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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Seeking Peace on June 22, 2007, at 9:22:41
Sorry yet again for more questions. I've never had so many questions when it comes to a medication but this one..oh well...
I've been on the patch (9mg) for almost 4 wks now. When I started my sleep was really bad and a lot of anxiety (heart racy etc) esp after putting it on, within an hour. About 3 wks into it, suddenly my sleep was better, not best...waking fewer times during night, still waking up early a.m. and unable to go back, but not waking 20 times during night. anxiety had gone away almost entirely that came with the patch. I was putting it on at regular time i think almost all the time...
Not sure about mood yet though
Anyways this week having been off work, not having a schedule and other things to take care of...it's been a little less on schedule. On regular schedule I was putting it on around 5:30 a.m. this week, that went off on Wed, I forgot it and didn't put it on till 3 p.m. Then next day I went to my regular sched (sort of) and changed it around 8 a.m. Today too I changed it around 8 a.m. Thing is though my anxiety is back. yesterday night I couldn't sleep well. Today i'm having racy heart thing again.
Has anyone else noticed this that a bit of change in schedule will do this to you? I checked my bp just now and that's ok, though pulse is more than usual.
I'm not liking this med due to little things like this...so many restrictions it seems. Plus I'm traveling to another country on Sunday and am afraid of being in a place where if I get sick and have to go to a doc, they won't really know much about this med.
My doc had suggested zyprexa to go with it (i was on zyprexa and welbutrin before and it worked ok). I was reluctant, didn't start zyprexa again due to some reasons. Now I'm wondering with the anxiety... anyone else been on that combo? Does going on that combo give you any side effects...like if I add zypexa now, would i have any side effects?
i hate anxiety... :(
Posted by Honore on June 22, 2007, at 9:32:03
In reply to Emsam, posted by Seeking Peace on June 22, 2007, at 9:22:41
I'd add the zyprexa, if that's good for anxiety. There is some anxiety esp at the beginning with Emsam, although it gets less after a while. I use a small dose of abilify with it, and I find that helps me.
If you go up on the dose, the anxiety might start up again for a period.
What do you use to help you sleep, by the way? Maybe you could try sonata if you wake up without enough sleep. It has a short half=life and I use it sometimes.
There really aren't that many restrictions on Emsam. Which restrictions bother you? You can always taken instuctions abroad-- as to contraindications-- you could take a few xeroxed pages from the PDR, if you're really worried. Also there are PDRs online, for anyone who wants access-- so foreign doctors could use them. Unless you're going to third world countries, I wouldn't worry too much about that aspect of MAOIs.
You might have had upsurge of anxiety because you didn't have much time between the 3 pm and next 8 am dose-- and also by 3 pm, there probably wasn't much left on the patch. On the other hand, it may have been something else.
You say you haven't had any mood effects though. So would you say it's working at all?
Honore
Posted by Phillipa on June 22, 2007, at 11:25:10
In reply to Re: Emsam » Seeking Peace, posted by Honore on June 22, 2007, at 9:32:03
Honore has a great many good points I'd listen to her. Love Phillipa
Posted by Seeking Peace on June 23, 2007, at 8:45:24
In reply to Re: Emsam » Seeking Peace, posted by Honore on June 22, 2007, at 9:32:03
Spoke with pdoc yesterday and decided to stay off zyprexa unless absolutely necessary. I feel (she agrees) that zyprexa has in past kept me from feeling some emotions, like anger, which is needed for me to deal with certain things at work and to speak up. Maybe it's the anxiety factor leading to anger...I feel different from past not being on zyprexa/welbutrin and I like the "take charge/get angry/speak up" that I feel at moment.
Sleeping pills.. Over the counter doesn't work well for me, very unpredictable, untimely etc. She prescribed Ambien before which i took once (plus ate some bad food so I think had food poisoning too), it reacted very very quickly, I threw up 2x (food poisoning), i was 'out of it' sort of, next 2 days was very 'on air'. So I decided not to take it again. Plus due to my S thoughts maybe it's best I stay away from sleeping pills...esp prescription ones.
Sleep...When I started Emsam, sleep got worse (was sleepless even before due to depression/stress), waking up again and again and again, plus anxiety, heart racy. So I started cutting patch and slowly upped it. helped some with anxiety to do it that way. The sleeping got better, suddenly, in 3rd week. Woke up couple of times only, was able to go back to sleep, would wake up 1-2 hrs before my scheduled time to wake up. not best, but much better and I was ok with it for now. Was still tired etc but i figured it was getting better. Now I'm back to square one.
