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Re: EMSAM Question Again - Help

Posted by dewdropinn on July 13, 2007, at 14:03:00

In reply to EMSAM Question Again - Help, posted by JohnSky on July 13, 2007, at 9:54:38

EMSAM can be an absolutely fantastic drug -- but the dosing parameters and best practices for using the med are still not clearly defined.

First off, you can definitely cut the patches to either reduce the dose or to raise it incrimentally. I have no idea why Bristol-Meyers has advised against this because it simply is not a problem, and it provides greater flexibility in dosing. Doctors are already starting to figure this out, so I anticipate that the guidelines will be amended in the future.

Secondly, EMSAM can have dramatically differing effects depending upon dosage -- and these dose dependent effects are somewhat counter-intuitive. The lower doses frequently produce anxiety, aggitation, and insomnia particularly during the early phases of treatment. The higher doses can frequently ameliorate these side effects while producing stronger and more sustained benefits for depression and anxiety. Basically, the lower doses inhibit MAO-B, the substance that breaks down dopamine and norepinephrine, but it may not significanly impact MAO-A, which is involved with the breakdown of serotonin, dopamine and norepinephrine. So, with the 6mg dose, you get activation but you may also get anxiety -- as you raise the dose, you get a true antidepressant response, which also helps with anxiety.

I would strongly advise that you remove the patch before bed time -- it can definitely compromise sleep -- it certainly did for me at first, but once I started removing the patch at bedtime, this side effect went away.

So, you certainly can cut the patch and test your response at the lower doses. I would also recommend exploring the possibility of raising the dose to 9mg (my dose level), because this may resolve the side effects your are currently dealing with.

EMSAM is a great drug, and I think once doctors figure out exactly how to administer it, it will become a mainstay of psychiatric pharmacopia.

Drew


> Hello. I have been on the 6mg patch for 15 days now. When I started the patch from day 1 my anxiety jumped up. Through this period my anxiety has risen and held at a high level to date. I'm very sensitive to medications. I feels like torture at times and has me thinking about the anxiety alot. I take a benzo and gabapentin to help with the anxiety but it doesn't cut into it enough. Today I cut the patch in half (I hope you can do that) to see how where the anxiety goes. I thought I could hold at 3mg and work back up to 6mg very slowly.
> My pharmacist says don't cut the patch.
>
> I really want to give EMSAM a fair trial because I already seem to be feeling better from a depression perspective... And I have taken about every other med there is.
>
> My questions:
>
> 1. Is cutting the patch OK?
>
> 2. Have others experienced the intense anxiety
> of starting EMSAM and has it gone away.. and
> how long did it take?
>
> I just can't take too much more of the anxiety/agitation from the EMSAM, but I am willing to tough it out another week or so if there is a decent chance the anxiety will go down.
>
> Would love to hear from others on this.


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URL: http://www.dr-bob.org/babble/20070710/msgs/769378.html