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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 32. This is the beginning of the thread.
Posted by em_kath on January 18, 2010, at 15:51:24
I am currently on Emsam 9mg/24hr. This morning when I got out of bed my vision went blurry, and instead of clearing in a few seconds as usual (this sometimes happens when I stand up too fast), it stayed blacked out for several minutes. It was quite frightening, and I think I even lost consciousness for a moment. I did some research and read my medication booklet again and apparently this is called orthostatic hypotension and can be a side effect of MAOIs. Emsam hasn't been working very well for me so far, so I was debating between either going up to 12mg or switching to Parnate, which I have heard good things about. My question to other MAOI users out there is, should I be concerned? It really scared me to go blind like that. I tried calling my psychiatrist but the office is closed for the holiday. This is the only time this has happened in the 6 weeks I've been on this medication, and at first I thought it was brought on by panic (I had overslept and was late for work). I don't know whether I should keep pursuing MAOIs or if I should try something else. I have atypical depression that hasn't responded well to anything yet. I apologize for rambling, basically I'm just wondering if any other MAOI users have encountered temporary blindness like this? And if so, how often?
Posted by inanimate peanut on January 18, 2010, at 16:43:21
In reply to MAOIs and orthostatic hypotension, posted by em_kath on January 18, 2010, at 15:51:24
I haven't experienced any continual blinding like you mention. I ended up on the floor a couple times now knowing how I get there. Hypotension can do crazy things. I would definitely talk to your doctor about the blindness part, since that's unlike anything I've heard and sounds scary. Plus, going up to the 12mg or going up in Parnate doses might make the hypotension bad for awhile, but that goes away once you stay on one dose for awhile. Now that I'm at proper doses, I rarely notice any at all. So, it's worth getting through it for the benefits you may get from Emsam or Parnate.
Posted by floatingbridge on January 18, 2010, at 18:33:44
In reply to MAOIs and orthostatic hypotension, posted by em_kath on January 18, 2010, at 15:51:24
Em-Kath,
Have you fainted before? Sounds like you did--though the blindness lasting for minutes? I'd be frightened. Talk to a doctor. Did you google fainting?
Posted by em_kath on January 18, 2010, at 19:08:31
In reply to Re: MAOIs and orthostatic hypotension » em_kath, posted by floatingbridge on January 18, 2010, at 18:33:44
> Em-Kath,
>
> Have you fainted before? Sounds like you did--though the blindness lasting for minutes? I'd be frightened. Talk to a doctor. Did you google fainting?
I've never fainted before, so it was very unusual for me. Luckily I was sitting down. The blindness lasted for several minutes, it started to pass and I could see outlines of things briefly but then it went black again. My internet search is what led me to the orthostatic hypotension conclusion and then I looked in my Emsam booklet and saw it there. So I was reassured to know that it's probably a side effect but I'm still scared and unsettled. I'm going to call my doctor tomorrow.
Posted by em_kath on January 18, 2010, at 19:15:14
In reply to Re: MAOIs and orthostatic hypotension, posted by inanimate peanut on January 18, 2010, at 16:43:21
> I haven't experienced any continual blinding like you mention. I ended up on the floor a couple times now knowing how I get there. Hypotension can do crazy things. I would definitely talk to your doctor about the blindness part, since that's unlike anything I've heard and sounds scary. Plus, going up to the 12mg or going up in Parnate doses might make the hypotension bad for awhile, but that goes away once you stay on one dose for awhile. Now that I'm at proper doses, I rarely notice any at all. So, it's worth getting through it for the benefits you may get from Emsam or Parnate.
It's reassuring to hear that it went away once your dosage was stable. I could probably put up with occasional incidents like that if my medication was actually alleviating my depression, but I've been really disappointed with Emsam so far. I just don't want to get on an even more powerful drug like Parnate and find myself losing consciousness while driving or something... I'll just wait and see what my psychiatrist recommends before I decide. Thanks!
