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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by yznhymer on September 20, 2007, at 22:25:27
I've been on this 6mg Post-It Note for a couple of months or more and have gotten some benefit from it. Woo!
But its been uneven and I couldshouldwould be doing much better in an ideal world. My unscientific take from the "babble" is those who have done well on EMSAM have done so on bigger patches. So its TIME. My new pdoc is willing but very conservative and has even implored to me to follow dietary restrictions on the 6mg patch.
So yeah, I'll stop licking that hunk of Roquefort cheese but aside from the party line what's the consensus on the real need to follow dietary restrictions at 9mg?
Anybody know what BMS maintains about the safety of their product at higher levels as opposed to what The Man makes them print on their package inserts?
Those of you who have titrated upwards, did you experience a recurrence or intensifying of any side effects? Care to share your experiences?
Did your prescribing doc also give you a small prescription to counteract a hypertensive crisis (antidote) in the event one should occur? Anybody ever actually deal with a hypertensive crisis? (This last question assumes you survived.)
Thanks in advance for your responses.
Y
Posted by Dragon Black on September 21, 2007, at 3:04:58
In reply to Movin' on up to the Big Time - EMSAM 9mg patch, posted by yznhymer on September 20, 2007, at 22:25:27
sorry, don't have any actual "helpful" advice, just wanted to say good luck on your trial. from everything I've read, the restrictions placed on the 9mg patch are mostly out of a liability-conscious abundance of caution, and at least one poster on this site has stated that he had no intention of following any restriction on the 9 or the 12. HOWEVER, i strongly advise you to research this until you are blue in the face, and make sure. by this time there are surely websites with reviews of emsam at all doses (I haven't tracked it 'cause i aint on it). i'm hoping to start a trial of selegiline soon, but my shipment hasn't arrived yet (4 weeks already) and I have no idea if it will. [Note*: this is also a test to see if a post that mentions an IOP shipment will get blocked even if it doesn't mention any specific information, like URLs.]
Good luck, everyone! May we all find peace someday!
> I've been on this 6mg Post-It Note for a couple of months or more and have gotten some benefit from it. Woo!
>
> But its been uneven and I couldshouldwould be doing much better in an ideal world. My unscientific take from the "babble" is those who have done well on EMSAM have done so on bigger patches. So its TIME. My new pdoc is willing but very conservative and has even implored to me to follow dietary restrictions on the 6mg patch.
>
> So yeah, I'll stop licking that hunk of Roquefort cheese but aside from the party line what's the consensus on the real need to follow dietary restrictions at 9mg?
>
> Anybody know what BMS maintains about the safety of their product at higher levels as opposed to what The Man makes them print on their package inserts?
>
> Those of you who have titrated upwards, did you experience a recurrence or intensifying of any side effects? Care to share your experiences?
>
> Did your prescribing doc also give you a small prescription to counteract a hypertensive crisis (antidote) in the event one should occur? Anybody ever actually deal with a hypertensive crisis? (This last question assumes you survived.)
>
> Thanks in advance for your responses.
>
> Y
Posted by Brody on September 21, 2007, at 11:00:56
In reply to Movin' on up to the Big Time - EMSAM 9mg patch, posted by yznhymer on September 20, 2007, at 22:25:27
>>I've been on this 6mg Post-It Note for a couple of months or more and have gotten some benefit from it. Woo! >
>That's terrific... I know how you feel.
>
>But its been uneven and I couldshouldwould be doing much better in an ideal world. My unscientific take from the "babble" is those who have done well on EMSAM have done so on bigger patches.>
>Good Luck with this... hopefully, you will feel even better on the 9mg. So that I might compare to my own experience, can you describe what seems to be "missing" on the 6mg?
>
>what's the consensus on the real need to follow dietary restrictions at 9mg? >
>I can't say about the consensus, but my experience has been:
Over a 5 month period I have been through all 3 patch strengths, and have now settled in at 9mg.
