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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 77. This is the beginning of the thread.
Posted by jealibeanz on May 24, 2006, at 6:33:46
Has anyone been prescribed or told of EMSAM from a general practitioner? I know a lot of people on here see pdocs. I'd like to give it a try, but only see my GP.
Posted by yxibow on May 24, 2006, at 16:52:19
In reply to Are Family Doctors prescribing EMSAM?, posted by jealibeanz on May 24, 2006, at 6:33:46
> Has anyone been prescribed or told of EMSAM from a general practitioner? I know a lot of people on here see pdocs. I'd like to give it a try, but only see my GP.
I'd be precautious about any MAOI regime from a GP unless he/she has taken CE credits and knows about the effects of psychiatric medication, personally.
Posted by valene on May 24, 2006, at 19:52:29
In reply to Are Family Doctors prescribing EMSAM?, posted by jealibeanz on May 24, 2006, at 6:33:46
My pdoc prescribed my EMSAM and she also said that the insurance company is much more likely to approve a prescription from a psychiatrist than a GP.
Val> Has anyone been prescribed or told of EMSAM from a general practitioner? I know a lot of people on here see pdocs. I'd like to give it a try, but only see my GP.
Posted by jealibeanz on May 24, 2006, at 19:54:21
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by yxibow on May 24, 2006, at 16:52:19
Why is it more complex than SSRI's in terms of use? Doesn't the transdermal delivery lessen the concerns of side effects?
Posted by jealibeanz on May 24, 2006, at 19:59:26
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by valene on May 24, 2006, at 19:52:29
My insurance covers all prescriptions, on or off-label, for a $3-$5 copay, so that's no worry.
Posted by valene on May 24, 2006, at 20:02:59
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on May 24, 2006, at 19:59:26
You must have a great insurance plan then. Mine is BC/BS and there are three "tiers" - this being the highest will cost $25.00 but that's still cheap considering the cost of EMSAM w/o insurance is over $400. Best of luck to you.
Val> My insurance covers all prescriptions, on or off-label, for a $3-$5 copay, so that's no worry.
Posted by Phillipa on May 24, 2006, at 20:11:11
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by valene on May 24, 2006, at 20:02:59
EnSAM is over $400 a month vaies up and over the $500 mark. I don't think a copay from anyone but a pdoc who says it's the only med will pay for it. Love Phillipa
Posted by jealibeanz on May 24, 2006, at 21:55:08
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by Phillipa on May 24, 2006, at 20:11:11
Phillipa, why didn't you get your script? Has anyone else out there had experience with GP's and opinions of EMSAM?
Posted by Phillipa on May 24, 2006, at 21:56:42
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on May 24, 2006, at 21:55:08
Because he doesn't give you time to talk and I didn't write it down like an idiot. Love Phillipa
Posted by ZeitGuest on May 25, 2006, at 1:08:23
In reply to Are Family Doctors prescribing EMSAM?, posted by jealibeanz on May 24, 2006, at 6:33:46
I knew it wouldn't fly, but just for the heck of it I asked my general prac doc if he would consider prescribing EMSAM for me. He chuckled condescendingly and said that there was no way he was going to prescribe an MAOI. He did, however, offer to refer me to a pdoc.
Posted by jealibeanz on May 25, 2006, at 11:33:42
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Phillipa on May 24, 2006, at 21:56:42
I'm very surprised by these responses. I figured asking would be a stretch, but not out of the question by any means.
Posted by yxibow on May 25, 2006, at 23:03:12
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on May 24, 2006, at 19:54:21
> Why is it more complex than SSRI's in terms of use? Doesn't the transdermal delivery lessen the concerns of side effects?
Oh goodness its much more complex than SSRIs in terms of use. The transdermal delivery system only in the lowest dose barely lessens the concerns of MAOI effects. Only a psychiatrist who has had training and cases should be giving an MAOI. After the lowest dose, the risk rises to the level of a full on MAOI. These aren't things to be treated lightly, such as hypertensive crises that can, in some unfortunate circumstances, leave someone with a stroke, however unlikely, and I think I've argued my views, and others have on MAOIs -- that isn't the issue here -- its being versed on what is and what isnt a good risk with current and proper medical knowledge of MAOIs in general.
And as far as GPs writing scripts for SSRIs, even then, they should have had some CE credit training for psychiatric medications. Most all psychiatric medications affect what is known as the P450 system, the cytochromes that your liver processes a drug. Mixing the wrong P450 cytochromes could raise or lower the level of other medications in someone's body.
--tidings
Jay
Posted by Jakeman on May 25, 2006, at 23:55:24
In reply to Are Family Doctors prescribing EMSAM?, posted by jealibeanz on May 24, 2006, at 6:33:46
I suspect the Britol-Myers Squibb reps have not made all there rounds yet to all the GP's. They do a presentation and give a case of samples. After they get that info the response to patients may change. It's an old drug, just a different method of delivery.
warm regards, Jake
> Has anyone been prescribed or told of EMSAM from a general practitioner? I know a lot of people on here see pdocs. I'd like to give it a try, but only see my GP.
