1mg. That's for pain management in non-opioid dependent people. ie people with no tolerance. People like us are different. We need higher doses whether it's for pain management or addiction management.

As for which dose provides more antidepressant effects, obvs increasing your dose until the ceiling effect = more mu-agonism = more euphoria = less depression. But this comes at a trade-off of higher tolerance, and later difficulty in coming off if that's what you want to do.

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Re: Whats your effective "antidepressant" dose?

Post by TeeJay » Mon Apr 15, 2019 7:21 am

Cory wrote:Thanks everyone for welcoming me here. Some changes have occured in the past couple of weeks. I began to loose the antidepressant effect of the Sub. I have a feeling the dose is too high for that side of things. For addiction purposes it is still helpful. I suppose we all try at least once to get high from the Sub. I began adding a tab in the afternoon as a booster with positive effects but of course that left me short. Well then a good opportunity to see if my old friend codeine would level it off. In fact it did, slightly but no high. I'm content now to know that I really can't get high on this stuff but also that the codeine works a little if there is a WD concern but then also to know that I can't get high on opioids with the Sub flooding the receptors. I am an addict after all. I will have to confess to my Dr. all this. I'm not used to being honest with doctors. I'm a very good scammer. A con. That's not what I want in my life anymore so I will be upfront. I have a feeling he will suggest that I am not stable yet. I really felt that the booster dose in the afternoon was helpful and I can work with that. I understand the normalizing of behaviour by once daily dosing but I am not really at the place where I am ready to give up my drugs totatally. I just don't want to die from it. I dropped twice 2 months ago when the fentanyl in my meth syringe hit me. I have been using drugs since I was 15. I'm now 56. I really can't see and maybe don't really want to see or be totally off drugs. That may not be the road to good health. Again, it's a matter of safety. We will see if my opinion changes as my depression lifts. If it does.
My depression came back hard 10 days ago. I'm now as of today put myself on disability. Short term. My Psych is on board as are my friends and my GP. I have started lamotrigine day 4 now. I swear I can feel a positive lift already. I am a dedicated musician but I have not touched an instrument in months due to the depression. This has never happened in the past so I know that something is dramatically wrong. Maybe the time away from work and stress will allow me back to my 1st love. I live on the ocean in the PNW Canada. I have never seen a more beautiful place. I will try to hike and maybe go camping and indulge myself in the healing properties of the forest and nature.
Getting out there sounds really good.

I still personally see a lot of benefit in continuing to take maintenance medications like methadone and buprenorphine even when people are not motivated to quit using. That's for the simple fact that staying on maintenance allows you to hold onto enough opioid tolerance that if you do decide to lapse, your chances of fatal overdose are much less. This is especially important these days with all that fenanyl doing the rounds, especially in your country. Can't get clean once you're dead!

I've been on lamotrigine. From memory it had less side-effects to the other mood stabilisers. But for me - another tortured creative musician type - the only thing that's really helps my depression is high doses of lithium. ie blood levels around 1.1mmol/l. And by then I'm shaking like Muhummad Ali! :lol:

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Re: Whats your effective "antidepressant" dose?

Post by Steffen36 » Tue May 28, 2019 1:25 am

Hello to everyone. An update was needed as its been a while since starting this thread. Hopefully I am posting this correctly, its not a reply to anyone, I forget if I should hit new topic or reply when in a thread...if I screwed up my apologies.

Still on suboxone. I have gone off it twice because of getting annoyed with a couple side effects. However both times the mania and depression return with a vengeance and I realize just how well this works as both an antidepressant and a mood stabilizer, for me at least. I will add, I know everyone gets depressed coming off opiates, even people that never experienced severe depression in their life go through it when dopamine levels plummet in withdrawal and during PAWS but I have always suffered depression since a kid before dabbling in opiates. Even with years, 5+ of clean time away from opiates long ago it never improved for me. I read peoples stories of returning to normal, happier even after stopping suboxone and it makes me jealous. Though I am happy for them, its quite a feat. I do think thats where the difference lies between people with straight up addiction and people with addiction plus a co-occuring mental illness. Only my 2 cents.

Here is what I take daily for both mental illness and opiate addiction:

suboxone 0.75mg 3 x day
lamictal 25mg 1 x day
xanax 0.5mg 3 x day
paxil CR 25mg 1 x day

Changes made since my older post are zoloft being swapped out for paxil due to relentless panic attacks. Zoloft just doesn't touch my panic attacks like paxil does. Suboxone dose went up from 0.5mg 3 x day to 0.75mg 3 x day as the lower dose was just not handling cravings/depression/mania quite enough. Still a far cry from my starting dose coming off pods/opium/norcos abuse at 2mg 3 x day. Tolerance has not been an issue, surprisingly. Its effects have stayed the same for I think 3, almost 4 years now.

Sorry for such a long detailed post. I know many people read forum posts from google searches like my self and I often wish they added more specifics.

-Steffen

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Re: Whats your effective "antidepressant" dose?

Post by wannaBdrugfree » Tue May 28, 2019 6:27 pm

Interesting post, it’s informative and imo helps others see just where they stand on their recovery. I hope by the grace of God you find relief from your panic attacks. I am at 6 mg/day of suboxone, 4mg in the morning and 2mg in the afternoon. Fortunately i’ve never been prescribed anything other than suboxone as far as mental health issues.I’ve been on suboxone for 10 years straight. Over time I’ve taken as much as 12 mg/day and as little as 6 mg/day.

Like others, I’ve benefited from a notable antidepressant along with anti anxiety effect while on suboxone. Also,the tolerance with this drug is truly amazing as you pointed out. After ten years, this drug performs as well as day one without dosage increases. I wish you well and I hope your situation improves.

