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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by satsumas on May 1, 2008, at 19:25:26
Hi, I need some help as i'm in the middle of the worst depression I've felt in a long time. My dr. is having me switch from the Emsam I have been taking back to the first drug I tried so long ago, Effexor, as the Emsam didn't work for me. I was on 9mg of emsam, 12mg for the last 4 days I was on it before I stopped cold turkey, and now i'm wondering how long I need to wait until I can start with the 37.5mg effexor that the doctor is starting me on. I've had so many suicidal thoughts that I don't want to wait any longer than necessary to start the effexor. The doctor said to wait 10 days and then do a week at 37.5 and then another week at 75mg. Has anyone moved off of an MAOI faster than this?
For background, since Emsam seems to work for so many people, the Emsam did give me energy and in some respects normalized parts of my mood, but everything became very "HEAVY" and "SERIOUS" on it. I had lots of psychological insightful thoughts, was reading the bible quite a bit, self help books, etc., but couldn't just 'chill' and watch tv or hang out, and it never resolved the long-standing anhedonia.
A few weeks ago after a stressful trigger event I sunk into the worst depression I've felt in 3 years. It's been suicidal thoughts every single day and a complete loss of will and hope. I am trying my hardest to complete my cognitive behavioral therapy exercises and engage in social activities, but I had to come back to my parents home for a few days the loneliness became so acute..not that its the healthiest place to be, but it's something.
Thanks.
Posted by Phillipa on May 1, 2008, at 21:07:46
In reply to Emsam switching to Effexor question NEED HELP!, posted by satsumas on May 1, 2008, at 19:25:26
So sorry as Emsam seemed the perfect med to try being in a patch form. Only complaint I heard from a lot of others was anxiety. Isn't the washout two weeks? I'm not sure and hope the effexor works for you. Post here daily while you are waiting. Someone is always posting so can distract your mind. Love Phillips
Posted by satsumas on May 1, 2008, at 21:20:33
In reply to Re: Emsam switching to Effexor question NEED HELP! » satsumas, posted by Phillipa on May 1, 2008, at 21:07:46
I guess i want to do the minimum required. And 37.5 is a small dose of effexor anyway. I'm willing to take a reasonable risk to get my blood levels of effexor up ASAP. Doctor also prescribed 150mg of lithium which i've started on right away.
Every single day its been suicidal thoughts, for 3.5 weeks. It takes all my power just to push them out and try to concentrate on something else, but the spirit and concentration is so weak too. Just read the Bible and pray to God and not think about how "off track" i am from my peers.
Hardest part is looking in the mirror and seeing wasting potential and having to hide this illness from peers. Already quit my job in January because it wasn't the right job for me and I was so unhappy for so long, but it's tough to start looking for a new one especially since I was already at the "top of the top" in terms of companies...feeling sorry for myself doesn't help I know and turns single depression to double depression to triple depression...so i will stop.
But it just hurts on so many levels.
Posted by undopaminergic on May 2, 2008, at 14:47:51
In reply to Emsam switching to Effexor question NEED HELP!, posted by satsumas on May 1, 2008, at 19:25:26
As a general rule, two weeks should pass after stopping an irreversible MAOI before starting a SSRI/SNRI. This is in order to allow time for replenishment of the MAO enzymes that were deactivated by the MAOI.
The main risk of starting a serotonergic drug too soon after a MAOI is the potentially life-threatening serotonin syndrome. Since it's the dose that makes the poison, it may be safe to start a serotonin reuptake inhibitor sooner at a low dose, but I have no data on that. If you decide to take the risk, you should first familiarise yourself with the signs and symptoms of serotonin toxicity, and keep cyproheptadine (Periactin) tablets available as an antidote (the relevant pharmacodynamic property is serotonin 5-HT2A-receptor blockade).
Posted by bleauberry on May 2, 2008, at 18:07:36
In reply to Emsam switching to Effexor question NEED HELP!, posted by satsumas on May 1, 2008, at 19:25:26
I am so sorry for the pain you are enduring. I know it. Every 5 minutes segment of a day is an excruciating journey. The good news is that it does lessen. It is not permanent. What I have noticed is that some meds can actually cause depression to slowly get worse, until one day it is just overwhelming and seems like it hit overnight, when in fact it had been sneaking up deceptively. To make it worse, when the offending drug is stopped, depression gets even worse. A double edged very sharp sword. But be assured, it passes. If you did absolutely nothing except endure it, you would be in better shape 3 weeks from now than you are today.
