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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 34. This is the beginning of the thread.
Posted by brooke484 on July 8, 2008, at 13:53:27
I have had no benefit from this drug. If anything it has made me worse. Do you think I should give it 3 more weeks or rip it off? I read that you have to give a drug 8 weeks, but my doctor seems to think that if I'm feeling worse then it's time to quit.
Any suggestions?
Thanks so much.
Posted by SLS on July 8, 2008, at 15:08:17
In reply to Doctor wants me to quit EMSAM after 5 weeks, posted by brooke484 on July 8, 2008, at 13:53:27
> I have had no benefit from this drug. If anything it has made me worse. Do you think I should give it 3 more weeks or rip it off? I read that you have to give a drug 8 weeks, but my doctor seems to think that if I'm feeling worse then it's time to quit.
>
> Any suggestions?
>
> Thanks so much.What dosage are you taking, and how long have you been taking it?
If you have been feeling worse, I doubt you will glean an antidepressant response from Emsam. Emsam made me feel worse also, and because of my past experiences with negative responses to various drugs, I decided to quit after 2 weeks.
Very important: If you do not respond to one MAOI, that doesn't mean that you won't respond to another. You might want to look at Parnate. I'm guessing that you suffer from a lack of energy. If social anxiety is a severe symptom, you might do better on Nardil.
- Scott
Posted by Roslynn on July 8, 2008, at 15:59:00
In reply to Doctor wants me to quit EMSAM after 5 weeks, posted by brooke484 on July 8, 2008, at 13:53:27
> I have had no benefit from this drug. If anything it has made me worse. Do you think I should give it 3 more weeks or rip it off? I read that you have to give a drug 8 weeks, but my doctor seems to think that if I'm feeling worse then it's time to quit.
>
> Any suggestions?
>
> Thanks so much.
Hi Brooke,I was going to write to you yesterday. Couldn't find the thread we had going.
I've been told EMSAM can take 6-8 weeks-- but that can be a really long time when you're feeling bad! And if it's making you feel WORSE, well, maybe your doctor is right? especially since I remember you said you couldn't exercise or even walk the dog without feeling lightheaded.
If you do decide to go off the EMSAM, make sure you and your doc have a good plan in place for the switchover period.
Hang in there and let us know how you are doing.Best,
Roslynn
Posted by Phillipa on July 8, 2008, at 18:09:55
In reply to Re: Doctor wants me to quit EMSAM after 5 weeks, posted by Roslynn on July 8, 2008, at 15:59:00
Sorry making you worse and agree with others maybe time to quit the med. What meds in the past have worked for you? Phillipa
Posted by brooke484 on July 8, 2008, at 22:17:28
In reply to Re: Doctor wants me to quit EMSAM after 5 weeks » brooke484, posted by SLS on July 8, 2008, at 15:08:17
6 mgs for 5 weeks. Parnate was too stimulating (made me want to jump out of my skin) and Nardil didn't work the second time (it did back in 1996). I went off Marplan about 2 months ago and that was a bust also. Couldn't go above 30 mgs without practically fainting. I took that for 6 months, I think.
If this fails my doctor wants me to try a stimulant. My main problem is severe derealization that continues to get worse.
brooke
Posted by brooke484 on July 8, 2008, at 22:18:22
In reply to Re: Doctor wants me to quit EMSAM after 5 weeks, posted by brooke484 on July 8, 2008, at 22:17:28
.
Posted by brooke484 on July 8, 2008, at 22:23:28
In reply to Re: Doctor wants me to quit EMSAM after 5 weeks, posted by Roslynn on July 8, 2008, at 15:59:00
My doctor also thinks I have blood sugar issues so he wants me to have that glucose tolerance test done, or whatever it's called. The last time I did that I passed out. But that's when I was pregnant so I just thought that was normal. My doctor said that could be causing some of my "fog" issues. Maybe that and my low blood pressure combined. I can only hope!
Did you hear from your insurance company yet?
brooke
Posted by brooke484 on July 8, 2008, at 22:24:50
In reply to Re: Doctor wants me to quit EMSAM after 5 weeks, posted by Phillipa on July 8, 2008, at 18:09:55
The only ones were Lexapro and Imipramine. I've tried over 20 since 1992, at least.
brooke
Posted by SLS on July 9, 2008, at 6:20:58
In reply to Re: Doctor wants me to quit EMSAM after 5 weeks, posted by brooke484 on July 8, 2008, at 22:17:28
Hi.