The dietary restrictions have been a non-issue for me. I have a dairy allergy and compensate with a lot of soy products which are supposed to be a "no-no" and I have not had any problems. One notable exception: Soy Sauce. I had a habit of drowning some Chinese dishes in the stuff... It gave me a headache, so I now avoid it entirely.
If I have the occaisional cured meat, I keep the portion small, and I don't combine it with another restricted food, ie. red wine.
I eat a banana everyday.... never have wanted to eat the peel, so I hardly consider this a "restriction". Same goes with "spoiled meat"... does anybody eat spoiled meat?
Here is an interesting link regarding the move toward a "friendlier maoi user diet"
http://www.nil.wustl.edu/labs/kevin/psy/maoi.htm
>
>Anybody know what BMS maintains about the safety of their product at higher levels as opposed to what The Man makes them print on their package inserts?>
>I have not looked into this. I would expect them to be very conservative and advise adhering to the restrictions... others may have a better idea?
>
>Those of you who have titrated upwards, did you experience a recurrence or intensifying of any side effects? Care to share your experiences?>
>I did feel a recurrance of already abated side effects (a little anxiety and insomnia), but they subsided within a week or so, same as at 6mg. My doctor had me on a little Xanax for this. It helped immensely. I still have occaision to take .5mg if I have a big-time stress situation.
My biggest side effect issue, and the reason I went back down to 9mg from 12mg, is orthostatic hypotension, which I still experience daily, but I just deal with it. It's certainly not enough to go off a med that is actually working for me for a change.
>
>Did your prescribing doc also give you a small prescription to counteract a hypertensive crisis (antidote) in the event one should occur? >
>No, she did not.
>
>Thanks in advance for your responses.>
>
You are most welcome.... and the very best of luck to you as you move ahead with the 9mg post it note!Janet
Posted by Phillipa on September 21, 2007, at 12:11:45
In reply to Re: Movin' on up to the Big Time - EMSAM 9mg patch » yznhymer, posted by Brody on September 21, 2007, at 11:00:56
Since my pdoc says it would be too stimulating for me did you have anxiety before the patch and do you work or does hypotension keep you from driving. Thanks Phillipa ps I keep trying to learn all I can about the patch over a year now.
Posted by yznhymer on September 21, 2007, at 14:53:14
In reply to Re: Movin' on up to the Big Time - EMSAM 9mg patch » yznhymer, posted by Brody on September 21, 2007, at 11:00:56
Hi Janet...
Thanks for the response. The link you posted was indeed interesting. I did google on restricted foods for an MAOI diet as well and have been down this road before so its not entirely new. However, what I find online is all over the map and, I think, overly restrictive in some cases. Your approach sounds sensible and is probably similar to what I am inclined to follow. Since I am working on getting my weight down, I'd be staying away from many of the restricted foods anyway. Say "cheese!"
Regarding BMS, it was my understanding that they applied for approval to market EMSAM without dietary restrictions at all doses and the government wouldn't go for it... mostly out of fear that a reaction was "theoretically" possible. I have not been able to find any information about whether they plan to revisit this, or if there have been any adverse reactions to EMSAM since its been in use.
At 6mg, what's been missing is a consistent response. My mood is generally good, and I'm a lot more talkative, but my energy, motivation and focus rise and fall. Too often it still takes a huge effort to get myself moving - its like one part of my mind is geared up and ready but it can't get the rest of me to follow through. I'm particularly affected by cloudy overcast days; sometimes I feel like I'm asleep with my eyes open. I sleep between 5 and 6 hours a night - better, but still not enough. Ambien and klonopin at .5mg as needed are also in the mix, so who knows what the carryover is during the day?
