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Dr. Bob is Robert Hsiung, MD,
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Posted by RobertDavid on May 15, 2006, at 13:46:07
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by cecilia on May 15, 2006, at 5:59:35
>Tomorrow will be day 7 for me on Emsam, chronic insomnia may be worse, though at least not having the every hour wake-up of marplan, otherwise no effects. Well, maybe more anxious, how do you tell, I'm always anxious.
My doctor suggested taking the patch off at bedtime and back on when you wake up if you deal with insomnia. He thought it would still have theraputic effects, just get less selegiline at night (which is activating).
I've had a lifetime of insomnia and though EMSAM isn't making it worse, I still have to deal with it.
His theary is that by being more energized and active during the day you'll naturally be more physically tired at night. And by taking it off at night you'll get less seleginline, less activation, but blood levels should still remain high enough for the benefits throught the day.
Anyway, I trust him and am playing with that for a few nights and have slept much better and still feeling good (no patch 3 nights now). That said, if I lose any of the positives I've gotten from EMSAM I'll be right back to the patch 24/7.
Just a thought.......Rob
Posted by ZeitGuest on May 15, 2006, at 17:16:01
In reply to Re: Everyone PLEASE share your ENSAM updates? » cecilia, posted by RobertDavid on May 15, 2006, at 13:46:07
I'm on day 12 of EMSAM and so far I've had no insomnia. I haven't felt the energizing effect that others have described. Maybe it just takes time; or maybe the 6mg dose isn't enough for me to feel those effects.
Posted by cecilia on May 15, 2006, at 17:50:54
In reply to Re: Everyone PLEASE share your ENSAM updates? » cecilia, posted by RobertDavid on May 15, 2006, at 13:46:07
Robert David, I thought the 6mg patch was designed to give you 6 mg in 24 hours, so wouldn't taking it off at night only give you half as much? Of course, some people may only need half as much. Anyway, since this patch has no terrible side effects, no real effects of any sort so far, I plan to give it a fair trial, probably the 6mg patch 24/7 for a month, then if tolerated the 9 mg for a month, then the 12 mg for a month. Anyone know how long there's still medication in the patch after 24 hours? If it really lasts longer than 24 hours, which I suspect it does, a cheaper way to determine whether you're going to be able to tolerate higher doses would be to leave the old patch on for a while after placing the new one on. Cecilia
Posted by RobertDavid on May 15, 2006, at 18:40:34
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by cecilia on May 15, 2006, at 17:50:54
> Robert David, I thought the 6mg patch was designed to give you 6 mg in 24 hours, so wouldn't taking it off at night only give you half as much? Of course, some people may only need half as much. Anyway, since this patch has no terrible side effects, no real effects of any sort so far, I plan to give it a fair trial, probably the 6mg patch 24/7 for a month, then if tolerated the 9 mg for a month, then the 12 mg for a month. Anyone know how long there's still medication in the patch after 24 hours? If it really lasts longer than 24 hours, which I suspect it does, a cheaper way to determine whether you're going to be able to tolerate higher doses would be to leave the old patch on for a while after placing the new one on. Cecilia
Cecilia:
I don't really know how much less medicine that I will be getting by taking the patch off at night. I don't think it's half the medicine. And in thinking about it I have the patch on 16 hours, off 8. The way I understood my doctors reasoning was that I would still have selegiline in my blood (it takes weeks to get it out of your system), but I wouldn't be releasing more of it during my sleep which might help me sleep.
He thought the dose would still be theraputic, but I'm just "testing" it as the level certainly is less, but not sure how much less. Since I'm feeling still feeling fine after 3 days I suspect it's only slightly less and perhpas it's all I need, but?
If I in any way start feeling worse, I'm right back to wearing the patch 24/7. It's just a something my doctor gave me to try as an option opposed to adding more drugs to help my lifetime of terrible insomnia.
Rob
Posted by ttee on May 15, 2006, at 18:57:22
In reply to Re: Everyone PLEASE share your ENSAM updates? » cecilia, posted by RobertDavid on May 15, 2006, at 18:40:34
Rob, aren't you taking Klonopin? Why don't you just take your Klonopin before bed?
Posted by Phillipa on May 15, 2006, at 19:04:03
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by ttee on May 15, 2006, at 18:57:22
What if valium puts you to sleep and you don't have insomnia. And you don't want to crawl out of your skin during the day with too much energy is EMSAM still okay? Love Phillipa
Posted by RobertDavid on May 15, 2006, at 21:00:20
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by ttee on May 15, 2006, at 18:57:22
> Rob, aren't you taking Klonopin? Why don't you just take your Klonopin before bed?
