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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 21 to 45 of 65. Go back in thread:
Posted by laima on July 21, 2006, at 15:14:20
In reply to Re: emsam 6 mg/24 = ? oral selegiline?, posted by Declan on July 14, 2006, at 1:51:12
I'm utterly confused about the dosing. Emsam 6 did nothing for me; today I saw my doctor, who just came back from an EMSAM conference where he heard that a lot of people don't get much relief from the 6. So I am going up to "9" as soon as the pharmacy gets it in. Then he mentioned that the "9" is approximately equal to 60-90 mg of the oral???? Anyone out there move up? Did you notice a huge change?
Posted by laima on July 21, 2006, at 15:39:23
In reply to Re: emsam 6 mg/24 = ? oral selegiline?, posted by SLS on July 9, 2006, at 11:03:49
Here's part of my confusion too- if 20mg is the total amount of the drug in the 6/24 patch, why is that not the dose? Ie., why is the dose not known as "20 mg."? Is it not all absorbed over 24 hours? What's with the "6"? Or is this topic so abstract that only a chemist can understand? I just posted on another message in this thread- I have just been raised to the 9/24 patch, and my doctor told me it's roughly equal to 60-90 mg of the pills and a major step up from the "6" patch. I don't get it. He just got back from an EMSAM conference and expertly went on about EMSAM's superior absorption efficiency... So while I wait for my pharmacy to get the 9's in, I wonder if I can or should cut my 6's in half and wear a 6 plus half of a six to equal 9? I wonder if that would be accurate. Whatever, I'll only have to wait for a day or two for the 9's, so maybe I'll just hold off lest I do something really drastic by accident.
> I think the 20mg refers to the total amount of selegiline contained in the patch.
>
>
> - Scott
Posted by laima on July 21, 2006, at 15:58:06
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » willyee, posted by Jakeman on May 18, 2006, at 21:58:29
Dear Jakeman,A teaching doctor affiliated with a university or medical school might be a good bet- they are required to keep up with the latest research to keep their positions, and have a rep of being interested in being the first to know of all the latest available treatments. They discuss everything with their colleagues, and write articles for journals. They also have a rep of being inquisitive and open-minded. I feel very fortunate to have such a doctor- he's a professor, always going to conferences and his office is always strewn with all kinds of medical journals and articles about treatments. One thing I can say, he sure understands we are all different, the finer details of our disorders vary, that not much is simple, and that the same treatment does not fit everyone. He's also not afraid to use drugs in less than conventional ways.
In the past I had a doctor who was not affiliated with teaching, and while a great, smart guy, he seemed ok to dole out the same extolled ssri to everyone, as per conventional wisdom, and with few questions. He seemed to miss nuances about subtypes of depression, and appeared confused when treatment failed. Just kept raising that dose...When utterly at wit's end, he sent me to the aforementioned specialist for a consultation, and this new doctor deduced that I do not agree with ssris (as they can sometimes appparently exasperate sleep problems-making depression worse) and he devised a very different, and far more effective program for me.
If there is no med school hospital anywhere near you, I can tell you that I have a friend who went to Mayo once, and she was thrilled with her experience with the doctors there. She reported that they really "thought outside the box" in an interdisciplinary way.
Very good luck to you, be well.
> > Where do u guys have these doctors who know about these unconventional drugs like oral deprenyl.......prior to the patch i could forget about a doc knowing about deprenyl,or molcimide,or gervitol,or any unconventional drug that isnt main stream us drug,these r the reasons im forced to play doc on my own cause the real docs dont bring things to the table!
>
>
Posted by jealibeanz on July 21, 2006, at 17:57:38
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » Jakeman, posted by laima on July 21, 2006, at 15:58:06
Does your doctor seem to have a positive opinion of EMSAM, or think it's mostly hype?
