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Dr. Bob is Robert Hsiung, MD,
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Posted by Jost on September 28, 2006, at 12:03:35
In reply to Re: discontonuimg Emsam, posted by Donna Louise on September 28, 2006, at 5:42:05
Not wanting to bring in anything from left field, but is it possible you were getting too high a dose of Emsam, and a low dose, or even a lower dose kept on only part of the time, would have worked for you.
There may be some aspects of the delivery of the drug that aren't yet known. For example, did you apply the patch to the same spot every day, or alternate spots? If you alternated, how many days in a row did you put it in the same place?
How many separate spots did you use?
I'm curious because of a question about how long the emsam from the patch can remain unabsorbed, but capable of absorption, after the patch is removed.
Thanks, Jost
Posted by SLS on September 28, 2006, at 15:13:43
In reply to Re: discontonuimg Emsam, posted by Donna Louise on September 28, 2006, at 5:42:05
Hi Donna.
> Well, I took the plunge and pulled the patch. Nice alliteration if I do say so myself...
Show off.
> And right now i feel better than I have for the past month.
Discontinuation rebound improvement. I get that from Nardil.
> But I know that never lasts...
Me too.
> unless this time I can get some mileage out of just the lamictal, klonopin and provigil.
Hey, it just might be.
> but even with the new understanding that i probably have bipolar II, I get such bad depression I can't imagine that I can get away with it and at some point will have to take yet another AD.
Probably.
> I keep thinking that if I took a tiny dose of oral selegiline I could keep the energy and lose the mixed state..
Ever try Wellbutrin or Parnate? Are you a partial responder to either?
> Anyway, that is my update.
:-)
- Scott
Posted by Phillipa on September 28, 2006, at 18:52:04
In reply to Re: discontonuimg Emsam » Donna Louise, posted by SLS on September 28, 2006, at 15:13:43
Donna please answer Jost's question as it's very important. As my pdoc if I'd tried it said only use 1/4 of a patch. And are you the one who could only use the area above her breasts to apply. Thanks Phillipa
Posted by Donna Louise on September 29, 2006, at 5:32:20
In reply to Re: discontonuimg Emsam » Donna Louise, posted by Jost on September 28, 2006, at 12:03:35
> Not wanting to bring in anything from left field, but is it possible you were getting too high a dose of Emsam, and a low dose, or even a lower dose kept on only part of the time, would have worked for you.
>
> There may be some aspects of the delivery of the drug that aren't yet known. For example, did you apply the patch to the same spot every day, or alternate spots? If you alternated, how many days in a row did you put it in the same place?
>
> How many separate spots did you use?
>
> I'm curious because of a question about how long the emsam from the patch can remain unabsorbed, but capable of absorption, after the patch is removed.
>
>
> Thanks, JostI don't know, I tried all the different dose sizes, at the end I was using half a nine. Too little and I was rageful, more and I was depressed. It took awhile for all this to show up, at least the depression took a while, I was easily aggravated and enraged early on. I was enjoying the energy so much I thought that this was it. It is really disappointing. I had been trying to find the right dose since April.
I was alternating hips, a little different spot on each hip every other day. Anywhere else I put it would either come off with sweat or something would knock it off, like a tree limb. That sounds odd doesn't it. No, I have not regressed and climbing trees, I run through narrow trails on horses and had more than one hanging from a branch. They always stayed on my hip.
My pdoc and i tried everything we could think of and finally I had to throw in the towel. sighdonna
Posted by Donna Louise on September 29, 2006, at 5:41:04
In reply to Re: discontonuimg Emsam » Donna Louise, posted by SLS on September 28, 2006, at 15:13:43
> Hi Donna.
>
> > Well, I took the plunge and pulled the patch. Nice alliteration if I do say so myself...
>
> Show off.
>
> > And right now i feel better than I have for the past month.
>
> Discontinuation rebound improvement. I get that from Nardil.
>
> > But I know that never lasts...
>
> Me too.
>
> > unless this time I can get some mileage out of just the lamictal, klonopin and provigil.
>
> Hey, it just might be.
>
> > but even with the new understanding that i probably have bipolar II, I get such bad depression I can't imagine that I can get away with it and at some point will have to take yet another AD.
>
> Probably.
>
> > I keep thinking that if I took a tiny dose of oral selegiline I could keep the energy and lose the mixed state..
>
> Ever try Wellbutrin or Parnate? Are you a partial responder to either?
>
> > Anyway, that is my update.
>
> :-)
>
>
> - ScottI wish I knew how or had a Mac or something so I could respond line by line like you and some others do. it is like having a conversation. I would tell you that I can't help but be poetic, I am just so artistic that way... not.
