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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by greywolf on March 19, 2007, at 23:36:38
It's been a few months since I last posted. I'm BPII with severe OCD problems. I'm currently in CBT for the OCD, and I'm trying to find a pharmaceutical aid for the BP.
Over the past decade, I've been through almost every AD, benzo, MAOI, mood stabilizer, antipsychotic, etc. that you can imagine. I've recently given up on Seroquel because the sedating effect made it impossible to work effectively. I have few options left to me, and my doctor has recommended a VNS implant.
While I am waiting for VNS approval, I am starting on Emsam 6mg, along with Xanax up to 4mg/day. I had a long course of Nardil a few years ago and found it somewhat effective. I expect that Emsam will have a similar ramping up time, and I'm interested in what everyone's experience has been with benefits of the patch. Anything you can pass along would be great.
Thanks.
Posted by UgottaHaveHope on March 20, 2007, at 8:02:45
In reply to Starting Emsam, wondering what to expect, posted by greywolf on March 19, 2007, at 23:36:38
I have been on Emsam for 11 weeks, and felt more energy the first day I put the patch on. Around week 7, I felt like the medicine started to kick in a little bit.
You need to move the patch around each day. You may have some insomnia, but can take benadryl.
Let me ask this: I am considering Nardil for my generalized anxiety. Did Nardil help with anxiety for you? Can you explain? Did you have any side effects? Why did you stop? Thanks, Michael
Posted by stargazer on March 20, 2007, at 8:58:13
In reply to Starting Emsam, wondering what to expect, posted by greywolf on March 19, 2007, at 23:36:38
Greywolf, I have been on it since November with varying degrees of improvement and minimal side effects. I started at 6 mg and moved to 9 mg, I think in early January.
I did try to go up to 12 mg with some increase in hypotension, lightheadedness. So I went back to 9 mg and have been there about 2 mos.
I'm not totally impressed with its ability to reduce stress and bolster my resilience to negativity. I feel I am not handling situations that seem relatively stress free. I have no faith that the results will be uselful in real life situations, like work, and this is what I am looking for. In the past, my best outcomes have made me quite confident and resilient to many situations especially day to day stress you have in any job.
But you may have better results depending on your chemistry, etc.
Stargazer
Posted by greywolf on March 20, 2007, at 10:48:22
In reply to Re: Starting Emsam, wondering what to expect » greywolf, posted by UgottaHaveHope on March 20, 2007, at 8:02:45
> I have been on Emsam for 11 weeks, and felt more energy the first day I put the patch on. Around week 7, I felt like the medicine started to kick in a little bit.
>
> You need to move the patch around each day. You may have some insomnia, but can take benadryl.
>
> Let me ask this: I am considering Nardil for my generalized anxiety. Did Nardil help with anxiety for you? Can you explain? Did you have any side effects? Why did you stop? Thanks, MichaelMichael:
When I took Nardil a few years ago, it was under the direction of a GP who was a little more liberal than most GPs when it comes to trying a wide range of ADs. He had me on Nardil for several months to help with the depressive element of my bipolar disorder. I had (and still have) a need to avoid the fatigue and lethargy caused by way too many ADs, and Nardil was great in that respect. It also had zero sexual SEs.
However, Nardil did not do much for my anxiety, and I found that the longer I was on the Nardil, the worse my OCD was getting. I ended up dropping Nardil and going back on Anafranil, which didn't work either.
I think that my situation is not generally representative because the OCD problem is really severe, and that carries in itself a high degree of stress that Nardil and benzos won't really touch. So I wouldn't read my situation as a suggestion that Nardil can't address anxiety with any effectiveness.
I would recommend giving Nardil a chance. I have had a lot of experience with a tremendous number of medications, and Nardil was very gentle with respect to side effects. It provided somewhat of a benefit on the depression side at only a moderate dosage, though it's nothing like a mood elevator.
And don't be put off by the diet restrictions. You'll make the adjustment easily.
