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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Racer on October 13, 2007, at 0:00:37
I've gotten much worse again, and my therapist convinced me to contact my pdoc. (In fact, I think she called him, too.) He wants me to try EMSAM, and I guess I'm willing. Mostly...
My general fear of trying new medications, combined with my fear of giving up Concerta and Wellbutrin, combined with the hopelessness associated with depression -- I'm not sure I want to try anything new. Every time I get to where I think, "OK, I can do this, I can try this new medication, it can't be too bad --" I get caught up into the memory of how bad it really can be -- but filtered through the depression, it looks far bleaker than it probably is. So, since it's almost certainly going to happen, I thought I'd ask people what they'd experienced with it. I have some specific questions I want to ask, so if you have any input on these items, PLEASE don't hesitate to offer it.
The one thing I want to say at the outset, though, is this: there are a number of drugs I cannot or will not take, for a variety of reasons. My pdoc and my therapist also have a range of drugs they are not willing for me to take. The one drug my pdoc would like me to try right now is EMSAM. I appreciate everyone who may want to suggest other medications, but I ask that you please respect my request not to suggest other medications right now.
My biggest concerns are weight gain, sedation, apathy, weight gain, brain fog, hypotension, and weight gain. Not necessarily in that order... Leaving aside the question of weight gain, can anyone tell me anything about whether to expect brain fog or sedation? What about apathy? That's been a big problem for me with SSRIs, how does EMSAM rate on that? Hypotension? I've read warnings about it on the BMS website, and it's noted as a side effect on rxlist, but I'd like to hear from people here if it's a common problem or not. If you did have trouble with it, is your normal blood pressure low/high/perfect range? And, of course, weight gain? If so, has that been a problem for you with other drugs?
Thank you very much, in advance, to anyone who responds.
Posted by Sigismund on October 13, 2007, at 3:04:11
In reply to Grrr... EMSAM again, what to expect?, posted by Racer on October 13, 2007, at 0:00:37
Racer
I've never tried Emsam but I have lots of experience with deprenyl and selegeline and I think they (and by extension Emsam) are drugs that might be useful to you.
Unlikely to get brainfog, sedation or weightgain.
I wonder if this might be truer for the lower dose patches?
Posted by Racer on October 13, 2007, at 4:02:55
In reply to Re: Grrr... EMSAM again, what to expect? » Racer, posted by Sigismund on October 13, 2007, at 3:04:11
Thank you, Sigismund. I really appreciate your answer. I'll try to hold on to that for the next few days -- maybe it'll help me get past my anxiety about trying a new medication.
If nothing else, it feels nice that you took the time to answer.
Posted by d0pamine on October 13, 2007, at 5:06:28
In reply to Grrr... EMSAM again, what to expect?, posted by Racer on October 13, 2007, at 0:00:37
By now, you likely know what I think of EMSAM. As far as this imperfect world of AD meds goes, it's tough to beat.
Lets see
>My biggest concerns are weight gain, sedation, apathy, weight gain, brain fog, hypotension, and weight gain..oO(Hmm weight gain mentioned twice, must be a big deal. I'll start there)
I have put on some weight since starting EMSAM, but I'm absolutely certain it is only indirectly related, as the med gives me a HUGE craving for sugar. I mean it even makes it taste soooo much better, particularly chocolate. I stopped EMSAM for a month and went and bought a bag of peanut M&Ms and was amazed to find that comparatively they had NO TASTE AT ALL!!! I can't overstate how much better and more tempting this stuff makes chocolate taste. Don't give in, and you'll not gain weight.
Brain fog: It helps it instead of causes.
Hypotension: I normally have super hypertension and I've NO idea why (I'm quite active, not overweight, and I eat nearly perfectly (except for the occasional bag of Mz)... Anyway without additional BP meds my BP is still a smidge high on EMSAM, with BP meds it's perfect, unless I go out in the sun and dig a trench, then I'm guaranteed to go hypo, but only if I'm taking meds, not on EMSAM alone. I can usually avoid this by drinking about 1/2 gallon of water prior to going out and working in the sun.
Apathy: Like brain fog, it helps instead of causes.
The big deal as I see it is the 6 week wait to get it going, but I'm sure you're used to that sort of thing by now, and the increased libido may or may not be a problem for you. However I personally respond very well to Bupropion also, except it makes me chew my tongue out and makes it sound to my ears like a jet is landing.
