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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 24 to 48 of 49. Go back in thread:
Posted by JohnSky on July 26, 2007, at 10:15:26
In reply to Re: Patch decision - What to do?, posted by dewdropinn on July 24, 2007, at 12:33:00
Thank you Drew for your very detailed reply and history. It helps. After talking with my Doc I have decided to stay with the 6mg patch but not cut it in half at night.. thus I will have the full 6mg throughout the day. I slept Ok this way last night. My doc felt with me cutting the patch at night to help with sleep I was ending up with say 4.5mg for the day which was just not a high enough dose to help me. I have decided to see if I can handle the anxiety at this dose until this Sunday. If not I will likely try the 9mg patch for a week. The anxiety I have felt has been very tough to deal with and it wears me down so much and makes me feel so hopeless. Two days ago was the most I've felt depressed in some time. Scared me as the dark thoughts came quickly and I thought the very worst.
I am on a medium dose of Lithium and Seroquel. Sometimes I wonder if the Lithium is depressing me.
Posted by JohnSky on July 26, 2007, at 10:27:38
In reply to Re: Patch decision - What to do?, posted by JohnSky on July 26, 2007, at 10:15:26
Forgot to ask. If I go up to 9mg does the preferred method seem to be to take it off at night? Also, Are most people abiding by the dietary restrictions or are they "soft".
John
Posted by dewdropinn on July 26, 2007, at 14:00:19
In reply to Re: Patch decision - What to do?, posted by JohnSky on July 26, 2007, at 10:27:38
Even though Lithium is sometimes thought of as having antidepressant qualities, I don't think it's particularly effective in this capacity -- it made me feel a bit stupid and spacey, and it certainly didn't help my mood. The anti-psychotics can have a whole range of effects and side effects -- I marvel at the extreme reaction people have to various atypical anti-psychotics -- from miraculous improvements to a rapid descent into total wackiness. So, I would say all bets are off as far as assessing what lithium and seroquel are doing for the overall picture. I would trust your doctor though -- he's prescribed you EMSAM, so he's clearly open to experimentation -- I would keep him appraised of your mood fluctuations.
The dietary precautions with the 9mg patch are definitely soft. I'm guessing that you're familiar with the mechanisms involved with the tyramine reaction. If not, it's associated with MAOI metabolism in the liver -- the theory behind the patch is that it largely bypasses the liver, and thereby bypasses the whole tyramine problem. During the clinical trials, they worked very hard to induce the tyramine reaction, and as far as I know, they were unable to -- the lack of dietary risks was supposed to be one of the major selling points of the drug, which is why Bristol-Meyers fought with the FDA to get these warnings removed -- it would seem they had the clinical evidence in hand, but the FDA was unyielding. The FDA decision was based on the fact that, even though the patch largely bypasses the liver, at the higher doses a sufficient amount of the drug could conceivably accumulate in the liver so as to pose a risk. So, that's the scoop on the dietary restrictions. The big risk with the patch is associated with drug-drug interactions -- over-the-counter drugs like Sudafed and any other decongestants can trigger a hypertensive reaction, so this should be the primary safety concern.
I removed the patch at bedtime both when I was at 6mg and now that I am at 9mg -- I literally could not sleep if I kept it on, unless I took klonopin or ativan. When I started removing the patch at bedtime, I found that I was able to fall asleep without any additional medication.
One final thought -- raising the EMSAM dose to 9mg should help the overall depression situation, so long as more serious bipolar issues are present. Lithium and seroquel may be needed, but the pharamocology of the 2 drugs may be compromising or altering the efficacy of EMSAM -- both drugs impact serotonin and dopamine (albeit in different ways), so it would seem to follow that they will at the very least impact the effect of EMSAM (for the better or worse.) I've already mentioned lamictal -- so that's an option. But an even easier option would be Klonopin, which would address any residual insomnia and anxiety. Some doctors -- particularly doctors under the age of 40 -- are ridiculously skittish about giving patients benzos for fear of addiction. They instead give non-benzo hypnotics, which are somewhat unpredictable, and APs like seroquel, which have no long-term track record and some worrisome potential side effects. One of my very old school pdoc pals said that, in all of his years of practice, the benzos were simply the greatest anti-anxiety/sedative drugs of all-time -- and the addiction risks vary considerably from one drug to the next -- halcyon being the most addictive, klonopin being the least. Having given all the non-benzos and most of the APs a whirl, I believe the old guy was right -- that's my personal opinion and the very old school doc's assessment, rather than any kind of universally excepted truth. In any event, I would definitely consider Klonopin -- it will help with the anxiety and insomnia, it will greatly simplify your regiment, and so long as you don't escalate the dose, the risk of long-term dependency is low.
