Posted by dewdropinn on August 1, 2007, at 12:32:08
In reply to Re: Why do all anti-depressants make me anxious, posted by JohnSky on August 1, 2007, at 9:28:37
Experimenting with the lower dose of EMSAM makes a lot of sense -- it's incredibly easy to do (simply a matter of cutting the patch in half and slapping it on), and it will give you the definitive answer as to whether or not EMSAM play a role in your future treatment regiment.
I would not concern yourself with the recommended dosage guidelines -- if you were dealing with unipolar major depression, then those target numbers will be of benefit, but since you are contending with something more complicated, the published dosage parameters aren't necessarily relevant. With bipolar patients, doctors will commonly prescribe miniscule doses of antidepressants, so as to provide mood elevation without worsening the underlying condition -- I know one doctor who prescribes the 75mg instant release Wellbutrin tablets (the original drug formulation), and instructs patients to cut the pills into quarters -- so the starting dose is almost 1/10 the lowest "effective" dose of the drug. So, don't worry about the published guidelines -- they probably don't apply to your situation in any way, and your experience seems to validate this.
You are actually really lucky -- you have a familial precedent to guide your future treatment, and it seems that you're already heading in the right direction. I would suggest talking to your brother about his dosage -- your doctor may want to keep you dose low so as to avoid side effects, but your brother's dose will probably be highly suggestive of the dose that will be effective for you.
I would check out the website below -- it's really the ultimate source on just about everything related to bipolar disorders -- great info on drugs and treatment options, lots of studies and analysis, a great questions and answers section, and the site author, Jim Phelps, is one of the true experts on the subject. I have a suspicion that, if you poke around (the site isn't particularly well organized), you should find answers to most of your queries.
http://www.psycheducation.org/
Drew
> I wondered about keeping the anti-depressant dose low as to not create anxiety and aggitation... my concern was would a anti-depressent work at lower doses than the marketed targeted dose. I am on EMSAM and I'm wondering if a 3mg level would help me instead of the minimum suggested dose of 6mg.
>
> John
poster:dewdropinn
thread:773047
URL: http://www.dr-bob.org/babble/20070730/msgs/773311.html