![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 21 to 45 of 45. Go back in thread:
Posted by Crazy Horse on January 6, 2007, at 11:51:57
In reply to Re: Benadryl worked, hope it's OK to use, posted by UgottaHaveHope on January 5, 2007, at 13:05:35
>
> Is it OK to take Benadryl? Can you take it indefinitely? Does it mess with EMSAM effects? Thanks, MichaelYes it's okay to take Benadryl. You can take it indefinitely, however you will most likely develop tolerance to it eventually. I would say No, it doesn't mess with the effects of EMSAM.
-Monte
Posted by Karen44 on January 6, 2007, at 15:48:33
In reply to Re: EMSAM, posted by laima on January 5, 2007, at 13:23:59
Been on Emsam two weeks and two days and overall don't notice any difference. Two days ago I thought I was feeling better, but it was gone by yesterday and today; feel like I am sliding back down again. Is it worth it; the thought of going to work next week leaves me feeling overwhelmed. I have a meeting to run and four comprehensive evaluations to complete and write up. I think it is best not to think on it too much and just take one day at a time, I guess.
It also does not give me insomnia at the dose I am on--6 mg. patch.
Karen44
Posted by Honore on January 6, 2007, at 20:08:18
In reply to Re: EMSAM, posted by Karen44 on January 6, 2007, at 15:48:33
It can take three or more weeks for Emsam to have an effect--or really, even more--but you also might try 9 mg. A number of posts here have suggested that that's a more likely therapeutic dose than 6 mg (ie people report that their pdocs speculate to that effect).
By the way, my pdoc has used MAOIs for years, even though many other pdocs haven't. He prescribed both adderall and ritalin with both parnate and emsam. While it depends on individual response (he wanted me to be careful at the beginning with both), it's certainly possible to use them.
As far as taking the emsam patch off at night-- I do it, and it really helps me. I don't know the pharmacological explanation of the change in effect. It may be because there are some amphetamine-like breakdown products that are reduced when the patch is off--- Mainly, though, I believe in it-- because it works. I do also take a little seroquel and some ambien to get to sleep-- but I've always had insomnia, and I find that I'm sleeping as well or better than I ever have, with that combination.
Honore
Posted by liliths on January 8, 2007, at 7:52:26
In reply to Re: EMSAM » liliths, posted by laima on January 5, 2007, at 16:12:20
Hi Liama,
would you know the dose that one can take EMSAM on without having the dietary restrictions and in your opinion, would this dose be efficacious? I remember the restrictions of old being absolute and difficult in that I am a vegetarian.
what are the benefits of the EMSAM patch over oral selegeline?
If I may ask, what is your current combination and dosages of each?
I am looking to make a major change in my meds. It has been initated by forces outside me and and I'm probably going to being forced off the only one that still works. But I haven't felt the wellbutrin or buspar were doing much for me these days, though when I went to my pdoc about making changes, he told me it wasn't the meds, I just needed more exercise and structure in my life. Oh Duh! If I could've been doing those things, I wouldn't have been asking him to change meds to begin with. But I ended up agreeing it was ALL my fault and not his laziness!
indeed! so I am most likely going to need a new pdoc anyway. I'd honestly like to go off as many meds as possible but I think I also need to be realistic
the only other question I have is whether there's weight gain associated with EMSAM? I had a real backlash weight problem after a number of successful months on nardil, which caused me to have to stop the drug. But I also did have a lot of unpleasant side effects. Passing out from low blood pressure as well as an inability to urinate... ended up on medication to help the side effect and that's not something I'd be willing to do again
But the nardil really did help, if only for a while... if EMSAM doesn't carry weight gain and I could eat most of my food, it seems to be a pretty good candidate along with my focalin XR and klonopin.
And I could also consider going back on Concerta, which I used for years. I only changed when my insurance threatened to stop covering it. Then I guess when they realized people were just switching to focalin (which was more expensive LOL), it appeared back on my formulary. I'm thinking Concerta might be more gentle with the EMSAM... but what do I know?
sorry for posing so many questions. You seem to be the one person on a combo that 'might' work for me as well.
thanks for your help.
namaste,
lilith> Hi Liliths,
>
> You sound like you may indeed be a good candidate for a stimulant-Emsam combo, like me! I hope your doctor is ok about it. Mine is, but he also teaches pharmacology at a major medical school, so he's comfortable with "unconventional". He did write me a note to take to the pharmacy the first time, saying it's ok, because he said they might balk. Now the pharmacy is used to me, and there's no questioning. I was using ritalin with Emsam for a long time, until I consulted with a super-expert (for second opinion), and he said that in his observation, many people tended to particularly respond to an Emsam/adderall combo. I was switched immediately after, and I think it's true, at least for me. I haven't had any weight gain at all from Emsam. Are you using it now, or looking to use it in the future?
>
> I figured you'd know about mixing MAOIs and other meds as most people around here do, but with the dangers being what they are, and here I am blathering on about the wonders of an unconventional drug combo- I thought I'd bring it up just to be safe. Never know who's reading and what ideas pop into people's minds. Thanks for understanding :)
>
> Anyway, good luck!
