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Old 10-08-2005, 06:09 PM   #1
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TexasWildRose04 HB User
SHORELINE!?!?!?! Please Read

Hey Shoreline.... I was just curious if you know if it is safe for me to take my Zoloft with my Oxycontin? My Pain Management doc had told me that I may experience some depression again with this drug like I did with the Methadone... and Yes, I can tell a difference, as far as depression goes.... so my question is, Do you know anything about if it is safe to take the Zoloft with the Oxy? I have an appointment with him on Wed, and will talk to him about it, but just wanted to see if you could tell me as well....

The 10 mg 3 times a day Oxy is maybe VERY slightly taking the edge off my pain... but not much.... probably from a 9 down to a 7-8..... but my fear is he is not going to want to up my dosage on my visit... hes gonna push that darn pump again.... and also when I ask about the Zoloft Im afraid hes gonna bite at that being another reason to take me off the Oxy and push the pump... know what I mean.... but anyway... just wondered if you knew about the Zoloft...

Thanks Alot

TRose

 
Old 10-09-2005, 03:06 PM   #2
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Re: SHORELINE!?!?!?! Please Read

Hi Tex, Sorry to hear your not getting relief yet but 10 mg oxycontin is a very low dose and I have read some reports of the clinical trials where there was mimimal difference between patients recieving 10mg of oxycontin twice a day and a plecebo. The reason is you don't reach a theraputic level of oxycodone to produce anelgesia and make much difference

I ran a drug interaction checker on Zoloft and oxy and although Oxy hasn't proven to have any effect of serritonin levels they have to tell you about the one case report where somene experienced Serritonin syndrome. There were other factors involved, so take it with a grain of salt. Almost everyone treated for chroonic pain has at some time used anti depressant due to the reactive depresion caused by CP and the potential effect to reduce substance P "a neuro inflamatory agent asociated with chronic pain."

IF you had a history of depression prior to pain that's a completly different circumstance. There is no proof that oxy has an effect on serritnon and no proof that antidepressants relieve reactive depression.

Depression is a form of chemical imbalance, being depressed because your in pain or because a family member died or a child being depressed because their hamster died doesn't mean they have true deprsssion that requires use of an anti depressant. There is no pill or antidepressant that would make me happy about being dissabled. That doesn't mean I'm cliniclly depressed acording to the critriea that has to be met to properly diagnose true depression.

True depression is more than feeling depressed, and methadone side effects can be very intense and duplicate many of the diagnostic requirements for depression. Somnalence "lack of emotion", Lack of ambition, lack of pleasure for previous enjoyable activities, lack of motivation, Loss of sex drive are all common side effects associated with methadone and these side effects mimick the criteria for diagnosing true depression.

IMO In the absence of previously diagnosed depression, the depression CP patients experience is simply reactive to a patients circumstance. It would be more unusual not to be depressed than it would to not have an emotional response to chronic pain.

If you didn't have truely diagnosed depression prior to CP and taking methadone, it sounds more like a side effect from meth then true depression using the DSM-1V guidlines to diagnose any mental illness caused by a chemical imbalance, brain injury or organic cause.

But here is the drug to drug interaction
oxycodone and sertraline (moderate Drug-Drug) Description:

MONITOR:
A case report suggests that use of serotonin reuptake inhibitors with oxycodone may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A receptors. However, unlike other analgesics such as phenylpiperidine opioids (e.g., meperidine) and tramadol, oxycodone is not known to possess serotonergic activity and has not previously been associated with the serotonin syndrome. The report describes a bone marrow transplant patient who developed severe tremors and visual hallucinations after he dramatically increased his dosage of oxycodone while on a stable dosage of sertraline and cyclosporine. Discontinuation of cyclosporine did not completely resolve his hallucinations and had no effect on the tremors after 72 hours, which led to consideration of a possible sertraline-oxycodone interaction. The patient's symptoms resolved after sertraline was withheld and cyproheptadine (a central serotonin antagonist) administered.

MANAGEMENT:
Until further data are available, caution is advised if serotonin reuptake inhibitors is coadministered with oxycodone, particularly in complicated patients such as transplant patients who are also receiving cyclosporine. Close monitoring is recommended for signs and symptoms of excessive serotonergic activity such as CNS irritability, altered consciousness, confusion, myoclonus, ataxia, abdominal cramping, hyperpyrexia, shivering, pupillary dilation, diaphoresis, hypertension, and tachycardia. Particular caution is advised when increasing the dosages of these agents.
..................................

