![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 45. Go back in thread:
Posted by ttee on May 17, 2006, at 21:05:43
In reply to Re: Emsam two patches at once, posted by aabag on May 17, 2006, at 12:25:55
Is paranoia a side effect from Emsam?
Posted by Phillipa on May 17, 2006, at 21:58:29
In reply to Re: Emsam two patches at once, posted by ttee on May 17, 2006, at 21:05:43
Oh no you're paranoid? say it's not true. Love Phillipa
Posted by cecilia on May 18, 2006, at 3:23:26
In reply to Re: Emsam two patches at once, posted by aabag on May 17, 2006, at 12:25:55
Don't worry, I wasn't insinuating anything about you or anyone else in particular. There are so many on Emsam now I can't keep track of who's having good reactions and who's having bad reactions. I'm just very cynical about drug companies in general and the Emsam manufacturer in particular because of its ridiculous price. To charge that much-I mean it wasn't even a new drug, just an old one in a new format. So it isn't that I have suspicions about anyone here, just that I wouldn't put it past the drug company to use tactics like that. That would be mild compared to some of the other tactics I've read about them using, like some of the tactics
they used to get doctors to prescribe Neurontin off-label, or all the tweaking and renaming all the companies do when their patents are about to expire. Cecilia
Posted by lymom3 on May 18, 2006, at 6:30:49
In reply to Re: Emsam: aabag, posted by cecilia on May 18, 2006, at 3:23:26
I am having a good reaction to Emsam but I'm with you on drug costs. My son takes Focalin XR for his ADHD. He started on it when it was fairly new and the first month I had to pay for the prescription until I could get the insurance company to cover it. It was over $400. At least that was a "new" drug. Not totally new, just a refined version of an "old" drug but ridiculous to me.
Posted by ttee on May 18, 2006, at 9:03:01
In reply to Re: Emsam: aabag, posted by lymom3 on May 18, 2006, at 6:30:49
I was just teasing. Drug costs are a big problem and there does not seem to be any quick fixes. The FDA made Emsam jump through a million hoops before they gave it the low dose approval and that cost an extra 4 years and who knows how many millions of dollars. The more trouble the drug company has with the FDA, the more they have to charge for the end product to recover their costs. Last time I checked, the drug companies are in the business of making money and if we take that away from them, there won't be any new meds discovered. Since Emsam is never going to be a 1st or 2nd line med choice, it is never going to make big bucks for the drug company. For the majority with its only FDA approved indication of Depression, Emsam is going to be reserved for those that have already spent thousands on other "safer" meds first. If the FDA had approved Emsam 5 years ago, I would guess the cost would be the same as any other new AD. No matter how well Emsam works, it will never be a billion dollar seller like the other AD are, or were before they went generic. Emsam will never be a blockbuster for any of the drug companies involved. The target market for Emsam is too small being the minority of us that have failed every other possible med there is. In this day and age that it only makes economic sense for the drug companies to develop blockbuster meds, I feel lucky that Emsam got through the drug company’s bean counters objections.
A company called Neurocrine just lost 75% of it's market value on Tuesday, when the FDA said it didn't have time to review the new drug application and didn't approve Indoplin. Neurocrine is working on 3 other new meds for depression. This FDA decision is going to hurt all the drug companies working on new meds and we will end up footing the bill for these added costs. In my opinion, the FDA needs to be totally reorganized.
Posted by aabag on May 18, 2006, at 13:41:27
In reply to Re: Emsam: aabag, posted by cecilia on May 18, 2006, at 3:23:26
Anyway, another thing I noticed about EMSAM is that exercise increases its benefits. So just going for a run in the afternoon, which I've been more inclined to do anyway, seems to help. That, and making sure to get enough sleep. So I guess that's a pretty old prescription, sleep and exercise, but in combination w/ an MAO-inhibitor, it seems more pronounced.
Posted by Iansf on May 19, 2006, at 16:52:06
In reply to Re: Emsam: aabag, posted by ttee on May 18, 2006, at 9:03:01
> Since Emsam is never going to be a 1st or 2nd line med choice, it is never going to make big bucks for the drug company. For the majority with its only FDA approved indication of Depression, Emsam is going to be reserved for those that have already spent thousands on other "safer" meds first.>
From the initial responses I've read about, I think Emsam WOULD have the potential to become a 1st or 2nd choice. Both the side effect and success profiles appear to be much better than with most antidepressants. But the high cost is going to make it all but impossible for Emsam to gain widespread use. It looks to me more like a case of a drug company finding a way to make a lot of money off a new product while making sure it doesn't cut deeply into the sales of its existing products.