Posted by emmanuel98 on January 18, 2010, at 20:27:16
In reply to Re: MAOIs and orthostatic hypotension » inanimate peanut, posted by em_kath on January 18, 2010, at 19:15:14
If you're losing consciousness and vision, it's probably not the emsam. MAOI's do cause orthostatic hypotension, but you won't lose consciousness driving because of that. It's just a brief drop in blood pressure after rising from sitting or lying down for a long time and it's pretty easy to manage and generally gets better as you get used to MAOI's in your system.
I took Emsam 12mg and it did nothing for my severe depression. I went to a see a consultant at Harvard Medical School and he was very down on Emsam, said it's been over-hyped and doesn't work as well as parnate. So I went to parnate and have been depression free for five months. Parnate is the best of the MAOI's, I think.
> It's reassuring to hear that it went away once your dosage was stable. I could probably put up with occasional incidents like that if my medication was actually alleviating my depression, but I've been really disappointed with Emsam so far. I just don't want to get on an even more powerful drug like Parnate and find myself losing consciousness while driving or something... I'll just wait and see what my psychiatrist recommends before I decide. Thanks!
>
>
Posted by Phillipa on January 18, 2010, at 21:56:24
In reply to Re: MAOIs and orthostatic hypotension, posted by emmanuel98 on January 18, 2010, at 20:27:16
Do you have a Blood pressure cuff? Phillipa
Posted by em_kath on January 18, 2010, at 23:57:11
In reply to Re: MAOIs and orthostatic hypotension, posted by emmanuel98 on January 18, 2010, at 20:27:16
> If you're losing consciousness and vision, it's probably not the emsam. MAOI's do cause orthostatic hypotension, but you won't lose consciousness driving because of that. It's just a brief drop in blood pressure after rising from sitting or lying down for a long time and it's pretty easy to manage and generally gets better as you get used to MAOI's in your system.
>
> I took Emsam 12mg and it did nothing for my severe depression. I went to a see a consultant at Harvard Medical School and he was very down on Emsam, said it's been over-hyped and doesn't work as well as parnate. So I went to parnate and have been depression free for five months. Parnate is the best of the MAOI's, I think.
>
>
>Congratulations on your success on Parnate! I keep hearing more and more praise about it and I'm excited to give it a try. I also keep hearing about similar unsatisfactory experiences on Emsam and I wish I had known before I started because I wouldn't have wasted my time with it! The only reservation I have about Parnate is I've heard it has a tendency to spontaneously stop being effective, though really I'll take a few months of being depression-free even if it doesn't last. Thanks for your input!
Posted by JayBTV2 on January 19, 2010, at 8:04:14
In reply to MAOIs and orthostatic hypotension, posted by em_kath on January 18, 2010, at 15:51:24
I'm currently on Parnate. Was on 10mg for a month and just started taking 20mg. (My doc wants to go really slow as I'm Bipolar 1 and can get psychotic manic w/ the wrong combo). Anyway I tried 30mg yesterday just to test and I experienced quite a bit of orthostatic hypotension late in the day. Like getting up from a sitting or lying position would cause my hearing to deafen for a min or two and I'd feel week.
SLS commented on orthostatic hypotension w/ parnate in another thread (possibly from years ago) and said for him it went away. I'm going back to 20 until I official graduate to 30 (which is the recommended theraputic dose). At that point I'll give it a few days/weeks and hopefully my body will adjust.
I also take Lamictal (150mg) and Lithium (600mg) so perhaps the total combo exacerbated the situation....
Just my .02....
-Jay
Posted by inanimate peanut on January 19, 2010, at 16:36:23
In reply to Re: MAOIs and orthostatic hypotension » inanimate peanut, posted by em_kath on January 18, 2010, at 19:15:14
I've never had any trouble driving, even when the orthostatic hypotension was at its absolute worst. It's generally a positional thing when you go from laying down to sitting or sitting to standing and your heart doesn't keep up. If you're dizzy just sitting down, that's something else.
