Buprenorphine Depression Again

[RiversW]

Hi All,

As I have written before, I live in Brasil where the only access I have to Buprenorphine is in the form of a patch. And it is expensive. So when I was in California recently, I asked my neurologist to write a prescription for Buprenorphine in tablet form. With my insurance it is quite cheap.

When I was using a patch I had noticed a slight turn toward depression that I successfully counteracted with Wellbutrin. However, with the tablet my depression has gotten significantly worse. At times I am ambushed by a sadness and darkness so heavy that I am unable to fight it off; often ending up in bed weeping until I fall asleep. Then just as suddenly, I can feel my mood lift and I am ok. Needless to say these ping ponging emotions are not easy to handle for me or my wife and I live with some fear that another cloud will descend out of nowhere.

Unfortunately, in the states the smallest dose of Buprenorphine available in a tablet is 2mg. Even cutting the tablet in half is more Buprenorphine than the 20 mg 7 day patch was delivering. Could the increased depth of my depression be a result of the increased dose? At least for now, I have switched back to the patch as a test. So I will see. Any thoughts?

Also, I have also been taking pregabalin for about a year and was up to 200mg a day. My neurologist shotgun approach to treating my RLS. Try anything. Since my symptoms seem to be covered by the Buprenorphine I thought I would try to eliminate one of the many medications I have been taking. After a month, I am down to 100mg. Could the deeper depression be a sign of withdrawing from pregabalin to quickly?

Thanks so much for reading.

Rivers

[SueJohnson]

Yes withdrawal from pregabalin too quickly can cause depression. I usually recommend reducing by 25 mg every 2 weeks and you came down twice as fast. And Amrob even believes in reducing by 10% / month. Try going back up and see if that takes care of your symptoms however it is best to make only one change at a time so you know which is the cause.

[RiversW in reply to SueJohnson]

Thanks Sue, that is what I will do.

[LotteM]

I cannot advise you on the depression or the pregabalin. I can only tell you that when taking bup pills the level of bup in you system is likely to oscillate with an about-24h rhythm. Whereas on the 7d patch the level is more or less constant. Could that be a factor?

And I appreciate the issue that the patch is expensive for you. Is it affordable for you and is it worth it if it keeps the RLS at bay and the depression to a minimum?

[smilingjane in reply to LotteM]

That's an interesting thought Lotte. That hadn't occured to me and may well account to my up and down extreme moods in a 24 hour period..Thank you

Jane 😊

[davchar23]

Dear Rivers W,

I thought it might help if i simply gave you my experience of much personal usage research with bup patches and tablets and pregabalin.

My hopefully final scenario to cover my RLS augmentation & beyond is a 15mcg/hour7 day (lasts 5) bupre patch backed up once a day with half a 200mcg bupre tablets (ie total daily input (0.46mg burpe). i take the100mcg half tablet in the early evening each day.

Side effects are nausea and depression I am currently attempting to reduce the nausea with haloperidol but for depression/anxiety I take a small dose of pregabalin (currently 37.5 mg once per day). That seems to cover my depression adequately. I would not recommend reduction of more than 25mg once every week and i have been on much higher doses immediately after augmenting on rotigotine. i agree that you have perhaps reduced to quickly.

Kind regards

Davchar

[amrob123 in reply to davchar23]

Is it definitely Haloperidol that you're using for nausea Davchar? Haloperidol is an anti-psychotic drug that is used for schizophrenia and other mental health disorders.

[davchar23 in reply to amrob123]

Dear amrob123,

Yes definitely Haloperidol and my GP knew this but has had some experience of it working for nausea. I had previously tried several anti nausea drugs (and several other things as well) without any success

Thanks for noting it though

Davchar

[amrob123 in reply to davchar23]

Thanks for the explanation Davchar. I'm glad you've found something that helps the nausea and hopefully its side effects aren't too bothersome for you.

[davchar23 in reply to amrob123]

Dear amrob123,

Thanks your reply and by coincidence i am having one or two problems with the side effects of the haloperidol. It seems to cause problems in my legs with swelling and a rash like redness. I have reduced the dose significantly and hope I can fid a compromise because the nausea was really making life miserable in the mornings.

