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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by former poster on June 13, 2010, at 1:23:08
There are very few posts about Emsam. I have started the 6mg patch. I noticed agitation, loss of libido and E.D. only slight mood and motivation and mood improvement.
Posted by em_kath on June 13, 2010, at 2:46:13
In reply to Emsam: Did everyone give up on it?, posted by former poster on June 13, 2010, at 1:23:08
A few months ago I was on Emsam (up to the 12 mg patch) and I posted here a lot during that time. I've only heard a few accounts on this site of it being especially helpful, and those that I talked to who were helped by it often had severe skin reactions that forced them to discontinue. It didn't do much for my depression or lack of energy/motivation, though it helped some with my social anxiety. I had no libido issues but I did experience some orthostatic hypotension. Considering the price and the common skin reactions I would personally recommend trying one of the stronger MAOIs with established effectiveness instead. The only real advantage Emsam seems to have over Parnate or Nardil is its lack of dietary restrictions, which IMO isn't worth it.
However, depending on how long you've been on Emsam, it might be too soon to tell if it will work for you or not. I was on it for almost 2 months before I felt a (slight) lift in depression, and I've heard similar stories of it taking an unusually long time to kick in compared with other antidepressants. Also, you might know about the different neurotransmitters that are affected with higher doses, so you might need to go up to at least 9 mg before you get a noticeable benefit.
Posted by zonked on June 13, 2010, at 11:12:49
In reply to Emsam: Did everyone give up on it?, posted by former poster on June 13, 2010, at 1:23:08
> There are very few posts about Emsam. I have started the 6mg patch. I noticed agitation, loss of libido and E.D. only slight mood and motivation and mood improvement.
Before my lovely late '06 (or was it early '07?)-08 Nardil remission, my pdoc gave me a week's worth of Emsam samples. My insurance at my (then) new job hadn't kicked in yet, so I continued with the generic selegiline caps (forget the dose) for several months--it made me *very* anxious/panicky and agitated. Felt very much like Wellbutrin to me, only more anxiety and agitation.
(Wellbutrin did weird things to me. It helped a teeny bit with depression, made me horny as hell, gave me awful anxiety and panic attacks, and made my fuse very short. Goes along with my "too much NE is bad for zonked" theory--I had similar agitation/anxiety from Effexor, Cymbalta and nortriptyleine.. All NE-ergic.)
I have met a woman who'd been on Emsam for some time though and raved about it...should have asked her what dose and how long.
-z
Posted by former poster on June 13, 2010, at 12:15:42
In reply to Re: Emsam: Did everyone give up on it? » former poster, posted by em_kath on June 13, 2010, at 2:46:13
In my experiences, taking a long time to kick in could be an indicator that it is very effective. I am having a hard time finding general information on Emsam. I thought that since in its originally a parkinsons drug it worked primarily on dopamine. This stuff makes me feel like I drank a whole pot of coffee.
Posted by Phillipa on June 13, 2010, at 12:33:50
In reply to Re: Emsam: Did everyone give up on it?, posted by former poster on June 13, 2010, at 12:15:42
I always said google Robert David the first poster to go on Emsam. He did very well at 6mg with 2mg of klonopin. Reminds me I still have a sample box of original Emsam. At first my pdoc said try it but only a tiny piece of the patch as anxiety is or was such a bad side effect. She retracted trying it as had a lady with such a bad rash even the dermatoligists said no. Yes she rotated the sites liked the med but according to pdoc the rash was horrible. But I never heard it was originally for Parkinson's? Phillipa
Posted by em_kath on June 13, 2010, at 12:35:07
In reply to Re: Emsam: Did everyone give up on it?, posted by former poster on June 13, 2010, at 12:15:42
> In my experiences, taking a long time to kick in could be an indicator that it is very effective. I am having a hard time finding general information on Emsam. I thought that since in its originally a parkinsons drug it worked primarily on dopamine. This stuff makes me feel like I drank a whole pot of coffee.
My understanding is that at the 6 mg dose Emsam is selective for MAO-B, so it works mainly on dopamine, and once you go past 9 mg it loses its selectivity for MAO-B and reduces the breakdown of MAO-A, at which point it also works on serotonin and norepinephrine. If you feel agitated on a lower dose maybe a higher dose would have a calming effect once you have the benefit of serotonin, although I suppose the norepinephrine could contribute to agitation as well.
Posted by Roslynn on June 13, 2010, at 17:16:25
In reply to Emsam: Did everyone give up on it?, posted by former poster on June 13, 2010, at 1:23:08
Hi,
I took it last year at 6mg. It did elevate my mood, but I had the very bad skin reaction to the patch and could not get rid of it no matter what I tried. If the news came out that the company was reformulating the patch with less-irritating adhesive or glue or whatever I would try it again in a heartbeat.