This was one patient after a bone marrow transplant who was also using bacterial suppresive therapy.

Many many people take SSRI's, the catagory of antidepressants that zoloft falls in while taking opiates. The only pain med I'm aware of that has a direct cause and effect relation to serritonin is using Ultram with a SSRI, because Ultram also has SSRI activity, so it creates problems like serritonin syndrome caused by SSRI overdose or abrupt discontinuation.

The zoloft is as merly an adjunct med in treating pain. If you have true depression diagnosed by a Psychiatrist using the proper criteria, thay have found that Medication treatment alone is no more effective than counseling alone, but when the two are combined depression can be managed and treated succesfully.

Every doc in the world from your GP to your GYN prescribes antidepressants every day based on 10 questions asked on a leaflet passed out by the sales reps for each antiD. That's an absurd way to DX depression and begin chemical treatment.

Let the psych specialist due his job if you have depression, but use of oxy doesn't cause depression. Being in chronic pain causes reactive depression that wouldn't respond to chemical treatment since there is no chemicl imbalance that needs to be corrected.

Depression is the most over diagnosed and treated problem in the country and people are looking for a pill to make them feel better about a job they don't like , a relationship that's troubled or grieveng a loss in someway. Too many people are thrown on to these meds by any doc that might even suggest your depressed that have no understanding of the complexity of mental illnes.

Of course you depressed about being in CP. Does tha mean you have a chemical imbalance that requires changing your brain chemistry? Would you meet the criteria used by a psycthiatrist to diagnose moderate to sevre depression? Most likely not.

Using it prophylactically simply because your using any CNS depressnt is misuse of the drug. Do you feel better about living in pain thanks to Zoloft? If it helps with pain due to it's effect on substance P, that's one thing. If it improves sleep due to a specific side effect that's using it for an off label purpose and another reaon to use it. BUt simply prescribing an anti depressant to everyone that takes a CNS deressant is abuse of the medication IMO.

Did Zoloft relieve the side effects of the methadone or make you hapier about being in pain? Obviously not, since you changed opiates due to the side effects. You may also be feeling bad because of differntial withdrawal. Methadone is much more potent than oxy, and has properties that no other opiates have. Even if you switch to an equianelgesic dose or even higher dose of oxy or morphine, your not getting all the receptor activity that meth creates and you will likely still experience differential withdrawal, which includes feelings of deression.

One of the major symptoms of withdrawal is depression, not the organic kind an anti depressant will fix, but caused by experiencing withdrawal which will deminsh as time passes.

What dose of meth where you taking and for how long? How long ago did you switch and was there a period of no opiate in between or did you just do a cold switch from meth to oxy. I've switched from meth to a different opiate 3 times and experienced differential withdrawal each time and the feeling of depression is profound but doesn't meet the diagnostic requirements to alter my brain chemsistry with an anti depressant.

Unfortunately you can't discontinue Zoloft abruptly but the true test would be to discontinue zoloft and see if it made any difference in your mood or in levels of pain. If it doesn't, you don't need to take it.

The doc seems to pretty sold that Zoloft and anti D's are wonder drugs and will somehow alter a natural response to loss or pain. You certainly don't need to increase the Zoloft every time you increase the oxy.

Good luck, Dave

Last edited by Shoreline; 10-09-2005 at 03:45 PM.

 
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Old 10-09-2005, 06:32 PM   #3
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Lightbulb Re: SHORELINE!?!?!?! Please Read

I currently take 150 mg of zoloft (a moderate dose) along with 60 mg's oxycontin and 15-30 mg's roxicodone daily. Have been on this combo for over 2 years without any type of interaction or serious side-effects. Perhaps the only side-effect i can attribute to the combo is intermittent increased drowsiness. However, it could be from one or the other of the meds alone, rather than both reacting together. But, I have talked to several doctors and all of them agree that there is virtually no danger (serotonin syndrome or otherwise) of taking an ssri and the category of narcotic that morphine falls into, as well as the catergory of narcotic that oxycodone falls into. The only dangerous interaction between an ssri and a narcotic is with the category of narcotic that includes demerol. With that type of narcotic, the risk of serotonin sydrome is increased. hope that helps.