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Re: Whats your effective "antidepressant" dose?

Post by Amy-Work In Progress » Tue May 28, 2019 8:29 pm

"I do think thats where the difference lies between people with straight up addiction and people with addiction plus a co-occuring mental illness."

Steffen, I think this is spot on! I couldn't agree more with your assessment. Treatment Resistant Depression, which it sounds like you have, is such a struggle! There are several members here who report that buprenorphine is effective for their TRD. I'm sorry that you have some troubling side-effects. That stinks. However, the fact that you've found a medication that really helps and is available to you is a blessing.

I really appreciate you coming back and writing an update! You're right that so many people end up leaving us hanging and wanting more. Plus I appreciate that you still come back to the forum. The longevity of some of our members is amazing!

Amy
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Re: Whats your effective "antidepressant" dose?

Post by jennjenn » Wed May 29, 2019 9:39 am

I have a question for those of you that have panic attacks. Is there a difference between a panic attack and an anxiety attack? Is it the same thing or is there a difference?

There’s been a couple instances where I have had what I describe as an anxiety attack. It has happened at a time when I’ve been really stressed out and had been stressing out for a few days prior. I woke up one morning and I just physically felt awful and it was a feeling of just the weirdest thing and mentally I was just shaking inside and a bit panicked I guess. I never had trouble breathing or anything like that. After this was happening I literally talked myself down and I was able to get myself bk to feeling normal again after about 30 minutes. A few days later..... oh let me bk up, I also have racing thoughts about the things that are stressing me out so much and I couldn’t stop them unless I talk myself down. I had another one a couple days later but nowhere near as bad. The racing thoughts thing happens while I’m having these 'attacks'. Is this a panic attack or anxiety attack or is there a difference?

I used to be on Paxil for 10 years before my active addiction started. I was taking it for anxiety issues. I think I may need an antidepressant again, maybe not Paxil but something that will help me with this anxiety I’m starting to experience again.
Jennifer

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Re: Whats your effective "antidepressant" dose?

Post by Amy-Work In Progress » Sat Jun 01, 2019 5:55 pm

Jennifer, that is an extremely good question! I think that many of us are confused about the differences between an anxiety attack and a panic attack, including me. When I looked it up I found this article, which seems like a good place to start:

https://www.verywellmind.com/anxiety-at ... ks-2584396

Now that I know the difference between them I know that I've had both. I distinctly remember the anxiety attack I had when Jacob was about 4 years old. I was in my dad's church and I had left Jacob, the only kid there, in the nursery with an older lady who I was somewhat familiar with. When the service started I noticed that the woman who I thought was watching my son was a couple of pews behind me! "Who is watching Jacob?" I asked her during greeting time. "Mr Jones asked if I would like him to be in the nursery for me today, and I wanted to be in the service because my sister is visiting." Oh.

My anxiety began building through the next hymn, scripture, reading and by the time my dad was giving his sermon, the anxiety became overwhelming. I needed to go check on my son!!! However, I was hemmed in on both sides. One way there was a very obese person blocking the end of the pew. And on the other side, my Aunt Be and her walker prevented me from being able to leave the pew. It was the middle of the sermon and no one would be standing back up (enabling me to leave the pew) for 10 to 15 minutes. I started sweating, my heart was racing, I couldn't sit still. The only thing that kept me from leaping over the top of the pew was my church manners and the fact that I had no reason to suspect this man of any funny business. It was an awful feeling.

My first panic attack hit in my mid 30s. I was very tired as it was about 2am, and my husband, who works nights, was gone. It was just me and a young, sleeping Jacob in the house. Suddenly, out of nowhere, my heart started pounding out of my chest and my breathing pattern became rapid. My heart hurt, I was dizzy. Two overwhelming thoughts are all that I remember thinking. 1. I need someone!! 2. I'm dying!! I had heard about panic attacks, and frankly, I thought that the description was exaggerated. How can someone who is perfectly healthy feel like they're dying? Now I knew. The only thing that kept me from dialing 911 was the knowledge that I was most likely having a panic attack.

The main characteristic of panic attacks for me was the suddenness and the feeling like I was dying. I don't think that anyone could forget how terrible and frightening it feels.

Does that help, Jennifer?

Amy
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Re: Whats your effective "antidepressant" dose?

Post by jennjenn » Wed Jun 05, 2019 3:16 pm

It definitely helped Amy, thank you so much (once again lol) for answering me. You always have my back!

I totally agree that anxiety attacks aren’t exactly the feeling of dying like panic attacks can be. I don’t really know a lot about panic attacks though because I don’t think I’ve ever truly experienced one. I do think what I had the other day was from anxiety...... major anxiety. I’m still having anxiety. I’ve had stress headaches and I guarantee you that my blood pressure is probably high but I’m not checking it because I don’t want to scare myself. Gosh, I need a vacation from my life right now! Maybe Hawaii.
Jennifer

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Re: Whats your effective "antidepressant" dose?

Post by Amy-Work In Progress » Sun Jun 09, 2019 6:36 pm

Can I please come too??? :wink:

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Re: Whats your effective "antidepressant" dose?

Post by raudy1975 » Mon Jun 10, 2019 4:02 pm

I am so glad this thread came back up. I was able to read what I was taking in 2017

Current Update on my Medications:

Viibryd 40 mg (SSRI) once a day and .81 mg of Zubsolv once a day. I no longer need as much Zubsolv as I needed 2 years ago. That really is the great thing about Bup is over time you truly do need "less and less". I am hoping in a couple of years I will be at another decrease or not. Either way this medication has really worked so well with my Anti-depressant.

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