Posted by pedr on January 21, 2010, at 18:27:51
In reply to MAOIs and orthostatic hypotension, posted by em_kath on January 18, 2010, at 15:51:24
> I am currently on Emsam 9mg/24hr. This morning when I got out of bed my vision went blurry, and instead of clearing in a few seconds as usual (this sometimes happens when I stand up too fast), it stayed blacked out for several minutes. It was quite frightening, and I think I even lost consciousness for a moment. I did some research and read my medication booklet again and apparently this is called orthostatic hypotension and can be a side effect of MAOIs. Emsam hasn't been working very well for me so far, so I was debating between either going up to 12mg or switching to Parnate, which I have heard good things about. My question to other MAOI users out there is, should I be concerned? It really scared me to go blind like that. I tried calling my psychiatrist but the office is closed for the holiday. This is the only time this has happened in the 6 weeks I've been on this medication, and at first I thought it was brought on by panic (I had overslept and was late for work). I don't know whether I should keep pursuing MAOIs or if I should try something else. I have atypical depression that hasn't responded well to anything yet. I apologize for rambling, basically I'm just wondering if any other MAOI users have encountered temporary blindness like this? And if so, how often?
Hi,
I've posted a few times regarding hypotension on Nardil recently. Contrary to what others say, IT'S NOT JUST WHEN YOU STAND UP TOO QUICKLY! I would get it after walking up a flight of stairs, turning my head quickly, even looking to the side of my vision!
Regarding blindness, I did not get that. My symptom was everything would go blinding white, like a searchlight shining right in your eyes. This would last for a minute or two.
I highly, highly, highly recommend increasing your blood pressure (assuming you have no related complications) thus:
1/ drink a pint of water with 1/2 teaspoon of salt (or more if you can tolerate) with breakfast
2/ drink another 2 pints of water (if possible)
3/ keep drinking water during the day.
4/ moderate amounts Caffeine helps too.
All these things really helped with my hypotension. I was even able to play soccer. Badly, but still play.
HTH,
Petep.s. if the salty water is too much, try Thermotabs salt supplements. You can get them on eBay.
Posted by em_kath on January 22, 2010, at 13:57:18
In reply to Re: MAOIs and orthostatic hypotension » em_kath, posted by pedr on January 21, 2010, at 18:27:51
> Hi,
> I've posted a few times regarding hypotension on Nardil recently. Contrary to what others say, IT'S NOT JUST WHEN YOU STAND UP TOO QUICKLY! I would get it after walking up a flight of stairs, turning my head quickly, even looking to the side of my vision!
> Regarding blindness, I did not get that. My symptom was everything would go blinding white, like a searchlight shining right in your eyes. This would last for a minute or two.
> I highly, highly, highly recommend increasing your blood pressure (assuming you have no related complications) thus:
> 1/ drink a pint of water with 1/2 teaspoon of salt (or more if you can tolerate) with breakfast
> 2/ drink another 2 pints of water (if possible)
> 3/ keep drinking water during the day.
> 4/ moderate amounts Caffeine helps too.
> All these things really helped with my hypotension. I was even able to play soccer. Badly, but still play.
> HTH,
> Pete
>
> p.s. if the salty water is too much, try Thermotabs salt supplements. You can get them on eBay.
Thanks for the suggestions, I did notice today it happened after I walked up some stairs! I have been on this medication for 7 weeks and just this week it's become an issue. Instead of the salt do you think electrolyte water like sports drinks or something would be helpful, or does it have to be salt? I don't think I could drink salty water, I may look into those Thermotabs or just eat more salty foods, and I'd have no problem drinking more caffeine. Thanks again!
Posted by pedr on January 22, 2010, at 14:08:41
In reply to Re: MAOIs and orthostatic hypotension » pedr, posted by em_kath on January 22, 2010, at 13:57:18
> Thanks for the suggestions, I did notice today it happened after I walked up some stairs! I have been on this medication for 7 weeks and just this week it's become an issue. Instead of the salt do you think electrolyte water like sports drinks or something would be helpful, or does it have to be salt? I don't think I could drink salty water, I may look into those Thermotabs or just eat more salty foods, and I'd have no problem drinking more caffeine. Thanks again!