I like that you are focusing on the bible. Sometimes I wonder if God allows us to go through these painful things, as did some of his favorite men of the bible, in order to gain some special strength or insight that will be our gift in later life or beyond. Give glory to God in your prayers, even when you can't think of anything heartfelt to give glory for. He doesn't make mistakes. What is happening has a glorious purpose even though we cannot in our wildest imagination fathom what it might be.
Ensam takes a while to wash out and for the MAO mechanisms to begin refunctioning. Unlike other MAOIs, I do not believe Ensam is as strong on serotonin as the others. Though you need to google serotonin syndrome, type out a list of symptoms and keep it with you, and be very watchful for early signs, it is my best guess you could probably carefully cautiously respectfully begin effexor...BUT, at super low doses. You would have to empty a capsule onto a plate. Then with a razor blade or knife separate it into approximately equal piles of 4ths or 6ths. Dose it by swallowing on applesauce. No need to put it back in the capsule. I think you would be safe doing 5mg effexor to start, and increase it by maybe 1mg a day.
That being said, the comedown from ensam is still going to be painful until it has run its course. I doubt effexor is going to give any immediate relief, but at least you could get a headstart on things with tiny doses. I could be wrong and it might even help a lot right away. But you gotta do it very safe and smart with a lot of respect. 37.5mg is way too much at this point. I may be right and I may be wrong, but that is my best opinion based on being in your shoes several times.
Posted by satsumas on May 2, 2008, at 21:08:06
In reply to Re: Emsam switching to Effexor question NEED HELP!, posted by bleauberry on May 2, 2008, at 18:07:36
Thanks for the kind words.
I wonder sometimes if my faith is weak, relying on all these medications instead of throwing them away and just relying on God. I wonder if this is part of my sin, focusing too much on myself and what i'm currently "on" instead of focusing on God and his message. I wonder, especially given the fact that no medication has ever made me truly "well" if it is not a biological problem at all and if my spirit is simply weak. But I admit that these are not thoughts I try to harbor often as they only lead to more self-blame.
I agree and do get inspiration from the Bible especially the stories of pain and endurance. For a book and religious tradition so based on love and and trust there is an awful number of stories of abject pain and suffering. I try to trust God's plan but the depression itself makes the actualization of faith so difficult sometimes. I guess that's part of the challenge...if it was easy, it wouldn't have meaning. I HAVE been meditating a bit in my prayers on the nature of what faith and trust in adversity really means...and im coming to the conclusion that such faith and trust is easy to have in situations that are bad, but without depression. But it's in the depressive state when such trust seems empty and unfulfilled, where the faith is weak, when one doesn't even know what it means to trust and have faith for the will is weak regardless. Does it mean to put on a happy face despite the pain? Does it mean to do things with others despite wanting to hole up in bed? Does it mean to actively hope for a future worth living when hope itself seems to be actually malfunctioning? I don't know.
All I know is that i'm at the prime of my life, 28, with intelligence and gifts and resources and capacities and options and opportunities, and I look at the past few years with sadness of what this illness has caused me to miss out on, on the fact that this illness has made it so hard, so very hard to enjoy the gifts that i've been given and to take advantage of the opportunities and responsibilities i've been presented with. And the hope for a future that is different from the recent past dims with each day of feeling this way.
It's been especially sad to see, to get a glimpse, of the DESIRE, for at least a relationship, for the libido that is different than the mechanics of sexual functioning, that I didn't realize was gone for so long. The Emsam gave me some of that back, despite screwing with everything else. To see how I have rationalized away the desire for engaging with others socially or romantically past few years, well, its nothing short of heartbreaking. But I guess I can also say that the realization is also hopeful...that what I thought was just "me" may have been a part of the disease state I just didn't recognize, though wow, I thought I had known all corners of what this illness (or if it isnt an illness, my personality) did to me.
It's almost like once you get the hint of getting better, the abject sadness of the loss of the years past rears its ugly head and makes the getting better a much sadder process than one might think.
