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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Dave954 on April 28, 2006, at 22:32:54
My name is David and I have been on psych meds since 1999. As of late, I am on a combination of lexapro, seroquel and neurontin. The lexapro is taken in the morning for depression, and the seroquel and neurontin are both taken at bedtime for insomnia (and are a god-send for that purpose, I might add). As of the past month, I've spoken with my psychiatrist about switching from lexapro to EMSAM - but not because the lexapro isn't working (it is working quite well), but because EMSAM has reportedly less sexual side effects, if any (comparable to placebo in clinical trials), and does not cause lethargy, lack of motivation, and clouded concentration as lexapro (and other SSRIs) do. I do have some concerns, however. Primarily, I am worried that EMSAM may cause me extreme agitation/anxiety as wellbutrin did. Let me add that the last two times that I even had a single cup of coffee or anything that had caffeine in it, I ended up in the emergency room with a sustained heart rate of 160 bpm (for HOURS) for which they had to keep me overnight for observation and give me beta blockers and benzos. I am understandably apprehensive and hope that EMSAM won't be the equivalent of caffeine or wellbutrin. I will say that in the past I have been on Strattera without a problem (though that is a norepinepherine reuptake inhibitor and doesn't affect dopamine). Ever since the seroquel was added to the lexapro and neurontin I have felt less agitated and sleep a lot better. My fear of going on EMSAM became ignited the moment that I read other postings from people saying that they experienced extreme anxiety and insomnia without any antidepressant effect (one poster even mentioned that her experience paralleled that of wellbutrin and that she tried throwing klonopin, seroquel and ambien at it and still the anxiety didn't lessen and she eventually had to discontinue treatment). I desperately want an antidepressant without sexual side effects and thought this might be the answer since it is an MAOI that doesn't have the typical side effect profile of traditional antidepressants. However, I am now starting to get the idea that the reason why is because this is an MAOI that is more partial to inhibiting MAO-B (dopamine, etc) than MAO-A (serotonin, etc). Typically, antidepressants with good serotonergic activity tend to be the most effective, but also tend to cause the most sexual side effects (the exact opposite seems to apply to antidepressants that work primarily on norepinerpherine and dopamine - in that they seem to be less effective for depression but allow better sexual functioning). And I may add that I have been on almost every medication so far *except* the MAOIs and most have helped my depression - its just the sexual side effects that have been so frustrating. The exceptions being serzone, remeron and wellbutrin - they didn't cause sexual side effects, but also weren't particularly effective antidepressants either. I am willing to give EMSAM an honest try, but only if I feel confident that it won't send me to the emergency room. I hope my doctor will allow me to stay on the neurontin and seroquel (as I don't believe there would be any sigificant interactions with EMSAM - but anyone tell me if I'm wrong). I told him my history of emergency room admissions from caffeine - but he seemed to down-play it. Any replies or opinions would be appreciated. Thank you.
Posted by strugglingsteve on April 28, 2006, at 22:48:12
In reply to EMSAM - A little worried about taking the plunge, posted by Dave954 on April 28, 2006, at 22:32:54
I am on it now and my agitation and anxiety is probably a little worse than it was before I started it. But its not unbearable. No one can tell you how may fare on it but I will tell you that I like no side effects so far. I am more scared of it not working than anything else. Best of luck!
Posted by ravenstorm on April 29, 2006, at 10:17:08
In reply to Re: EMSAM - A little worried about taking the plunge » Dave954, posted by strugglingsteve on April 28, 2006, at 22:48:12
I share your concerns. I am waiting to try ensam because I am afraid of having more anxiety and agitation. It took me several months to get calmed down after the wellbutrin fiasco. I can not have any caffiene either. I shudder just to think of it. I have severe physical anxiety. Wellbutrin also made my running thoughts worse.
I am waiting to see if someone who couldn't tolerate WB can tolerate the patch. Also, almost everyone trying emsam right now also seems to be taking a benzo, so that makes it hard to gauge how anxiety provoking it would really be.
Just my two cents: if I had a medication regime that worked I would stay with it. I know sexual side effects suck, but not having a life due to mental illness is much worse. Spoken by someone who knows: three years (will be four in September) of treatment resistance/intollerance since going off of paxil.
If you do decide to try it, please keep us posted and good luck whatever your decision.
p.s. hope I didn't rain on your parade
Posted by Enigma on April 29, 2006, at 12:33:38
In reply to EMSAM - A little worried about taking the plunge, posted by Dave954 on April 28, 2006, at 22:32:54
I've had a horrible experience with Emsam so far, and I'm not sure how much more I can stand.
Read my other post (the one minutes before this one).
I'd be wary too. I'm wary of every drug I take, as most give me unbearable side-effects and 0 relief to what they are actually supposed to relieve.
Posted by Phillipa on April 29, 2006, at 21:08:58
In reply to Re: EMSAM - A little worried about taking the plun, posted by Enigma on April 29, 2006, at 12:33:38
I was under the impression that although ENSAM is expensive that most side effects are nonexixtent. Including food restrictions and the idea of a patch appeals to me as you can take it off and within 2-6 hous med completely out of your system. The sex part who care not me just want to feel like myself and get back to work my love of work and not have horrible anxiety. BTW I already take valium for over 30yrs. No I'm not young hence my urgency to find a med that works none of the others have Love Phillipa
Posted by ravenstorm on April 30, 2006, at 9:17:32
In reply to Re: EMSAM - A little worried about taking the plun » Enigma, posted by Phillipa on April 29, 2006, at 21:08:58
Emsam has side effects. It does not have sexual side effects like the SSRI's but for some people it can cause insomnia and increased anxiety. For SOME people, not all. The side effect ensam doesn't have because it is in patch form is the food restrictions. If you took selegeline orally at the dose of the patch, you would have to restrict yourself to the MAOI diet. With the patch, you don't have to.
Also, be aware that the only side effect info we have is from the clinical trials, more will come to light as it is used in the actual population.
If you ever look at the SSRI side effects charts from the PI sheets (gathered during clinical trials) the side effects are incredibly low, close to that of placebo. But we know in the real world that the SSRI's have much higher side effect profiles than that.
It seems so far from the small pool of people here starting ensam, that those who had horrible side effects from SSRIs are having a much smoother ride with ensam, but we don't know if that is due to the ensam itself being side effect free, or if these people just don't do well on serotonin type drugs and so are doing better on ensam because it is more suited to what their brains need.
Posted by Last Chance on April 30, 2006, at 12:49:05
In reply to Re: EMSAM - A little worried about taking the plun, posted by ravenstorm on April 30, 2006, at 9:17:32
I am also concerned about anxiety and difficulty sleeping - I already have that, but I will try Emsam anyway with some extra Valium handy in case it gets to be too much. Waiting for the patch to arrive, and with some fear I will place it on my body. I feel like this IS my Last Chance. I still have high hopes that it will work for me and many others. Richard
This is the end of the thread.
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