Posted by ttee on May 20, 2006, at 12:06:44
In reply to Re: Emsam: aabag » ttee, posted by Iansf on May 19, 2006, at 16:52:06
First, BMS makes NO other competing anti-depressants to worry about. BMS is not going to give a crap about dipping into Lexapro sales; in fact they would like that to happen. Paxil, Zoloft, and Celexa are already off patent. Effexor will follow the end of the year.
Emsam still has the same drug/drug interactions that are the main reason most PCP's and pdocs were scared to prescribe Nardil or Parnate in the first place. Nardil and Parnate combined only represented 0.01% of all anti-depressants prescribed. In that over 80% of all anti-depressants are prescribed by PCP, not psychiatrists, for a drug to become a blockbuster it needs to have full support from the majority of the PCP's. PCP's are scared to death of the liability to prescribe any MAOI's. That will not change until Emsam has been out for over 7 years and there have been no deaths from drug or dietary problems. Even BMS in the financial statements estimates peak Emsam sales to be around $200 million per year. Compare that to Effexor that makes over 3 Billion per year. Since the average new drug takes $800 million to get FDA approval, it is going to take many years of only making $200 million per year for BMS to breakeven on Emsam. If they can get EMSAM approved for other indications like ADHD, Anxiety, Dementia, etc. then it might become more then a minor footnote in the annual financial statements for the drug company.
As far as knowing how well Emsam works, I doubt the 5 or 8 people on the site represent a scientific study as to efficiency. In addition, I think it is about even as to those that are finding it helpful and those that are discontinuing Emsam early because they were going out of the mind.
Amphetamines have a similar fast response and low side effect profile as Emsam. But I don't think amphetamines are the long term answer for many.
I would be worried about a doctor that treats a first time depressed patient with Emsam before seeing if and SSRI (generic) or SNRI might do the trick without the fuss of potentially fatal drug/drug interactions with something as simple as getting Novocain at the dentist's office.
Time will tell and I think Emsam is a great alternative to the older MAOI's for a certain subtype of depressed patients. The more different treatments there are, the better the chances people have to get a response.
Good luck all your Emsam'ers!!
Posted by Enigma on May 21, 2006, at 0:25:30
In reply to Re: Emsam: aabag, posted by aabag on May 18, 2006, at 13:41:27
> Anyway, another thing I noticed about EMSAM is that exercise increases its benefits. So just going for a run in the afternoon, which I've been more inclined to do anyway, seems to help. That, and making sure to get enough sleep. So I guess that's a pretty old prescription, sleep and exercise, but in combination w/ an MAO-inhibitor, it seems more pronounced.
Man, I wish I could do that. Exercise that is. To depressed, un-energetic, and non-motivated to even begin. Even something like walking. Sad.
Got my new 12mg/24 patch, and it's *bigger* than then 6mg patch... maybe by about 50-75%.. I didn't measure it yet.
I'm getting skin reactions to wherever I put the patch, and I'm running out of new places to put the patch (new being a place where it won't come off by muscles flexing, etc, and where there is no hair.. I guess I could shave part of my quads and put the patches there.. dunno.. I've had rashes for days now and they are healing very very slowly.
Mood still aint great, and I'm still exhausted (actually got worse again for seemingly no reason). Needed to take naps two days in a row, or fall asleep on the floor.
This is hell. I can't accept another AD failure. There's almost nothing left to try.
Maybe I'll be lucky next time I'm out, and a plane will land on me and put me outta my misery.
Posted by aabag on May 21, 2006, at 13:29:45
In reply to Re: Emsam: aabag, posted by Enigma on May 21, 2006, at 0:25:30
Maybe you can remove the patch in the shower and replace it thereafter? Do you have rashes if you put on a band-aid, i.e. is it a skin thing? I haven't noticed any rashes, other than some slight redness that goes away after certainly less than a day. I generally put the patches on my quads because I just don't notice them there, whereas on my back, the muscles/skin tend to move around and therefore wrinkle up the putch somewhat. As for shaving your quads, bikers do it :)
Did any other anti-depressants help you? reason I ask is that they didn't help me, whereas a benzo did, some I'm curious if you fit that profile. As for exhaustion, do you attribute that to lack of restorative sleep?