That's my 2 cents -- just let me know if you have any other questions.
> Forgot to ask. If I go up to 9mg does the preferred method seem to be to take it off at night? Also, Are most people abiding by the dietary restrictions or are they "soft".
>
> John
Posted by JohnSky on July 26, 2007, at 16:59:03
In reply to Re: Patch decision - What to do?, posted by aegle on July 25, 2007, at 3:45:26
Thanks for your reply aegle. i am not sure about my bi-polar diagnosis with one manic episode in my entire life caused by a medication.
My doc said they think I am bi-polar because when I stopped taking the medication I continued to be manic for several weeks. I think the mania just runs its course no matter how started (bi-polar... or via a medicine).I plan to take the 6mg daily (including at night) until Sunday. If my anxiety doesn't back down I want to go to 9mg to give it a try to see if my anxiety drops off as others have experienced when they went to 9mg... and a decrease in depression. I just don't know whether to take the patch off at night. If I don't I think I would only get about 6mg in my blood stream daily???? Ideas and experience?? but I'm not sure wwh
Posted by dewdropinn on July 27, 2007, at 7:31:19
In reply to Re: Patch decision - What to do?, posted by JohnSky on July 26, 2007, at 16:59:03
As for removing the patch at bedtime. I do not believe that the patch delivers medication in a consistent pattern throughout the 24 hour day -- I suspect it releases the majority of the drug during the hours immediately following application, and the amount gradually diminishes throughout the day. While the 4.5mg calculation makes sense if you do straight arithmatic of the dose and hours taken, I pretty sure you're actually getting more than 4.5mg. Also, the efficacy of the drug is closely linked to sleep -- and I think you'll notice this trend with almost everyone who takes MAOIs -- the drug works far better when insomnia is under control. I would experiment with removing the patch because the sleep issue is at least as important as the dosage total.Here's my experience in a tiny nutshell --
1) Lithium and seroquel were just way to powerful -- they severely compromised cognition. Lamictal and klonopin were a much kinder and gentler solution to my low grade bipolar symptoms.
2) The true antidepressant benefits of EMSAM only kicked in at 9mg -- it vastly improved mood, and reduced anxiety.
3) In order for EMSAM to be effective at any dose, I need to sleep. In order to sleep, I need to remove the patch before bed.
Anectodal evidence, rather than scientifically verifiable and universally applicable -- so it may not hold true for you, but it's worked for me.
Drew
> Thanks for your reply aegle. i am not sure about my bi-polar diagnosis with one manic episode in my entire life caused by a medication.
> My doc said they think I am bi-polar because when I stopped taking the medication I continued to be manic for several weeks. I think the mania just runs its course no matter how started (bi-polar... or via a medicine).
>
> I plan to take the 6mg daily (including at night) until Sunday. If my anxiety doesn't back down I want to go to 9mg to give it a try to see if my anxiety drops off as others have experienced when they went to 9mg... and a decrease in depression. I just don't know whether to take the patch off at night. If I don't I think I would only get about 6mg in my blood stream daily???? Ideas and experience?? but I'm not sure wwh
>
Posted by JohnSky on July 27, 2007, at 14:20:38
In reply to EMSAM Dosage + Sleep, posted by dewdropinn on July 27, 2007, at 7:31:19
Thanks Drew for the comments and ideas. Right now I am back to 6mg all day and the anxiety is very harsh and I'm not sleeping well. My doc wanted me back up to 6mg all day. I will continue with this through Sunday and if I am still struggling with all the anxiety I go to the 9mg on Monday. I will give the 9mg one week to see if the anxiety goes down. If not, I'm done with EMSAM. If 9mg brings me more anxiety I just have had enough. Hopefully the anxiety will come down soon after I go to 9mg.
