Psycho-Babble Medication Thread 630549

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Re: EMSAM - First Day -- what to try for insomnia?

Posted by mayzee on July 19, 2006, at 9:12:31

In reply to Re: EMSAM - First Day, posted by SLS on July 19, 2006, at 6:08:31

Since hypersomnia has always been my problem, this insomnia thing is totally new to me. I've never taken any kind of sleep aid.

What would be the first thing to try?

My problem is that I'm now waking up 4-6 times a night. Usually I can fall back to sleep, but my sleep is very restless. Also, I feel tired during the day, but then more alert/awake at bedtime so I end up staying up too late; not having enough sleep time. (When I first started on 6mg, and since I upped to 9mg, I've had more nights when I had a lot of trouble falling asleep or back to sleep, but I think that will wear off like it did after a few weeks on 6mg)

 

Re: EMSAM - First Day -- what to try for insomnia? mayzee

Posted by SFY on July 19, 2006, at 12:21:02

In reply to Re: EMSAM - First Day -- what to try for insomnia?, posted by mayzee on July 19, 2006, at 9:12:31

> Since hypersomnia has always been my problem, this insomnia thing is totally new to me. I've never taken any kind of sleep aid.
>
> What would be the first thing to try?
>
> My problem is that I'm now waking up 4-6 times a night. Usually I can fall back to sleep, but my sleep is very restless. Also, I feel tired during the day, but then more alert/awake at bedtime so I end up staying up too late; not having enough sleep time. (When I first started on 6mg, and since I upped to 9mg, I've had more nights when I had a lot of trouble falling asleep or back to sleep, but I think that will wear off like it did after a few weeks on 6mg)

Some people have found relief from insomnia by taking the patch off at night. I've been taking generic Benadryl (diphenhydramine) for my early morning awakening issues. I believe others have found success with Seroquel.

 

Re: EMSAM - First Day -- what to try for insomnia?

Posted by Phillipa on July 19, 2006, at 19:57:12

In reply to Re: EMSAM - First Day -- what to try for insomnia? mayzee, posted by SFY on July 19, 2006, at 12:21:02

Robert David uses two mg of klonopin for sleep. Love Phillipa

 

Re: EMSAM - First Day -- what to try for insomnia? SFY

Posted by mayzee on July 20, 2006, at 12:24:59

In reply to Re: EMSAM - First Day -- what to try for insomnia? mayzee, posted by SFY on July 19, 2006, at 12:21:02

SFY, Thanks for your reply.

Is it OK to take Benadryl with EMSAM? For some reason I thought that was a no no.

I've read posts about Seroquel success, I just thought that might not be a good first choice; that there might be other less heavy duty (less scary to me) things to try first.

Thanks,
mayzee


>
> Some people have found relief from insomnia by taking the patch off at night. I've been taking generic Benadryl (diphenhydramine) for my early morning awakening issues. I believe others have found success with Seroquel.
>

 

Re: EMSAM - First Day -- what to try for insomnia? Phillipa

Posted by mayzee on July 20, 2006, at 12:35:39

In reply to Re: EMSAM - First Day -- what to try for insomnia?, posted by Phillipa on July 19, 2006, at 19:57:12

Would that be a good first thing to try for help with sleep? I thought that Robert David used klonopin for anxiety, but I may be wrong.

I wondered if I'd be better off trying one of the drugs that are specifically targeted for sleep problems first (ambien? lunesta? I only know about them from the advertisements). I guess like everything, everyone has their own reaction and this would be another trial & error thing.

I am a scaredy cat re. taking drugs and I hate the idea of having to take a drug to treat a drug-induced side effect. But today is the 3rd day in a row that I'm feeling a little bit better (knock wood) so if EMSAM turns out to be the AD that actually works for me, I expect I'll be ready to take a sleep aid if necessary.

Thanks for your reply!

mayzee


> Robert David uses two mg of klonopin for sleep. Love Phillipa

 

Re: EMSAM - First Day -- what to try for insomnia?

