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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 102 to 126 of 431. Go back in thread:
Posted by ttee on April 14, 2006, at 17:10:13
In reply to Half life $ Anesthesia, posted by strugglingsteve on April 14, 2006, at 16:14:15
Having a medic alert bracelet sounds like a cheap good thing to do. You never know what could happen in an emergency situation and/or will the resident intern at your local hospital know what EMSAM is?
I think you are right about Selegiline having a sort half-life. However, I don't think the half-life is relevant with an MAOI. Selegiline is an irreversible MAOI, so once you have destroyed your MAO with Emsam, it will take 2 wks after you discontinue the Emsam for you body to remanufacture some normal functioning MAOI. So if Emsam is working for someone, it might be a scary proposition to have to go off of it just to have some minor surgery, or a tooth filling. Will it work again when you restart it, or is it like the other AD's that sometimes doesn’t work again like they had done before stopping them?
TTEE> I am going to get a medic alert bracelet if emsam pans out as a long term med. I know with nardil its 10 days off it before hospital surgery or anesthesia at a dentist. Isnt selegiline a very short half life so wouldnt the time off of it be much shorter to, anyone out there with any ideas on this??
Posted by tom_p on April 14, 2006, at 19:20:15
In reply to Re: Emsam Price, posted by Iansf on April 13, 2006, at 16:39:26
Hi,
I've been reading messages here for years and I thought I'd start posting.
I'm really interested in trying Emsam and I too have been checking prices for the med.
I spoke with someone at Costco and she estimated the cost for 30 days of the 6mg patch at $405.
Another local pharmacy said their price would be $480 to $500.
Tom
Posted by Phillipa on April 14, 2006, at 19:39:36
In reply to Re: Emsam The Anxiety Community, posted by strugglingsteve on April 14, 2006, at 15:59:44
It has to work there has to be something out there. Is it us? Love Phillipa
Posted by strugglingsteve on April 14, 2006, at 21:07:49
In reply to Emsam The Anxiety Community, posted by Last Chance on April 14, 2006, at 10:57:31
I couldnt find that posting of ny marine, did anyone else post there?
Posted by Last Chance on April 14, 2006, at 22:25:54
In reply to Re: Emsam The Anxiety Community, posted by strugglingsteve on April 14, 2006, at 21:07:49
> I couldnt find that posting of ny marine, did anyone else post there?
Struggling Steve - sorry, my post wasn't very clear. Go to www.anxietyhelp.org - site is called "The Anxiety Community" Click on Treatment, then list of medications, then Nardil. That will get you to NY Marine's post. Richard
Posted by gardenergirl on April 14, 2006, at 22:56:22
In reply to SW OHIO Decent Price, posted by pulse on April 14, 2006, at 15:58:33
Posted by Sarah T. on April 15, 2006, at 3:59:41
In reply to Re: EMSAM-Day 5-Too early?? » strugglingsteve, posted by RobertDavid on April 12, 2006, at 15:41:49
Hi Robert David,
Your news is wonderful, and I really appreciate your keeping us informed on your progress. Thank you for your reply the other day regarding getting the patch wet. I'm delayed in replying because my computer is ailing.
I'm wishing you continued success with the new medicine.
Sarah
Posted by pulse on April 15, 2006, at 9:44:35
In reply to Love Jungle Jim's! (nm) » pulse, posted by gardenergirl on April 14, 2006, at 22:56:22
gardengirl,
you mean you're in my area and have been to jungle jim's...OR... was this a general (!) comment?
btw, they can save me at least $10-$15 on my 3 other (2 are non-psych meds) scripts.
best,
pulse
Posted by pulse on April 15, 2006, at 9:54:33
In reply to EMSAM - First Day, posted by RobertDavid on April 8, 2006, at 11:15:36
my report: day 1 & 2 were unbelievably good. day 3, i had a slight dip back into some depression, but my best guess is that the lack of sleep had caught up with me, and caused this. night #3/ day#4 (today) - i got 7 hours sleep in one stretch last night. depression gone again. hoping for repeats from here on...
still NO stomach problems, nor other side-effects. yippee!
pulse
Posted by ravenstorm on April 15, 2006, at 11:51:10
In reply to All - my day #4, posted by pulse on April 15, 2006, at 9:54:33
Congratulations on your lack of side effects! Sorry I didn't respond to your earlier reply about GI problems. The last two days have not been good and I haven't been up to posting.
