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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on October 28, 2006, at 13:02:39
In reply to Re: Trying Emsam./?PEA, posted by Phillipa on October 28, 2006, at 12:04:11
> Scott really? You know I'll be following this thread. But my doc said you have to be ad free for two weeks. You're not are you? Love Phillipa
I would say that serotonin syndrome would be a significant risk were you to continue with Luvox. There is some risk with nortriptyline, but not as much.
- Scott
Posted by SLS on October 28, 2006, at 13:05:59
In reply to Re: Trying Emsam./SLS, posted by lymom3 on October 28, 2006, at 12:12:24
Thanks for the well-wishes.
:-)
Where did you find to be the ideal locations for the patch?
- Scott
Posted by lymom3 on October 28, 2006, at 13:12:34
In reply to Re: Trying Emsam./SLS » lymom3, posted by SLS on October 28, 2006, at 13:05:59
I favored upper area above the breast or just reached over my shoulder and slapped it on my back. The small of your back isn't bad either but stay away from hairy spots :) Whatever adhesive they use is really not bad. It never hurt to remove the patch unlike the Daytrana patch. That one was horrible.
For certain wash and dry the area like it says. The patches stick great that way but will not stick for anything if you haven't "prepped" the area. Those suckers are too expensive to waste!
Posted by Racer on October 28, 2006, at 15:00:10
In reply to Re: Trying Emsam., posted by SLS on October 28, 2006, at 8:51:57
> . I am being really silly about this. I don't usually go into something with a negative attitude,
Welcome to my world, Scott! Resistance is futile. You will be assimilated.
At this point, I figure it's best for me to expect I'll panic over starting any new drug. That way, when I decide that my life is effectively over because the drug is poisoning me, I'll have a pretty good chance at laughing about it. At least in between the crying jags... {rolls eyes}
Seriously, though, Scott, I think it's pretty normal to find yourself thinking that way. You've had a lot of disappointments over the past year or so, and I've watched your outlook become less and less positive. I can't imagine what it must be like to be you right now, and I wish there was anything I could offer to help. I know I'm thankful my situation isn't as bleak: Wellbutrin on its own is good enough to keep me halfway functional, even if my anxiety is a problem; and the addition of Ritalin or Dexedrine boosts my mood, although the combination does nothing good for anxiety. (It does help a bit, in that I don't go into that vicious circle as often, where the anxiety and the depression whirl off into a Viennese waltz that spirals into the Slough of Despond.) At least there is something that allows me mostly a tolerable level of functioning.
I wish there was something that offered at least that much for you.
> Of course, I might be singing its praises two months from now.
>
>
> - ScottAnd so you might. I hope you are.
On a very personal note, Scott, although you often refer to the cognitive difficulties you have due to your illness, I think you may have lost sight of some of the cognitive abilities you've maintained through it all. For one thing -- a very important thing, in my not-so-humble-on-this-topic opinion -- you're curious. Your curiosity about options, mechanisms, how it all fits together, and where it fits in the larger context of life seems to be intact. That, in and of itself, is a tremendous accomplishment. And you've obviously been able to collect and synthesize information about your condition, and the options on the horizons for treating it. Again, particularly considering the complexities involved, that's pretty damned impressive, if you ask me -- although no one did. Despite your pain, you're still able to look outside of yourself to see others' pain, and try to help. And I don't just mean in the passive sense of looking at what's written here and saying, "Oh, yeah, other people say they're hurting." Whenever I read your responses here, what comes across most is how much you really seem to empathize and *care* about the people you're writing to. It never comes across as impersonal data being shared, but as though you have a personal stake in this person's recovery. That's why you're so popular here, you know. Even if you don't always see it. You've earned every bit of the respect people here have for you, as well as every bit of the affection we feel for you.
There's more, of course, but I gotta do laundry. ;^) Taken all together, though, don't you think that's one hell of an accomplishment, considering the handicap you're working under?
If I could, I'd kiss the spot under that patch every morning for luck. I can't, but the caring is still there. Good luck with it.
Posted by Lindenblüte on October 28, 2006, at 17:02:03
In reply to Welcome to my world! » SLS, posted by Racer on October 28, 2006, at 15:00:10
Yeah, I have to second Racer,
you deserve to feel better, having helped so many others with your wit and knowledge.I have 3 questions. They are not important at all, but you may be bored one of these days and feel like responding.
1) what is "anergia". Oh, I could look it up on my own, but I've never heard of it, and I'd like to hear about it from your own experience.
