Last Resort - End Of My Tether

[Cracker]

If anyone could read this I'd be most appreciative, and offer any advice please.

Ive written a long long long 6 page letter to my psych. I'll post it if anyone could be bothered to read it. It's very through. It explains everything and I'd really hope someone could find the time to read it for me please...please!

I've tried every med, I've tried ECT X 15. I've tried anti depressants, anti psychotics, mood stabilisers you name it.

I have CRIPPLING anxiety and then depression. I just don't function. I can't work. I don't enjoy my gorgeous kids or stunning wife. Someone knocking on the door scares me to death. I CAN go out though and 'pretend'

The only thing that has EVER helped is codeine or Buprenorphine, which I found out by mistake when taking it for a slipped disc. It was profound.

Phenibut is quite amazing too, but tolerance builds quickly as it does with the highest dose of pregabalin. Trouble is pregabalin is that it put 2/3 stone on me and then stopped working!!

This has been going on all of my life, but the last 3 years I've totally lost it and had crisis teams involved etc etc.

Has anyone, anywhere ever been given Buprenorphine for severe treatment resistance? Incidentally has anyone heard of ALKS4561

Thanks in advance people. Keep going x

[Davit]

Codeine stimulates your mind to produce dopamine.
Have you tried Trimipramine.
Dopamine supplements do not cross the blood brain barrier.

I don't see any CBT here

[MyNameIsTerry]

ALKS-5461 is in clinical trials in the US. That would be one to talk to your psychiatrist about I guess to see if there are any trials due in the UK that you could join.

If you go to this webpage, it will tell you which trials are being recruited for & where:

http://www.nhs.uk/conditions/depression/pages/clinical-trial.aspx?Condition=Depression~buprenorphine

There seem to be none for the UK currently but there are a fair few which should bring some hope about it being introduced. Maybe with current evidence or trial updates, a psychiatrist would consider using it "off label"?

There is a study of Buprenorphine in refractory depression post antidepressants & ECT.

There is an older study here but its a tiny sample size:

http://www.ncbi.nlm.nih.gov/pubmed/7714228

Further trials that you could read about:

- Bodkin JL, Zornberg GL, Lucas SE, Cole JO. (1995): Buprenorphine treatment of refractory depression. Journal of Clinical Psychopharmacology, 16:49-57.
- Emrich HM, Vogt P, Herz. (1982): Possible antidepressive effects of opioids: action of buprenorphine. Annals of the New York Academy of Sciences, 398:108-112.
- Kosten TR, Schottenfeld R, Ziedonis D, Falcioni J. (1993): Buprenorphine versus methadone maintenance in opioid dependence. J Nerv Mental Dis 181:358-364.
- Strain EC, Stitzer ML, Liebson IA, Bigelow GE. (1994): Buprenorphine vs. methadone in the treatment of opioid-dependent cocaine users. Psychopharmacology 116:401-406.

Trials that are ongoing, recruiting, etc but some have finished so you might be able to track down the results:

https://www.clinicaltrials.gov/ct2/results?term=Buprenorphine+Depression

[Cracker]

Thanks for your replies.

I've tried CBT, 2/3 separate therapists. It's just generally hopeless for me.

I ALSO have a form of Body Dysmorphic Disorder. I've got a lazy eye......

It certainly adds to my anxiety and depression considerably, but it absolutely is not the main cause.

Does anyone genuinely feel I have a chance of off-label Buprenorphine? I think realistically I have no chance, but it won't stop me asking.

Has ANYONE at all on here EVER had it prescribed off label please?

Does anyone know of any forward thinking, flexible, psychiatrists who are genuinely prepared to think outside of the box with regards meds please?

Strangely,,paradoxically, stimulants also work, calm me down, let me think clearly, and help tremendously with moods and depression and energy. Basically they make me functional. It's weird.

The alternative is a melancholic funk of epic proportions, plainly and simply I just DO NOT function. It's a sinking feeling, indescribable despair, especially of a morning. I can't even get a shower, brush my teeth etc etc. I know that sounds pathetic, and when I say 'can't' I of course 'can' do that but it's just, well, full of angst, agitation, anxiety, etc.

I'm seriously out of options, and very close to being admitted. :-(

I would appreciate any other views, medically first, of dealing with this severe treatment resistance. When I get my meds genuinely helping, I think THEN CBT may have a place.

Thank you for reading my post.

[MyNameIsTerry]

SNRI's are stimulating due to the adrenaline element and they were originally conceived for things like Major Depressive Disorder (MDD) so it makes sence about the stimulating element although I've always been baffled as to why you want to keep more adrenaline in your body when you have anxiety.

I hope someone can help you here but with you having ECT which is usually for treatment resistence (unless you are a celebrity, of course) then I guess your psychiatrist will be open to newer meds. Since its being trialled in the US, and some have completed, then maybe you can get the ammo together that you need from them and take it to him with a direct question and if he/she says no, then they will need to say why & what else they plan to try.

[Davit]

Dopamine is called the happy hormone. It has only 400,000 synapses under it's control through the whole body. LDopa is used in Parkinsons medication and crosses the blood brain barrier and converts to Dopamine in the brain. Addiction to cocaine is actual a craving for the good feeling from Dopamine. Withdrawal causes malfunction in those synapses, involuntary movement mostly. Production is otherwise controlled my mood. Happy (positive) stimulates the production and you feel good and things work smooth the way they are supposed to. Sad and the body and brain slow down and don't function well. this is probably the physical side of depression.

[Cracker]

The most hardest thing to accept is that out of everything, including the harshness of ECT (which didn't help at all), Buorenorphine helps incredibly well and I just know I'll be refused it.

[xvolatileheart]

It's been trialled in depression, and you have exhausted all other options, so I don't see why a psych wouldn't be open to prescribing it.

I really hope you find some relief soon. :hugs:

[Cracker]

It's been trialled in depression, and you have exhausted all other options, so I don't see why a psych wouldn't be open to prescribing it.

I really hope you find some relief soon. :hugs:

Thanks so much for you reply,and for all other replies too.

I just know[I] that they won't 'allow' it.

I'd post my letter if anyone would like to read it, it's a long read but it captures probably everything that you all feel on here x