Posted by laima on July 21, 2006, at 18:53:56
In reply to Re: emsam 6 mg/24 = ? oral selegiline?, posted by jealibeanz on July 21, 2006, at 17:57:38
> Does your doctor seem to have a positive opinion of EMSAM, or think it's mostly hype?Well, he's a med-school affiliated researcher, and has that nonreactive way about him that you might imagine a researcher would have. I do know he consulted with the pharmaceutical company as they developed the drug, and is giving them loads of feedback now, passed along from his patients. I am positive he isn't the only doctor in their circle doing so. I passed on my concerns about how I don't think it's sticky enough, and he put me right on the phone with them and they will be sending me a more detailed questionaire. The lady I talked to seemed very concerned (?).
Overall, I think he has high hopes but knows we are still in the early stages of the drug's use. I get the impression that the company is taking all comments very seriously and that they may try to make improvements to make it easier to use.
Today (being on the 6) I asked, "should I just go back to the pills", and he said "no!" The patch is believed to be much more efficient in terms of getting to the brain, and at the EMSAM conference he just attended there apparently was much talk about how the 6 is simply too weak for most patients. The 9 of course is dicier diet-wise--but still not nearly as dangerous as the pills. He conveyed, "be careful what you eat while on the 9, but if you slip up, it won't be the same level of danger as if you were on the pills".
Overall, I think he shares our hopes, but comprehends improvements and tweaks are needed. This seems reasonable, it's such a new concept. And me, I hope he's right about the dosage and that the 9 provides the relief I am desperate for! I read between the lines---Big push with the 6 involved the fact it didn't really require any dietary restrictions- a big selling point- whereas the 9 and up do require cautions. An MAOI with no dietary restrictions at all- isn't that what so many of us got so excited about? That total diet freedom might not be reality for many of us yet, alas. Maybe one day, hopefully? Perhaps some of the "diet freedom" then is hype. Massive bummer. I am also told to not let up on being careful with any medications that could interact with an MAOI, even on the 6--because no one seems to know for sure what could happen. Obviously they didn't test people for that, and the incidental reports haven't poured in yet.
Back to the point, I think his opinion is overall positive and quite hopeful. The patch is believed to offer a more efficient delivery to the brain, and to be safer diet-wise. The recent conference sounds as though doctors in attendence were overall positive and enthusiastic. One of them apparently has treated over 150 patients with EMSAM successfully- though most didn't respond until they got 9 or higher. It's still so new though there are many unknowns.
Anyone else have a doctor who went to this recent event? Would be interesting to hear what they had to say...
Posted by jealibeanz on July 21, 2006, at 19:56:47
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » jealibeanz, posted by laima on July 21, 2006, at 18:53:56
I'm surprised they had an entire conference devoted to EMSAM. I wonder if that's common. I've never heard of such a thing. You're lucky to have such an open-minded and informed doctor. Is he a general practitioner or a psychiatrist?
It's good to hear that actual physicians have positive experiences to report. We've heard a great deal of negatives on this message board, but that's probably because the people who are doing well are out living and not searching for something else to help relieve the depression.
That makes sense that the 6mg is too low, but is still being produced. They were probably just desperate to have a dosage which could definitely be marketed as not requiring dietary restriction. I've never found any of the studies that differentiates between the efficacy of the 3 dosages. Maybe they were trying to hide the fact that 6 mg isn't so great. Nonetheless, it can be used as a stepping stone to 9 or 12 mg. Do you know if any discussion has been made about going higher than 12?
I don't see much problem with the diet though. There's really nothing I personally have to avoid, except tap beer, but bottled is OK, which I prefer anyway. The rest of the foods are rather odd... pickled meat, ect. I realize some people will have to give up aged cheese, but at least pizza is still alright!
Do you have any side effects to report? I'm sure there will be many that will be coming in within the next year or so. That's why I question whether my doctor (a GP) would ever consider prescribing this, if he;s even aware of the drug (he should be, right?) unless I begged. It's not that he's one of the docs who's paranoid about being sued for malpractice (especially by me), he just wouldn't want to hurt me or cause any further discomfort (because I have a lot right now!) in my life.
Posted by laima on July 22, 2006, at 9:40:07
In reply to Re: emsam 6 mg/24 = ? oral selegiline?, posted by jealibeanz on July 21, 2006, at 19:56:47
I just tried to reply, wrote a long response, but hit a wrong button and deleted it- so please forgive if I am repeating myself here is this slightly shorter response.
