A strategy for EDS relief

‘K, so you took the “Do you have EDS” test, are pretty sure you need opiate therapy, have read the Recommended Posts, and are contemplating going to your doc looking for opiates. First of all, good luck with that, and if you’ve got a silver tongue and have managed to wheedle a long-term prescription, let me know; maybe you and I can go unicorn hunting some time and sell one to a zoo for some serious cash.

The only way you’ll legally get what you’re looking for, if you get it at all, is if you arm yourself with your own documented drug failure history and printed opinions from experts and primary studies from the web.

If you’re a virgin, you have to start from the start. The first thing to do is get yourself diagnosed. If you’re truly depressed the doctor will see it clearly as soon as you walk into his office and start talking. EDS sells its self, for sure.

Next, start going through the standard on-label antidepressants. Remember to give these meds a chance, and at the same time keep in mind that it can take months for meds to cease working, or adverse effects to develop, after a time of efficacy. But if you find a med that actually does the job, thank your particular magical sky fairy for your good fortune and get on with life. You probably don’t have EDS… …otherwise, other tactics must be employed.

Take the meds your doctor prescribes. Start keeping detailed records of types and efficacy. Make sure that they are clear and lucid, because if these drugs don’t work, you want to be taken seriously when eventually asking to go off-label for opiates. Sertraline (Zoloft) and fluoxetine (Prozac) are standard SSRIs and will probably be scripted first; so if the doc scripts these, try one or both. If they don’t work, go on to one or two SNRIs. Venlafaxine (Effexor) is standard and will probably be the first of these. Effexor has a unique profile in that it has somewhat of an opioid profile, though what that really means for us, I have no idea. Effexor has also some hellish side effects and withdrawal symptoms; I had a particularly nasty time with this drug (though I won’t go into my bad experience with the carnival ride of ADs. I don’t want to bias your perspective).

Bupropion (Wellbutrin), an NDRI, might be the next choice, then maybe something different like trazodone and on and on. Try to get through quite a few different types, and include some old-school ADs like the tricyclics and MAOIs. If these don’t work, perhaps suggest going off-label and trying something like lamotrigine or amphetamine. Again, if something works for you, breathe a sigh of relief and get on with the business of living. If not, at least you’ve kept meticulous records, eliminated possibilities and narrowed down your options and diagnoses… you can now make some choices and think about opiate therapy.

I recommend going to a doctor who will read your research and drug history and listen with interest and sincerity. You should be able to get a good read on his attitude right from the start; and if he isn’t into it or is an opiate dumdum, maybe tactfully ask him to refer you to someone less timid, or find someone yourself.

In my opinion, the first opiate used should be buprenorphine. It is a legal opiate with an interesting profile of action used in withdrawal therapy and is becoming relatively popular as an off-label antidepressant… if you can find a willing doc. Also, despite my reservations, low dose naltrexone (LDN) seems to be having a good effect on some depressives, though I wonder how much of this is placebo. Nevertheless, if bupe doesn’t do it or you can’t find a doc to prescribe, it can’t hurt to try it, and who knows? it might just be the ticket.

However, if everything has been done under the sun and you haven’t found relief, you might have to look for shade under the big guns. This is where the full agonist opiates/opioids come in, and where the adventure, for better or worse, begins. There are a few ways to procure opiates; some legal, some not so much, but one can with some effort find them (my blog gives some ideas). There doesn’t seem to be much difference in efficacy between opiates, though codeine doesn’t like me too much. As well, I have made it clear in this blog that when dosing, the object is to achieve relief without a shred of the nod(!). Again, if one goes into nod territory, one goes into drug abuse territory and the whole raison de plus gets shot to hell…

…don’t do this…

…just don’t.

I refuse to acquire a guilt trip because my good intentions get ignored and someone’s life goes down the tubes.

So just don’t do it. Don’t turn a potential gift into a curse.

~There is one fairly sure way to get what you’re looking for without riding the med-go-round; if you’re already addicted (and really, how many opiate abusers aren’t simply self-medicating depressives?) and don’t have the will to stay out of the nod, you can go into methadone or bupe therapy. This will help you get back on track and focus on life because you don’t have to worry about scoring and fixing, your jones is satisfied without the obsessive distraction of euphoria, and both bupe and ‘done have a fantastic anecdotal efficacy for depression; in fact, if going into ‘done therapy wasn’t such a pain in the ass, it would be my first choice above bupe, despite its troublesome half-life. And if you’re not addicted, you have to be pretty desperate for answers to try this approach and lie; but, well, who am I to judge; no one should be dictating what drugs an adult can take anyway… bloody patronising…

…which brings me to the downside of this approach. Titrating off these drugs can be more painful than heroin(!), and odds are, this therapy will become part of your medical records (which might create a different perception than scripting opiates simply for depression); also, methadone therapy requires a daily trip to the clinic which inconveniently cuts into one’s day.

Whatever you do, study and read, read and study, weigh the pros and cons and be honest with your motives. If you make your life your highest value, the choices you make should keep you on the right track.

Good luck to you…