Posted by RobertDavid on July 20, 2006, at 13:09:18

In reply to Re: EMSAM - First Day -- what to try for insomnia? Phillipa, posted by mayzee on July 20, 2006, at 12:35:39

> Would that be a good first thing to try for help with sleep? I thought that Robert David used klonopin for anxiety, but I may be wrong.
>

I take klonopin for SAD, however I have no doubt it helps with sleep and probably some of the side effects others feel from EMSAM such as agitation.

To sleep better at least until your body adjusts I'd recommend going with lunests, ambien, restoril, seroquel, benedryl, a benzo, whatever works best for you. It's trial and error.

In time you may find you can take less and less of the sleeping aids and perhaps get all the way off them. I no longer need any, though I take the patch off at night. Good luck everyone!

 

Re: EMSAM - First Day -- what to try for insomnia? mayzee

Posted by SFY on July 20, 2006, at 13:51:19

In reply to Re: EMSAM - First Day -- what to try for insomnia? SFY, posted by mayzee on July 20, 2006, at 12:24:59

> SFY, Thanks for your reply.
>
> Is it OK to take Benadryl with EMSAM? For some reason I thought that was a no no.
>
> I've read posts about Seroquel success, I just thought that might not be a good first choice; that there might be other less heavy duty (less scary to me) things to try first.
>
> Thanks,
> mayzee

No, Benadryl is fine with EMSAM. (In fact, topical Benadryl is one of the recommended treatments when EMSAM causes skin irritation.)

 

Re: EMSAM - First Day -- what to try for insomnia? RobertDavid

Posted by Phillipa on July 20, 2006, at 20:04:05

In reply to Re: EMSAM - First Day -- what to try for insomnia?, posted by RobertDavid on July 20, 2006, at 13:09:18

Rob Congratulations!!!!!! I know that was your goal. Love Phillipa When you get the time E-mail and update me okay?

 

Re: EMSAM - First Day -- what to try for insomnia?

Posted by ttee on July 21, 2006, at 0:11:54

In reply to Re: EMSAM - First Day -- what to try for insomnia? RobertDavid, posted by Phillipa on July 20, 2006, at 20:04:05

Benadryl is contraindicated with Emsam. Benadryl effects serotonin. In fact, Benadryl derivatives were the predecessors of all the modern SSRI antidepressants. I would check with your doc and/or a pharmacist before mixing the two.

 

Re: EMSAM - First Day -- what to try for insomnia?

Posted by SLS on July 21, 2006, at 6:27:07

In reply to Re: EMSAM - First Day -- what to try for insomnia?, posted by ttee on July 21, 2006, at 0:11:54

> Benadryl is contraindicated with Emsam. Benadryl effects serotonin. In fact, Benadryl derivatives were the predecessors of all the modern SSRI antidepressants. I would check with your doc and/or a pharmacist before mixing the two.

Good catch!

I think this is precisely why Benadryl acts to mitigate the withdrawal symptoms from SRI antidepressants.


- Scott

 

Re: EMSAM - First Day -- what to try for insomnia?

Posted by pulse on July 24, 2006, at 8:27:39

In reply to Re: EMSAM - First Day -- what to try for insomnia?, posted by ttee on July 21, 2006, at 0:11:54

on the contrary, i yesterday asked my doc and 2 pharmacists re: benadryl OR any antihistime, such a zyrtec regular - NOT zyrtec-d - and emsam. their firm conclusion: benadryl and the like are NOT contra-indicated for emsam.

it is ONLY the decongestants - or combo decongestants and antihistimes - which, of course , will still contain psuedephedrine - OR - any of the newer non-psuedephedrine other drugs termed 'non drowsy' - with which emsam should NEVER be taken.

it's not serotonin or serotonin sydrome that's the worry (re: the former).

it IS raised bp, possibly to probably, very extreme, that IS. (re: the latter).

i'm no longer on emsam, but like to find out all i can...'just in case'... even though i'm in full mdd remsision now w/no ad.
this is because my real hope is that someday w/in my lifetime there will be the options, if needed ever again for me, of one to many ads , that will come in the patch form. for me, that would be one/s that are NOT maois.