How long were you on 9mg before you noticed benefits?
While on 9mg I will likely take the patch off at night.
John
Posted by dewdropinn on July 27, 2007, at 17:30:01
In reply to Re: EMSAM Dosage + Sleep, posted by JohnSky on July 27, 2007, at 14:20:38
You should feel the difference between EMSAM doses almost immediately -- like within a week. So, on the upside, you should be able to determine whether or not EMSAM is for you in relatively short order. It's a great drug, but it's not necessarily for everybody.
If you noticed a significant benefit from lithium an seroquel, then this may suggest a direction for your next trial. There are APs that target depression more specifically than seroquel -- like Geodon for instance. Lamictal is commonly added to lithium for added mood stabilization and unresolved depressive symptoms -- klonopin can be added if insomnia and anxiety are still a problem. This would jive with the stanard mode of treatment for bipolar -- mood stabilizers first, then benzos and atypical anti-psychotics as needed -- antidepressants are added only when mood stabilizes.
Let me know how all goes,
Drew
> Thanks Drew for the comments and ideas. Right now I am back to 6mg all day and the anxiety is very harsh and I'm not sleeping well. My doc wanted me back up to 6mg all day. I will continue with this through Sunday and if I am still struggling with all the anxiety I go to the 9mg on Monday. I will give the 9mg one week to see if the anxiety goes down. If not, I'm done with EMSAM. If 9mg brings me more anxiety I just have had enough. Hopefully the anxiety will come down soon after I go to 9mg.
>
> How long were you on 9mg before you noticed benefits?
>
> While on 9mg I will likely take the patch off at night.
>
> John
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Posted by JohnSky on July 29, 2007, at 20:05:13
In reply to Re: EMSAM Dosage + Sleep, posted by dewdropinn on July 27, 2007, at 17:30:01
My anxiety has not settled down on 6mg patch so I will talk with my doctor tomorrow about what to do... The plan is to go to 9mg. The problem is I just don't feel right on EMSAM. I feel out of sorts and pretty tired at times. I just feel the medication is masking who I am somewhat. I feel strange and struggle for words at times... symptom of anxiety probably. Maybe that goes away with time. My main issue for months and months has been anxiety. I take Ativan to help with the anxiety but I just am not the generally relaxed person I used to be. Anxiety and depression dog me. I realize antidepressants normally work on the depression and then anxiety... I just haven't found a AD that works for me and I can say I have tried almost all of them. But I am not done with EMSAM yet. I would think the Lithium and Seroquel would help but I think they have just settled my mood down.
I am back meditating and doing many other things that should help me. The anxiety I may just have to deal with by accepting and working through the feelings.... that is after I get the EMSAM anxiety induced down.
Frustrated to say the least.
Posted by dewdropinn on July 30, 2007, at 11:25:59
In reply to Re: EMSAM Dosage + Sleep, posted by JohnSky on July 29, 2007, at 20:05:13
I look forward to hearing how everything goes -- it sounds like you've got your plan A established.
You know, there's an entire psychopharm. theory emerging based on the fact that a large percentage of people suffering from major depression are in fact contending with a bipolar spectrum disorder and antidepressants ultimately complicate and worsen the overall situation -- it explains why antidepressants don't work or work for a period of time and then poop out for many who suffer from long-term treatment resistant depression. This is the opinion of many bipolar experts.
If you fit into this group, your responses to lithium, seroquel and EMSAM all make perfect sense. Lamictal can act as both a mood stabilizer and an antidepressant, particularly at the higher doses -- Tegretol has antidepressive properties for some -- Geodon and Abilify have antidepressant properties -- and there other options as well. So, should things not work out with EMSAM, you have lots of options, and you will have completed an important step in targeting a viable treatment program for the future.
