What are the side effects of Opana? How is Opana abused? What are the signs of Opana addiction? Get the facts about this powerful opioid pain reliever.

Opana’s Concerning Rise in Popularity

Over 1 million prescriptions were written in 2012 for the powerful opioid narcotic pain reliever Opana, also known by its generic name oxymorphone. The Drug Enforcement Administration (DEA) classifies Opana as a Schedule II controlled substance due to its high potential for diversion, abuse, and dependency.

Prescription opioid drugs like Opana are among the most highly abused substances in the United States. The National Survey on Drug Use and Health (NSDUH) reported that in 2014, approximately 4.3 million Americans aged 12 and older were currently abusing prescription painkillers. These powerful opioid drugs are highly addictive, as they not only reduce pain but also induce a sense of euphoria and relaxation that may be desirable, leading to drug dependency and addiction.

How Opana Is Abused

Opana comes in an octagon-shaped tablet in either an extended-release (Opana ER) or immediate-release format. It may be swallowed, chewed, or crushed and then snorted, smoked, or injected. On the street, it is known by many names, such as “Stop signs,” “New blues,” “Pink lady,” “Mrs. O,” and “Blue heaven.”

When abused, Opana slows down some of the functions of the central nervous system that are related to the stress response, such as heart rate, blood pressure, breathing rate, and anxiety level. Even when used as prescribed for pain relief, a person can develop a tolerance, need to take more of it to get relief, and potentially become dependent on Opana.

The Dangers of Opana Dependence

Once someone becomes dependent on Opana, medical detox is often the safest and smoothest way to get the drug out of the body. Suddenly stopping Opana use can induce an opioid withdrawal syndrome with intense withdrawal symptoms. With medical detox, withdrawal can be managed with medications and psychological support.

Behavioral therapies, support groups, and counseling sessions, as well as holistic methods, can help to promote long-term recovery. However, the risk of relapse remains high, as Opana addiction can have a powerful grip on an individual’s brain and behavior.

Who Is Most at Risk of Opana Abuse?

Like with other prescription opioids, the DEA postulates that oxymorphone is most frequently abused by young white males. The NSDUH of 2014 reported that the most common age demographic of those who abuse prescription opioid drugs was 18-25.

Opana abuse may have spiked after OxyContin (oxycodone) was reformulated in 2010, making it harder to abuse. This led individuals to switch to Opana, as it is a more easily altered opioid drug.

The Impact of Opana on the Brain

Opana changes people’s brain chemistry related to how they feel pain, process reward, and feel pleasure. Over time, with continued use, first a tolerance and then a dependence can form. Drug dependence is both physical and psychological, as an individual who suffers from it likely experiences drug cravings, trouble feeling happy or relaxed, or difficulty sleeping easily without the drug.

An imbalance of some of the brain’s chemical messengers is created from the regular presence of opioid drugs in the system, which fill opioid receptors and induce a surge of some of these neurotransmitters that are responsible for feelings of pleasure, mood regulation, decision-making abilities, and motivation. When Opana is then removed from the body after a dependence has formed, the brain struggles to restore balance, causing some undesirable side effects that may entice an individual to continue taking the drug and lead to compulsive drug abuse, or addiction.

Recognizing the Signs of Opana Addiction

Opana intoxication is not that dissimilar from being drunk on alcohol. Individuals may slur their speech, stagger around or fall down, make poor choices, take bigger risks, have fewer inhibitions, engage in risky sexual behaviors, have slowed reflexes and short-term memory lapses, be unable to think clearly, be drowsy, and experience other concerning effects.

These signs of Opana abuse and addiction can have serious consequences, both for the individual and those around them. It is crucial to seek professional help and support to overcome an Opana addiction and regain control of one’s life.

Understanding the Complexity of Opana Abuse

The rise in Opana abuse and addiction is a testament to the broader opioid crisis facing the United States. As these powerful painkillers continue to be widely prescribed and abused, the need for comprehensive treatment and prevention strategies has never been more urgent.

By understanding the dangers of Opana, its impact on the brain, and the signs of addiction, individuals and communities can better equip themselves to address this complex and pervasive public health issue.

Side Effects, Signs of Abuse & Overdose

Opana Statistics & Drug Schedule

Over 1 million prescriptions were written in 2012 for the powerful opioid narcotic pain reliever Opana, also known by its generic name oxymorphone.

The Drug Enforcement Administration, or DEA, classifies Opana as a Schedule II controlled substance due to its high diversion, abuse, and dependency potential.

Prescription opioid drugs are some of the most highly abused drugs in the United States, as the National Survey on Drug Use and Health (NSDUH) reported that at the time of the 2014 survey approximately 4.3 million Americans (aged 12 and older) were currently abusing prescription painkillers like Opana. These powerful opioid drugs are highly addictive, as they not only reduce pain, but induce a sense of euphoria and relaxation that may be desirable, and regular use can lead to drug dependency and addiction. The National Institute on Drug Abuse (NIDA) estimates that more than 2 million people in the United States suffer from a prescription opioid-related substance use disorder.

