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Dr. Bob is Robert Hsiung, MD,
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Posted by laima on January 8, 2007, at 17:54:53
In reply to Re: EMSAM Add-ons...Please help with suggestions » laima, posted by Phillipa on January 8, 2007, at 11:23:40
Yes, I doubt it works for everyone, or else there wouldn't be any warning in the first place.> And most people have complained of insomnia or agitation on EMSAM so again your mileage may vary. Good luck Stargazer you've done well so far. Love Phillipa
Posted by med_empowered on January 8, 2007, at 22:11:47
In reply to Re: EMSAM Add-ons...Please help with suggestions » Phillipa, posted by laima on January 8, 2007, at 17:54:53
MAOI+stims have been combined pretty successfully before. Some docs apparently do it a good bit (I think Ivan Goldberg has written about using pretty high doses of both the MAOI and the stims in these situations). The craziest combo I've heard of is an MAOI, a TCA, and a stimulant. I think with proper management and dosing, everything should be OK.
Posted by SLS on January 9, 2007, at 5:59:28
In reply to EMSAM Add-ons...Please help with suggestions, posted by stargazer on January 8, 2007, at 10:37:06
I think you might want to try going up in dosage first. MAOIs are strange beasts. You might need to go up to recapture the antidepressant effect if your percentage of inhibition was borderline at the lower dosage. It is not infrequent that people must adjust their dosage of MAOI throughout the years - up or down.
My doctor and his colleagues are using Emsam to treat ADD.
I wouldn't know what to suggest adding. There are so many possibilities. Lack of interest and anhedonia are problems and are symptoms of residual depression. I'd like to see what others suggest.
- Scott
Posted by SLS on January 9, 2007, at 6:10:31
In reply to EMSAM Add-ons...Please help with suggestions, posted by stargazer on January 8, 2007, at 10:37:06
So far, the Adderall idea looks pretty good, right?
Like others, I had been leaning in the direction of a stimulant.
I would still go up to 9mg/24hr first, wait 3 weeks, and then add the Adderall if necessary.
Provigil would be interesting, too. However, the clinical experience of an expert is probably worth more than our guesses, and might make for a better first choice.
- Scott
Posted by SLS on January 9, 2007, at 6:18:36
In reply to Re: EMSAM Add-ons...Please help with suggestions, posted by med_empowered on January 8, 2007, at 22:11:47
> The craziest combo I've heard of is an MAOI, a TCA, and a stimulant.
Are you calling me crazy?
:-)
Parnate 120mg + desipramine 200mg + Dexedrine 20mg + Synthroid
I felt better for the first 3 days after adding the Dexedrine. For some reason, 3 days has been the critical number for me. When I get a robust response to something, it lasts for 3 days exactly, then disappears abruptly. I guess my brain stubbornly clings to a dysregulated homeostasis. Apparently, it takes 3 days to accomplish this feat.
- Scott
Posted by laima on January 9, 2007, at 13:14:51
In reply to Re: EMSAM Add-ons...Please help with suggestions » med_empowered, posted by SLS on January 9, 2007, at 6:18:36
I just thought of something else: there's a lot of information out there about combining the amino acid phenylalanine with selegeline, if you google. It's supposed to be an excellent combination.(The topic verges here into the "alternative" category.)
Posted by Phillipa on January 9, 2007, at 19:10:35
In reply to Re: EMSAM Add-ons...Please help with suggestions » med_empowered, posted by SLS on January 9, 2007, at 6:18:36
Scott when did you add the synthroid? I thought yours was normal range? Love Jan
Posted by RN320 on January 12, 2007, at 14:46:21
In reply to EMSAM Add-ons...Please help with suggestions, posted by stargazer on January 8, 2007, at 10:37:06
Hi Stargazer-
THe same thing has happened to me at the 12mg EMSAM. It seems that you get an initial boost and then eventually lose focus. It's still better at the 12mg for me, though. My pdoc says that the only safe stimulant to use with EMSAM is Provigil. I'm supposed to be starting it shortly. ALso, he mentioned Aricept of all things....he said that it's helped cognitive abilities in many non-Alzheimers patients. I'm supposed to start Provigil next week. I've read from others that they use adjunct Adderal and Ritalin, but my pdoc was adamant that they're "expressly contraindicted" in conjunction with EMSAM.Hope that helps, and that you're feeling better soon.
