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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 38. Go back in thread:
Posted by aabag on May 20, 2006, at 23:08:33
In reply to Is EMSAM Not The Med People Thought It Was?, posted by Phillipa on May 20, 2006, at 12:07:58
Is EMSAM the end all be all? No, it cannot be, due to genetic and environmental variability. Is there an a-priori test to determine which compounds or compounds will prove effective anti-depressants for you? Not yet.
I'm closing in our 4 weeks with the 6mg/20cm2 patch and I can say I did believe EMSAM would "work", but couldn't know. I believed this having trialed the combination of DLPA and some oral selegiline to occasional and short-lived success. I realize there are those to which EMSAM was intolerable. To me, Effexor XR was intolerable. Yet, its a multi-billion dollar med. I imagine I might find Haldol intolerable. I don't know, its doesn't match my dx.
As to whether I'm noticing more side effects, the answer is no, I am not. Friends/family have noticed and remarked on my overall increased happiness and less "shrinking-violet", disinterested attitude. And I agree. I wish you all the best, as I empathize with the tormentingly long wait.
Posted by Glydin on May 21, 2006, at 7:02:10
In reply to Re: » Glydin, posted by Phillipa on May 20, 2006, at 21:52:47
> Glydin that's what I knew you'd say. But how come everyone likes klonopin?
~~~ I don't think everyone does.
Again, I think it's a question of what's a good fit. The reference to Klonopin was just used as my personal example of the power and impact of influence. I was just using my K start as an example of how I was doing pretty well on a med until I began second guessing it by being influenced by outside sources. For me, using head meds in general was something I did NOT WANT to do. Finding negative info just fueled my thoughts of how awful they could be. It was an example of how when I looked for something - I found it and could easily discard the positive actual personal results I was getting.
NO med is suited, tolerated, and the best choice for everyone.
Posted by Glydin on May 21, 2006, at 7:21:02
In reply to Re: » Phillipa, posted by Glydin on May 21, 2006, at 7:02:10
Just to add...
It was helpful for me to explore some of the reasons I thought I was med phobic. Sometimes we think we have the obvious answer but for me there were alot of deep rooted reasons, fears concerns, etc.. once uncovered and admitted to myself, helped me. The process gave me alot of insight about myself. I needed to see the forest for the trees, so to speak.
Posted by bulldog2 on May 21, 2006, at 12:31:22
In reply to Is EMSAM Not The Med People Thought It Was?, posted by Phillipa on May 20, 2006, at 12:07:58
I don't think emsam was ever marketed to be the drug of all drugs. It was marketed as another alternative to try when an maoi is indicated for atypical depression. The big selling point was no dietary restrictions at lower doses.
I think it will be more effective for mdd than for anxiety. Selegiline always had a rep of being energizing but many experienced an increase of anxiety on it. I think if one has anxiety a benzo should be used on it. I like klonopin at about 1.5 to 2 milligrams a day. If I find that I would start to need more and more klonopin for anxiety I would stop the emsam.
Personally I don't think it will as effective as nardil or parnate for mdd and social phobia. But those have dietary restrictions and nardil causes weight gain and sexual problems. That's why I chose to try emsam first. But again if one has anxiety a benzo should probably be used with it.
Posted by Phillipa on May 21, 2006, at 13:06:35
In reply to A bit more on med phobia - phillipa, posted by Glydin on May 21, 2006, at 7:21:02
Glydin I know why I'm med phobic cortisone killed my mother in the 60's before they knew what the drug would do she used it for psoriasis a skin condition and she died when I was l7. Love Phillipa
Posted by Glydin on May 21, 2006, at 17:41:05
In reply to Re: Glydin » Glydin, posted by Phillipa on May 21, 2006, at 13:06:35
Are med phobic about all meds?Sometimes the obvious answers we have are just the tip of the iceberg.
I have deep rooted reasons for my fears with psych meds specifically and mine have to do with a traumatic death also but I found out it wasn't the whole story for me.
Posted by Bonnie_CA on May 22, 2006, at 18:07:32
In reply to Re: Glydin » Glydin, posted by Phillipa on May 21, 2006, at 13:06:35
I wasn't the biggest fan of klonopin, it caused me to get very depressed. However, I was taking it because the celexa wasn't working as well anymore. I was thinking about taking it again now that I'm on prozac because it makes me a bit anxious when it peaks in my bloodstream. it didn't make me feel bad otherwise, just depression. Nothing wrong with the xanax, but I've got this klonopin that I could be using. sorry I don't have any input on emsam, as I haven't been on an MAOI.
