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Dr. Bob is Robert Hsiung, MD,
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Posted by corafree on October 31, 2006, at 15:27:38
In reply to Re: Trying Emsam. » Lindenblüte, posted by SLS on October 31, 2006, at 14:56:22
There always seems to be some IRL incident/situation keeping us from giving ourselves the best care we can. Don't think there is ever a right time.
I feel like not getting dressed to go over to help daughter w/ t-or-treeturds, butt will force myself.
I have to remind myself, often, 'I don't have to look perfect' to go out the front door.
Also, these peeps I'd be going to see, love me, 'not how I look'; I imagine just like your grandmother loves you.
Hope that helps some.
cf
Posted by SLS on October 31, 2006, at 15:33:11
In reply to Re: Trying Emsam. » linkadge, posted by zeugma on October 30, 2006, at 16:06:38
> I am curious to know if Emsam has any subjectively similar effects to clorgyline (a structurally related MAO-A inhibitor).
In 2000, Dennis Murphy, MD at the NIH recommended I try selegiline based upon my positive response to clorgyline. I understood the chemical relationship, but wasn't sure of his rationale given the differences in selectivity. I guess we'll have to see. I don't know what my doctor has in mind regarding the rate of titration of Emsam.
- Scott
Posted by Lindenblüte on October 31, 2006, at 17:32:42
In reply to Re: Trying Emsam. » Lindenblüte, posted by SLS on October 31, 2006, at 14:56:22
> Hi Li.
Hey Scott,
> > 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.Okay, well that's good. you hang in there. Treat yourself extra kindly, okay?
> > 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?AD is not a big payoff. it's a very slowly accumulating pile of quarters. You play the slot machine that is hopefully rigged in your favor. After a week or three, you look down, and there's a pile of quarters in the tray, so you keep playing, and after a while you realize that it's been a couple of days since you lost money.
Depression is an insidious illness. It creeps up on you, if you're not watching out. Well, it has to creep off too. I wish AD were as immediate and fast acting as a stimulant, or a beta blocker, or one those other hundred classes of drug that you are so clever knowing :)
You gotta regenerate some neurons and synapses. Takes time. Takes sleep. Takes amino acids. If you're not vegetarian, I think you should treat yourself to a nice steak dinner. next time you go to the market, get a 16 oz NY strip. who cares if it costs 8 bucks? you deserve it. salt and pepper both sides, sear in an oiled skillet 3-6 mins per side. it's fast. and before you know it you have a lovely amino acid supplement.
> > 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.I know a lot of babblers 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?Um, I settled on 90 mg for about 4 months. then I unsettled and now I'm on my 4th day at 120mg. so, I've got a few side effects going too. Nothing like the first time though. Just annoying things like my digestion is somewhat um. yeah. and other private matters which are also less than ideal. and my muscles are twitchier than usual, and I'm feeling more hyper-vigilant/exxagerated startle than usual. and more nappish than usual. *yawn* but it's okay. got to have hope. If this won't work, I'm going to have to switch AD. oh goody...
> > 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?You can only do so much. Tell yourself that Scott fell and broke his limbic system (or make up something silly). When you get a good afternoon or a good morning, or even a burst of anxiety- HARNESS it and use it as ENERGY to get out, call your grandmother, go shopping. Eat ice cream.
Don't be shy to call your friends and ask them to maybe pick up a gallon of milk and a couple of frozen pizzas on their way over to watch HOUSE tonight at your place. (better be House. I'm sick of baseball!) Your friends would no doubt like to help out, but they don't know what you need.
Tell us more about your grandmother-- that's major stress, especially if your family is placing pressure on you to hold things together on your end. That sounds SO tough. You are hurting right now because you are HUMAN, and you can only handle so much. I think these life events are more relevant that g-protein coupled receptors anyways. But that's my bias ;)
(((((hugs for you)))))
hope you get an hour or two where you can get some peace and some Scott-Time ((((((rest))))))If you find yourself in trouble this evening, and need some distraction or discussion, come hang out on babble-chat. I found that if I log in, even if there's no one there, within 10-15 mins someone will pop in and say hi. chat is so slow that the time really flies by, and then, before you know it, it's bedtime.
((((more hugs for you))))
-Li
> - Scott
Posted by johnnyj on October 31, 2006, at 20:42:09
In reply to Re: Trying Emsam. » zeugma, posted by SLS on October 31, 2006, at 15:33:11
Scott:
I am praying and pulling for you. I hear the advice people are giving you and agree, give it some time. I will do the same. Hang in there.
johnnyj
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
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