How Opana Is Abused

Opana comes in an octagon-shaped tablet in either an extended-release (Opana ER) or immediate-release format that may be swallowed, chewed, or crushed and then snorted, smoked, or injected.  On the street, it is known by many names, such as:

• Stop signs
• New blues
• Pink lady
• Mrs. O
• Blue heaven
• Octagons
• The O bomb
• Pink O
• Pink heaven
• Orgasna IR
• Oranges
• OM

When abused, Opana slows down some of the functions of the central nervous system that are related to the stress response, such as heart rate, blood pressure, breathing rate, and anxiety level. Even when used exactly as prescribed for pain relief, a person can develop a tolerance, need to take more of it to get relief, and potentially become dependent on Opana, per the labeling and drug information published by the U.S. Food and Drug Abuse Administration (FDA). The risk for dependency increases if an individual is taking the drug for nonmedical purposes (i. e., recreationally to get high).

Once someone becomes dependent on Opana, medical detox is often the safest and smoothest way to get the drug out of the body. Suddenly stopping Opana use can induce an opioid withdrawal syndrome with intense withdrawal symptoms. With medical detox, withdrawal can be managed with medications and psychological support.

Behavioral therapies, support groups, and counseling sessions as well as holistic methods can help to promote long-term recovery.

Range of Opana Abuse

Like with other prescription opioids, the DEA postulates that oxymorphone is most frequently abused by young white males. The NSDUH of 2014 reported that the most common age demographic of those who abuse prescription opioid drugs was 18-25.

Opana abuse specifically may have spiked after OxyContin (oxycodone) was reformulated in 2010, making it harder to abuse. This led individuals to switch to Opana, as it is a more easily altered opioid drug, Reuters reports. In 2013, the makers of Opana and Opana ER, Endo Pharmaceuticals, tried to make Opana abuse-deterrent and petitioned the FDA to restrict the sale of generic forms of oxymorphone that didn’t have these safeguards in place. The FDA denied the petition, and generic oxymorphone may still be easily altered to be abused for recreational purposes via injecting or snorting the drug.

The DEA reported that 1.2 million oxymorphone prescriptions were dispensed in 2012 for the treatment of pain.

Opana changes people’s brain chemistry related to how they feel pain, process reward, and feel pleasure. Over time, with continued use, first a tolerance and then a dependence can form. Drug dependence is both physical and psychological, as an individual who suffers from it likely experiences drug cravings, trouble feeling happy or relaxed, or difficult sleeping easily without the drug. In addition, an individual may suffer from physical withdrawal symptoms that are like a really bad case of the flu.

An imbalance of some of the brain’s chemical messengers is created from the regular presence of opioid drugs in the system, which fill opioid receptors and induce a surge of some of these neurotransmitters that are responsible for feelings of pleasure, mood regulation, decision-making abilities, and motivation. When Opana is then removed from the body after a dependence has formed, the brain struggles to restore balance, causing some undesirable side effects that may entice an individual to continue taking the drug and lead to compulsive drug abuse, or addiction.

Signs of Opana Addiction

Opana intoxication is not that dissimilar from being drunk on alcohol. Individuals may slur their speech, stagger around or fall down, make poor choices, take bigger risks, have fewer inhibitions, engage in risky sexual behaviors, have slowed reflexes and short-term memory lapses, be unable to think clearly, be drowsy, and have impaired motor coordination. Those who are addicted to Opana are unable to control drug usage, which means they can’t control the amount of Opana they abuse at one time, how often they abuse it, or for how long. They may try, and fail, to stop using Opana on their own several times.

Mood swings and irregular sleeping and eating habits may be common, as Opana abuse can interfere with sleep patterns and suppress appetite, which may cause weight fluctuation as well. Those battling Opana addiction may retreat into themselves, be secretive, and withdrawn. They may stop joining or engaging in activities that used to be important to them as well. Social circles may dwindle to just those who are also abusing drugs, and most of their time may be spent getting Opana, using it, and recovering from the drug. They may not be as productive at work or school, and have a lot of absences.

Those battling drug addiction may continue to use the drug even though doing so will likely have negative social, emotional, or physical consequences. They may also use Opana in situations that could put them at risk for accident, injury, or legal trouble.

Increased tolerance to Opana, requiring higher doses of the drug, and physical dependence are also possible warning signs of an addiction. Individuals dependent on and battling Opana addiction are likely to suffer from opioid withdrawal symptoms as the drug leaves the body. These symptoms may include anxiety, depression, irritability, restlessness, tremors, high blood pressure and heart rate, nausea, vomiting, diarrhea, dilated pupils, runny nose, tearing, yawning, insomnia, muscle and joint pain, fever, chills, sweating, and agitation. These symptoms likely start within about 14 hours or so of the last dose of Opana, since oxymorphone has a half-life of 7-9 hours, according to the journal Practical Pain Management.

Medical detox can help an individual manage detox by easing some of the withdrawal symptoms with the aid of pharmaceutical tools like buprenorphine products or other medications. It is possible to be physically dependent on Opana without being addicted to it, although dependency is a potential sign of addiction. Addiction is classified as a brain disease that is treated with detox, therapy, and counseling in a comprehensive substance abuse treatment program.

Opana Overdose Potential

Opioid overdose is a major problem in the United States that the Centers for Disease Control and Prevention (CDC) calls an epidemic, as 78 people die every day as the result of an opioid overdose. More than half of these deaths involve a prescription opioid like Opana.