Greywolf
Posted by greywolf on March 20, 2007, at 10:52:59
In reply to Emsam/my analysis of 5 month trial/Greywolf, posted by stargazer on March 20, 2007, at 8:58:13
> Greywolf, I have been on it since November with varying degrees of improvement and minimal side effects. I started at 6 mg and moved to 9 mg, I think in early January.
>
> I did try to go up to 12 mg with some increase in hypotension, lightheadedness. So I went back to 9 mg and have been there about 2 mos.
>
> I'm not totally impressed with its ability to reduce stress and bolster my resilience to negativity. I feel I am not handling situations that seem relatively stress free. I have no faith that the results will be uselful in real life situations, like work, and this is what I am looking for. In the past, my best outcomes have made me quite confident and resilient to many situations especially day to day stress you have in any job.
>
> But you may have better results depending on your chemistry, etc.
>
> Stargazer
Thanks, Stargazer.I am not expecting great things from Emsam because an innumberable medications have not been effective for me. But I am trying to keep a positive outlook because the only other option at this point appears to be VNS or ECT, and I can't have ECT because of my job.
I will take Emsam for as long as it has any chance of helping me. Your response and others' comments will help me keep my expectations at a reasonable level.
Greywolf
Posted by UGottaHaveHope on March 20, 2007, at 11:11:17
In reply to Re: Starting Emsam, wondering what to expect » UgottaHaveHope, posted by greywolf on March 20, 2007, at 10:48:22
Thanks for your insight on Nardil. Even though it didnt work out perfect for you, what you said gives me confidence to try it if Emsam does not work out for me. Right now on Emsam, I say I feel like a 6 on scale 1-10. Would you be satisfied with that or try Nardil?
Hey, there is always Ultram for us to try, if all else fails.
Posted by Phillipa on March 20, 2007, at 11:44:43
In reply to Re: Starting Emsam, wondering what to expect » greywolf, posted by UGottaHaveHope on March 20, 2007, at 11:11:17
Michael can you get a script for ultram? Or how will you get it? As if depressed cause of my response to percocet l at night I was happy. And I don't care about addiction I am 6l today so what does it matter? Love Phillipa
Posted by UgottaHaveHope on March 20, 2007, at 15:22:50
In reply to Re: Starting Emsam, wondering what to expect » UGottaHaveHope, posted by Phillipa on March 20, 2007, at 11:44:43
Jan: I totally agree with you. What do you have to lose? You have two routes: Print up material on a medical website that shows Ultram is being prescribed for depression and take it to your pdoc. Or order it online. Good to hear you are doing better. Michael
Posted by greywolf on March 20, 2007, at 16:02:53
In reply to Re: Starting Emsam, wondering what to expect » greywolf, posted by UGottaHaveHope on March 20, 2007, at 11:11:17
> Thanks for your insight on Nardil. Even though it didnt work out perfect for you, what you said gives me confidence to try it if Emsam does not work out for me. Right now on Emsam, I say I feel like a 6 on scale 1-10. Would you be satisfied with that or try Nardil?
>
> Hey, there is always Ultram for us to try, if all else fails.
If I could get a 6 out of 10 from anything, I'd stick with it. A 6 sounds like a pretty significant beneficial effect that might increase somewhat or might give you a foundation on which to add compatible additional meds or therapy.Greywolf
Posted by chiron on March 20, 2007, at 16:41:38
In reply to Re: Emsam/my analysis of 5 month trial/Greywolf » stargazer, posted by greywolf on March 20, 2007, at 10:52:59
I've been trying Emsam for a couple weeks now. I didn't get the energizing effect that most people get, I actually have a harder time getting up in the morning now. I don't think it's doing anything so far - which is better than the worsening I often get. I did have an ECT last Friday to lessen the 'craziness' in my head & will probably have one this Friday. They do usually work for me, but the memory thing is a pain. I will probably be trying VNS unless this Emsam miraculously kicks in. And if it does, drinks for everyone!
