Posted by Another Phil on June 28, 2006, at 15:12:03
In reply to Re: Emsam and Attention Problems?, posted by Pops_1 on June 26, 2006, at 12:53:24
> 1 - Dexedrine/EMSAM/Attention - Did you consider >reducing< your dexedrine dose to see if that helped? One of EMSAM's metabolites is itself an amphetamine, and maybe the stimulation producing by EMSAM and/or this metabolite is revving you up so much that you're more distracted than you were without any drugs. I know when I really upped my Dexedrine doses I was overexcited and distractable, maybe your combo is producing net negative effects at previously effective doses.
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> 2. Effexor - Combining MAOI's with other ADs that affect serotonin is contraindicated to guard against "serotonin syndrome". I know effexor targets Serotonin (and norepinephrine), which would seem like the basis for contraindication. while I've seen doctors try contraindicated combos (MAOIs & wellbutrin, MAOIs + TCAs), usually this is for treatment resistant conditions or to counteract side effects. Given that the MAOI+SSRI prohibition is one rather religiously adhered to, I would personally be wary of combining Effexor + EMSAM given the risks. On the other hand, a qualified psychophamarcologist should know what they're doing...Actually, I've considered both of these. I often skip doses of Dexedrine on the weekend when I don't have much "thinking" work to accomplish. There hasn't been any effect on my ability to concentrate (as measured by my tendency to go from task-to-task on one long endless tangent).
#2 is the primary reason why I had been trying to wait it out for a while after Effexor withdrawal. However, my depression has gotten bad enough again that I don't think that's a good idea. After consulting with my psychopharmacologist yesterday, I've started tapering up on Parnate and stopping Emsam. Already, I'm experiencing the Parnate-induced insomnia (even at my starting dose of 10 mg). So, thanks for your help, but I think that since my mood was so good on Emsam that I waited too long to address the attention problems. In the intervening time, I've ignored dealing with some really important logistical issues in my life that just can't wait any longer.
I've been on pretty much every antidepressant (or, at least, representatives from each class). All have either had intolerable side effects or insufficient antidepressant effect. I did have a pretty good stretch (mood-wise) on Parnate many years ago, but stopped because the insomnia was making me unable to function. So, I hope my current doc can help me come up with an acceptable solution for the insomnia.
Thanks again.
Phil
poster:Another Phil
thread:660319
URL: http://www.dr-bob.org/babble/20060623/msgs/662291.html