Posted by RN320 on January 13, 2007, at 10:38:59
In reply to Re: EMSAM Q? » RN320, posted by liliths on January 13, 2007, at 6:38:01
> hi /m,
>
> it's great to hear of someone having such good results though I do worry about the dietary restrictions. I'm a vegetarian as well as a female who uses soy for many things, including supplmenetation - I'll have to find out if soy supplments carry the same risks
>
> if I may ask, what sort of obstacles did you hit on the EMSAM? I guess I'm hoping to be as informed and forewarned as possible LOL.
>
> of course, I stil have to find a new pdoc and one that will be willing the even consider the med combo of it with my ADD meds
>
> when will you be starting the provogil and what dose are they starting you on?
>
> Please keep me updated...
> and good luck!
>
> namaste,
> lilith
>
> > Hi Lillith-
> > At 12mg you do have dietary restrictions, but they're not as bad as with the oral MAOIs.
> > I recently had a tyramine reaction (hypertensive crisis) which was scary but managed ok. Still don't know the source of it, but it came from a Thai restaurant (where I was promised that there was no soy, MSG or fermented products in what I ordered.) My pdoc is in the process of following up with a "Medical Letter" to BMS and to the FDA.
> >
> > I have had several serious obstacles that have popped up in the course of getting regulated on EMSAM, but they've all been able to be handled successfully.
> >
> > I will be starting provigil next week as an adjunct. My pdoc has told me that the only really safe atimulant is Provigil. I told him that people take adderall and ritalin and he said that they were "expressly contraindicated" in use with EMSAM.
> >
> > Good luck to you. Feel free to write anytime, if you think that I could be of help.
> > /m
>
>
Hi Again!
About the dietary restrictions.... I don't eat red meat, and only eat poultry or fish once or twice a week. I used to supplement my diet with cheese, but other than fresh mozzarella, ricotta, american (who could ever call that cheese??!! I think it's petroleum by-products!) and believe it or not, Jarlsburg (an aged swiss), and cottage cheese- that's not an option for me. My pdoc got a new study a couple of weeks ago that shows the levels of tyramine in foods once thought to be high in it. It used to be that any aged cheese was a no-no. Now they've found that Jarlsburg is low in tyramine. I've been eating it since last week and haven't had a problem. About soy- good news and bad for you on that one. My understanding is that soy milk, oil and flour are ok (try buying a loaf of bread that doesn't have soy oil and/or flour!). However, any protein supplements from soy are out, as well as tofu, soy sauce, miso. I found this out recently since I've got what they call "sub-clinical diabetes" and my treatment is just as if I was a full blown diabetic. My internist has been all over me that I'm not getting enough protein, so I thought that I'd buy some dietary supplement (like Glucerna or Ensure). I saw soy protein on the label, so I decided not to buy it until I checked with my pdoc. He said absolutely NOT, even though it's not on the EMSAM PI as something to avoid. I guess they feel that they cover it in the broad category of "soy". I really paid attention to that one, because my pdoc has been telling me all along that I'm too strict with dietary restrictions and that I should feel free to lighten up on myself. The major things that you have to avoid are Soy, broad beans, the aged cheeses, anything that's overripe (fruit/vegs) figs, sauerkraut (fermented), the meats (which don't apply to you so I won't go into that), anything smoked, dried, pickled or fermented, figs, brewers yeast (although my pdoc says that you can now drink small amounts of beer) liquers, chianti, vermouth and port wine (although my pdoc says that the new study shows that you can even drink a little red wine not listed in the above categories). According to this new study, you can now have dark chocolate, but try to avoid Belgian, I think.
then of course, there are the OTC meds that you need to stay away from. I miss using sudafed on occasion, as well as Afrin when I have a bad cold. You can take benadry, so it's not like you can't use all antihistamines. A couple of people have said that they use Afrin, but I personally think that they may be playing with fire. You should also avoid any vitamins that have a yeast base. I think that's about it. Truly, if the drug is working for you, than to me it's worth it to just suck it up and accept the limitations. But that's just my opinion......You asked about the pbstacles that I've encountered along the way. None at 6mg. At 9mg I suddenly lost consciousness and feel down the basement stairs head first this past August. I sustained a serious concussion, and I'm told that as they were transferring me from the ER to an observation unit I had an arrest (don't know if it was cardiac or respiratory because I wasn't monitored). I had developed some orthostatic hypotension initally at 9mg. We still aren't sure if the sudden loss of consciousness was due to a drop in BP or if my blood sugar tanked, because that's right around the time that I found out about the sub-clinical diabetes (and in monitoring my blood sugars at home I was having sudden dangerously low blood sugars with no symptoms- like in the low 40's to high 30's, which is enough all by itself to cause loss of consciousness or even a seizure). I also have a mild heart problem, so it's also possible that I had a sudden arrhythmia that caused me to drop. So, they worked me up for the arrhythmia angle, and that came back negative. So we're still not certain if it was a sudden drop in BP or blood sugar that caused this whole incident. I had to go through rehab to get back on my feet recovering from the head injury and am just starting to feel more "normal" over the past few weeks.
I am currenlty in cardiac rehab, and had another problem when rising from a recumbent stepper I dropped like a rock, and because I was monitored and they immediately did blood sugars and pressures, I know that this was a direct result of orthostatic hypotension. So that goes back to the EMSAM, however my pdoc had recently switched me from Seroquel to trazadone for sleep. It's working so I no one wants me off of it, and they suspect that this has added to the hypotensive effect. So, now I take florinef and my BP is normal for the first time in about 4 months!! I had been running high 80's to low 90's/ 50-60 and now I'm 110/70 and darned proud of it!! (It's amazing the energy that I have now with a higher BP..)
And of course, the other thing that happened was the tyramine reaction, which was bvery scary, but it was managed.
I think that the important thing is to understand that most things, even the worst can be managed. You have to have doctors that really communicate with each other as far as meds go. My cardiologist, Internist,and Immunologist all feel free to contact my pdoc before starting me on anything new if there's a question. And he always makes himself available to my other docs. I think that my problems with BP, although initially caused by the EMSAM, were complicated/exaggerated by other problems and the meds that I take (cardiac in particular). I'm currently taking 14 prescription drugs on a daily basis, and 4 of them are psych drugs. No doubt I'm more at risk for the problems with BP than others. I'm not really a big fan of polypharmacy, but it's what I have to do right now to maintain my best state of health and well being.
As far as the provigil goes, my pdoc is planning to start me on it next week....he mentioned the dose but I don't remember. I'll let you know how it goes.
I hope that I've answered your questions and in doing so haven't scared you away from EMSAM. It's just worked so well for me...I'll do just about anything to stay on it. Without it I would revert to absolutely no quality of life and that would bring me back to life not being worth living. I hope that I am never forced with that decision.
Best wishes.
/m
poster:RN320
thread:719417
URL: http://www.dr-bob.org/babble/20070113/msgs/721930.html