One of the hazards that Opana represents is that, per milligram, it is more potent than oxycodone (OxyContin), Reuters publishes. Individuals who are used to taking this OxyContin recreationally may take too much Opana at one time, which can cause a person’s breathing rate to slow down too much and even stop altogether.

An overdose is when a drug overwhelms a person’s system and can no longer be metabolized, causing vital systems, like respiration and cardiovascular functions, to shut down. The DEA reports the following as signs of an oxymorphone overdose that require immediate medical attention:

• Blue tinge to skin, lips, or nails
• Dizziness
• Pinpoint pupils
• Significant drowsiness
• Irregular heart rate, pulse, and/or blood pressure
• Chest pain
• Clammy and/or cold skin
• Limp muscles
• Numbness in extremities, like the hands and feet
• Slow breathing or trouble breathing
• Loss of consciousness and coma

Altering Opana ER by chewing or crushing and then snorting, smoking, or injecting it, circumvents the drug’s extended-release format, meaning that the entire dosage of the drug enters the bloodstream at once. This can result in a life-threatening overdose as well.

In 2014, over 14,000 Americans died from a prescription opioid overdose, according to the CDC. Opioid overdose is preventable with the help of medical detox and a comprehensive substance abuse treatment program. Treatment should address the root causes of drug abuse and help an individual to learn what may have led to drug abuse in the first place. In addition, treatment should teach new strategies for avoiding potential use triggers and coping with stress and everyday life. Peer support groups offer long-term support that can help individuals to maintain abstinence.

Overdose is reversible in some cases with the help of an opioid antagonist like Narcan (naloxone) that many first responders carry. If an Opana overdose is suspected, call 911 immediately. Prompt medical care can decrease the likelihood of death and other long-term complications.

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Last Updated on Mar 22, 2023

Opana Abuse Side Effects, Withdrawal, & Addiction Treatment

What Is Opana Used For?

Opana is the trade name for the prescription medication oxymorphone—a semi-synthetic opioid painkiller.

In various formulations, oxymorphone has been available on the U.S. pharmaceutical market since 1959. In 2006, the FDA approved two new formulations of this powerful painkiller: Opana (immediate-release) and Opana ER (extended-release)

Though it is a potent and effective opioid analgesic, Opana may be intentionally misused and taken recreationally by those seeking a powerful high. People who use Opana report feelings of euphoria and relaxation, in addition to an overall decrease in pain. The drug is classified as a Schedule II substance, meaning it carries a high potential for abuse and dependence. Although Opana tablets are instructed to be taken orally, people abuse the drug in various ways, including via nasal insufflation (crushing and snorting) and needle injection. In December 2011, the FDA approved a reformulated version of the drug that was crush-resistant in an effort to curb abuse.

With chronic use of Opana, users may develop a tolerance to the drug—spurring a pattern of continuously taking more and more of it to experience the same effects. Like other Schedule II drugs, Opana carries a severe risk of psychological and/or physiological dependence and is considered dangerous when misused. If you or someone you love is abusing Opana, learn how to find help.

Street Names

Due to its potency, Opana is a highly sought-after opiate of abuse. It is sold under various street names, including:

• Blue heaven.
• Blues.
• Mrs. O.
• New blues.
• Octagons.
• Pink lady.

Signs and Symptoms of Opana Abuse

The most noticeable signs and symptoms of Opana abuse are:

• Crushing, chewing, snorting, or injecting the dissolved form of the drug.
• A strong desire to take the drug despite negative consequences.
• Making using Opana a higher priority than attending to responsibilities such as family, friends, and work.
• Claiming to have lost prescriptions.
• Lying about having pain or exaggerating pain levels to get a prescription for Opana.

Opana abusers sometimes share pills with friends, buy the drug illegally, or engage in “doctor shopping” to obtain more of the drug.

Effects of Opana Abuse

Opana Abuse Treatment

Chronic use of Opana can lead to the development of tolerance and physical drug dependence. Those dependent on Opana will feel as if they require the drug to function normally and will indefinitely experience a characteristic set of opioid withdrawal symptoms any time use is abruptly ended. A number of factors will influence the exact nature of an Opana withdrawal syndrome, including the chronicity of the abuse, the amount recently used, and factors like physical and mental health status.

Opana withdrawal symptoms may include:

• Anxiety.
• Restlessness.
• Insomnia.
• Fast heartbeat.
• Watery eyes.
• Sweating.
• Chills.
• Diarrhea.
• Nausea.
• Vomiting.

Acute opioid withdrawal is often uncomfortable enough to trigger relapse in many people, so many recovering users prefer to detox under medical supervision so that professionals can handle any cravings, medical complications, or emotional distress that arises as a result of toxins leaving the body.

Post-Detox Addiction Treatment

Addiction treatment post-detox may occur on an inpatient or outpatient basis. Inpatient facilities are the more structured option of the two. Outpatient programs allow you the flexibility to live at home and check in with a counselor at the facility on a daily basis. Each type of facility has pros and cons and it is important to choose the best program to fit your needs.

Residential treatment centers, also known as inpatient treatment, offer intensive, around-the-clock care. Individuals live at the facility for the duration of their treatment so that they can completely focus on their recovery. Inpatient facilities also offer programs to address underlying mental and behavioral issues related to addiction.