In some ways, it feels like anxiety is more of an issue than the depression, but they have always gone hand in hand for me. In fact, sometimes it seems like the anxiety induces the depression. I'm hitting things from all angles now - diet, exercise, some good therapy, etc. I see a definite positive impact from each of these, and its clear I have some deep issues to work through as well as normal life issues that contribute to my depressive state. Still, it felt like Emsam gave me a foundation on which to build - without it I don't know that I would have been able to employ the other strategies. Its interesting how it worked out - Emsam helped me get it together enough to find a kick-*ss therapist, who in turn worked with me to get myself into the gym and build a good exercise routine, nutrition plan, and to trade off a psychiatrist I've been wanting to dump for years for a much better situation... and so on and so on.
I called in for the 9mg prescription today. It will take a few days for the pharmacy to get it... in the meantime, I decided this morning to use a 6mg patch and a half to get going - I've felt myself slipping lately with the change in seasons so the time is right.
I guess the additional question I'd have for you is what differences in antidepressive response did you experience at the different doses - did Emsam work better for you at 9 and 12 as opposed to 6?
Thanks again,
Y~r
Posted by yznhymer on September 21, 2007, at 15:03:49
In reply to Re: Movin' on up to the Big Time - EMSAM 9mg patch » Brody, posted by Phillipa on September 21, 2007, at 12:11:45
> Since my pdoc says it would be too stimulating for me did you have anxiety before the patch and do you work or does hypotension keep you from driving. Thanks Phillipa ps I keep trying to learn all I can about the patch over a year now.
Yes, anxiety has hounded me for as long as I can remember. I'm not working and haven't for some years now. This has actually been fortuitous because it has allowed me to pull my life together in most other respects.
I like to say the state of my apartment is a pretty good reflection of the state of my mind. It needs a thorough cleaning top to bottom but its straightened up, organized, comfortable and "fabulous." Not the sty I hid out in during the darkest days.
I've experienced no hypotension at 6mg. My BP is high, tho within normal range with meds to control it. I'm hoping as my weight continues to fall so will the BP - historically it has once I'm down below a certain weight.
Now, Phillipa, tell me - Can Lindt chocolate truffels cause hypotension?
;-)
Y
Posted by yznhymer on September 21, 2007, at 18:46:16
In reply to Re: Movin' on up to the Big Time - EMSAM 9mg patch, posted by Dragon Black on September 21, 2007, at 3:04:58
I picked up my 9mg patches today... I haven't opened one up yet but the pouches are a lot bigger. Anyway, the accompanying literature from BMS and approved by the FDA lays out the dietary restrictions and they are simpler and more reasonable than a lot of the very dated information that's all over the internet. This is what is says:
OK: fresh meat, poultry, fish, including fresh processed meats such as lunch meats, hot dogs, breakfast sausage and cooked sliced ham.
NO WAY: Air dried, aged, and fermented meats, sausages, and salamis; pickled herring; spoiled products that have changed color, odor, or become moldy.
OK: all vegetables EXCEPT broad bean pods
OK: processed cheeses, MOZZARELLA, ricotta, cottage cheese, and yogurt
NO WAY: aged cheeses
NO WAY: all TAP beers and beers that have not been pasteurized
OK (sort of): *Bottled and canned beers AND WINES contain little or no tyramine; but drinking alcohol is not recommended with any antidepressants.
NO WAY: concentrated yeast extract, sauerkraut, most soybean products, over the counter supplements containing tyramine
OK: Brewer's yeast, Soy milk, commercially prepared pizzas from chain restaurants prepared with cheeses low in tyramine.
All foods must be fresh or properly frozen.
My feeling is that this is probably as reliable as it gets, since its included with a new product at the FDA's insistance, and the info is approved by the FDA itself.
Except for the feta in my salad and the occassional smoked salmon, I'm not sure I'll be making any real changes in my diet. The thing is, you start wondering about things they don't mention at all - like cured olives, etc. My feeling is if it isn't on the prohibited list, and there is a question in my mind, just skip it or stick to small quantities.