Posted by SFY on May 21, 2006, at 16:52:37
In reply to Re: Emsam: aabag, posted by ttee on May 20, 2006, at 12:06:44
> Even BMS in the financial statements estimates peak Emsam sales to be around $200 million per year. Compare that to Effexor that makes over 3 Billion per year. Since the average new drug takes $800 million to get FDA approval, it is going to take many years of only making $200 million per year for BMS to breakeven on Emsam.
Ignoring the fact that the $800 million stat has very little basis in reality (It arose from one study almost 20 years ago that has been adjusted for inflation ever since), Emsam isn't an average new drug by any means.
The bulk of the figure cited includes the money spent on drugs that didn't make it through the development process. Emsam, being based on the already developed selegiline, isn't one of these drugs.
Somerset didn't have to put any money into actual drug discovery and development. Selegiline was already out there for the taking. While not a small task, all that needed to be done was to develop a transdermal delivery system for selegiline and then test its efficacy and side effect profile.
Posted by ttee on May 22, 2006, at 16:53:03
In reply to Re: Emsam: aabag, posted by SFY on May 21, 2006, at 16:52:37
I admit I am not privy to what Somerset paid to get EmSam approved, but I know it took much longer than anyone anticipated and whenever that happens the expenses go way up. The clinical trials are the most expensive part and EmSam had plenty of those, plus the tyramine studies, plus a FDA non approval, then a FDA advisory committee meeting. That all costs lots of $$$$. I still think the reason Emsam costs more than other new AD's is because it is a nitche med for those that have tried everything else prior. There may be 12 million American's with depression, but there is a much smaller amount of the 12 million that don't respond to conventional AD's. Since Emsam sales will never be on the volume of Effexor, they have to charge more for the EmSam they can sell. In this day and age when the drug companies only want blockbuster meds, I still feel lucky that EmSam made it. If Emsam worked for me after all the cheaper meds had failed, it would be worth every penny they charged me.
Posted by Iansf on May 24, 2006, at 0:39:00
In reply to Re: Emsam: aabag, posted by ttee on May 22, 2006, at 16:53:03
<If Emsam worked for me after all the cheaper meds had failed, it would be worth every penny they charged me. >
To the tune of more than $5,000 a year?
Many people who suffer from long-term depression earn below-average incomes and can in no way afford to pay this kind of price.
Meanwhile the CEO of BristolMyers Squibb squeezes out a meager livelihood of $40 million a year.
Posted by ttee on May 24, 2006, at 9:30:21
In reply to Re: Emsam: aabag, posted by Iansf on May 24, 2006, at 0:39:00
Some people with TRD can not longer work at all. I had to give up a great job because of it over 3 years ago and am on disability and at the tax payers expense now. One trip to the hospital runs Medicare around 50K. I would gladly pay $5000 a year to be able to work again. If I was able to work, I would have health insurance and it would pay for my Emsam and no more hospital stays. As it is now, I pay no taxes and have much higher than $5000 a year an expense because of it. My lost productivity, income loss, and medical costs are over $10,000 per month. The average annual medical costs for someone with TRD that is disabled is over $80 K per year. All newer meds are expensive. If you’re taking Zyprex and Effexor that will run you more than the cost of Emsam, not including the costs you might get of Diabetes, TD, and a long hospitalization when you eventually taper off of Effexor.
Those who have the lowest incomes are offered free meds from the drug companies. BMS has a program for FREE Emsam for those that a doctor feels could benefit.
Is Emsam going to be the first of second med to use for the majority, I think not. The price and the risk of drug drug reactions are too great. This is the reason why Emsam costs more, because it will never have the sales volume compared to the other AD's (many now generic) and do help a good percentage of those that take them.
Most cancer infusion meds cost over $10,000 a week. Emsam is a bargain compared to those.
I all comes down to volume. If BMS could sell the volume of patches equal to the volume of Lexapro prescriptions, then the price would be similar.
I really don't think the pay of the CEO of BMS is unique in corporate America. I think you will find the same problem in all industries including the necessities of oil, electric power, banks, health insurance, and hospitals.
> <If Emsam worked for me after all the cheaper meds had failed, it would be worth every penny they charged me. >
>
> To the tune of more than $5,000 a year?
> Many people who suffer from long-term depression earn below-average incomes and can in no way afford to pay this kind of price.
> Meanwhile the CEO of BristolMyers Squibb squeezes out a meager livelihood of $40 million a year.