 

Re: EMSAM - First Day -- what to try for insomnia?

Posted by mayzee on July 24, 2006, at 10:28:00

In reply to Re: EMSAM - First Day -- what to try for insomnia?, posted by pulse on July 24, 2006, at 8:27:39

>
> - OR - any of the newer non-psuedephedrine other drugs termed 'non drowsy' - with which emsam should NEVER be taken.
>

Hi pulse,

Can you please give some examples of the newer other drugs you mention?

thanks!

mayzee (still on emsam)

 

Re: EMSAM - 30 days and beyond

Posted by WirelessWally on August 21, 2006, at 18:38:07

In reply to EMSAM - First Day, posted by RobertDavid on April 8, 2006, at 11:15:36

I am on my 21st day with EMSAM. I find that I am doing much more activity wise but still feel a lack of joy in my life. Also I am still not very patiant or tolerant of things/others. Will this improve as I gain more time on ENSAM? I also take clonazepam .5mg 4 times a day which seems to help with my agitation. Wally

 

Re: EMSAM - 30+ day questions

Posted by WirelessWally on August 27, 2006, at 12:34:59

In reply to Re: EMSAM - 30 days and beyond, posted by WirelessWally on August 21, 2006, at 18:38:07

I am on my 21st day with EMSAM. I find that I am doing much more activity wise but still feel a lack of joy in my life. Also I am still not very patiant or tolerant of things/others. Will this improve as I gain more time on ENSAM? I also take clonazepam .5mg 4 times a day which seems to help with my agitation. BTW I just checked the response box. Wally

 

Re: Emsam Price

Posted by Mimi321 on September 4, 2006, at 23:44:10

In reply to Re: Emsam Price, posted by Iansf on April 13, 2006, at 16:39:26

Why is everyone using (or wanting to use) Emsam when you can get selegeline in a topical cream from a compounding pharmacist for 50-100 dollars a month depending on how much you shop around. It works the same as a patch, but you rub it on your skin once a day. You get the same options of dosage. Just need a prescription and go to a compounding pharmacist. YOu can find a list of them in your area - just google and poke around.
Here's another option: you can order liquid selegeline on the web with no prescription - its sold as a supplement under the names denepryl, selepril, ceprenyl (spelling may be off). it costs 57-65$ for 300ml which translates into about a months supply (a drop contains one mg, so 6 drops a day is one lowest dose.) YOu can put it under the tongue or rub on skin or use intra-vaginal (good absorption). you just google 'deprenyl' and you'll see it. its not a controlled substance, so its my understanding that its legal to sell in the u.s. Good luck all - I just started the liquid selegeline and will see how it goes.

 

Re: Emsam Price Mimi321

Posted by Phillipa on September 5, 2006, at 19:43:31

In reply to Re: Emsam Price, posted by Mimi321 on September 4, 2006, at 23:44:10

How come no one has told us of this? The Patch was the big breakthrough. That's how I used hormones from a compounding pharmacy in a cream. Anyone else know of this? Love Phillipa

 

Re: Emsam Price

Posted by SFY on September 6, 2006, at 12:56:29

In reply to Re: Emsam Price, posted by Mimi321 on September 4, 2006, at 23:44:10

The price of Emsam luckily isn't an issue for me since my insurance covers it.

But even if it were, I don't think that a cream would be an adequate substitute for Emsam. While it would have the benefit of delivering selegiline transdermally, the dosage would likely not be delivered in a continuous, constant timed-release fashion over 24 hours. It would probably cause a dosage spike right after the time of application and might require more than one daily application to smooth out the selegiline delivered.

