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Re: Emsam and Attention Problems?

Posted by Pops_1 on June 23, 2006, at 12:29:37

In reply to Re: Emsam and Attention Problems?, posted by Another Phil on June 23, 2006, at 9:17:38

> Actually, treating people with the respect they deserve is very important to me. My wise-*ss comment was in response to the person whose only contribution began with a condescending "Umm...," and whose entire substance was a critique of the timeline of my original post. Well, I *did* say I was having problems paying attention. And if I began taking Emsam in March, not February, it doesn't change the question posed by my original post.

Hi Phil - Just to let you know, when I read your self-described wise-*ss response I thought - "Hmm, seems like an overreaction to a mild comment..."

I use email a ton for my work and I've found it's useful to presume goodwill on the part of others until demonstrated otherwise. Often I've seen what I thought was a rude comment and later discovered, after meeting the person, that they just have a different way of communicating than I'm used to and they meant nothing offensive. I think Phillipa's comments could easily have been interpretted as "I'm confused, are you sure you mean EMSAM?" or "Did you really mean February"? I really doubt she meant anything like "you're a liar" or "Get your facts straight!") (Although granted, she could have been less casual in her wording to reduce chance of confusion or risk of offending you.) For what it's worth.

But back to your question - I've been using EMSAM for almost 30 days to help primarily with motivation and attention. I used to use dexedrine (10mg a day - not much!) and EMSAM isn't >quite< as effective (so far), but I haven't noticed it excarebating attention problems. Maybe you're just noticing the absence of the stimulant?

I'm personally thinking about adding some dexedrine back to the EMSAM. This is contraindicated but I've seen some research articles that indicate adding stimulants to MAOI's can be done safely and effectively if done carefully with proper monitoring. See below for an abstract from pubmed.

Keep us posted on your experience...


J Clin Psychiatry. 2004 Nov;65(11):1520-4.


Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication.

Feinberg SS.

Department of Psychiatry, Albert Einstein College of Medicine, Bronx, NY, USA. Shalomf@aol.com

BACKGROUND: Among antidepressant augmentation strategies, the addition of a stimulant to a monoamine oxidase inhibitor (MAOI) has received little attention in the literature in recent years because of the diminished clinical use of the latter and concerns of precipitating a hypertensive crisis or other serious complication. Despite that fact, experienced clinicians continue to use this combination for a variety of indications after other options have failed. This article reviews these reported uses and presents a case suggesting another possible indication. METHOD: A MEDLINE search was conducted for articles published from 1962 to December 2003 using relevant search terms (psychostimulant, stimulant, amphetamine, dextroamphetamine, pemoline or methylphenidate, atomoxetine, bupropion, monoamine oxidase inhibitor, and selegiline). A manual search was conducted of cross-references and other relevant recent psychiatric sources (2000-2003). RESULTS: The described uses of the MAOI-stimulant combination have included treatment of refractory depression and the MAOI-related side effects of orthostatic hypotension and daytime sedation. No documented reports were found in the recent literature of hypertensive crises or fatalities occurring when the stimulant was cautiously added to the MAOI. Also presented here is another possible indication for this therapeutic regimen: treatment of attention-deficit/hyperactivity disorder in an adult patient whose major depression had uniquely responded to the MAOI tranylcypromine. CONCLUSION: As in other fields of medicine, potentially hazardous medication combinations are utilized in psychiatry after cautiously weighing the danger of the treatment against the morbidity and risk of not adequately addressing the illness. Particularly, as the potential arrival of the apparently safer transdermal selegiline may increase the use of MAOIs, we feel this combination deserves additional controlled study.


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poster:Pops_1 thread:660319
URL: http://www.dr-bob.org/babble/20060623/msgs/660594.html