Yes I do take klonopin. Was taking 2mgs before emsam and now am down to 1.5mgs without change in anxiety.
I take the full dose at night. I've been on it 12 years and it still works great for SAD/GAD. But though the anti anxiety benefits remain, the other side effects such as sedation do go away. So though it may still help sleeping a little by taking it at night, it's not that effective anymore for sleep.
Kind of like if you take sleeping pills every night, after a while you will build up tolerance and it will stop helping you sleep. But again, fortunately the anti anxiety benefits remain and it's long half life allow me to just take it once a day. Rob
Posted by ttee on May 15, 2006, at 23:10:23
In reply to Re: Everyone PLEASE share your ENSAM updates? » ttee, posted by RobertDavid on May 15, 2006, at 21:00:20
I got it, thanks Rob.
Posted by pulse on May 16, 2006, at 3:05:19
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by cecilia on May 15, 2006, at 17:50:54
Excerpt form you post: "Anyway, since this patch has no terrible side effects..."
No terrrible side-effects? You were on the thread I started "Anyone Applying Emsam at Night?", so I would have thought you'd read that, in fact, Emsam does have terrible GI side-effects for the few of us, for whom this is a HUGE concern.
Other quite troublesome side-effects of concern to more folks are: urinary retension, teeth-clenching, insomnia, and an increase in anxiety, not a decrease.
Warning to you and others: BMS was kind enough to at least include this ALERT in the long pkg. insert: NEVER put 2 patches on at the same time...ever!
pulse
Posted by Donna Louise on May 16, 2006, at 6:36:03
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by ttee on May 15, 2006, at 18:57:22
Seems like it is time for another update although it was just a couple of days ago..This is day 17 and I have had no more or that irritable rage kinda thing. I seriously doubt it had anything to do with the patch as that is a major problem I have always had. I have started taking a whole .5mg klonopin at night and .25 mg midday and maybe another .25mg in there somewhere but the main difference is the whole .5mg at night as suggested by Robert David. And my mood is really really good too. I am so sorry that others are having some really bad side effects, I know that hell from most of the other drugs I have taken. I am just having none on this drug at all, just I am tempted to say, moving towards what feels like a total remission. Dare I say that out loud??? oh dear lord, let me knock on some wood..
Donna
Posted by strugglingsteve on May 16, 2006, at 17:07:33
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by Donna Louise on May 16, 2006, at 6:36:03
I am not on the 9 mg patch as of tomorrow morning. 5 weeks at the 6 mg patch did nothing for me. I am researching the diet so I can really decide what to eat and what not to eat, anyone out there with experience please babblemail me!!
Posted by jkshrews on May 16, 2006, at 23:37:55
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by lymom3 on May 12, 2006, at 10:25:22
> "Today is day 11 for me and I have not had that lingering rage or any sobbing for a couple of days now."
>
> Was that something you had before or just switching over? I am crying at the drop of a hat right about now and yesterday when my bluetooth connection in my car didn't repeat a phone number to dial back correctly, I called the lady's voice in my car speakers a stupid b****! The only thing she had to say about it was, "mis recogntion"!!
> I do feel like that is getting somewhat better but I am only on day 9 so it might be wishful thinking on my part. Please keep updating on your journey. I have a lot of pluses with this med, but snapping at people all the time is not going to work if it won't go away.
> Someone else suggested Lamictal to help with that. Any experience with that?
>
> Thanks!
>
> Lisa
Lisa,Lamictal is supposed to be a wonder drug for bipolar depression. MAOIs, like the EMSAM patch, are also supposed to be highly recommneded for bipolar (especially "atypical") depression. Some people have trouble with Lamicatal because of a skin reaction that can potentially be very dangereous.
It sounds like you might be subject to irritation. As I understand it, the drugs that help bipolar irritation are supposedly Lithium and the atypical antipsychotics, like Quietapine.