Posted by Greenmtn on October 13, 2007, at 9:24:48
In reply to Re: Grrr... EMSAM again, what to expect?, posted by d0pamine on October 13, 2007, at 5:06:28
I have been thru years of major depression/ dysthymiaI i.e. "Double depression". I have been treated by a good psychiatrist and tried lots of meds and all the side effect crap. Some periods semi-functional- mostly nonfunctional or in the dark pit. No real relief.
Since 7/25/07 I have been taking Emsam 6mg (with 2 other meds). I have probable Crohn's and it seemed to aggravate that but a new gastro drug fixed that problem. As time goes by on Emsam I feel it has changed my life. Not perfect- still some SHORT periods of major depression and minor side effects. I am functional and feel moderately upbeat 90% of the time. At first the gastro problem almost made me give it up but I am so glad I did'nt.
Weight Gain> My appetite and weight have not changed but I need to loose some weight.
Sedation / Brain Fog> I am more together and more able to be motivated and accomplish things. And enjoy things. (this is not normally me- I am quite low energy) Even when fatigued my mental outlook is good.
Hypotension> I have been a bit hypotensive but this is not a major problem. If it becomes one I will probably deal with it rather than go off Emsam.
Posted by Phillipa on October 13, 2007, at 10:32:23
In reply to Re: Grrr... EMSAM again, what to expect?, posted by Greenmtn on October 13, 2007, at 9:24:48
Racer oh you're so much braver than me I have had contact with original success story Robert David and he's again back on a low dose if you can do it maybe I can. Just knowing you can see it and rip it off if side effects too bad is a big plus to me and I do know that it does stay in your body after that it's psychological. I hope and know it will help you. The best of success with it. Phillipa ps and you can cut those patches and take them off at night as I think aggitation is biggest problem.
Posted by Brody on October 13, 2007, at 13:56:25
In reply to Grrr... EMSAM again, what to expect?, posted by Racer on October 13, 2007, at 0:00:37
Hi Racer,
I've been on Emsam since May '07. I'll answer your specific questions below, but a general comment is that I have noticed increased benefits and lessening of side effects continually for the entire 5 months.
> my fear of giving up Concerta and Wellbutrin, ................... It looks far bleaker than it probably is.>>
So it sounds as though you are prepared for the washout period you may experience going off of these meds? I, too, had been on Wellbutrin (450mg and augmented with Abilify) before going on Emsam. The washout was not pleasant.... It will be helpful if you can remember that last sentence you wrote above....
>
> can anyone tell me anything about whether to expect brain fog or sedation?>>Brain Fog: I experienced the reverse. "Hello? Did someone turn the lights on?".
Sedation: After about 8 weeks, I did begin to experience some afternoon somnolence, and my p-doc has since added Provigil. I take only 50 mg, and after reading D0pamine posts, I now take it on an as needed basis.... less often all the time.... 2 to 3 times per week.
Perhaps the less frequent need to augment with Provigil is due to the accumulative nature of EMSAM's effects.... the energy boosting mechanisim that wasn't there for me initially seems to have kicked in.
>> What about apathy?>>I am taking more pleasure in everyday things and I have much more interest in those around me.
For me, EMSAM was the tool that lifted the DEPRESSION, and it did so in a big way. BUT, again, I did not get the initial boost in energy that many users have reported. I now am able to tackle and work through large complicated tasks, and I attribute that to the med combo, and the addition of CBT.
>>Hypotension?>> If you did have trouble with it, is your normal blood pressure low/high/perfect range?
Oh Boy! This was a big problem for me. My normal blood pressure has always been low, say around 110/60. I had orthostatic hypotension with EMSAM at 6mg and 9mg, and I was falling on the floor at 12mg. (My p-doc was very agressive with dosing EMSAM, I think because my depression was bordering on crisis and she didn't feel like waiting around. Hindsight, she maybe went too fast, but dropping the dose has worked out fine.)
We tried Florinef to raise BP but I didn't like side effects... too much water retention. After dropping back to 9mg Emsam, I just dealt with the hypotension, and it has lessened over time. I rarely notice it anymore and my BP has actually gone up a little. Unfortunately, so has my pulse rate.
>
>And, of course, weight gain? If so, has that been a problem for you with other drugs?
>
>I will agree 100% with D0pamine here. The carb cravings are something to behold! Having this info in advance..... maybe you can stay disciplined... DON'T GO ANYWHERE NEAR CHOCOLATE! I now have to deal with a 10 pound weight gain!
