[AFchick1]

I have a couple of questions regarding Buprenex...
I read through some of the links on the page and it said it was used for borderline depression. Why are they giving narcotics to borderlines? Aren't we notorious for drug abuse? Is it considered 'safe' because it must be administered by shot and therefore, presumably, by a physician who is monitering the situation closely? How long would the treatment last? Is it a short time thing like ECT? Why were borderlines specifically chosen for the study? Is it really a good option?

[Jerod Poore]

AFchick1, on Wed 22 October 2008 10:26:14 GMT +0000, said:

I have a couple of questions regarding Buprenex...
I read through some of the links on the page and it said it was used for borderline depression.

Buh? There's all of one link on that page, and it's regarding refractory depression, especially bipolar depression. The word "borderline" isn't on the page. The two words don't appear together on any page on the site.

AFchick1, on Wed 22 October 2008 10:26:14 GMT +0000, said:

Aren't we notorious for drug abuse?

Apparently, as all the studies I can find regarding buprenex and borderline personality disorder are about the prevalence of BPD and the substance abuse buprenex is being used to treat.

[AFchick1]

Jerod Poore, on Wed 22 October 2008 12:58:47 GMT +0000, said:

AFchick1, on Wed 22 October 2008 10:26:14 GMT +0000, said:

I have a couple of questions regarding Buprenex...
I read through some of the links on the page and it said it was used for borderline depression.

Buh? There's all of one link on that page, and it's regarding refractory depression, especially bipolar depression. The word "borderline" isn't on the page. The two words don't appear together on any page on the site.

AFchick1, on Wed 22 October 2008 10:26:14 GMT +0000, said:

Aren't we notorious for drug abuse?

Apparently, as all the studies I can find regarding buprenex and borderline personality disorder are about the prevalence of BPD and the substance abuse buprenex is being used to treat.

From the study link on your page: . Buprenorphine was also successful in reducing depressive symptoms in patients with borderline personality disorder(29).

I tried to Google the study but all I could find was a site you had to pay for. In the footnotes there was reference to addiction, which I skipped over. I'm assuming then, that the Buprenex was used as a way to wean the patient off of drugs, and then found to have beneficial effects on the depression Borderlines often suffer.
I'm glad you're the one that answered, as you say your partner has tried it and it worked for her depression? It's something I've been interested in for the last couple of months, but nobody seems to know that much about it. I've tried most anti-convulsants, atypicals and anti-depressents. My amazing awesome pdoc suggested an MAOI patch at an extremely low dose, but my psychiatric nurse praticioner didn't think that would be a good idea because of my suicidality. I've tried ECT, and had little to no effect. The reason this drug appeals to me so much isn't that it's an opiate but that 1) It's extremely hard to overdose on and 2) Access to it is controlled. However, I'm forced to doubt my own motives because I like the way I feel on opiates. Not high, but...functional. And a lot of things I've read about Borderline indicates a problem with drugs and alcohol, so I'm weary.
At this point I'm willing to try sparrow brains and esoteric herbs if they'll help me stay out of my all-encompassing depressions.

[dymphna]

I have no idea what you are linking to. The Buprenex page links to a free page (http://balder.prohos...page/bupe.html) that says the following (truncated):

Quote

Buprenorphine Treatment of Refractory Depression

J. Alexander Bodkin, MD, Gwen L. Zornberg, MD, Scott E. Lukas, PhD,
and Jonathan O. Cole, MD.
Journal of Clinical Psychopharmacology, 1995, 15, pp. 49-57


Abstract
Opiates were used to treat major depression until the mid-1950s. The advent of opioids with mixed agonist-antagonist or partial agonist activity, with reduced dependence and abuse liabilities, has made possible the reevaluation of opioids for this indication. This is of potential importance for the population of depressed patients who are unresponsive to or intolerant of conventional antidepressant agents. Ten subjects with treatment-refractory, unipolar, non-psychotic, major depression were treated with the opioid partial agonist buprenorphine in an open-label study. Three subjects were unable to tolerate more than two doses because of side-effects including malaise, nausea and dysphoria. The remaining seven completed 4 to 6 weeks of treatment and as a group showed clinically striking improvement in both subjective and objective measures of depression. Much of this improvement was observed by the end of 1 week of treatment and persisted throughout the trial. Four subjects achieved complete remission of symptoms by the end of the trial (Hamilton Rating Scale for Depression scores < 6), two were moderately improved, and one deteriorated. These findings suggest a possible role for buprenorphine in treating refractory depression.

There is no borderline personality disorder to be found.


Dymphna

[AFchick1]

Edited, I think I might have been a tad rude. But Jared answered my question. Thank you for taking time to respond, though.