Posted by darcan on May 28, 2006, at 8:36:31
In reply to Is EMSAM Not The Med People Thought It Was?, posted by Phillipa on May 20, 2006, at 12:07:58
> At first people were saying EMSAM was the med of all meds. Not people seem to be getting side effects worse than their original symptoms. Would you say EMSAM is not living up to what you thought it would be in the earlier weeks. And is it better for anxiety or depression or the combo of both. Thanks Phillipa
I've been searching for an anti-depressant that works for me for nearly 6 years. My doc had suggested MAOI's for nearly 3 years as a possiblity having exhausted virtually all other meds with no success. I had resisted the MAOI's due to the dietary restrictions and quite frankly the dietary instructions available from the two universities where my doc's worked. The lists of restricted foods were just too ambiguous and the risks great. EMSAM promised a way to try the MAOI's while minimizing the risk.
No one ever said it was a wonder drug, and has a published efficacy of 40% (it has helped only 40% of patients trying it). This is actually a bit better than the SSRI's and SSNRI's with a 30% success rate.
I'm on day 15 and it is not working thus far. In fact I am suffering from some of the worse depression and anxiety that I have in 5 years. As with all of these meds you have to give it 4 to 6 weeks so I'm haning in there.
It is not looking good at this time.
Posted by katie san diego on May 28, 2006, at 19:54:55
In reply to Re: Is EMSAM Not The Med People Thought It Was?, posted by darcan on May 28, 2006, at 8:36:31
i am also taking the emsam for major depression and am now almost done with week 4. like you, i think my anxiety and depression is actually worse than before i started the drug, but my doctor thinks we have to wait it out 5 - 6 weeks before moving on to a higher dose. is this normal? I wish i knew how to read all the emsam threads, but i cant figure out how to sort thru them all here.
a few days after i started, i had a super high energy day - everything seemed great. i wanted to maked plans - do 100 things. then major crash. has anyone else experienced this. my doc thinks this is a "good" sign - like the drug will have a positive effect for me if we just wait it out, but i cant help but believe that weeks of waiting is not a good sign. that feeling worse than before reminds me of other SSRIs where is had bad reactions had eventually had to stop (effexor, wellbutrin)
please, if anyone has anything to offer...
Posted by darcan on May 29, 2006, at 7:34:34
In reply to Re: Is EMSAM Not The Med People Thought It Was? » darcan, posted by katie san diego on May 28, 2006, at 19:54:55
<i am also taking the emsam for major depression and am now almost done with week 4. like you, i think my anxiety and depression is actually worse than before i started the drug, but my doctor thinks we have to wait it out 5 - 6 weeks before moving on to a higher dose. is this normal?
Who knows what normal is, but I've been told that it takes a full 6 weeks before knowing if any drug is effective. My doc had me get off my previous drug (Cymbalta) for three full weeks before starting EMSAM so I don't know if I am having a reaction to EMSAM or just a general lack of antidepressants in my system.
The doc told me that EMSAM actually alters the structure of the brain cells and that the life of a brain cell is 3 weeks therefore the waiting period.
Posted by katie san diego on May 29, 2006, at 10:09:27
In reply to Re: Is EMSAM Not The Med People Thought It Was?, posted by darcan on May 29, 2006, at 7:34:34
Well, i know for a fact that you dont have to wait 6 weeks to find out if any drug is fully effective. i felt so great on on prozac after only a few weeks. unfortunately, that was 13 years agao, and the prozac seems to have gradually stopped working for me.. increasing dosages gradually over the years and then finally nothing.. no effect at all.
i guess i was spoiled. i wish these doctors knew more about the emsam, or at least made more of an effort to find out how it is affecting the current users.
Posted by jetcity10 on May 30, 2006, at 0:07:42
In reply to Re: Is EMSAM Not The Med People Thought It Was?, posted by katie san diego on May 29, 2006, at 10:09:27
I am about a month and a half into EMSAM. The first few weeks were full of increased anxiety and a major increase in lethal suicidal thinking. Now the suicidal feelings have decreased some and overall I think this is the best response I have ever had to an AD.