>No problem. FWIW my hypotension has decreased over time. Most days I don't increase my salt intake now.
Unfortunately it has to be salt. Electrolytes won't raise your blood pressure. You could bump up your salt intake in other ways like food but then your food will taste pretty bad! An "everything bagel" with bacon and salt would do the job and might still be palatable? I just hold my nose and gulp the salty water down. After a week or two it's no big deal.
My best feat before I got my blood pressure up was falling up and falling down the same flight of stairs within 2 minutes. Fairly embarrassing as it was outside during rush hour...
Posted by JayBTV2 on January 27, 2010, at 10:11:55
In reply to Re: MAOIs and orthostatic hypotension, posted by JayBTV2 on January 19, 2010, at 8:04:14
> I'm currently on Parnate. Was on 10mg for a month and just started taking 20mg. (My doc wants to go really slow as I'm Bipolar 1 and can get psychotic manic w/ the wrong combo). Anyway I tried 30mg yesterday just to test and I experienced quite a bit of orthostatic hypotension late in the day. Like getting up from a sitting or lying position would cause my hearing to deafen for a min or two and I'd feel week.
>
> SLS commented on orthostatic hypotension w/ parnate in another thread (possibly from years ago) and said for him it went away. I'm going back to 20 until I official graduate to 30 (which is the recommended theraputic dose). At that point I'll give it a few days/weeks and hopefully my body will adjust.
>
> I also take Lamictal (150mg) and Lithium (600mg) so perhaps the total combo exacerbated the situation....
>
> Just my .02....
>
> -Jay
Well I officially (pDoc sanctioned) went up to 30mg three days ago and the hypotension has definitely faded a good deal. Hardly notice it now and it only seems to occur if I've been lying down or sitting for a long while.Meanwhile my response to the Parnate has improved. Starting to feel a bit better. Hoping to raise to 40mg and probably sit there for a bit soon. Seeing the doc again on Monday (5days).
-Jay
Posted by em_kath on January 27, 2010, at 12:37:47
In reply to Re: MAOIs and orthostatic hypotension, posted by JayBTV2 on January 27, 2010, at 10:11:55
> Well I officially (pDoc sanctioned) went up to 30mg three days ago and the hypotension has definitely faded a good deal. Hardly notice it now and it only seems to occur if I've been lying down or sitting for a long while.
>
> Meanwhile my response to the Parnate has improved. Starting to feel a bit better. Hoping to raise to 40mg and probably sit there for a bit soon. Seeing the doc again on Monday (5days).
>
> -Jay
>I'm glad to hear Parnate is working for you and that the hypotension has leveled out. Did you feel better at all for the first month or did you not respond at all until you got to 30mg? Are you hoping to eventually go higher than 40, or just see how it goes?
Posted by JayBTV2 on January 28, 2010, at 9:05:23
In reply to Re: MAOIs and orthostatic hypotension » JayBTV2, posted by em_kath on January 27, 2010, at 12:37:47
> I'm glad to hear Parnate is working for you and that the hypotension has leveled out. Did you feel better at all for the first month or did you not respond at all until you got to 30mg? Are you hoping to eventually go higher than 40, or just see how it goes?
>I don't think I got much from 10mg or 20mg but 30mg is definitely helping. It's only been about 5 days now at that dose. But it could also be that in total I'm approaching 6 weeks or so on the medication. I'm seeing my doc on Monday. He wanted to go really slow on dose increases since when I go manic it's bad (thinking I'm god causing public scenes cops hopsital bad situations :( But I'm still going to see if I can convince him to let me go to 40 and stay there for a few months. Kinda settle there. I won't be one of those people taking 60+ anytime soon and hopefully the positive benefits will stick around at lower dosages anyway...