2) could you draw a smiley face (or a frowny face) on your Emsam patch with a permanent marker? Then you can call it your "happy tattoo"?
3)PEA is the molecule in dark chocolate that the girlie magazines say makes us feel like we're in "Love". So, what's the difference between feeling in "Love" and tipping the balance towards psychosis?
a) does chocolate PEA and emsam-nortryp.-potentiated PEA cross the BBB?
b) is it a difference in the PEA concentration, PEA receptor binding action, or (kinetics? metabolites? brain areas? comorbidity?)?
c) are people in acute "Love" also psychotic? [this is my personal favorite interpretation]
cheering you on,
-Li
Posted by Phillipa on October 28, 2006, at 20:41:23
In reply to Hey Scott,, posted by Lindenblüte on October 28, 2006, at 17:02:03
Li yeah people in love must be pschotic. Look what we do to please the other when first in love? Now half of that was joking. Seriously I agree that Scott is the most patient loving man I have ever had the experience of knowing. And I think he is very intelligent. When the patch works for him as we are positive aren't we that it will he will be the discoverer of the magic pill. Love Phillipa
Posted by snapper on October 29, 2006, at 1:28:27
In reply to Re: Trying Emsam., posted by SLS on October 28, 2006, at 8:26:45
> > Will you be combining it with nortryptaline? That could be stimulating. Emsam increasing PEA concentrations. PEA acting as an endogenious amphetamine will cause NE/DE release. PEA actually inhibits the reuptake of norepinephrine, like amphetamine.
>
> Yes. I'll be keeping nortriptyline. I hadn't considered the PEA potentiation. Does Emsam produce increases in PEA levels any differently than other MAOIs? I had taken Parnate with nortriptyline not too long ago. 20 years ago, that would have kept me up all night long. Now, I sleep right through the night. My brain has become numb to these drugs.
>
>
> I'll be taking:
>
> nortriptyline 100mg
> Emsam 6mg/24hr
> Lamictal 150mg
> Topamax 100mg
> Abilify 10mg
>
>
> I can't tell you how much I hate the idea of having to wear a patch. I don't know why. It is certainly less invasive than wearing wires inside my neck.
>
>
> - ScottHi Scott, how are ya dude? I know best as u can be. I know we have not spoken in a while.... but just wanted to let you know myself and all are pulling for you. Dude I am moving forward with VNS. I figure I have nothing to lose except a couple of minor scars and the hope it has of offering a 30% or more chance of helping me and you and many others. It does kind of freak me out to about the wires and what not ...but it is so much less invasive than short trials of meds and cocktails of meds or long for that matter and ECT...which we have been through.. man e-mail me at cinkc2003@yahoo.com ...lets chat and talk....I do not know all the answers but obviously "modern chemistry" is not getting us anywhere.... I have an appointment with an ENT surgeon on Jan 8th 2007 to discuss the 90 minute out patient surgery.... I figure if I get it done , the best thing that can happen is I have the best of "chemistry and another viable option" in my bag to help me get to at least half way normal...and if I do not, then I continue to suffer 100% more than I should. I do not say these things lightly. Man lets talk!
Best-
Clint
Posted by snapper on October 29, 2006, at 1:30:50
In reply to Re: Trying Emsam., posted by snapper on October 29, 2006, at 1:28:27
Scott.......... talk to me!!!
AKA ---Snapper
Clint
Msg above
Posted by linkadge on October 29, 2006, at 7:18:05
In reply to Re: Trying Emsam.....for SLS » snapper, posted by snapper on October 29, 2006, at 1:30:50
I read on www.neurotransmitter.net that there existed certain compounds in red wine, that are both serotonin/norepinephrine inhibitors *and* inhibitors of monoamine oxidase B.
Intereesting eh?
Linkadge
Posted by SLS on October 29, 2006, at 9:47:38
In reply to Trying Emsam., posted by SLS on October 27, 2006, at 22:50:24
> I am to start Emsam in a few days. I am not too enthused about it, though. I really don't think it is going to work, and I hate having to wear a patch.
I don't know if I will be able to take this drug or not. Apparently, my prescription drug plan does not have it on its formulary. I have to make some phone calls.
- Scott
Posted by corafree on October 29, 2006, at 12:55:41
In reply to Re: Trying Emsam.....for SLS, posted by linkadge on October 29, 2006, at 7:18:05
Linkadge - Nonscientifically speaking, does this mean red wine is a help or a hindrance 2 depression?
duh, cf
Posted by theo on October 29, 2006, at 15:33:04
In reply to Trying Emsam., posted by SLS on October 27, 2006, at 22:50:24
Let me know how it goes, I left you a message above in the Low dose Lamictal thread. If you get a chance, please read and reply.
