The problem with opiods and most phychoactive drugs is that they artificially alter the brain chemistry, which needs to be balanced to think rationally and feel ‘happy’ and ‘well’. For people with natural brain chemistry inbalances (which it sounds like you may be experiencing if you are very frequently feeling depressed and anxious) this is a god-send. The brain in these cases has a hard time balancing itself chemically and the proper application of the correct drug fixes these problems.
The downside to this is that the brain is very good at altering its own chemistry to compensate. For those with abnormal chemistry this isn’t a problem as the brain is being helped into a state that it’s trying to get to on its own but doesn’t have a specific resource to do so. For chemically normal people however the brain compensates by shutting down the production of the endogenous drug analogue as it’s already getting too much with the addition of the drug. This leads to withdrawal when the drug is removed as the brain takes time to increase its (lagging) production. Note that this is not the same case as with reuptake inhibitors like cocaine that spend a weeks worth of dopamine in a few evenings and leave your brain struggling to compensate on a Monday morning.
Endorphins (endogenous morphine) are natural brain chemicals responsible for analgesics (which is why you get them after a surgery), anti-tussives (prior to Robotussin you used to have to take opium to cure your cough), anti-diharehals (talk about my post-wisdom tooth Percoset constipation) and, among other things, a sense of euphoria and well-being. This endorphin-happy affect is linked to the same gene that makes the endorphin-analgesic for fight-or-flight reactions. When the cave-bear mauls you, you want to run like hell despite your injury and feel good about getting away.
I think that others have already expressed the fact that getting high on opium isn’t quite the same as fixing abnormal chemistry. Opium can make anyone feel good and just ‘feeling good’ is not what you want, you just want to feel ‘normal’.
Bowel smooth muscle relaxes under the influence of opiates, so transit slows down, more fluids are absorbed from stool in the colon, and the stool becomes rather hard, in addition to collecting more in the colon.
Thank you all for the responses. I haven’t considered illegally seeking out opiates as a cure, but I could see how someone with less self-control would. Again, I never felt euphoria, a “hug from God”, etc. - I just felt normal for the first time in almost five years.
It just seems colossally unfair that any of the accepted drugs that “might” help me have caused worse depression, seizures, panic attacks, weight gain, impotence, etc., while the good ol’ vicodin just made me feel “cured.”
No. Vicodin is a schedule III narcotic because of its propensity for abuse.
The term “narcotic” is more a legal term than medical. A narcotic is whatever the FDA says it is.
The main reason drugs become scheduled is their addictive qualities. Vicodin is a synthetic opiate making it a prime abuse candidate. The above link is the FDA’s drug schedules. Most prescription pain relievers fall into schedule III.
Also, people confuse addtion and abuse. Most drugs that are abused, are not physically addicting. The individual’s personality and possibley unique brain chemistry causes them to crave their drug of choice. There is a scale for addiction that I can’t find reference to now, that rates substances for physicial and psychological addictiveness, each on a scale of 1-4, 4 being the most addictive. There is only one drug that is a 4-4 that’s alcohol. Physical addiction is defined by what damage is done by withdrawing the drug. One can die from the sudden withdrawal of alcohol. The next closest are barbituates which can cause seizures during withdrawal. Opiates can also cause seizures from withdrawal when the abuse has gone on for a long time, but its not that common.
Paxil, like the other Seratonin re-uptake inhibitors, changes the way the brain uses seratonin and related neuro transmitters.
The reason your friend can’t come off it is his brain isn’t producing the the neurotransmitters it needs to function properly. He should be under the care of a physician while withdrawing. Its not truly a physical addiction, because his brain chemistry will stablize with no long term side effects.
As an aside. there is one Seratonin re-uptake inhibitor that is a scheduled drug, that’s GHB.
If your main problem is panic attacks I have found that a combination of Lexapro and Ativan has been the most effective in treating mine. You are right in that you can’t go off them and expect to feel normal. It is very easy to lghten up on your dose when you feel well and try to ween yourself from them (or just forget to take them) but it is analogous to a diabetic trying to ween himself from insulin.
I had some of the side effects that you described from other SSRI inhibitors but Lexapro is supposed to be cleansed of a lot of these and in my case I have found this to be true.
One interesting thing I didn’t find out until I had been through a few different drugs (mainly SSRI’s, Buspar etc…) was that my 86 year old father had taken Ativan all of his adult life. It appears (galling as it is to admit) we share a common brain chemistry and if there wasn’t such a stigma surrounding such drugs I might have happened upon a more effective combination sooner. Hang in there and give each drug you take time to work. It really can take several weeks before you know if something is going to work for you. I have had friends with similar problems who have self medicated and that is definately the wrong way to go.
