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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 37. This is the beginning of the thread.
Posted by stargazer on January 8, 2007, at 10:37:06
Hi everyone on Emsam....
I have been on 6 mg for past two months or so. Initially got good energy and motivation but have lost this in last few weeks.
My symptoms now are lack of motivation, interest, focus, etc and want to hear from others what meds have been added to Emsam to help with symptoms like these. I may have ADD and have gotten some improvement when I was on Adderral with Celexa and Wellbutrin, but depression got worse on this combo.
Also, are they meds that are allowed with Emsam or is your pdoc stretching the so-called safe med list of what can be added with Emsam,since I want to let my pdoc know what has been safely added and is helping others.
I don't really feel depressed, just in limbo about what I'm supposed to be doing with my life. I have intelligence and education but just no motivation or passion for anything lately. I need to find a job but have little motivation to do this.
Also, I have no interest in reading and find it very hard to concentrate for long on anything.
Any suggestions for add-ons with Emsam? I'm not sure a higher dose is indicated although I'm sure this is the direction my pdoc will want to try first, yet I think something else would work better.
Thanks for any suggestions of what to try. I prefer only one additional med if possible.
Stargazer
Posted by laima on January 8, 2007, at 10:59:25
In reply to EMSAM Add-ons...Please help with suggestions, posted by stargazer on January 8, 2007, at 10:37:06
My doctor arranged for me to have a consulation session with a very respected researcher a couple months ago, I suppose because I just wasn't responding the way I should and as he put it, "let's see if someone else can see something we're not seeing". I was on Emsam 9 plus 20mg ritalin. Anyway, this second opinion person said that in his observation, adderall and Emsam seem to work synergistically, and he's seen a number of tough cases do really, really well with the combo. So my doctor switched me to 10mg adderall (5mg 2x per day), then upped to 15mg (split up, 2x per day), along with Emsam 9. I gotta say, my mood is considerably better than it was before with just this switch.
Yes, this is one of those unconventional combos, might not be for everyone. The combo can increase blood pressure and heart rate. My blood pressure is quite low naturally, but ridiculously low on Emsam. I have been required to check my blood pressure at home quite a bit to monitor for trouble. When I first got the adderall, that meant lying down and then standing up first thing in the morning, then three hours after taking adderall, this routine twice a day, and then again at bedtime. But the hassle has been worth it.
Adderall might be different for you with Emsam than it was with Celexa or Wellbutrin. I speculate the possibility because I used ritalin with wellbutrin, and that wasn't the greatest. It was quite beneficial with Emsam, not so prone to jangelyness or agitation. In other words, different experience.
> Hi everyone on Emsam....
>
> I have been on 6 mg for past two months or so. Initially got good energy and motivation but have lost this in last few weeks.
>
> My symptoms now are lack of motivation, interest, focus, etc and want to hear from others what meds have been added to Emsam to help with symptoms like these. I may have ADD and have gotten some improvement when I was on Adderral with Celexa and Wellbutrin, but depression got worse on this combo.
>
> Also, are they meds that are allowed with Emsam or is your pdoc stretching the so-called safe med list of what can be added with Emsam,since I want to let my pdoc know what has been safely added and is helping others.
>
> I don't really feel depressed, just in limbo about what I'm supposed to be doing with my life. I have intelligence and education but just no motivation or passion for anything lately. I need to find a job but have little motivation to do this.
>
> Also, I have no interest in reading and find it very hard to concentrate for long on anything.
>
> Any suggestions for add-ons with Emsam? I'm not sure a higher dose is indicated although I'm sure this is the direction my pdoc will want to try first, yet I think something else would work better.
>
> Thanks for any suggestions of what to try. I prefer only one additional med if possible.
>
> Stargazer
Posted by Phillipa on January 8, 2007, at 11:23:40
In reply to Re: EMSAM Add-ons...Please help with suggestions, posted by laima on January 8, 2007, at 10:59:25
And most people have complained of insomnia or agitation on EMSAM so again your mileage may vary. Good luck Stargazer you've done well so far. Love Phillipa
Posted by UGottaHaveHope on January 8, 2007, at 15:05:02
In reply to EMSAM Add-ons...Please help with suggestions, posted by stargazer on January 8, 2007, at 10:37:06
Stargazer, how many days after wearing the patch did you feel an effect from it?