I get psychotic on wellbutrin, hiding from cars when I was jogging (gotta get back to that, jogging I mean, not hiding from cars). And the social phobia was like paranoia. yick and yuck.
I have not tried Parnate, I was considering it after some of you suggested it. My pdoc thinks I will get the awful mixed state again. Maybe all the anxiety is just not going to let me do well on a stimulating med. I really did well on paxil a million years ago before i became mummifed in front of the tv.
I have been thinking about revisiting strattera. I got alot done when I was on it before and lord knows i could use some focus. I don't know why I quit taking it. It is a good thing my pdoc takes copious notes.donna
Posted by Donna Louise on September 29, 2006, at 5:46:33
In reply to Re: discontonuimg Emsam, posted by Phillipa on September 28, 2006, at 18:52:04
> Donna please answer Jost's question as it's very important. As my pdoc if I'd tried it said only use 1/4 of a patch. And are you the one who could only use the area above her breasts to apply. Thanks Phillipa
Nope, not me, I am not the breast lady. I think I may have tried that spot once but it sweated off. I am very active outside in the summer, even if I am in a coma, as I am on my way to being again without the patch.donna
Posted by SLS on September 29, 2006, at 6:09:48
In reply to Re: discontonuimg Emsam » SLS, posted by Donna Louise on September 29, 2006, at 5:41:04
Then Nardil?
- Scott
Posted by jealibeanz on September 29, 2006, at 10:28:33
In reply to Re: discontonuimg Emsam, posted by Donna Louise on September 29, 2006, at 5:46:33
So have you officially been diagnosed with Bipolar?
Posted by Donna Louise on September 29, 2006, at 13:09:12
In reply to Re: discontonuimg Emsam » Donna Louise, posted by SLS on September 29, 2006, at 6:09:48
> Then Nardil?
>
>
> - ScottI apologize for the exteme vanity, but I am terrified I would gain weight. I don't think any positive effects would offset the agony of weight gain out of my control.
BTW, the patch put on about 5lbs that I could live with..barely...and it is magically coming off since I quit. I didn't think a drug with so amphetamine metabolites, albeit, not nearly as with the transdermal absorbtion but there you go, you just never know. What is with the poetry??? A new aspect of rebound?
Posted by Donna Louise on September 29, 2006, at 13:14:52
In reply to Re: discontonuimg Emsam, posted by jealibeanz on September 29, 2006, at 10:28:33
> So have you officially been diagnosed with Bipolar?
i am not sure what would qualify as official since there are no PET scans or anything that can scientifically prove any of these afflictions. My pdoc thinks so if that can be considered official. I considered myself to have many manifestations of soft bipolar for many years and it may be that the patient, if they can still think, may be the best one to know. My pdoc didn't think so until I responded so well to the lamictal because I sleep like a log for many hours. Insomnia is a major hallmark of bipolar and I just don't have that, never had. I slept like a rock as a baby.
Posted by Phillipa on September 29, 2006, at 13:24:08
In reply to Re: discontonuimg Emsam » jealibeanz, posted by Donna Louise on September 29, 2006, at 13:14:52
Insomnia is a hallmark of bipolar? Never heard that before. All types of things to my knowledge(limited) like excessive stress can cause insomnia to my knowledge. Love Phillipa
Posted by SLS on September 29, 2006, at 14:53:28
In reply to Re: discontonuimg Emsam » jealibeanz, posted by Donna Louise on September 29, 2006, at 13:14:52
> Insomnia is a major hallmark of bipolar
This is true in the manic phase of the illness or during a mixed-state - and then not always.
> and I just don't have that, never had. I slept like a rock as a baby.
Me too, in my depressed state. Mania is another story. The few times I had it, I could exist on 3-4 hour of sleep without really missing it.
Phillipa is right about insomnia being a component of some forms of unipolar depression. In fact, it was part of the original diagnosis.
In other words, you can sleep or oversleep and still be bipolar.
- Scott
Posted by jealibeanz on September 29, 2006, at 15:43:58
In reply to Re: discontonuimg Emsam » SLS, posted by Donna Louise on September 29, 2006, at 13:09:12
> > Then Nardil?
> >
> >
> > - Scott
>
> I apologize for the exteme vanity, but I am terrified I would gain weight. I don't think any positive effects would offset the agony of weight gain out of my control.
> BTW, the patch put on about 5lbs that I could live with..barely...and it is magically coming off since I quit. I didn't think a drug with so amphetamine metabolites, albeit, not nearly as with the transdermal absorbtion but there you go, you just never know. What is with the poetry??? A new aspect of rebound?