Best of luck!
Drew
> My anxiety has not settled down on 6mg patch so I will talk with my doctor tomorrow about what to do... The plan is to go to 9mg. The problem is I just don't feel right on EMSAM. I feel out of sorts and pretty tired at times. I just feel the medication is masking who I am somewhat. I feel strange and struggle for words at times... symptom of anxiety probably. Maybe that goes away with time. My main issue for months and months has been anxiety. I take Ativan to help with the anxiety but I just am not the generally relaxed person I used to be. Anxiety and depression dog me. I realize antidepressants normally work on the depression and then anxiety... I just haven't found a AD that works for me and I can say I have tried almost all of them. But I am not done with EMSAM yet. I would think the Lithium and Seroquel would help but I think they have just settled my mood down.
>
> I am back meditating and doing many other things that should help me. The anxiety I may just have to deal with by accepting and working through the feelings.... that is after I get the EMSAM anxiety induced down.
>
> Frustrated to say the least.
>
Posted by JohnSky on July 30, 2007, at 15:49:46
In reply to Re: EMSAM Dosage + Sleep, posted by dewdropinn on July 30, 2007, at 11:25:59
Thanks for the encouragement Drew.
My doctor and I have discussed this very issue. That if I am bipolar, medications like Lithium and Seroquel will help me but regular anti-depressants just aggrevate the situation. This is my experience so far in the last 1.5 years... but before that I was on a low dose of Prozac for 15 years and did fine.... I don't understand. This aggrevation issue is the case with my brother. He takes Lithium and is doing fine but he is still slowly getting off Paxxil that he says "messes him up".
I will give the EMSAM the 9mg try and then I am done. I am wired today at 6mg and it has been this way for nearly 5 weeks. Enough is enough.
I can't see how giving this 6mg another couple weeks would help... and I simply can't take any more.I hope the Lithium will kick in soon. I did try Abilify over a year ago with very bad results. I walked liked a 90 year old man. But as you mentioned there are other choices.
Maybe I may just need to wait for the Lithium to work. My brother says he feels wonderful and he has been on it 5 months. I have only been on it 2 months. It took a good 4 months for the Lithium to really show it's stuff.
John
Posted by dewdropinn on July 30, 2007, at 17:37:31
In reply to Re: EMSAM Dosage + Sleep, posted by JohnSky on July 30, 2007, at 15:49:46
I think you may have hit on a most likely answer. One of my very old school research doc friends once told me that if there's any family history with bipolar, then the diagnosis is easy -- you're bipolar or heading in that direction. And if a family member has responded well to a medication, then the chances are very good that other family members will get a good response from the same med.
There is supposedly a threshhold beneath which an antidepressant may not trigger mania -- so I suspect you were below the mania inducing dose of Prozac, but you may have been unwittingly setting the stage for the issues you are now contending with.
Just based on what I'm hearing, it sounds like it may be best to follow your gut instincts, ditch the antidepressants for now, and focus on optimizing your lithium dose. This would seem to jive with much of the latest research and a family precedent. I'll be interested in hearing how everything progresses.
Drew
> Thanks for the encouragement Drew.
>
> My doctor and I have discussed this very issue. That if I am bipolar, medications like Lithium and Seroquel will help me but regular anti-depressants just aggrevate the situation. This is my experience so far in the last 1.5 years... but before that I was on a low dose of Prozac for 15 years and did fine.... I don't understand. This aggrevation issue is the case with my brother. He takes Lithium and is doing fine but he is still slowly getting off Paxxil that he says "messes him up".
>
> I will give the EMSAM the 9mg try and then I am done. I am wired today at 6mg and it has been this way for nearly 5 weeks. Enough is enough.
> I can't see how giving this 6mg another couple weeks would help... and I simply can't take any more.
>
> I hope the Lithium will kick in soon. I did try Abilify over a year ago with very bad results. I walked liked a 90 year old man. But as you mentioned there are other choices.