It is too bad that you haven't raised the dosage. Emsam doesn't seem to get many people well at 6mg/24hr. However, if you are sure that Emsam is making you worse, you might consider aborting the trial. I did. I felt worse at the lowest dosage.
It is a hard decision to have to make. Do you think you can tolerate raising the dosage for a few more weeks?
- Scott
> 6 mgs for 5 weeks. Parnate was too stimulating (made me want to jump out of my skin) and Nardil didn't work the second time (it did back in 1996). I went off Marplan about 2 months ago and that was a bust also. Couldn't go above 30 mgs without practically fainting. I took that for 6 months, I think.
>
> If this fails my doctor wants me to try a stimulant. My main problem is severe derealization that continues to get worse.
>
> brooke
Posted by Roslynn on July 9, 2008, at 18:02:55
In reply to Roslynn, posted by brooke484 on July 8, 2008, at 22:23:28
> My doctor also thinks I have blood sugar issues so he wants me to have that glucose tolerance test done, or whatever it's called. The last time I did that I passed out. But that's when I was pregnant so I just thought that was normal. My doctor said that could be causing some of my "fog" issues. Maybe that and my low blood pressure combined. I can only hope!
>
> Did you hear from your insurance company yet?
>
> brookeHi Brooke,
It would be good if it were the blood sugar thing (well, not really "good") but at least you'd have an answer and that's a condition can be fixed, right? I mean, they know how to address it. Unlike psychiatry, where we have to try so many drugs and combinations. I hope you find some solutions re: the blood sugar and blood pressure issues.
I did hear back from my insurance--they reversed their decision and approved the patch after much pestering from my doctor's office. I was greatly relieved. I will basically need to start my trial over back at day 1 since I was without the patch for 7 days.
I know it is hard trying to make these decisions of whether or not to discontinue a med. It can be so frustrating. I wish you the best during this hard time and please keep us posted.Roslynn
Posted by brooke484 on July 9, 2008, at 22:08:38
In reply to Re: Doctor wants me to quit EMSAM after 5 weeks » brooke484, posted by SLS on July 9, 2008, at 6:20:58
I just picked up my prescription yesterday for more 6 mg patches.
I think I remember UGottaHaveHope (forget his real name) saying that he contacted the maker of EMSAM and he said if you don't feel better in 8 weeks on 6 mg then you probably won't on a higher dose. I'll have to find that old post.
brooke
Posted by SLS on July 10, 2008, at 5:07:45
In reply to Scott, posted by brooke484 on July 9, 2008, at 22:08:38
> I just picked up my prescription yesterday for more 6 mg patches.
>
> I think I remember UGottaHaveHope (forget his real name) saying that he contacted the maker of EMSAM and he said if you don't feel better in 8 weeks on 6 mg then you probably won't on a higher dose. I'll have to find that old post.
>
> brooke
That is interesting. I can almost agree with that. However, they do make higher dosage forms for a reason. I don't know if you can trust a general statement like that from someone who does not have to suffer the same pain that you do. It seems a bit pretentious. Some people go to great lengths to seem smarter than everyone else around them. It is your life, not his. I would still titrate the drug clinically and cut the patches if necessary to get to 9mg/24hrs (they are patterned in such a way to be easily split). I doubt your doctor will allow you to do that.If the drug is making you feel more depressed after all this time, I would abort the trial now. See, now there I go trying to be smarter than I really am. There is no way that I could recommend taking such an action and be 100% correct that it is the right one. This is a difficult decision to make. I have never had a drug make my depression worse and go on to ultimately work. Yet, I am nearly 100% sure that it does happen from time to time. If you can tolerate the drug, then you might as well continue with it.
How's that for ambivalence?
Sorry I couldn't make your decision any easier.
Good luck.
- Scott
Posted by cumulative on July 10, 2008, at 19:53:39
In reply to Doctor wants me to quit EMSAM after 5 weeks, posted by brooke484 on July 8, 2008, at 13:53:27
Posted by SLS on July 10, 2008, at 20:18:36
In reply to Many people 'skyrocketed' with this med at week 6. (nm), posted by cumulative on July 10, 2008, at 19:53:39
Any particular dosage?