This post has been edited by AFchick1: 22 October 2008 - 12:40 PM

[Jerod Poore]

AFchick1, on Wed 22 October 2008 11:16:20 GMT +0000, said:

Jerod Poore, on Wed 22 October 2008 12:58:47 GMT +0000, said:

AFchick1, on Wed 22 October 2008 10:26:14 GMT +0000, said:

I have a couple of questions regarding Buprenex...
I read through some of the links on the page and it said it was used for borderline depression.

Buh? There's all of one link on that page, and it's regarding refractory depression, especially bipolar depression. The word "borderline" isn't on the page. The two words don't appear together on any page on the site.

AFchick1, on Wed 22 October 2008 10:26:14 GMT +0000, said:

Aren't we notorious for drug abuse?

Apparently, as all the studies I can find regarding buprenex and borderline personality disorder are about the prevalence of BPD and the substance abuse buprenex is being used to treat.

From the study link on your page: . Buprenorphine was also successful in reducing depressive symptoms in patients with borderline personality disorder(29).

Now I understand, the study references another study about using buprenorphine to treat depression in people with borderline personality disorder.

AFchick1, on Wed 22 October 2008 11:16:20 GMT +0000, said:

I tried to Google the study but all I could find was a site you had to pay for. In the footnotes there was reference to addiction, which I skipped over. I'm assuming then, that the Buprenex was used as a way to wean the patient off of drugs, and then found to have beneficial effects on the depression Borderlines often suffer.

I found a study that references and summarizes the Resnick & Falk study. From Effectiveness of buprenorphine in double diagnosed patients.Buprenorphine as psychothropic drug:

Quote

Resnick and Falk (50) studied two groups of patients with a high prevalence of DSMIII-
rated borderline personality disorder (60%): the first group did not include heroin
addicts, while the second consisted of abstinent heroin addicts. Among non-addicts,
borderline patients only showed improvement after receiving buprenorphine stably for
the first month of treatment (with a 30-50% reduction along the HAMD scale and a
43-50% fall in overall psychopathology). This short-term effect was placebo-controlled
along a Pl-B-Pl 9-14 day schedule, or a Pl-B / B-Pl reverse switching schedule. Some
limitations should, however, be recognized in this study. The second group was not
suitable for an evaluation of the primary psychotropic properties of an opiate drug,
because it consisted of former heroin abusers, whose current state of abstinence was
not enough to qualify them as possessing a normal opiate metabolism. Moreover, the
first group was suitable for evaluation, but the conclusive observation that symptoms
re-emerged after the withdrawal of medication fails to provide any new evidence.

[...]

Resnick and Falk reported a reduction in psychopathological symptoms in 9
out of 15 patients, and were able to identify borderline personality disorder rated according
to the DSM-IIIR as a predictor of response. In borderline patients, the HAMD
score fell by 30-50% during the first month of treatment, at dosages ranging from 0.3
to 12.3 mg/day, while other subjects performed the same as when on placebo (50).

It doesn't look as if that study was published in any peer-reviewed journal, though. Here's the abstract from the National Institute of Drug Abuse's big pile of monographs that may or may not have been published anywhere:

Quote

Buprenorphine (BUP), a morphine-type mixed agonist/antagonist, has
low dependence liability and toxicity, with a pharmacological
profile determined primarily by partial agonism and slow kinetics
at u-receptors. These features, plus clinical reports indicating
acceptance by heroin addicts and antidepressant activity, suggest
it be evaluated for use in treating psychiatric disorders. Two
groups were studied.

In Group A, 15 symptomatic patients in ongoing psychotherapy,
received a sublingual test dose BUP 0.2 mg. Positive responders
(N=9) all met DSM-III criteria for borderline personality disorder
(BPD), while negative responders (N=6) all had other diagnoses.
Symptom severity scores, BUP vs. placebo (PL), were reduced by a
mean of 43% and 50% respectively, in 5 ss who received,
single-blind, BUP (0.3-1.2mg IM) or PL daily for 9-14 days in an
ABA design (A=PL; B=BUP) and 4 ss who received, in 2 sessions, BUP
and PL administered 1-2 hours apart, in counterbalanced order.
Hamilton depression scores were reduced by 30-50% (mean 13.9 to
5.7). after 1 month on daily self-administered BUP. Subjects
reported a profound sense of feeling better, but upon discontinuing
BUP, symptoms returned immediately and most subjects asked
to continue treatment.

In Group B, 20 opiate dependent subjects, in various stages of
withdrawal, received IM BUP (0.3-1.2mg) and, after 1-2 hours, mean
abstinent severity scores were reduced by 65%. Eight ss completed
detoxification (14 days BUP + 7 days PL). Except for 4 ss who
started naltrexone, all others met DSM-III criteria for BPD.
Twelve subjects received maintenance BUP (0.6-3.0mg/day); 5 were
terminated for illicit drug use, 7 were drug-free at 6-9 months.
Diagnostic comparisons between negative and positive responders to
BUP and the favorable clinical results, support the idea of using
BUP to identify and treat a homogeneous subgroup within the
borderline personality disorder category. Guidelines need to be
developed for using BPN in clinical psychiatry.

