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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Wasp on February 5, 2014, at 4:48:55
Hey Hi All!
I wrote a book on the newbie board telling my whole life story as my intro. I just had to get it all out! And now I have so many questions...
I spent the day researching Emsam some more and really digging into Atypical, because my doctor just recently told me that's what I am going through and it is not normal. I thought this was normal and I was just extremely moody, and I thought the new feelings I was getting from the Emsam was hypomania. At least it's what I had always called hypomania. I make a lot of goals, but they are all goals I could reach if I just stayed that way and not get depressed. I just make a lot of goals normally even when I am aypical, I just get excited because I can do them when I am in that "hypomanic" mode. So now I know I have always had four modes but misinterpreted them incorrectly: Depressed (which was melancholic depression), Normal (which was atypical depression), very brief Hypomania (which I just found out was everyone else's normal, being happy, getting normal stuff done) and Manic (which of course was hypomanic and manic). What a revelation for me. I knew before that I never had middle ground, just depressed and then hypomanic/manic because I misinterpreted normal as hypomanic. Being on the Emsam is my first long experience of normal since before I was in high school. And I haven't experienced it in 11 years. I am 48. I just experienced a month of normal. What a mind blower!
Now that was over a month ago when I was trying to figure out how to go between the 6 and 9 patches without cutting the nines and sleep was a roller coaster because my doctor had me alternating 6 and 9 patches.
Then life caved in. First, my husband got appendicitus and I took it very hard because I am disabled from Fibromyalgia, and the doctor had to make sure we repeatedly told he could die from the surgery or get aids from a blood transfusion if it was deemed necessary, so I saw my world as being fragily held together by my now suddenly mortal husband.
Then my mother-in-law died a few days later and everyone was grieving and my husband was getting over surgery and the whole 9 yards that went with that. Then our finances collapsed and we are bouncing more and more checks every month to survive, In December it was $1000, in January it was $1500.Which means we have to move in with my 93yo father-in-law, asap & all of a sudden, who is now suffering dementia badly because his wife just passed away. We own his house outright, so now we need to live there. But I am going to have to be dealing with his dementia now one on one all day which I don't think I can manage. And we are commuting an hour there and back staying there three days and two nights a week, trying to help and trying to get used to being around him like this since we will be moving in. We have absolutely no other chioce.
It is depressing me terribly to be around him. We are being subsumed by his illness and have no time with each other and my life is taking a backseat to my taking care of him when I am not up to the task.
All this happened since Thankgiving and I became really depressed on the 9 patches where before I thought they were too much and made me anxious. So My doctor and I are trying the 12's and after 4 weeks I am much less depressed, but still depressed, so I am considering 15mg if she will let me cut the 6 patches or 18 if she won't and maybe I'll cut them anyway.
My questions are:
1.) Has anyone had this happen where you were normal on the dosage or high and then because of extenuating circumstances got depressed again and then upped the patch and felt better? Has your normal range changed before like mine has?
2) I know you don't know, but do you think I could find normal again, because I was so grateful to have it and can't imagine staying depressed now?
3.) I know the diet is different for all people what you tolerate, but what types of changes should I see going from the 9-12, 12-15/18? I know what my diet can handle on the 9's. Will that stay similar or change drastically?
The patch is making me less anxious and less in pain everytime I go up it seems now and I don't know if my original anxiety on the 9's when it was really getting in my system was because it was too much or from some other reason. I was on the 6's before and that helped my anxiety, not gave me more.
4.) How do you know it is too much? What are your symptoms? Would it be Serotonin Syndrome? Because I am really watching out for that because my doctor kept me on Trileptal and is confident we can catch Serotonin Syndrome early because I am so hypervigilant and know my body really well.
5.) When I felt I was on too much with the 9's I thought maybe I was getting manic because I was getting unfocused at times, although actually that was a new symptom I had not had while manic before. I think that was from Serotonin Syndrome, and can that level where you get Serotonin Syndrome change based on how depressed you are?
I will be seeing my doctor on the 13th after the 12's are more in my system. Before on the nines I just had dry mouth at night and bad breath in the mornings. Now I have tinnitus, dizzyness, and I wake up early in the mornings repeatedly really tired and unable to function because I am so tired, but unable to sleep, as well.