>
>
Posted by Enigma on May 24, 2006, at 10:40:39
In reply to Re: Emsam: aabag, posted by aabag on May 21, 2006, at 13:29:45
> Maybe you can remove the patch in the shower and replace it thereafter? Do you have rashes if you put on a band-aid, i.e. is it a skin thing? I haven't noticed any rashes, other than some slight redness that goes away after certainly less than a day. I generally put the patches on my quads because I just don't notice them there, whereas on my back, the muscles/skin tend to move around and therefore wrinkle up the putch somewhat. As for shaving your quads, bikers do it :)
>
> Did any other anti-depressants help you? reason I ask is that they didn't help me, whereas a benzo did, some I'm curious if you fit that profile. As for exhaustion, do you attribute that to lack of restorative sleep?
>In the Emsam documentation, they did mention some percentage of people in the study had "application site reactions". I'm one of those people too now.
No, I don't have any other skin problems, such as rashes from bandaids, medical tape, or anything like that. No excema??, dry skin, etc.
The patches, in just 1 day, are leaving being rashes that take many days to go away. I'm not even sure what to put on them... tried diaper rash (seems to help)...But, I can't put the patch in the same place again for days, or the rash gets really bad so I'm running out of places to put the patch.
Since the 12mg/24h patch is a good amount larger than the 6mg patch, it makes things worse. For now, I'm stuck shaving my quads. :(
It's been 1 month at the 6mg dose, and 1 week+, at the highest dose. I only feel marginally better (which may have nothing to do with the drug), but my mood seems to fluctuate more now, during the same day. I'm even getting angry and irritable again, which was a big problem for me many years ago only.
The fatigue is unbearable, but it's like my mood, and changes during the day, coming and going. I had to take a nap 3-4 days in a row now, when it gets really bad, I could litterally fall down if I didn't run to bed. It's overpowering, like someone slipped some powerful narcotic in my drink.
I'm at a loss.. and no, no other drugs besides nardil have helped my depression. Some made it worse, many game me horrible side-effects.
Nardil is hard to tolerate too, side-effect-wise so I don't want to restart that. It also helped only.. didn't make me 'normal' by any means.I'm not sure if I'm getting poor/non-restorative sleep. I had two sleep studies years ago, and they were unable to determine anything, although they said the results were not 100% normal. That's all I remember.
Posted by merry_dove on May 25, 2006, at 19:29:57
In reply to EMSAM - 3 weeks - 6mg/24h dose -not working for me, posted by Enigma on May 11, 2006, at 12:50:56
I read your post with interest as I have been debating whether to take the risk of switching to Emsam. Your problems sound very similar to mine. Atypical depression, possible partial OCD, no hypo-mania, though I begin having more severe anxiety in the last few years including social anxiety. I have also had severe fatigue, racing bad thoughts at bedtime, deep depression. Each SSRI I have taken worked for awhile but eventually poops out. When I say "worked" I mean it enabled me to function a little bit. On SSRI's I have experienced weight gain, cognitive problems, memory loss, and a complete loss of motivation. Maybe I am asking too much but I just want to feel normal. I am tired of struggling to get by every single day, trying to appear normal to everyone around me for the sake of my family. That's why I was considering Emsam. My current medicines are Cymbalta, Buspar, Ritalin (to help with energy), and Serax (before bed to sleep). (It's strange - I have no trouble taking a 2 hour nap in the morning or afternoon but can't go to sleep at bedtime.) I have been diagnosed with Chronic Fatigue Syndrome and Fibromyalgia - whether I truly have them or just the symptoms - since there are no conclusive tests.
In addition to the medication above, I also take 1 to 1 1/2 Vicodin pills a day. This is what really allows me to function at all. I discovered the marked effect it had on my depression when I was prescribed it for back pain a couple years ago. My primary dr. prescribed it and my psychiatrist is aware that I take it and of the benefits. The most I ever increase the dosage is by 1/2 pill a day because I don't want to chance addiction or tolerance. My psychiatrist told me it was perfectly find to take it at the current dosage as long as it benefited me - BUT he won't prescribe it. ???? I worry there may come a day when my primary dr. won't prescribe it - and that would be the end of my ability to function. So, I was wanting to try Emsam for that reason as well. Maybe I could actually feel "good" rather than just "ok". Maybe I could socialize again, cook meals, have a clean house for a change, and run more than 1 errand at a time.
It sounds like you are at the lowest point a person can get and I feel bad for you. I know how it is to be there. Maybe there's hope for Emsam yet. If not, maybe you could talk to your doctor about a low dosage of vicodin. Just thought I'd share.