>
> Laima
Posted by laima on January 8, 2007, at 9:40:24
In reply to Re: EMSAM Q? » laima, posted by liliths on January 8, 2007, at 7:52:26
Hi Liliths,
The # 6 doesn't have any dietary restrictions, and I get a little sloppy sometimes following the restrictions with the 9, and everything's been fine. (Technically, dietary restrictions haven't been officially studied with the 9 or 12-so they have to warn people, and caution is prudent.) It's only the MAOI drug warnings which are in full and undisputed effect for all three. I'd say that dietary freedom and relaxation is the # 1 benefit of Emsam over oral selelgeline. My doctor also seems to believe that the selegeline is somehow absorbed by the body differently or more efficiently from Emsam, but I didn't quite catch the details of why he believes that. I've not associated any weight gain or increased appetite with any strength Emsam. I'm personally not so sure about the efficacy of the 6, however. My doctor even said that he went to an Emsam conference where there was talk between the doctors that most people started responding when the dose was at least # 9--though the 6 has helped a fair number of people. I'm using the 9 right now with 15 mg adderall (it went up!). With the adderall increase especially, it's working out alright. Winter has always been really tough for me, and the weather has been very dark lately... I think I could be much, much better, but I'm back to believing my doctor when he keeps emphasizing therapy and lifestyle adjustments. His mantra could be, "Medication while it works gives you a window of opportunity..." (Working on that!) I blew off those urgings in the past, but this time I am heading as best as I humanly can. It's so interesting, he's a psychpharmacology expert who doesn't believe antidepressents work indefinately, but that's a whole other thread and story. So I completely believe you when you say wellbutrin and buspar aren't doing much for you these days. I've been on Emsam or selegeline for a year, and my doctor told me it was indeed entirely possible that it's not as helpful for me now as it used to be- but that there should still be some mileage left. And finally- the low blood pressure has been the only side effect I've associated with Emsam- but adderall keeps that under control, so it's not a problem. On days that I take a break from a stimulant, I remain a weak feeling slug, even after the stimulant's washed out. That's how I was when I started the Emsam by itself, too. I don't recall the low blood pressure being this big of an effect with the oral version- there's something about the oral version being more stimulating. But yes, I've been instructed to be super cautious with adderall, and before, with the ritalin. Especially with adderall- for the first couple weeks I was instructed to check my blood pressure both lying down and standing up in the morning, then about three hours after taking the adderall (because that's when it supposedly is at highest level in the body), and then at the end of the day. I had to show off my numbers so he'd feel ok that I wasn't in danger. I'm so sick of that blood pressure reader I could throw it out the window!
By the way, I was reading up about use of stimulants as antidepressents, and it seems that dexedrine is most associated with an anti-depressent effect (but it's hard to get a prescription). I am completely convinced that adderall is really giving me a mood boost in addition to its other benefits. Dexedrine is a component of adderall. The second expert, a researcher I consulted with per my doctor's suggestion, says he's observed that Emsam and Adderall appear to work synergistically. A clinical observation and hunch- not a study. (But that's why I was switched over from ritalin.) Neither doctor thought tolerance would be much of an issue with adderall or other short-acting stimulant if dose was kept as low as possible, and if not taken late in the day. The theory is it then gets a chance to wash out on a daily basis, and the brain gets lots of recovery time at night.
I hope I answered everything you were wondering. Good luck, Liliths!
Laima
> Hi Liama,
>
> would you know the dose that one can take EMSAM on without having the dietary restrictions and in your opinion, would this dose be efficacious? I remember the restrictions of old being absolute and difficult in that I am a vegetarian.
>
> what are the benefits of the EMSAM patch over oral selegeline?
>
> If I may ask, what is your current combination and dosages of each?
>
> I am looking to make a major change in my meds. It has been initated by forces outside me and and I'm probably going to being forced off the only one that still works. But I haven't felt the wellbutrin or buspar were doing much for me these days, though when I went to my pdoc about making changes, he told me it wasn't the meds, I just needed more exercise and structure in my life. Oh Duh! If I could've been doing those things, I wouldn't have been asking him to change meds to begin with. But I ended up agreeing it was ALL my fault and not his laziness!
>
> indeed! so I am most likely going to need a new pdoc anyway. I'd honestly like to go off as many meds as possible but I think I also need to be realistic
>
> the only other question I have is whether there's weight gain associated with EMSAM? I had a real backlash weight problem after a number of successful months on nardil, which caused me to have to stop the drug. But I also did have a lot of unpleasant side effects. Passing out from low blood pressure as well as an inability to urinate... ended up on medication to help the side effect and that's not something I'd be willing to do again
>
> But the nardil really did help, if only for a while... if EMSAM doesn't carry weight gain and I could eat most of my food, it seems to be a pretty good candidate along with my focalin XR and klonopin.
>
> And I could also consider going back on Concerta, which I used for years. I only changed when my insurance threatened to stop covering it. Then I guess when they realized people were just switching to focalin (which was more expensive LOL), it appeared back on my formulary. I'm thinking Concerta might be more gentle with the EMSAM... but what do I know?
>
> sorry for posing so many questions. You seem to be the one person on a combo that 'might' work for me as well.
>
> thanks for your help.
>
> namaste,
> lilith
>
> > Hi Liliths,
> >
> > You sound like you may indeed be a good candidate for a stimulant-Emsam combo, like me! I hope your doctor is ok about it. Mine is, but he also teaches pharmacology at a major medical school, so he's comfortable with "unconventional". He did write me a note to take to the pharmacy the first time, saying it's ok, because he said they might balk. Now the pharmacy is used to me, and there's no questioning. I was using ritalin with Emsam for a long time, until I consulted with a super-expert (for second opinion), and he said that in his observation, many people tended to particularly respond to an Emsam/adderall combo. I was switched immediately after, and I think it's true, at least for me. I haven't had any weight gain at all from Emsam. Are you using it now, or looking to use it in the future?
> >
> > I figured you'd know about mixing MAOIs and other meds as most people around here do, but with the dangers being what they are, and here I am blathering on about the wonders of an unconventional drug combo- I thought I'd bring it up just to be safe. Never know who's reading and what ideas pop into people's minds. Thanks for understanding :)
> >
> > Anyway, good luck!
> >
> > Laima
>
>
Posted by liliths on January 8, 2007, at 11:28:27
In reply to Re: EMSAM Q? » liliths, posted by laima on January 8, 2007, at 9:40:24
hi Liama,
I'm guessing that not having to be digested gastrointestinally probably has a lot to do with the patch not necessarily having dietary restrictions. Gee, I actually thought about it LOL
Thank you SO much for your info.
I seems to me that the blood pressure effects of the stims would be a 'good' thing, considering how low the MAOI's make it - I'm actually surprised to hear of the caution.
when I was on the nardil - I had to constantly take readings because my bp went so low, so I understand how what starts out interesting ends up annoying!
the few times I've missed my morning meds (accidently) I'd realize it only because I'd spend the day like a slug as well, only also crying a LOT and eating for 'comfort'
I'm pretty athletic - weight gain is a BAD thing LOL
Though my pdoc was among the first to tell me I'd have to be on meds the rest of my life (I'd always thought of them more as that 'window of opportunity' thing), he also told me that someone like me couldn't be helped by any pill unless I worked out regularly.
But the stupid pills do have to at least relieve some of the symptoms or else why take them? It doesn't help to 'know' working out will make me feel better if I can't go out of the house and do it!! That's what pissed me off about his unwillingness to realize the meds weren't working anymore.