AFchick1, on Wed 22 October 2008 11:16:20 GMT +0000, said:

I'm glad you're the one that answered, as you say your partner has tried it and it worked for her depression? It's something I've been interested in for the last couple of months, but nobody seems to know that much about it. I've tried most anti-convulsants, atypicals and anti-depressents. My amazing awesome pdoc suggested an MAOI patch at an extremely low dose, but my psychiatric nurse praticioner didn't think that would be a good idea because of my suicidality. I've tried ECT, and had little to no effect. The reason this drug appeals to me so much isn't that it's an opiate but that 1) It's extremely hard to overdose on and 2) Access to it is controlled. However, I'm forced to doubt my own motives because I like the way I feel on opiates. Not high, but...functional. And a lot of things I've read about Borderline indicates a problem with drugs and alcohol, so I'm weary.
At this point I'm willing to try sparrow brains and esoteric herbs if they'll help me stay out of my all-encompassing depressions.

In what limited communication I've had from her since, it was still the only thing that worked for her. The way you describe things is just as she did, functional. I'm not sure if she ever did the new MAOIs now available.

Why suicidality makes Emsam a bad idea is beyond me. One would think the exact opposite would be the case, in that getting some delivered immediately would be a good thing.

[AFchick1]

Jared, THANK YOU! I really appreciate the time you took to look things up. I have bookmarked those links, though I think I am going to read them just as soon as I finish posting to you. The NP told me that with an MAOI I could 'accidentally on purpose' forget to not take cough syrup I think he said. I haven't read your pages on MAOIs as those were ruled out very early as a treatment for me, but I will go look at them now. He also no-no'd tricyclics because of how lethal they are when overdosed on, and in that respect I've been amazingly lucky.

However, I wouldn't mind input from you on some weird, esoteric medication that may help with my depression.

[She of the metaverse]

AFchick1, on Thu 23 October 2008 5:39:36 GMT +0000, said:

The NP told me that with an MAOI I could 'accidentally on purpose' forget to not take cough syrup I think he said.

He also no-no'd tricyclics because of how lethal they are when overdosed on, and in that respect I've been amazingly lucky.

However, I wouldn't mind input from you on some weird, esoteric medication that may help with my depression.

I thought once or twice (actually 5 times) before deciding to post this.

The reason they will trial narcotics on borderlines is that they will try ANYTHING to shut us up and try to find a way to cope with the drain put on the medical system by over needy borderliners.

There is alot more than one drug that is administered by injection and I seriously doubt that that would be the cause, especially when you think about it having someone else being responsible for medical maintenence is actually worse for all involved as it is pandering to the BPD's need to be recognised as "sick" and "needing someone" to do it for them.

BPD depression has been shown to actually affect the brain, so yes bpd drepression is real, however how it does affect the brain is no different from normal depression, so while we might THINK its SO much worse and painful than what a "normal" person wih depression feels it actually isnt.

Following that line of thought it stands to reason that specialized treatment for bpd depression is actually a load of bs.

The depression is the same and pharmalogically should be treated the same, ssri's, nri's whatever works, but specialised treatment in so far as pharmalogically NO.

If you trully want the depression to stop you're going to have to start taking responsibility, nothing you put into your mouth, or inject or shove up your butt is going to beat the bpd depression alone.

Crazy meds arent happy pills, while an antidepressant will deal with your physical depression - only and ONLY - by getting down to the bare basics of what made you (and I) borderline in the first place is going to truly help ease the depression and the pain.

Having nurses and psychs who "care for you" and look after you by not giving you meds incase you Od on them is nice, but ultimately it isnt going to help you.

If you trully want to get better and not feel like the worlds largest pain receptor, alone every second in a room full of people then you are going to have to take responsibilty for your own treatment and safety.

It is not the doctors responsibilty to protect you from yourself, only you can do that.

Same as being happy, only you can do that.

Despite popular belief borderline is NOT incurable, apart from the depression and occassional psychosis its not even physical.

You CAN beat it and you CAN be "well", but to do that you have to drop all the walls and stop all the excuses.

This does work, last month I was "downgraded" in my official diagnosis from borderline to cluster B.

If you want the depression to end you CAN do it.

[AFchick1]

Dude, you don't even know me.
I don't need a BPD pep-talk, I am aware of my disease and I am in control. Part of taking responsibility is that I know that since it was only a few months ago that I last attempted suicide is that I don't get meds that would make it more likely for me to die if I act out again. Other than that I am in control of my meds. I don't want someone to give me a shot in the ass because it makes me feel special. Being a leech on society does not make me feel special. I don't think my big bad BPD depression is worse than everyone elses. I have treatment resistant MDD, and I have been through a LOT of drugs to try to help it. This one sounded potentially beneficial, and therefore, in my book, worth a try.