- Scott
Posted by Phillipa on July 11, 2008, at 19:16:14
In reply to Re: Scott » brooke484, posted by SLS on July 10, 2008, at 5:07:45
Scott Robert David did well on the 6mg patch and took klonopin 2mg with it but he didn't feel worse on the EMSAM. Reason I know as we used to talk on the phone when I wanted to try the med. I guess you know he no longer takes it. But if he had felt worse I think he would have discontinued the med. Don't know that as a fact. Phillipa
Posted by brooke484 on July 12, 2008, at 21:58:10
In reply to Doctor wants me to quit EMSAM after 5 weeks, posted by brooke484 on July 8, 2008, at 13:53:27
.
Posted by Marty on July 17, 2008, at 14:41:13
In reply to Re: Doctor wants me to quit EMSAM after 5 weeks, posted by brooke484 on July 8, 2008, at 22:17:28
I didn't research derealization at all, but my guess is that for your doc to prescribe EMSAM to treat it you should already have tried ALOT of other meds before, am I right ?Have you tried something acting on the NMDA system in an antagonistic/inhibiting way ? Again I didn't do any research on derealization, but I feel NMDA systems is implicated. For me, nothing induce deralization (and some depersonalisation) more than something stimulating them (ie: glutamic acid / glutamate / aspartame etc) or something acting too much with the norephinephrine system.
What has worked best for you so far and what was the worst of the bunch ?
/\/\arty
Posted by brooke484 on July 17, 2008, at 22:14:22
In reply to derealization » brooke484, posted by Marty on July 17, 2008, at 14:41:13
Oh, you have no idea how many I've tried. Sigh.
The only two drugs that worked were Imipramine in 1991 (total remission) and Lexapro in 2002 (about 75% remission). Nothing has worked since those two. Sorry, I don't know what NMDA stands for.
Probably the worst were Remeron, Effexor, Parnate, and Pristiq. I can't think of any others right now.
This is my 6th week on EMSAM and I feel worse than when I started. At least the headaches are gone.
If you have any advice I'll take it. I need all the help I can get. Living 15 years in a fog is not living, if you get my drift. I question my sanity about every minute of every day. It's torture.
brooke
Posted by UGottaHaveHope on July 18, 2008, at 1:57:33
In reply to Re: Scott » brooke484, posted by SLS on July 10, 2008, at 5:07:45
brooke484: i have to agree w/SLS. i will have to look up that old post, too, about emsman, and my pdoc was involved somehow in the creation of emsam.
but i would consider following the advice of SLS. because you have been on Emsam so long, you could consider going up in dosage to see if it makes a difference.
despite what my pdoc or any pdoc says, the X factor in all of this (unfortunately) is that all meds affect everyone differently. and even if my pdoc was the premiere expect in the world on emsam, he couldn't know exactly how it will affect your body and your body chemistry.
so why not finish a full trail on emsam and try a new dosage? at least consider, best wishes, michael
+ + +> > I just picked up my prescription yesterday for more 6 mg patches.
> >
> > I think I remember UGottaHaveHope (forget his real name) saying that he contacted the maker of EMSAM and he said if you don't feel better in 8 weeks on 6 mg then you probably won't on a higher dose. I'll have to find that old post.
> >
> > brooke
>
>
> That is interesting. I can almost agree with that. However, they do make higher dosage forms for a reason. I don't know if you can trust a general statement like that from someone who does not have to suffer the same pain that you do. It seems a bit pretentious. Some people go to great lengths to seem smarter than everyone else around them. It is your life, not his. I would still titrate the drug clinically and cut the patches if necessary to get to 9mg/24hrs (they are patterned in such a way to be easily split). I doubt your doctor will allow you to do that.
>
> If the drug is making you feel more depressed after all this time, I would abort the trial now. See, now there I go trying to be smarter than I really am. There is no way that I could recommend taking such an action and be 100% correct that it is the right one. This is a difficult decision to make. I have never had a drug make my depression worse and go on to ultimately work. Yet, I am nearly 100% sure that it does happen from time to time. If you can tolerate the drug, then you might as well continue with it.
>
> How's that for ambivalence?
>
> Sorry I couldn't make your decision any easier.
>
> Good luck.
>
>
> - Scott
Posted by brooke484 on July 18, 2008, at 9:53:24
In reply to brooke484, I have to agree w/SLS » SLS, posted by UGottaHaveHope on July 18, 2008, at 1:57:33
I'm thinking about quitting EMSAM today. All week I've been close to passing out and the lightheadedness lasts all day. I can't function or leave the house. As I type this I'm seeing spots. I'm weak and just want to spend all day in bed.
Is there anything I could do to increase my blood pressure? I doubt my doctor would give me Florinef. Last night when I checked my blood pressure it was 75/42, or something like that.