Davchar

[RiversW in reply to davchar23]

Dear Davchar,

Thanks so much for sharing your experience. I seem to remember that you had difficulty dealing with nausea. Iam happy you have found a solution.

My impatience often gets the better of me. It seems likely that I have rushed the reduction of the pregabalin dose and possibly triggered my depression. My plan is to go back up on my dose, wait for things to settle and then experiment with the Buprenorphine tablets again. At the very least the tablets can hopefully extend the life of the patch to the 7 days as designed.

Again, I appreciate your thoughts,

Rivers

[davchar23 in reply to RiversW]

Dear RiversW,

Impatience-yes I know the problem but RLS and the frustration because of lack of professional understanding causes it

I understand why you are rethinking tablets but personally I feel very unsure about the levels of bupre in my system when tablets are the main RLS "blocker". I know fairly accurately that i need 0.46 to 0.48mg per day of bupre and by using a 15mcg/hr patch I get 0.36mg/day and half a 200mcg tablet gives the top up . i find that this way i do not get any significant withdrawal symptoms nor does my body get confused by constant top ups. But then there are other ways and everyone is different.

Kind regards and good luck!

Davchar

[RiversW in reply to davchar23]

Dear Devchar,

Thanks so much for your thoughts. Your points are well-taken. You are right, often one is on an island with no ship in sight when when suffering from RLS.

I understand and appreciate your insights about dosing. I have been impatient when adjusting mine and too often go about it in willy nilly fashion. As a result I have yet to discover what works for me. I am going to slow down and try to be more methodical. I am lucky to have for the most part gotten my sleep back. Now it's time to fine tune. Again thanks for writing.

Rivers

[SueJohnson in reply to davchar23]

That's interesting because haloperidol is on the Medical Alert Card from the RLS Foundation which lists things that make RLS worse. It just goes to show that people react differently to the same medicine.

[davchar23 in reply to SueJohnson]

Sue,

Yes and my GP warned me about this and we agreed we might have to increase the bupre to compensate but they way the side effects are happening i doubt i will be the haloperidol for long. I have swollen legs and red painful rash on both legs below the knee.

Thanks for your comments

Davchar

[Joolsg]

Very likely to be the pregabalin. I reduced from 150mg to zero over 9 months. I cut open the pills and divided the powder into quarters. I reduced by a quarter every 2 weeks. After my experience on dopamine agonists, I was determined to avoid any more withdrawal symptoms.It's a shame that the USA doesn't make the smaller dose of pills as a quarter (0.5mg) is all you need. It's why many use the buccal film - It's easier to cut into the correct dose.

[RiversW]

Thanks Jools for taking the time to write. I am going to reduce Pregabalin more slowly. Hopefully that will eliminate these bouts of depression. It's very challenging especially as it can seem to come from nowhere.

I did not think to ask if the buprenorphine film was available when I was in California. On my next visit I will. Thanks again. Rivers

[LotteM in reply to RiversW]

The buccal film (Belbuca) should be available in CA as Dr Buchfuhrer prescribes it and he is based in (southern) California.

[RiversW in reply to LotteM]

Thanks! Next time I am in LA, I will ask for the buccal film.

[707twitcher in reply to RiversW]

There are two types of film - Belbuca and Butrans. I looked into the differences when I first got on buprenorphine and decided on the Butrans, but I don’t recall why. I think the Butrans is more easily available. You put it under your tongue, just like the pill. The Belbuca goes on your cheek I believe.

[RiversW in reply to 707twitcher]

Thank you Mr. Twitcher!

[707twitcher in reply to RiversW]

Oops. I really shouldn’t be posting at 4 in the morning 😱. Butrans is the patch, Suboxone is the sublingual film. That is the alternative to pills.

bicyclehealth.com/suboxone-...

[RiversW in reply to 707twitcher]

No worries. Thanks for the update. Rivers

[RiversW]

After so much good advice here, I thought it important to follow up. After attempting to ween myself too rapidly from pregabalin and multiple episodes of serious depression, I have restored my dose of pregabalin to the previous level. I am happy to report that I have not had an episode since. Thanks everyone! Rivers