How about this...try asking questions to people you don't know, instead of making assumptions.

[She of the metaverse]

*shrugs* OK

Good luck with your meds.

[AFchick1]

She of the metaverse, on Thu 23 October 2008 8:55:43 GMT +0000, said:

*shrugs* OK

Good luck with your meds.

Thanks, I need it right now, unfortunately.

[Jerod Poore]

AFchick1, on Wed 22 October 2008 13:39:36 GMT +0000, said:

I haven't read your pages on MAOIs as those were ruled out very early as a treatment for me, but I will go look at them now.

There's no point in reading the MAOI pages, they suck. The MAOI board has much better information.

AFchick1, on Wed 22 October 2008 13:39:36 GMT +0000, said:

He also no-no'd tricyclics because of how lethal they are when overdosed on,

That makes sense.

AFchick1, on Wed 22 October 2008 13:39:36 GMT +0000, said:

However, I wouldn't mind input from you on some weird, esoteric medication that may help with my depression.

Other than MAOIs, antipsychotics + antidepressants with or without lithium or Lamictal (which you've probably tried), you start getting into things like the anti-Parkinson's meds (have fun on the sex and gambling binges) and even anti-Alzheimer's medications (goodbye bank account). The latter of which helped Mouse, and I think it may have been a drug-drug interaction that caused her to have to stop. That and the projectile vomiting that she'd get whenever she forgot to take her Exelon.

[dymphna]

This is a specious topic: the OP is pregnant.


Dymphna

[AFchick1]

dymphna, on Mon 27 October 2008 3:15:37 GMT +0000, said:

This is a specious topic: the OP is pregnant.


Dymphna

I'm not going to be pregnant forever.

[AFchick1]

Jerod Poore, on Sun 26 October 2008 15:27:34 GMT +0000, said:

AFchick1, on Wed 22 October 2008 13:39:36 GMT +0000, said:

I haven't read your pages on MAOIs as those were ruled out very early as a treatment for me, but I will go look at them now.

There's no point in reading the MAOI pages, they suck. The MAOI board has much better information.

AFchick1, on Wed 22 October 2008 13:39:36 GMT +0000, said:

He also no-no'd tricyclics because of how lethal they are when overdosed on,

That makes sense.

AFchick1, on Wed 22 October 2008 13:39:36 GMT +0000, said:

However, I wouldn't mind input from you on some weird, esoteric medication that may help with my depression.

Other than MAOIs, antipsychotics + antidepressants with or without lithium or Lamictal (which you've probably tried), you start getting into things like the anti-Parkinson's meds (have fun on the sex and gambling binges) and even anti-Alzheimer's medications (goodbye bank account). The latter of which helped Mouse, and I think it may have been a drug-drug interaction that caused her to have to stop. That and the projectile vomiting that she'd get whenever she forgot to take her Exelon.

Those were sorta the options I thought I had. That and VNS.

[bin there]

AFchick1, on Mon 27 October 2008 4:35:42 GMT +0000, said:

Jerod Poore, on Sun 26 October 2008 15:27:34 GMT +0000, said:

AFchick1, on Wed 22 October 2008 13:39:36 GMT +0000, said:

I haven't read your pages on MAOIs as those were ruled out very early as a treatment for me, but I will go look at them now.

There's no point in reading the MAOI pages, they suck. The MAOI board has much better information.

AFchick1, on Wed 22 October 2008 13:39:36 GMT +0000, said:

He also no-no'd tricyclics because of how lethal they are when overdosed on,

That makes sense.

AFchick1, on Wed 22 October 2008 13:39:36 GMT +0000, said:

However, I wouldn't mind input from you on some weird, esoteric medication that may help with my depression.

Other than MAOIs, antipsychotics + antidepressants with or without lithium or Lamictal (which you've probably tried), you start getting into things like the anti-Parkinson's meds (have fun on the sex and gambling binges) and even anti-Alzheimer's medications (goodbye bank account). The latter of which helped Mouse, and I think it may have been a drug-drug interaction that caused her to have to stop. That and the projectile vomiting that she'd get whenever she forgot to take her Exelon.

Those were sorta the options I thought I had. That and VNS.

Just so you know, Buprenex is available in pill form in the US. Since Boprenex is not absorbed in the stomach, the pill is taken sublingually. In fact, most people on Buprenex will take the liquid form sublingually. Subutek is buprenex alone in the pill. Suboxone adds a small dosage of nalaxone which is an antagonist to short acting opiates. Physicians must get special training in order to be issued an additional DEA number in order to prescribe the pills.