6.) I usually get 11 hours of sleep a night because of the Fibromyalgia, but I am getting about 8-9 now non-functional. When I was on the nines, I would sometimes wake up way early, but have energy, what should I make of this?
7.) And should I take off the patch at night yet and how will that affect me switching to 15/18's, will it make it less of a jump? I have read on here that most of the patch's meds go out during the day and it doesn't matter if you take it off, but there is still enough meds in there to disturb your sleep, and when I was tring to titrate the nines I found great differences in how they affected me by how long I left them on. Often I would feel it was too long at one dose and too short at another whan it was about two hours different. because I would wake up really early or a bit early. I was trying for 8 hours and waking up wide awake and I was getting close once in a while, but it was really inconsistant. But I always woke refreshed, which isn't happening now. I probably need to give it more time. I liked having the patch on at night because I woke up chipper, but waking would be at unpredictable hours.
I guess I had a lot of questions!! Please be patient with me. I am new at this. This med is a lot more complicated than any other I have been on before, or at least my experience has been.
Thank you. Love to All.
Posted by Phillipa on February 5, 2014, at 9:46:06
In reply to Emsam Questions, Dosage change 9-12, 12-15?, posted by Wasp on February 5, 2014, at 4:48:55
I don' know. But first one can no longer get Aids from blood transfusions as the blood is all tested. Second I didn't know one could take 15mg of Emsam. Maybe someone who knows can answer your questions. Phillipa
Posted by Wasp on February 5, 2014, at 13:39:25
In reply to Re: Emsam Questions, Dosage change 9-12, 12-15? » Wasp, posted by Phillipa on February 5, 2014, at 9:46:06
The blood here isn't tested. I was thinking of taking a twelve patch and either a half or whole six patch which would be 15 or 18mgs.
With love, from the Wasp
Posted by baseball55 on February 5, 2014, at 19:25:13
In reply to Re: Emsam Questions, Dosage change 9-12, 12-15?, posted by Wasp on February 5, 2014, at 13:39:25
I may be wrong about this, but it has been my understanding that you can't cut these patches - whether ensam, nicotine, fentanyl, whatever. The patches don't work if they're cut. At least that's what I was told. Don't know for sure.
Posted by Phillipa on February 5, 2014, at 21:01:39
In reply to Re: Emsam Questions, Dosage change 9-12, 12-15?, posted by baseball55 on February 5, 2014, at 19:25:13
You can cut the patches just can't get on your skin. Archieves to Robert David first on ensam. If you babblemail him he will answer at least he does me. Phillipa
Posted by Phillipa on February 5, 2014, at 21:03:32
In reply to Re: Emsam Questions, Dosage change 9-12, 12-15?, posted by Wasp on February 5, 2014, at 13:39:25
Where are you? You can babblemail me yours isn't turned on though? Phillipa
Posted by Willful on February 6, 2014, at 0:46:27
In reply to Re: Emsam Questions, Dosage change 9-12, 12-15?, posted by baseball55 on February 5, 2014, at 19:25:13
As far as I know you can cut the patches. I've at least never heard to the contrary. Also they stick just as well if you cut them as if you don't. I've cut them once or twice when I accidentally put on the wrong one, and they stick just as well. Plus if they don't stick, you can sbuy certain types of tape (one is called hypafix) that are used for skin, and they can hold them on.
I've done that lots of times when they don't stick 100%.
Posted by former poster on February 13, 2014, at 1:35:28
In reply to Re: Emsam Questions, Dosage change 9-12, 12-15?, posted by Willful on February 6, 2014, at 0:46:27
I took 18 mg of Emsam for a while. It would have been a great anti-depressant if I could just get more than 4-5hrs of sleep a night. I cut a lot of patches and the dose seemed to correspond with % of the size I cut.
Emsam is a good AD. No sex side-effects, but need something really strong to help you sleep.
Good luck.
Posted by Wasp on February 13, 2014, at 6:03:06
In reply to Re: Emsam Questions, Dosage change 9-12, 12-15? » Willful, posted by former poster on February 13, 2014, at 1:35:28
> I took 18 mg of Emsam for a while. It would have been a great anti-depressant if I could just get more than 4-5hrs of sleep a night. I cut a lot of patches and the dose seemed to correspond with % of the size I cut.
> Emsam is a good AD. No sex side-effects, but need something really strong to help you sleep.