Thanks!
Posted by SLS on October 29, 2006, at 18:23:21
In reply to Re: Trying Emsam., posted by SLS on October 29, 2006, at 9:47:38
> > I am to start Emsam in a few days. I am not too enthused about it, though. I really don't think it is going to work, and I hate having to wear a patch.
>
> I don't know if I will be able to take this drug or not. Apparently, my prescription drug plan does not have it on its formulary. I have to make some phone calls.Everyone was closed today.
I decided to slap a patch on anyway.
- Scott
Posted by Phillipa on October 29, 2006, at 18:56:23
In reply to Re: Trying Emsam., posted by SLS on October 29, 2006, at 18:23:21
Scott so you have samples? Can you get more? I know you know your way around these things. So now its later in the day do you feel anything? Love Jan
Posted by SLS on October 30, 2006, at 6:51:41
In reply to Re: Trying Emsam. » SLS, posted by Phillipa on October 29, 2006, at 18:56:23
> Scott so you have samples? Can you get more?
Probably.
> So now its later in the day do you feel anything?
Skeptical.
- Scott
Posted by linkadge on October 30, 2006, at 8:29:42
In reply to Re: Trying Emsam.....for SLS » linkadge, posted by corafree on October 29, 2006, at 12:55:41
Well, presumably these compounds would be potetial new agents for depression. I don't think they have been given any formal testing though.
Linkadge
Posted by linkadge on October 30, 2006, at 8:35:47
In reply to Re: Trying Emsam., posted by SLS on October 30, 2006, at 6:51:41
Supposedly some of the TCA's have affinity for MAO-b. I remember reading that amitryptaline either directly inhibits MAO-B, or leads to a functional inhibition of MAO-B.
Linkadge
Posted by zeugma on October 30, 2006, at 16:06:38
In reply to Re: Trying Emsam., posted by linkadge on October 30, 2006, at 8:35:47
> Supposedly some of the TCA's have affinity for MAO-b. I remember reading that amitryptaline either directly inhibits MAO-B, or leads to a functional inhibition of MAO-B.>>
And nortriptyline has identical MAO-B inhibiting (it is small, but direct) potential as amitriptyline.
I would guess that there is a functional inhibition as well, in that dopamine and probably PEA have an affinity for the norepinephrine transporter, and the MAO enzyme degrades the transmitter after it enters the cell. So blocking the transporting step leaves MAO with less substrate to degrade (I hope I'm getting this right).
It is conjectured that TCA's, and possibly AD's in general, are functional inhibitors (meaning the effect is downstream, as opposed to actually blocking a receptor or enzyme) of the NMDA receptor. That is why zinc is conjectured to be a good augmentor of AD's.
Passing on to Emsam,
I would think transdermal selegiline, compared to the oral route, would have a much more delayed effect, because most of selegiline's immediate effect is mediated through its amphetamine metabolites and the patch increases the parent-to-metabolite ratio.That is why 6mg/day Emsam apparently inhibits enough MAO-A to have an AD effect, while orally afministered selegiline requires over 10 mg/day to lose selectivity for MAO-B.
I am curious to know if Emsam has any subjectively similar effects to clorgyline (a structurally related MAO-A inhibitor).
-z
>
> Linkadge
Posted by linkadge on October 31, 2006, at 6:47:34
In reply to Re: Trying Emsam. » linkadge, posted by zeugma on October 30, 2006, at 16:06:38
Regional dampening of glutamatergic function. Its an interesting theory, but it doesn't explain everything.
For instance, would NMDA receptor modulation occur with all classes of antidepressants, both activating and calming? Aren't certain disorders like ADHD actually linked to low glutamatergic function. In which case, would an activating AD like bupropion, with utility in ADHD have the same downstream effect?
Glutamate dampening would concevably usefull for neurotic depression, but would it be usefull for atypical depression, or anergic depression? Is zinc at all usefull in atypical depression?
Linkadge
Posted by SLS on October 31, 2006, at 9:12:14
In reply to Re: Trying Emsam. » linkadge, posted by zeugma on October 30, 2006, at 16:06:38
> I would think transdermal selegiline, compared to the oral route, would have a much more delayed effect, because most of selegiline's immediate effect is mediated through its amphetamine metabolites and the patch increases the parent-to-metabolite ratio.
The parent compound might have stimulant effects of its own.