>
> Maybe I may just need to wait for the Lithium to work. My brother says he feels wonderful and he has been on it 5 months. I have only been on it 2 months. It took a good 4 months for the Lithium to really show it's stuff.
>
> John
>
Posted by d0pamine on July 31, 2007, at 10:54:32
In reply to EMSAM Dosage + Sleep, posted by dewdropinn on July 27, 2007, at 7:31:19
Just to repeat what I mentioned in a previous post 600 mg or so of potassium CITRATE (has to be citrate) taken 300 in the morning and 300 at lunch COMPLETELY resolved the insomnia that I experienced with EMSAM
Posted by JohnSky on July 31, 2007, at 19:29:11
In reply to Re: EMSAM Dosage + Sleep, posted by dewdropinn on July 30, 2007, at 17:37:31
Thanks Drew. Rest assured I will post how my story plays out. My gut tells me the Lithium will help as it has helped my brother. It lifted his depression and anxiety but took some time to do it. I'm Ok with waiting if I am seeing some little progress forward from time to time.
John
Posted by JohnSky on August 1, 2007, at 9:21:27
In reply to Re: EMSAM Dosage + Sleep, posted by JohnSky on July 31, 2007, at 19:29:11
Today I started on the 9mg patch. If the anxiety comes roaring in this will be a short experiment. Yesterday on 6mg was one of the most anxious days ever. I decided to cut the patch down in the morning to something around 4mg and that seemed to increase the dose from how I felt... porbably just due to how much is built up in my system over 5 weeks. I was wired
all day, having anxiety attacks, and my chest hurt from the tension. I ended up taking the patch off at 1:00 in the morning because I kept waking up. The story goes that going up to 9mg the anxiety and agitation should come down. Sure hope so.. can't take any more days like yesterday.John
Posted by dewdropinn on August 2, 2007, at 10:20:02
In reply to Re: EMSAM Dosage + Sleep, posted by JohnSky on August 1, 2007, at 9:21:27
This is fantastic! You now have the opportunity to find out definitively whether or not your treament needs to follow the classic bipolar protocol, or if you are in fact among those with a much milder bipolar spectrum disorder, and will be best treated with a combination of mood stabilizers and antidepressants.
Best of luck and let us know how this all goes.
Drew
> Today I started on the 9mg patch. If the anxiety comes roaring in this will be a short experiment. Yesterday on 6mg was one of the most anxious days ever. I decided to cut the patch down in the morning to something around 4mg and that seemed to increase the dose from how I felt... porbably just due to how much is built up in my system over 5 weeks. I was wired
> all day, having anxiety attacks, and my chest hurt from the tension. I ended up taking the patch off at 1:00 in the morning because I kept waking up. The story goes that going up to 9mg the anxiety and agitation should come down. Sure hope so.. can't take any more days like yesterday.
>
> John
Posted by JohnSky on August 2, 2007, at 15:31:17
In reply to Re: EMSAM Dosage + Sleep, posted by dewdropinn on August 2, 2007, at 10:20:02
We'll I have to say I am thinking this higher dose of 9mg is causing less anxiety. Yesterday was my first day. I was very anxious in the evening for a couple hours for some reason... alot tension in my chest as well (no diet issues... I followed the guidelines). I cut the patch in half last night and slept Ok with the help of benzos. Today I feel less anxious again.... and tired as I'm not sure how well I slept... didn't feel very rested. We'll see how this goes. My fear is the medication is building in my blood level and anxiety will return. I hope the anxiety doesn't hit me as hard this evening... don't understand why that is happening. So I will give this experiment a few more days and hope the anxiety comes down and the depression gets better. The depression has lightened some since I started this EMSAM experiment 5 weeks ago... not sure how long it will take to get much better on this higher dose.
So I guess I should focus on what is going better.
Posted by JohnSky on August 3, 2007, at 15:15:49
In reply to Re: EMSAM Dosage + Sleep, posted by dewdropinn on August 2, 2007, at 10:20:02
I've seen this debated somewhat on the forum... I'm wondering if I really need to follow the dietary constraints if I am on the 9mg patch. I seen written that the answer is no but I would sure like to see more evidence and hear from some people that have not followed the dietary constraints.