> Good luck.Thank you willful, I am on temazepam for sleep which is weak for me, but I haven't had any unusual difficulty sleeping at the 12mg dose. It is the best antidep I have ever tried, and that's saying a lot. What are you on now? If I may ask? I am feeling almost normal, just depressed some because of the circumstances I am in which are very stressful for me. The Emsam is working wonders keeping me on an even keel with what is happening in my life. And I am so grateful for it.
Love to you
Posted by former poster on February 13, 2014, at 9:41:47
In reply to Re: Emsam Questions, Dosage change 9-12, 12-15?, posted by Wasp on February 13, 2014, at 6:03:06
I'm in frigid northern Minnesota. Below zero for the last 3 months.
Emsam is one of the best AD's out there. Many people are having miraculous responses. Stimulant properties kick in on the first dose where its metabolized into a form of amphetamine. It's well tolerated at the 18 mg dose, but it made me tired. Maybe it was the lack of sleep? Older posts here say the serotonin effects kick in at higher doses. Perhaps a low dose of Trazodone will help with sleep?
Posted by Wasp on February 13, 2014, at 14:17:23
In reply to Re: Emsam Questions, Dosage change 9-12, 12-15? » Wasp, posted by former poster on February 13, 2014, at 9:41:47
> I'm in frigid northern Minnesota. Below zero for the last 3 months.
>
> Emsam is one of the best AD's out there. Many people are having miraculous responses. Stimulant properties kick in on the first dose where its metabolized into a form of amphetamine. It's well tolerated at the 18 mg dose, but it made me tired. Maybe it was the lack of sleep? Older posts here say the serotonin effects kick in at higher doses. Perhaps a low dose of Trazodone will help with sleep?
>Hi former poster, I thought you were Willful before, but you were just referring to them... sorry. Thanks for the reply!
It feels like a heatwave here to me...
Trazodone makes me manic. I have an energy deficit from Fibromyalgia and the Ensam is really helping with that and my really bad anxiety cuz I have Panic Disorder. It is cutting down my pain levels too.
Did you ever have the case where the amount of the dosage depended on the situations you found yourself in, or does it go one dosage no matter what, because I thought I was good, then got a lot of problems and now need to up the dose? Will I need to lower the dose when my problems go away? I am worried about serotonin syndrome because my doc still has me on Trileptal, but I've been fine so far.
Love to you
Posted by former poster on February 15, 2014, at 1:41:36
In reply to Re: Emsam Questions, Dosage change 9-12, 12-15?, posted by Wasp on February 13, 2014, at 14:17:23
Emsam seems to help with my chronic pain / fibro too. I'm not sure about the dose changing for the situation like you mentioned. Seems like when my situation got really bad was when I noticed how much it was helping. Keep in mind, it can take months to get the full effect. This is a characteristic of MAOI's. The longer you take it the better you will feel. Trileptal doesn't seem to interact with many meds. I wouldn't worry too much.
Posted by Wasp on February 15, 2014, at 10:55:59
In reply to Re: Emsam Questions, Dosage change 9-12, 12-15?, posted by former poster on February 15, 2014, at 1:41:36
> Emsam seems to help with my chronic pain / fibro too. I'm not sure about the dose changing for the situation like you mentioned. Seems like when my situation got really bad was when I noticed how much it was helping. Keep in mind, it can take months to get the full effect. This is a characteristic of MAOI's. The longer you take it the better you will feel. Trileptal doesn't seem to interact with many meds. I wouldn't worry too much.
Hey former poster! Thanks for trying to answer all of my questions. I really appreciate you taking the time and energy to do so. Yeah, the Ensam seems to be really helping my Fibromyalgia. I had very, very bad nights (equal to the birth of my son believe it or not) about once a week which are now once a month. And I was taking Celebrex on a regular schedule cuz I could count on evening pain, but now I am skipping some doses.
I saw my pdoc and she okayed cutting the patch after a thorough discussion of how to best keep it safe. I am on 15mgs, but have permission to go to 18 in about 6 weeks. She lowered the Trileptal because she is worried about serotonin syndrome, so we are both expecting a little mania, then we will back down to the proper dose. That is what we did with Cymbalta which was working, but gave me a constant, bad, unusual headache - took it until mania was looming then backed the dose down until it was feasible. She has only had patients with the Emsam patch up to 9mgs and one had the reaction, so she is nervous, but willing to experiment because it is doing so well.