I found a few abstracts that hint at this.
This would help explain the acute energizing effect that appears within the first few days of initiating Emsam treatment as reported by people here on Psycho-Babble. It may indicate that selegiline is actually more potent as a releaser of DA and NE than are its metabolites and explains why the transdermal delivery system produces a greater energizing effect that does the oral preparation.
I subsequently found another abstract that demonstrated an inhibitory effect for tyramine-induced release of NE, but not for DA by Emsam, perhaps an index of reuptake inhibition. This might indicate a greater energizing effect than reward/hedonic effect by Emsam during the first few weeks of treatment. So far, this is consistent with what has been reported here.
- Scott
-------------------------------------------
Neurobiology (Bp). 2000;8(2):179-99. Related Articles, Links(-)Deprenyl (Selegiline): past, present and future.
Knoll J.
Department of Pharmacology, Semmelweis University of Medicine, Budapest, Hungary.
(-)Deprenyl (Selegiline), the N-propargyl analogue of (-)methamphetamine, is the only drug in clinical case which, by enhancing the impulse propagation mediated release of noradrenaline and dopamine in the brain (catecholaminergic activity enhancer, CAE, effect), keeps in small doses without side-effects the catecholaminergic brain system on a higher activity level. (-)Deprenyl stimulates the catecholaminergic neurons selectively in the brain because, in contrast to PEA and the amphetamines which induce the continuous release of noradrenaline and dopamine from their intraneuronal stores, (-)deprenyl is devoid of this property. It is due to the CAE effect that a) the maintenance of rats on (-)deprenyl during the postdevelopmental phase of their life slows the age-related decline of sexual and learning performances and prolongs life significantly; b) patients with early, untreated Parkinson's disease maintained on (-)deprenyl need levodopa significantly later than their placebo-treated peers, and when on levodopa plus (-)deprenyl, they live significantly longer than patients on levodopa alone; and c) in patients with moderately severe impairment from Alzheimer's disease, treatment with (-)deprenyl slows the progression of the disease. It is reasonable to expect that a prophylactic low dose administration of a safe catecholaminergic activity enhancer substance during the postdevelopmental phase of life will slow the age-related decline of behavioral performances, delay natural death and decrease susceptibility to Parkinson's disease and Alzheimer's disease.
--------------------------------------------
Pharmacol Res. 2004 Mar;49(3):253-8. Related Articles, Links
Click here to read
(-)-Deprenyl inhibits tyramine-induced noradrenaline release, but not tyramine-induced dopamine release or potassium-induced noradrenaline release, from rat brain synaptosomes.Takahata K, Shimazu S, Yoneda F.
Research Institute, Fujimoto Pharmaceutical Corporation, 1-3-40 Nishiotsuka, Matsubara, Osaka 580-0011, Japan.
The effect of (-)-deprenyl (selegiline), a therapeutic agent for Parkinson's disease, on the tyramine-induced release of catecholamine from rat brain synaptosomes was studied using a superfusion system. Tyramine (10(-7) to 10(-5)M) enhanced the release of [3H]noradrenaline (NA) and [3H]dopamine (DA) from forebrain and striatal synaptosomes in a dose-dependent manner. (-)-Deprenyl (5x10(-5)M) had no effect on spontaneous catecholamine release, suggesting that it has no tyramine-like catecholamine releasing effect. Pretreatment with (-)- or (+)-deprenyl (5x10(-5)M) significantly prevented the tyramine (10(-6)M)-induced NA release, but not DA release. The inhibitory action of (-)-deprenyl was not observed on potassium (15mM)-induced NA release. (-)-Desmethyldeprenyl (5x10(-5)M), a metabolite of (-)-deprenyl, and a monoamine oxidase-A (MAO-A) inhibitor, clorgyline (5x10(-5)M), failed to block the tyramine-induced NA and DA release. Although (+)-deprenyl, a potent DA uptake inhibitor, did not inhibit tyramine-induced DA release, a catecholamine uptake inhibitor nomifensine (5x10(-5)M) did. In summary, (-)-deprenyl at a dose inhibiting tyramine-induced NA release did not have any effect on tyramine-induced DA release or potassium-induced NA release.
PMID: 14726221 [PubMed - indexed for MEDLINE]
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Posted by SLS on October 31, 2006, at 11:22:15
In reply to Re: Trying Emsam., posted by SLS on October 31, 2006, at 9:12:14
> The parent compound might have stimulant effects of its own.
