![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 19 to 43 of 101. Go back in thread:
Posted by snapper on October 29, 2006, at 1:28:27
In reply to Re: Trying Emsam., posted by SLS on October 28, 2006, at 8:26:45
> > Will you be combining it with nortryptaline? That could be stimulating. Emsam increasing PEA concentrations. PEA acting as an endogenious amphetamine will cause NE/DE release. PEA actually inhibits the reuptake of norepinephrine, like amphetamine.
>
> Yes. I'll be keeping nortriptyline. I hadn't considered the PEA potentiation. Does Emsam produce increases in PEA levels any differently than other MAOIs? I had taken Parnate with nortriptyline not too long ago. 20 years ago, that would have kept me up all night long. Now, I sleep right through the night. My brain has become numb to these drugs.
>
>
> I'll be taking:
>
> nortriptyline 100mg
> Emsam 6mg/24hr
> Lamictal 150mg
> Topamax 100mg
> Abilify 10mg
>
>
> I can't tell you how much I hate the idea of having to wear a patch. I don't know why. It is certainly less invasive than wearing wires inside my neck.
>
>
> - ScottHi Scott, how are ya dude? I know best as u can be. I know we have not spoken in a while.... but just wanted to let you know myself and all are pulling for you. Dude I am moving forward with VNS. I figure I have nothing to lose except a couple of minor scars and the hope it has of offering a 30% or more chance of helping me and you and many others. It does kind of freak me out to about the wires and what not ...but it is so much less invasive than short trials of meds and cocktails of meds or long for that matter and ECT...which we have been through.. man e-mail me at cinkc2003@yahoo.com ...lets chat and talk....I do not know all the answers but obviously "modern chemistry" is not getting us anywhere.... I have an appointment with an ENT surgeon on Jan 8th 2007 to discuss the 90 minute out patient surgery.... I figure if I get it done , the best thing that can happen is I have the best of "chemistry and another viable option" in my bag to help me get to at least half way normal...and if I do not, then I continue to suffer 100% more than I should. I do not say these things lightly. Man lets talk!
Best-
Clint
Posted by snapper on October 29, 2006, at 1:30:50
In reply to Re: Trying Emsam., posted by snapper on October 29, 2006, at 1:28:27
Scott.......... talk to me!!!
AKA ---Snapper
Clint
Msg above
Posted by linkadge on October 29, 2006, at 7:18:05
In reply to Re: Trying Emsam.....for SLS » snapper, posted by snapper on October 29, 2006, at 1:30:50
I read on www.neurotransmitter.net that there existed certain compounds in red wine, that are both serotonin/norepinephrine inhibitors *and* inhibitors of monoamine oxidase B.
Intereesting eh?
Linkadge
Posted by SLS on October 29, 2006, at 9:47:38
In reply to Trying Emsam., posted by SLS on October 27, 2006, at 22:50:24
> I am to start Emsam in a few days. I am not too enthused about it, though. I really don't think it is going to work, and I hate having to wear a patch.
I don't know if I will be able to take this drug or not. Apparently, my prescription drug plan does not have it on its formulary. I have to make some phone calls.
- Scott
Posted by corafree on October 29, 2006, at 12:55:41
In reply to Re: Trying Emsam.....for SLS, posted by linkadge on October 29, 2006, at 7:18:05
Linkadge - Nonscientifically speaking, does this mean red wine is a help or a hindrance 2 depression?
duh, cf
Posted by theo on October 29, 2006, at 15:33:04
In reply to Trying Emsam., posted by SLS on October 27, 2006, at 22:50:24
Let me know how it goes, I left you a message above in the Low dose Lamictal thread. If you get a chance, please read and reply.
Thanks!
Posted by SLS on October 29, 2006, at 18:23:21
In reply to Re: Trying Emsam., posted by SLS on October 29, 2006, at 9:47:38
> > I am to start Emsam in a few days. I am not too enthused about it, though. I really don't think it is going to work, and I hate having to wear a patch.
>
> I don't know if I will be able to take this drug or not. Apparently, my prescription drug plan does not have it on its formulary. I have to make some phone calls.Everyone was closed today.
I decided to slap a patch on anyway.
- Scott
Posted by Phillipa on October 29, 2006, at 18:56:23
In reply to Re: Trying Emsam., posted by SLS on October 29, 2006, at 18:23:21
Scott so you have samples? Can you get more? I know you know your way around these things. So now its later in the day do you feel anything? Love Jan
Posted by SLS on October 30, 2006, at 6:51:41
In reply to Re: Trying Emsam. » SLS, posted by Phillipa on October 29, 2006, at 18:56:23
> Scott so you have samples? Can you get more?