A typical day will look different based on which facility you enter and their corresponding treatment philosophy; however, an example day might include:

• Group therapy—In group therapy, you will share your experience with others who are facing similar struggles as you. This type of therapy brings recovering individuals together under the guidance of a trained facilitator. In a group, people can express themselves while being received by others in a compassionate, nonjudgmental way.
• Family therapy—A person’s behavior is difficult to separate from the context of family and other relationships, and family can play a significant role in the recovery process. Family therapy integrates family members into the rehabilitation process by keeping them informed of treatment goals and interventions, facilitating healthy communication between them and their loved one, and enabling them to play a significant role in their loved one’s sobriety after discharge.
• Individual therapy—This is an opportunity to meet one-on-one with a counselor or therapist. Someone struggling with an Opana addiction may have a pattern of thoughts, beliefs, behaviors, and/or co-occurring psychiatric disorders that contributes to their drug use. Individual therapy focuses on identifying these patterns to help users learn to work through them in a healthier way.
• Additional therapeutic offerings—These may include education, healthy eating, meditation, etc.

Types of Treatment Programs

Inpatient programs provide a safe and sober living environment in which addicted individuals can find the space to heal.

Outpatient programs offer more flexibility. Individuals can attend to responsibilities at home or work and return to the facility for regularly scheduled treatment. Therapy is a major part of outpatient treatment, and you may participate in individual and group therapy to learn healthy ways to cope with stress and manage cravings.

The goal of treatment is for you to learn how to live without using drugs. You may attend support groups while in treatment, and this can be a healthy way to build a supportive community around you. Receiving and giving support to others who understand your experience and support your journey towards sober living can make a huge difference in treating your addiction over the long term. While receiving opioid addiction treatment at an outpatient facility, you may participate in:

• Individual therapy sessions.
• Group therapy sessions.
• Educational talks about recovery and addiction.

Opana Statistics

The total number of prescriptions written for oxymorphone in 2007 was 268,000. That number jumped to 1.2 million in 2012. Opana was involved in 4,599 emergency room visits in 2010. By 2011, the number of visits climbed to 12,122, meaning there were 2.6 more times people seeking emergency care due to Opana just one year later (DEA, 2013).

Opana abuse via injectable routes is a growing concern. The risk of co-infection with hepatitis C and HIV/AIDS is high among users. The reformulated version of the drug can be dissolved in water and drawn up through a syringe, and needle sharing is all-too-common among injection users. The number of injections a person may take in a day typically ranges from 4 to 15, with the number of injection partners ranging from one to six (Conrad, 2015). Injection-drug use is risky, no matter the drug of choice. In January 2015, over 150 cases of HIV infection occurred among people who were sharing needles, syringes, and injection equipment to take Opana. Additionally, studies have also found that Opana use by injection can lead to blood clotting and permanent organ damage (FDA, 2012).

The use of prescription opioids such as Opana is increasing among pregnant women—whether they are taken to help manage pain or due to drug dependency. The prolonged use of Opana can put a child at risk of developing a number of birth complications, including neonatal abstinence syndrome (NAS). NAS occurs in 55-94% of newborns who are exposed to opioids in utero and can cause infants to experience withdrawal after birth (Kraft, et al., 2008).

Teen Opana Abuse

In 2015, roughly 5% of high school seniors reported using opioid painkillers such as Opana for non-medical reasons (NIH, 2015). Teen prescription painkiller abuse is extremely risky and puts them at risk for future heroin use. In fact, according to statistics from the CDC, past prescription opioid addiction makes you 40 times more likely to develop a heroin dependence.

Painkiller abuse also poses other dangers, such as that of fatal overdose, and male teens may be especially at risk. Studies found that males aged 15-24 are almost 4 times more likely to die from an opioid overdose than their female counterparts (Calcaterra, Glanz, & Binswanger, 2013).

Overdosing on Opana can lead to death. It is important to talk to your teenager about the dangers of drug use if you suspect that they have a problem. Try to have an open conversation with your teen about the risks of opioid abuse.

Find Opioid Addiction Treatment Programs

If you or a loved one is struggling with problematic Opana use, help is available and recovery is possible. Professional treatment can start anyone battling addiction on the path to a happier and healthier life. Rehab programs are located throughout the U.S., and many offer specialized treatment that can cater to individual needs. You can use SAMHSA’s Behavioral Services Locator to search for rehab centers. Many state government websites will also provide local drug and alcohol resources to those in need. To find your state government’s website, do a web search for your state name and ‘.gov.’ Once your state website is located, substance use resources shouldn’t be hard to find, and they should provide further phone contacts for your assistance.

American Addiction Centers (AAC) is a leading treatment provider and has trusted rehab facilities across the country. To learn about opioid addiction treatment options with AAC, please contact one of our caring admissions navigators free at . There are also free opioid hotline numbers you can call.

Opana Addiction Treatment Levels of Care

Recommended Opana Rehab-Related Articles

Health effects of energy drinks

In small quantities, energy drinks are believed to speed up the reaction, increase aerobic and anaerobic endurance, prevent drowsiness while driving, increase the intensity of perception, improve mood and well-being. Health problems associated with energy drinks are mainly associated with excess caffeine, especially for people whose daily dose of caffeine exceeds 200 mg.