Sorry for the hijack, but it is hard to see someone else suffer in a way you yourself have suffered.
You know, I’ve had several interviewees tell me that even after being on methadone or heroin constantly for years, after injection of an opioid antagonist like naloxone, their tolerance almost disappears (or at least goes way down) and when they start using again, they temporarily feel effects almost like they did before they started developing tolerance in the first place. And that it becomes very easy to overdose in that situation, thinking you still need (X) milligrams to feel anything and taking that much when your tolerance is actually much lower. Have you ever heard of anything like this?
This is hilarious. Mind if I appropriate it for a sig?
Anti-depressant was one of the uses of opium back when it was legal.
Alot of people have glossed over your original comparison between paxil and opium though. Both are physically addictive and both can treat depression. I guess the main difference is that opium builds tolerance, I do not know if paxil does too. However I have heard of prozac poopout which is tolerance to SSRIs so the 2 drugs even have that in common. So there really is no difference from what I can tell minus the fact that opium is also psychologically addictive as well as physically addictive. Both drugs are physically addictive, can treat mood disorders and can result in tolerance.
On another note have scientists developed a drug that can prevent tolerance from being built up? Are there drugs that prevent the creation of new opioid receptors?
Slight hijack, but on topic and while I have the proper attention…
Should a non-opiate user be able to feel a 15 mg muscular injection of morphine?
I ask because after surgery I was given several shots in the arm every x hours. The nurse asked me, one of the times, what the before and after pain level difference was - As far as I could tell she was shooting water in my arm.
Perhaps it is picking a bit of a nit, and a hijack, but I’ll take exception to this. If I come off a 10 year run on China White, my brain chemistry will stabilize with no long term side effects (heroin’s primary effects take place, after all, in the CNS). No arguing that it’s addictive, though.
Generally, the two hallmarks of physical adddiction are tolerance and/or physical dependence (as evidenced by withdrawal symptoms). As picunurse correctly pointed out, addiction and abuse get confused. The Controlled Substances Act addresses the propensity for abuse, not addiction. If it causes withdrawal symptoms, it’s addictive.
So, as Wesley Clark has pointed out (I see on preview, but why waste a composed post?), Paxil is physically addictive. SSRIs can truly be a dog to come off of. We tend to gloss over the “addictive” yoke for relatively safe and useful medications like SSRIs, for political, social, and cultural reasons.
My experience is similar. I’ve had a long time problem with Chronic Atypical Depression, and I once detoxed off an anti-depressant under the supervision of my pyschiatrist. My symptoms were extreme, due to what the doctor referred to as the “heroic” dosages my prior uninformed doctor had me taking. I agree that we tend to classify these drugs as safe and non-addicting because they are culturally acceptable. One should never underestimate the fact that they mess with your brain chemistry.
Hijacking further, coming off paxil for me was another experience I would not want to relieve, although this isn’t the one I refer to above. For me, this drug was highly addicting and I wouldn’t ever take it again.
One of the things they warn methadone patients about is that taking stimulants like cocaine or amphetamines results in the creation of new receptors, which means your existing dosage will not fill as large a proportion of the receptors as it did previously and you will need to increase your dosage.
I recall reading about experiments with rats that determined that another tolerance mechanism involves the formation of … dang, now I can’t remember exactly, I’ll have to look it up. I believe it was a specific endorphin that acted as an antagonist and which was produced in response to continued stimulation of the opioid receptors (making the same dosage of opioid less effective over time), and, when opioids were given in combination with something that disabled formation of this particular endorphin, the development of tolerance was greatly reduced.
Now, if only I could find that article … whatever it was they administered that disabled the endorphin might be the sort of thing you’re talking about, something that would prevent the development of tolerance, or at least slow it down. Of course, it might have to be administered intrathecally, which would be trouble for your average patient.
I also remember reading an article about how administering morphine along with very low doses of naloxone, a potent antagonist, reduced development of tolerance. Ah, here’s the abstract.
And I’ve heard several people claim that cough syrup containing dextromethorphan significantly reduces existing opioid tolerance and prevents it from developing if you aren’t already tolerant, but I haven’t really done any research on that.
Okay, you have a valid point. And it brings up a question. In the late '60s medicine gave us a wonderful new drug with “almost no side effects” 10 years later it was classified schedule III. That was Valium. There were, indeed side effects, but the were played down for the same reasons as SSRIs. I wonder, will SSRIs become scheduled Narcotics in a few years?