As I recall it took a few weeks to work and caused mild headaches at first.Roslynn
Posted by Phillipa on June 13, 2010, at 19:35:05
In reply to Re: Emsam: Did everyone give up on it?, posted by Roslynn on June 13, 2010, at 17:16:25
I remember. Wonder what's on their site now. Might look. Phillipa
Posted by Blossom on June 13, 2010, at 19:48:53
In reply to Emsam: Did everyone give up on it?, posted by former poster on June 13, 2010, at 1:23:08
I used to take Emsam (6mg). Stopped Jan of last year. I loved the effect on my mood, but after a while, I became so fatigued that I was barely functional. I believe that it affected my sleep, even though I didn't necessarily realize that I wasn't sleeping well. After I stopped taking it, it took about six weeks before the fatigue went away.
Posted by former poster on June 13, 2010, at 21:52:12
In reply to Re: Emsam: Did everyone give up on it? » former poster, posted by em_kath on June 13, 2010, at 12:35:07
Thats just the information I was looking for. Sounds like its not going to mix with my bupropion very well. Perhaps someone will find a cocktail that works well with it.
Posted by Matryoshka on June 18, 2010, at 13:37:00
In reply to Emsam: Did everyone give up on it?, posted by former poster on June 13, 2010, at 1:23:08
> There are very few posts about Emsam. I have started the 6mg patch. I noticed agitation, loss of libido and E.D. only slight mood and motivation and mood improvement.
Loss of libido at 6mg is unusual, as it primarily boosts dopamine. (Agitation on Emsam makes me suspect you may want to try something that is a bit less activating than Wellbutrin. But then, a higher dose of Emsam may have an anxiolytic effect once you reach MAO-A inhibition and get some serotonin boost.)I've been on Emsam since September of last year. I am not going off it anytime soon. It didn't have significant AD effect until I reached 12mg. I'm also on thyroid hormone (T3) for a mild thyroid impairment, and Adderall (at a very low dose) for cognition and attention.
So far it has worked well for me, but I can imagine the combination might be agitating for some people. Anergic depression has been my primary issue, not anxiety.
I suspect many people get on the 6mg patch, stay there, and expect to feel better. That's not the way it works. You may easily need 9mg or 12mg to get significant MAO-A inhibition, which is required for antidepressant effectiveness. My advice to anyone on Emsam is that if they can tolerate the skin patch, move up from 6mg to 9mg within 2-3 weeks, and if any glimmer of improvement is felt, move up to 12mg within another 2-4 weeks.
Emsam seems to take a while to work compared to even the SSRIs, for some people; for others it works faster than the SSRIs. (A moot comparison for me, as the SSRIs no longer work at all.)
I had low dose (75-150mg) Provigil as an augmentation initially (until I developed severe heartburn on it), which was a good booster for energy and mood.
If you take sedatives at night, they can be "amplified" by an MAOI and sabotage your energy the next day. Be wary.
My mood now feels better than it has in years, although I have to pick up the pieces of a career and social life that was shredded by depression -- but that's the way it goes, isn't it? It's like rebuilding after a disaster.
Posted by former poster on June 18, 2010, at 22:43:13
In reply to Re: Emsam: Did everyone give up on it?, posted by Matryoshka on June 18, 2010, at 13:37:00
Thank you very much for the valuable post. I am so happy to hear such success and very grateful you shared your information. I had wondered if Emsam worked so well that the patients taking it were out enjoying their lives and thats why no one hears about them
I now believe Emsam has started working for me. I'm feeling short bursts of motivation. You are right about the sex part. Maybe some other factor was causing the ED? No problem now. Any libido problems at the 12mg level? Is there a 12mg patch or just put (2)6mg patches on every morning? My Dr. handed me a sack full of Emsam sample packets and I'm sure when I see him again he will just ask me what dose level I'm at, then accommodate my needs.
I tried Provigil and it worked incredible but I got flu like symptoms so I had to stop. I had the worst withdrawl symptoms from Provigil.
Posted by Elanor Roosevelt on June 19, 2010, at 15:31:44
In reply to Re: Emsam: Did everyone give up on it?, posted by former poster on June 18, 2010, at 22:43:13
It's good to hear some positive news on the emsam front. I just started this week. My pdoc gave me a thumbs down on the provigil after consulting his electric med-o-meter.
What does help with the energy?
Posted by jackford on June 24, 2010, at 1:43:13
In reply to Re: Emsam: Did everyone give up on it?, posted by Matryoshka on June 18, 2010, at 13:37:00
Yes, it is very much like rebuilding after a disaster. Getting through the storm is very tough, can take years. Then the hard work of reconstruction begins . . . can be very daunting
> > There are very few posts about Emsam. I have started the 6mg patch. I noticed agitation, loss of libido and E.D. only slight mood and motivation and mood improvement.