It has been only two days, but I feel that Emsam might be producing some anxiety and dysphoria. I am already tempted to stop taking it. It is hard to know, though. The Lyrica really screwed me up, and I don't know what to attribute to which. I guess I'll go one more day. My gut feeling is that there might be stimulant properties of Emsam that are causing these things to occur.
- Scott
Posted by corafree on October 31, 2006, at 13:22:43
In reply to Re: Trying Emsam., posted by SLS on October 31, 2006, at 11:22:15
<My gut feeling is that there might be stimulant properties of Emsam that are causing these things to occur.>
Good Scott.
You've been pondering this drug for a while, and 'all the hype' might also be causing some you to 'over-examine' your feelings.
Don't know if you work or not. Hope don't right now and have a close friend/family there.
If not, well 'the whole of babble' is pretty much sittin' on your couch.
If I were really there, I'd do a crazy rain dance and jump around 'whooping and hollering' in your living room and make you laugh, and make 'you' feel 'too' normal! ;)
(Whose been on Emsam for a while successfully and can you talk with them?)
friends, cf
Posted by Lindenblüte on October 31, 2006, at 13:32:27
In reply to Re: Trying Emsam. » SLS, posted by corafree on October 31, 2006, at 13:22:43
Hey Scott,
changing meds makes me feel things too. Can you try and give it a week? I really hope that this is just a temporary side effect that will fade. Some of it might be anxiety about starting a new medicine or about the bad lyrica experience.please give yourself a good chance. You owe it to yourself to give it a real trial, otherwise you might always wonder.
hang in there, and keep posting. I felt pretty awful the first week after starting cymbalta, and again for a few days every time my dose was increased. It ended up working out well for me though.
still cheering you on, hoping the dysphoria fairy comes and takes all your bad thoughts away. You have to be really quiet though, otherwise she gets scared. She's a pretty timid little thing. She can handle your bad thoughts though- she just waves her magic wand and they start shrinking and becoming quieter and quieter. Eventually you won't even be able to hear bad thoughts or see bad things.
-Li
Posted by SLS on October 31, 2006, at 14:25:57
In reply to Re: Trying Emsam. » SLS, posted by corafree on October 31, 2006, at 13:22:43
Hi CF.
> You've been pondering this drug for a while, and 'all the hype' might also be causing some you to 'over-examine' your feelings.
I know. I'll try not to over-think things.
> Don't know if you work or not. Hope don't right now and have a close friend/family there.
This illness makes it difficult to maintain relationships. I do have a few friends, and I'm blessed to have some family in the area.
> If not, well 'the whole of babble' is pretty much sittin' on your couch.
Another blessing.
> If I were really there, I'd do a crazy rain dance and jump around 'whooping and hollering' in your living room and make you laugh, and make 'you' feel 'too' normal! ;)
Woohoo!
> (Whose been on Emsam for a while successfully and can you talk with them?)
I don't know of any.
Thanks, CF.
- Scott
Posted by SLS on October 31, 2006, at 14:56:22
In reply to Re: Trying Emsam., posted by Lindenblüte on October 31, 2006, at 13:32:27
Hi Li.
> changing meds makes me feel things too. Can you try and give it a week?
I'll try. Right at this exact moment, I'm not feeling so bad that I would have to abort the trial.
> I really hope that this is just a temporary side effect that will fade.
The thing is, how long is long enough? How long do you put yourself through hell to wait for untoward effects to disappear in the hopes for a big pay-off?
> Some of it might be anxiety about starting a new medicine or about the bad lyrica experience.
You are right. These are contributors.
> please give yourself a good chance. You owe it to yourself to give it a real trial, otherwise you might always wonder.
I probably would.
> hang in there, and keep posting. I felt pretty awful the first week after starting cymbalta, and again for a few days every time my dose was increased. It ended up working out well for me though.
That's good news. What dosage did you settle on?
> still cheering you on, hoping the dysphoria fairy comes and takes all your bad thoughts away. You have to be really quiet though, otherwise she gets scared. She's a pretty timid little thing. She can handle your bad thoughts though- she just waves her magic wand and they start shrinking and becoming quieter and quieter. Eventually you won't even be able to hear bad thoughts or see bad things.It's hard to quiet my mind when the world seems so unmanageable and the future so bleak. There are demands being placed on me by my family to help take care of my 96 year old grandmother, who just broke her hip. I really don't do that much, but just leaving the house is often more than I have the mental energy to accomplish. I feel trapped. I need to remain functional enough to help her. Can I afford to allow Emsam to make me feel worse? Not really. But, if not now, when? You know?
- Scott
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