I definitely agree that we have to change our lifestyles, habits, and behavior since depression as a lifestyle itself can become pretty addicting - no matter how miserable you are - it's the misery you know
Interesting information about the adderall - I'd definitely be willing to try it with the EMSAM and my klonopin if I can find a pdoc willing to do it.
what's the exchange for adderall? Is it like focalin, which is half what one would take on ritalin or concerta?
you've been great
thanks again
namaste,
lilith> Hi Liliths,
>
> The # 6 doesn't have any dietary restrictions, and I get a little sloppy sometimes following the restrictions with the 9, and everything's been fine. (Technically, dietary restrictions haven't been officially studied with the 9 or 12-so they have to warn people, and caution is prudent.) It's only the MAOI drug warnings which are in full and undisputed effect for all three. I'd say that dietary freedom and relaxation is the # 1 benefit of Emsam over oral selelgeline. My doctor also seems to believe that the selegeline is somehow absorbed by the body differently or more efficiently from Emsam, but I didn't quite catch the details of why he believes that. I've not associated any weight gain or increased appetite with any strength Emsam. I'm personally not so sure about the efficacy of the 6, however. My doctor even said that he went to an Emsam conference where there was talk between the doctors that most people started responding when the dose was at least # 9--though the 6 has helped a fair number of people. I'm using the 9 right now with 15 mg adderall (it went up!). With the adderall increase especially, it's working out alright. Winter has always been really tough for me, and the weather has been very dark lately... I think I could be much, much better, but I'm back to believing my doctor when he keeps emphasizing therapy and lifestyle adjustments. His mantra could be, "Medication while it works gives you a window of opportunity..." (Working on that!) I blew off those urgings in the past, but this time I am heading as best as I humanly can. It's so interesting, he's a psychpharmacology expert who doesn't believe antidepressents work indefinately, but that's a whole other thread and story. So I completely believe you when you say wellbutrin and buspar aren't doing much for you these days. I've been on Emsam or selegeline for a year, and my doctor told me it was indeed entirely possible that it's not as helpful for me now as it used to be- but that there should still be some mileage left. And finally- the low blood pressure has been the only side effect I've associated with Emsam- but adderall keeps that under control, so it's not a problem. On days that I take a break from a stimulant, I remain a weak feeling slug, even after the stimulant's washed out. That's how I was when I started the Emsam by itself, too. I don't recall the low blood pressure being this big of an effect with the oral version- there's something about the oral version being more stimulating. But yes, I've been instructed to be super cautious with adderall, and before, with the ritalin. Especially with adderall- for the first couple weeks I was instructed to check my blood pressure both lying down and standing up in the morning, then about three hours after taking the adderall (because that's when it supposedly is at highest level in the body), and then at the end of the day. I had to show off my numbers so he'd feel ok that I wasn't in danger. I'm so sick of that blood pressure reader I could throw it out the window!
>
> By the way, I was reading up about use of stimulants as antidepressents, and it seems that dexedrine is most associated with an anti-depressent effect (but it's hard to get a prescription). I am completely convinced that adderall is really giving me a mood boost in addition to its other benefits. Dexedrine is a component of adderall. The second expert, a researcher I consulted with per my doctor's suggestion, says he's observed that Emsam and Adderall appear to work synergistically. A clinical observation and hunch- not a study. (But that's why I was switched over from ritalin.) Neither doctor thought tolerance would be much of an issue with adderall or other short-acting stimulant if dose was kept as low as possible, and if not taken late in the day. The theory is it then gets a chance to wash out on a daily basis, and the brain gets lots of recovery time at night.
>
> I hope I answered everything you were wondering. Good luck, Liliths!
>
> Laima
>
>
>
>
> > Hi Liama,
> >
> > would you know the dose that one can take EMSAM on without having the dietary restrictions and in your opinion, would this dose be efficacious? I remember the restrictions of old being absolute and difficult in that I am a vegetarian.
> >
> > what are the benefits of the EMSAM patch over oral selegeline?
> >
> > If I may ask, what is your current combination and dosages of each?
> >
> > I am looking to make a major change in my meds. It has been initated by forces outside me and and I'm probably going to being forced off the only one that still works. But I haven't felt the wellbutrin or buspar were doing much for me these days, though when I went to my pdoc about making changes, he told me it wasn't the meds, I just needed more exercise and structure in my life. Oh Duh! If I could've been doing those things, I wouldn't have been asking him to change meds to begin with. But I ended up agreeing it was ALL my fault and not his laziness!
> >
> > indeed! so I am most likely going to need a new pdoc anyway. I'd honestly like to go off as many meds as possible but I think I also need to be realistic
> >
> > the only other question I have is whether there's weight gain associated with EMSAM? I had a real backlash weight problem after a number of successful months on nardil, which caused me to have to stop the drug. But I also did have a lot of unpleasant side effects. Passing out from low blood pressure as well as an inability to urinate... ended up on medication to help the side effect and that's not something I'd be willing to do again
> >
> > But the nardil really did help, if only for a while... if EMSAM doesn't carry weight gain and I could eat most of my food, it seems to be a pretty good candidate along with my focalin XR and klonopin.
> >
> > And I could also consider going back on Concerta, which I used for years. I only changed when my insurance threatened to stop covering it. Then I guess when they realized people were just switching to focalin (which was more expensive LOL), it appeared back on my formulary. I'm thinking Concerta might be more gentle with the EMSAM... but what do I know?
> >
> > sorry for posing so many questions. You seem to be the one person on a combo that 'might' work for me as well.
> >
> > thanks for your help.
> >
> > namaste,
> > lilith
> >
> > > Hi Liliths,
> > >
> > > You sound like you may indeed be a good candidate for a stimulant-Emsam combo, like me! I hope your doctor is ok about it. Mine is, but he also teaches pharmacology at a major medical school, so he's comfortable with "unconventional". He did write me a note to take to the pharmacy the first time, saying it's ok, because he said they might balk. Now the pharmacy is used to me, and there's no questioning. I was using ritalin with Emsam for a long time, until I consulted with a super-expert (for second opinion), and he said that in his observation, many people tended to particularly respond to an Emsam/adderall combo. I was switched immediately after, and I think it's true, at least for me. I haven't had any weight gain at all from Emsam. Are you using it now, or looking to use it in the future?
