Trying Buprenorphine after methadone

[rls_optimist]

Hi, All, I'm in the process of trying out buprenorphine (Subutex sublingual tablets). I had been on 12.5 mg methadone for 1 1/2 years. It did a super job in controlling my RLS (after augmenting on all the DAs, and finally getting free of those about 1 year ago). But I have developed depression since starting methadone. Dr. B. suggested the methadone may have caused that, and he said I might do better with buprenorphine. He told me that depression resolves in about 80% of his patients after switching from methadone.

Dr. B recommends the Belbuca form (film on inside of cheek), citing fewer side effects, lower dosages needed, easier to use. However, my neurologist has no experience with that. He is in Dr. Winkleman's lab at MGH here in Boston, and I believe Dr. W. himself also has no experience with Belbuca. So my plan is to try Subutex for the 30 prescription period, then check in with my neurologist, who has been very helpful and accommodating. I may ask him to try prescribing Belbuca, and will send him my email exchange with Dr. B. about that.

Meanwhile, I thought I'd get 30 days' experience with Subutex, so I can at least see how it affects me. It *certainly* controls all my RLS symptoms. And after 9 days, I believe I'm seeing some improvement in depression, although it's not a continuous improvement (some ups and downs still). One paper I saw on a small, 8-week open label study using bup to treat depression found that most subjects had significant depression relief, and that most of them achieved that level of relief in the first 3 weeks. So I'll be patient. I'm still having some other side effects, but they're diminishing.

I think I understand why Dr. B. prefers the Belbuca film: it comes in much smaller doses (75 mcg up to 900 mcg, note mcg, not mg), whereas Subutext *starts* at 2 mg (note mg). I have to carefully cut and shave those tablets, which tend to break into "crumbs" as Shumbah calls them. I'm still trying different doses, but I think about 0.75 mg (i.e., about 3/8 tablet) seems to work best, so far. I take 0.5 mg at 6:00 PM, then 0.25 mg about 1 hour before bedtime. (Note: I also take 900 mg gabapentin at 9:00 PM. This may muddy the waters some, but I don't want to change more than one variable at a time.)

I'd love to hear what buprenorphine forms, doses, and time(s) of day any of you who are taking it use. Thanks! And thanks for your patience with this long posting. I hope you all are well.

[Joolsg]

I hope the buprenorphine resolves the depression issues. We still cannot get either methadone or buprenorphine for RLS here in the UK but it's useful to hear about dosage and side effects so that if, in the hopefully not too distant future, we manage to persuade our neurologists that these drugs are extremely effective, we can pass on the info.

Perhaps gabapentin is also a culprit in causing depression? Just a thought. But if you ever decide to reduce it, do it very slowly.

Good luck, and let's hope things improve soon.