I’ve been on SSRI’s for almost 5 years now for depression and anxiety and noticed minimal withdrawal when I abruptly stopped taking Zoloft over a year ago. However, the decent into depression, although slow, was worse than before I ever started the meds. Now I’m on Paxil and everyone tells me the withdrawal is a nightmare. The closest experience I’ve had to it is forgetting to take my meds one day and I was dizzy, nauseated and a bit catatonic all day.
So what next? Since the FDA really doesn’t feel obliged to protect the public are we going to find out that long term use of SSRI’s cause brain tumors, birth defects, schizoprenia, leprosy, and rectal bleeding?
I take it because I need it to function but it’s always in the back of my mind that one day these drugs will come back and bite me in the ass.
How did Thomas deQuincy wind up? He wrote a book about his experience with opium (“CONFESSIONS OF AN ENGLISH OPIUM-EATER”). I’ve never read it, but I understand that deQuicy began to suffer from some very frightening hallucinations, which lead him to go cold turjkey. How about the Chinese and their opium dens? I read once that the Chinese opium addicts would spend every penny they had…and even stop eating (in their pursuit of the drug). Eventually they died of malnutrition. Was smoking opium as harmful as injecting it?
It depends on what you mean by “harmful.” The effects are pretty much the same – in fact, smoking gets the opioids to the brain a little faster than injection, just not in the same quantity, which is why injection gives a “rush” and smoking doesn’t – but you can’t really overdose while smoking, and since you don’t actually burn anything when you’re “smoking” opium, you don’t have the same lung cancer risk from smoking something that actually burns. Still, I would bet that inhaling vapors of almost anything is not exactly good for you. But it’s still less harmful than injection due to the risk of infection from puncturing your skin.
As for spending every penny and dying of malnutrition, well, that depends on the price of the drug and the amount of money the addict has. People who can afford it (rich people, or methadone clinic patients, today) often do fine and even gain weight due to the sugar craving that opioids often produce. People who can’t afford it, well, then it’s big trouble. I’m not sure how much it cost back in the days of classic opium dens, though.
From my ecperience with sevewral SSRI’s only one Paxil was difficult to come off and even that I could do by slowly reducing the dosage over a month and a half. All the others I stopped within a few days of using reduced dosage without side effects. I don’t know if anyone can come off Opiates so easily.
Perhaps, but I doubt it. Remember, as you so astutely pointed out, it is the potential for abuse that drives a drug being listed in the CSA, not the potential for addiction.
And I’ve always interpreted abuse as “get high”. I mean why else is MJ sched I?? No medicinal value? None? Cancer patients and AIDS patients will beg to differ. But I won’t go off on THAT rant (I know, there are cannabinoids, but some cancer patients who’ve tried both have told me that cannbinoids just aren’t as effective as a big ol’ left hander. Not all cancer patients, but enough to make me think there is something to it)
So, as soon as the Feds realized people were taking Valium recreationally…
If there develops an illicit market for Paxil, and people take it to get high, you can bet it will end up on one of the schedules. But I don’t think that’s likely.
Aside/hijack for a story that made me smile when I heard it. Turns out in the 60’s they started handing out Valium in the Massachusetts prison system. A former inmate a Walpole (max security) told me the story of how he was hanging out in the yard and saw one of his buddies come rolling across to him, relaxed, happy, not a care in the world. He asked him what gives. The buddy replied " I went to th shrink and told him I didn’t like being in prison, and he gave me these Valoom pills, and life is pretty ok." So this guy goes to the shrink, says “I don’t like being in prison”, and spent the next several years chewing down “Valooms”. Says it took him a while after he got out to make the connection between 'Valooms" and Valium. And yup, he sure agreed it made prison more tolerable.
Eventually they made me sleepy and unable to concentrate. I seemed to get to a stage quite quickly where they weren’t very effective, and my doctor kept upping the dosage [which would help with the pain for a few weeks, and then it would seem as bad as ever, so I’d be given even more]. Eventually I started feeling like a zombie 24/7 - hence my choice of user name. I decided to come off it myself, as my doctor wouldn’t help me … as soon as I got off it I changed my doctor.
My concentration and memory still aren’t back to what they were [I’ve been off morphine for 2 years], and the hospital pain clinic signed me off because I wouldn’t start taking it again and it was the only available treatment for my back injury. They tried an operation last year and it made things worse. The only pain-killers I’ll take now are co-codamol - and not very many of those.
Sometimes the pain is almost unbearable and I have very little mobility, but at least I no longer feel that I’m losing my mind. In the New Year I’m going on a pain management course for a week - which is supposed to help you live with chronic pain without drugs. Anything’s better than drugs - even pain IMO.