To be fair I'm also taking Lithium (900mg), Lamictal (150mg), and Seroquel (50 to 100) for sleep at night.
The hypotension definitely dissipated - still get it on occasion but not as bad and definitely not as frequently. When I tried 30mg a couple times during my official 20mg run I was scared that would be a deal breaker. Luckily it's been fine.
Thanks for asking! :)
-Jay
Posted by George Romero on February 7, 2010, at 16:24:10
In reply to Re: MAOIs and orthostatic hypotension, posted by JayBTV2 on January 28, 2010, at 9:05:23
Was wondering how long each episode lasts for you guys. i just switched to parnate from emsam about a week ago and i've basically been bedridden for two days. i'd had episodes before on emsam where i felt lightheaded for a few seconds (maybe even a few minutes), but now i'm having them constantly, every time i stand up for as long as i'm standing up. also, as an aside, the emsam was actually starting to work really well (after like 6 or 7 weeks but it was destroying my skin so that's why i switched).
btw - i had some hypotension issues several years ago (not rx related) and was given a series of b12 shots, so i'm wondering if, in addition to the other things suggested on this board (like water, salt, caffeine, etc.), it might be helpful to take some airborne or emergen-c or something like that.
Posted by floatingbridge on February 7, 2010, at 17:14:41
In reply to Re: MAOIs and orthostatic hypotension, posted by George Romero on February 7, 2010, at 16:24:10
Did the b12 help? What dosages?
Maybe some more B12? Sublingual is available--check for contraindications w/ maoi's.
Not sure is emerg-e-C or airborne will help.
Posted by pedr on February 8, 2010, at 10:16:09
In reply to Re: MAOIs and orthostatic hypotension, posted by George Romero on February 7, 2010, at 16:24:10
I've not heard that happen to anyone else on Parnate, that sounds really bad. How long did you leave between switching? could there be some emsam lingering around, interfering? Also, did you start at a low-enough dose of Parnate?
I'd tell your doc ASAP about these side-effects.
Posted by George Romero on February 8, 2010, at 11:08:06
In reply to Re: MAOIs and orthostatic hypotension » George Romero, posted by pedr on February 8, 2010, at 10:16:09
thanks for your post. i didn't really wash out between the emsam and parnate for any meaningful period of time. the doctor said not to worry about it, but the pharmacist made such a big deal about it that i did wait 2 days before starting parnate anyway (doc said 0 days, pharmacist said 7, so i figured 2 was probably good enough). so i went from 9 mg of emsam, waited two days, then started 5 mg of parnate. did that for about a week, then started taking 5 mg twice per day. that's when the super-bad hypotension started. feeling much better today though. no idea why, but i'll take it. i was expecting for this to be a problem since i've always had very low bp--maybe that's why i wasn't more freaked out.
btw, floatingbridge, i think the b-12 shots helped, but that was like 15 years ago, so i don't really remember much about it. i just know that i was having super-low bp for no apparent reason (other than just being sort of petite and young), so the doctor gave me a series of b-12 shots, like maybe every other days for a couple of weeks or something. but i do remember it helping, which is what made me think about taking b-12 supplements in some form this time.
Posted by JayBTV2 on February 13, 2010, at 6:52:02
In reply to Re: MAOIs and orthostatic hypotension, posted by George Romero on February 8, 2010, at 11:08:06
> thanks for your post. i didn't really wash out between the emsam and parnate for any meaningful period of time. the doctor said not to worry about it, but the pharmacist made such a big deal about it that i did wait 2 days before starting parnate anyway (doc said 0 days, pharmacist said 7, so i figured 2 was probably good enough). so i went from 9 mg of emsam, waited two days, then started 5 mg of parnate. did that for about a week, then started taking 5 mg twice per day. that's when the super-bad hypotension started. feeling much better today though. no idea why, but i'll take it. i was expecting for this to be a problem since i've always had very low bp--maybe that's why i wasn't more freaked out.
>So you're splitting the 10mg pills? They look coated to me - not sure if splitting does anything. I take the brand and perhaps the generic are different if that's what you're taking.