Probably.
> So now its later in the day do you feel anything?
Skeptical.
- Scott
Posted by linkadge on October 30, 2006, at 8:29:42
In reply to Re: Trying Emsam.....for SLS » linkadge, posted by corafree on October 29, 2006, at 12:55:41
Well, presumably these compounds would be potetial new agents for depression. I don't think they have been given any formal testing though.
Linkadge
Posted by linkadge on October 30, 2006, at 8:35:47
In reply to Re: Trying Emsam., posted by SLS on October 30, 2006, at 6:51:41
Supposedly some of the TCA's have affinity for MAO-b. I remember reading that amitryptaline either directly inhibits MAO-B, or leads to a functional inhibition of MAO-B.
Linkadge
Posted by zeugma on October 30, 2006, at 16:06:38
In reply to Re: Trying Emsam., posted by linkadge on October 30, 2006, at 8:35:47
> Supposedly some of the TCA's have affinity for MAO-b. I remember reading that amitryptaline either directly inhibits MAO-B, or leads to a functional inhibition of MAO-B.>>
And nortriptyline has identical MAO-B inhibiting (it is small, but direct) potential as amitriptyline.
I would guess that there is a functional inhibition as well, in that dopamine and probably PEA have an affinity for the norepinephrine transporter, and the MAO enzyme degrades the transmitter after it enters the cell. So blocking the transporting step leaves MAO with less substrate to degrade (I hope I'm getting this right).
It is conjectured that TCA's, and possibly AD's in general, are functional inhibitors (meaning the effect is downstream, as opposed to actually blocking a receptor or enzyme) of the NMDA receptor. That is why zinc is conjectured to be a good augmentor of AD's.
Passing on to Emsam,
I would think transdermal selegiline, compared to the oral route, would have a much more delayed effect, because most of selegiline's immediate effect is mediated through its amphetamine metabolites and the patch increases the parent-to-metabolite ratio.That is why 6mg/day Emsam apparently inhibits enough MAO-A to have an AD effect, while orally afministered selegiline requires over 10 mg/day to lose selectivity for MAO-B.
I am curious to know if Emsam has any subjectively similar effects to clorgyline (a structurally related MAO-A inhibitor).
-z
>
> Linkadge
Posted by linkadge on October 31, 2006, at 6:47:34
In reply to Re: Trying Emsam. » linkadge, posted by zeugma on October 30, 2006, at 16:06:38
Regional dampening of glutamatergic function. Its an interesting theory, but it doesn't explain everything.
For instance, would NMDA receptor modulation occur with all classes of antidepressants, both activating and calming? Aren't certain disorders like ADHD actually linked to low glutamatergic function. In which case, would an activating AD like bupropion, with utility in ADHD have the same downstream effect?
Glutamate dampening would concevably usefull for neurotic depression, but would it be usefull for atypical depression, or anergic depression? Is zinc at all usefull in atypical depression?
Linkadge
Posted by SLS on October 31, 2006, at 9:12:14
In reply to Re: Trying Emsam. » linkadge, posted by zeugma on October 30, 2006, at 16:06:38
> I would think transdermal selegiline, compared to the oral route, would have a much more delayed effect, because most of selegiline's immediate effect is mediated through its amphetamine metabolites and the patch increases the parent-to-metabolite ratio.
The parent compound might have stimulant effects of its own.
I found a few abstracts that hint at this.
This would help explain the acute energizing effect that appears within the first few days of initiating Emsam treatment as reported by people here on Psycho-Babble. It may indicate that selegiline is actually more potent as a releaser of DA and NE than are its metabolites and explains why the transdermal delivery system produces a greater energizing effect that does the oral preparation.
I subsequently found another abstract that demonstrated an inhibitory effect for tyramine-induced release of NE, but not for DA by Emsam, perhaps an index of reuptake inhibition. This might indicate a greater energizing effect than reward/hedonic effect by Emsam during the first few weeks of treatment. So far, this is consistent with what has been reported here.
- Scott
-------------------------------------------
Neurobiology (Bp). 2000;8(2):179-99. Related Articles, Links(-)Deprenyl (Selegiline): past, present and future.
Knoll J.
Department of Pharmacology, Semmelweis University of Medicine, Budapest, Hungary.
