![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 53 to 77 of 86. Go back in thread:
Posted by laima on December 21, 2006, at 0:43:19
In reply to Oral dosing equivalence is very, very high, posted by psychobot5000 on December 19, 2006, at 15:08:18
Yet, my knowledgeable doctor told me that the 6mg Emsam was roughly equivalent to 20 mg oral selegeline- which is what I was using before starting Emsam. The switch was very smooth. If anything, I found the oral version of 20 mg to be more potent. I eventually had to start the 9mg Emsam.> It is almost impossible to get an equivalent to 6mg EMSAM from oral selegiling--the doses would be alost absurdly high. --According to my math, you would need not five or ten mg, but 102mg of oral tablets to equal just a 6mg EMSAM patch. This is because the transdermal system is far more effective at getting it into your bloodstream. The oral version has 4.4% bioavailability, compared with about 74% from the patch--about seventeen times higher.
>
>
> As far as I understand, the normal max-dose for oral pills is 60mg, but that some docs push it to about 85mg. It's still not equivalent to EMSAM, as far as I understand, but you also have to deal with significant levels of amphetamine metabolites that are almost absent in the patch. And there are the dietary restrictions. So basically, the two delivery systems are not really equivalent in terms of their effects.
>
> Here's some more of my blather about it:
> http://www.dr-bob.org/babble/20061206/msgs/711307.html
>
> Psychbot
>
>
> > Is the 6 mg patch the equivalent of 5 mg pill or 10 mg (2 pills)?
> >
> > SG
>
>
Posted by psychobot5000 on December 21, 2006, at 2:17:30
In reply to Re: Oral dosing equivalence is very, very high » psychobot5000, posted by laima on December 21, 2006, at 0:43:19
>
> Yet, my knowledgeable doctor told me that the 6mg Emsam was roughly equivalent to 20 mg oral selegeline- which is what I was using before starting Emsam. The switch was very smooth. If anything, I found the oral version of 20 mg to be more potent. I eventually had to start the 9mg Emsam.It's hard to know with certainty, but I used to think that 20mg oral was equivalent to 6mg transdermal--I now believe this to be a misunderstanding. You see, the 6mg patch actually contains 20mg selegiling, but if you wear it for 24 hours, an estimated 30%, or about 6 mg, will actually be absorbed. This is where the 6/20 mg equivalence comes from, I believe.
However, with the oral selegiline you have the amphetamines, and they are (often) beneficial for mood and motivation, so there is that added benefit. Also, the blood-levels spike suddenly, and maybe that's good too. I took 20mg oral selegiline daily for many months, and definitely found it beneficial. But a doc I spoke to once (who worked with developing EMSAM) explained to me that the blood-levels were not nearly as high from 20mg oral tablets as they would be from any EMSAM patch.
Glad to hear that the oral was a good replacement for you!
Posted by CrimsonVik on December 21, 2006, at 2:39:56
In reply to Re: Oral dosing equivalence is very, very high » psychobot5000, posted by laima on December 21, 2006, at 0:43:19
Laima, if you have been on the 6 mg. patch and 20 mg. oral as we both seem to have, it is stronger to the patient than a patch. Especially at first.
I think 10 mg. feels more like the 6 mg. patch.
V.
Posted by laima on December 21, 2006, at 10:49:30
In reply to Re: Oral dosing equivalence is very, very high » laima, posted by psychobot5000 on December 21, 2006, at 2:17:30
I used the oral first, then moved to Emsam when it became available. Actually though, I'm not convinced that the transdermal delivery is very even, because heat affects it, how well it sticks affects it, sometimes it rumples up- I even wonder if different kinds of skin on different parts of the body affect how well it is absorbed. Sometimes it just plain falls off, especially in summer. I definately agree that the oral version is more stimulating. But my doctor felt very strongly that the Emsam would do more and be "more available" than the oral version of selegeline. I use a small amount of adderall with it, and that wasn't necessary with the oral. He had some remote hand in reviewing Emsam, too-sounds like a lot of consultants involved! Small world. Interestingly, the longer it's been out, the less sure anyone seems to be about what the exact equivalence between the oral and patch is.
> >
> > Yet, my knowledgeable doctor told me that the 6mg Emsam was roughly equivalent to 20 mg oral selegeline- which is what I was using before starting Emsam. The switch was very smooth. If anything, I found the oral version of 20 mg to be more potent. I eventually had to start the 9mg Emsam.