 

Re: Emsam Price Phillipa

Posted by mimi321 on September 6, 2006, at 13:43:06

In reply to Re: Emsam Price Mimi321, posted by Phillipa on September 5, 2006, at 19:43:31

> How come no one has told us of this? The Patch was the big breakthrough. That's how I used hormones from a compounding pharmacy in a cream. Anyone else know of this? Love Phillipa

I dunno - I thought of the compounding issue myself and then comtacted compounding pharmacists, and I found out about denepryl (liquid selegeline - the active ingred in emsam) by poking around on the web. Like I say - just google 'denepryl' or liquid selegeline or ceprenil or selephyl (spelling on last 2 might be off) and you will find it for sale by the 300 ml bottle. pass it around - i think emsam is outrageous unless you have insurance that covers. do others a favor - if you are on the other boards (anxiety, etc) feel free to copy the info from my post and put it up so others can see. it breaks my heart to hear that others are spending 400 that they cant afford on monthly meds, or worse - going without.

 

Re: Emsam Price

Posted by dbc on September 8, 2006, at 0:43:16

In reply to Re: Emsam Price, posted by Mimi321 on September 4, 2006, at 23:44:10

I havent seen anyone having much luck with any oral solution. Belive me i really considered it when i saw the insane price of emsam. Redosing is an issue also as the oral solutions only have a half life of 3 to 4 hours and most only come available in very small doses (1mg droppers) that are intended for the nootropic market.

 

Re: Emsam: constant dosing?

Posted by Jost on September 21, 2006, at 21:28:07

In reply to Re: Emsam Price, posted by SFY on September 6, 2006, at 12:56:29

My pdoc just told me that the company making Emsam doesn't promise constant, time-release absorption of the drug from the patch.

More likely, absorption varies considerably. First of all, it varies from person to person. But also, it varies within 24 hours.

The most the company claims is that you'll get about 6 mg (actually probably between 4-6 mg) from the 6 mg patch every twenty-four hours. But there's a good chance, for example that the highest absorption could be at the beginning right after application of the patch.

I'm not sure this matter so much, under good conditions, as long as you replace the patch every 24 hours.

Jost

 

Re: Emsam: constant dosing? Jost

Posted by WeeWilly on September 21, 2006, at 22:55:11

In reply to Re: Emsam: constant dosing?, posted by Jost on September 21, 2006, at 21:28:07

> My pdoc just told me that the company making Emsam doesn't promise constant, time-release absorption of the drug from the patch.
>
> More likely, absorption varies considerably. First of all, it varies from person to person. But also, it varies within 24 hours.
>
> The most the company claims is that you'll get about 6 mg (actually probably between 4-6 mg) from the 6 mg patch every twenty-four hours. But there's a good chance, for example that the highest absorption could be at the beginning right after application of the patch.
>
> I'm not sure this matter so much, under good conditions, as long as you replace the patch every 24 hours.
>
> Jost

Interesting. I have been on Emsam for about 1 month. 2 weeks or so on 12mg. I have been leaving each patch on for 48 hrs. I wear 2 patches. So far my response has been disapointing. Seeing my Pdoc 9/26 tues and I am leaning toward discontinuing Emsam and maybe trying Marplan. Many years ago when I first tried Parnate my response was complete within a 1/2 hour it remained great for 3 months then abruptly quit. Increased the dose to 100 mg's with no luck. Every year since then I have returned to Parnate for 3 months per year. Usually the response is quick and last 3 months. Last spring it was not quite so good, likely because of my being on Nardil a few months before the parnate. Nardil was not as effecatious as Parnate. It also lost its effectiveness after 3 months. I sure thought I would stumble onto a treatment long ago but providence has'nt provided that. At one time I responded great to sleep deprivation, but not anymore. If you knew my existence you would not believe how strange it is. Oh well, thems the cards I have been dealt. I often wonder if I am playing them the best possible way. I think so. Of course if I did'nt have the disableing symptoms of this disorder I could be more organized in recording factors in my condition and analyzing the best course of action then do it. I would like to hook up with an influential research scientist at NIMH or similar place. I think I have unique information that I have accumulated that would illuminate disorders such as mine. I'm running on here so I'll just wish you all the best fortune. Thanks for listening.

 

Re: Emsam: constant dosing? WeeWilly

Posted by Jost on September 22, 2006, at 3:35:00

In reply to Re: Emsam: constant dosing? Jost, posted by WeeWilly on September 21, 2006, at 22:55:11

Hi. Do you use two 12 mg patches for 48 hours to achieve the same dose as 12 mg?