Posted by ttee on May 26, 2006, at 17:36:12
In reply to Re: EMSAM - 3 weeks - 6mg/24h dose -not working for me, posted by merry_dove on May 25, 2006, at 19:29:57
Enigma - I have empathy for where you are right now. Been there done that. Emsam might help but are you prepared to give up most all your other meds to do it? I don't think you can take anything but the Serex with EmSam.
Posted by laima on July 22, 2006, at 10:19:22
In reply to Re: Emsam: aabag, posted by Iansf on May 24, 2006, at 0:39:00
Let's all hope that a merciful generic comes out sooner than later.
> <If Emsam worked for me after all the cheaper meds had failed, it would be worth every penny they charged me. >
>
> To the tune of more than $5,000 a year?
> Many people who suffer from long-term depression earn below-average incomes and can in no way afford to pay this kind of price.
> Meanwhile the CEO of BristolMyers Squibb squeezes out a meager livelihood of $40 million a year.
>
>
Posted by laima on July 22, 2006, at 10:22:28
In reply to Re: Emsam: aabag, posted by ttee on May 24, 2006, at 9:30:21
That's a promising possibility! My doctor has loads of sample boxes containing 5 patches in each for example. And the company apears to be eager for all and any feedback from users--maybe something could be worked out!> Those who have the lowest incomes are offered free meds from the drug companies. BMS has a program for FREE Emsam for those that a doctor feels could benefit.
Posted by laima on July 22, 2006, at 11:06:28
In reply to EMSAM - 3 weeks - 6mg/24h dose -not working for me, posted by Enigma on May 11, 2006, at 12:50:56
Dear Enigma,I just learned some new stuff about EMSAM, just as I was giving up entirely on it and basically everything else, from my doctor, a psychiatrist/psychopharmacologist/researcher, who just returned from a special EMSAM conference, attended by psychiatrists, researchers, and reps from the drug company. Some of the news he relayed back gave me fresh sparks of real hope, and I'd like to share some of it in hopes you too might feel encouraged by any of the information. They do say MAOIS are ususually most effective treatment foor atypical depression.
I'd like to add that before EMSAM, I tried (with lackluster success) selegeline pills, and before that, stimulants. The stimulants were effective!!! And fast acting!! 1/2 hour to relief from hell! The only one I was able to tolerate was ritalin. I also tried dexedrine, which was a miracle at first, but something odd happened with it, I freaked out, and I won't touch it or the others ever again. But at the higher doses, I could see I behaved a tad strangely at times even with the ritalin, and it turned into a upper/downer regimine. I also ended up more anxious, and the anti-depressent effects of the ritalin waned, though the stimulant effects remain intact.
The 6/24 did nothing for me either, and I'm moving to the 9. Just waiting for it to arrive at the pharmacy.
Most confusingly, the 9 is said to be roughly equivalent to 60-90mg of the oral selegeline- stunning news and as I re-read my package insert- I still just don't comprehend. I am told more efficient metabolism plays a factor--but even so, why do they label as they do??? In any case, perhaps that is why they warn about using two patches at once- sounds like potential for unintential super-HIGH dose. Also, the 9 is said to be far more potent than the 6- but I didn't quite get the details. Is it plausable that a 6 plus half of a 6 is NOT a 9? Didn't ask, don't know, but I am starting to wonder-especially since it is so expensive and i do have 6's left. The 9 will require far more dietary caution- but I was told that a minor goof won't be quite as dangerous as it could be with the oral version. Furthermore, interestingly, the patches, even the higher patches with full restrictions and warnings, are believed by the conference attendees to be superior to the pills because by going straight to the bloodstream and bypassing the digestive system, they are acting via "a more efficient delivery system and are better able to enter the brain".My doctor reports that there seemed to be a consensus at this conference that few patients get much relief from the 6--the dose highly tauted as being nearly restriction free! It's apparently just not turning out to be potent enough to be an effective anti-depressent for most of us. I heard that one doctor stood up and said he has treated successfully about 150 patients already using the 9 and the 12- but rarely bothers with the 6. Could the 6 have been a marketing, attention getting ploy that raised our hopes?
There was an acknowlegment even by the company that insomnia is a huge problem for lots of people using EMSAM.