 
Old 10-09-2005, 09:21 PM   #4
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TexasWildRose04 HB User
Re: SHORELINE!?!?!?! Please Read

Quote:
Originally Posted by Shoreline
Hi Tex, Sorry to hear your not getting relief yet but 10 mg oxycontin is a very low dose and I have read some reports of the clinical trials where there was mimimal difference between patients recieving 10mg of oxycontin twice a day and a plecebo. The reason is you don't reach a theraputic level of oxycodone to produce anelgesia and make much difference

I ran a drug interaction checker on Zoloft and oxy and although Oxy hasn't proven to have any effect of serritonin levels they have to tell you about the one case report where somene experienced Serritonin syndrome. There were other factors involved, so take it with a grain of salt. Almost everyone treated for chroonic pain has at some time used anti depressant due to the reactive depresion caused by CP and the potential effect to reduce substance P "a neuro inflamatory agent asociated with chronic pain."

IF you had a history of depression prior to pain that's a completly different circumstance. There is no proof that oxy has an effect on serritnon and no proof that antidepressants relieve reactive depression.

Depression is a form of chemical imbalance, being depressed because your in pain or because a family member died or a child being depressed because their hamster died doesn't mean they have true deprsssion that requires use of an anti depressant. There is no pill or antidepressant that would make me happy about being dissabled. That doesn't mean I'm cliniclly depressed acording to the critriea that has to be met to properly diagnose true depression.

True depression is more than feeling depressed, and methadone side effects can be very intense and duplicate many of the diagnostic requirements for depression. Somnalence "lack of emotion", Lack of ambition, lack of pleasure for previous enjoyable activities, lack of motivation, Loss of sex drive are all common side effects associated with methadone and these side effects mimick the criteria for diagnosing true depression.

IMO In the absence of previously diagnosed depression, the depression CP patients experience is simply reactive to a patients circumstance. It would be more unusual not to be depressed than it would to not have an emotional response to chronic pain.

If you didn't have truely diagnosed depression prior to CP and taking methadone, it sounds more like a side effect from meth then true depression using the DSM-1V guidlines to diagnose any mental illness caused by a chemical imbalance, brain injury or organic cause.

But here is the drug to drug interaction
oxycodone and sertraline (moderate Drug-Drug) Description:

MONITOR:
A case report suggests that use of serotonin reuptake inhibitors with oxycodone may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A receptors. However, unlike other analgesics such as phenylpiperidine opioids (e.g., meperidine) and tramadol, oxycodone is not known to possess serotonergic activity and has not previously been associated with the serotonin syndrome. The report describes a bone marrow transplant patient who developed severe tremors and visual hallucinations after he dramatically increased his dosage of oxycodone while on a stable dosage of sertraline and cyclosporine. Discontinuation of cyclosporine did not completely resolve his hallucinations and had no effect on the tremors after 72 hours, which led to consideration of a possible sertraline-oxycodone interaction. The patient's symptoms resolved after sertraline was withheld and cyproheptadine (a central serotonin antagonist) administered.

MANAGEMENT:
Until further data are available, caution is advised if serotonin reuptake inhibitors is coadministered with oxycodone, particularly in complicated patients such as transplant patients who are also receiving cyclosporine. Close monitoring is recommended for signs and symptoms of excessive serotonergic activity such as CNS irritability, altered consciousness, confusion, myoclonus, ataxia, abdominal cramping, hyperpyrexia, shivering, pupillary dilation, diaphoresis, hypertension, and tachycardia. Particular caution is advised when increasing the dosages of these agents.
..................................

This was one patient after a bone marrow transplant who was also using bacterial suppresive therapy.

Many many people take SSRI's, the catagory of antidepressants that zoloft falls in while taking opiates. The only pain med I'm aware of that has a direct cause and effect relation to serritonin is using Ultram with a SSRI, because Ultram also has SSRI activity, so it creates problems like serritonin syndrome caused by SSRI overdose or abrupt discontinuation.

The zoloft is as merly an adjunct med in treating pain. If you have true depression diagnosed by a Psychiatrist using the proper criteria, thay have found that Medication treatment alone is no more effective than counseling alone, but when the two are combined depression can be managed and treated succesfully.