jkshrews
Posted by jkshrews on May 16, 2006, at 23:56:13
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by Donna Louise on May 6, 2006, at 21:38:24
> I have been posting nearly everyday, they are just coming out all over the board, I guess. I am not real savy on thread starting, ect. I just write after someone wrote something I want to respond to. so there is some stuff there, basically I have been talking about problems with the thing not sticking. And somewhere on here I talked about how I have not had a great two days past. and rambled a bunch of speculation. It is on here somewhere. I have had some rage, and alot of sobbing, basically how I am untreated. I think my happy effexor withdrawal rebound is over and the EMSAM has not kicked in enough to to overcome these particular symptoms, probably i am not getting enough medicine. But I have no trouble sleeping, I am sleeping less hours per night and that is a good thing because I get hypersomnulant. I feel rested and wanting to do more and get out more. But I still feel worn out from the effexor withdrawal so not doing as much as I would if I felt better. I am worried about all this irritability but I am not blaming it on the patch, this is normal unmedicated hell for me. It has only been a week and I do have alot of moments of feeling depression free. Oh, I do take klonopin, I know that helps with the anxiety. I dont know how anxious I would be if I didn't take it. I can say this, I don't feel any more anxious than usual, maybe less, except for the irritablity which I know is anxiety in another one of its entertaining forms.
> I will post more later. I am having a hard time typing now. I also have alot of real life stuff going on so I can't say this is all endogenous.
>
> Donna
Donna,If by your "happy effexor withdrawl rebound" you mean that you had an episode of euphoria (or irritation) after suddenly stopping the Effexor without tapering it down slowly, I think that is usually considered a strong indication that you may have bipolar disorder. It is called a "hypomania," and will often happen after suddenly stopping an antidepressant, if you have bipolar disorder.
Being hypersomnolent is an indication of "atypical depression," and the EMSAM patch should help with that. But many authorities consider atypical depression to be a kind of bipolar disorder, and your mention of irritability might be taken to confirm that somewhat. The EMSAM addresses the depression aspects of the disorder, but not the euphoria/dysphoria (irritabilility) aspect. You might think about trying to get some Lithium to go along with your EMSAM. That may help with the irritability problems. The only way to know is to try it.
jkshrews
Posted by jkshrews on May 17, 2006, at 0:44:56
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by Donna Louise on May 16, 2006, at 6:36:03
> Seems like it is time for another update although it was just a couple of days ago..This is day 17 and I have had no more or that irritable rage kinda thing. I seriously doubt it had anything to do with the patch as that is a major problem I have always had. I have started taking a whole .5mg klonopin at night and .25 mg midday and maybe another .25mg in there somewhere but the main difference is the whole .5mg at night as suggested by Robert David. And my mood is really really good too. I am so sorry that others are having some really bad side effects, I know that hell from most of the other drugs I have taken. I am just having none on this drug at all, just I am tempted to say, moving towards what feels like a total remission. Dare I say that out loud??? oh dear lord, let me knock on some wood..
>
> DonnaDonna,
The Klonopin has such a long half life, 18 to 50 hours, I am curious how breaking the dose up could have much real effect. I think one can take it all at bedtime to get the sedative effect, and get the antianxiety effect the next day with no problem. The antianxiety effect is associated with the blood concentration, which is very constant due to the very long elimination half life of the drug.
I think it is wonderful that your "irritable rage" thing is diminishing with EMSAM. I think usually people will need Lithium as an adjunct medication to deal with this. But if you are having good success with just the MAOI, that is super!
jkshrews
Posted by cecilia on May 17, 2006, at 5:46:07
In reply to Re: Everyone PLEASE share your ENSAM updates? » cecilia, posted by pulse on May 16, 2006, at 3:05:19
Sorry if I phrased that wrong. I meant that, so far, compared to many of the drugs I've tried, Emsam hasn't had terrible side effects for me, and that was why I was going to continue the trial. I know every drug has terrible side effects for some people, I have tried virtually everything and most I would NEVER try again because of side effects. Everyone is different, science is still in the dark ages. Sorry if I offended by not making it clear that I was just speaking of my own personal reactions. I'm on day 8 and definitely getting more anxious, irritable and stressed as the drug builds up in my system, but will continue for now. Cecilia
Posted by zero on May 17, 2006, at 10:23:10
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by cecilia on May 15, 2006, at 5:59:35
Posted by SFY on May 17, 2006, at 12:37:50
In reply to Emsam 9 mg patch, posted by strugglingsteve on May 16, 2006, at 17:07:33
> I am not on the 9 mg patch as of tomorrow morning. 5 weeks at the 6 mg patch did nothing for me. I am researching the diet so I can really decide what to eat and what not to eat, anyone out there with experience please babblemail me!!
The Sunnybrook Health Science Center MAOI Diet as published in Gardner DM, Shulman KI, Walker SE, Tailor SA. The making of a user friendly MAOI diet. J Clin Psychiatry. 1996 Mar;57(3):99-104, is a good, fact-based summary of how to follow a MAOI diet.