Posted by stargazer on January 8, 2007, at 15:22:24
In reply to Re: EMSAM Add-ons...Please help with suggestions, posted by laima on January 8, 2007, at 10:59:25
Thank you for responding as I have been following your responses to Lilith on the other post but have a hard time digesting things that aren't specific to my situation although sometimes I can do this. Having alot more issues with attention and comphrehension lately.
I just checked my pharmacy bin and have Adderall-XR 20 mg caps and Amphetamine 10mg tabs. Only other med for ADD I have tried is ritalin and like you caused me agitation.
Since amphetamine meds are contraindicated with Emsam, I thought that Strattera or Provigil may be a better choice although I have no experience with either. Do you or anyone else?
Also, since you are connected with some pretty high level pdocs, do you think my pdoc could contact them for their opinion/advice on the Adderall/Emsam combo since they have suggested it and it is working for you? Of course this would be with their agreement and done in confidence, etc. I have an appt with my pdoc 1/16 and wouldlike him to know about the combo and perhaps get him to agree to prescribe it. I too have very low BP and had many falls over the past few months after being on Lamictal, so part of my problem may be hypotension but I have checked it fairly often and it is around 110/70, which is actually higher than I have ever been in my life, although I have vertigo and lightheadedness daily.
I am getting more and more desparate. It's a very long, boring story and I am running out of endings. Too much time lost to depression over the past 30 years. Sometimes I think I was better off before seeking help. only 2 meds that worked were Nardil and Marplan. Nardil stopped working after 2 yrs and Marplan was d/c'ed by manufacturor (Roche)in late 80's and I have not had a good response to another med since then!
Life with depression is NO LIFE!
Stargazer
Posted by laima on January 8, 2007, at 17:42:48
In reply to Laima, others, Strattera/Provigil experience?, posted by stargazer on January 8, 2007, at 15:22:24
Hi Stargazer,I understand that the reason adderall and other stims are not typically recommended with MAOIs is risk of hypertensive crisis/high pulse rate, high blood pressure. So, not sure about Strattera, provigel. Also not sure if they would have dangers along the lines of seratonin crisis or not. Isn't Strattera related to ritalin, or am I totally mixed up? Whether stimulants would be safe for a person or not probably varies person to person, and depends on their blood pressure as well as on how they are absorbing the drugs. There have been other people on babble combining stimulants with MAOIs, even with parnate I think, so I really can't imagine it's all that weird. If someone is looking into a prescription cookbook- it's against the official rules. If someone looks at how a particular patient is doing on their Emsam, what their blood pressure and pulse are doing- it may be a good option and make perfect sense. My doctor is looking closely- not just at a snapshot reading, but pulse in relation to blood pressure, is there a humungous difference between sitting and standing. (Looking to see if the heart is gasping to keep up- or if it's ok.)
I'm not keen on identifying my doctors publically, risk getting myself identified, or getting them interested in snooping up on me, so I'll babblemail you! :)
Laima
> Thank you for responding as I have been following your responses to Lilith on the other post but have a hard time digesting things that aren't specific to my situation although sometimes I can do this. Having alot more issues with attention and comphrehension lately.
>
> I just checked my pharmacy bin and have Adderall-XR 20 mg caps and Amphetamine 10mg tabs. Only other med for ADD I have tried is ritalin and like you caused me agitation.
>
> Since amphetamine meds are contraindicated with Emsam, I thought that Strattera or Provigil may be a better choice although I have no experience with either. Do you or anyone else?
>
> Also, since you are connected with some pretty high level pdocs, do you think my pdoc could contact them for their opinion/advice on the Adderall/Emsam combo since they have suggested it and it is working for you? Of course this would be with their agreement and done in confidence, etc. I have an appt with my pdoc 1/16 and wouldlike him to know about the combo and perhaps get him to agree to prescribe it. I too have very low BP and had many falls over the past few months after being on Lamictal, so part of my problem may be hypotension but I have checked it fairly often and it is around 110/70, which is actually higher than I have ever been in my life, although I have vertigo and lightheadedness daily.