Posted by bleauberry on May 3, 2008, at 17:53:19
In reply to Re: Emsam switching to Effexor question NEED HELP!, posted by satsumas on May 2, 2008, at 21:08:06
Off topic from the initial inquiry about switching meds, but...
I felt deep in reading your spiritual thoughts. I sure can relate. I am lead electric guitarist on the worship team of a Christian church with 2 synth keyboardists, 5 lead vocalists, 2 acoustic guitars, drums, percussion section, 6 backup vocalists, the choir, huge sound system, huge stage, hundreds of people in the congregation, 3 services per weekend...the whole thing is big and powerful. Not the average Christian church. BUT, all around me I see people engulfed in the happiness of Jesus, saturated in faith, and they have not the slightest foggiest clue of how I want desperately to feel that. I usually feel like an outsider just visiting to check things out. I mean, my legs are so weak I can hardly stand. I am so depressed I just want to die. I am so foggy minded I can't remember what the next song is, or what the next verse is. People tell me, "When you play you open the doors to heavan"; "I saw fire fly from your fingertips and went right through me"; "You are annointed"; on and on. I appreciate those things and hold them dearly and give God all the glory. It is not me. BUT...do I feel the things these people feel? No. Depression is like a concrete wall that does not allow me to feel the joy or the faith or the depth that they all feel. But I make every effort at it anyway. God can see I'm trying my best with all I have. He knows.
Taking medications is not a weakness. It is not a sin. Most Christians rely on medications of some kind...blood pressure, diabetes, impotence, pain, psychiatry, weight loss, cancer, allergies, infections, etc. God created the very people that invented the meds and the doctors that prescribed them. We are all His children. Back in the old days they took herbs for symptoms. Herbs are just as powerful as meds, and many meds are directly derived from herbs. God put stuff here for us to use to our benefit. That doesn't mean that everything is good for us, but that when we find something that is good for us, that is a good thing, not a sin. If something can help us be a better lover of other people, a stronger worshipper, a more faithful servant, well, that something is good stuff.
It is easy, oh so easy, for those without mental illness to have an abundance of joy and fatih in God. For those of us in mental pain, it is a real struggle to feel the faith. It is almost like a practice or an effort, but not a heartfelt thing. That's ok. God knows. He sees our efforts and he sees the brick wall in our path. What we are able to do in worshipping him from our dungeon is more meaningful than the bountiful worship of someone normal. They don't even have to hardly try...not much effort...but you and me have to try real hard...great effort...and therefore much more meaningful. After all, we could choose to look the other way and not believe and not worship...since we aren't seeing any healing and nothing good in the bible is happening to us...but we don't. Now THAT is meaningful. I think God approves of that struggle, because it means for some reason He has chosen us for something special and we need to be stronger than those around us. In other words, I truly believe those in pain and weakness are God's special chosen annointed ones for great things down the road. He doesn't choose perfectly normal everyday happy people. He never did in the bible. It was the lost, the downtrodden, the sick, the poor...He eventually after years or decades of testing these people, He made them Kings. Who did Jesus save at the last minute? Some normal person praising the heck out of Him? No. They were destitute thieves hanging on a cross beside Him. At the last moment, they passed the test. How long did Job suffer in the bible? A real long time. How bad was it? Really really bad. At least as bad as you and me, except with all kinds of physical ailments on top of it, as well as scrutiny and abandonment from loved ones. Job was in worse shape than you or me. He had absolutely no reason to believe or have faith or to give worship. But he did anyway. He held fast. He was not only healed eventually, but he was restored all the years the locusts had taken away.
So a rich man donates to the cause of Jesus a huge sum of money. A poor woman donates 25 cents. Who was the one God praised? It was the poor woman. Why? Because that 25 cents was all she had. The rich man had plenty more that he didn't give. The poor lady gave everything. That is you and me. We give everything we have. The other normal happy unafflicted people? I am so glad they believe and worship and they are my brothers and sisters...but what they give in comparison to what they have is far less than what you and me give in comparison to what we have.