>
>
> Loss of libido at 6mg is unusual, as it primarily boosts dopamine. (Agitation on Emsam makes me suspect you may want to try something that is a bit less activating than Wellbutrin. But then, a higher dose of Emsam may have an anxiolytic effect once you reach MAO-A inhibition and get some serotonin boost.)
>
> I've been on Emsam since September of last year. I am not going off it anytime soon. It didn't have significant AD effect until I reached 12mg. I'm also on thyroid hormone (T3) for a mild thyroid impairment, and Adderall (at a very low dose) for cognition and attention.
>
> So far it has worked well for me, but I can imagine the combination might be agitating for some people. Anergic depression has been my primary issue, not anxiety.
>
> I suspect many people get on the 6mg patch, stay there, and expect to feel better. That's not the way it works. You may easily need 9mg or 12mg to get significant MAO-A inhibition, which is required for antidepressant effectiveness. My advice to anyone on Emsam is that if they can tolerate the skin patch, move up from 6mg to 9mg within 2-3 weeks, and if any glimmer of improvement is felt, move up to 12mg within another 2-4 weeks.
>
> Emsam seems to take a while to work compared to even the SSRIs, for some people; for others it works faster than the SSRIs. (A moot comparison for me, as the SSRIs no longer work at all.)
>
> I had low dose (75-150mg) Provigil as an augmentation initially (until I developed severe heartburn on it), which was a good booster for energy and mood.
>
> If you take sedatives at night, they can be "amplified" by an MAOI and sabotage your energy the next day. Be wary.
>
>
> My mood now feels better than it has in years, although I have to pick up the pieces of a career and social life that was shredded by depression -- but that's the way it goes, isn't it? It's like rebuilding after a disaster.
Posted by former poster on June 24, 2010, at 7:15:49
In reply to Re: Emsam: Did everyone give up on it?, posted by former poster on June 18, 2010, at 22:43:13
I was wrong again. The E.D. did come back and my wife requested that I stop the 6mg patch. I was on Nardil for over a decade and I remember this is exactly how the Nardil effected me. No morning erection. No erection for days. I wish someone knew how to counteract this side effect. I really want to keep taking this med.
Posted by jade k on June 24, 2010, at 11:18:34
In reply to Re: Emsam: Did everyone give up on it?, posted by Matryoshka on June 18, 2010, at 13:37:00
> Loss of libido at 6mg is unusual, as it primarily boosts dopamine. (Agitation on Emsam makes me suspect you may want to try something that is a bit less activating than Wellbutrin. But then, a higher dose of Emsam may have an anxiolytic effect once you reach MAO-A inhibition and get some serotonin boost.)
>
> I've been on Emsam since September of last year. I am not going off it anytime soon. It didn't have significant AD effect until I reached 12mg. I'm also on thyroid hormone (T3) for a mild thyroid impairment, and Adderall (at a very low dose) for cognition and attention.
>
> So far it has worked well for me, but I can imagine the combination might be agitating for some people. Anergic depression has been my primary issue, not anxiety.
>
> I suspect many people get on the 6mg patch, stay there, and expect to feel better. That's not the way it works. You may easily need 9mg or 12mg to get significant MAO-A inhibition, which is required for antidepressant effectiveness. My advice to anyone on Emsam is that if they can tolerate the skin patch, move up from 6mg to 9mg within 2-3 weeks, and if any glimmer of improvement is felt, move up to 12mg within another 2-4 weeks.
>
> Emsam seems to take a while to work compared to even the SSRIs, for some people; for others it works faster than the SSRIs. (A moot comparison for me, as the SSRIs no longer work at all.)
>
> I had low dose (75-150mg) Provigil as an augmentation initially (until I developed severe heartburn on it), which was a good booster for energy and mood.
>
> If you take sedatives at night, they can be "amplified" by an MAOI and sabotage your energy the next day. Be wary.
Interesting post. Thanks.
>> a career and social life that was shredded by depression -- but that's the way it goes, isn't it? It's like rebuilding after a disaster.
Without insurance, lol~jade
Posted by jade k on June 24, 2010, at 11:35:49
In reply to Emsam: Did everyone give up on it?, posted by former poster on June 13, 2010, at 1:23:08
> There are very few posts about Emsam. I have started the 6mg patch. I noticed agitation, loss of libido and E.D. only slight mood and motivation and mood improvement.