> > >
> > > I figured you'd know about mixing MAOIs and other meds as most people around here do, but with the dangers being what they are, and here I am blathering on about the wonders of an unconventional drug combo- I thought I'd bring it up just to be safe. Never know who's reading and what ideas pop into people's minds. Thanks for understanding :)
> > >
> > > Anyway, good luck!
> > >
> > > Laima
> >
> >
>
>
Posted by laima on January 8, 2007, at 18:08:43
In reply to Re: EMSAM Q? THANK YOU » laima, posted by liliths on January 8, 2007, at 11:28:27
Hi Liliths,I'm with you- the blood pressure increase from the stims is a good thing. But we do have lower blood pressure than a lot of people. Like you, I guess I would also be considered athletic, because I do a lot of active stuff. I think that it would be an entirely different story for a sedentary person with high blood pressure and resting pulse. I'm sure there's plenty of reason for a warning.
What does your doctor think about your low blood pressure anyway? He/she should be sympathetic, one would think. How is one supposed to feel better when faint and weak? I understand that the two choices are either a hormone (don't recall what it's called) or a stimulant, small dose. And viola- the stimulant just so happens to also help ADD stuff. Getting THAT under control helps loads!
I asked if there was any stimulant comparison chart, something like what there is for comparing benzos, but no. My doctor wasn't keen on making any specific comparisons like that either, just said adderall is much stronger than ritalin. Hard to get straight answers sometimes!
Good luck, very eager to hear what happens for you.
Laima
Posted by stargazer on January 8, 2007, at 22:38:13
In reply to Re: EMSAM Q? THANK YOU » liliths, posted by laima on January 8, 2007, at 18:08:43
I think the drug to increase BP might be Florinef. My father was put on this when he developed hypotension with his parkinson's meds. It is used to prevent dehyration and therefore keeps BP from becoming too low when your body excretes more fluid than it needs to maintain a normal BP.
SG
Posted by laima on January 9, 2007, at 10:08:30
In reply to Re: EMSAM Q? THANK YOU/Laima, posted by stargazer on January 8, 2007, at 22:38:13
Florinef- Yes, I think that's the one.
Posted by liliths on January 10, 2007, at 14:51:28
In reply to Re: EMSAM Q? THANK YOU » liliths, posted by laima on January 8, 2007, at 18:08:43
Hi Liama,
my bp's been low all my life. Since I'm on the focalin, it 'appears' so normal LOL so no one cares. It was really only a problem those many years ago when I was trying MAOI's. What a trip that was! I was fainting everywhere. Even ended up with a mild concussion from one fall... of course, no one ever treated the low bp - just told me to be very careful and check it often
I'm not likely to be making any changes soon. I'm going to have to find a new pdoc as a result of the current nightmare I'm enduring with the state. My hearing is next week and I won't be doing anything until that is over
in case you haven't a clue what I'm talking about, there are long threads on both "work" and "alternative" about the fact that in applying to the state for a license, my being on medication kicked me into a kafkaesque nightmare, which basically left me suicidal and totally dysfunctional. Whether you want to bother reading them is totally up to you, but I will warn you that they're upsetting...
my current pdoc reacted so poorly to it that I've totally lost faith and respect for him and so I now have to find someone else. And I will say, the stress of that is totally overwhelming, though I'm hoping my primary will write my scripts in the interim.
But I don't want to ask her to write something like EMSAM, when she's clearly not knowledgeable. I know she'd be extremely uncomfortable writing anything I'm not already on.
But if I survive the next few weeks and actually manage to find a GOOD pdoc willing to take a chance... I promise to keep you informed
btw, I've read some of your other posts and I've noticed you've expressed some concerns that the EMSAM isn't really doing much... how ARE you doing on the combo? Do you think it's more the adderall that's helping? Are you at all satisfied with the EMSAM or are you thinking about trying something else?
I hope it all works out for you!
thanks for your help
namaste,
lilith>
> Hi Liliths,
>
> I'm with you- the blood pressure increase from the stims is a good thing. But we do have lower blood pressure than a lot of people. Like you, I guess I would also be considered athletic, because I do a lot of active stuff. I think that it would be an entirely different story for a sedentary person with high blood pressure and resting pulse. I'm sure there's plenty of reason for a warning.
>
> What does your doctor think about your low blood pressure anyway? He/she should be sympathetic, one would think. How is one supposed to feel better when faint and weak? I understand that the two choices are either a hormone (don't recall what it's called) or a stimulant, small dose. And viola- the stimulant just so happens to also help ADD stuff. Getting THAT under control helps loads!
>
> I asked if there was any stimulant comparison chart, something like what there is for comparing benzos, but no. My doctor wasn't keen on making any specific comparisons like that either, just said adderall is much stronger than ritalin. Hard to get straight answers sometimes!
>
> Good luck, very eager to hear what happens for you.
>
> Laima
>
>
Posted by RN320 on January 12, 2007, at 13:54:09
In reply to Re: EMSAM Q? » laima, posted by liliths on January 8, 2007, at 7:52:26
Hi- For what it's worth, I'm on EMSAM (12mg) and I take florinef to keep my BP up. It's worked really well. I still have some moderate orthostatic problems but they are more manageable and my baseline BP has gone from 86/48 to 110/70......works for me, and gives me an incredible boost in energy! Also, at the 12mg dose I found my anxiety to decrease greatly, and the first couple of weeks I had a sudden weight loss of 11 pounds. (I became the size of the Hindenburg on Seroquel, so I was really worried about it and am pleased that weight gan is not something you need to worry about on EMSAM. My understanding of the reason that oral selegeline is not supposed to be an option is that the "Safe dose" is for treatment of Parkinson's and that much higher doses are required to treat depression (because it absorbs better from the skin than the gut). My pdoc will not use selegeline for depression because he says that the required doses to really treat depression are at a dangerous/toxic level. Anyway, that's what I was told.
Regards.
/m
Posted by liliths on January 12, 2007, at 14:43:16
In reply to Re: EMSAM Q?, posted by RN320 on January 12, 2007, at 13:54:09
thank you for posting... you're probably one of the first people to post such an extremely positive response to the drug.