Yes!! Recent ENSAM Conference. I think it was attended by psychiatrists and drug rersearchers and the company who manufactures EMSAM. I understand there were presentations and then the various doctors stood up to share their clinical observations and reports from patients. One important consensis that came up is that it seems that the 6 is simply too low of a dose to benefit most people. One doctor reported that he succesfully treated 150 people with the 9 and the 12. Good news: company apparently took loads of notes on what the doctors were reporting.
I will be switching to the 9, which unfortunately will require dietary cautions and restrictions. I suspect the 6 was so heavily touted precisely because it doesn't require the strict restrictions, but alas some of the freedom supposedly offered by EMSAM apparently isn't turning out to be exactly true in real practice. I think many people might feel let down by this reality. Regardless, the higher dose patches are still said to be safer than the oral pills in case one slightly goofs with their diet. The 9 is said to be roughly equal to 60-90mg of the oral.
My doctor is a psychopharmacologist (psychiatrist who specializes in drugs) and is affiliated with a med school- I guess that's why he's so up on this stuff.
I didn't experience any side effects with the 6- nothing. I think it wqas utterly ineffective for me. This 9 is said to be far more potent, so i'll see how it goes. As for going back to pills- I'm told that all strengths of the patches are safer than the pills, and are far more effective in reaching the brain eficiently. My doctor believes it is a superior product.
Perhaps your gp hasn't heard much about EMSAM yet? It's so new, after all. Are you able to try to find a psychiatrist who might me more informed?
> I'm surprised they had an entire conference devoted to EMSAM. I wonder if that's common. I've never heard of such a thing. You're lucky to have such an open-minded and informed doctor. Is he a general practitioner or a psychiatrist?
>
> It's good to hear that actual physicians have positive experiences to report. We've heard a great deal of negatives on this message board, but that's probably because the people who are doing well are out living and not searching for something else to help relieve the depression.
>
> That makes sense that the 6mg is too low, but is still being produced. They were probably just desperate to have a dosage which could definitely be marketed as not requiring dietary restriction. I've never found any of the studies that differentiates between the efficacy of the 3 dosages. Maybe they were trying to hide the fact that 6 mg isn't so great. Nonetheless, it can be used as a stepping stone to 9 or 12 mg. Do you know if any discussion has been made about going higher than 12?
>
> I don't see much problem with the diet though. There's really nothing I personally have to avoid, except tap beer, but bottled is OK, which I prefer anyway. The rest of the foods are rather odd... pickled meat, ect. I realize some people will have to give up aged cheese, but at least pizza is still alright!
>
> Do you have any side effects to report? I'm sure there will be many that will be coming in within the next year or so. That's why I question whether my doctor (a GP) would ever consider prescribing this, if he;s even aware of the drug (he should be, right?) unless I begged. It's not that he's one of the docs who's paranoid about being sued for malpractice (especially by me), he just wouldn't want to hurt me or cause any further discomfort (because I have a lot right now!) in my life.
Posted by SLS on July 22, 2006, at 11:29:20
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » jealibeanz, posted by laima on July 22, 2006, at 9:40:07
Posted by laima on July 22, 2006, at 11:49:46
In reply to Re: emsam 6 mg/24 = ? oral selegiline? - Thanks. (nm) » laima, posted by SLS on July 22, 2006, at 11:29:20
I hope I don't seem stupid- but do you mean thanks for the post? I got a bit carried away there due to excitement, and don't know yet what "nm" means.
Thanks.
Posted by SLS on July 22, 2006, at 12:07:21
In reply to Re: emsam 6 mg/24 = ? oral selegiline? - Thanks. » SLS, posted by laima on July 22, 2006, at 11:49:46
> I hope I don't seem stupid- but do you mean thanks for the post? I got a bit carried away there due to excitement, and don't know yet what "nm" means.
>
> Thanks.(nm) = No Message
I was thanking you for the information you provided regarding Emsam 9mg/24 = 60-90mg oral selegiline. I guess I should have made that clear. I was just being lazy.