Posted by cecilia on May 26, 2006, at 1:18:05
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by yxibow on May 25, 2006, at 23:03:12
Do you really think most pdocs have the slightest clue what meds affect what P450 cytochromes? I guess I'm cynical, but I sure don't think so. Cecilia
Posted by jealibeanz on May 26, 2006, at 1:42:58
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by cecilia on May 26, 2006, at 1:18:05
I know that the cytochromes are part of the electron transport chain involved in the degradation of medications in the liver. Is this necessary when breaking down all medications, or just those that go through the GI tract? Does transdermal delivery avoid processing in the liver?
Posted by jealibeanz on May 26, 2006, at 11:03:25
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by Jakeman on May 25, 2006, at 23:55:24
Is ther a way to contant the company to see if they've begun to market toward GP's, or anyone for that matter through drug reps? I looked on the website for contant info, but couldn't find any.
Posted by Phillipa on May 26, 2006, at 19:47:44
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on May 26, 2006, at 1:42:58
From my understanding yes. Love Phillipa
Posted by yxibow on May 27, 2006, at 0:43:13
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on May 26, 2006, at 1:42:58
> I know that the cytochromes are part of the electron transport chain involved in the degradation of medications in the liver. Is this necessary when breaking down all medications, or just those that go through the GI tract? Does transdermal delivery avoid processing in the liver?
No, transdermal delivery does not avoid the processing of what, as was correctly noted, an older drug used in Parkinson's (Eldepryl, selegiline hydrochloride) often in combination with Sinemet (levodopa/carbidopa).
It is simply a different method of entry into your bloodstream. A number of medications and chemical substances can enter your bloodstream through your skin -- it is porous.
If you cover too much of your body with Benadryl or Ben-Gay creams you may reach a toxic level inside your system, as the medication goes through the layers of your skin, the outer always being dead, which protects us from some substances being harmful, but not all.
Once the drug is in your bloodstream, it will eventually be metabolized by your liver (or in the case of certain, fewer medications, that bypass the liver route and go through your kidneys, such as Serax -- often through a process known as glucuronidation.)
And as for psychiatrists knowing P450 -- if they dont, they're in serious jeapordy of their license.Its a basic principle -- but I agree, if you are "old school" you may not have been taught all the intricacies which are now routinely taught in medical school, and which if you read a drug monograph or as we call it in the US, a PI, or prescribing information, they will list testing for cytochromes.
This wasn't done routinely until the last decade because the knowledge wasn't out there -- as one who takes polypharmacy (multiple medications), I've had a few curveballs with mixing modern medications with older ones and having to adjust to avoid things like serotonin syndrome.
Posted by jealibeanz on May 27, 2006, at 6:07:32
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by yxibow on May 27, 2006, at 0:43:13
Right, OK, drugs have to be broken down in the liver when enyering the bloodstream. However, they avoid the stomach. Would this decrease the likelihood of weight gain? Where does insulin come in to play? Does EMSAM involve histamine blockers like the SSRIs/SNRIs (which could be a reason for my weight problems in addition to serotonin, right?)?
Posted by pulse on May 27, 2006, at 15:08:59
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on May 27, 2006, at 6:07:32
sorry, but Emsam does NOT avoid the gut, far a GI problems. the pharmacist i dislike, of the 2 at my regular drugstore, was right, for once, when he predicted this could - and did happen - to me. oh, boy, did it ever!
another pharmacist at a compounding pharmacy that i'd switched to for a better price on emsam, said same: of course, Emsam thru bloodstream only, can still cause GI problems. i sincerely hope this applies to GI problems/ meds intolerant (not treatment resistant) folks like me - only.
pulse
Posted by pulse on May 27, 2006, at 15:18:04
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by pulse on May 27, 2006, at 15:08:59
forgot to add that yes, my gp (actually an allergy specialist) did (somewhat begrudgingly) prescribe Emsam for me. he has 300 psych. patients, as we have next to no competent p-docs here (revise that to none, imo, at least). he has done much volunteer work at a transitional living place for the seriously mentally ill, so he does know his stuff. he will also work in conjunction with my therapist. all in all, a very good support system.. for me.
sorry, i can't address your questions on weight, insulin, etc.
pulse
Posted by jealibeanz on May 27, 2006, at 19:01:15
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by pulse on May 27, 2006, at 15:08:59
Well then, I don't understand the advantage of transdermal vs. oral selegiline.
Posted by Phillipa on May 27, 2006, at 19:38:11
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on May 27, 2006, at 19:01:15
Me either I thought it avoided all that mess? Love Phillipa and the high cost for what!!!!!!!
Posted by Iansf on May 27, 2006, at 19:42:07
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by pulse on May 27, 2006, at 15:08:59
Pulse,
You mention getting a better price through a compounding pharmacy. Can you say more about this? Does the compounding pharmacist simply take selegiline and put it onto skin patches of some sort? How much cheaper is it? Thanks.
Ian> sorry, but Emsam does NOT avoid the gut, far a GI problems. the pharmacist i dislike, of the 2 at my regular drugstore, was right, for once, when he predicted this could - and did happen - to me. oh, boy, did it ever!
>
> another pharmacist at a compounding pharmacy that i'd switched to for a better price on emsam, said same: of course, Emsam thru bloodstream only, can still cause GI problems. i sincerely hope this applies to GI problems/ meds intolerant (not treatment resistant) folks like me - only.
>
> pulse
Posted by jealibeanz on May 27, 2006, at 19:42:25
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Phillipa on May 27, 2006, at 19:38:11
This doesn't make much sense to me. Surely, the patch was not created to people could wear a sticker instead of swallowing a pill.
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