Why the 48 hours? The patch apparently is set up for 24-hour use. Although there's enough emsam for more than 6 mg (on the 6 mg patch), I'm not sure there's any claim by the company that you'd get any particular amount in the second 24 hours.

From what my pdoc said, if you use any size for 24 hours, there's real chance you're getting most of the drug absoption in the first hours, and then less for the latter part of the period. This could be even more so in a 48 hour period.

So if some of the effect is from the amphetamine, you'd be possibly getting much less of that after the first some hours-- leading to a shifting dose.

Did you and your pdoc come to the conclusion that a high emount for a few hours every 48 hours and lesser amounts for the rest was a better rhythm for you?

Jost

 

Re: Emsam: constant dosing?

Posted by WeeWilly on September 22, 2006, at 15:05:03

In reply to Re: Emsam: constant dosing? WeeWilly, posted by Jost on September 22, 2006, at 3:35:00

> Hi. Do you use two 12 mg patches for 48 hours to achieve the same dose as 12 mg?
>
> Why the 48 hours? The patch apparently is set up for 24-hour use. Although there's enough emsam for more than 6 mg (on the 6 mg patch), I'm not sure there's any claim by the company that you'd get any particular amount in the second 24 hours.
>
> From what my pdoc said, if you use any size for 24 hours, there's real chance you're getting most of the drug absoption in the first hours, and then less for the latter part of the period. This could be even more so in a 48 hour period.
>
> So if some of the effect is from the amphetamine, you'd be possibly getting much less of that after the first some hours-- leading to a shifting dose.
>
> Did you and your pdoc come to the conclusion that a high emount for a few hours every 48 hours and lesser amounts for the rest was a better rhythm for you?
>
> Jost
Hello Jost,

I use 12mg patches. Each one stays on 48 hours. In the morning I take off the patch that has been on 48 hrs and put a new one on. So each morning I start with a new 12mg patch and the one that has been on for 24 hrs. Maybe the patch totally depletes in 24 hrs, I don't know.
Emsam on its own is not producing much of a response in me. If I add 15 or 20mg of Adderall, there is some response but not great. I would like to use Emsam alone for awhile to see its effecacy alone. But I need to accomplish some projects right now and for this past month on Emsam I have done so little.
I am sort of on my own in my treatment plan. I would have to travel 4 to 5 hrs to a large city to possibly find a Psychopharmacologist that would treat my condition out side the box like is needed. Finding a doc to prescribe treatments like stimulants with MAOI's or other legitimate aggressive coctails is very diffucult in this area of the country and probably most places. You read of people struggling to find a doc who will prescribe MAOI's alone. It's so ridiculous.
Are you doing quite well with the Emsam? I'm sure I have read how long and what dose you are currently on, but could you update me on this and what if anything you are adding to it. Thanks and best wishes.

 

Re: Emsam: constant dosing? WeeWilly

Posted by Jost on September 22, 2006, at 19:16:14

In reply to Re: Emsam: constant dosing?, posted by WeeWilly on September 22, 2006, at 15:05:03

I'm doing really well-- at least until a recent problem-- but I'm planning to start again.

I must be lucky-- I have a pdoc who's really dedicated to finding what works. He'll do maois and other things --. He did that for me- He's extremely careful-- and keeps up with all the developments, but really cares about helping patients to find the best treatment available.

If he thinks the combo is potentially okay, but potentially not--and knows you'll be careful and keep him informed of any problems that arise-- he''ll go ahead-- and then pull back, very firmly, if any adverse reactions arise. I always check with him, if I have any doubt about what's happening-- I'm pretty careful myself if things don't feel right.

I was doing 12 mg of emsam, and taking it off at night, for 5-6 hours, and then putting it on and sleeping a few more hours. Seems to work really well- but I've had a good response to emsam. -- That amounted to about 9 mg (approximately).