:-)
- Scott
Posted by jealibeanz on July 22, 2006, at 13:50:56
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » jealibeanz, posted by laima on July 22, 2006, at 9:40:07
I haven't asked my doctor if he's heard of it, just wondering what the likelihood would be that he at least knows of the name and what it is. I'm sure he isn't following any reports, because there really aren't any publications of clinical use. No, I don't have access to a psychiatrist. I found one, had a terrible experience. He was the only I was able to see.
Posted by mayzee on July 22, 2006, at 16:26:33
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » SLS, posted by laima on July 21, 2006, at 15:39:23
> So while I wait for my pharmacy to get the 9's in, I wonder if I can or should cut my 6's in half and wear a 6 plus half of a six to equal 9? I wonder if that would be accurate. >
>Hi, not sure if anyone else replied to you about this, but I am using 1 1/2 6mg patches to get to 9mg. ...because I was given a big batch of 6mg samples for free and they don't have any 9mg samples to give out. (I don't have insurance to cover it)
If anyone knows any reason this would be a problem, please let me know!
Thanks,
mayzee
Posted by laima on July 22, 2006, at 17:44:46
In reply to Re: emsam 6 mg/24 = ? oral selegiline? - Thanks. » laima, posted by SLS on July 22, 2006, at 12:07:21
Oh no, not lazy at all! I'm simply just not up on all the lingo yet; there seems to be a lot to learn and keep track of around here. Thanks for your response and for your explaining!> > I hope I don't seem stupid- but do you mean thanks for the post? I got a bit carried away there due to excitement, and don't know yet what "nm" means.
> >
> > Thanks.
>
> (nm) = No Message
>
> I was thanking you for the information you provided regarding Emsam 9mg/24 = 60-90mg oral selegiline. I guess I should have made that clear. I was just being lazy.
>
> :-)
>
>
> - Scott
Posted by laima on July 22, 2006, at 17:51:46
In reply to Re: emsam 6 mg/24 = ? oral selegiline?, posted by jealibeanz on July 22, 2006, at 13:50:56
Oh. I'm sorry to hear of your experience. I think a lot of us have had some less than ideal encounters with some psychiatrists. (Whew! I sure have...) They're not all bad, though.Initially, just about 6 weeks ago, no one at my pharmacy had heard of EMSAM, and my script bewildered them. They had to special order it. But they've since reported that they attended a seminar, and they are all very interested and excited. So the good news is that the company seems to be on a huge publicity/education blitz, and more and more is turning up in the media about it. It IS a very new and novel treatment, after all. Hopefully if your doctor doesn't know about it yet, he or she soon will. What if you found something in the media by google and brought it in? Or something off the manufacturer's website? (I think-Glaxo Kline Smith (?)) Good luck.
> I haven't asked my doctor if he's heard of it, just wondering what the likelihood would be that he at least knows of the name and what it is. I'm sure he isn't following any reports, because there really aren't any publications of clinical use. No, I don't have access to a psychiatrist. I found one, had a terrible experience. He was the only I was able to see.
Posted by Jost on July 22, 2006, at 17:54:37
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » SLS, posted by laima on July 21, 2006, at 15:39:23
> So while I wait for my pharmacy to get the 9's in, I wonder if I can or should cut my 6's in half and wear a 6 plus half of a six to equal 9? I wonder if that would be accurate. Whatever, I'll only have to wait for a day or two for the 9's, so maybe I'll just hold off lest I do something really drastic by accident.
>
>
> >
>
>You can definitely cut the 6 in half and use it with another 6, to get 9.
Both my pdoc, and those of other people here have said it's fine to do so.
Also, as you might be aware, there's some evidence that the food restrictions either don't apply, or don't apply very much even with 9 and 12 mg.
There are some other threads where people have been experimenting successfully with disallowed foods. On the other hand, it's good to test with small amounts, until the definitive results are in-- or are in and are formally accepted.
If you check the tyramine challenges that they did, even large amounts of tyramine=rich foods didn't create any tyramine reaction for those with larger doses. But the FDA wants to be careful, so that's where it stands.