Every doc in the world from your GP to your GYN prescribes antidepressants every day based on 10 questions asked on a leaflet passed out by the sales reps for each antiD. That's an absurd way to DX depression and begin chemical treatment.

Let the psych specialist due his job if you have depression, but use of oxy doesn't cause depression. Being in chronic pain causes reactive depression that wouldn't respond to chemical treatment since there is no chemicl imbalance that needs to be corrected.

Depression is the most over diagnosed and treated problem in the country and people are looking for a pill to make them feel better about a job they don't like , a relationship that's troubled or grieveng a loss in someway. Too many people are thrown on to these meds by any doc that might even suggest your depressed that have no understanding of the complexity of mental illnes.

Of course you depressed about being in CP. Does tha mean you have a chemical imbalance that requires changing your brain chemistry? Would you meet the criteria used by a psycthiatrist to diagnose moderate to sevre depression? Most likely not.

Using it prophylactically simply because your using any CNS depressnt is misuse of the drug. Do you feel better about living in pain thanks to Zoloft? If it helps with pain due to it's effect on substance P, that's one thing. If it improves sleep due to a specific side effect that's using it for an off label purpose and another reaon to use it. BUt simply prescribing an anti depressant to everyone that takes a CNS deressant is abuse of the medication IMO.

Did Zoloft relieve the side effects of the methadone or make you hapier about being in pain? Obviously not, since you changed opiates due to the side effects. You may also be feeling bad because of differntial withdrawal. Methadone is much more potent than oxy, and has properties that no other opiates have. Even if you switch to an equianelgesic dose or even higher dose of oxy or morphine, your not getting all the receptor activity that meth creates and you will likely still experience differential withdrawal, which includes feelings of deression.

One of the major symptoms of withdrawal is depression, not the organic kind an anti depressant will fix, but caused by experiencing withdrawal which will deminsh as time passes.

What dose of meth where you taking and for how long? How long ago did you switch and was there a period of no opiate in between or did you just do a cold switch from meth to oxy. I've switched from meth to a different opiate 3 times and experienced differential withdrawal each time and the feeling of depression is profound but doesn't meet the diagnostic requirements to alter my brain chemsistry with an anti depressant.

Unfortunately you can't discontinue Zoloft abruptly but the true test would be to discontinue zoloft and see if it made any difference in your mood or in levels of pain. If it doesn't, you don't need to take it.

The doc seems to pretty sold that Zoloft and anti D's are wonder drugs and will somehow alter a natural response to loss or pain. You certainly don't need to increase the Zoloft every time you increase the oxy.

Good luck, Dave

Actually I did stop Zoloft abruptly, because when I was having problems with the chest pains that they felt was comming from the Methadone they also said it coudl be the Zoloft and told me to stop it....I was on Methadone 30mg 3 times a day.....for a year and a half... then they weaned me off and I was off any narcotic or opiate drugs for nearly 2 months... then they started me on the Oxycontin....and when I started the Oxy my Pain Management doctor told me to be very very aware of the possability of depression on the Oxy... but we called the Pharmacy and they said that since I am on Klonopin at night, 2 at bedtime to help me sleep.....they said I would more likely have depression effects from it then the Oxy... but they said I should not take the Klonopin for extended time... also they said it would not hurt to take the Zoloft with the Oxy....I can say the Zoloft did make me not fell like I just wanted to lay in bed and go to sleep and never awake, or get out of bed... I basically was a vegetable, I didnt want to do anything, go anywhere, nothing... and I think the Zoloft did help that somewhat... And I did not have the depression between drugs, only while on the Methadone, and now on the Oxycontin..... they put me on Elavil to help me with weaning off the Methadone...I see my doc on wed... I will tell him about the depression and just see what he tells me... but thank you for getting back to me....

TRose

 
Old 10-09-2005, 10:41 PM   #5
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Re: SHORELINE!?!?!?! Please Read

Hey T rose, I didn't mean to imply that you couldn't have or feel real depression that responded to antidepressants, But as far as Oxy being notorious for causing depression, it's not known to be. If anything it considered to be one of the opiates that are more stimulating being in the keto synthetic class.