At 12mg do you have any dietary restrictions? Do you leave the patch on all the time? How long have you been using it and do you augment with anything else?
sorry for all the questions
I'm hoping to be able to combine it with my ADD meds so the low bp shouldn't be a problem.
thanks again
namaste,
lilith> Hi- For what it's worth, I'm on EMSAM (12mg) and I take florinef to keep my BP up. It's worked really well. I still have some moderate orthostatic problems but they are more manageable and my baseline BP has gone from 86/48 to 110/70......works for me, and gives me an incredible boost in energy! Also, at the 12mg dose I found my anxiety to decrease greatly, and the first couple of weeks I had a sudden weight loss of 11 pounds. (I became the size of the Hindenburg on Seroquel, so I was really worried about it and am pleased that weight gan is not something you need to worry about on EMSAM. My understanding of the reason that oral selegeline is not supposed to be an option is that the "Safe dose" is for treatment of Parkinson's and that much higher doses are required to treat depression (because it absorbs better from the skin than the gut). My pdoc will not use selegeline for depression because he says that the required doses to really treat depression are at a dangerous/toxic level. Anyway, that's what I was told.
> Regards.
> /m
Posted by RN320 on January 12, 2007, at 15:15:19
In reply to Re: EMSAM Q? » RN320, posted by liliths on January 12, 2007, at 14:43:16
Hi Lillith-
At 12mg you do have dietary restrictions, but they're not as bad as with the oral MAOIs.
I recently had a tyramine reaction (hypertensive crisis) which was scary but managed ok. Still don't know the source of it, but it came from a Thai restaurant (where I was promised that there was no soy, MSG or fermented products in what I ordered.) My pdoc is in the process of following up with a "Medical Letter" to BMS and to the FDA.I have had several serious obstacles that have popped up in the course of getting regulated on EMSAM, but they've all been able to be handled successfully.
I will be starting provigil next week as an adjunct. My pdoc has told me that the only really safe atimulant is Provigil. I told him that people take adderall and ritalin and he said that they were "expressly contraindicated" in use with EMSAM.
Good luck to you. Feel free to write anytime, if you think that I could be of help.
/m
Posted by laima on January 12, 2007, at 15:43:58
In reply to Re: EMSAM Q?, posted by RN320 on January 12, 2007, at 15:15:19
It's true, I too hear selegeline (ie, Emsam) is only a modest antidepressent. I wonder then why they chose it to be the one for patch development?
Posted by RN320 on January 12, 2007, at 18:07:26
In reply to Re: EMSAM Q?, posted by laima on January 12, 2007, at 15:43:58
>
> It's true, I too hear selegeline (ie, Emsam) is only a modest antidepressent. I wonder then why they chose it to be the one for patch development?I believe that the reason that they chose it is that they knew it was absorbed well sublingually- people have used selegeline drops for parkinson's. I think that it's the same premise that led to the development of nitroglycerine patches (since it works well sublingually) and oral contraceptives/ HRT- since hormonal creams have also been effective. That's my take on it anyway.
/m
Posted by laima on January 12, 2007, at 18:35:36
In reply to Re: EMSAM Q?, posted by RN320 on January 12, 2007, at 18:07:26
Well it makes sense then. Maybe it seemed like a promising bet for developing and testing the patch technology. Now that they got this, perhaps they'll move on to tackling others.
> >
> > It's true, I too hear selegeline (ie, Emsam) is only a modest antidepressent. I wonder then why they chose it to be the one for patch development?
>
> I believe that the reason that they chose it is that they knew it was absorbed well sublingually- people have used selegeline drops for parkinson's. I think that it's the same premise that led to the development of nitroglycerine patches (since it works well sublingually) and oral contraceptives/ HRT- since hormonal creams have also been effective. That's my take on it anyway.
> /m
>
>
Posted by Phillipa on January 12, 2007, at 19:12:28
In reply to Re: EMSAM Q?, posted by laima on January 12, 2007, at 18:35:36
How about one for anxiety and insomnia? Love Phillipa
Posted by laima on January 12, 2007, at 22:03:50
In reply to Re: EMSAM Q? » laima, posted by Phillipa on January 12, 2007, at 19:12:28
? I don't know, Phillipa. Insomnia's never been a major issue for me, though anxiety has. I had some insomnia when I first started Emsam, but it went away. I've used klonopin with Emsam, (slept ok), but I already was developing a tolerance to it and had to discontinue it. My doctor didn't want me to go up on it for whatever reason, though I was only prescribed 2 mg. My anxiety has been much improved lately, and I've got my fingers crossed it stays that way. So that would probably be just the Emsam now. Like I said, fingers are crossed!
Posted by liliths on January 13, 2007, at 6:38:01
In reply to Re: EMSAM Q?, posted by RN320 on January 12, 2007, at 15:15:19
hi /m,
it's great to hear of someone having such good results though I do worry about the dietary restrictions. I'm a vegetarian as well as a female who uses soy for many things, including supplmenetation - I'll have to find out if soy supplments carry the same risks
if I may ask, what sort of obstacles did you hit on the EMSAM? I guess I'm hoping to be as informed and forewarned as possible LOL.
of course, I stil have to find a new pdoc and one that will be willing the even consider the med combo of it with my ADD meds
when will you be starting the provogil and what dose are they starting you on?
Please keep me updated...
and good luck!namaste,
lilith> Hi Lillith-
> At 12mg you do have dietary restrictions, but they're not as bad as with the oral MAOIs.
> I recently had a tyramine reaction (hypertensive crisis) which was scary but managed ok. Still don't know the source of it, but it came from a Thai restaurant (where I was promised that there was no soy, MSG or fermented products in what I ordered.) My pdoc is in the process of following up with a "Medical Letter" to BMS and to the FDA.
>
> I have had several serious obstacles that have popped up in the course of getting regulated on EMSAM, but they've all been able to be handled successfully.
>
> I will be starting provigil next week as an adjunct. My pdoc has told me that the only really safe atimulant is Provigil. I told him that people take adderall and ritalin and he said that they were "expressly contraindicated" in use with EMSAM.
>
> Good luck to you. Feel free to write anytime, if you think that I could be of help.
> /m
Posted by RN320 on January 13, 2007, at 10:38:59
In reply to Re: EMSAM Q? » RN320, posted by liliths on January 13, 2007, at 6:38:01
> hi /m,
>
> it's great to hear of someone having such good results though I do worry about the dietary restrictions. I'm a vegetarian as well as a female who uses soy for many things, including supplmenetation - I'll have to find out if soy supplments carry the same risks
>
> if I may ask, what sort of obstacles did you hit on the EMSAM? I guess I'm hoping to be as informed and forewarned as possible LOL.
