Posted by WeeWilly on September 22, 2006, at 22:14:14
In reply to Re: Emsam: constant dosing? » WeeWilly, posted by Jost on September 22, 2006, at 19:16:14
> I'm doing really well-- at least until a recent problem-- but I'm planning to start again.
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> I must be lucky-- I have a pdoc who's really dedicated to finding what works. He'll do maois and other things --. He did that for me- He's extremely careful-- and keeps up with all the developments, but really cares about helping patients to find the best treatment available.
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> If he thinks the combo is potentially okay, but potentially not--and knows you'll be careful and keep him informed of any problems that arise-- he''ll go ahead-- and then pull back, very firmly, if any adverse reactions arise. I always check with him, if I have any doubt about what's happening-- I'm pretty careful myself if things don't feel right.
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> I was doing 12 mg of emsam, and taking it off at night, for 5-6 hours, and then putting it on and sleeping a few more hours. Seems to work really well- but I've had a good response to emsam. -- That amounted to about 9 mg (approximately).
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> I was using it with provigil (about 200 mg a day, sometimes more), and possibly ritalin-- although I'm not sure if the ritalin will work-- I had an adverse reaction--I'm sure to the Emsam, but don't know if the ritalin played a role. It remains to be seen when I start up again.
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> I might not need ritalin, though. I'll stick with the provigil, however. Ensam has given me a lot more energy, and a much better outlook-- I'm much less depressed, and easily thrown by situations, more confident, and less prone to negative ruminations.
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> At the beginning, after using 6 mg and feeling like I needed more than 6--but also having bad insomnia, I switched to 18 mg for 12 hours a day. After a while, I noticed was getting much more irritable, easily upset, and prone to constant agitation. It was extremely uncomfortable and oppressive, until I thought about the amount-- and went down to 12 mg, taken off at night for 6 hours or so. I felt much better pretty quickly--and also slept better, too.
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> My sense is that you have to accommodate fairly slowly and make sure not to go up too quickly. Going up too quickly on the assumption that, as with most ADs, you'll reach a therapeutic dose, over time, by doing that-- might be a bad strategy with Emsam.
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> But then I'm not a pdoc-- and probably the data aren't in. I just worry that maybe some people are missing a good drug because taking too much, esp. too soon, is counterproductive-- ? I could be wrong, though.
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> Jost
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Hey Jost,I envy your relationship with your Pdoc. From my experience with many docs and what I read of others it seems that the wellfare of the patient is way down on the priority list. Could you elaborate on the adverse reaction you had? Do you think Emsam has a chance to work as monotherapy for you without the Provigil? I am hopeing it will work well enough on its own for me. There are so many draw backs to polypharmacy. Anyway I sure wish you the best of fortune. Thanks for the update.
poster:WeeWilly
thread:630549
URL: http://www.dr-bob.org/babble/20060919/msgs/688322.html