>
> It's hard to know with certainty, but I used to think that 20mg oral was equivalent to 6mg transdermal--I now believe this to be a misunderstanding. You see, the 6mg patch actually contains 20mg selegiling, but if you wear it for 24 hours, an estimated 30%, or about 6 mg, will actually be absorbed. This is where the 6/20 mg equivalence comes from, I believe.
>
> However, with the oral selegiline you have the amphetamines, and they are (often) beneficial for mood and motivation, so there is that added benefit. Also, the blood-levels spike suddenly, and maybe that's good too. I took 20mg oral selegiline daily for many months, and definitely found it beneficial. But a doc I spoke to once (who worked with developing EMSAM) explained to me that the blood-levels were not nearly as high from 20mg oral tablets as they would be from any EMSAM patch.
>
> Glad to hear that the oral was a good replacement for you!
Posted by laima on December 21, 2006, at 11:04:24
In reply to Re: Oral dosing equivalence is very, very high » laima, posted by CrimsonVik on December 21, 2006, at 2:39:56
It seems to get more confusing all the time about those equivalencies. Maybe it's like comparing apples and oranges, as the saying goes. If Emsam cuts out the amphetamine aspect that oral selegeline has, maybe it's not even really the same drug anymore (?) I definately believe I "felt" the oral stronger, I wonder if that has to do with the amphetamine involved. However, I have discovered a "magic combo"- Emsam with tiny amount of adderall. This is definately working better than either the oral or the Emsam alone! (Or maybe it's working like a much larger dose of the oral?) It's a new development for me: I had been using small amount of ritalin to raise my very low blood pressure, and that was ok. One of my doctor's colleagues consulted with my case, and voiced his clinical observation that a lot of people do really well with Emsam plus adderall- that the two appear to work synergistically. So I was switched fairly recently, and it works! Amazing! So now it's Emsam 9 plus 5 mg adderall, twice a day.
> Laima, if you have been on the 6 mg. patch and 20 mg. oral as we both seem to have, it is stronger to the patient than a patch. Especially at first.
> I think 10 mg. feels more like the 6 mg. patch.
> V.
Posted by CrimsonVik on December 21, 2006, at 13:10:00
In reply to Re: Emsam enhancement » CrimsonVik, posted by laima on December 21, 2006, at 11:04:24
I'm being troubled by low blood pressure too and my Dr. is out of town. I was already on hypertension medicine so it's confusing.
I feel bad and weak on the oral now..possibly going back to Emsam, probably.
I asked him about ADD before and that I had some symptoms like short attention span: didn't seem to believe it. I'd love to try Adderall though.
> It seems to get more confusing all the time about those equivalencies. Maybe it's like comparing apples and oranges, as the saying goes. If Emsam cuts out the amphetamine aspect that oral selegeline has, maybe it's not even really the same drug anymore (?) I definately believe I "felt" the oral stronger, I wonder if that has to do with the amphetamine involved. However, I have discovered a "magic combo"- Emsam with tiny amount of adderall. This is definately working better than either the oral or the Emsam alone! (Or maybe it's working like a much larger dose of the oral?) It's a new development for me: I had been using small amount of ritalin to raise my very low blood pressure, and that was ok. One of my doctor's colleagues consulted with my case, and voiced his clinical observation that a lot of people do really well with Emsam plus adderall- that the two appear to work synergistically. So I was switched fairly recently, and it works! Amazing! So now it's Emsam 9 plus 5 mg adderall, twice a day.
>
Posted by laima on December 21, 2006, at 13:33:40
In reply to Re: Emsam enhancement » laima, posted by CrimsonVik on December 21, 2006, at 13:10:00
You might be a perfect candidate then, just like me! I am told that the reason selegeline (or other MAOI) plus stimulant is "officially" a no-no is because of the possibility of over-stimulation and dangerously high blood pressure- but my doctor and his colleagues say they've cautiously used such combinations countless times without incident. I've gotten notes to take to the pharmacy before saying it's ok- but they are used to me and my weird prescriptions at this point. I do have to have a blood pressure reader, and have been instructed to monitor my blood pressure this month- before and after taking the adderall, and if I feel strange, to be sure of what's going on. I'm very impressed with this adderall plus Emsam combo- can't gush enough! I don't believe there is any study to prove or disprove it though- just the one guy's hunches and clinical observations. Makes sense to me- I wonder if it's got anything to do with replacing the amphetamine that Emsam lacks? (Is that why ritalin helps, but not nearly as much? Because though it boosts blood pressure, it's not an amphetamine?) That, and of course, low blood pressure can make a person blahhhh, which is in itself depressing. And Emsam can lower blood pressure... I wonder if regular selegeline can lower blood pressure? I think it can. Maybe if your doctor has trouble with understanding your attention span and other ADD symptoms, he or she could understand low blood pressure if you emphasized that angle. (I know they like to say that poor attention is a symptom of the depression.)Good luck!