I became medication intolerant/treatment resistant after a very protracted withdrawal to paxil that left me with worse depression and anxiety than I ever had before. Celexa gave me askathesia (I know I didn't spell that right), Lexapro and zoloft made me throw up. I was about to try prozac (which was the only drug I have ever tried that I didn't have severe start up or discontinuation syndrome with) when my anti-med husband took me to a naturopath who claimed he could cure me with amino acids etc but that I had to take them on an empty stomach etc despite the fact that at the time my stomach was bad enough that taking supplements with food was enough of a problem. Anyway, that not only didn't work, it screwed my stomach up so much that I then couldn't tolerate prozac which was my ace in the hole, so to speak.
Then it was on to remeron. Which, because of its nausea blocking properties, helped me eat for awhile, but made me extremely angry, made my anxiety worse and only gave partial remission to depression. It also permanently altered my blood sugar responses. After several months on this drug, it started causing severe heartburn/gastric distress, however I couldn't just stop taking it due to withdrawal syndrome, so I had to keep taking it for two months as I weaned off and during that time erosions in my esophagus occurred which are taking forever to get under control. I basically can eat oatmeal, rice, potatoes and some chicken and thats about it. Remeron is the first medication I've taken that has done permanent damage to my stomach. The other medications would upset my stomach or make me nauseaus to the point of non functioning, but once I discontinued them I could resume eating somewhat normally.
So, come this September I'll have been in this agitated/depressive episode for three years.
I started following the patch with great interest several years ago because of my stomach issues, but then gave up on it when I delved more into selegine and discovered how activating it was (Wellbutrin and Remeron both made my anxiety/anger worse). So, I am interested to see how someone with severe physical/anxiety/agitation will do on the patch.
Also, at this point, I'm just worried about making myself even worse. When I go through withdrawal to these drugs I end up worse than when I started and I just can't face getting any worse. Its always a huge gamble for me to try another drug.
Sorry this is so long. Thanks for your continued posts and I wish you continued good luck!
Posted by RobertDavid on April 15, 2006, at 13:01:56
In reply to Re: GI issue reply/pulse, posted by ravenstorm on April 15, 2006, at 11:51:10
I'm still void of any negative side effects. It amazes me as I've dealt with SAD and GAD all my life. I'd heard before trying EMSAM that oral selegiline would not be good for someone like me which was of concern, but so far my best start to any med.
One of the many reasons I have not been able to stay on the typical SSRI's and SNRI's was that I just felt more anxious and didn't sleep well (not to mention they didn't work).
Whenever I start a new med I tend to really pay attention to what I'm feeling, like a fear of when the side effects going to kick in and how bad will they be once here. Now at day 9 I put the patch on and don't give it a thought.
If my mood and energy were not better and if my anxiety was not more under control I'd think I was just putting on a piece of tape with no medicine.
My take is that for me I got a quick response, now things are improving gradually. My guess is that I won't know just how much EMSAM is going to benefit me until I get 3 to 4 weeks further out. At that time I can also determine if I will just stay on the 20mg patch or go up.
So at least in my case, a guy that primarily has anxiety issues with some depression, it's helping in all area's with NO side effects. I remain optimistic. Rob
Posted by Crazy Horse on April 15, 2006, at 13:22:18
In reply to Day 9 Report, posted by RobertDavid on April 15, 2006, at 13:01:56
> I'm still void of any negative side effects. It amazes me as I've dealt with SAD and GAD all my life. I'd heard before trying EMSAM that oral selegiline would not be good for someone like me which was of concern, but so far my best start to any med.