One other thought- I was told that for some people ssris can disrupt and/or diminish "deep sleep" by being "too activating", causing daytime fatigue. Sure enough, once I quit ssris for good, my sleep finally started to turn around.Finally- I agree with Phillippa- your fatigue sounds frustratingly mysterious, particularly since it began before you started EMSAM in the first place. I am told that EMSAM can for some people lower blood pressure, which can manifest as blah fatique- perhaps in your case, as in mine, even more fatigue. The higher the EMSAM dose, the lower the blood pressure can supposedly go. Though MAOI plus stimulant is a classic no-no, I have been prescribed a very, very low dose of ritalin (5mg 2x daily) to raise my already low blood pressure a teeny tad, and I feel WAY better as a result. My doctor said this practice is gaining in popularity, even though it still freaks most pharmacists out. I am required, however, to keep a blood pressure reader (it was about 50$) and keep an eye on it every day or so.
I guess my post was long. Sorry. I'm still so excited by all this news I just heard from a source that sounds to be the ultimate in credible. I'm starting to feel optimistic again.
In short, I hope you manage to hold on, and I hope that the higher dose of the EMSAM proves helpful and brings relief.
Best Wishes,
Respectfully,
Laima.
> Quick bio
>
> Age: 37
> Height: 5'9"
> Weight: 170 (target for me is 165)
> Sex: hopefully (just kidding, Male)
> Occupation: software engineer on disability
> Family: Married, 3 kids
> Diagnosis: Severe atypical, treatment-resistant depression, some hypo-mania, possible partial OCD
> Treatments: Tried most SSRI's, Nardil+Parnate, ECT (10 treatments), other psychotropics, with little to no success - mostly I just suffer from intense side-effects from meds and get no beneficial effect. (Nardil did help the depression though)
> Also tried vitamins/minerals, fish oil, noni juice, and others to no avail.
>
> Current Status:
>
> Finished 3 weeks of the 6mg/24h dose (still taking it). Been suffering from intense dibillitating fatigue for the same length of time (severe fatigue seemed to start 2 days before starting Emsam)
>
> Anti-depressant effects obtained: Seem to have increased sense of humor (humor is 'normal' for me) and sex drive
>
> Continuing problems:
>
> Still very depressed. Having suicidal ideation, a great deal. At least 1-2 times each day, I'm so depressed that it's almost unbearable. I feel like knocking myself out with a mallet so I don't have to "feel" anymore, at least until I wake up.
>
> "bed time" for me consists of manic type racing thoughts of every kind... Hopelessness, violence, fantasy, worry, stress, etc - most to all, unwanted.
>
> I could easily lie in bed for 2 hours a night with my head spinning like this before falling asleep, just to wake up again in 20 mins for more thought racing.
>
> Lunesta 3mg seems to be working great to stop the racing mind and get me to sleep. Klonpin 1mg seems to help too, but Lunesta works better for me.
>
> I unfortunately need 11-12 hours a sleep a night, and still wake up exhausted. I might sleep more due to the fact I don't like being awake, and hence, depressed, so I hide in "dream land" as long as I can.
>
> During the day, I'm generally exhausted, and can't get much done around the house. All house projects are on hold and have been for a long time.
>
> Also, for some reason, even the slightest activity (like vacuuming a room) will cause me to sweat and need to go back to couch potato mode. Even a hot coffee or medium hot shower will cause me to sweat and keep sweating.
>
> The sweating problem started with Wellbutrin and a couple other meds, but for some reason stayed with me, AND, got WORSE after dicontinuing those meds (beed off them for 1 year). This is very annoying to say the least. Not sure how I'm going to handle the summer, and sadly, I used to be very heat tolerant.
>
> I go back to the doc in 2 weeks (I might move it up a week) and -try- to get the 12mg/24h dose (skipping over the 9mg/24h) dose. Tyramine restrictions do exist at these doses, but I could care less about that.
>
> Oh yeah, on alcohol consumption. I force (seriously) myself to go out once every 1-2 weeks to hang and drink with ex-coworkers, aka "friends" .
> I found drinking to be very difficult on Emsam. I can usually have a 4-6 drink during a night and be fine the next day. On Emsam, I usually get nausea (and other hangover symptoms) a few hours after starting to drink, lasting another 12+ hours, with headaches, etc. So, it's really NOT worth it.
>
> In other words, very bad hangovers. So, I'm going to try and quit drinking alcohol when I go out even though the few hours of drunkeness is a welcome (and needed) break from the depression.
>
> Anyway, that's my update. I might have missed something here and there (like the daily headaches I get), but I hope this info helped someone.
>
> Take care,
>
> -(Dark) Enigma
Posted by Enigma on July 22, 2006, at 23:16:07
In reply to Re: EMSAM - 3 weeks - 6mg/24h dose -not working for me » Enigma, posted by laima on July 22, 2006, at 11:06:28
I forget how long I tried it now, but I'd say 1 month on the lowest dose, and 2-3 on the highest. I think I quit part way into the 3rd month.