> I'm being troubled by low blood pressure too and my Dr. is out of town. I was already on hypertension medicine so it's confusing.
> I feel bad and weak on the oral now..possibly going back to Emsam, probably.
> I asked him about ADD before and that I had some symptoms like short attention span: didn't seem to believe it. I'd love to try Adderall though.
>
>
>
>
> > It seems to get more confusing all the time about those equivalencies. Maybe it's like comparing apples and oranges, as the saying goes. If Emsam cuts out the amphetamine aspect that oral selegeline has, maybe it's not even really the same drug anymore (?) I definately believe I "felt" the oral stronger, I wonder if that has to do with the amphetamine involved. However, I have discovered a "magic combo"- Emsam with tiny amount of adderall. This is definately working better than either the oral or the Emsam alone! (Or maybe it's working like a much larger dose of the oral?) It's a new development for me: I had been using small amount of ritalin to raise my very low blood pressure, and that was ok. One of my doctor's colleagues consulted with my case, and voiced his clinical observation that a lot of people do really well with Emsam plus adderall- that the two appear to work synergistically. So I was switched fairly recently, and it works! Amazing! So now it's Emsam 9 plus 5 mg adderall, twice a day.
> >
>
Posted by stargazer on December 21, 2006, at 17:43:27
In reply to Re: Emsam enhancement » CrimsonVik, posted by laima on December 21, 2006, at 13:33:40
This is all very interesting and I thank you for your experiences with Ensam, selegiline and Adderall.
I think, don't know for sure, that Ensam will be covered by insurance so I may not have to take Selegiline but I will print out your posts if I need to know equivalents. It sounds as though either 10 or 20 mg will be good starting point if I need to go there. I have taken Adderall in combination with Wellbutrin and Celexa and felt it helped with my symptoms of disorganization and lack of focus. When I stopped it I felt like it contributed to my downward spiral as I got more and more disorganized and eventually life seemed to get very overwhelming.
My pdoc will say it is not allowed with Emsam but it may be helpful down the road. I also have suffered with hypotension, although recently it seemed more WNL.
All of this information is very helpful. The 6 mg patch which I have been on for a month may not be enough since I'm starting to lose my energy level so perhaps I need an increase?
Stargazer
Posted by laima on December 21, 2006, at 19:14:57
In reply to Re: Emsam enhancement/Helpful suggestions, posted by stargazer on December 21, 2006, at 17:43:27
Do you know, when I tried the 12mg Emsam, my blood pressure absolutely tanked, so I had to go back to 9. (It was something like 92/61, even when I was moving around in the middle of the day! I felt pretty faint. I haven't felt any agitation from Emsam, as others have reported. In other words, as it was increased, I became more sluggish, to say the least.) With the 9, a grand total of 10 mg adderall per day is sufficient to keep my blood pressure at the low end of normal (in the neighborhood of 110/70 when moving around moderately), and it boosts my energy and mood as well as focus, etc. If I understand correctly what my doctor was saying and what I was reading, selegeline can somehow increase a stimulant's effects, so "less acts like more". Sounds like it could get dicey fast for someone with high blood pressure. Perhaps if your doctor wavers, you might offer to get a blood pressure reader and promise to monitor yourself? That would seem prudent anyway until you are very sure how you react. 10 mg adderall a day is a pretty low dose, I believe--but pretty effective with the Emsam. Interestingly, before I started using selegeline oral version, I was giving wellbutrin a fair trial, with the same doctor. I tried ritalin with it for awhile for ADD and sleepiness, but the combination left me pretty frazzled so it was stopped. Another interesting discovery is that my overall anxiety seems to have gone way down as I gave up klonopin and now added the adderall- go figure.> This is all very interesting and I thank you for your experiences with Ensam, selegiline and Adderall.
>
> I think, don't know for sure, that Ensam will be covered by insurance so I may not have to take Selegiline but I will print out your posts if I need to know equivalents. It sounds as though either 10 or 20 mg will be good starting point if I need to go there. I have taken Adderall in combination with Wellbutrin and Celexa and felt it helped with my symptoms of disorganization and lack of focus. When I stopped it I felt like it contributed to my downward spiral as I got more and more disorganized and eventually life seemed to get very overwhelming.