The drug interactions are a different story, and there you do have to be careful.
Jost
Posted by jealibeanz on July 22, 2006, at 18:10:55
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » jealibeanz, posted by laima on July 22, 2006, at 17:51:46
I would assume that doctors are aware of new FDA approvals, however, I'm not certain of how every physician practices. He's fairly young and very energetic, so it's not like he's set in his ways.
Do you mean the pharmacists attended a conference? What region of the country are you located in?
Posted by laima on July 22, 2006, at 18:31:03
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » laima, posted by mayzee on July 22, 2006, at 16:26:33
Clueless- all know is that it suddenly seems like the dosing is so complex hardly anyone comprehends it. Is this practice of cutting up 6's working out for you? I'll do the same if you and others have found it to be safe and accurate...I've got a lot of 6's left, and they ARE expensive-even with insurance!
> > So while I wait for my pharmacy to get the 9's in, I wonder if I can or should cut my 6's in half and wear a 6 plus half of a six to equal 9? I wonder if that would be accurate. >
> >
>
> Hi, not sure if anyone else replied to you about this, but I am using 1 1/2 6mg patches to get to 9mg. ...because I was given a big batch of 6mg samples for free and they don't have any 9mg samples to give out. (I don't have insurance to cover it)
>
> If anyone knows any reason this would be a problem, please let me know!
>
> Thanks,
> mayzee
Posted by laima on July 22, 2006, at 18:37:05
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » laima, posted by Jost on July 22, 2006, at 17:54:37
There's so much conflicting info out there about EMSAM! Very confusing. If people have found that the dietary restrictions with the 9 and 12 are exaggerated, maybe that's the drug company and doctors being hyper-cautious??? I'm gonna go check out those threads you refer to. Thank you.> > So while I wait for my pharmacy to get the 9's in, I wonder if I can or should cut my 6's in half and wear a 6 plus half of a six to equal 9? I wonder if that would be accurate. Whatever, I'll only have to wait for a day or two for the 9's, so maybe I'll just hold off lest I do something really drastic by accident.
> >
> >
> > >
> >
> >
>
> You can definitely cut the 6 in half and use it with another 6, to get 9.
>
> Both my pdoc, and those of other people here have said it's fine to do so.
>
> Also, as you might be aware, there's some evidence that the food restrictions either don't apply, or don't apply very much even with 9 and 12 mg.
>
> There are some other threads where people have been experimenting successfully with disallowed foods. On the other hand, it's good to test with small amounts, until the definitive results are in-- or are in and are formally accepted.
>
> If you check the tyramine challenges that they did, even large amounts of tyramine=rich foods didn't create any tyramine reaction for those with larger doses. But the FDA wants to be careful, so that's where it stands.
>
> The drug interactions are a different story, and there you do have to be careful.
>
> Jost
Posted by laima on July 22, 2006, at 18:39:54
In reply to Re: emsam 6 mg/24 = ? oral selegiline?, posted by jealibeanz on July 22, 2006, at 18:10:55
One would sure HOPE doctors keep up on new approvals!!!I live in Chicago, and the pharmacists at my pharmacy attended some kind of educational seminar about EMSAM shortly after it was approved. My Doctor, on the other hand, attended a full-blown conference.
> I would assume that doctors are aware of new FDA approvals, however, I'm not certain of how every physician practices. He's fairly young and very energetic, so it's not like he's set in his ways.
>
> Do you mean the pharmacists attended a conference? What region of the country are you located in?
Posted by jealibeanz on July 22, 2006, at 18:52:22
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » jealibeanz, posted by laima on July 22, 2006, at 18:39:54
Was the conference in your area?
Posted by laima on July 22, 2006, at 19:17:42
In reply to Re: emsam 6 mg/24 = ? oral selegiline?, posted by jealibeanz on July 22, 2006, at 18:52:22
> Was the conference in your area?
Clueless. I get the impression it was a national event, though.
I might add, after thinking about recent posts, that even these so-called expert doctors appear to be a tad confused, just like us. I wonder if that was an inspiration for such a conference to even be held.