Although taurine and glucuronolactone have not been shown to be dangerous when taken alone, data regarding their synergistic effects when combined with each other or with caffeine and guarana are incomplete. As the main health disorders associated with the use of energy drinks, there are:

According to American scientists, energy drinks contain enough stimulants to cause anxiety, insomnia, dehydration, irritation of the digestive system, irritability, nervousness, redness of the skin, increased urination, and palpitations. The use of energy drinks has also been associated with seizures, manic seizures, and bleeding. The content of guarana, taurine and ginseng in popular energy drinks is too low to have any therapeutic effect or vice versa – to lead to any negative phenomena. But the amounts of caffeine and sugar contained in energy drinks can have a harmful effect on the body.

Central nervous system effects

Adverse events reported in association with energy drink use include headache, anxiety, irritability, tension, dizziness, tremors, confusion, psychosis, convulsions, and altered mental states. Patients with bipolar disorder and other psychiatric diagnoses have experienced manic episodes, that is, mania.

It has also been noted that excessive consumption of energy drinks can cause hypervigilance (excessive attention and focus on all external and internal stimuli, which is usually a secondary manifestation of delusions or hallucinations) and psychomotor restlessness, followed by a deterioration in mental state, especially in people with poorly controlled or undiagnosed mental disorders.

Cardiovascular effects

Cardiovascular conditions that may be associated with energy drink abuse include palpitations, chest pain, rapid heart rate, abnormal heart rhythms, and hypertension. Energy drinks are high in caffeine, which can alter the elasticity of blood vessels and thus contribute to cardiovascular disease. The risk is increased if energy drinks are consumed with alcohol.

Effects on the digestive system

Excessive intake of caffeine with energy drinks can lead to hyperstimulation of the digestive tract, nausea, vomiting, diarrhea and abdominal pain. Caffeine can also cause gastroesophageal reflux disease, heartburn, and esophagitis. In addition, excess sugar can disrupt the normal balance of intestinal microflora.

Dental health and excess weight

Decreased dental health and erosion are common among energy drink drinkers due to their high sugar content. Erosion of the teeth and their increased sensitivity is aggravated by the high acidity of energy drinks. Energy drink-related obesity is also a concern. Energy drinks are high in calories – one bottle or can contains up to 200 or more kilocalories. If energy drinks are consumed in amounts that exceed the daily energy requirement, this can lead to the appearance of excess body weight, and already in childhood.

Energy Drinks and Eating Disorders

People with eating disorders (especially anorexia) may regularly consume large amounts of caffeine to cope with depression caused by lack of energy, suppress appetite, facilitate bowel movements and increase urine output. Considering that people with eating disorders are already so prone to cardiovascular disease that their body’s electrolyte balance is disturbed, large doses of caffeinated energy drinks can exacerbate these risks.

Energy drinks and physical activity

It is not uncommon to consume energy drinks before exercise, during exercise and during competition. This can lead to very rapid dehydration, heart attack, heat stroke, or a heart attack. The combination of the diuresis-enhancing properties of caffeine, increased sweating, and fluid loss can all contribute to severe dehydration.

Energy drinks and sports drinks are often confused, but they are fundamentally very different. Sports drinks may contain carbohydrates, minerals, electrolytes (eg, sodium, potassium, calcium, magnesium), flavors, and sometimes vitamins, and other nutrients that are designed to replace water and electrolytes lost during exercise through sweat. Energy drinks do not contain electrolytes, but they do contain caffeine and other stimulants.

Physically active people are often unaware of the need for more fluids and nutrients due to sports, and they often think that energy drinks are the way to meet their increased energy needs. Drinking energy drinks instead of sports drinks results in high levels of caffeine in the body, which has the opposite effect of meeting the body’s fluid needs. Therefore, it is very important to choose the right drink that can be consumed before or after exercise, and also in other cases to replace fluid loss, while avoiding the intake of high doses of sugar and large amounts of energy.

In some cases sports drinks may be justified for athletes, but it is not necessary for people with normal physical activity to drink sports drinks instead of water.

Energy drinks and alcohol

There has not been enough research on the concomitant use of alcohol and energy drinks, but those that have done have identified three main possible risk factors.

1. Decreased sensitivity to signs of alcohol poisoning, which increases the likelihood of both poisoning itself and an incorrect assessment of the situation, which can lead to accidents (for example, on the road), bad decisions (for example, driving drunk), risky behavior ( e.g. sexual or violent).

2. Dehydration, which may cause:

• diarrhea, nausea or vomiting,
• fatigue and headache,
• increased heart rate,
• muscle cramps gi,
• severe hangover syndrome (which in turn prevents work and drive).

3. Vastuolulised signaalid närvisüsteemile, mis võivad kaasa tuua kardiovaskulaarseid probleeme (näiteks südamepekslemine või kõrgenenud vererõhk) ning häiritud une.

Conflicting signals to the nervous system, which can lead to cardiovascular problems (such as palpitations or high blood pressure) and sleep disturbances. Mixing energy drinks with alcohol can be dangerous due to the fact that energy drinks are stimulating and alcohol is depressing. The stimulating effect of energy drinks can make it difficult for a person to determine the degree of their intoxication, and it becomes unclear to him how much he has drunk. Both alcohol and energy drinks have a diuretic effect, and together they interfere with the body’s ability to break down ethyl alcohol and can increase alcohol poisoning.

how to take drugs, effect, can you drink without a prescription and with alcohol

Medicine and health

Ekaterina Kushnir

treats anxiety disorder

I have generalized anxiety disorder.