I feel like I'm close to death.
brooke
Posted by UGottaHaveHope on July 18, 2008, at 12:39:23
In reply to I'm in bad shape - UGottaHaveHope, posted by brooke484 on July 18, 2008, at 9:53:24
Brooke:
If you are feeling this badly, please consider calling your pdoc or, at least, some family members or friends for support.
These meds, sometimes they can do amazing things. You'll feel as low as a human can feel, and then it will bring you back up.
The great news is this: There are thousands of different combos for you to try, along with new meds coming out every day. My advice is this: Dont give up hope, help could only be one med adjustment or new combo away!!!
Posted by brooke484 on July 18, 2008, at 13:00:36
In reply to Anyone w/any advice for Brooke? URGENT » brooke484, posted by UGottaHaveHope on July 18, 2008, at 12:39:23
Thank you for trying to help. I did call my doctor and he will not let me try Florinef and wants me to quit EMSAM and try some new Alzheimer's drug that was just approved for depression. I don't know the name.
I do not want to quit just yet because it's only been 7 weeks. I wanted to give it 8 weeks, at least. My husband is going to buy me some Gatorade and see if that helps. I also made an appt with my family doctor on Aug 4th (kind of a long wait) to discuss my blood pressure.
Nardil, Marplan and EMSAM gave me the same side effect and I ended up quitting. That's why I can't understand why my doctor is so against letting me try Florinef. How else do you raise your blood pressure? I tried salt pills and that didn't work. I drink water all day but I do not eat a lot of salt. I don't like salt. Hopefully Gatorade will get rid of these spots in front of my eyes.
Thanks again for caring.
brooke
Posted by Marty on July 18, 2008, at 14:00:19
In reply to UGottaHaveHope, posted by brooke484 on July 18, 2008, at 13:00:36
> try some new Alzheimer's drug that was just approved for depression.
Many Alzheimer drug works on what I was talking about in my last post : NMDA .. and as I told you I fell NMDA dysregulation in some part of the brain / pathway is implicated in depersonalization and derealization. Please comeback with the name of the med ...
Hang on,
/\/\arty
Posted by Marty on July 18, 2008, at 14:24:16
In reply to UGottaHaveHope, posted by brooke484 on July 18, 2008, at 13:00:36
> I did call my doctor and he will not let me try Florinef and wants me to quit EMSAM and try some new Alzheimer's drug that was just approved for depression. I don't know the name.
---
Anyone know why Alzheimer drug he is talking about ? sounds interesting!/\/\arty
Posted by Roslynn on July 18, 2008, at 17:40:15
In reply to UGottaHaveHope, posted by brooke484 on July 18, 2008, at 13:00:36
> Thank you for trying to help. I did call my doctor and he will not let me try Florinef and wants me to quit EMSAM and try some new Alzheimer's drug that was just approved for depression. I don't know the name.
>
> I do not want to quit just yet because it's only been 7 weeks. I wanted to give it 8 weeks, at least. My husband is going to buy me some Gatorade and see if that helps. I also made an appt with my family doctor on Aug 4th (kind of a long wait) to discuss my blood pressure.
>
> Nardil, Marplan and EMSAM gave me the same side effect and I ended up quitting. That's why I can't understand why my doctor is so against letting me try Florinef. How else do you raise your blood pressure? I tried salt pills and that didn't work. I drink water all day but I do not eat a lot of salt. I don't like salt. Hopefully Gatorade will get rid of these spots in front of my eyes.
>
> Thanks again for caring.
>
> brooke
Hi Brooke,I am sorry you are feeling so badly.
Being lightheaded or dizzy for an extended period of time is horrible--it happened to me many years ago. I basically could not stand up --had to stay in bed about a week. Had to wash my hair in the sink because standing too long in the shower made me feel worse. It turns out I was dehydrated...but I know your situation is more complicated with the meds and all.Any way you can get in to see your doc sooner? To discuss your blood pressure?
Also remember you can go to the ER if you feel it is necessary. Going there with a complaint of lightheadedness is tough but I bet if you tell them you are seeing spots they'll take you seriously. And don't let them dismiss your concerns just because you're on psych meds (I've had that happen to me too)
By the way, not to get too personal but are you taking any other meds that might be interacting with the EMSAM? I had to switch all my asthma meds. but I notice I do get headaches when I use my rescue inhaler (that was the one there is no substitute for so I am just supposed to use it sparingly). Could you be experiencing any interactions?
Along with others on this board, I am concerned about you and hope things get better soon.
Roslynn
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