My experience with 6mg emsam was first week felt excellent, lots of energy. Then had to move up to 9, then 12. At that point food rescrictions come into play so I switched to Parnate. Same thing. First week excellent response. Then it took a couple of months of unpleasant side effects before it started working. The s/e's went away then also. I had had a sudden bout of mdd and parnate took care of roughly 60% of that.As for loss of libido, I had the complete opposite effect with both maoi's. I think your reaction is unusual, not sure though. Good luck.
~Jade
Posted by Greenmtn on June 24, 2010, at 14:15:18
In reply to Re: Emsam: Did everyone give up on it? » former poster, posted by jade k on June 24, 2010, at 11:35:49
I have been on Emsam for over 2 years. Plus 150mg Lamictal(NOT GENERIC LAMICTAL!)and 2 mg clonazapam.. Emsam did'nt work well till I'd been trying it for a while. The bump from 6mg to 9mg did the trick. I am not considering stopping Emsam.
All I know is that before Emsam I was giving up on life. Constant disabling depression for years. Bouts of uncontrollable sleepiness are still an issue. And yet, when I'm not hit by sleepiness I feel plenty of energy and no depression.I am back in college after 30 years and doing well. Hope this helps.
Posted by zonked on June 24, 2010, at 14:37:07
In reply to Re: Emsam: Did everyone give up on it?, posted by Greenmtn on June 24, 2010, at 14:15:18
> I have been on Emsam for over 2 years. Plus 150mg Lamictal(NOT GENERIC LAMICTAL!)and 2 mg clonazapam.. Emsam did'nt work well till I'd been trying it for a while. The bump from 6mg to 9mg did the trick. I am not considering stopping Emsam.
>
> All I know is that before Emsam I was giving up on life. Constant disabling depression for years. Bouts of uncontrollable sleepiness are still an issue. And yet, when I'm not hit by sleepiness I feel plenty of energy and no depression.I am back in college after 30 years and doing well. Hope this helps.Wow.
Did you try any other MAOIs? I'm wondering if I should give Emsam another go if Marplan doesn't work out... I should call the pharmacy I filled my selegiline pills at to find out what dose I was taking. (It seemed to make me anxious as hell and prone to anger, like Wellbutrin--did that happen to you?)
So ya guys, the relief I've had on Marplan has been infrequent and short lived I am sorry to report...I am going to stay on it until my next appointment and I think the doc wants to try adding Synthroid.
-z
Posted by Greenmtn on June 24, 2010, at 17:05:02
In reply to Re: Emsam: Did everyone give up on it? » Greenmtn, posted by zonked on June 24, 2010, at 14:37:07
> Wow.
>
> Did you try any other MAOIs? I'm wondering if I should give Emsam another go if Marplan doesn't work out... I should call the pharmacy I filled my selegiline pills at to find out what dose I was taking. (It seemed to make me anxious as hell and prone to anger, like Wellbutrin--did that happen to you?)
>
> So ya guys, the relief I've had on Marplan has been infrequent and short lived I am sorry to report...I am going to stay on it until my next appointment and I think the doc wants to try adding Synthroid.
>
> -zZ:
Never tried any other MAOI's. Oral selegiline pills work differently. Did you try the Emsam patch? Emsam did not make me anxious or angry. I did not get much positive from Emsam until I went up to 9mg. Just affects sleep. The other meds I'm on may help with anxiety. Hope you find a combo that works.
Steve K
Posted by Phillipa on June 24, 2010, at 19:27:30
In reply to Re: Emsam: Did everyone give up on it? » Greenmtn, posted by zonked on June 24, 2010, at 14:37:07
Zonked I'm sorry thought you were doing well. Phillipa
Posted by zonked on June 24, 2010, at 19:44:33
In reply to Re: Emsam: Did everyone give up on it? » zonked, posted by Phillipa on June 24, 2010, at 19:27:30
Me too! I dunno--SLS and I seemed to have had the same thing happen, blips/days of feeling well that didn't last.
I guess I have no choice but to continue until my pdoc comes back into the office 2nd week of July. Pdoc should have my TSH and testosterone levels in my chart; I left a voicemail asking if she wanted any other endocrine labs before our appointment that I can have my GP order.
I am hopeful to an extent, I guess...there must be _something_ out there that will work. I wish Nardil had never pooped out; I wonder if anyone had it poop out, took a break and had it work as well as before...
-z
> Zonked I'm sorry thought you were doing well. Phillipa
Posted by Phillipa on June 24, 2010, at 20:14:16
In reply to Re: Emsam: Did everyone give up on it? » Phillipa, posted by zonked on June 24, 2010, at 19:44:33
In all seriousness my pdoc told me this week she feels my problems are all related to my hasimotos thyroiditis and when working in pscy such a trend of the patients with thyroid disease. Phillipa
This is the end of the thread.
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