Posted by aegle on July 16, 2007, at 13:17:03
In reply to Re: EMSAM Question Again - Help, posted by JohnSky on July 16, 2007, at 9:56:49
JohnSky, my reply is interwoven among your post below.
> Thank you for your replay aegle. Glad to hear you detailed experence.... and glad to hear I'm not alone in how I am responding.
You're welcome. Psychobabble is great that way; at least one person here can generally relate to a medication's side effects and validate your experience.
>
> A couple of questions:
>
> 1. While on the 6mg patch how many weeks was your anxiety severly elevated and when did it come down.... or maybe it just came down when you went to 9mg? I am taking a benzo and some seroquel that helps some, I exercise, and I do relaxation breathing.To my best recollection, it took about five weeks on the 6mg patch to feel a reduction in the anxiety surge I experienced immediately after beginning the patch. I distinctly remember the night I had a far better quality of sleep without increasing my sleep med dose. That marked the beginning of reduced anxiety levels during waking hours.
What's difficult for me is to tease out the reason why my anxiety level began to diminish. I'd had no increase or decrease in external stressors at that time, so my guess is that higher anxiety is a normal side effect in those prone to it at the beginning of treatment with this particular med. I could spend some quality time researching the pharmacological reasons for that, or simply ask my psychiatrist, but there are other issues that are more pressing for me at this time.
>
> 2. The last three nights I have taken the patch off per doc orders. I sleep better but I feel down in the morning until the patch kicks in late morning... then the anxiety comes back. Doing this I can't imagine I am getting a full 6mg for a day?It's hard to say what dose you're getting, because with transdermal dosing, the medication is more available immediately in the bloodstream because it doesn't have to go through a first pass in the digestive system. The one thing we do know is that you're not getting the full daily 20mg dose (6mg patch worn for 24 hours) because your patch is off while you sleep.
For what it's worth, my psychiatrist and I discussed the option of removing the patch while I slept and we decided against it. For one thing, I needed the most anti-depressant effect I could get; I'd been at a very low point. The second was that I was managing to get sleep (about five to six hours a night with few arousals) using a nightly dose of 50mg of Seroquel.
Obviously since that time, I've been able to reduce my Seroquel dose to 12.5mg a night and I hope to wean off it completely within the next month. The sleep issue as gotten far better with time.
>
> 3. What sort of dietary restrictions do you deal with on the 9mg patch?Following the recommended MAOI diet strictly at first was not been a problem for me. Over time, I've experimented with adding back some aged cheese and small amounts of soy sauce. I kept a blood pressure cuff handy when I tried these experiments, and I did just fine.
It's important to note that there's never been a reported case of hypertensive crisis from food with the Emsam patch at any dose. I've read that Bristol-Meyers Squibb has petitioned the FDA to drop the food restrictions normally associated with MAOIs to be dropped for all doses of Emsam.
> 4. If the anxiety keeps up I am going to stop the medication at the 3 week mark (Thursday)... unless my doc has another choice... maybe going up to the 9mg mark is the trick based on the replies I am getting.That's an option. The other is to give the 6mg patch a full six weeks to see how you react, if you can manage the anxiety. Everyone responds to medications in their own way and in their own time (that's why there are so many psych med options), so you may experience a reduction in the anxiety yet.
Unsolicited book recommendation: The Anxiety and Phobia Workbook by Edmund J. Bourne. It's easily found online at Amazon or other booksellers and it's a quick way to work on the roots of your anxiety and the thought patterns that can perpetuate and exacerbate it. If you're not a fan of cognitive behavioral therapy, though, I'd pass this one by.
Whatever you choose to do, continued good wishes for some real relief.
>
> John
>
> > John, my experience with Emsam has been very similar to yours. I started taking it in March of this year.
> >
> > At 6mg, my anxiety level increased dramatically and felt little active relief from depression. The most obvious symptom that the medication was working was a reduction in thoughts of self-harm by about 90%.
> >
> > I managed the anxiety by using benzos (Xanax, in my case), along with the other methods of self-care - aerobic exercise, eliminating caffeine from my diet, using relaxation exercises - and those helped me get through.
> >
> > My psychiatrist was hesitant to increase my dosage given the foregoing, but a family health crisis precipitated a severe mood dip, so after eight weeks on 6mg, we increased my dose to the 9mg patch. The relief is palpable. Instead of increasing, my anxiety level dropped to a lower level and my symptoms of depression have lifted more than I could have thought possible.
> >
> > I've gotten a tremendous boost in energy and motivation, and as an atypical depressive, these effects are very welcome. As I'm able to be more active, my mood is far brighter. I feel more optimistic today than I have in 14 years after medication trials with every other SSRI, SNRI and augmenting strategy (mood stabilizers, atypical antipsycholitcs, stimulants). I'm considering returning to work full-time after a long absence.
> >
> > For me, Emsam is a miracle drug, but it can't fix everything. I often feel "tired but wired" in mid-afternoon, but that passes. I need to take a small dose of Seroquel (12.5mg) with Xanax in order to fall asleep. And, I'm still dealing with some anxiety and a fairly high level of irritability. However, the latter have been aspects of my personality for as long as I can remember and can not be attributed to this medication. I'd adore it if all those issues could be relieved with medications, but (again) after numerous med trials and 11 years on Effexor, I know now that will be my work.
> >
> > I strongly urge you to consider staying with the medication. If your experience continues to mirror that of the other participants here, an increase to 9mg could provide the relief you've been seeking. The fact that you're experiencing an uptick in anxiety, while extremely uncomfortable, is also a promising sign - it means you'll most likely be an MAOI responder.
> >
> > With regard to cutting the patch, I read in the babble archives of a patient (Robert David) who contacted one of the researchers on the Emsam trials and was told it was acceptable to cut the patch. Here's a link to that post:
> >
> > http://www.dr-bob.org/babble/20060520/msgs/646774.html
> >
> > Wishing you relief soon.
> >
> >
> >
> >
> >
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poster:aegle
thread:769334
URL: http://www.dr-bob.org/babble/20070710/msgs/769886.html