Posted by Erewhonian on December 26, 2011, at 13:39:35
tl;dr Emsam worked (really worked not hypomania) for a period of two weeks, then stopped working. Suspect cause of poop out was insufficient sleep over the two months I was on emsam before it stopped working. I'm sleeping now, thanks to pharmacological help, but despite adequate sleep full effect has not returned over the last 5 months. Been on emsam for a total of 7 months. Will another maoi work?
(Hello. New user. First time, long time.)
The long version:
I've been suffering from atypical depression for (literally) half my life (now aged 28). Also have some (generalized-ish) anxiety and general social anxiety (no panic attacks or acute symptoms), now mostly under control with propranolol and klonopin (both prn, I'm taking as little of the klonopin as possible to avoid cross tolerance with my sleep meds I'm totaling about 1.5mg per week now).
I've previously been on a good number of antidepressants, all at high doses and for at least a couple of months, but I never had one work.
That changed with Emsam. Started with the 6mg patch in the middle of May, going up to 9mg after two weeks. After being on the 9mg for four weeks (so total time on Emsam, regardless of dose, was six weeks at this point) one morning I just realized things were different: no physical fatigue, had motivation, and my default mood was slightly positive.
This glorious victory lasted for two weeks.
Soon after starting the Emsam, the insomnia had kicked in. I was only able to sleep 3 hours at a stretch, then woke up energized without feeling tired again for sometime. I'd nap again in the afternoon for another 2-3 hours. But after more than two months of sleeping 5 or (at most) 6 hours a day it seems the sleep debt demon decided to take away almost all the benefit I was getting from the Emsam (I still have some partial response, limited mostly to helping with the leaden paralysis).
About a month after the antidepressant effect faded my pdoc bumped the emsam up to the 12mg patch and added seroquel to help with sleep. The seroquel helped great with sleep initially, but I adapted quickly to its antihistamine effects and had to keep bumping the dosage.
The pdoc that first prescribed the emsam was overly wary about drug interactions and really didn't feel comfortable prescribing much alongside it, so I changed psychiatrists. The new pdoc changed the seroquel out for ambien cr and ativan.
So, I've been able to sleep now for over 4 months but the emsam isn't giving me anywhere near the effect it had between weeks 6 and 8. I've been on the emsam for more than 7 months total.
Now I want to switch to another maoi, like nardil, but my current pdoc thinks changing between MAOIs won't give me any additional benefit.
So, a couple of questions that I haven't been able to find answers to (maybe my google-fu is weak, but I can't find these asked or answered anywhere else):
1. Does the idea of the insomnia causing the emsam to (mostly) stop working make sense? Has anyone else had something similar happen to them?
2. Is this enough time for longer term brain adjustments to the emsam to have taken effect? Basically, have I given this enough time?
3. Is my current pdoc correct in believing that a different maoi won't be any more effective? I've read some things in medical books and journals that suggest one maoi trial just isn't enough, yet the experiences of his past patients suggest otherwise to him (for whatever it's worth, he is an academic pdoc, and supposedly a skilled psychopharmacologist, though I suspect he's strongly motivated to tell me this because of his fear of oral MAOIs).
poster:Erewhonian
thread:1005595
URL: http://www.dr-bob.org/babble/20111226/msgs/1005595.html