>
>You did gain weight? Ughhh... that saddens me. I feel the same way you do. Was it when you increased the dose that you noticed it? I was thinking of asking my doc about EMSAM when I see him in 2 weeks. I no longer think I'll be doing that. I majorly gained on my AD's in the past for no reason other than medication. I just happen to be very susceptible. That just makes me feel worse in the end. Not worth it. :(
Posted by Donna Louise on September 30, 2006, at 21:15:09
In reply to Re: discontonuimg Emsam, posted by jealibeanz on September 29, 2006, at 15:43:58
> > > Then Nardil?
> > >
> > >
> > > - Scott
> >
> > I apologize for the exteme vanity, but I am terrified I would gain weight. I don't think any positive effects would offset the agony of weight gain out of my control.
> > BTW, the patch put on about 5lbs that I could live with..barely...and it is magically coming off since I quit. I didn't think a drug with so amphetamine metabolites, albeit, not nearly as with the transdermal absorbtion but there you go, you just never know. What is with the poetry??? A new aspect of rebound?
> >
> >
>
> You did gain weight? Ughhh... that saddens me. I feel the same way you do. Was it when you increased the dose that you noticed it? I was thinking of asking my doc about EMSAM when I see him in 2 weeks. I no longer think I'll be doing that. I majorly gained on my AD's in the past for no reason other than medication. I just happen to be very susceptible. That just makes me feel worse in the end. Not worth it. :(I personally don't mind 5lbs, it would be well worth it if the drug had worked well. 5 lbs is insignifant to me. That is all I gained. And I can't swear it was the patch. other things going could have done it too. So don't not try it just because of something I said. I am just one person and not even sure if that is what caused me to gain a few measely lbs. It is the 10+ lbs I would find unacceptable. And I have not gained weight on meds that others have and vice versa. What I said about it just isn't applicable to another person's situation.
donna
Posted by Donna Louise on September 30, 2006, at 21:18:05
In reply to Re: discontonuimg Emsam » Donna Louise, posted by Phillipa on September 29, 2006, at 13:24:08
> Insomnia is a hallmark of bipolar? Never heard that before. All types of things to my knowledge(limited) like excessive stress can cause insomnia to my knowledge. Love Phillipa
You misunderstand. I am not saying that bipolar is the only thing that causes insomnia, just that it does for most people. Of course there are a myriad of other etiological possibilies for insomnia. Too many to count probably.
donna
Posted by Phillipa on September 30, 2006, at 21:18:44
In reply to Re: discontonuimg Emsam » jealibeanz, posted by Donna Louise on September 30, 2006, at 21:15:09
Donna do you think you may have eatten more? Feeling better and all? If it's transdermal and bypasses the gut and liver how could it add pounds? Love Phillipa
Posted by Donna Louise on September 30, 2006, at 21:25:38
In reply to Re: discontonuimg Emsam » Donna Louise, posted by SLS on September 29, 2006, at 14:53:28
> > Insomnia is a major hallmark of bipolar
>
> This is true in the manic phase of the illness or during a mixed-state - and then not always.
>
> > and I just don't have that, never had. I slept like a rock as a baby.
>
> Me too, in my depressed state. Mania is another story. The few times I had it, I could exist on 3-4 hour of sleep without really missing it.
>
> Phillipa is right about insomnia being a component of some forms of unipolar depression. In fact, it was part of the original diagnosis.
>
> In other words, you can sleep or oversleep and still be bipolar.
>
>
> - ScottI have never had the classice bipolar I mania so I don't know how that would effect my sleep. I imagine I would be up painting the garage or some other productive activity...I have just had this major agitation, irritablity, panic and rage one minute, then fine the next and then towards the end of my run with the patch I fell into a pretty serious depression. We raised my lamictal to 200mg a few days before I quit the patch and I don't know which to credit for the cessation of my bipolar type symptoms. Either it was drug induced or the lamictal is working really really well for me. Or reboudn as we talked about before. Whatever, I am going to run with it as long as it lasts. BTW, I had much more subtle symptoms of soft bipolar before I started the patch, the patch just seemed to bring it to the surface. Probably any type of peripherally active stimulant would do the same thing. I won't be finding out, not going there, no siree.
donna
>
Posted by jealibeanz on September 30, 2006, at 21:30:08
In reply to Re: discontonuimg Emsam » jealibeanz, posted by Donna Louise on September 30, 2006, at 21:15:09
Yeah, you're right. It's just that I've been so susceptible in the past, I don't want to go down that road again.