For a long time I coped without pills and other help, but one day I got tired of constant anxiety and began to interfere with my normal life. As a result, I turned to a private psychiatrist.

The doctor prescribed an antidepressant from the SSRI group – these are selective serotonin reuptake inhibitors. Such drugs are the first thing prescribed in the treatment of depression and a number of other conditions, including my disease.

The doctor immediately warned me about some peculiarities associated with taking the drug. Some of them I then felt on myself. I think everyone who plans to be treated with antidepressants should know about them.

At the same time, it should be taken into account that most of the negative effects of therapy are temporary and not dangerous, and if they do not go away, one medicine can be replaced with another. Antidepressants help many people with mental disorders and other illnesses get rid of their symptoms and return to a full life, so you definitely should not be afraid of them. The main thing is to take such drugs when they are really needed: as prescribed by a competent doctor and under his control.

Go see a doctor

Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don’t write prescriptions, we give recommendations. Relying on our point of view or not is up to you.

Fact No. 1

Antidepressants may make symptoms worse at first

Antidepressants can increase anxiety in anxiety disorders, as well as cause irritability and agitation – the so-called causeless motor agitation, the inability to sit still. It’s not dangerous, but rather unpleasant. This condition is sometimes referred to as initial anxiety, that is, the anxiety of starting therapy. Up to 65% of people face it.

Antidepressant-induced anxiety syndrome – a systematic review in the British Journal of Psychiatry

There is also evidence that some classes of antidepressants, including SSRIs, may increase suicidal ideation in depression in young people aged 18 to 24 years. These data are not very reliable, and in older people, the risk of suicide no longer increases and even decreases.

Without treatment, depression is more likely to lead to suicidal thoughts, and in case of anxiety, you just need to prepare for such an effect, then it will be easier to survive the attacks.

The doctor told me that in the first two or three weeks there may be an increase in anxiety, but I did not take it too seriously.

Everything was fine for the first week. After about seven days, I became nervous and irritable. And then I woke up at night and after a while I felt an incomprehensible fear. My heartbeat increased, my head was spinning, my throat was constricted. Because of this, I felt a real panic – I spent the rest of the night fighting terrible thoughts, in the morning I got up completely broken.

8 myths about antidepressants

I never had such panic attacks before taking medication — my anxiety was background, general. I got scared and wrote to the doctor, who reassured me and said that it was not dangerous and would pass soon.

After that, I already expected these panic attacks, immediately tried to relax, calm down, remember that this was just a temporary effect of the drugs. And they ended faster, and then they completely disappeared.

My letter to a psychiatrist. I was scared: I expected an increase in background anxiety, but not panic attacks. I even thought about giving up the medicine

Fact No. 2

The effect of antidepressant treatment will not be immediate

Increase the dose of antidepressants gradually to reduce side effects. They usually start with the minimum, and then bring it up to the working one. For example, for SSRIs with the active ingredient “sertraline”, the working dose is from 100 mg per day. I started taking such a drug with 25 mg, and then gradually, in several steps, under the supervision of a doctor, raised the dose to 100 mg.

SSRI dosage – NHS

What doses of antidepressants will be optimal – an article in The Lancet

The process of reaching a working dose can take from two weeks to a month or more. It depends on the drug and its tolerance. I turned out to be sensitive to the medicine, it was hard for me to survive every increase in dosage: anxiety increased again, there were other side effects that then stopped. However, this is not the case for everyone, sometimes the process goes faster.

The full therapeutic effect, that is, the disappearance or a strong improvement in the symptoms of the disease, occurs some time after reaching the working dosage. As a rule, this is a week or two, although some positive changes may be earlier. For some people, this process stretches for a longer period: 6-12 weeks. Minimum initial doses of drugs usually do not work.

It is better to prepare for the fact that the symptoms of the disease will not disappear in the first weeks of treatment. And remember – this does not always mean that the drug needs to be changed, sometimes you just need to wait or further increase the dosage under the supervision of a doctor.

Fact No. 3

Antidepressants are usually taken in combination with other drugs

Another way to mitigate the side effects of antidepressants is to prescribe an additional drug along with them: for example, from the group of tranquilizers. Such drugs may have their own side effects, they should not be taken for a long time. Unlike antidepressants, some of them can be addictive. They are usually appointed for a month, but this period may be shorter or longer.

Antidepressants together with benzodiazepines work better for depression – BMJ magazine

My doctor prescribed a rather mild drug for me. However, he did not suit me. At first, it caused increased drowsiness: during the period of increased anxiety, it went away for a while, but then returned – even with half a pill I turned off and could sleep all day. And if I drank at night, I woke up with difficulty in the morning. The psychiatrist prescribed another medicine, but I could not buy it: the drug was not available in any pharmacy nearby.

As a result, I simply endured all the side effects of therapy – they were unpleasant, but tolerable. When discussing with the doctor, she called this option acceptable if the side effects of the second medicine only worsen the situation.