Posted by Donna Louise on May 30, 2006, at 6:47:49
In reply to Re: Is EMSAM Not The Med People Thought It Was?, posted by jetcity10 on May 30, 2006, at 0:07:42
i am always guilty of getting my hopes too high in spite of numerous disappointing med trials. I so want to be "fixed". Realizing that I want perfection, I also realize that I will be disappointed because no med or anything else for that matter is going to make me perfect because no one is. And it is really a weird thing to want to be in the first place, who would want to be my friend then?? anyway, it is so awful to feel awful that I can't help but hope to never feel awful again and that is just not realistic. Even if a med is working perfectly so to speak, life isn't and biology is too complicated to expect that it could be held static at a point of bliss. That said, yes I am disappointed, who wouldn't be with my expectations. However, it is still the best med I have taken and I am really really grateful for it. I have for some time had to be polypharmic (is tht a word??) so I use klonopin also and may at some point need to add something like lamictal. That is ok, as I said, it is the best med yet. And as someone else said, (UgottaHaveHope maybe?) it is a big deal breakthrough. I'll take the good I get and be grateful for it. I do wish it would work for everyone but of course it won't but maybe this is the launching pad for the next one that can help a greater population of us sufferers.
Donna
Posted by darcan on May 30, 2006, at 9:48:28
In reply to Re: Is EMSAM Not The Med People Thought It Was?, posted by jetcity10 on May 30, 2006, at 0:07:42
> I am about a month and a half into EMSAM. The first few weeks were full of increased anxiety and a major increase in lethal suicidal thinking. Now the suicidal feelings have decreased some and overall I think this is the best response I have ever had to an AD.
Jetcity, thanks very much for posting your note. It is difficult to stay with a med after having been through so many. One never knows for sure what will work and the docs don't seem to have a clue either so any positive response is very encouraging indeed!
Posted by RobertDavid on May 30, 2006, at 10:01:26
In reply to Re: Is EMSAM Not The Med People Thought It Was?, posted by Donna Louise on May 30, 2006, at 6:47:49
It seems to me that EMSAM will be different things to different people. I suspect for some, particularly those with depression as a primary disorter (particularly those that have not responded well to SSRI's) it will be a good option to treat their depression and perhaps will do so without the need to blend in other medications.
Others like me with anxiety disorters will probably find it's best use as a blend with a benzo (klonopin in my case) to improve mood, energy and mild depression that seems to come along with anxiety disorters as well as helping those that get benzo side effects such as depression and mental fog. I have tried going down on klonopin to see if EMSAM alone may work alone to treat SAD and GAD, but after 3 weeks at a 25% reduction in klonopin dose I started feeling about 25% of my anxiety returning. So it's my believe that for me anyway, it's the blend of the two that's my answer and I'm back up to my full 2mg klonopin dose and feeling great again. Klonopin nails the social anxiety like nothing I've taken and EMSAM is the only med I have been able to tolerate to treat my depression and energy without a boat load of side effects. I suspect that others with SAD and GAD will come to simmilar conclusions, but certainly there will be some such such as those that take parnate for anxiety disorters that will not need to blend it with anything else.
My doctor said he felt that EMSAM will probably prove to be helpful for those that are bi-polar, but I don't deal with that and can't say. I suspect it will be part of a blend for bi-polar individuals that may include other meds including mood stabilizers such as lamictal as well as other effective meds that can be blended with MAOI's. Again, some bi-polar individuals will probably do well with EMSAM by itself some will find it useful as a blend.
So my take is that like other meds, it's not an end to all other medications, but seems to have it's place to improve the quality of life for many dealing with many different disorters. It gives all of us another option and will have it's place in a doctors arsinal of medications to treat many different disorters.
Lastly I'd say that for those that are med sensitive and want to go up slower I'd recommed discussing with your doctor to cut the patch in half at first, then going up from there. Based on my source for suggesting the patch can be cut, I'm comfortable with it and others my want to consider it as a place to start, or a place to go up from 20 to 30mgs before paying for a $400+ batch of 30mg patches. Also, I'd suggest that as long as side effects are tolerable, I'd stay with it at least 6 to 8 weeks before a total conclusion is made. Though some like me got quick responses, it seems there are others who were ready to throw in the towel started getting relief after a month.
Anyway, for me, the best "blend" yet. Just my take, no doctor here, just an EMSAM user sharing my thoughts. Rob
Posted by Last Chance on May 30, 2006, at 11:16:37
In reply to Re: Is EMSAM Not The Med People Thought It Was?, posted by RobertDavid on May 30, 2006, at 10:01:26
This will be my third day on the "Patch" - I cut in half, and so far I have had increased anxiety, but tolerable with the help of .5mg Xanax in the evening, and my usual .125mg Klonapin (have slowly been reducing from 1mg over the past year, always experiencing strong withdrawal symptoms 4 or 5 days after miniscule reduction).