Now I have patches to sell ;)
Anyway, besides the severe insomnia, fatigue, and sweating/hot flashes/overheating from very little exertion(sp?), it was the rashes/application-site reactions that finally did me in.
As I said before, my doctor is a complete and utter moron. I'm am *convinced* she had to buy her degree illegally. There's just no way someone *this* inept could graduate with a Phd in psych.
Anyway, she had no idea what to do about the rashes, or any other of the side-effects. She wouldn't even bother to do any research on the matter. Talk about lazy, uncaring, inept, etc. Actually, I might go to the medical board about her and register a formal complaint. I have an appt. with a new doctor. Crossing my fingers..
Oh yeah, back to my story. So, I was ending up using my upper legs as targets for the patch, shaving them every few days. Each location that had a patch would become red, itchy, covered with bumps (becoming solid), etc. Both my quads were covered with these patch-sized rashes. Each took days just to return to normal.
Putting the patches anywhere else would have just spread the rasges to those locations and would just be too visible to others (like chest, arms, etc), and the patches were so big, they didn't stay on anywhere else anyway.
So, that was it for Emsam. I tried some anti-allergy stuff for the rashes and itching, but it made little difference. The allergist even gave me a script of something I forget the name of, but it's not something you can stay on long-term... so much for that, even though it was effective at removing the rashes faster than normal.
I went back on 45 mg of Nardil a day. Insomnia actually got worse, and so did the fatigue. I was quite litterally sleeping for 2 hours (waking up every 10-20 mins), getting so rest from it, and then getting up for 2-3 hours, then alternating back and forth like that for days. It was hell!
I cut back to 15 mg of Nardil in the morning. After a few days, the fatigue got better (not gone or even close), and I'm able to sleep longer, about 4-6 hours, but still restless and waking up every 20-40 mins.
Last night I tried a Seroquel pill, and I got the most sleep I have got in a while, BUT, was a zombie for the entire day, so no more of that for me.
Depression hasn't returned, yet, and we'll see what happens, but I assume it will return.
So, that's where I'm at now. Currently sweating my *ss off again, for absolutley no reason. Jeez.
Take care, and thanks for all your info. I actually to get ritalin from my "assclown", er, I mean 'doctor', but she denied me, assuming it wouldn't help. *sigh*...
Oh well, till next time.
Posted by laima on July 23, 2006, at 10:27:18
In reply to I'm all done with Emsam - read why... » laima, posted by Enigma on July 22, 2006, at 23:16:07
Sounds horrible! I once had a unbelievabley incompetent psychiatrist myself- I think she bought her degree at the same place yours did. I hope you are able to find someone better.Best wishes.
> I forget how long I tried it now, but I'd say 1 month on the lowest dose, and 2-3 on the highest. I think I quit part way into the 3rd month.
>
> Now I have patches to sell ;)
>
> Anyway, besides the severe insomnia, fatigue, and sweating/hot flashes/overheating from very little exertion(sp?), it was the rashes/application-site reactions that finally did me in.
>
> As I said before, my doctor is a complete and utter moron. I'm am *convinced* she had to buy her degree illegally. There's just no way someone *this* inept could graduate with a Phd in psych.
>
> Anyway, she had no idea what to do about the rashes, or any other of the side-effects. She wouldn't even bother to do any research on the matter. Talk about lazy, uncaring, inept, etc. Actually, I might go to the medical board about her and register a formal complaint. I have an appt. with a new doctor. Crossing my fingers..
>
> Oh yeah, back to my story. So, I was ending up using my upper legs as targets for the patch, shaving them every few days. Each location that had a patch would become red, itchy, covered with bumps (becoming solid), etc. Both my quads were covered with these patch-sized rashes. Each took days just to return to normal.
>
> Putting the patches anywhere else would have just spread the rasges to those locations and would just be too visible to others (like chest, arms, etc), and the patches were so big, they didn't stay on anywhere else anyway.
>
> So, that was it for Emsam. I tried some anti-allergy stuff for the rashes and itching, but it made little difference. The allergist even gave me a script of something I forget the name of, but it's not something you can stay on long-term... so much for that, even though it was effective at removing the rashes faster than normal.
>
> I went back on 45 mg of Nardil a day. Insomnia actually got worse, and so did the fatigue. I was quite litterally sleeping for 2 hours (waking up every 10-20 mins), getting so rest from it, and then getting up for 2-3 hours, then alternating back and forth like that for days. It was hell!