Why does Emsam seem like a hassle? Even a little change in schedule, forgetting a dose, has left me back to square one it seems with increased anxiety/sleepnessness etc. I'm traveling in a few for 2 1/2 months where my schedule will be totally thrown off. When traveling, due to jet lag, doing things, it's very very hard to have a schedule and I don't know how i"m going to deal with that. In past, welbutrin/zyprexa, I could always adjust, skip, etc as needed to change schedule. Now I can't..i can't understand why if not change of schedule, why i'm back with anxiety/awful sleep, yet again. So it seems like a hassle. I have anxiety even if I eat a little of my favorite swiss cheese (aged I think). have not touched soy stuff...i guess yeast stuff needs to be avoided too??? I'm never sure totally with certain things and that creates anxiety. Was shopping for meds to take when traveling with me (motion sickness, cold/allergies, pain, etc) and it's difficult as there's restrictions on MAOIs and other meds. I always read, but am always having anxiety 'just in case'. I've never had to worry so much on my other medications.
mood changes...not sure how I feel, if I see difference...maybe a little as at least I do certain things, a little more social with my family. Having read here that for most people it suddenly kicks in 6th week, I was hoping for same...just like suddenly sleep got a little better in 3rd week. It's hard to tell at moment how I feel. I have a lot of stress, work stuff, feelings of not being able to control my life, etc, which is life stuff..so is it depression or just life sucks? meds can't do it all.???I don't know..part of me wants to stop the patch, go back to old meds. They didn't always work as I used to still get S and all, but they were best combo for me for several years. I knew what I was like on it, how to adjust it, what side effects i'd have etc (though coming off was difficult). But because I'm traveling, leaving tomorrrow, away from pdoc for 2 1/2 months, i don't want to change things and be on my own etc. sometimes i wish i'd never started this patch :(
Today I decided to cut the patch just a little to lower the dose. This is what i did initially to help with anxiety and since that seems to have creeped back in (plus i had awful sleep last night), maybe that will help?
Questions...
Are there any withdrawal effects coming off of the patch if i decide that?
Anyone else felt zyprexa kept them from feeling certain emotions etc?
Anyone else have experience for what happens on the patch if you go off/change your schedule? If you forget to put it on and remember in a couple of hrs, do you just wait till next day? If you put it on when you remember, do you go back to original schedule next day?I don't know...i'm not very happy at moment due to anxiety..i can't tolerate anxiety
Posted by Honore on June 23, 2007, at 13:20:22
In reply to Re: Emsam » Honore, posted by Seeking Peace on June 23, 2007, at 8:45:24
Seeking Peace, you really don't have to worry about the food restrictions on Emsam. That's official for 6 mg, and pretty well demonstrated for the higher doses. If you want to be conservative, especially until after you get more used to Emsam, that's understandable-- but you don't have to worry. There really is no danger from cheese or soy, esp. on the low doses you're taking.
As I say, the company has demonstrated that even 9 mg and 12 mg seem to be safe from food/tyramine problems that other, oral MAOIs have. However, the FDA wants to be super-careful- so they've put that on hold.
That, at least, you really really don't need to be at all concerned about-- it's totally safe.
The travelling does sound like a hassle until you've gotten much more acclimated to Emsam. If I forget to put a patch on, I usually put it on as soon as I remember-- I do that, occasionally. The only reason I wouldn't put it on is that I use 12 mg and don't like to put that much on right before bed. So if I remember in the evening that I forgot to change the patch, I put on a smaller dose (half a patch) for the night, and then change to 12 mg in the morning-- or add the other 1/2. The patches probably have somewhat more than a 24 hour dose (that's not entirely clear, but is likely), so you may not have been entirely without it during the period when you forget to apply the new patch.
I wouldn't worry about discontinuation syndromes at 6 mg, especially when you haven't used it for a long time. If you'd been using it for years, I'm not sure what the implications would be-- but I've gone off 12 mg and 6 mg pretty much overnight, without any effects. This was after four months, and again after another three or four-- so I don't think in early stages of use, there's any withdrawal.
I do think Abilify is a good drug with Emsam, if you should ever consider APs again. I haven't noticed any emotional blunting with it.
Honore
Posted by Seeking Peace on June 24, 2007, at 15:09:31
In reply to Re: Emsam » Seeking Peace, posted by Honore on June 23, 2007, at 13:20:22
thanks again Honore for responding and your reassurances/experiences.
I am about to leave to go to airport, to catch my flight...so can't write much.
I am feeling a little better with anxiety having cut just a little of the patch off for past 2 days. I will go back up in a day or two. Hopefully my sleep will catch up and get better too as I'm really achy/tired. I will look into the APs options when I return, about 2 months later, if things are still bad...wish me luck in meantime. I don't want to start something new when I am away, plus I wouldn't be able to pick up meds/not have insurance etc when traveling. I will keep in touch with my pdoc through emails though, so that is reassuring...
Hoping things get better...
Seeking Peace
Posted by Honore on June 24, 2007, at 16:29:16
In reply to Re: Emsam » Honore, posted by Seeking Peace on June 24, 2007, at 15:09:31
Hi, Seeking Peace. I hope your sleep improves soon, despite jet lag, and also that you can increase the Emsam without any problems. Travelling always complicates things, but maybe the Emsam will help more than be a further complication.
If have any questions while you're gone, I'll try to answer.
Meanwhile, I hope you have a good trip!
Honore
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