>
> My pdoc will say it is not allowed with Emsam but it may be helpful down the road. I also have suffered with hypotension, although recently it seemed more WNL.
>
> All of this information is very helpful. The 6 mg patch which I have been on for a month may not be enough since I'm starting to lose my energy level so perhaps I need an increase?
>
> Stargazer
Posted by CrimsonVik on December 21, 2006, at 19:28:53
In reply to Re: Emsam enhancement/Helpful suggestions, posted by laima on December 21, 2006, at 19:14:57
He gave me Cytomel for thyroid/depression, SG. Dr. said I could NOT take Wellbutrin with an MAOI. It possibly would be harmless but I'm scared of that combo.
V.
Posted by laima on December 21, 2006, at 19:34:25
In reply to Re: Emsam enhancement/Helpful suggestions, posted by CrimsonVik on December 21, 2006, at 19:28:53
I think wellbutrin + Maoi might cause seratonin syndrome!
I wouldn't risk it if I were you.> He gave me Cytomel for thyroid/depression, SG. Dr. said I could NOT take Wellbutrin with an MAOI. It possibly would be harmless but I'm scared of that combo.
> V.
Posted by laima on December 21, 2006, at 19:50:33
In reply to Re: Emsam enhancement/Helpful suggestions, posted by laima on December 21, 2006, at 19:14:57
I should clarify part of what I just posted- when I tried the 12 Emsam, it was because I still felt pretty un-ok and going downhill, so an increase seemed like a good thing to try. I believe I was using 15 mg ritalin per day at the time- might have been 20, but I can't remember. When I started the 12, immediately my blood pressure went way down, my pulse went way up- like 97! I was afraid to use the ritalin- and I had klonopin- but that didn't seem like a hot idea either. I didn't know what to do, and was pretty freaked out over what was happening. So I pulled of the patch and went to see the doctor the next day. He said that when the heart rate goes way up while blood pressure goes way down, that means the heart is working much harder to try to keep up. Not good. So, decrease of Emsam, elimination of ritalin, and start of klonopin withdrawal all at once. And why klonopin withdrawal- because we both agreed that after 4 years it probably wasn't doing much of anything for my anxiety, and probably contributing to both it and depression. At end of November, 10 mg ritalin reintroduced, and I felt better- but still blah, and quite discouraged. That's when I had the consultation with the other guy who had ideas about adderall. So now, just the Emsam 9 and the 10 mg adderall seems like the formula for me. I feel better than I have in a long while, my mood is greatly improved, and no more weird blood pressure or heart rate fluctuations. I'm not feeling jittery anymore, either, and I sleep much better. A lot of changes, rocky for a couple weeks-still not perfect- but overall much better and so worth it now.I haven't used wellutrin for over a year, and I had to let it flush out for awhile before starting any selegeline. Sorry if I wrote that in a confusing way.
> Do you know, when I tried the 12mg Emsam, my blood pressure absolutely tanked, so I had to go back to 9. (It was something like 92/61, even when I was moving around in the middle of the day! I felt pretty faint. I haven't felt any agitation from Emsam, as others have reported. In other words, as it was increased, I became more sluggish, to say the least.) With the 9, a grand total of 10 mg adderall per day is sufficient to keep my blood pressure at the low end of normal (in the neighborhood of 110/70 when moving around moderately), and it boosts my energy and mood as well as focus, etc. If I understand correctly what my doctor was saying and what I was reading, selegeline can somehow increase a stimulant's effects, so "less acts like more". Sounds like it could get dicey fast for someone with high blood pressure. Perhaps if your doctor wavers, you might offer to get a blood pressure reader and promise to monitor yourself? That would seem prudent anyway until you are very sure how you react. 10 mg adderall a day is a pretty low dose, I believe--but pretty effective with the Emsam. Interestingly, before I started using selegeline oral version, I was giving wellbutrin a fair trial, with the same doctor. I tried ritalin with it for awhile for ADD and sleepiness, but the combination left me pretty frazzled so it was stopped. Another interesting discovery is that my overall anxiety seems to have gone way down as I gave up klonopin and now added the adderall- go figure.
>
> > This is all very interesting and I thank you for your experiences with Ensam, selegiline and Adderall.