>
> of course, I stil have to find a new pdoc and one that will be willing the even consider the med combo of it with my ADD meds
>
> when will you be starting the provogil and what dose are they starting you on?
>
> Please keep me updated...
> and good luck!
>
> namaste,
> lilith
>
> > Hi Lillith-
> > At 12mg you do have dietary restrictions, but they're not as bad as with the oral MAOIs.
> > I recently had a tyramine reaction (hypertensive crisis) which was scary but managed ok. Still don't know the source of it, but it came from a Thai restaurant (where I was promised that there was no soy, MSG or fermented products in what I ordered.) My pdoc is in the process of following up with a "Medical Letter" to BMS and to the FDA.
> >
> > I have had several serious obstacles that have popped up in the course of getting regulated on EMSAM, but they've all been able to be handled successfully.
> >
> > I will be starting provigil next week as an adjunct. My pdoc has told me that the only really safe atimulant is Provigil. I told him that people take adderall and ritalin and he said that they were "expressly contraindicated" in use with EMSAM.
> >
> > Good luck to you. Feel free to write anytime, if you think that I could be of help.
> > /m
>
>
Hi Again!
About the dietary restrictions.... I don't eat red meat, and only eat poultry or fish once or twice a week. I used to supplement my diet with cheese, but other than fresh mozzarella, ricotta, american (who could ever call that cheese??!! I think it's petroleum by-products!) and believe it or not, Jarlsburg (an aged swiss), and cottage cheese- that's not an option for me. My pdoc got a new study a couple of weeks ago that shows the levels of tyramine in foods once thought to be high in it. It used to be that any aged cheese was a no-no. Now they've found that Jarlsburg is low in tyramine. I've been eating it since last week and haven't had a problem. About soy- good news and bad for you on that one. My understanding is that soy milk, oil and flour are ok (try buying a loaf of bread that doesn't have soy oil and/or flour!). However, any protein supplements from soy are out, as well as tofu, soy sauce, miso. I found this out recently since I've got what they call "sub-clinical diabetes" and my treatment is just as if I was a full blown diabetic. My internist has been all over me that I'm not getting enough protein, so I thought that I'd buy some dietary supplement (like Glucerna or Ensure). I saw soy protein on the label, so I decided not to buy it until I checked with my pdoc. He said absolutely NOT, even though it's not on the EMSAM PI as something to avoid. I guess they feel that they cover it in the broad category of "soy". I really paid attention to that one, because my pdoc has been telling me all along that I'm too strict with dietary restrictions and that I should feel free to lighten up on myself. The major things that you have to avoid are Soy, broad beans, the aged cheeses, anything that's overripe (fruit/vegs) figs, sauerkraut (fermented), the meats (which don't apply to you so I won't go into that), anything smoked, dried, pickled or fermented, figs, brewers yeast (although my pdoc says that you can now drink small amounts of beer) liquers, chianti, vermouth and port wine (although my pdoc says that the new study shows that you can even drink a little red wine not listed in the above categories). According to this new study, you can now have dark chocolate, but try to avoid Belgian, I think.
then of course, there are the OTC meds that you need to stay away from. I miss using sudafed on occasion, as well as Afrin when I have a bad cold. You can take benadry, so it's not like you can't use all antihistamines. A couple of people have said that they use Afrin, but I personally think that they may be playing with fire. You should also avoid any vitamins that have a yeast base. I think that's about it. Truly, if the drug is working for you, than to me it's worth it to just suck it up and accept the limitations. But that's just my opinion......You asked about the pbstacles that I've encountered along the way. None at 6mg. At 9mg I suddenly lost consciousness and feel down the basement stairs head first this past August. I sustained a serious concussion, and I'm told that as they were transferring me from the ER to an observation unit I had an arrest (don't know if it was cardiac or respiratory because I wasn't monitored). I had developed some orthostatic hypotension initally at 9mg. We still aren't sure if the sudden loss of consciousness was due to a drop in BP or if my blood sugar tanked, because that's right around the time that I found out about the sub-clinical diabetes (and in monitoring my blood sugars at home I was having sudden dangerously low blood sugars with no symptoms- like in the low 40's to high 30's, which is enough all by itself to cause loss of consciousness or even a seizure). I also have a mild heart problem, so it's also possible that I had a sudden arrhythmia that caused me to drop. So, they worked me up for the arrhythmia angle, and that came back negative. So we're still not certain if it was a sudden drop in BP or blood sugar that caused this whole incident. I had to go through rehab to get back on my feet recovering from the head injury and am just starting to feel more "normal" over the past few weeks.
I am currenlty in cardiac rehab, and had another problem when rising from a recumbent stepper I dropped like a rock, and because I was monitored and they immediately did blood sugars and pressures, I know that this was a direct result of orthostatic hypotension. So that goes back to the EMSAM, however my pdoc had recently switched me from Seroquel to trazadone for sleep. It's working so I no one wants me off of it, and they suspect that this has added to the hypotensive effect. So, now I take florinef and my BP is normal for the first time in about 4 months!! I had been running high 80's to low 90's/ 50-60 and now I'm 110/70 and darned proud of it!! (It's amazing the energy that I have now with a higher BP..)
And of course, the other thing that happened was the tyramine reaction, which was bvery scary, but it was managed.
I think that the important thing is to understand that most things, even the worst can be managed. You have to have doctors that really communicate with each other as far as meds go. My cardiologist, Internist,and Immunologist all feel free to contact my pdoc before starting me on anything new if there's a question. And he always makes himself available to my other docs. I think that my problems with BP, although initially caused by the EMSAM, were complicated/exaggerated by other problems and the meds that I take (cardiac in particular). I'm currently taking 14 prescription drugs on a daily basis, and 4 of them are psych drugs. No doubt I'm more at risk for the problems with BP than others. I'm not really a big fan of polypharmacy, but it's what I have to do right now to maintain my best state of health and well being.
As far as the provigil goes, my pdoc is planning to start me on it next week....he mentioned the dose but I don't remember. I'll let you know how it goes.
I hope that I've answered your questions and in doing so haven't scared you away from EMSAM. It's just worked so well for me...I'll do just about anything to stay on it. Without it I would revert to absolutely no quality of life and that would bring me back to life not being worth living. I hope that I am never forced with that decision.
Best wishes.
/m
Posted by stargazer on January 13, 2007, at 11:52:02
In reply to Re: EMSAM Q?, posted by RN320 on January 13, 2007, at 10:38:59
RN320...we have spoken before and I appreciate all your knowledge and experience with Emsam.