She said 12mgs is the max according to the manufacturer. I always max out on meds and often need to go higher, like I was on 1k Seroquel until I became pre diabetic after a couple of years. It also seemed to accelerate the damage to my teeth from dry mouth at night which I have with the Ensam as well. That's slighty dry mouth which is not nearly so bad as the Seroquel dry mouth for me, and my other side effects are bad morning breath and ringing in my ears.
I took a depression scale inventory for her where up to ten was normal... I scored nine, but couldn't properly answer several questions about now compared to before I was depressed. I couldn't do them because I don't have that much experience with normal yet :p. But I am doing much better on the Emsam... I feel so much closer to normal. I remember to brush my teeth, and for the first time I can regularly check email and stuff like that, that was impossible before. I am not suffering, just sad. I am not always feeling like everything is impossible, I am just somewhat discouraged all of the time. Stuff like that. Getting so much closer though!!
Love to you!
Posted by Willful on February 16, 2014, at 10:39:49
In reply to Re: Emsam Questions, Dosage change 9-12, 12-15? » former poster, posted by Wasp on February 15, 2014, at 10:55:59
If you do take more than 9 mg and certainly if more than 12 mg, you should definitely go back to the food exclusions.
The food exclusions, which are not necessary at lower doses, are just as necessary at the higher doses of emsam as with other maois.
I imagine your doctor told you that, because you say she had a food reaction at 9 mg. That would be unusual, at least according to the FDA and the manufacturer-- although persumably it can happen if you eat enough tyramine.
But above that dose, everyone needs to be careful.
Posted by Wasp on February 17, 2014, at 3:03:00
In reply to Re: Emsam Questions, Dosage change 9-12, 12-15?, posted by Willful on February 16, 2014, at 10:39:49
> If you do take more than 9 mg and certainly if more than 12 mg, you should definitely go back to the food exclusions.
>
> The food exclusions, which are not necessary at lower doses, are just as necessary at the higher doses of emsam as with other maois.
>
> I imagine your doctor told you that, because you say she had a food reaction at 9 mg. That would be unusual, at least according to the FDA and the manufacturer-- although persumably it can happen if you eat enough tyramine.
>
> But above that dose, everyone needs to be careful.
>
>My doctor has been insisting on the diet even at the 6mg, so I just told her I was doing it. Thank you for that info... I was wondering how strict I needed to be now.
I take care of my father-in-law who is 93 and is always cold, so he always keeps the house shut up tight so there isn't any breeze and it gets rather hot, I live in Hawaii, so it's like spring and summer all year round, so I have been sweating off my patches.
I went to the drug store and asked at the pharmacy what would be a good tape to put on it, like the best waterproof tape. And I was told I have to use Tegaderm moisture barrier patches over it, because tape would "occlude" it and the medication would all be delivered at once.
That sounds like a disaster in the making and I wonder why I haven't heard of this before. I need to ask my doctor about it, but in the meantime I showed the person the online price, because at the drug store it costs $15 for 4 patches of the size I need to cover both patches! Outrageous!
That's around $100 a month.But online it's $27 for 50 patches of the same size, so much, much more reasonable. Have you heard anything about using tape on transdermal patches?
Love to you!
Posted by Willful on February 18, 2014, at 1:53:54
In reply to Re: Emsam Questions, Dosage change 9-12, 12-15?, posted by Wasp on February 17, 2014, at 3:03:00
I haven't heard anything about not using tape, and have used some tape on occasion around the edges to secure a patch that seemed not to be securely in place.
I notice that the manufacturer suggests that if a patch falls off, you should replace it, rather than reattaching the old patch; however this is different from using a little tape at the edges before it falls off.
I"m not sure if you pharmacist is correct; however if you do cover the entire patch, tegaderm probably is a good way to do it. I would definitely buy the online tape rather than in the drugstore. If it's much more reasonable in price and you're buying from a reputable seller, it seems just as likely to be good. But it always makes sense to ask your doctor about the occlusion issue. I saw nothing about it in a brief google search, but doctors do have a lot of information you can't get on the internet.
I personally think, based on what I read a few years ago when emsam was certified by the FDA, that your doctor is being awfully cautious. I would listen to her, but also go with your experience -- but always be careful.
But again, I"m not a doctor, just someone who has used emsam-- and it's important to note that everyone is somewhat different.
This is the end of the thread.
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