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Dr. Bob is Robert Hsiung, MD,
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Posted by Jost on October 31, 2006, at 21:19:02
In reply to Re: Trying Emsam., posted by SLS on October 31, 2006, at 11:22:15
Have you had that reaction to stimulants in the past? because it seems awfully early to pull the plug on an AD unless the reaction is consistent with other things in the past.
Given that someone knowledgeable recommended it, I wonder if it isn't too soon to draw any firm conclusions.
That depends on how acute the dysphoria or anxiety is, though. But it could be transient or likely to moderate.
There is the nocebo effect too-- because you seemed pretty disbelieving of its possible efficacy even before you started.
Maybe it's not the best time to try. Later when there's more evidence about how good Emsam is (or isn't), you could approach it with more optimism--or conviction that it could help, which might give it a chance to work (beyond also any placebo effect, too).
I don't know. I by no means think it's magic, or "the" answer-- but I also feel that Emsam has gotten a bit of a bad rap here.
Maybe I'm a negative (or non-) indicator, but it seemed good to me.
Jost
Posted by Phillipa on October 31, 2006, at 22:33:28
In reply to Re: Trying Emsam., posted by Jost on October 31, 2006, at 21:19:02
Scott I know of one person and haven't spoken to him in a while. His main symptom was anxiety. Klonopin 2mg stopped it and he is/was taking EMSAM for additional energy. I don't know if he will answer an e-mail after this time as he was only on babble to research EMSAM. Last I heard from him he was still doing great. Maybe you need a benzo? Love Phillip I will send him an e-mail now as I just got home
Posted by zeugma on November 1, 2006, at 8:25:28
In reply to Re: Trying Emsam., posted by linkadge on October 31, 2006, at 6:47:34
> 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?
>I think the NMDA theorists claim that reduced NMDA activity results in increased AMPA activity, and there are studies that show that AMPA positive modulators have antidepressant effects (in animal models).Positive AMPA modulators have also been proposed for ADHD.
-z
>
Posted by RN320 on November 1, 2006, at 13:21:59
In reply to Trying Emsam., posted by SLS on October 27, 2006, at 22:50:24
Scott-
I just wanted to give you some positive information on EMSAM. I started on EMSAM in June and currently use the 12mg patch. It's done a great job of controlling my depression and anxiety. It took about 8-9 days before I started feeling much of anything, and there was a lag time of about a week in between doseage increases before I saw an effect. The only problem I've had is related to a drop in my blood pressure, but for me all that meant was decreasing doses of antihypertensives. I wasn't crazy about wearing a patch myself, but have gotten used to it. It's not so bad. The patch does get larger with the dose, however. There are a number of places where it seems to stick better for me- like on my anterior chest wall. My pdoc is the #1 prescriber of EMSAM in the metro Detroit area and has many success stories using it. I've been dismayed with the bashing of this drug by many, but then I know that results are an individual experience.Prior to the EMSAM I had tried just about every SSRI and tricyclic, and immediately prior to starting it I was on a combination of Lexapro and Wellbutrin XL. That, along with Seroquel (for sleep and anxiety) and Geodon (for the psychotic symptoms of my depression) kept me barely functional. The EMSAM has allowed me to do things like watch a TV program that's an hour in length and still remember what I'm watching! It's helped greatly in decreasing my anxiety at the higher dose. I feel more settled and emotionally even on it. My pdoc and therapist have a complicated biochemical explanation for how this all happens but I don't remember it.
I would just encourage you to give it a thorough try before you decide it's not working. Best of luck to you.
/m
Posted by river1924 on November 1, 2006, at 19:44:44
In reply to Re: Trying Emsam., posted by SLS on October 28, 2006, at 8:26:45
Hi Scott,
Although I'm not real consistent about reading posts, I do know you seem to be knowledgeable about chemistry and neurotransmitters. (Lately I've been trying to figure out epigenetics... with methyl groups, and histones, and acetyl groups activating and inhibiting DNA etc... Not getting far. I just find it interesting that diet or stress in my parents or my grandparents effect my health.)
nortriptyline 100mg
Emsam 6mg/24hr
Lamictal 150mg
Topamax 100mg
Abilify 10mgI can't say that is a lot. I take more.
But I'm curious if you stopped those meds or one, two or three, who do you become?