>
> One of the many reasons I have not been able to stay on the typical SSRI's and SNRI's was that I just felt more anxious and didn't sleep well (not to mention they didn't work).
>
> Whenever I start a new med I tend to really pay attention to what I'm feeling, like a fear of when the side effects going to kick in and how bad will they be once here. Now at day 9 I put the patch on and don't give it a thought.
>
> If my mood and energy were not better and if my anxiety was not more under control I'd think I was just putting on a piece of tape with no medicine.
>
> My take is that for me I got a quick response, now things are improving gradually. My guess is that I won't know just how much EMSAM is going to benefit me until I get 3 to 4 weeks further out. At that time I can also determine if I will just stay on the 20mg patch or go up.
>
> So at least in my case, a guy that primarily has anxiety issues with some depression, it's helping in all area's with NO side effects. I remain optimistic. RobMan, it's really working for you!! I'm very happy for you Rob. And your reports are giving the rest of us hope in what sounds to be one fine medication. Keep up the good work.
-Crazy Horse
Posted by theo on April 15, 2006, at 14:05:26
In reply to EMSAM-Day 5, posted by RobertDavid on April 12, 2006, at 9:53:45
How did you already get Emsam? I was at the doc yesterday and am going to try it, but my doc said it would be a few more weeks before it hits the shelves??
Posted by RobertDavid on April 15, 2006, at 14:29:53
In reply to Re: EMSAM-Day 5 » RobertDavid, posted by theo on April 15, 2006, at 14:05:26
> How did you already get Emsam? I was at the doc yesterday and am going to try it, but my doc said it would be a few more weeks before it hits the shelves??
I called a few pharmacies till I found one that could order it, then had my doctor call in the perscription by phone. Most pharmacies probably are not stocking it, but can order it. If your pharmacy says they don't have it in there system ask them to check with their wholesaler. By now I'm sure it's easy to get, but your doctor may not be aware that it is. Good luck! Rob
Posted by Last Chance on April 15, 2006, at 14:34:09
In reply to Day 9 Report, posted by RobertDavid on April 15, 2006, at 13:01:56
Hi Rob - As you know I have been waiting a long time for the patch, and now that it is here I can't afford it. I am glad to hear you are doing so well, and wish I were along for the ride. Still trying to figure out a way, but not looking good. Continue to do well, and I know you will keep letting us know how it's going. Richard
Posted by RobertDavid on April 15, 2006, at 15:09:34
In reply to Re: Day 9 Report - Robert David, posted by Last Chance on April 15, 2006, at 14:34:09
> Hi Rob - As you know I have been waiting a long time for the patch, and now that it is here I can't afford it. I am glad to hear you are doing so well, and wish I were along for the ride. Still trying to figure out a way, but not looking good. Continue to do well, and I know you will keep letting us know how it's going. Richard
Richard:
There is part of me that struggles when I post how well my "start" has been with EMSAM because I know that there are many out there who just can't afford it/don't have insurance to cover it.
That said, I know that BMS did send out samples with many of their drug reps and perhaps you could get enough samples from a doctor to see what kind of response you may get with it. I know that's not an ultimate solution, but might help you find out if it's worth searching for a finacial solution for or not. At least you'd have some idea.
I do think the cost really stinks though especially for deserving individuals like you. Perhaps the price will come down sooner than later. You might try to call BMS directly and ask if they have or will have a program to get EMSAM at a reduced cost to those that can't afford these horrific prices. I wish you the best...
Rob
Posted by strugglingsteve on April 15, 2006, at 15:17:54
In reply to Re: Day 9 Report » RobertDavid, posted by Crazy Horse on April 15, 2006, at 13:22:18
I was doing ok the first few days but now at day 5 agitation has hit in a big way. My doc does not like benzos and I want to stay away from them if I can but its a bad scene. I just couldnt calm down yesterday. Today is a little better so far but this reminds of starting wellbutrin. Eventually it got better when the med starting working. I am not as depressed as I was but not sure if emsam had anything to do with it. I am going to fight this one out because there are no other side effects which is a miracle for me. I may try asking my doc about lyrica again but he wasnt too keen on it before. I just am hoping that it calms down quickly. Congrats Robert on having such an easy time of it so far, count your blessings dude.....
