Posted by SLS on September 26, 2006, at 16:29:51
In reply to Re: Can't Take it AnyMore !!!!!!!!!!!!!!!!!!!!!!Help!! » Phillipa, posted by ed_uk on September 26, 2006, at 14:34:56
> I don't believe that Emsam would be a suitable drug for you. I think it would make you agitated.
What makes you say this?
From the reports here and by my doctor, this drug seems to have anxiolytic properties, even though it is energizing in the beginning. People have even been able to reduce their dosages of Klonopin.
Having said that, I value your knowledge, opinions, and instincts.
I personally think that Nardil is well suited for Phillipa. It would probably be a good idea for her to start at 7.5mg, though, if it is possible to cut the new Nardil pills in half. I haven't seen them yet. Starting low and going slow with Nardil will help avoid any intitial sedation and hypotension.
For the times that I was on Nardil for extended periods of time, I didn't even know I was on the drug except that I had to take the pills every day. No side effects. The diet was no big dea. For the few months that it worked for me, it was a wonderful remission. The response waned and I then entered a mixed state hypomania. I remained in this state quite stable at 30mg for a few months. Things got very ugly after that. I actually entered a psychotic mania once I *discontinued* the Nardil.
Anyway, I don't know what I would do in Phillipa's position. Emsam is attractive for its lack of side effects, except for site reaction and insomnia. I would still follow the diet, though, because I would anticipate needing to go up to 9mg/24hr. I am still dubious of the safety at that dosage and higher.
I think my decision would pivot upon the pervasiveness and magnitude of the anxiety. I don't see Emsam as being a drug capable of treating Axis I anxiety disorders. I could be wrong, of course (I hope I am). Nardil, on the other hand, has been demonstrated for years to be a potent treatment for these disorders. As Phillipa describes her sometimes paralyzing anxiety, I am drawn to the conclusion that the anxiety should be treated as aggressively as the depression. This leaves Nardil.
Phillipa, if you are more comfortable trying Emsam first, then do that. You won't be sacraficing epochs of your life by doing so. If these patches deliver sufficient MAOI, you might end up with a very nice response, including a reduction in anxiety. If Ed is correct, as he often is, and you react to Emsam badly, you should know pretty quick. I am guessing it is the parent compound that would be doing the dirty work directly, not the consequences of MAO inhibition. Like you said, if it happens, you just rip the patch off, and that's that. It will clear up in a couple of days. Then move on to Nardil (or something else or nothing, whichever Jan thinks is right for her).
Remember Phillipa, these are powerful drugs. They are not sugar pills. They do have side effects, and you might feel some weird stuff in the beginning. You MUST expect that these things might occur. You MUST take things one day at a time. Jan, you must be in control here if this thing is going to work. Come here to report your progress and express your concerns. Call your doctor if necessary.
- Scott
poster:SLS
thread:688552
URL: http://www.dr-bob.org/babble/20060919/msgs/689413.html