/m
Posted by laima on January 12, 2007, at 15:30:40
In reply to Re: EMSAM Add-ons...Please help with suggestions, posted by RN320 on January 12, 2007, at 14:46:21
Provigel is probably safest in general for most people, but I'm living proof it's not the only stimulant safe to use with Emsam. My doctor and people who share his office do use other stimulants in combination with Emsam with a lot of patients. My doctor is a psychiatry and pharmacology professor, the entire office is faculty and researchers. Decent and respectable credentials. Doses are lower than they would be without the Emsam. A lot depends on patients's compliance reliability, blood pressure and heart-rate, and obviously, the combinations require close monitoring and cannot be recommended for everyone.
> Hi Stargazer-
> THe same thing has happened to me at the 12mg EMSAM. It seems that you get an initial boost and then eventually lose focus. It's still better at the 12mg for me, though. My pdoc says that the only safe stimulant to use with EMSAM is Provigil. I'm supposed to be starting it shortly. ALso, he mentioned Aricept of all things....he said that it's helped cognitive abilities in many non-Alzheimers patients. I'm supposed to start Provigil next week. I've read from others that they use adjunct Adderal and Ritalin, but my pdoc was adamant that they're "expressly contraindicted" in conjunction with EMSAM.
>
> Hope that helps, and that you're feeling better soon.
> /m
Posted by laima on January 12, 2007, at 15:41:25
In reply to Re: EMSAM Add-ons...Please help with suggestions » RN320, posted by laima on January 12, 2007, at 15:30:40
I hope that didn't come out sounding wrong. Obviously, stimulants other than provigel carry risk of high blood pressure crisis when used with Emsam, and good doctors will disagree about how much risk is acceptable to dinker with. The other stimulants have worked out really well for me, but I've always had lower than normal blood pressure, even before Emsam. So much so that doctors always double check me because they think their reader is broken. Emsam plunges it even lower, so the stimulants have been a godsend. Even with the stimulants plus Emsam, my readings are low to normal. Does provigel even affect blood pressure or attention deficit? That's probably why it's not my own optimal choice.
Posted by RN320 on January 12, 2007, at 18:03:05
In reply to Re: EMSAM Add-ons...Please help with suggestions » laima, posted by laima on January 12, 2007, at 15:41:25
I don't think that I got you wrong at all. Provigil is contraindicated with people that have hypertension,hyperthyroidism,glaucoma, drug abuse, severe anxiety states and CV disease. It's usually used for narcolepsy and sleep apnea, not really for ADHD.
Good Luck.
/m
Posted by stargazer on January 12, 2007, at 23:03:06
In reply to Re: EMSAM Add-ons...Please help with suggestions, posted by RN320 on January 12, 2007, at 18:03:05
Well I saw my pdoc today and told him straight out I had been experimenting with tiny doses of amphetamine along w Emsam. I told him another person (Laima) had done this and her pdoc had sanctioned this and I told him they were at Northwestern if he needed to speak with them. He said he had another pt who was using Emsam/Adderral combo, which surprised me since he is usually completely by the book...
Anyway, we agreed I would continue to use the short acting amphetamine that I had from previous script (substitute for Adderall)which I had taken last year when on Celexa.
He said I could go higher on the dosage and continue to monitor my BP/pulse which I told him I had been doing faithfully during the past few days trying amphetamines.
So, that's the direction I'm heading in and I feel like it is the right decision. My pdoc gave me full credit for figuring out that that is the missing component in my depression treatment.
I'm keeping my fingers crossed on it.