I typed it up and tried to copy the formatting as closely as possible as the original. You can download it from here:
http://s93235047.onlinehome.us/Sunnybrook.doc
Posted by lymom3 on May 17, 2006, at 12:46:50
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by cecilia on May 15, 2006, at 5:59:35
Day 15...still doing well. Had pdoc appt today and discussed the fact that I am still a little too irritable and weepy. We are going to give it 3 more weeks are re assess whether I might increase dosage or add another medication. I have noticed my crankiness getting better (I think...maybe should ask my family!!)
No negatives here...didn't even get my usual PMS migraine this month...hope that continues as well.
Lisa
Posted by pulse on May 17, 2006, at 15:08:55
In reply to Emsam Side Effects_Pulse, posted by cecilia on May 17, 2006, at 5:46:07
Thank so much for your clarification!
Even at the ultra low time - 1-2 hrs. at one setting that I've had no choice but to do - now I'm only applying Emsam ONCE per day, BTW (vs. nearly everyone else 24 hrs.), I'm sorry to report I still get all the side-effects I've mentioned in my "Anyone Emsam at night?" thread. This, still, at over one month, and my 4 attempts/ "solutions."
Also, my anxiety is definitely increased within a short time of applying until I take the patch off, and the half-life then winds down.
My therapist, also a nurse, told me that Emsam will indeed show up as amphetamine in any drug test for work, as someone earlier mentioned. I'm a former stimulant "addict," but only cocaine; no cocaine for almost 9 years, now. Unlike, perhaps (?), the majority (?!) of stim. "addicts", I have always hated speed, and haven't done it since 1970; then only twice. I've gotta be honest, Emsam feels like simple old-time speed to me, and that is about all. I can't imagine how it's having calming and no insomnia effects for others, even if they are on klonopin.
It' sure looking like, for me, I will soon be at the point of ONLY keeping Emsam "in my back pocket," in case I find I must apply it occasionally to avoid a complete descent into Major Depression.
pulse
Posted by bulldog2 on May 18, 2006, at 8:18:48
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by jkshrews on May 16, 2006, at 23:37:55
I'm on my third day of emsam. I apply the patch after my shower at night. So far no real side effects. Anxiety has been some what less the first three days. The first two days the depression was actually a little worse but today I woke up and felt like my mood had improved. I guess it's far to early to see how this will turn out. At two weeks I usually get a feeling wether an antidepressant is going to work.
Posted by sweetnlow on May 18, 2006, at 17:58:36
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by bulldog2 on May 18, 2006, at 8:18:48
I'm on day 3 also. Years ago, I responded wonderfully to Nardil (another MAOI), so I am optimistic about Ensam.
So far, no effects. That's O.K., it's early.
Posted by strugglingsteve on May 18, 2006, at 21:03:16
In reply to Re: Everyone PLEASE share your ENSAM updates? » bulldog2, posted by sweetnlow on May 18, 2006, at 17:58:36
I started the 9 mg patch today. It is alot bigger than the 6 mg patch such that you notice it now whereas before I didnt. Hopefully it will work......
Posted by Breeze on May 19, 2006, at 8:49:49
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by cecilia on May 15, 2006, at 5:59:35
Just put the patch on for the first time an hour ago. When I opened the package this morning I looked inside and said, "Nuts, I got an empty packge, there's nothing in here", but on checking further I saw it. I guess I didn't expect a clear patch, I was thinking it would be the color of a band-aid. I was also surprised at how small it was.
I've been waiting to put on the Emsam patch since August 2005. Let's hope it works for all us!
Breeze
Posted by gibber on May 19, 2006, at 11:26:09
In reply to Re: Emsam 9 mg patch » strugglingsteve, posted by SFY on May 17, 2006, at 12:37:50
The best information about the diet specific to EMSAM is at http://www.fda.gov/ohrms/dockets/ac/05/briefing/2005-4186B2_02_01-FDA-Emsam.pdf
The jist is that no special diet is required at any dosage, however the FDA is not in agreement with that and any doctor would say you need to obey the diet.
Posted by pulse on May 19, 2006, at 13:32:07
In reply to Everyone PLEASE share your ENSAM updates?, posted by UgottaHaveHOPE on May 5, 2006, at 13:30:01
Hi All,
Emsam has failed me. I am DONE! I could not overcome the major GI problems, much less the increased anxiety, urinary retension, and insomnia.
There was no improvement whatsoever in depression; it only felt like being on way too much speed, a feeling I hate.
My therapist and I must now conclude that my first (great) day on Emsam was merely the placebo effect, afterall.
Continued good luck to those doing well.
pulse
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