> >
> > I think, don't know for sure, that Ensam will be covered by insurance so I may not have to take Selegiline but I will print out your posts if I need to know equivalents. It sounds as though either 10 or 20 mg will be good starting point if I need to go there. I have taken Adderall in combination with Wellbutrin and Celexa and felt it helped with my symptoms of disorganization and lack of focus. When I stopped it I felt like it contributed to my downward spiral as I got more and more disorganized and eventually life seemed to get very overwhelming.
> >
> > My pdoc will say it is not allowed with Emsam but it may be helpful down the road. I also have suffered with hypotension, although recently it seemed more WNL.
> >
> > All of this information is very helpful. The 6 mg patch which I have been on for a month may not be enough since I'm starting to lose my energy level so perhaps I need an increase?
> >
> > Stargazer
>
>
Posted by CrimsonVik on December 21, 2006, at 19:55:30
In reply to Re: Emsam enhancement » CrimsonVik, posted by laima on December 21, 2006, at 13:33:40
I never felt like I had low bp on the 6 mg. patch. On oral 10 mg.dose Monday it was like 65/40 till it increased.
I wonder if it's safe to go from MAOI to MAOI. He gave me Nardil earlier and when I quit that he (Dr.) said to go straight to Selegiline...I napped, woke up, and the room was spinning. I could not get up. I've just always wondered afterward if there isn't a waiting period between MAOI'S, you know?
V.
Posted by stargazer on December 21, 2006, at 22:58:15
In reply to Re: Emsam enhancement/clarification of previous » laima, posted by laima on December 21, 2006, at 19:50:33
Laima,
It all just tells me there is no formula for figuring this stuff out. So much of what works is one doctor's suggestion and you willingtotry something,which I usually am as long as it's at tiny doses. I did resist when my psoc suggested the antipsychotics initially, but I eventually tried Risperdal, Zyprexa and seroquel. I thought if I took an AP, it meant I had psychosis, even though he said it had worked for some of his pts with TRD. Never felt they did much of anything though.
The effects of Emsam 6 mg are starting to fade so I'm wondering what to do next. My pdoc is away until 1/2/07 so I'll prob have to wait until then. It's not like with pills how you can just increase the dose on your own if you think you need a higher dose. That was something that I felt I could always do before seeing my pdoc. He trusted me to do that and I trusted myself to do it.
I have Adderall left but I don't think I should experiment with adding that, besides it's the 20 mg capsules, so I guess I'll wait to ask him about that. He may just want me to increase from 6 to 9 mg Emsam. Perhaps I'm just having a tired, sluggish couple of days, you can't feel good everyday, can you?
Do people that aren't depressed have mostly good, productive days or do they struggle with bad days on and off?
SG
Posted by laima on December 21, 2006, at 23:35:10
In reply to Re: Emsam enhancement » laima, posted by CrimsonVik on December 21, 2006, at 19:55:30
Wow, that's really low blood pressure! Is that when the room was spinning and you couldn't get up? I hope you are alright now.I didn't have so much of a problem on the oral selegeline, but perhaps because my dose was lower. Not sure why.
I thought there was a waiting period between MAOIs- I think someone just wrote on another thread that he experienced a reaction by switching MAOIs too quickly.
> I never felt like I had low bp on the 6 mg. patch. On oral 10 mg.dose Monday it was like 65/40 till it increased.
> I wonder if it's safe to go from MAOI to MAOI. He gave me Nardil earlier and when I quit that he (Dr.) said to go straight to Selegiline...I napped, woke up, and the room was spinning. I could not get up. I've just always wondered afterward if there isn't a waiting period between MAOI'S, you know?
> V.
Posted by laima on December 21, 2006, at 23:57:30
In reply to Re: Emsam enhancement/Helpful suggestions, posted by stargazer on December 21, 2006, at 22:58:15
It does seem that we all have different chemistries and different background "details" which affect how medications react and interact for us. Not as clean and simple as one might hope.
Definately, perhaps wait to see your doctor before experimenting with adderall lest you have a surprise reaction-over the holidays to make it even more dramatic. My personal unprofessional guess is that 20 mg adderall, all at one go, with Emsam, would be way, way too much.I do believe that even non-depressed people have sluggish days and drearier days. It seems almost unrealistic and un-human to expect otherwise. That doesn't sound so nice to us, but I observe that my non-depressed friends take such days in better stride and don't seem to lose sight so easily as me that they're temporary. I'm a bit fascinated and envious over how they manage to do that. Winter in particular really seems to lend itself to sluggish dreariness for a lot of people I think- for example, I hear lots of people complaining that they want to "hibernate by 8 oclock" or about how many zillion cups of coffee they require. I also hear a lot of people complain about a day once in awhile when they just overslept and couldn't get anything accomplished, and yet I hunch they do not have a depression because they perk right back up and are overall active and engaged, etc. (Does anyone else think they can often spot others who have a mood disorder similar to their own?) Also, everyone is so excited when the days get longer. My overall conclusion is that people's moods and energy levels can dip here and there without being actual depression-I think it's ok.