>
> I am getting more and more desparate. It's a very long, boring story and I am running out of endings. Too much time lost to depression over the past 30 years. Sometimes I think I was better off before seeking help. only 2 meds that worked were Nardil and Marplan. Nardil stopped working after 2 yrs and Marplan was d/c'ed by manufacturor (Roche)in late 80's and I have not had a good response to another med since then!
>
> Life with depression is NO LIFE!
>
> Stargazer
Posted by laima on January 8, 2007, at 17:54:53
In reply to Re: EMSAM Add-ons...Please help with suggestions » laima, posted by Phillipa on January 8, 2007, at 11:23:40
Yes, I doubt it works for everyone, or else there wouldn't be any warning in the first place.> And most people have complained of insomnia or agitation on EMSAM so again your mileage may vary. Good luck Stargazer you've done well so far. Love Phillipa
Posted by med_empowered on January 8, 2007, at 22:11:47
In reply to Re: EMSAM Add-ons...Please help with suggestions » Phillipa, posted by laima on January 8, 2007, at 17:54:53
MAOI+stims have been combined pretty successfully before. Some docs apparently do it a good bit (I think Ivan Goldberg has written about using pretty high doses of both the MAOI and the stims in these situations). The craziest combo I've heard of is an MAOI, a TCA, and a stimulant. I think with proper management and dosing, everything should be OK.
Posted by SLS on January 9, 2007, at 5:59:28
In reply to EMSAM Add-ons...Please help with suggestions, posted by stargazer on January 8, 2007, at 10:37:06
I think you might want to try going up in dosage first. MAOIs are strange beasts. You might need to go up to recapture the antidepressant effect if your percentage of inhibition was borderline at the lower dosage. It is not infrequent that people must adjust their dosage of MAOI throughout the years - up or down.
My doctor and his colleagues are using Emsam to treat ADD.
I wouldn't know what to suggest adding. There are so many possibilities. Lack of interest and anhedonia are problems and are symptoms of residual depression. I'd like to see what others suggest.
- Scott
Posted by SLS on January 9, 2007, at 6:10:31
In reply to EMSAM Add-ons...Please help with suggestions, posted by stargazer on January 8, 2007, at 10:37:06
So far, the Adderall idea looks pretty good, right?
Like others, I had been leaning in the direction of a stimulant.
I would still go up to 9mg/24hr first, wait 3 weeks, and then add the Adderall if necessary.
Provigil would be interesting, too. However, the clinical experience of an expert is probably worth more than our guesses, and might make for a better first choice.
- Scott
Posted by SLS on January 9, 2007, at 6:18:36
In reply to Re: EMSAM Add-ons...Please help with suggestions, posted by med_empowered on January 8, 2007, at 22:11:47
> The craziest combo I've heard of is an MAOI, a TCA, and a stimulant.
Are you calling me crazy?
:-)
Parnate 120mg + desipramine 200mg + Dexedrine 20mg + Synthroid
I felt better for the first 3 days after adding the Dexedrine. For some reason, 3 days has been the critical number for me. When I get a robust response to something, it lasts for 3 days exactly, then disappears abruptly. I guess my brain stubbornly clings to a dysregulated homeostasis. Apparently, it takes 3 days to accomplish this feat.
- Scott
Posted by laima on January 9, 2007, at 13:14:51
In reply to Re: EMSAM Add-ons...Please help with suggestions » med_empowered, posted by SLS on January 9, 2007, at 6:18:36
I just thought of something else: there's a lot of information out there about combining the amino acid phenylalanine with selegeline, if you google. It's supposed to be an excellent combination.(The topic verges here into the "alternative" category.)