I understand how you must feel on Emsam despite all of the restrictions and events that have occurred to you. I also understand why you are working so hard to stay on it as well. When they work, and I have had good results, currently and in the past on MAO's, they're worth it. I was sorry to hear of your recent event with the Thai food. That was a close one...
Do you carry the meds to reduce your BP in the event of a hypertensive crisis? Lucky for you you had them with you that night.
One question about your plan to add provigil...Is is for depression or for ADD? I saw my pdoc yesterday and the 2 other meds I wanted to have him consider were Provigil and Strattera, both non-stimulants, although I believe both are offically on warning list for use with Emsam.
My pdoc has sanctioned use of stimulants for me with Emsam as well and I have posted regarding this recent event. I am thrilled with his agreement to allow me to use a stimulant, since I thought he would not agree to it.
But, I am also curious about others use of Strattera or Provigil for their depressive/ADD symptoms which for me are too closely entwined to know what diagnosis is primary and what is econdary, if you know what I mean...Am I depressed because I am too unfocused and it makes me fail in social and occupational roles or am I disorganized and unmotivated because I am depressed...the old adage of what came first, the chicken or the egg. Even my pdoc missed the diagnosis (ADD) which I think has made me depression "treatment resistant" for 20+ years. It all seems too simple now since I'm optimistic that if I can treat the ADD component of my depression all will be well. Of course nothing is absolute, but I have higher hopes than I have had in a long time.
Watch yourself and keep safe.
SG
Posted by RN320 on January 13, 2007, at 12:20:08
In reply to Re: EMSAM Q?/RN320, posted by stargazer on January 13, 2007, at 11:52:02
Hi SG-
I will be going on provigil for depression. I don't have adhd. I've had some cognitive issues all along, but they seem to have worsened recently. I've been under a lot of stress lately, and I don't tend to handle it well, and this is when the cognitive problems really surface. I don't know about the "official" list for acceptable stimulants, if there are any. What my pdoc told me is that provigil is the only one that's safe to use with EMSAM. I trust him, as he's never led me wrong and he's been my pdoc since the abrupt onset of the depression almost 6 years ago. He also said that we could try a small dose of aricept, as that many have found that it can improve cognitive abilities in the non-Alzheimer population.All I had with the NTG with me when the reaction occurred. I have an appt with my internist on Tuesday and am planning on asking for a script for nifedipine (bite and swallow) for emergency use if it ever happens again. That's my plan for now.
It sounds like some strides have been made in diagnosing your adhd. I hope that you're able to get optimal relief with your combo.
Best wishes,
/m
Posted by liliths on January 14, 2007, at 12:52:43
In reply to Re: EMSAM Q?, posted by RN320 on January 13, 2007, at 10:38:59
hi /m
grrrr... I just lost everything I had written when I went to check the thread - just hate when that happens LOL
anyway... THANK YOU so much for such a comprehensive explanation. I really appreciate your taking the time
and I'm really proud of you for getting through all that hell and continuing to get better, despite the setbacks... you really persevered and it sounds like it paid off!!
Many years ago, while on Nardil, I too suffered terribly with hypotension and went down ALL the time - would black out & twitch just about everywhere... sometimes for the obvious reason of having gotten up (though it often didn't happen right away so I'd think I was ok), but sometimes it seemed to swoop down and get me for no reason. I lived in NYC at the time and people would often just walk around me, thinking I was just another druggie on the street
I tend to have naturally low bp anyway so I was always having to check it. And I did have one nasty fall in a stairwell which resulted in 'post-concussion syndrome' - they said there was a hairline fracture - took me out of commission for a few months.
I'm curious as to whether you wear a medic-alert bracelet? I know back then, I was advised to, in case of an accident so they'd know what NOT to give me
As I'm already on ADD meds, I'm hoping to get relief on a much lower dose of EMSAM which should also pose much less dietary restrictions. I'm already in the process of weaning down on the other meds I currently take which aren't tolerated at all on EMSAM (wellbutrin & buspar) and I still have to find a new pdoc so hopefully I'll be able to find someone willing to experiment.
I'll probably need to cut my ADD dose regardless and that does worry me as I think it's the only thing doing me any good these days.
anyway, I have a long road ahead of me. And as much as I love figs and am really dependent on soy... if need be, I'd be willing to trade them for that feeling of simply looking forward to living!
I agree, it's worth whatever it takes :)thanks again. I'm going to copy and paste your post into a document for future reference :)
namaste,
lilith
> Hi Again!
> About the dietary restrictions.... I don't eat red meat, and only eat poultry or fish once or twice a week. I used to supplement my diet with cheese, but other than fresh mozzarella, ricotta, american (who could ever call that cheese??!! I think it's petroleum by-products!) and believe it or not, Jarlsburg (an aged swiss), and cottage cheese- that's not an option for me. My pdoc got a new study a couple of weeks ago that shows the levels of tyramine in foods once thought to be high in it. It used to be that any aged cheese was a no-no. Now they've found that Jarlsburg is low in tyramine. I've been eating it since last week and haven't had a problem. About soy- good news and bad for you on that one. My understanding is that soy milk, oil and flour are ok (try buying a loaf of bread that doesn't have soy oil and/or flour!). However, any protein supplements from soy are out, as well as tofu, soy sauce, miso. I found this out recently since I've got what they call "sub-clinical diabetes" and my treatment is just as if I was a full blown diabetic. My internist has been all over me that I'm not getting enough protein, so I thought that I'd buy some dietary supplement (like Glucerna or Ensure). I saw soy protein on the label, so I decided not to buy it until I checked with my pdoc. He said absolutely NOT, even though it's not on the EMSAM PI as something to avoid. I guess they feel that they cover it in the broad category of "soy". I really paid attention to that one, because my pdoc has been telling me all along that I'm too strict with dietary restrictions and that I should feel free to lighten up on myself. The major things that you have to avoid are Soy, broad beans, the aged cheeses, anything that's overripe (fruit/vegs) figs, sauerkraut (fermented), the meats (which don't apply to you so I won't go into that), anything smoked, dried, pickled or fermented, figs, brewers yeast (although my pdoc says that you can now drink small amounts of beer) liquers, chianti, vermouth and port wine (although my pdoc says that the new study shows that you can even drink a little red wine not listed in the above categories). According to this new study, you can now have dark chocolate, but try to avoid Belgian, I think.