Stargazer
Posted by SLS on January 13, 2007, at 4:47:00
In reply to Re: EMSAM Add-ons...pdoc agrees w stim use, posted by stargazer on January 12, 2007, at 23:03:06
> Anyway, we agreed I would continue to use the short acting amphetamine that I had from previous script (substitute for Adderall)which I had taken last year when on Celexa.
trying amphetamines.
> So, that's the direction I'm heading in and I feel like it is the right decision. My pdoc gave me full credit for figuring out that that is the missing component in my depression treatment.
>
> I'm keeping my fingers crossed on it.
>
> Stargazer
Sounds good.Please post your results.
Good luck.
:-)
- Scott
Posted by ryanz on January 14, 2007, at 2:11:09
In reply to Re: EMSAM Add-ons...Please help with suggestions, posted by RN320 on January 12, 2007, at 14:46:21
Posted by littlebitpa on January 14, 2007, at 15:35:04
In reply to Laima, others, Strattera/Provigil experience?, posted by stargazer on January 8, 2007, at 15:22:24
Hi, this is my first time writing, but i wanted to respond to the provigil. I am taking 100mg a day because nothing I tried, including all the other stimilants, did anything at all and I have also been on every type of AD which only gave limited and short lived relief, with more side effects than help. The provigil was the first med that actually gave me a sense of well being and clarity. It made me feel more awake and alert without stimilating effects. Still had other mood disorder symptoms so Pdoc added emsam which worked great for the first 8 weeks but is now starting to lose its effect. My symptoms are returning in full force; Iritability, anxious,no motivation, fatigue, yell at my kids with no provication. Anyone else have emsam lose its effectivness? Sorry so long. Thanks for your patience.
Posted by RN320 on January 14, 2007, at 15:39:38
In reply to Re: Laima, others, Strattera/Provigil experience? » stargazer, posted by littlebitpa on January 14, 2007, at 15:35:04
My pdoc started me at 6mg, moved me up to 9mg in about 6 weeks and then to 12mg in early Sept. In the 4 1/2 months at 12mg I haven't seen any lessened effect thus far.
Welcome to psychobabble.
/m
Posted by littlebitpa on January 14, 2007, at 16:41:04
In reply to Re: Laima, others, Strattera/Provigil experience?, posted by RN320 on January 14, 2007, at 15:39:38
> My pdoc started me at 6mg, moved me up to 9mg in about 6 weeks and then to 12mg in early Sept. In the 4 1/2 months at 12mg I haven't seen any lessened effect thus far.
> Welcome to psychobabble.
> /mI see my pdoc 1/18, maybe he will up the dose. Emsam was working great initially. Thanks for the response and the welcome. I'm glad it is working for you! It gives me hope.
Posted by rich776 on January 15, 2007, at 20:54:32
In reply to EMSAM Add-ons...Please help with suggestions, posted by stargazer on January 8, 2007, at 10:37:06
Right now I take emsam, lamictal and a pinch of lexapro. I also take some provigil when I need a boost. So far I haven't felt anything consistent but its only been a couple of weeks. My (and my docs) favorite add-on is Lamictal. Almost no side effects but you have to go up slowly on dosage. I will let you know how things are going after at least 4 weeks on emsam. Hoping I will only need to take 1 med.
Posted by stargazer on January 15, 2007, at 23:07:42
In reply to Re: EMSAM Add-ons...Please help with suggestions, posted by rich776 on January 15, 2007, at 20:54:32
I took Lamictal earlier in the year and it caused me to have vertigo and after falling down a few times, I realized that wasn't normal for me. I actually was seen by a neurologist and was told the Lamictal was probably causing that. It didn't cause me any great concern to stop it because I had been telling the pdoc that I thought it was making me lose my memory and forget everything. Well it certainly wasn't helping me... just my experience w Lamictal...SG
Posted by RN320 on January 16, 2007, at 5:57:52
In reply to Re: EMSAM Add-ons.../No Lamictal for me/rich776, posted by stargazer on January 15, 2007, at 23:07:42
I also had a poor experience with lamictal a few years ago. It caused me to stumble alot and i never felt quite "there" on it. I felt like I had taken stupid pills or something. Just my experience.