> Laima,
>
> It all just tells me there is no formula for figuring this stuff out. So much of what works is one doctor's suggestion and you willingtotry something,which I usually am as long as it's at tiny doses. I did resist when my psoc suggested the antipsychotics initially, but I eventually tried Risperdal, Zyprexa and seroquel. I thought if I took an AP, it meant I had psychosis, even though he said it had worked for some of his pts with TRD. Never felt they did much of anything though.
>
> The effects of Emsam 6 mg are starting to fade so I'm wondering what to do next. My pdoc is away until 1/2/07 so I'll prob have to wait until then. It's not like with pills how you can just increase the dose on your own if you think you need a higher dose. That was something that I felt I could always do before seeing my pdoc. He trusted me to do that and I trusted myself to do it.
>
> I have Adderall left but I don't think I should experiment with adding that, besides it's the 20 mg capsules, so I guess I'll wait to ask him about that. He may just want me to increase from 6 to 9 mg Emsam. Perhaps I'm just having a tired, sluggish couple of days, you can't feel good everyday, can you?
>
> Do people that aren't depressed have mostly good, productive days or do they struggle with bad days on and off?
>
> SG
Posted by CrimsonVik on December 22, 2006, at 1:31:09
In reply to Re: Emsam enhancement » CrimsonVik, posted by laima on December 21, 2006, at 23:35:10
>
No, the spinning was around 3 weeks ago - the day I went from Nardil to Selegiline. God only knows what my BP was then!
V.> Wow, that's really low blood pressure! Is that when the room was spinning and you couldn't get up? I hope you are alright now.
>
> I didn't have so much of a problem on the oral selegeline, but perhaps because my dose was lower. Not sure why.
>
> I thought there was a waiting period between MAOIs- I think someone just wrote on another thread that he experienced a reaction by switching MAOIs too quickly.
>
>
> > I never felt like I had low bp on the 6 mg. patch. On oral 10 mg.dose Monday it was like 65/40 till it increased.
> > I wonder if it's safe to go from MAOI to MAOI. He gave me Nardil earlier and when I quit that he (Dr.) said to go straight to Selegiline...I napped, woke up, and the room was spinning. I could not get up. I've just always wondered afterward if there isn't a waiting period between MAOI'S, you know?
> > V.
>
>
Posted by RN320 on December 22, 2006, at 2:04:15
In reply to Re: Emsam enhancement/Helpful suggestions, posted by stargazer on December 21, 2006, at 22:58:15
Stargazer-
What I found with EMSAM dosing is that I definitely plateaued (or maybe a slight decrease in effectiveness) after about 5-6 weeks at 6mg. I started with it during the first week of June.) My pdoc pushed it to 9mg then and I was on that dose for maybe 2 months and did better. I didn't notice any decrease in effectiveness while I was on the 9mg patch. My pdoc thought that I could do even better at the highest dose, so in September we decided to go to the 12 mg and I'm still there and it's definitely improved my function (and even mood more than I had gotten early on). I haven't noticed any decrease in effectiveness since September, so this dose seems to have held me so far. My pdoc had to change me over from seroquel to trazadone for sleep, and it's working really well. He says that he may try Provigil after the holidays for enhanced effect for the trazadone/EMSAM combination. Anyway, this is how it's worked for me.
Good Luck and Happy Holidays.
/m
Posted by Karen44 on December 22, 2006, at 2:19:05
In reply to Emsam Users, length of time, effects,pros/cons?, posted by stargazer on December 13, 2006, at 9:10:19
Just started Ensam. Has anyone had a side effect of nausea from Ensam, or might this nausea be due to something else? I just had hand/thumb surgery a little over a week ago and still take Vicodin at night due to pain waking me up.