Praise God. Keep the faith. Invite Jesus to be with you many times during a day. There is a happy ending. He is indeed watching every moment of your pain and He has a good plan. What is hard for you and me is that God's timing is not our timing. We might think now is the best time to be healed. But God knows better. There is a different time that will be much better than now. Keep you faith on that.
Through our weakness and pain God's glory shall be seen. You and me are on a journey to become powerful testimonies for others to follow.
I am going to go play some outrageous lead guitar right now and think about you the whole time.
Posted by satsumas on May 3, 2008, at 19:24:51
In reply to Re: Emsam switching to Effexor question NEED HELP! » satsumas, posted by bleauberry on May 3, 2008, at 17:53:19
Thank you for your kind and helpful post and thoughts, I can tell writing it was helpful in sorting out your own thoughts too.
Posted by satsumas on May 13, 2008, at 20:06:52
In reply to Re: Emsam switching to Effexor question NEED HELP!, posted by satsumas on May 3, 2008, at 19:24:51
UPDATE: It's over a week later and I am still feeling the worst depression I've ever felt. Just moved up to 150mg of Effexor. Cannot believe I am in such a hole. Entire life is just blankness and hopeless -- I have been without work (due to leaving my job on my own accord as it wasn't the right place for me) since January, did fine in Feb March while I was on Emsam, but the bottom fell out in April and its just been getting worse.
Ever since stopping the Emsam I feel like the bottom has fallen out of an already terrible depression. At this point I am putting all my faith in Effexor starting to work and am titrating up as fast as possible but the suicidal thoughts just aren't stopping...it's been constant, for 6 weeks now.
BEWARE for anyone else thinking about stopping Emsam cold turkey -- not sure it's such a good idea. Even though the MAO enzyme grows back at a relatively slow pace, it still turned my atypical depression into a horrifically melancholic, suicidal, staring-at-the-walls experience that I have no idea how I am going to get out of. I just take it a day at a time and put it in God's hands and trust that my brain isn't processing reality accurately right now.
Posted by lady scruffe on May 16, 2008, at 19:56:14
In reply to Re: Emsam switching to Effexor question NEED HELP!, posted by satsumas on May 13, 2008, at 20:06:52
All the best to you - and hang in there. You will be feeling better soon, I am sure.If in the future you decide to go off Effexor to try another med - Don't stop Effexor cold turkey. Although Effexor can be very helpful to so many, it needs to be titrated down very very slowly - sometimes over a period of months not weeks. Suddenly stopping any of these meds cold turkey is not a good idea - but Paxil and Effexor especially can land you in the hospital right quick.
Posted by Phillipa on May 16, 2008, at 20:10:26
In reply to Re: Emsam switching to Effexor question NEED HELP!, posted by lady scruffe on May 16, 2008, at 19:56:14
Paxil was my first ad and it worked took it for two years and just bit off tiny pieces and was off in about two weeks. Wasn't bad for me. Love Phillipa
Posted by satsumas on May 22, 2008, at 18:36:58
In reply to Re: Emsam switching to Effexor question NEED HELP! » lady scruffe, posted by Phillipa on May 16, 2008, at 20:10:26
So to continue my horrible month of May experience, after going off the Emsam and building up to now 300mg of Effexor, I am having some incredible cravings, and while the Effexor has gotten me out of bed, and cut off the worst suicidal depression I had ever been in, it is now causing some INTENSE cravings that were NOT there on Emsam: for alcohol, for cigarettes, for food, for sugar, and for other addictive rewards (like, for me, internet use). I am not feeling AS suicidal but I still feel like CRAP.
Clearly, something is majorly wrong with dopamine system. I'm assumign this is a side effect of effexor that those with screwy dopamine systems would be more likely to experience. What should I do? What have others in this position who have experience these sorts of things done? I was on Effexor and have been on Cymbalta in the past, never really liked them, but they got me to a semi-functional (but apathetic, anhedonic I now realize) state. Being on Emsam has made the cravings coming from Effexor ever more obvious to me.
I want to get off the Effexor but at this point do not know what else to do. Should I try Wellbutrin as an add-on or simply replacement?
Have an appointment with the pdoc on mon but at this point it has been 2yrs with him and i don't know how much I trust his judgement since I am STILL NOT WELL after 5 years of this nonsense.
This is the end of the thread.
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