Y
Posted by Phillipa on September 21, 2007, at 20:43:02
In reply to Re: Movin' on up to the Big Time - EMSAM 9mg patch, posted by yznhymer on September 21, 2007, at 15:03:49
Gee I don't know but hopefully give me a bit of energy? I have two boxes of emsam now in the cabinet but it's not on the medicaire plan I have so I wouldn't be able to continue it. Hoping prices go down. Phillipa
Posted by Brody on September 22, 2007, at 16:33:29
In reply to Re: Movin' on up to the Big Time - EMSAM 9mg patch » Brody, posted by yznhymer on September 21, 2007, at 14:53:14
>
> At 6mg, what's been missing is a consistent response. My mood is generally good, and I'm a lot more talkative, but my energy, motivation and focus rise and fall.
>
>Yes! This sounds very much like my experience at 6mg, and fairly typical of what I have read from others. It's like, "Oh YES! I DO feel better, but, am I missing something here?"
>
> In some ways, it feels like anxiety is more of an issue than the depression, but they have always gone hand in hand for me. In fact, sometimes it seems like the anxiety induces the depression. >
>
>
For me, the anxiety came on much (years) later than the depression, and I feel it was the depression "lifestyle" that induced the anxiety. (stress related issues as a result of inaction)
>
>
I'm hitting things from all angles now - diet, exercise, some good therapy, etc. Still, it felt like Emsam gave me a foundation on which to build - without it I don't know that I would have been able to employ the other strategies.
>
>
Yes, yes, and more yes! You are definitely singing my song here! The Emsam was the first step (the "foundation"), and I had to have relief from severe depressive symptoms in order to take the next steps. EXCEPT, I did not get as far as you have at only 6 mg!! Just curious, does your therapist happen to be a practioner of CBT?
>
> I guess the additional question I'd have for you is what differences in antidepressive response did you experience at the different doses - did Emsam work better for you at 9 and 12 as opposed to 6?
>
>
Okay. My doctor was very aggressive with increasing my Emsam dose... more so than any I have read about. I was on 6mg for 2 weeks.... felt nothing; then 9 mg for 2 weeks, and I felt some of the depression lift; then we went on up to 12 mg, where I was seeing steady and significant improvement in mood for the month that I was at that dose. Then, the blasted orthostatic hypotension became too severe to shrug off. We tried Florinef to raise my blood pressure but that was unsuccessful, so we had no choice but to drop back down to 9mg. (I still experience the side effect, but not as severe) I did feel a slight lowering of the anti-depressant effects when I went back to 9mg.Back at 9mg, the Emsam was still doing a good job working on my "mood" and even my excruciatingly painful morning depressions were abated, however I did NOT get the energy and focus that many Emsamers were reporting. I found out you can be happier, and still not be able to MOVE!
After several months and still no help with the desire to happily just sit, and also some increasing afternoon sleepiness, my doctor added 100mg Provigil, and that was the bonus for me. There is synergy in the two meds for me. Now I have an increasingly positive mood, plus energy and concentration to apply to diet, exercise and therapy.
I have (as most MAOI users do) atypical, treatment resistant, major depression and the hardest problem to solve for me has always been the lethargy and apathy.
>
> Thanks again,
>
You're welcome! Getting well is a process. Best of luck with your next step.Janet
Posted by Brody on September 22, 2007, at 16:51:43
In reply to Re: Movin' on up to the Big Time - EMSAM 9mg patch » Brody, posted by Phillipa on September 21, 2007, at 12:11:45
> Since my pdoc says it would be too stimulating for me did you have anxiety before the patch and do you work or does hypotension keep you from driving. Thanks Phillipa ps I keep trying to learn all I can about the patch over a year now.>
>
>Hi Phillipa,
"Are you talkin' ta me?" (my very best Robert De Niro)
I'll answer anyway....
Yes, I did have mild anxiety before the patch. In spite of this, I really need lots of stimulation from an AD for it to work, and even the EMSAM at 12 mg was not enough. As you may remember, I had to augment with Provigil.