Is this your first MAOI? It is mine, and I have not experienced a med related weight gain before. Quite terrifying!
Best of luck to you, Racer.If you can... please give this med a good LONG trial.
P.S. You didn't ask about anxiety. Let me know if you want my input on that.
Posted by Racer on October 13, 2007, at 15:06:18
In reply to Re: Grrr... EMSAM again, what to expect?, posted by Phillipa on October 13, 2007, at 10:32:23
Please don't babblemail me again.
Posted by Cecilia on October 13, 2007, at 18:50:24
In reply to Grrr... EMSAM again, what to expect?, posted by Racer on October 13, 2007, at 0:00:37
I didn't have weight gain, sedation, apathy, brain fog or hypotension on Emsam. I did have extreme insomnia, anxiety and severe dry eyes and eye pain. Cecilia
Posted by Jay_Bravest_Face on October 13, 2007, at 20:02:19
In reply to Grrr... EMSAM again, what to expect?, posted by Racer on October 13, 2007, at 0:00:37
> I've gotten much worse again, and my therapist convinced me to contact my pdoc. (In fact, I think she called him, too.) He wants me to try EMSAM, and I guess I'm willing. Mostly...
>
> My general fear of trying new medications, combined with my fear of giving up Concerta and Wellbutrin, combined with the hopelessness associated with depression -- I'm not sure I want to try anything new. Every time I get to where I think, "OK, I can do this, I can try this new medication, it can't be too bad --" I get caught up into the memory of how bad it really can be -- but filtered through the depression, it looks far bleaker than it probably is. So, since it's almost certainly going to happen, I thought I'd ask people what they'd experienced with it. I have some specific questions I want to ask, so if you have any input on these items, PLEASE don't hesitate to offer it.
>
> The one thing I want to say at the outset, though, is this: there are a number of drugs I cannot or will not take, for a variety of reasons. My pdoc and my therapist also have a range of drugs they are not willing for me to take. The one drug my pdoc would like me to try right now is EMSAM. I appreciate everyone who may want to suggest other medications, but I ask that you please respect my request not to suggest other medications right now.
>
> My biggest concerns are weight gain, sedation, apathy, weight gain, brain fog, hypotension, and weight gain. Not necessarily in that order... Leaving aside the question of weight gain, can anyone tell me anything about whether to expect brain fog or sedation? What about apathy? That's been a big problem for me with SSRIs, how does EMSAM rate on that? Hypotension? I've read warnings about it on the BMS website, and it's noted as a side effect on rxlist, but I'd like to hear from people here if it's a common problem or not. If you did have trouble with it, is your normal blood pressure low/high/perfect range? And, of course, weight gain? If so, has that been a problem for you with other drugs?
>
> Thank you very much, in advance, to anyone who responds.I honestly think we all have to change meds every once in awhile. I don't think most can stay on the same meds forever. I am sorry, I know there is so much to fear with new meds, but....even though I am not an AA'er, I still believe in one day at a time. Somehow...we've got to take us out of ourselves as well. That means I gotta stop writing
about my stupid self...lol. There is a 'Critical Mass' in all of our suffering. Too bad we couldn't just chuck it in a large-size Glad bag and hurl it
far away. Okay I'll shut up now. :-)Peace...
Jay
Posted by cumulative on October 13, 2007, at 22:00:44
In reply to Grrr... EMSAM again, what to expect?, posted by Racer on October 13, 2007, at 0:00:37
>My biggest concerns are weight gain, sedation, apathy, weight gain, brain fog, hypotension, and weight gain.
Yeah, I don't think you're going to get much of these with EMSAM either. It's somewhat stimulating, although probably not enough to monotherapy an inattentive or something. I only heard of postural hypotension occurring with EMSAM on the 12mg. My biggest problems with it were worsened insomnia and nervousness -- it was really very little help for my social phobia, but I probably didn't give 9mg a long enough trial.
If amineptine was available, that probably would have been a great adjunct.
Posted by Phillipa on October 13, 2007, at 22:42:46
In reply to Re: Grrr... EMSAM again, what to expect?, posted by cumulative on October 13, 2007, at 22:00:44
No more babblemails to you was just trying to be supportive.But that's fine. Phillipa
Posted by Racer on October 14, 2007, at 1:22:08
In reply to Re: Grrr... EMSAM again, what to expect?, posted by cumulative on October 13, 2007, at 22:00:44
> > My biggest problems with it were worsened insomnia and nervousness -- it was really very little help for my social phobia, but I probably didn't give 9mg a long enough trial.