Karen44
Posted by laima on December 22, 2006, at 10:14:14
In reply to Re: Emsam Users, length of time, effects,pros/cons?, posted by Karen44 on December 22, 2006, at 2:19:05
Is vicodin an opiate painkiller? If it is, maybe it's interacting with Emsam?> Just started Ensam. Has anyone had a side effect of nausea from Ensam, or might this nausea be due to something else? I just had hand/thumb surgery a little over a week ago and still take Vicodin at night due to pain waking me up.
>
> Karen44
Posted by Karen44 on December 22, 2006, at 10:48:52
In reply to Re: Emsam Users, length of time, effects,pros/cons? » Karen44, posted by laima on December 22, 2006, at 10:14:14
> I am not sure if vicodin is an opiate painkiller, but I did ask my pdoc about starting to use the patch while still using the vicodin. He said it would be okay, that the only thing was that the effects of the vicodin might be potentiated.
I want the Emsam to work as this is the end of the line for me. I have tried everything including Parnate which used to work years ago and no longer does. I have had so many bad side effects and/or allergic reactions to everything other than MAOI's, even at low doses, that I don't want to have to stop the Emsam. No Vicodin this a.m. and still feeling a bit nauseous plus sweating like crazy. I will see how it goes the rest of the day.
Karen44
> Is vicodin an opiate painkiller? If it is, maybe it's interacting with Emsam?
>
> > Just started Ensam. Has anyone had a side effect of nausea from Ensam, or might this nausea be due to something else? I just had hand/thumb surgery a little over a week ago and still take Vicodin at night due to pain waking me up.
> >
> > Karen44
>
>
Posted by laima on December 22, 2006, at 11:25:32
In reply to Re: Emsam Users, length of time, effects,pros/cons? » laima, posted by Karen44 on December 22, 2006, at 10:48:52
Karen,You're sweating too? That doesn't sound good, I do wonder if you might not be experiencing a drug interaction. I had thought vicodin was an official no-no with Emsam, though based on what your doctor said, perhaps it's a "no-no" the way "MAOI plus stimulant" is an official no-no. (In other words, murky and not exactly always true.)
Is your pain such that it would be possible for you to stay away from vicodin and try substituting something more noncontroversially benign (Maoi-wise) like ibuprofin? I just don't think sweating is an Emsam side effect, and hope you are able to use it, and that it works out, everything safe.
Good luck.
> > I am not sure if vicodin is an opiate painkiller, but I did ask my pdoc about starting to use the patch while still using the vicodin. He said it would be okay, that the only thing was that the effects of the vicodin might be potentiated.
>
> I want the Emsam to work as this is the end of the line for me. I have tried everything including Parnate which used to work years ago and no longer does. I have had so many bad side effects and/or allergic reactions to everything other than MAOI's, even at low doses, that I don't want to have to stop the Emsam. No Vicodin this a.m. and still feeling a bit nauseous plus sweating like crazy. I will see how it goes the rest of the day.
>
> Karen44
> > Is vicodin an opiate painkiller? If it is, maybe it's interacting with Emsam?
> >
> > > Just started Ensam. Has anyone had a side effect of nausea from Ensam, or might this nausea be due to something else? I just had hand/thumb surgery a little over a week ago and still take Vicodin at night due to pain waking me up.
> > >
> > > Karen44
> >
> >
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Posted by Karen44 on December 22, 2006, at 11:47:56
In reply to Re: Emsam Users, length of time, effects,pros/cons?, posted by laima on December 22, 2006, at 11:25:32
Thanks. I am going to try to not use any Vicodin today no matter the pain and instead go back to taking my a.m. Neurotin. I want the Emsam to work as the last resort will loom on the horizon, ECT, and I really don't want to go down that road as I am still working at a job that requires me to have not only very good verbal cognitive skills but also very good nonverbal cognitive skills. If this does not work I will ask to give Parnate a chance again as even though it did not work well as it did years ago, I think it helped some and at least helped me to not feel suicidal. That's something at least!
Karen44
Posted by shoshana on December 23, 2006, at 13:57:59
In reply to Emsam Users, length of time, effects,pros/cons?, posted by stargazer on December 13, 2006, at 9:10:19
I have been on the EMSAM 6mg/24 hour patch for almost 3 months. It has helped my mood and I have not had the weight gain and very severe memory problems that I have gotten on the SSRIs and SSNIs, although it has done nothing to help my anxiety. Also, in the last 2-3 weeks, I have begun to experience side-effects and wanted to share them. I am going to make an appointment to see my doctor, though, probably some of the side-effects could be controlled by watching what I eat (even though the patch at this level is not supposed to have dietary restrictions - I have noticed a reaction after I have had some of the things on the 'do not eat' list for those MAOIs of a higher dosage). Side-effects:
1) Head-rushes: I have to grab on to the wall/furniture sometimes to prevent myself from falling, when getting up from my bed or from a seated position.