What issues are you dealing with and what is the hope for ENSAM. What enviromental and social factors aggravate you difficulties?
I'm curious because I've never got a strong feeling about what is going on... in your head.
I'll look back at your Lyrica probs. I liked it but it lowered my functional capacity and memory capacity a lot.
Sometimes, I don't know why I'm taking what for what reason anymore. I'm just curious about your reasons.
River.
Posted by linkadge on November 1, 2006, at 20:32:04
In reply to Re: Trying Emsam. » SLS, posted by river1924 on November 1, 2006, at 19:44:44
>Lately I've been trying to figure out >epigenetics... with methyl groups, and histones, >and acetyl groups activating and inhibiting DNA >etc... Not getting far. I just find it >interesting that diet or stress in my parents or >my grandparents effect my health.
Hey thats interesting, I have read a little bit about it myself. Not much. From what I read, depression and anxiety are associated with methlated DNA? (or something), and that antidepressants don't actually unmethalate the DNA, and presumably don't get to the heart of the problem?
Don't understand it at all. :(
Linkadge
Posted by Lindenblüte on November 1, 2006, at 21:43:54
In reply to Re: Trying Emsam. » SLS, posted by river1924 on November 1, 2006, at 19:44:44
Hey Scott,
how you doing today?I'm on my 5th day of cymbalta increase from 90 to 120. I didn't really feel "awake" until about 7 pm.
Oh well. somehow in my slumbery morning I wrote a paper. I have no idea how. napped for 2 hours this afternoon.
all this sleeping despite 200mg provigil and a pot of green tea and 3-4 cups of coffee. Oh. and a diet coke.
*yawn*
just when I feel "awake" it's time to take meds and go to bed again. yuck!
Scott tell us about your side effects- you doing okay? It's okay if you talk about feelings instead of methyl groups. Don't stress out if you don't have an answer for everything. Some things are just beyond minds.
arrivederci,
thanks for your halloween website- it's clever and it was nice to get to know you better.-Li
Posted by SLS on November 1, 2006, at 22:15:15
In reply to Re: Trying Emsam., posted by Lindenblüte on November 1, 2006, at 21:43:54
> Don't stress out if you don't have an answer for everything.
Who told?
:-)
I felt dysphoric and anxious last night and for most of today. My patch fell off around 2:00pm and I didn't have an opportunity to replace it. Tonight, the dysphoria and anxiety have all but disappeared. I think I'll wait until tomorrow afternoon before rechallenging myself with the drug.
- Scott
Posted by Phillipa on November 1, 2006, at 22:37:02
In reply to Re: Trying Emsam. » Lindenblüte, posted by SLS on November 1, 2006, at 22:15:15
Scott what mg is the patch? hope you got that mail. Love Jan ps it's not out in my mind yet either. I will pray for you and I usually don't pray.
Posted by SLS on November 2, 2006, at 7:52:25
In reply to Re: Trying Emsam. » SLS, posted by Phillipa on November 1, 2006, at 22:37:02
> Scott what mg is the patch? hope you got that mail. Love Jan ps it's not out in my mind yet either. I will pray for you and I usually don't pray.
I've been on the 6mg/24hr patch.So far this morning, I feel only a touch of dysphoria. I am seriously thinking of waiting a few days before trying the Emsam again.
- Scott
Posted by linkadge on November 2, 2006, at 8:02:17
In reply to Re: Trying Emsam. » SLS, posted by Phillipa on November 1, 2006, at 22:37:02
Don't poison yourself with it if its not your style.
Linkadge
Posted by SLS on November 2, 2006, at 9:39:35
In reply to Re: Trying Emsam., posted by linkadge on November 2, 2006, at 8:02:17
> Don't poison yourself with it if its not your style.
That's what these drugs feel like sometimes.
But then, I am faced with "What if?"
It sure is a relief to be without the increased dysphoria and anxiety. Is it an unrelated coincidence that I have been without the patch for 18 hours? I can tell that there is still some leftover crap from the Lyrica. I think I should let things settle down for a few days before rechallenging myself with Emsam.
This really sucks.
- Scott
Posted by river1924 on November 2, 2006, at 11:22:56
In reply to Re: Trying Emsam., posted by SLS on November 2, 2006, at 9:39:35
100mg dose of nortriptyline and emsam and abilfy...