Posted by Jeff81 on March 20, 2007, at 16:49:12
In reply to Re: Emsam/my analysis of 5 month trial/Greywolf, posted by chiron on March 20, 2007, at 16:41:38
Hi Greywolf,
I totally identify with you. I too have severe OCD and have not had much success. Anafranil was the worst. I started Emsam a little over a week ago and have not found any benefit. People say it energizes them.... It has made me very tired. I am losing a little hope with meds, but I do want to go up to 9mg bc I think it doesn't work well on seratonin at 6mg. Keep me posted.
God Bless,
Jeff
Posted by chiron on March 20, 2007, at 20:05:26
In reply to Re: Emsam/my analysis of 5 month trial/Greywolf, posted by Jeff81 on March 20, 2007, at 16:49:12
just as an fyi...I have a mild form of trichotillomania. I know it is not a true OCD disorder, but I did notice that the urge to pull was stronger with the 6mg & less with the 9mg.
Posted by greywolf on March 20, 2007, at 20:08:41
In reply to Re: Emsam/my analysis of 5 month trial/Greywolf, posted by Jeff81 on March 20, 2007, at 16:49:12
> Hi Greywolf,
>
> I totally identify with you. I too have severe OCD and have not had much success. Anafranil was the worst. I started Emsam a little over a week ago and have not found any benefit. People say it energizes them.... It has made me very tired. I am losing a little hope with meds, but I do want to go up to 9mg bc I think it doesn't work well on seratonin at 6mg. Keep me posted.
>
>
> God Bless,
> Jeff
>OCD really screws up an otherwise perfectly good bipolar disorder! The unrelenting OCD behaviors often pave the way into depressive episodes, while manic times seem to intensify the agony of the behaviors. I've been in regular CBT for the OCD for several months now, and it has helped me to get a handle on some of the lesser checking behaviors, but the experience thus far has shown me that it will take years of CBT to achieve significant progress, and even then the effectiveness of the meds or VNS on the BP side will determine much of what I can achieve with the OCD.
As you might understand, it's an incredibly frustrating combination.
Good luck to you also.
Greywolf
Posted by stargazer on March 20, 2007, at 21:33:34
In reply to Re: Starting Emsam, wondering what to expect » UGottaHaveHope, posted by greywolf on March 20, 2007, at 16:02:53
Greywolf,
thanks for pointing out 6 is better than
nothing since my doctor just added abilify with the Emsam yesterday. Why Abilify? Not sure of the rationale, if there is any, but he says others have gotten improvement on this combo. He said rather than go directly to Nardil, which I am desperate to retry (worked for 2 years in 1987 at at very low dose), he usually has a valid point about trying something else first.That is how I ended up on Emsam. I asked for Nardil and he convinced me to try Emsam first...funny how he never gives me what I want immediately, but I think if the Abilify/Emsam trial fails, I will push again for Nardil. I just need to know if it will work again, 20 years later. Of course they had to go and mess up the formula on us. They can't keep their grubby hands off a good drug. They messed me up with Marplan once and it didn't work the second time.
The only other med another pdoc I saw in consultation suggested was Depakote, because he said I never had a "real" mood stabilizer. What do they call Lamictal, a fake one?
stargazer
Posted by Phillipa on March 20, 2007, at 21:47:37
In reply to Re: Starting Emsam/add-ons/greywolf, posted by stargazer on March 20, 2007, at 21:33:34
Stargazer I think SLS's maybe remission is due to Nardil, ambilify, nortiptalline, and darn I can never remember the last one. But he said that it would take a year for full remission as his depression has been going on as long as yours or longer. Love Phillipa
Posted by stargazer on March 20, 2007, at 22:03:02
In reply to Re: Starting Emsam/add-ons/greywolf » stargazer, posted by Phillipa on March 20, 2007, at 21:47:37
Topomax and Lamictal, I wrote it down, can't rely on the 'old' memory myself. That's quite a combination (5 meds) and most pdocs would never come up with this combination themselves. I'm sure it's SLS's own formula and his pdoc must just go along with him since he researches everything himself. That is something i wished I was better at. I know basics but not all the biochemical reactions that are the only way to figure this stuff out, else it's just experimentation and that is why neither myself or my pdoc can find anything to work very well.