Posted by Phillipa on January 9, 2007, at 19:10:35
In reply to Re: EMSAM Add-ons...Please help with suggestions » med_empowered, posted by SLS on January 9, 2007, at 6:18:36
Scott when did you add the synthroid? I thought yours was normal range? Love Jan
Posted by RN320 on January 12, 2007, at 14:46:21
In reply to EMSAM Add-ons...Please help with suggestions, posted by stargazer on January 8, 2007, at 10:37:06
Hi Stargazer-
THe same thing has happened to me at the 12mg EMSAM. It seems that you get an initial boost and then eventually lose focus. It's still better at the 12mg for me, though. My pdoc says that the only safe stimulant to use with EMSAM is Provigil. I'm supposed to be starting it shortly. ALso, he mentioned Aricept of all things....he said that it's helped cognitive abilities in many non-Alzheimers patients. I'm supposed to start Provigil next week. I've read from others that they use adjunct Adderal and Ritalin, but my pdoc was adamant that they're "expressly contraindicted" in conjunction with EMSAM.Hope that helps, and that you're feeling better soon.
/m
Posted by laima on January 12, 2007, at 15:30:40
In reply to Re: EMSAM Add-ons...Please help with suggestions, posted by RN320 on January 12, 2007, at 14:46:21
Provigel is probably safest in general for most people, but I'm living proof it's not the only stimulant safe to use with Emsam. My doctor and people who share his office do use other stimulants in combination with Emsam with a lot of patients. My doctor is a psychiatry and pharmacology professor, the entire office is faculty and researchers. Decent and respectable credentials. Doses are lower than they would be without the Emsam. A lot depends on patients's compliance reliability, blood pressure and heart-rate, and obviously, the combinations require close monitoring and cannot be recommended for everyone.
> Hi Stargazer-
> THe same thing has happened to me at the 12mg EMSAM. It seems that you get an initial boost and then eventually lose focus. It's still better at the 12mg for me, though. My pdoc says that the only safe stimulant to use with EMSAM is Provigil. I'm supposed to be starting it shortly. ALso, he mentioned Aricept of all things....he said that it's helped cognitive abilities in many non-Alzheimers patients. I'm supposed to start Provigil next week. I've read from others that they use adjunct Adderal and Ritalin, but my pdoc was adamant that they're "expressly contraindicted" in conjunction with EMSAM.
>
> Hope that helps, and that you're feeling better soon.
> /m
Posted by laima on January 12, 2007, at 15:41:25
In reply to Re: EMSAM Add-ons...Please help with suggestions » RN320, posted by laima on January 12, 2007, at 15:30:40
I hope that didn't come out sounding wrong. Obviously, stimulants other than provigel carry risk of high blood pressure crisis when used with Emsam, and good doctors will disagree about how much risk is acceptable to dinker with. The other stimulants have worked out really well for me, but I've always had lower than normal blood pressure, even before Emsam. So much so that doctors always double check me because they think their reader is broken. Emsam plunges it even lower, so the stimulants have been a godsend. Even with the stimulants plus Emsam, my readings are low to normal. Does provigel even affect blood pressure or attention deficit? That's probably why it's not my own optimal choice.
Posted by RN320 on January 12, 2007, at 18:03:05
In reply to Re: EMSAM Add-ons...Please help with suggestions » laima, posted by laima on January 12, 2007, at 15:41:25
I don't think that I got you wrong at all. Provigil is contraindicated with people that have hypertension,hyperthyroidism,glaucoma, drug abuse, severe anxiety states and CV disease. It's usually used for narcolepsy and sleep apnea, not really for ADHD.
Good Luck.
/m
Posted by stargazer on January 12, 2007, at 23:03:06
In reply to Re: EMSAM Add-ons...Please help with suggestions, posted by RN320 on January 12, 2007, at 18:03:05
Well I saw my pdoc today and told him straight out I had been experimenting with tiny doses of amphetamine along w Emsam. I told him another person (Laima) had done this and her pdoc had sanctioned this and I told him they were at Northwestern if he needed to speak with them. He said he had another pt who was using Emsam/Adderral combo, which surprised me since he is usually completely by the book...
Anyway, we agreed I would continue to use the short acting amphetamine that I had from previous script (substitute for Adderall)which I had taken last year when on Celexa.