Posted by pulse on April 15, 2006, at 17:51:41
In reply to Re: GI issue reply/pulse, posted by ravenstorm on April 15, 2006, at 11:51:10
ravenstorm,
good gracious, don't be sorry about anything. i well know what having multiple GI problems is like, although i must admit, it sounds like you've had an even rougher road to hoe than i. i never had to take a proton pump inhibitor until i had the misfortune of being seen by a doctor, during my first, of 4 stays in detox and/ or extended treatment centers (this 1st time in was only 4 days), for exactly FIVE minutes. this psychiatrist MISdiagnosed me as - get this - bipolar I w/ rapid cycling. yes, i know it's usually "the other way around."
i later found out that anyone who went to this doc at his private practice was automatically diagnosed as some variant of bipolar. he was later found to be a total crook, when he stole money in various ways - he was found out, had his license yanked, and was banished to florida. (i can easily see him down there now practicing w/out a license.)
my point is: only when they introduced the mood stabilizers, did my stomach get really bad. i was more serious about staying clean by then, so i was too petrified, and MUCH too compliant and accepting (a lifetime problem) to refuse taking them. it then took me 9 years to get my (correct) and original diagnosis from 1979 (Major Depressive Disorder) back on my chart. it also took a kind, young female psychiatrist to finally REALLY observe me, my moods and behavior, (not just see bipolar in my records), and also see that i could only take a very sub-theraputic dosage of any stabilzer, (i'd never had one single mini hypo mania, anyway).
unfortuntely, 6 months later, SHE moved....to florida!
the serotonin in so many of the ads has further done my digestive system in, in a very big way; to a lesser degree noradrenaline. wellbutrin is the only med a doc has pulled me off of on day one. oh, i could have got through the anxiety i'm sure, but i literally burped every waking minute i was on it. most pharmacists will tell you they've rarely heard of folks having stomach trouble on wellbutrin. i've instead heard the saying goes: for those who do well on wellbutrin, they really love it; for those who don't, they really HATE it.
i so wish i had never had to start the PPIs, because, imo, and my docs, it's next to impossible to ever get off them, and the price just keeps goin up, up , up.
my day has gone south again. so wish i was riding as smoothly as robert. i am trying to lower my klonopin dosage a quickly as i possibly can. i pretty much know that doing it this way, i will barely, if at all, sleep for the next month. (1 mg down each week) - that was my ECT doc's way of doing it, but i know from experiencing both ways, down 1/4 mg every 2 weeks is the way to go. i simply don't feel i have that kind of time, or i will blow my chance with ensam.
pulse
Posted by Phillipa on April 15, 2006, at 18:24:44
In reply to Agitation has arrived, posted by strugglingsteve on April 15, 2006, at 15:17:54
I thought if you had no insurance and no or very low income the drug companies would send it to your doc and you would get a 90 day supply free. At least Eli Lilly has this plan as I was given the form to fill out for cymbalta. But I couldn't tolerate the side effects and went off it. I have disability Medicaire. Who manufactures Ensam I must have missed that post. Love Phillipa
Posted by ttee on April 15, 2006, at 21:02:54
In reply to Re: Day 9 Report - Robert David » Last Chance, posted by RobertDavid on April 15, 2006, at 15:09:34
I don't know this as a fact or not for Emsam, but it is my understanding that the pharmaceutical companies do have programs for people that can not afford their meds. I have been told that often times, drugs that have a smaller target market like Emsam and the atypical antipsychotic, have inflated prices to help off set the known expense for the drug company to make their meds available to those without insurance. Generally the docs are aware of these programs or you can call BMS to see if you qualify. Usually your doc has to fill out the forms and the drug company will send your meds straight to your doc, NO CHARGE. It is certainly worth the time to make a few phone calls. The drug company benefits because it gets more exposure with their med and might help increase the number of prescriptions made and gets the docs comfortable in prescribing the med. A large percentage of the subsequent prescriptions will be a full price and/or covered by the patient's insurance. Sort of like Robin Hood. Ask your doc for help. The BMS reps will help your doc with the process. It is a hassle for your doc, but the better docs will go to bat for you if you are truly in dire straights. Good luck.
