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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by aabag on July 12, 2006, at 15:03:57
Hello all,
Wanted to report EMSAM progress after 80 or so days. Still doing well on EMSAM (have bumped up from 6mg to 9mg ) and have also augmented with some L-phenylalanine (500mg x3) on an empty stomach. LPA is an amino acid you normally get from food. The augmentation with LPA is definitely a mood brightener. The basis for this idea was the a couple small studies done with selegiline in combination with LPA on an empty stomach (one of them added B6).
Posted by jealibeanz on July 12, 2006, at 20:04:37
In reply to EMSAM @ 80 days, posted by aabag on July 12, 2006, at 15:03:57
do you have any sleep problems or other side effects?
Posted by Phillipa on July 12, 2006, at 21:39:45
In reply to Re: EMSAM @ 80 days, posted by jealibeanz on July 12, 2006, at 20:04:37
So glad to hear a success story. Love Phillipa
Posted by aabag on July 16, 2006, at 12:22:54
In reply to Re: EMSAM @ 80 days, posted by jealibeanz on July 12, 2006, at 20:04:37
> do you have any sleep problems or other side effects?
That is the one problem I do have, sleep. Basically, for that, I just remove the patch at night and go to bed. Otherwise, my mind is over-active. I did try the 1/2 patch approach for the entire 24 hours x 5 days, just to see what it felt like, and there is really not a sleep issue with that amount, while with the 9mg/30cm2 patch, its more of an issue. But for myself, the 1/2 patch was not as effective as the 6mg/20cm2 or 9mg/30cm2.
Nevertheless, this is the first antidepressant that's worked for me beyond the "hey something feels different" hopeful placebo phase. Sleep management hasn't been the easiest (but at least its possible due to the transdermal application).
I find it quite interesting that the positive responses vary from 3mg up to 12mg (1/2 patch 6mg patch up to 12mg patch).
Posted by jealibeanz on July 16, 2006, at 14:32:24
In reply to Re: EMSAM @ 80 days, posted by aabag on July 16, 2006, at 12:22:54
Do you plan on moving up to 12 mg? Do you take anything for sleep, or does removing the patch provide enough help? Are you taking any other medications?
Posted by aabag on July 22, 2006, at 16:46:59
In reply to Re: EMSAM @ 80 days, posted by jealibeanz on July 16, 2006, at 14:32:24
No, I don't plan on moving up to 12. I got an interesting follow up post regarding an EMSAM conference indicating 9-12 were relatively more efficacious. For me, 9 is certainly better than 6 or 3 (1/2 of the 6 patch).
As for sleep, its an interesting dichotomy, 9 absolutely helps during the day. Its been 90 days now since I began EMSAM, so the placebo effect is ruled out by now. Nevertheless, 9 seems to inhibit sleep, and without sleep, no amount of anti-depressant this or that will help. So, I have been taking off the patch at night (around 9pm or so). I will continue to "tune" the timing and amount for sleep, but other than that, EMASM has been a godsend.
I've been on .5 to .75 Klonopin before starting EMSAM, which has not changed.
Posted by jealibeanz on July 22, 2006, at 17:01:49
In reply to Re: EMSAM @ 80 days, posted by aabag on July 22, 2006, at 16:46:59
Did they mention the sleeping problems at the conference? Since you're taking it off at night, does that mean you have unsteady levels of the medication in your bloodstream at night and in the morning?
Posted by aabag on July 23, 2006, at 12:39:38
In reply to Re: EMSAM @ 80 days, posted by jealibeanz on July 22, 2006, at 17:01:49
I didn't actually attend any conference. An an aside, I'd love to find the PDF notes of the conference, since I basically "sold" my pdoc on allowing my a trial of EMSAM, and he is now starting others based on the success in my case. As for the conference regarding EMSAM, I was referring to the following post: http://www.dr-bob.org/babble/20060717/msgs/669325.html
I believe it was acknowledged therein that insomnia was an issue of significance.
And yes, to your question of selegiline "levels", there would be unsteady levels of medication by patch removal or reduction at night, but at least you control that. That's why I like this transdermal approach so much, you can actually tweak it to match your situation.
This is the end of the thread.
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