He said I could go higher on the dosage and continue to monitor my BP/pulse which I told him I had been doing faithfully during the past few days trying amphetamines.
So, that's the direction I'm heading in and I feel like it is the right decision. My pdoc gave me full credit for figuring out that that is the missing component in my depression treatment.
I'm keeping my fingers crossed on it.
Stargazer
Posted by SLS on January 13, 2007, at 4:47:00
In reply to Re: EMSAM Add-ons...pdoc agrees w stim use, posted by stargazer on January 12, 2007, at 23:03:06
> Anyway, we agreed I would continue to use the short acting amphetamine that I had from previous script (substitute for Adderall)which I had taken last year when on Celexa.
trying amphetamines.
> So, that's the direction I'm heading in and I feel like it is the right decision. My pdoc gave me full credit for figuring out that that is the missing component in my depression treatment.
>
> I'm keeping my fingers crossed on it.
>
> Stargazer
Sounds good.Please post your results.
Good luck.
:-)
- Scott
Posted by ryanz on January 14, 2007, at 2:11:09
In reply to Re: EMSAM Add-ons...Please help with suggestions, posted by RN320 on January 12, 2007, at 14:46:21
Posted by littlebitpa on January 14, 2007, at 15:35:04
In reply to Laima, others, Strattera/Provigil experience?, posted by stargazer on January 8, 2007, at 15:22:24
Hi, this is my first time writing, but i wanted to respond to the provigil. I am taking 100mg a day because nothing I tried, including all the other stimilants, did anything at all and I have also been on every type of AD which only gave limited and short lived relief, with more side effects than help. The provigil was the first med that actually gave me a sense of well being and clarity. It made me feel more awake and alert without stimilating effects. Still had other mood disorder symptoms so Pdoc added emsam which worked great for the first 8 weeks but is now starting to lose its effect. My symptoms are returning in full force; Iritability, anxious,no motivation, fatigue, yell at my kids with no provication. Anyone else have emsam lose its effectivness? Sorry so long. Thanks for your patience.
Posted by RN320 on January 14, 2007, at 15:39:38
In reply to Re: Laima, others, Strattera/Provigil experience? » stargazer, posted by littlebitpa on January 14, 2007, at 15:35:04
My pdoc started me at 6mg, moved me up to 9mg in about 6 weeks and then to 12mg in early Sept. In the 4 1/2 months at 12mg I haven't seen any lessened effect thus far.
Welcome to psychobabble.
/m
Posted by littlebitpa on January 14, 2007, at 16:41:04
In reply to Re: Laima, others, Strattera/Provigil experience?, posted by RN320 on January 14, 2007, at 15:39:38
> My pdoc started me at 6mg, moved me up to 9mg in about 6 weeks and then to 12mg in early Sept. In the 4 1/2 months at 12mg I haven't seen any lessened effect thus far.
> Welcome to psychobabble.
> /mI see my pdoc 1/18, maybe he will up the dose. Emsam was working great initially. Thanks for the response and the welcome. I'm glad it is working for you! It gives me hope.
Posted by rich776 on January 15, 2007, at 20:54:32
In reply to EMSAM Add-ons...Please help with suggestions, posted by stargazer on January 8, 2007, at 10:37:06
Right now I take emsam, lamictal and a pinch of lexapro. I also take some provigil when I need a boost. So far I haven't felt anything consistent but its only been a couple of weeks. My (and my docs) favorite add-on is Lamictal. Almost no side effects but you have to go up slowly on dosage. I will let you know how things are going after at least 4 weeks on emsam. Hoping I will only need to take 1 med.
Posted by stargazer on January 15, 2007, at 23:07:42
In reply to Re: EMSAM Add-ons...Please help with suggestions, posted by rich776 on January 15, 2007, at 20:54:32
I took Lamictal earlier in the year and it caused me to have vertigo and after falling down a few times, I realized that wasn't normal for me. I actually was seen by a neurologist and was told the Lamictal was probably causing that. It didn't cause me any great concern to stop it because I had been telling the pdoc that I thought it was making me lose my memory and forget everything. Well it certainly wasn't helping me... just my experience w Lamictal...SG
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