>
> I cut back to 15 mg of Nardil in the morning. After a few days, the fatigue got better (not gone or even close), and I'm able to sleep longer, about 4-6 hours, but still restless and waking up every 20-40 mins.
>
> Last night I tried a Seroquel pill, and I got the most sleep I have got in a while, BUT, was a zombie for the entire day, so no more of that for me.
>
> Depression hasn't returned, yet, and we'll see what happens, but I assume it will return.
>
> So, that's where I'm at now. Currently sweating my *ss off again, for absolutley no reason. Jeez.
>
> Take care, and thanks for all your info. I actually to get ritalin from my "assclown", er, I mean 'doctor', but she denied me, assuming it wouldn't help. *sigh*...
>
> Oh well, till next time.
Posted by jedi on July 28, 2006, at 4:02:01
In reply to I'm all done with Emsam - read why... » laima, posted by Enigma on July 22, 2006, at 23:16:07
...
> I went back on 45 mg of Nardil a day. Insomnia actually got worse, and so did the fatigue. I was quite litterally sleeping for 2 hours (waking up every 10-20 mins), getting so rest from it, and then getting up for 2-3 hours, then alternating back and forth like that for days. It was hell!
>
> I cut back to 15 mg of Nardil in the morning. After a few days, the fatigue got better (not gone or even close), and I'm able to sleep longer, about 4-6 hours, but still restless and waking up every 20-40 mins.
...Hi Enigma,
Since your depression has yet to return, try working up your dosage of Nardil slowly over several weeks or months. I've been on and off Nardil about four times in the past ten years. Each time I went off of it my major atypical depression eventually returned. The last time I went back on the medication, I titrated up to 90mg way to fast. This caused the type of insomnia for me that you describe. I've been on Nardil for several months again now, and the insomnia has subsided. The residual insomnia is controlled with diphenhydramine hydrochloride(Benadryl). This works for me, obviously it will not work for everybody. I am still getting some daytime sleepiness with the Nardil. I would like to add some modafinil(Provigil) to counteract this, but my MD is not ready for that step yet.
Good Luck,
Jedi
Posted by gardenergirl on July 28, 2006, at 10:15:48
In reply to Emsam - to Nardil » Enigma, posted by jedi on July 28, 2006, at 4:02:01
> ...
> > I went back on 45 mg of Nardil a day. Insomnia actually got worse, and so did the fatigue. I was quite litterally sleeping for 2 hours (waking up every 10-20 mins), getting so rest from it, and then getting up for 2-3 hours, then alternating back and forth like that for days. It was hell!I had insomnia early in my Nardil experience, and at 75 mg it was unbearable and also included akathisia. I found that the early awakening eventually passed, although I still have sleep problems. I manage that with ambien.
And jedi, I've had my atypical depression return every time I try to lower my dose to 45 mg or less. That alone is depressing, but it does show me that Nardil really is helping still. And my pdoc has agreed to Provigil for me. It takes away the late afternoon naps I used to crave all the time. And I've had no ill effects from combining the two (along with Lamictal for any residual depression) except if I get too much caffeine.
gg
Posted by Enigma on July 28, 2006, at 16:23:25
In reply to Emsam - to Nardil » Enigma, posted by jedi on July 28, 2006, at 4:02:01
Well, I spoke too soon as the depression returned. I went back to 2 Nardil (30mg) a day. I'm sure my insomnia and fatigue will return (not that it ever went away 100%).
The insane sweating I get from doing next to nothing (I'm 5'9", athletic "look" (anyway), and only 160 pounds - male), so I know this is a side-effect. I used to be able to tolerate heat like crazy, now I'm a mess from just doing a small chore. If I had the energy to work out, this sweating/overheating may even be dangerous for me.
Wow, it's pouring out, thunder, lightning, I should shut off my pc... Anyway, I went to bed at, get this, 6 am last night (morning). Slept till 3 pm today. What a mess.
I guess I'll take this over the depression though, as with just adding another pill, it pushed back the depression again. For how long, I don't know.
I've never even come close to taking 90mg a day. I would get severe side effects from just 60. I used to take 3 (45mg) for my normal dose, which I could tolerate for a few months before I couldn't stand the side-effects anymore.
At 60mg I would get severe:
Insomnia
Daytime Fatigue
Sweating/hot flashes/overheating
Dizzy/lightheadedness
Restless sleep
Vivid dreams (some just too vivid for my tastes)Maybe others I can't remember.
Weeeeeee!
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