Although I have no doubts opiates may cause you to feel depressed itís just not listed as a warning or side effect. Definitely talk to your doc but were all obviously different, you can stop Zoloft cold without a problem, where other people would end up in the ER. Go figure?

Sorry if I went on about reactive depression Vs true organic depresion, the do feel the same to the patient but the causeis different and there just isn't anfo linking opiates to major onset of depression.

All you asked was about a specific side effect. Fortunately there isn't so I'll try to stick to the point in the future.

AntiD's and every doic feeling qualified to prescribe meds that change your brain chemsitry withot propper follow up is a real pet peeve of mine. A shrink would not presribe a potent psych med without following up the next week, where other docs pass them out like candy. But that's my pet peeve, It doesn't have to be yours.

If it was theĒ realĒ part of me describing depression, Iím sorry if that offended you. Reactive depression feels just as real as organic depression, but an anti depressant IMO isnít the answer to a normal reaction. What you eperienced isn't typical but if antiD's allow you to achieve pain relief it's no different than treating any other side effect.
Take care and I hope you find something that works.
Dave

Last edited by Shoreline; 10-09-2005 at 10:55 PM.

 
Old 10-12-2005, 10:07 PM   #6
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TexasWildRose04 HB User
Re: SHORELINE!?!?!?! Please Read

Well, I went to my Pain Management Doc today.... I mentioned the Depression, which he had told me several times when he put me on is..."BE AWARE OF DEPRESSION" well, I had called their office I couldnt get ahold of anyone yesterday, so I called the pharmacy I use, told them I was on Oxycodone ER and Klonopin.... and that I was experiencing Depression, well the pharmacist told me that out of the two, he would say the Klonopin would cause the depression before the Oxy.... so I told my PM Doc today this, and he said NO!... he wanted me to stop the Oxy and the Klonopin for the rest of the week and the weekend and see if the depression goes away.... then if so... says... if backed against the wall, of the morphine pump and stimulator which one would I choose, I said... "Stimulator" but I am not interested in either at this point.... So he thinks Im stopping the Oxy and Klonopin, Im just stopping the Klonopin... staying on the Oxy and he started me on Lunesta.... so thats where we stand for now.... He said if the Oxy is not whats causing the depression he wants to up me to 20mg 3 times a day... So we will see....I mean I dont go back to him until December... so they have to do something....but just wanted to kinda give an update...

Thanks for you input... I appreciate it.

 
Old 10-13-2005, 02:38 PM   #7
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friendly_one HB User
Re: SHORELINE!?!?!?! Please Read

Hi Texas,

Are you taking Elavil? I took this years ago for 3 months and gained 50 pounds!! My Mom took it for 2 months and gained 30 pounds!! It took us both almost 1 year to loose that "Elavil" weight. Before the Elavil, neither of us cared for anything sweet or sugary. When taking the Elavil, we would have been happy eating sugar out of the bag with a spoon! LOL Anyway, it did help with the sleep, but did nothing for the depression. Are you experiencing this side effect??

 
Old 10-13-2005, 09:12 PM   #8
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TexasWildRose04 HB User
Re: SHORELINE!?!?!?! Please Read

Quote:
Originally Posted by kstone_queen
Hi Texas,

Are you taking Elavil? I took this years ago for 3 months and gained 50 pounds!! My Mom took it for 2 months and gained 30 pounds!! It took us both almost 1 year to loose that "Elavil" weight. Before the Elavil, neither of us cared for anything sweet or sugary. When taking the Elavil, we would have been happy eating sugar out of the bag with a spoon! LOL Anyway, it did help with the sleep, but did nothing for the depression. Are you experiencing this side effect??
Hi, yes actually I have taken Elavil... It did not make me gain any weight, actually I lost weight on it.... but it did make my restless leg syndrome worse then it already was... so they had to take me off of it.....Now they have me on Lunesta to help me sleep, and he didnt put me on anything for the depression, because he says why give me a drug for pain that is going to depress me and then a drug to bring me up... which is understandable.... I think? LOL..... but anyway... I stopped the Klonopin and I am still gonna take the Oxy and see what that does see if it helps my depression first.... thanks for the input though....Take Care.

Last edited by TexasWildRose04; 10-13-2005 at 09:13 PM.

 
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