My prescriptions for drugs. I never used one, because there was no such medicine in pharmacies

Fact No. 4

Side effects are not always, but they are

Modern antidepressants, including SSRIs, are mild and have almost no side effects. Older drugs – tricyclic antidepressants and monoamine oxidase inhibitors – cause more side effects. Doctors usually use them when milder first-line drugs don’t work or when they can’t be prescribed.

Side effects of antidepressants – NHS

Side effects of different antidepressants – UpToDate

Side effects of antidepressants and their impact on the outcome of treatment of major depressive disorder – Nature

Selective reuptake inhibitors with erotonin – UpToDate

How to deal with side effects effects of antidepressants – advice from the Mayo Clinic staff

Choosing an SSRI drug does not guarantee the absence of side effects – many people tolerate treatment easily, but sometimes a change in drug may be necessary.

The first couple of weeks of taking there is a risk that the state of health will be so-so – it’s worth thinking about. It may be worth scheduling the start of therapy on vacation.

I work remotely, and it was easier for me: the first pill was taken on Saturday, I slept through the weekend. Then she continued to work, but refused any additional loads: housework, part-time jobs, training and everything else.

It was hard work: I wanted to sleep, then I began to worry and get distracted. I also had diarrhea, nausea, headaches, tremors, i.e. hand trembling, hot flashes, sweating, palpitations. At night, panic attacks began, in the morning I had difficulty getting up because I was in pain and dizzy.

There are mixed data on how common side effects of antidepressants are. If we summarize them, then the numbers look something like this:

• nausea – about 25% feel it;
• diarrhea – it happens in 15% of people, and 5%, on the contrary, will have constipation;
• about 20% of people have sweating and feeling hot;
• sexual dysfunction, decreased libido may occur in 80% of cases;
• insomnia – in 11% of cases;
• headache and dizziness – in about 10-11% of cases;
• weight gain – not all drugs have this effect. Some, on the contrary, can reduce weight. On my medicine, I lost 2 kilograms in the first month, despite the fact that I quit training due to poor health. True, then they returned back.

It can be seen that most side effects occur in less than half of the cases. In addition, in most cases they pass in the first weeks and are not dangerous.

Side effects not listed above are very rare. I was “lucky”, and I faced one such – a decrease in visual acuity. Once in the morning I noticed that I see worse without glasses. A little later, I realized that something was wrong with the glasses.

I wrote to the doctor, she replied that this happens, as a rule, is not dangerous and passes, but it is better to visit an ophthalmologist. I went to the ophthalmologist, everything was fine with my eyes, there was nothing terrible, but my vision really worsened – it was not a subjective feeling. On the right eye, it was -0.5 diopters, it became -0.75, and on the left eye it was -1. 5, and it became -3.5.

I was offered to try changing the drug, but I decided to wait. Vision was then restored. I have not yet gone to the doctor to have it measured, but according to subjective feelings, it is at the same level as before: I am comfortable again in my glasses.

Side effects should not be tolerated – if something greatly worries, scares or interferes with life, it is better to tell the doctor right away. The psychiatrist will be able to determine whether the side effect of the drug is dangerous and whether it is worth continuing to take it. There are several antidepressants of the SSRI group, in addition, there are groups of drugs with a slightly different mechanism of action. As a rule, doctors manage to find a medicine that gives a good effect without side effects.

If there is no danger, the doctor can adjust the dose or increase it more gradually – this often helps to cope with unpleasant effects.

I wrote to the doctor again when my visual acuity decreased

Fact No. 5

Antidepressants need to be taken long term

Antidepressants are not drugs that you can stop drinking as soon as you get better. They are taken for a long time: usually from several months, less often several years.

Anxiety Therapy – UpToDate

For example, for generalized anxiety disorder, the duration of treatment is at least a year. Moreover, the date is not counted from the very beginning, but from the moment when a lasting effect appeared from the pills. In fact, they will have to be drunk for about 1.5 years – it depends on how long it takes to reach the working dosage of the medicine.

The cost of a package of the most famous antidepressant “Zoloft” is about 700 R, enough for about a month. That is, a course of therapy will cost about 10,000 R – maybe more or less, depending on which drug is selected.

Psychotherapy review – UpToDate

Another drug of the same group already costs more than 2000 R per pack. Source: rigla.ru

The cost of an appointment with a good psychiatrist in Moscow is 3000-5000 R. At first, you will need to visit him about once every 1-1.5 months, then less often.

You can apply to the psycho-neurological dispensary at the place of residence under compulsory medical insurance – it’s free. At the same time, they will not put you on psychiatric registration: it was canceled in 1993. People with disorders that do not threaten their lives or those around them are on consultative and diagnostic care. If you stop going to the doctor, he will not find out what happened: a person seeks help at will.

Psychotherapy, usually cognitive-behavioral, is also commonly prescribed to enhance and sustain the effects of antidepressants. In many cases, it improves the effectiveness of drugs, including depression and generalized anxiety disorder. An appointment with a psychotherapist in Moscow costs an average of 5000 R. For treatment, you will need about 10 sessions or more.

How psychotherapy works

Fact No. 6

Antidepressants should not be stopped abruptly

Antidepressants do not develop dependence. However, if you abruptly stop drinking them, there will be a withdrawal syndrome. This is felt as electric current discharges while moving or turning the head, headaches, dizziness, insomnia. Many people experience symptoms similar to the flu or an intestinal virus: low fever, diarrhea, general malaise, chills. Often there is anxiety, there are intrusive images.