Also, I went up to 9mg two days ago and I'm doing OK on this dose... meaning the anxiety isn't too bad. I was at 6mg for 5 weeks. The anxiety was bad for me at 6mg. I'm wondering how long before the 9mg is likely to kick in and help my depression?
Thanks
John
Posted by dewdropinn on August 4, 2007, at 15:36:16
In reply to Re: EMSAM Dosage - Dietary constraints?, posted by JohnSky on August 3, 2007, at 15:15:49
As I noted in an earlier post, the dietary risks associated with the higher doses of EMSAM are largely theoretical -- the theory is that, even though the patch enables selegiline to largely bypass the liver, some small modicum of the drug builds up in the liver, which in turn raises the risk of a tyramine induced hypertensive crisis. I would keep in mind that this is largely theoretical. During the clinical trials, independent and drug financed studies failed to produce any incidents of this tyramine reaction at any dose -- and they tried very hard to induce these reactions, because you can imagine the liability problems associated with releasing an MAOI that allegedly doesn't prose any risk of inducing tyramine related reactinos, and upon release patients begin experiencing this reaction en masse. In fact, one of the major delays in bringing the drug to market was due to Bristol-Myers desperate attempts to get the black box warning removed. So, there is a theoretical risk, and I would imagine there are isolated incidents of these reactions having occured, but in the real world setting, your chances of developing a tyramine reaction are incredibly remote and all clinical studies I am aware of demostrate that this is not a risk factor. The drug-drug interactions are where very real risks exist -- anti-histamines, narcotic pain killers, and many drugs commonly used in psychiatry are big no-no's (I'm sure your doctor is very aware of this.)
It's great to hear that your anxiety is decreasing -- this is totally consistent with my experience. I suspect that the true serotonergic effects of the drug start kicking in once you get to the higher doses, which should reduce anxiety and improve depression. As I mentioned earlier, removing the patch at bedtime can improve insomnia and the quality of sleep immeasurably -- and the vast majority of the drug is released during the course of the day, so you really aren't significanly reducing the dose by taking off the patch at night. I would at least experiment with removing the patch before bed -- it's such a simple thing to do, and you should know within a couple of days whether or not this procedure reduces the effect of the drug in any way. Sleep is essential to optimizing the response to almost any antidepressant, so even though you may be reducing the dose incrementally, you are probably also improving you capacity to respond to the drug. Does this make sense?
Best of luck,
Drew
> I've seen this debated somewhat on the forum... I'm wondering if I really need to follow the dietary constraints if I am on the 9mg patch. I seen written that the answer is no but I would sure like to see more evidence and hear from some people that have not followed the dietary constraints.
>
> Also, I went up to 9mg two days ago and I'm doing OK on this dose... meaning the anxiety isn't too bad. I was at 6mg for 5 weeks. The anxiety was bad for me at 6mg. I'm wondering how long before the 9mg is likely to kick in and help my depression?
>
> Thanks
>
> John
Posted by cumulative on August 5, 2007, at 19:21:53
In reply to Re: EMSAM Dosage - Dietary constraints?, posted by dewdropinn on August 4, 2007, at 15:36:16
Hello dr-bobbers, I'm cumulative.
Interesting about the help people have reported of removing the patch before bedtime.
Regardless of selegiline's half-life, at these dosages I believe the inhibition of MAOI is irreversible -- MAOI sticks around for about two weeks.
So I wonder what is at play? Subjectively the patch calms one down? Perhaps the l amphetamine isomers that are known to metabolize from selegiline are having some effect.
Just about to start on EMSAM + Ambien CR,
cumulative
Posted by JohnSky on August 6, 2007, at 10:53:45
In reply to Re: EMSAM Dosage - Dietary constraints?, posted by dewdropinn on August 4, 2007, at 15:36:16
Something is up with the 9mg patch. I started the higher dose on 8/1. I was having trouble sleeping so I cut the patch on 8/3 to 1/2. I slept better but still didn't feel rested. The last 2 nights I went to 1/4 of the patch and slept Ok but still not great. Today I feel down... more so than I have in a couple weeks or so. I probably am depressed about how long I have been dealing with depression but I wonder if the patch is causing a problem. I also have had some bouts of high anxiety that have me feeling down and losing hope... so that may be it.