2) Changes in blood pressure: I have always had very good blood pressure. Recently, when I started getting head-rushes, I checked and noticed that my average blood pressure has dropped around 30 points.
3) Acute insomnia: I cannot sleep more than 3 hours a night on my own. If I take Klonopin, Xanex, or Ambien, I get an extra 2 hours, at best.
4) Mild memory problems and problems concentrating: I think this may be caused by lack of sleep, though the symptoms seems to slowly be getting worse.
5) Hypersensitivity to light in the morning: when I go out of my house in the morning, I feel like the sky is painfully bright and it hurts my eyes.
6) Detection of a strange odor: I very often feel as if I'm smelling spoiled milk and can't get rid of the smell. It occurs when I'm in different places (at home, at work, at a store, etc), so I know it doesn't have anything to do with my housekeeping skills!
7) Extreme anxiety: Feels as if I'm having a very severe panic attack (which I'm not): I noticed that this happened the other day after I had one piece of imported chocolate. It can last for several days and is very unpleasant. I have tried to alleviate the feeling of anxiety by working out at the gym and it helps only slightly. Also, Xanex helped a little bit.
8) Difficulty doing simple math equations: For example, I used to be the person everyone turned to when figuring out the bill at a restaurant. Now I have problems calculating in my head and have stopped trying because it is too frustrating. This also may be caused by lack of sleep (?)
9) Involuntary muscle spasms: I had these when I was taking Cymbalta and they seem to have returned but they are less frequent and not as strong.
> Hi, just checking in to update my Emsam post for anyone interested.
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> Duration: approx 1 month now.
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> Effects:
> Positive: more motivation, decrease in anxiety, better focus, no dietary restrictions.
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> Negative: patch falls off sometimes, cost (have samples now but not sure if my insurance will cover it, I will fight if they don't)
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> I see my pdoc today and although I am feeling better than a few months ago, I don't really feel great. That is one of the problems with depression...being able to judge how you feel and knowing that you are getting some response or not.
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> I'd like to keep posting and hear from others on Emsam.
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> P.S. Still take 25 mg of seroquel to sleep prn.
>
> Stargazer
>
Posted by RN320 on December 23, 2006, at 14:54:15
In reply to Re: Emsam Users, length of time, effects,pros/cons? » stargazer, posted by shoshana on December 23, 2006, at 13:57:59
hi Shoshana-
I read your post with great interest. I'm now stabilized at the 12mg dose of EMSAM and doing really well. I can relate to a lot of the side effects that you're reporting.At the 6mg dose my anxiety went up a little. Any anxiety that i experience at 12mg is much more manageable and is only related to things like extreme personal stress or unfamiliar places and people. I do pretty well day-to-day now.
I had insomnia prior to the EMSAM, so i can't say that it caused it. I took seroquel for over a year to help with sleep, but although it is still effective to augment the EMSAM, it has ceased to be useful for insomnia- so my pdoc has put me on trazadone, and that is starting to work well for me. I'm now averaging 7-9 hours of sleep almost every day (vs. 1-3 hours per night for the month of November!).
I also have the major changes in blood pressure. I used to have hypertension, and I have some cardiac problems, so I'm sure that this all adds to the hypotensive effect of EMSAM. Because I get so orthostatic, I've had to train myself to get up verrrry slowly from bed in the morning. I actually sit with my legs dangling for at least 5 minutes....otherwise I have a pretty good chance of passing out. I also try to be really careful when I've been sitting for any longer than 15 minutes because going from sitting to standing can also cause me to pass out. My internist and pdoc are working together on this problem, and they are thinking about using a drug called Florinef or something like that, which helps to increase your BP.
My experience has been that it takes a long time for your body to acclimate to the initial drug and subsequent dose changes. It seems like most of these side effects could be manageable if you feel that you're getting really good results with the EMSAM and want to stay on it.
As far as the diet goes, even though my pdoc reiterated to me that I had no restrictions at the 6mg dose, I chose to implement them anyway. That was in June, so I'm pretty used to reading labels and avoiding any food that's moderate to high in tyramine now. After reading about your dietary experiences/reactions I think I'm glad that I chose to go the route I did.
Good luck to you, Shoshana. I hope you have a happy holiday.
/m
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