>Huh... My psychopharmacologist suggested it would be a good choice, because it is so helpful for anxiety... Not your experience, huh? (Then again, my Wellbutrin/Concerta combo isn't exactly great for it, now that you menion it...)
How long did you take it? And are you still on it? Were you taking anything else? What dose were you on? And how long did the Hundred Years War last?
Thanks for responding.
Posted by Netch on October 14, 2007, at 9:34:01
In reply to Grrr... EMSAM again, what to expect?, posted by Racer on October 13, 2007, at 0:00:37
If you have bipolar, mixed or schizzoaffective tendencies maybe a combo of lamictal and abilify could help you.
/Netch
Posted by Racer on October 14, 2007, at 12:38:21
In reply to Re: Grrr... EMSAM again, what to expect? » Racer, posted by Netch on October 14, 2007, at 9:34:01
> If you have bipolar, mixed or schizzoaffective tendencies maybe a combo of lamictal and abilify could help you.
>
> /NetchNope -- and I've tried them both. Lamictal initially improved my depression, and then increased it markedly. The initial improvement only lasted two to three days as I titrated to 150mg and then to 200mg, and it also caused some other side effects which I found too unpleasant.
Abilify had me feeling as though I'd twitch out of my skin, and gave me insomnia.
And my pdoc wants to try EMSAM, and he's the guy with the prescription pad.
Posted by Netch on October 14, 2007, at 13:07:39
In reply to Re: Grrr... EMSAM again, what to expect? » Netch, posted by Racer on October 14, 2007, at 12:38:21
> > If you have bipolar, mixed or schizzoaffective tendencies maybe a combo of lamictal and abilify could help you.
> >
> > /Netch
>
> Nope -- and I've tried them both. Lamictal initially improved my depression, and then increased it markedly. The initial improvement only lasted two to three days as I titrated to 150mg and then to 200mg, and it also caused some other side effects which I found too unpleasant.
>
> Abilify had me feeling as though I'd twitch out of my skin, and gave me insomnia.
>
> And my pdoc wants to try EMSAM, and he's the guy with the prescription pad.Yes, a prescription pad would be nice :-)
/Netch
Posted by cumulative on October 14, 2007, at 18:54:03
In reply to Hm... Not good for anxiety? » cumulative, posted by Racer on October 14, 2007, at 1:22:08
>Huh... My psychopharmacologist suggested it would be a good choice, because it is so helpful for anxiety...
Yeah, sad to say this wasn't my experience. YMMV but I'm pretty sure most of the people here who took EMSAM found it to have no effect on or increase overall anxiety as well. Anything that metabolizes to peripheral amphetamines like EMSAM does I would think has a propensity for jitters.
I'm curious, where did your guy hear/on what basis does he think EMSAM is helpful in this indication, compared to any other MAOI? IMO The king of anti-anxiety MAOIs (or antidepressants in general) remains Nardil, and it's because of activity at GABA transaminase.
I took it at 6mg for a month, and 9mg for two months. I took Ambien CR for sleep, and for a week or two I trialed transdermal nicotine for additional help with focus but for me this wasn't too successful.
Anyway, there are some pretty long threads on EMSAM here in the archives it might be worth searching. I wish you luck.
My next attempt at medication: low-dose selegiline, amineptine, and gotu kola. I expect this to be very successful.
Posted by Maxime on October 15, 2007, at 19:21:51
In reply to Hm... Not good for anxiety? » cumulative, posted by Racer on October 14, 2007, at 1:22:08
> > > My biggest problems with it were worsened insomnia and nervousness -- it was really very little help for my social phobia, but I probably didn't give 9mg a long enough trial.
> >
>
> Huh... My psychopharmacologist suggested it would be a good choice, because it is so helpful for anxiety... Not your experience, huh? (Then again, my Wellbutrin/Concerta combo isn't exactly great for it, now that you menion it...)
>
> How long did you take it? And are you still on it? Were you taking anything else? What dose were you on? And how long did the Hundred Years War last?
>
> Thanks for responding.
Hi Racer. A lot of people complain that it makes them more anxious. But since you respond oddly to meds (the ED thing), maybe it won't increase your anxiety!Maxime
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