> then of course, there are the OTC meds that you need to stay away from. I miss using sudafed on occasion, as well as Afrin when I have a bad cold. You can take benadry, so it's not like you can't use all antihistamines. A couple of people have said that they use Afrin, but I personally think that they may be playing with fire. You should also avoid any vitamins that have a yeast base. I think that's about it. Truly, if the drug is working for you, than to me it's worth it to just suck it up and accept the limitations. But that's just my opinion......
>
> You asked about the pbstacles that I've encountered along the way. None at 6mg. At 9mg I suddenly lost consciousness and feel down the basement stairs head first this past August. I sustained a serious concussion, and I'm told that as they were transferring me from the ER to an observation unit I had an arrest (don't know if it was cardiac or respiratory because I wasn't monitored). I had developed some orthostatic hypotension initally at 9mg. We still aren't sure if the sudden loss of consciousness was due to a drop in BP or if my blood sugar tanked, because that's right around the time that I found out about the sub-clinical diabetes (and in monitoring my blood sugars at home I was having sudden dangerously low blood sugars with no symptoms- like in the low 40's to high 30's, which is enough all by itself to cause loss of consciousness or even a seizure). I also have a mild heart problem, so it's also possible that I had a sudden arrhythmia that caused me to drop. So, they worked me up for the arrhythmia angle, and that came back negative. So we're still not certain if it was a sudden drop in BP or blood sugar that caused this whole incident. I had to go through rehab to get back on my feet recovering from the head injury and am just starting to feel more "normal" over the past few weeks.
>
> I am currenlty in cardiac rehab, and had another problem when rising from a recumbent stepper I dropped like a rock, and because I was monitored and they immediately did blood sugars and pressures, I know that this was a direct result of orthostatic hypotension. So that goes back to the EMSAM, however my pdoc had recently switched me from Seroquel to trazadone for sleep. It's working so I no one wants me off of it, and they suspect that this has added to the hypotensive effect. So, now I take florinef and my BP is normal for the first time in about 4 months!! I had been running high 80's to low 90's/ 50-60 and now I'm 110/70 and darned proud of it!! (It's amazing the energy that I have now with a higher BP..)
>
> And of course, the other thing that happened was the tyramine reaction, which was bvery scary, but it was managed.
>
> I think that the important thing is to understand that most things, even the worst can be managed. You have to have doctors that really communicate with each other as far as meds go. My cardiologist, Internist,and Immunologist all feel free to contact my pdoc before starting me on anything new if there's a question. And he always makes himself available to my other docs. I think that my problems with BP, although initially caused by the EMSAM, were complicated/exaggerated by other problems and the meds that I take (cardiac in particular). I'm currently taking 14 prescription drugs on a daily basis, and 4 of them are psych drugs. No doubt I'm more at risk for the problems with BP than others. I'm not really a big fan of polypharmacy, but it's what I have to do right now to maintain my best state of health and well being.
>
> As far as the provigil goes, my pdoc is planning to start me on it next week....he mentioned the dose but I don't remember. I'll let you know how it goes.
>
> I hope that I've answered your questions and in doing so haven't scared you away from EMSAM. It's just worked so well for me...I'll do just about anything to stay on it. Without it I would revert to absolutely no quality of life and that would bring me back to life not being worth living. I hope that I am never forced with that decision.
>
> Best wishes.
> /m
>
Posted by RN320 on January 14, 2007, at 15:00:30
In reply to Re: EMSAM Q? » RN320, posted by liliths on January 14, 2007, at 12:52:43
Liliths-
Thanks for your supportive message! I really appreciate someone who understands my situation. Although my family and friends are ecstatic about my progress on EMSAM, sometimes when something happens they "suggest" that I perhaps shouldn't be taking it.
No, I don't wear a medic alert bracelet, and I I probably should. That's a great idea....thanks. Do they make one specifically ofr MAOIs?
Thanks again. Feel free to babble mail me if you ever need anything.
/m
Posted by liliths on January 15, 2007, at 7:37:38
In reply to Re: EMSAM Q?, posted by RN320 on January 14, 2007, at 15:00:30
hi /m
if there's one thing I've learned, it's that most people outside this board haven't a clue what we go through and I've learned to stop expecting them to understand what is apparently too foreign... that said, it never makes it any easier to deal with... sigh... so I feel for you.
The public has been made to expect a magic pill that makes everything ok without any 'severe' problems. I'm happy for the few that's true for but suspect there are far more like us than them
I thought it was a good idea to wear to the medic alert. Now this was over 20 years ago, so I just had one engraved with my doctor's name and number plus the fact that I was on an MAOI which carried serious contraindications - I don't remember how much detail I went into but I do know I did also carry a small card in my wallet going into more depth about it and I most likely referenced it. I think I would have mentioned the most obvious possibilities on the bracelet itself.
funny, I'd been debating having another made just because I've been on so many meds... were I to be in an accident, I hate to think of the repercussions of having them suddenly stopped. Now that I'm looking into different meds, of course I'm glad I didn't do it but depending on what I end up on, I'm thinking about using one again.
If nothing else, it 'alerts' them to possible problems and 'directs' them to hopefully look inside your wallet where you can keep more info. Too often, they just react and I shudder to think of the consequences of that!
by now, they may have one for MAOI's and I would think having sub-clinical diabetes might make a good reason to wear one as well.. I'd suggest doing an online search to see what they offer but personally, I liked the idea of having my own engraved anyway as I could add the name of number of the physician I'd want contacted
continued good luck to you! I'm so thrilled to hear you're feeling well! That's makes me feel better!! Never quite understood those telling me to look at the people worse off than me when I'm down - all that does is depress me. Other people's success & happiness is what does it for me!
and thank you for the babblemail invitation.. the same goes to you!! :)
blessed be
namaste,
lilith> Liliths-
>
> Thanks for your supportive message! I really appreciate someone who understands my situation. Although my family and friends are ecstatic about my progress on EMSAM, sometimes when something happens they "suggest" that I perhaps shouldn't be taking it.
>
> No, I don't wear a medic alert bracelet, and I I probably should. That's a great idea....thanks. Do they make one specifically ofr MAOIs?
>
> Thanks again. Feel free to babble mail me if you ever need anything.
> /m
This is the end of the thread.
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