I was using it with provigil (about 200 mg a day, sometimes more), and possibly ritalin-- although I'm not sure if the ritalin will work-- I had an adverse reaction--I'm sure to the Emsam, but don't know if the ritalin played a role. It remains to be seen when I start up again.

I might not need ritalin, though. I'll stick with the provigil, however. Ensam has given me a lot more energy, and a much better outlook-- I'm much less depressed, and easily thrown by situations, more confident, and less prone to negative ruminations.


At the beginning, after using 6 mg and feeling like I needed more than 6--but also having bad insomnia, I switched to 18 mg for 12 hours a day. After a while, I noticed was getting much more irritable, easily upset, and prone to constant agitation. It was extremely uncomfortable and oppressive, until I thought about the amount-- and went down to 12 mg, taken off at night for 6 hours or so. I felt much better pretty quickly--and also slept better, too.

My sense is that you have to accommodate fairly slowly and make sure not to go up too quickly. Going up too quickly on the assumption that, as with most ADs, you'll reach a therapeutic dose, over time, by doing that-- might be a bad strategy with Emsam.

But then I'm not a pdoc-- and probably the data aren't in. I just worry that maybe some people are missing a good drug because taking too much, esp. too soon, is counterproductive-- ? I could be wrong, though.

Jost


 

Re: Emsam: constant dosing? Jost

Posted by WeeWilly on September 22, 2006, at 22:14:14

In reply to Re: Emsam: constant dosing? WeeWilly, posted by Jost on September 22, 2006, at 19:16:14

> I'm doing really well-- at least until a recent problem-- but I'm planning to start again.
>
> I must be lucky-- I have a pdoc who's really dedicated to finding what works. He'll do maois and other things --. He did that for me- He's extremely careful-- and keeps up with all the developments, but really cares about helping patients to find the best treatment available.
>
> If he thinks the combo is potentially okay, but potentially not--and knows you'll be careful and keep him informed of any problems that arise-- he''ll go ahead-- and then pull back, very firmly, if any adverse reactions arise. I always check with him, if I have any doubt about what's happening-- I'm pretty careful myself if things don't feel right.
>
> I was doing 12 mg of emsam, and taking it off at night, for 5-6 hours, and then putting it on and sleeping a few more hours. Seems to work really well- but I've had a good response to emsam. -- That amounted to about 9 mg (approximately).
>
> I was using it with provigil (about 200 mg a day, sometimes more), and possibly ritalin-- although I'm not sure if the ritalin will work-- I had an adverse reaction--I'm sure to the Emsam, but don't know if the ritalin played a role. It remains to be seen when I start up again.
>
> I might not need ritalin, though. I'll stick with the provigil, however. Ensam has given me a lot more energy, and a much better outlook-- I'm much less depressed, and easily thrown by situations, more confident, and less prone to negative ruminations.
>
>
> At the beginning, after using 6 mg and feeling like I needed more than 6--but also having bad insomnia, I switched to 18 mg for 12 hours a day. After a while, I noticed was getting much more irritable, easily upset, and prone to constant agitation. It was extremely uncomfortable and oppressive, until I thought about the amount-- and went down to 12 mg, taken off at night for 6 hours or so. I felt much better pretty quickly--and also slept better, too.
>
> My sense is that you have to accommodate fairly slowly and make sure not to go up too quickly. Going up too quickly on the assumption that, as with most ADs, you'll reach a therapeutic dose, over time, by doing that-- might be a bad strategy with Emsam.
>
> But then I'm not a pdoc-- and probably the data aren't in. I just worry that maybe some people are missing a good drug because taking too much, esp. too soon, is counterproductive-- ? I could be wrong, though.
>
> Jost
>
>
>
>
>
Hey Jost,

I envy your relationship with your Pdoc. From my experience with many docs and what I read of others it seems that the wellfare of the patient is way down on the priority list. Could you elaborate on the adverse reaction you had? Do you think Emsam has a chance to work as monotherapy for you without the Provigil? I am hopeing it will work well enough on its own for me. There are so many draw backs to polypharmacy. Anyway I sure wish you the best of fortune. Thanks for the update.


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