Yesterday I experienced pretty strong gastro-intestinal distress, like the stomach flu - may or may not be a side effect. So I'm optimistic, though I can't say I have felt anything good, yet. I have a question. If the half life is only a couple hrs., and one removes the patch at night - well, I guess what I don't understand is, if you are not supposed to have full therapeudic response for 4 to 6 weeks, how does that happen if you remove every night. It seems like you would be starting over every day? Richard
Posted by jetcity10 on May 30, 2006, at 11:33:01
In reply to Re: Is EMSAM Not The Med People Thought It Was?, posted by Last Chance on May 30, 2006, at 11:16:37
I too am a EMSAM/Klonipin mix person (1.5mg for the Klonipin). I had been on the Klonipin for several years at the same dose because of anxiety and insomnia. I had given up on taking anything for the major depression and had been white-knuckling it for a long time, but with the Klonipin, at least I could guarantee 4-5 hours of sleep a night which made it "somewhat tolerable." The decision on the EMSAM was made when the depression was so bad that I was becoming immobilized and had decided that suicide was the only answer considering the mounting problems around me due to the immobilization.
I feel that the Klonopin helped knock off the edge of the increased anxiety and increased sleeplessness associated with the first few weeks of EMSAM. I have no intention of even touching the Klonopin for a long time. I have had some minor GI problems on EMSAM, but nothing that compares to the positive benefits. Mostly constipation, but nothing compared to what I experienced on other ADs, and some diarrhea. But, I also have a pretty sensitive GI system and it doesn't take much to tip me from one extreme to the other...
Posted by katie san diego on May 30, 2006, at 14:04:40
In reply to Re: Is EMSAM Not The Med People Thought It Was?, posted by jetcity10 on May 30, 2006, at 0:07:42
you had to stick it out a month to start feeling better. did your doc increase the dosage? what mg patch are you on?
Posted by jetcity10 on May 30, 2006, at 16:50:56
In reply to Re: Is EMSAM Not The Med People Thought It Was?, posted by katie san diego on May 30, 2006, at 14:04:40
I am still on the lowest dose. I saw my pdoc after 3 1/2 weeks, and due to the reluctance to consider possible dietary restrictions we decided to stay at the lowest dose for now. Through the years I have been forced to be patient and since I had mostly given up on ADs, I have been off of everything but the Klonipin for years and just struggled with the depression. Maybe that is what gave me the patience to wait it out. Like I have said, it was worth it. I have never had as noticible a difference. I still get suicidal, but it doesn't last as long and I am thinking much more rationally about it as well as the rest of my life. I would say my biggest problem right now is figuring out how to deal with feeling better. It has been longer than I can remember since I have felt even this good. It seems like a strange problem, but it has been a significant challenge thus far. Still worth it though.
Posted by alisseus on June 4, 2006, at 18:37:34
In reply to Re: Is EMSAM Not The Med People Thought It Was? » rvanson, posted by Maximus on May 20, 2006, at 22:31:14
> > In my experience, Aurorix (Mannerix)is a much better A/D med then Emsam, but the FDA will never approve it for use in the USA.
>
> Manerix has been approved here in Canada for about 8 or 9 years. I don't know much about USA politics, but a couple a friends have imported from USA Moclobemide without trouble. Manerix appears to be better tolerated than Selegiline.We have Arorix here in Australia too, but all i have read about it is that it is pretty useless. I have tried it myself and hated it. I have or am also using selegiline drops at a very small dosage along with celexa 20mg. I use the Celexa constantly and selegiline intermittently. Selegiline aka ensam has been amazingly effective for me. Ensam hasn't been released here in Oz yet, but I am very keen to try the ensam klonopin thing. I think the combo is the secret. I have never found any mono therapy that even looked like working for me.