/m
Posted by littlebitpa on January 16, 2007, at 17:21:38
In reply to Re: EMSAM Add-ons.../No Lamictal for me/rich776, posted by RN320 on January 16, 2007, at 5:57:52
I was also on lamictal and trileptal at one time with the same results. I now take 50mg of topomax 2x day but am getting off it soon. It doesn't do much of anything except give me pins and needles. The stupid feeling went away after a few weeks. The Doc didn't want to make to many changes at once thats why I'm still on it. Just really want to be on one med. Feel like crap right now and don't know what med is or isn't working. Nothing seems to work for long.
Posted by RN320 on January 16, 2007, at 19:24:41
In reply to EMSAM Add-ons...Please help with suggestions, posted by stargazer on January 8, 2007, at 10:37:06
Hi SG and Lilith-
I just thought I'd let you know that I saw both my pdoc and Internist today. My pdoc started me on 200mg of provigil once/day to see if it'll help. Then, because of the recent tyramine reaction/hypertensive crisis, my internist gave me a script for emergency catapress 0.1mg to use if I ever have the misfortune of having another. I had askd her about some nifedipine (bite and swallow) for those purposes and she said that they have now found that using nifedipine for these reasons causes too rapid a drop in BP- will actually bottom you out and then you can have an MI so she uses catapress for that reason.Just thought I'd let you know.
/m
Posted by stargazer on January 16, 2007, at 20:38:25
In reply to Re: EMSAM Add-ons...Please help with suggestions, posted by RN320 on January 16, 2007, at 19:24:41
RN320...I'll be thinking of your trial with Provigil, another poster, Karen, has just started it too so you two should start a thread specific to Emsam and Provigil.
I'm trying amphetamines (generic short acting Adderall) + Emsam myself. If necessary, I may be giving either Provigil or Strattera a try if this doesn't help...have to always be planning ahead.
Good luck m...SG
Posted by stargazer on January 16, 2007, at 21:13:05
In reply to Re: EMSAM Add-ons...Please help with suggestions, posted by RN320 on January 16, 2007, at 19:24:41
m...I will be following your posts on this latest addition to your treatment plan. What are the symptoms you are hoping to alleviate w Provigil?
Karen44 is also starting provigil so you may want to start a new thread together, specific to Emsam and Provigil combination.
I may need to taken a different stim if the amphetamine doesn't work for me with Emsam,so either provigil (which is not really a stim), or Strattera may be another option for me.
Wishing you good results with provigil, keep posting your feedback...SG
Posted by liliths on January 19, 2007, at 7:39:14
In reply to Re: EMSAM Add-ons...Please help with suggestions, posted by RN320 on January 16, 2007, at 19:24:41
hi /m
sorry for the delay. I was away and ended up without internet access. Now just recovering from the ordeal of the trip
I'm thrilled you've started on the provigil. I hadn't realized it was finally available in the US. oh duh! :)
have you started it yet? notice anything? yes, I ask a lot of questions LOL
good luck and please keep us updated!!
as a result of my 'experience', I've decided to try and not see any pdocs for awhile. Am going to see if my primary will write my focalin & klonopin since they are stable prescriptions, try to discontinue the wellbutrin & buspar and am going to give tianeptine a try.
my concerns about EMSAM is that I would probably need to reduce my focalin dose so I'm going to wait. Of course, I'd also need to find another pdoc... another good reason to try this route first :)
I wish you all the best and hope you report your progess :)
namaste,
lilith> Hi SG and Lilith-
> I just thought I'd let you know that I saw both my pdoc and Internist today. My pdoc started me on 200mg of provigil once/day to see if it'll help. Then, because of the recent tyramine reaction/hypertensive crisis, my internist gave me a script for emergency catapress 0.1mg to use if I ever have the misfortune of having another. I had askd her about some nifedipine (bite and swallow) for those purposes and she said that they have now found that using nifedipine for these reasons causes too rapid a drop in BP- will actually bottom you out and then you can have an MI so she uses catapress for that reason.
>
> Just thought I'd let you know.
> /m
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