I posted a lot earlier in this thread that I was having issues w/ Parnate and orhtostatic hypotension as well. But there's good news. The o.h. started when I hit 30mg but then after a few days of 30mg went away. When I went up to 40mg (a few weeks later) it came back for a few days.
So IMO it appears (at least for me) to be a side effect that goes away w/in a few days of a dose increase.
Posted by tonyz on February 16, 2010, at 19:13:49
In reply to Re: MAOIs and orthostatic hypotension » pedr, posted by em_kath on January 22, 2010, at 13:57:18
I am a bit confused by these postings. I had taken Nardil at one time, and never experienced any of these symptoms. I thought the greater danger with the MAOIs was avoiding foods that contained tyramine which could cause the opposite effect of what has been described in these posts - dangerously high blood pressure.
I had taken amitriptyline in the past (a tricyclic) and did have the dizziness if standing too quickly, but I don't remember this symptom when being on Nardil. The diet was a real pain though.
Posted by George Romero on February 16, 2010, at 23:13:30
In reply to Re: MAOIs and orthostatic hypotension, posted by JayBTV2 on February 13, 2010, at 6:52:02
tonyz - i don't know what to tell you. orthostatic hypotension has definitely been a huge problem for me on parnate, and it appears that many people on parnate have the same problem. then again, i have always had really low bp anyway. almost just as bad is the high pulse rebound. when i'm having OH, it's not unusual for my bp to be 80/50 with a pulse of 100+, which feels pretty terrible.
i have to concur with JayBTV2, though--thankfully, it appears to be a temporary problem. when i started parnate, and each time i've increased my dose (started at 5mg and am up to 15mg) i have about 2 days of really low (read "debilitating") bp. then about another 2 days of semi-low bp--i.e., uncomfortable, but bearable. by the time i am completely okay bp-wise, it's time to increase my dose again and i have to go through the whole process again. i'm optimistic, though. emsam was working well for me (i only switched b/c of the skin problems), and parnate already seems to be working well even though i'm only up to 15 mg. the target is supposed to be 40mg. i'm finding myself actually (surprisingly) really enjoying my job again and getting a ton of work done and my relationship with my husband is going way better (fyi - i am a woman - my name's not really george).
i am curious about the dietary restrictions though--so far, i haven't changed my diet at all and I haven't noticed any side effects. i'm wondering if, when the hypotension finally subsides for good, the dietary hypERtension will start to become an issue.
Posted by tonyz on February 17, 2010, at 15:34:05
In reply to Re: MAOIs and orthostatic hypotension, posted by George Romero on February 16, 2010, at 23:13:30
Here's a link of foods to avoid when taking MAOIs - basically a tyramine free diet
http://www.vitacost.com/Healthnotes/Diet/Tyramine-Free-Diet.aspx#Diet-Avoid-Foods
As far as your blood pressure issue everyone reacts differently to meds.
Posted by evenintherain on February 25, 2010, at 13:25:51
In reply to Re: MAOIs and orthostatic hypotension, posted by George Romero on February 16, 2010, at 23:13:30
i was wondering if your hypotension has resolved yet?
i am having some problems with this too (started fainting after getting to 30mg of parnate on week three). went back down to 20mg.
in addition, dr says to increase salt intake, stay hydrated (drink a lot of gatorade, which is salty), and he has presribed .1mg fludrocortisone acetate (flornef) in the morning. i am hoping not to have cut down to 10mg because i'm not getting much of an AD effect yet.
i wouldn't worry about suddenly developing hypertension, i think that is very rare, and different from getting the hypertensive crises (also rare, esp if you're following the diet). i find it strange that your doctor didn't stress the diet, at the very least no aged cheeses? is it is because you are getting such extreme hypotension?
my dr. took my bp while laying down (100/70) and then tried to take it after i stood up but could only get the systolic (80), the diastolic was too low to read.
have you been able to take more than 15mg yet?
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