Posted by Donna Louise on September 30, 2006, at 21:30:53
In reply to Re: discontonuimg Emsam » Donna Louise, posted by Phillipa on September 30, 2006, at 21:18:44
> Donna do you think you may have eatten more? Feeling better and all? If it's transdermal and bypasses the gut and liver how could it add pounds? Love Phillipa
No, if anything I ate less, I eat more when I don't feel good. Don't ask me how it could happen.Who know what any of these drugs are going to do or how they actually do it to any one given individual. I guess there is vague general idea how they work but that is just scratching the surface. It is not a matter of first pass metabolism that would make the difference though.
I am surely not the one to ask, that is all I really know.donna
Posted by Donna Louise on September 30, 2006, at 21:34:25
In reply to Re: discontonuimg Emsam, posted by jealibeanz on September 30, 2006, at 21:30:08
> Yeah, you're right. It's just that I've been so susceptible in the past, I don't want to go down that road again.
I can surely understand that. You can always try it and then pull it if you don't like what happens. Trying these things is not some kind of binding contract. That is the way I think of it, otherwise I doubt I would try anything. No, that is not true. When I am in the middle of a bad depression I would drink lye if I thought it would help. Well, that is an exaggeration....donn
Posted by Phillipa on September 30, 2006, at 21:43:36
In reply to Re: discontonuimg Emsam » jealibeanz, posted by Donna Louise on September 30, 2006, at 21:34:25
Donna how bad are your depressions are you in bed all day and night? Or functional? And I thought the patch med stayed in your sytem for days? Love Phillipa
Posted by Jost on September 30, 2006, at 22:42:08
In reply to Re: discontonuimg Emsam » Donna Louise, posted by Phillipa on September 30, 2006, at 21:43:36
One other question occurred to me, which maybe a strange one, but only because of some SEs I'm having: did you happen to use rozerem?
Just curious, no particular reason to think it.
Jost
Posted by jealibeanz on October 1, 2006, at 0:15:27
In reply to Re: discontonuimg Emsam » jealibeanz, posted by Donna Louise on September 30, 2006, at 21:34:25
Was the gain throughout your entire trial with EMSAM or when you got to higher doses? How long were you on it?
Posted by Another Phil on October 1, 2006, at 1:16:41
In reply to Re: discontonuimg Emsam, posted by jealibeanz on October 1, 2006, at 0:15:27
Just to add my two cents.... I started with oral selegeline in January, then switched to the Emsam 6mg patch about a month after it came on the market (the end of March?). For me it was a fantastic antidepressant. I've tried a lot of others and had very limited success. For the first time in a few years, I had the energy and motivation to work out every other day, and even worked up the nerve to ask out a woman I work with (previously unthinkable).
The reason I had to stop taking it is that I simply could not pay attention. I'm a highly-organized person; but while on Emsam, it got to the point that I was afraid that I was going to really screw up my finances, because I just couldn't pay attention. For years, I've taken Dexedrine spansules to help me pay attention. I thought that maybe the combination of the two was too activating, so I'd try not taking them sometimes; it really made no difference to my ability to concentrate whether or not I took the Dexedrine.
Well, I'm taking Parnate now. It is a very good antidepressant, as some have mentioned, but I wouldn't make the decision to take it lightly. I had a *very* traumatic ramp-up period. But...that's another topic.
Phil
P.S. I almost forgot, I gained about 7 pounds while on Emsam (and I hadn't gained a single pound in the past 12 years or so--except while taking Zyprexa), but that may have due to the Neurontin I was taking because I couldn't sleep otherwise. Lot's of laughs.
Posted by SLS on October 1, 2006, at 1:27:57
In reply to Re: discontonuimg Emsam » SLS, posted by Donna Louise on September 30, 2006, at 21:25:38
Hi Donna.
> I have never had the classice bipolar I mania so I don't know how that would effect my sleep. I imagine I would be up painting the garage or some other productive activity...
No, you'd be up painting all of your neighbors' houses red in lamb's blood after watching "The Ten Commandmants".
> I have just had this major agitation, irritablity, panic and rage one minute, then fine the next and then towards the end of my run with the patch I fell into a pretty serious depression.
What were you like immediately before starting the patch?
> We raised my lamictal to 200mg a few days before I quit the patch and I don't know which to credit for the cessation of my bipolar type symptoms.
Lamictal can work fast as an antidepressant when you increase the dosage. I don't know so much about manic symptoms.
> Either it was drug induced or the lamictal is working really really well for me. Or reboudn as we talked about before. Whatever, I am going to run with it as long as it lasts. BTW, I had much more subtle symptoms of soft bipolar before I started the patch, the patch just seemed to bring it to the surface. Probably any type of peripherally active stimulant would do the same thing. I won't be finding out, not going there, no siree.
Any family history? How old were you when you first displayed any kind of mood or anxiety symptoms?
- Scott
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