Stargazer
Posted by Phillipa on March 20, 2007, at 22:07:46
In reply to Re: Starting Emsam/add-ons/phillipa, posted by stargazer on March 20, 2007, at 22:03:02
Stargazer yes he does and I think he may have some ties with major Universities or did. Don't like to talk about someone who isn't here. I'd google SLS or Scott as he has tried so many. Maybe from him you will find a combo to work for you? Love Phillipa
Posted by TheMeanReds on March 21, 2007, at 11:11:38
In reply to Re: Starting Emsam/add-ons/phillipa, posted by stargazer on March 20, 2007, at 22:03:02
Hmmm, interesting. I proposed that I be able to take topamax instead of abilify. But doc said topamax doesnt mix with lamictal.
Posted by lcat10 on March 24, 2007, at 23:08:55
In reply to Emsam/my analysis of 5 month trial/Greywolf, posted by stargazer on March 20, 2007, at 8:58:13
I couldn't take Emsam for two reasons. First, I had an allergic reaction to the patch. Second, it did not really do anything for my depression. And, since I had so many allergic reactions and adverse reactions to antidepressants of all sorts, I opted for the ECT. So far I can't say it is doing wonders either. At least I don't have the really bad problems with memory.
Posted by d0pamine on March 25, 2007, at 4:21:05
In reply to Starting Emsam, wondering what to expect, posted by greywolf on March 19, 2007, at 23:36:38
I guess we're all different, but for me...
EMSAM doeth rock, period
My experience was one of an initial 5 weeks of nothing positive combined with various odd stuff mixed with some taste perversion and a generous helping of only sleeping 3 hours a night followed by a much welcomed unrelenting (thus far) motivationally functional normalcy. I could only wish everyone could feel the as well.
Posted by greywolf on March 25, 2007, at 7:36:44
In reply to Re: Starting Emsam, wondering what to expect, posted by d0pamine on March 25, 2007, at 4:21:05
Thanks everyone for your responses.
I've been on the patch since last Tuesday, and I've noticed nothing significant, good or bad. I expect that it will take a few more weeks before I notice anything, so I'll keep sticking them on.
Unfortunately, that doesn't help the depression in the meantime.
Greywolf
Posted by stargazer on March 26, 2007, at 0:26:22
In reply to Re: Starting Emsam, wondering what to expect, posted by greywolf on March 25, 2007, at 7:36:44
Greywolf, That is the downside of treating depression, the long delay in feeling better and that isn't always a guarentee, so the whole process can be extremely fristrating. I have spent so much time testing meds and waiting for weeks and trying to get through side effects, ect.
That's one thing with Emsam, most here have not had to stop because of terrible side effects, so that is a positive.
Good luck and hang in there, it will get better, hopefully sooner, rather than later...SG
Posted by greywolf on March 26, 2007, at 3:54:51
In reply to Re: Starting Emsam, wondering what to expect, posted by stargazer on March 26, 2007, at 0:26:22
Thanks, stargazer.
So far so good. Of course, that's only with respect to SEs. It certainly isn't acting yet on my depression, which causes me concern because the only other thing I've got is Xanax. But, I've been here many times before, so I'll just deal with what comes.
Posted by Honore on March 26, 2007, at 10:27:45
In reply to Re: Starting Emsam, wondering what to expect, posted by greywolf on March 25, 2007, at 7:36:44
Don't give up yet. It can take anywhere from 2-4 weeks to have a strong enough reaction to the Emsam to be sure it's Emsam and not just a good day or two.
Plus you can enhance the effect with other drugs.
From my experience-- of course me only-- Emsam is a really good drug, if you're the type of person who responds better to activating, as opposed to sedating, types of drugs.
I hope it does work for you soon.
Honore
This is the end of the thread.
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