>
>
>
Posted by pulse on June 5, 2006, at 17:26:22
In reply to Re: Is EMSAM Not The Med People Thought It Was?, posted by alisseus on June 4, 2006, at 18:37:34
i'm reposting this from another (advair + emsam) thread.
i had 4 short failed trials on emsam, primarily due to very bad - for me - GI side-effects (mostly lower GI). other main, and seemingly intractible, problems were insomnia and urinary ...can't think of the word now, so i'll just call it "hard to go."
btw, ppl, i am now on my 5th trial of emsam - day six and feeling great, with NONE of the former side-effects. how did i FINALLY accomplish this?:
(once dr. bodkin responded to robert david's emails that you COULD indeed cut the patch (he said in 1/2s); i took a chance and cut it into 1/8s. not that hard to do, even on the lowest - smallest - 6 mg patch.)
***i now apply 1/4 to 3/8 of the patch - AND only this small amount for 3-4 hrs daily - about 4-5 hrs after i get up. i think it's important for ppl to know that, especially if, like me, you always need below norm doses on all ADs, that this may be a option for you, too.***
Posted by Donna Louise on June 5, 2006, at 18:38:51
In reply to Re: Is EMSAM Not The Med People Thought It Was?, posted by pulse on June 5, 2006, at 17:26:22
> i'm reposting this from another (advair + emsam) thread.
>
> i had 4 short failed trials on emsam, primarily due to very bad - for me - GI side-effects (mostly lower GI). other main, and seemingly intractible, problems were insomnia and urinary ...can't think of the word now, so i'll just call it "hard to go."
>
> btw, ppl, i am now on my 5th trial of emsam - day six and feeling great, with NONE of the former side-effects. how did i FINALLY accomplish this?:
>
> (once dr. bodkin responded to robert david's emails that you COULD indeed cut the patch (he said in 1/2s); i took a chance and cut it into 1/8s. not that hard to do, even on the lowest - smallest - 6 mg patch.)
>
> ***i now apply 1/4 to 3/8 of the patch - AND only this small amount for 3-4 hrs daily - about 4-5 hrs after i get up. i think it's important for ppl to know that, especially if, like me, you always need below norm doses on all ADs, that this may be a option for you, too.***
>
>Yippee oh wonderful! I am so glad that you got it going for you. I myself made a 9mg patch out of two sixes so I can report to the pdoc that I need more. May end up on 12. But I have had no side effects and some lingering depression. Seems resolved on 9mg though.
Is this the same Dr. Bodkin that did a study about bupenorphine or am I all confused as usual??Donna
Posted by pulse on June 5, 2006, at 23:05:01
In reply to Re: Is EMSAM Not The Med People Thought It Was? » pulse, posted by Donna Louise on June 5, 2006, at 18:38:51
thanks so much for the yippee, Donna Louise.!!! much appreciated.
it has been an extremely long haul for me, considering i did my 1st of the four failed trials, starting back on april 13th - two days before most could even get emsam!
i believe this must be the very same dr. bodkin. perhaps if elizabeth pops in she could confirm that re: the bupe.
regards,
pulse
Posted by Donna Louise on June 6, 2006, at 7:08:49
In reply to Re: Is EMSAM Not The Med People Thought It Was? » Donna Louise, posted by pulse on June 5, 2006, at 23:05:01
> thanks so much for the yippee, Donna Louise.!!! much appreciated.
>
> it has been an extremely long haul for me, considering i did my 1st of the four failed trials, starting back on april 13th - two days before most could even get emsam!
>
> i believe this must be the very same dr. bodkin. perhaps if elizabeth pops in she could confirm that re: the bupe.
>
> regards,
> pulseI know all about the long and winding road that leads to the same door you left from...it is great to find a fork that can get you some relief from this crippydoodle (nice word). I admire your..ah crippy, what is that word I want..stick toitness, to keep trying. We are roadrunners, no, roadclearers, no, pathfinder! That is it. I wish I could remember the words I want...it is getting bad.
Anyway, I thought I would do some googling about Bodkin this morning in case Elizabeth does not stop by. I havent' seen a post from her in many years, have you? I have been copying some articles to give to the pdoc about bupe in the even I need yet another add-on and I am not going back to sri's or trying anything over again anymore.
Donna
Posted by pulse on June 6, 2006, at 16:52:54
In reply to Re: Is EMSAM Not The Med People Thought It Was? » pulse, posted by Donna Louise on June 6, 2006, at 7:08:49
yep, i'm known for my relentlessness (have driven many crazy with it, i'm smugly proud to say.) however, on the front we are discussing here, too much of it has been brought forth by desperation.. thanks just the same!
i do believe most here have stick-to-it-ness.. or have HAD to acquire it.
re: elizabeth, i can't recall how long it's been since she's posted.
regards,
pulse
This is the end of the thread.
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