Withdrawal symptoms after taking serotonin reuptake inhibitors – Journal of Clinical Psychiatry

How difficult it is to stop taking antidepressants – American Psychological Association

Stopping antidepressants in adults – UpToDate

for some reason they changed their minds about taking the pills or the term has expired treatment, they should be canceled only under the supervision of a doctor.

Antidepressant withdrawal occurs as gradually as the start of treatment. The dosage is slowly reduced, usually at this time again a cover-up drug is prescribed to alleviate side effects. As a rule, this is the same medicine that was at the beginning of the intake.

Withdrawal is usually harmless and resolves within the first weeks of stopping the drug. Sometimes even within a few days – it still depends on which medicine was prescribed. If severely disturbing symptoms appear during the withdrawal period, you should consult a doctor.

Fact No. 7

If you need to change the drug, everything will start over

It is far from always possible to immediately find the right antidepressant – sometimes the side effects do not go away and you need to take a new one.

Changing antidepressants in adults – UpToDate

Serotonin syndrome – MSD

Most often, it is started again with a small dosage, this delays the process of obtaining the effect of treatment. The new drug may also have side effects – the same or different. We will have to wait again until they pass.

You won’t be able to change the drug on your own, since all antidepressants are sold only by prescription – and that’s good. Switching from one drug to another can be dangerous if you do not know the characteristics of different groups of drugs.

For example, taking SSRIs is possible only some time after the withdrawal of antidepressants from the group of monoamine oxidase inhibitors – due to the risk of developing serotonin syndrome. This is a potentially fatal condition, accompanied by a change in mental state, high fever, increased muscle tone and other symptoms.

If the drug is changed correctly, there will be no dangerous negative effects, so consultation with a doctor is required.

How to choose a psychotherapist

Fact No. 8

Among antidepressants there are original drugs and generics

Preparations may be original or generic. Originals are medicines first released by some pharmaceutical company that have passed all clinical trials and checks. Generics are drugs with the same active ingredient from another pharmaceutical company, that is, copied from the original drug.

Theoretically, the action of generics should not differ from the action of original drugs. However, this is possible, since generics may contain other additional substances or the manufacturer may use other raw materials.

Due to my anxiety, I did not read anything in detail about specific drugs before I bought my first antidepressant in a pharmacy so as not to be scared and not think about taking it. I also didn’t think to ask the doctor about this question.

Psychoneurological complications after covid: memory problems and depression

As a result, I first bought a generic because it was in stock. Then it turned out that, after all, according to the experience of my psychiatrist, the original drug often gives fewer side effects and is better tolerated. As a result, I changed the generic to the original drug – and, indeed, the side effects softened.

In my subjective opinion, which is supported by some data, in the case of antidepressants and other psychotropic drugs, you should always choose the original medicine. Moreover, the cost of originals and generics is not always very different.

Originals and generics of some SSRIs

Sertraline

Original

Zoloft

Original price

About 700 R, tablets 100 mg

90 002 Generics

Serenata, Serlift

Cost of generics

500-600 R , tablets 100 mg

Escitalopram

Original

Cipralex

Original cost

3000 R, tablets 10 mg

Generics

Selektra, Elycea

Cost of generics

500-1300 R, tablets 10 mg

Fluoxetine

Original

Prozac

Original price

About 350 R, tablets 20 mg

Generics

Profluzak, Fluoxetine

Cost of generics

100-200 R, tablets 20 mg

My pills: I bought several packs of Serenata at once, so one remained unclaimed ovannoy

Fact No. 9

Do not take alcohol along with antidepressants

Drinking alcohol while taking antidepressants may exacerbate unpleasant side effects. Also, alcohol is a depressant, that is, it has the opposite effect, and its intake can adversely affect the results of treatment.

Why you shouldn’t mix antidepressants and alcohol – Mayo Clinic

Alcohol is strictly forbidden to drink with some groups of antidepressants, for example, tricyclic antidepressants and monoamine oxidase inhibitors: combination with the latter, for example, can lead to an uncontrolled increase in pressure. MAO inhibitors in general require a special diet – it is unlikely that a doctor will prescribe such drugs as the first antidepressants, but if necessary, he will issue a list of what is allowed and prohibited.

With other antidepressants, moderate use may not be dangerous and may even pass without consequences, but doctors still recommend abstaining so as not to increase side effects and improve treatment outcome.

The main thing is not to temporarily stop taking the drug in order to drink. This can lead to the development of a withdrawal syndrome.

How I Treated Generalized Anxiety Disorder under CHI

Fact No. 10

Antidepressants are incompatible with certain drugs and have contraindications

It is important to tell your doctor what medications you are taking and what chronic illnesses you have. For example, SSRIs may not be suitable for epilepsy and bleeding disorders, and tricyclic antidepressants are usually not prescribed for those who have recently had a heart attack, suffer from glaucoma, or porphyria.

Antidepressant Warnings – NHS

Drug Compatibility Test – Drugs.com

It is also important to be careful if you are about to take any over-the-counter medicine. For example, ibuprofen, which people often take on their own to relieve pain and reduce fever. It should not be taken with SSRIs as it increases the risk of gastrointestinal side effects.