You are the scientist but couldn't you build up a lot of serotonin with that group... doesn't that cause dysphoria?
Posted by corafree on November 2, 2006, at 11:33:00
In reply to Re: Trying Emsam., posted by SLS on November 2, 2006, at 9:39:35
A person named Dav*s is on it @
http://www.anxietyhelp.org/treatment/medication/selegiline.html
Maybe you're already following. Just FYI.
cf
Posted by ed_uk on November 2, 2006, at 14:58:52
In reply to Re: Trying Emsam., posted by SLS on November 2, 2006, at 9:39:35
Hi Scott
Might a benzo help for a few days while you get used to the Emsam?
Ed
Posted by Phillipa on November 2, 2006, at 18:13:40
In reply to Re: Trying Emsam. » SLS, posted by corafree on November 2, 2006, at 11:33:00
Corafree that's the most I've seen on Emsam yet. Why not seroquel with emsam? Love Phillipa
Posted by SLS on November 2, 2006, at 18:15:01
In reply to Re: Trying Emsam. » SLS, posted by river1924 on November 2, 2006, at 11:22:56
> 100mg dose of nortriptyline and emsam and abilfy...
>
> You are the scientistNot by a LONG shot.
> but couldn't you build up a lot of serotonin with that group... doesn't that cause dysphoria?
That's a thought. The thing is, I don't think there is any appreciable MAO inhibition yet.
Thanks for thinking of me.
- Scott
Posted by SLS on November 2, 2006, at 18:29:20
In reply to Re: Trying Emsam. » SLS, posted by ed_uk on November 2, 2006, at 14:58:52
> Hi Scott
>
> Might a benzo help for a few days while you get used to the Emsam?That is a very good idea. It would probably help with the anxiety. I doubt it would help with the dysphoria, though. It is the dysphoria that is making life difficult to tolerate.
Gosh, I really hate to slap one of those patches back on me again. I will probably wait two more days.
- Scott
Posted by Phillipa on November 2, 2006, at 19:21:26
In reply to Re: Trying Emsam. » river1924, posted by SLS on November 2, 2006, at 18:15:01
Well I looked up dysphoria. Believe it or not I thought is was depression. So I just learned that it is mania. Wow I have so much to learn. Love Phillipa
Posted by SLS on November 2, 2006, at 20:17:41
In reply to Re: Trying Emsam., posted by Phillipa on November 2, 2006, at 19:21:26
> Well I looked up dysphoria. Believe it or not I thought is was depression. So I just learned that it is mania. Wow I have so much to learn. Love Phillipa
Dysphoria is more like an uncomfortable depressive mood state sometimes accompanied by anxiety. It can occur in combination with mania, but is not the same thing as mania.
- Scott
Posted by Phillipa on November 2, 2006, at 21:12:00
In reply to Re: Trying Emsam. » Phillipa, posted by SLS on November 2, 2006, at 20:17:41
So you're depressed and can't sit still? If it is that's me. Love Phillipa
Posted by ed_uk on November 3, 2006, at 14:32:52
In reply to Re: Trying Emsam. » Phillipa, posted by SLS on November 2, 2006, at 20:17:41
Might a small dose of Zyprexa help for a few days?
Ed
Posted by SLS on November 3, 2006, at 16:51:15
In reply to Re: Trying Emsam. » SLS, posted by ed_uk on November 3, 2006, at 14:32:52
> Might a small dose of Zyprexa help for a few days?
Another good idea, Ed. Thanks.
I'm on Abilify right now. Zyprexa would probably work better, though. I've had to deal with some family issues, so I haven't wanted to add back the Emsam just yet.
- Scott
Posted by ed_uk on November 4, 2006, at 14:35:57
In reply to Re: Trying Emsam. » ed_uk, posted by SLS on November 3, 2006, at 16:51:15
Hi Scott
Perhaps it might be safe to take a smallish dose of Zyprexa in combination with Abilify for a week or two?
Ed
Posted by tgo on November 4, 2006, at 17:21:34
In reply to Re: Trying Emsam./SLS, posted by lymom3 on October 28, 2006, at 13:12:34
I was on the patch for 3 days. The third day I was so tired I slept most of the day. I stopped at that point as I couldn't afford to not get work done like that. Anyone know if the tiredness goes away?
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Dr. Bob is Robert Hsiung, MD,
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