Posted by gardenergirl on April 15, 2006, at 21:04:46
In reply to Re: Love Jungle Jim's! » gardenergirl, posted by pulse on April 15, 2006, at 9:44:35
Yes, I'm in your general area and have been there.
Isn't spring putting on a great show right now?
gg
Posted by germanium on April 15, 2006, at 21:21:19
In reply to Re: EMSAM-Day 5-Too early??, posted by strugglingsteve on April 12, 2006, at 15:14:13
Don't be supprised with the early relief as selegiline can be very rapid indead. Many times less than a week. for me it's 2 to 3 days so don't discount it
Posted by germanium on April 15, 2006, at 21:56:49
In reply to Agitation has arrived, posted by strugglingsteve on April 15, 2006, at 15:17:54
selegiline boost's ones energy radicaly & for some may seem agitating but it does subside some with continued use. it however remains present & accounted for. For me It boosts my energy & I do feel only slightly but very tolerably agitated but calm at the same time. makes it easier to get up & get moving early in the morning. & my sleep is actually better. I feel rested when I wake up
I did find some qualitatively different charateristics this time restarting it than before as before it interfered with sleep for a time (2weeks) but not this time. My sleep actually improved this time. You should monitor you blood pressure though.I will also admit to taking it a little different to as I no longer swallow the pill but absorb it sublingually as this seems to avoid much of the generation of methamphetamine as a result of first pass metabolisation. It does make the tonge numb though for about 10 minutes taking it that way though but I take that as a sign of its rapid assimilation. The patch does essentially the same thing but spreads it out over 24 hours instead of 10 minutes.
I only take 2.5 mg compared to 6 mg from the patch though
& it is very effective for me. So much so that my dispatcher at work started asking about it for his wife as apperently she suffers from really bad depression like me.
Posted by pulse on April 16, 2006, at 3:10:31
In reply to Re: Love Jungle Jim's! » pulse, posted by gardenergirl on April 15, 2006, at 21:04:46
gardengirl,
well, then, hi there "neighbor."
nope, for me (i also have summer variety SAD), it's ALREADY too hot for me. said to be seeing a few cooler (in 60's) days, then right back up into the 70's or 80 (!), as it was 2 days ago. 70 is my cut-off limit for our humidity here, especially if we're also having bright sunlight. at least for me, the bright light works against my depression in this summer variety.
i'll have to go on an up all night/ sleep all day schedule soon - too soon - i fear. i was hoping for a longer true spring, like our indian summers in fall, but, as has been the case in the last couple of years, i doubt i'll get it. cooler temps would have given me some additional help - that i now seem to need.
pulse
Posted by pulse on April 16, 2006, at 3:41:51
In reply to Re: Love Jungle Jim's! » gardenergirl, posted by pulse on April 16, 2006, at 3:10:31
all,
i had posted earlier that i was going to immediately start lowering my klonopin by 1 mg. per week - hoping to finally get totally off it, as i was just last year at this same time - although for only one month. you may recall i'm on emsam much more for major depressive illness, than for any anxiety help.
even before my therapist called me back last night, i realized this was just not realistic. i also realized that i needed to:
1) stop comparing my emsam start-up with anyone's else's.
2) be much more patient.
3) not go one bit lower on the klonopin for now.
4) give the ensam ample time, longer than the "up to 2 weeks to work," (cited on my pharmacy read-out).
(*i do still believe it's going to give me full remission of my MDD.)
therefore, i may well be more scarce around here for awhile.
many thanks to everyone who has helped me on this thread with their excellent info, and good luck to all on emsam.
pulse
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