Posted by jealibeanz on July 22, 2006, at 19:26:42
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » jealibeanz, posted by laima on July 22, 2006, at 19:17:42
I was just wondering if it were something that was widely advertised. Confusion? Oh no! Not a good thing. Maybe I'll just settle for an SSRI, which I'm sure I'll end up hating b/c of side effects.
Posted by mayzee on July 22, 2006, at 21:19:20
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » mayzee, posted by laima on July 22, 2006, at 18:31:03
>
> Is this practice of cutting up 6's working out for you? I'll do the same if you and others have found it to be safe and accurate...
>Seems to be working fine for me. Safe, yes. "accurate"? who knows?!
In going up to the higher dose I got a rebound on some of the side effects I'd had when starting at 6 (insomnia, GI distress).
I seem to have more orthostatic hypotension at 9mg; feel more spacey at times. I guess I should get a blood pressure monitor as I tend to have low bp anyway.
But I also seem to be starting to feel better at this dose too (knock wood) I'm in my 2nd week at 9mg, and just a few days ago started to notice an improvement. (I'm scared I'll jinx it!)Best of luck to you with it!!!
Posted by Jost on July 22, 2006, at 22:45:57
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » Jost, posted by laima on July 22, 2006, at 18:37:05
Laima, this is a powerpoint demonstration given to the FDA by Somerset, which describes the tyramine challenges and the reactions on those taking parnate vs emsam.
if the link doesn't work, I always find it by searching on google for "Lawrence Blob" the MD who made the presentation for Somerset.
www.fda.gov/ohrms/dockets/ac/05/slides/2005-4186S2_03_Somerset-EMSAM.ppt
Jost
Posted by laima on July 23, 2006, at 8:53:52
In reply to Re: emsam 6 mg/24 = ? oral selegiline?, posted by jealibeanz on July 22, 2006, at 19:26:42
I doubt it was heavily advertised- if you mean the conference I recently heard about. I got the impression it was specifically targeted to certain psychiatrists, only- meaning- those who specialize in drug research. Definately not open to us in the public or to other doctors. I think the company had an interest in getting feedback from people they considered experts (?). I think it was also quite academic. My doctor, who attended, is a medical professor and specializes in drugs, drug chemistry, etc. He consults and gives feedback to the companies as they develope new drugs. I'm sure that is why he was there.
As for my pharmacists- they made it sound like the EMSAM folks are going around trying to do an education blitz for pharmacists- so very likely your pharmacists will get this chance, too. I think the company is acknowlegeing that loads of people, even pharmacists, are uttery confused.
I do think it would be nice of the company to do more education to help us regular people figure out this confusing medication, Itotally agree with that. And I think they should have sessions for ordinary or more general psychiatrists and doctors- i bet they will.
On the positive side- they appear to be acknowledging our general mass confusion, and to be on a campaign to address it. I haven't checked their website, but i wonder if they might not have a feedback form somewhere there. I can tell you when my enthusiastic doctor put me on the phone with them, they were beside themselves to hear what I had to say about EMSAM, what my opinions were, all in excruciating detail. AND they have put a questionaire in the mail, which I am expecting soon, for even more feedback. I'm not special- I bet they will listen to any of us. We just need to find the channel.
As for confusion, what i gather from reading everyone's posts and from what i heard at the doctor's office- most of it seems to revolve around what on earth the doses mean, and are certain foods ok or not on the diffrent doses.
Oh ssris- easy, sure. If they work for you-lucky you. Prozac was a miracle for me once until it utterly "pooped out" after approximately 10 years. No ssri has ever worked for me ever again. Nor has any other anti-depresswent I ever tried. Scary. Did something happen to my brain? Is it because my depression can be described as "atypical" and ssris not famous for being super helpful with that?? I know I could be headed for a similar scenario with EMSAM- but I don't know if I have much choice.
> I was just wondering if it were something that was widely advertised. Confusion? Oh no! Not a good thing. Maybe I'll just settle for an SSRI, which I'm sure I'll end up hating b/c of side effects.
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