I work at home. I breed, raise and "start" performance Quarter Horses. The hypotension had me dropping to the ground everytime I had to toss a flake of hay over the fence, so this was a very lazy summer for the horses on this farm. The extreme heat made it all the worse.
If I were to go back to the city for a "normal" job, the hypotension could be a issue. Not so much for driving... remaining seated is easy; staying upright and continuing to walk around is easy. But if I had to stand up from a sitting position and walk across the room in a hurry, they might think they have a drunk employee on their hands! Same with bending over and then standing back up. I can get pretty wobbly! ;-)
Wondering..... are you still sleepy and fatigued alot?
Janet
Posted by Phillipa on September 22, 2007, at 21:10:54
In reply to Re: Movin' on up to the Big Time - EMSAM 9mg patch » Phillipa, posted by Brody on September 22, 2007, at 16:51:43
Yes I tire out very quickly and require a lot of sleep. Phillipa
Posted by trx resistant on October 29, 2007, at 16:46:44
In reply to Re: Movin' on up to the Big Time - EMSAM 9mg patch, posted by Dragon Black on September 21, 2007, at 3:04:58
Hi everyone! Really appreciate your sharing. I just moved up to 9mg. Wondering if anyone has found a review of EMSAM at all dose levels. I have MDD and the only drug that returned me to real life was Wellbutrin in 2000. But I developed severe seizures from it. Since then Effexor and cymbalta SSRIs did nothing unless I received maximum dosage then I got nocturnal seizure. So EMSAM provides me with a shred of hope, of which I have little. I spent 4 weeks at 6mg noticed a little help, but not enough to get me out of the house and functioning. Not working. Single, no family or social friends. Having a terrible time with motivation, have lots of messes (paperwork- year of unopened mail and boxes to unpack because of a forced move) to clean up since I have been SO STUCK. I am living out of a suitcase and my surroundings are so depressing. If I could just get organized enough to face everything maybe I ccould rebuild a life.
TRX Resistant
Posted by Astounder on October 31, 2007, at 7:21:00
In reply to Re: Movin' on up to the Big Time - EMSAM 9mg patch, posted by trx resistant on October 29, 2007, at 16:46:44
> Hi everyone! Really appreciate your sharing. I just moved up to 9mg. Wondering if anyone has found a review of EMSAM at all dose levels. I have MDD and the only drug that returned me to real life was Wellbutrin in 2000. But I developed severe seizures from it. Since then Effexor and cymbalta SSRIs did nothing unless I received maximum dosage then I got nocturnal seizure. So EMSAM provides me with a shred of hope, of which I have little. I spent 4 weeks at 6mg noticed a little help, but not enough to get me out of the house and functioning. Not working. Single, no family or social friends. Having a terrible time with motivation, have lots of messes (paperwork- year of unopened mail and boxes to unpack because of a forced move) to clean up since I have been SO STUCK. I am living out of a suitcase and my surroundings are so depressing. If I could just get organized enough to face everything maybe I ccould rebuild a life.
> TRX ResistantI found the effects to be pretty linear (6, 9, 12, 18, 24 mg/d). As I got happier, I became more obsessive about fixing up my surroundings, but no less avoidant. If you want to replicate Wellbutrin, you could take EMSAM and add on a noradrenergic antidepressant like protriptyline or desipramine.
Posted by trx resistant on October 31, 2007, at 13:03:31
In reply to Re: Movin' on up to the Big Time - EMSAM 9mg patch, posted by Astounder on October 31, 2007, at 7:21:00
Thanks again Astouder! I printed your suggestions and will take with me to psychiatrist tomorrow. He's a work comp pysch and although experienced (30 years) he never had a patient complicated by the seizures induced by Wellbutrin and dexidrine. So no neurologist will allow me to take any stimulants reducing seizure threshold.
Basically the attitude I get is just deal with it without meds. Obviously I haven't been able, even with psycologist.
trx resistant
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