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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by laurie7583 on January 26, 2007, at 2:10:46
All,
Glad to have found you - put on EMSAM as 2nd line med to resistant depression recently. Have had good response to Provigil previously, but my Pdoc (who I have alot of faith in - she appears quite well-read and current in knowledge base) won't allow me to combo EMSAM with any stim, tho it would seem Provigil's mech of action would be quite safe in combo with EMSAM.
Still having debilitating fatigue on EMSAM (just got bumped up to 9mg dose 2 weeks ago), and I wish I could find some published data (abstract form or otherwise) to present to her to attempt to change her mind and let me combine the two drugs.
What convinced other folks docs to combo stims and EMSAM? Does anyone have any published data or research they could point me in the direction of?
Thank you!
Posted by laima on January 26, 2007, at 8:45:46
In reply to EMSAM + Stimulants - is there any published data??, posted by laurie7583 on January 26, 2007, at 2:10:46
There are published articles about selegeline-phenylalanine.
Posted by laima on January 26, 2007, at 8:49:41
In reply to EMSAM + Stimulants - is there any published data??, posted by laurie7583 on January 26, 2007, at 2:10:46
Actually, the number one reason a lot of people are getting stims with Emsam is to counter-act the very low blood pressure Emsam can cause- a small amount of a stim can boost it up a tad to something more normal and functional. Not sure that provigel can help boost blood pressure though- but there is at least one person around here doing nicely with a Provigel-Emsam combo. I don't know if low blood pressure was one of that person's concerns.
Posted by Phillipa on January 26, 2007, at 10:31:40
In reply to Re: EMSAM + Stimulants - is there any published data??, posted by laima on January 26, 2007, at 8:49:41
Laima it might have been and she's doing well on the providgil EMSAM combo hope she sees this thread. Love Phillipa
Posted by psychobot5000 on January 26, 2007, at 13:12:01
In reply to EMSAM + Stimulants - is there any published data??, posted by laurie7583 on January 26, 2007, at 2:10:46
>
> What convinced other folks docs to combo stims and EMSAM? Does anyone have any published data or research they could point me in the direction of?
>I think that there are several studies out there, showing response to combinations of stimulants + MAOis in refractory patients. On Dr Bob's tips section, I think there are some notes containing descriptions of successful cases.
http://www.dr-bob.org/babble/20061003/msgs/693453.html
In the link, I copy-pasted the text of an article from www.currentpsychiatry.com, concerning MAOis. It's written by J Alexander Bodkin and Jonathon Cole, who are Harvard professors and MAOi experts. Near the bottom, in the section regarding treating side-effects such as low-blood pressure and altered sleep cycles, they recommend both traditional stimulants in small doses, and modafinil.
There ought to be other information as well--modafinil is considered by many MAOi-using docs a sophisticated and low-risk medication to use with MAOis.
Best of luck,
Pbot
Posted by laurie7583 on January 26, 2007, at 22:05:09
In reply to Re: EMSAM + Stimulants - is there any published da, posted by psychobot5000 on January 26, 2007, at 13:12:01
>
> >
> > What convinced other folks docs to combo stims and EMSAM? Does anyone have any published data or research they could point me in the direction of?
> >
>
> I think that there are several studies out there, showing response to combinations of stimulants + MAOis in refractory patients. On Dr Bob's tips section, I think there are some notes containing descriptions of successful cases.
>
> http://www.dr-bob.org/babble/20061003/msgs/693453.html
>
> In the link, I copy-pasted the text of an article from www.currentpsychiatry.com, concerning MAOis. It's written by J Alexander Bodkin and Jonathon Cole, who are Harvard professors and MAOi experts. Near the bottom, in the section regarding treating side-effects such as low-blood pressure and altered sleep cycles, they recommend both traditional stimulants in small doses, and modafinil.
>
> There ought to be other information as well--modafinil is considered by many MAOi-using docs a sophisticated and low-risk medication to use with MAOis.
>
> Best of luck,
> PbotThank you so much for your help! I will follow-up with this link...
Posted by jealibeanz on January 27, 2007, at 14:17:56
In reply to Re: EMSAM + Stimulants - is there any published da, posted by laurie7583 on January 26, 2007, at 22:05:09
I thought CNS stimulants and Provigil are contraindicated with MAOI's.
Posted by laima on January 28, 2007, at 8:52:36
In reply to Re: EMSAM + Stimulants - is there any published da, posted by jealibeanz on January 27, 2007, at 14:17:56
Technically contrained, in practice not so clear. Depends on variables like a patient's blood pressure. The danger is spike in blood pressure. I've used stimulants including ritalin, adderall, phenylalanine with Emsam, no incidents or even near-incidents. My blood pressure is naturally low, and plunges to ridiculous on emsam alone. The stimulants, particularly prescription ones, boost it up to livable, though still low.
Posted by psychobot5000 on January 28, 2007, at 10:07:03
In reply to Re: EMSAM + Stimulants - is there any published da, posted by jealibeanz on January 27, 2007, at 14:17:56
> I thought CNS stimulants and Provigil are contraindicated with MAOI's.
According to the books and labeling guidelines, they are--no one wants someone else to die because of MAOi-related complications.
However, many docs experienced with MAOis consider stimulants safe enough to use carefully--start low on the dosing, go slow, and monitor blood pressure and heart-rate carefully. Since MAOis are frequently an antidepressant for the severely treatment-resistant, there is pressure to use things like stimulants that could be helpful augmentors. For many they seem to do the trick together, when nothing else will, including for some on this board.
Stims can also be useful for the low blood-pressure caused by MAOis (as mentioned above), and for other side-effects like afternoon sleepiness from Parnate, or lack of motivation and energy with Nardil. ...But since, if someone screws up, the patient could DIE, docs continue rightly to be very wary, and the labeling guidelines stay the same.
...However, provigil should be relatively much safer--there does not appear to
be the same risk of cardiac side-effects. Physician opinions seem to vary on that, but I've never heard of a dangerous incident caused by combining them.
This is the end of the thread.
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