Any guesses on when the higher dose will help with depression and bring the anxiety down?
Frustrated on what to do.
Posted by Needhelp on August 6, 2007, at 12:43:14
In reply to Re: EMSAM Dosage - Dietary constraints?, posted by cumulative on August 5, 2007, at 19:21:53
on the 6mg patch and Lexapro 20 mg. Anyone know the effects of weed with this combo?
Posted by dewdropinn on August 6, 2007, at 16:29:12
In reply to Question for you Drew - Patch Problem?, posted by JohnSky on August 6, 2007, at 10:53:45
I would highly recommend that you remove the patch at bedtime. At any dose -- even a fraction of a a 6mg patch --EMSAM can disrupt sleep, and sleep is essential to optimizing your response to the drug. Please do not worry about the total dose calculations -- they are not as significant as I suspect you think they are -- the vast majority of the active drug goes into your bloodstream during the day, so you are not significantly reducing your dose, and if you aren't getting adequate sleep, you are dramatically reducing the efficacy of the drug, regardless of the dose you are taking.
Try removing the patch at bedtime for a few days -- and let us know how it goes. It will definitely improve the quality of your sleep, and may very well resolve the issues you are contending with.
Drew
> Something is up with the 9mg patch. I started the higher dose on 8/1. I was having trouble sleeping so I cut the patch on 8/3 to 1/2. I slept better but still didn't feel rested. The last 2 nights I went to 1/4 of the patch and slept Ok but still not great. Today I feel down... more so than I have in a couple weeks or so. I probably am depressed about how long I have been dealing with depression but I wonder if the patch is causing a problem. I also have had some bouts of high anxiety that have me feeling down and losing hope... so that may be it.
>
> Any guesses on when the higher dose will help with depression and bring the anxiety down?
>
> Frustrated on what to do.
Posted by JohnSky on August 7, 2007, at 15:10:23
In reply to Re: Question for you Drew - Patch Problem?, posted by dewdropinn on August 6, 2007, at 16:29:12
Thanks for the reminder to remove the patch at night to help with sleep... which in turn should help with mood. Sleeping well is a cornerstone in getting well. I will try taking the full patch off tonight and see how I do. I awoke pretty tired again today. At this I have to tell you that I am nervous about taking the full patch off at night instead of 1/2. I just keep thinking I will end up with a sub-optimal dose in total for the detail and risk my recovery...but how well can I recover if I'm not getting good rest?
At this moment (3 pm)the anxiety is pretty high as I have felt the activating nature of the drug build through the day. I spoke with my physician yesterday and I agreed to give the medication 2 more weeks. If my mood isn't coming up more by then and the anxiety down I will move on. That will make a 8 week trial including 5 weeks at 6mg and 3 weeks at 9mg. He told me he thinks the depression will improve soon and then the anxiety will follow... which is usually the case of the order of recovery.
I just hate how most anti-depressants make me anxious.
John
Posted by JohnSky on August 9, 2007, at 16:33:54
In reply to Re: Question for you Drew - Patch Problem?, posted by JohnSky on August 7, 2007, at 15:10:23
Have other people expeienced anxiety on the 9mg patch? I have been on the 9mg patch 8 days from when I stepped up from the 6mg patch. Others wrote that they experience the anxiety going down once they moved up to 9mg. I have not had that experience yet? Same building anxiety as the day goes along.
How long has it taken others on 9mg for the anxiety to go down? I'm getting really frustrated.
Thanks
John
Posted by Needhelp on August 13, 2007, at 12:53:16
In reply to Re: EMSAM Dosage + Sleep (THE SOLUTION) » dewdropinn, posted by d0pamine on July 31, 2007, at 10:54:32
can I get the p.citrate at the drug store without a prescription?
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