(-)Deprenyl (Selegiline), the N-propargyl analogue of (-)methamphetamine, is the only drug in clinical case which, by enhancing the impulse propagation mediated release of noradrenaline and dopamine in the brain (catecholaminergic activity enhancer, CAE, effect), keeps in small doses without side-effects the catecholaminergic brain system on a higher activity level. (-)Deprenyl stimulates the catecholaminergic neurons selectively in the brain because, in contrast to PEA and the amphetamines which induce the continuous release of noradrenaline and dopamine from their intraneuronal stores, (-)deprenyl is devoid of this property. It is due to the CAE effect that a) the maintenance of rats on (-)deprenyl during the postdevelopmental phase of their life slows the age-related decline of sexual and learning performances and prolongs life significantly; b) patients with early, untreated Parkinson's disease maintained on (-)deprenyl need levodopa significantly later than their placebo-treated peers, and when on levodopa plus (-)deprenyl, they live significantly longer than patients on levodopa alone; and c) in patients with moderately severe impairment from Alzheimer's disease, treatment with (-)deprenyl slows the progression of the disease. It is reasonable to expect that a prophylactic low dose administration of a safe catecholaminergic activity enhancer substance during the postdevelopmental phase of life will slow the age-related decline of behavioral performances, delay natural death and decrease susceptibility to Parkinson's disease and Alzheimer's disease.
--------------------------------------------
Pharmacol Res. 2004 Mar;49(3):253-8. Related Articles, Links
Click here to read
(-)-Deprenyl inhibits tyramine-induced noradrenaline release, but not tyramine-induced dopamine release or potassium-induced noradrenaline release, from rat brain synaptosomes.Takahata K, Shimazu S, Yoneda F.
Research Institute, Fujimoto Pharmaceutical Corporation, 1-3-40 Nishiotsuka, Matsubara, Osaka 580-0011, Japan.
The effect of (-)-deprenyl (selegiline), a therapeutic agent for Parkinson's disease, on the tyramine-induced release of catecholamine from rat brain synaptosomes was studied using a superfusion system. Tyramine (10(-7) to 10(-5)M) enhanced the release of [3H]noradrenaline (NA) and [3H]dopamine (DA) from forebrain and striatal synaptosomes in a dose-dependent manner. (-)-Deprenyl (5x10(-5)M) had no effect on spontaneous catecholamine release, suggesting that it has no tyramine-like catecholamine releasing effect. Pretreatment with (-)- or (+)-deprenyl (5x10(-5)M) significantly prevented the tyramine (10(-6)M)-induced NA release, but not DA release. The inhibitory action of (-)-deprenyl was not observed on potassium (15mM)-induced NA release. (-)-Desmethyldeprenyl (5x10(-5)M), a metabolite of (-)-deprenyl, and a monoamine oxidase-A (MAO-A) inhibitor, clorgyline (5x10(-5)M), failed to block the tyramine-induced NA and DA release. Although (+)-deprenyl, a potent DA uptake inhibitor, did not inhibit tyramine-induced DA release, a catecholamine uptake inhibitor nomifensine (5x10(-5)M) did. In summary, (-)-deprenyl at a dose inhibiting tyramine-induced NA release did not have any effect on tyramine-induced DA release or potassium-induced NA release.
PMID: 14726221 [PubMed - indexed for MEDLINE]
Display Show
Posted by SLS on October 31, 2006, at 11:22:15
In reply to Re: Trying Emsam., posted by SLS on October 31, 2006, at 9:12:14
> The parent compound might have stimulant effects of its own.
It has been only two days, but I feel that Emsam might be producing some anxiety and dysphoria. I am already tempted to stop taking it. It is hard to know, though. The Lyrica really screwed me up, and I don't know what to attribute to which. I guess I'll go one more day. My gut feeling is that there might be stimulant properties of Emsam that are causing these things to occur.
- Scott
Posted by corafree on October 31, 2006, at 13:22:43
In reply to Re: Trying Emsam., posted by SLS on October 31, 2006, at 11:22:15
<My gut feeling is that there might be stimulant properties of Emsam that are causing these things to occur.>
Good Scott.
You've been pondering this drug for a while, and 'all the hype' might also be causing some you to 'over-examine' your feelings.
Don't know if you work or not. Hope don't right now and have a close friend/family there.
If not, well 'the whole of babble' is pretty much sittin' on your couch.
If I were really there, I'd do a crazy rain dance and jump around 'whooping and hollering' in your living room and make you laugh, and make 'you' feel 'too' normal! ;)
(Whose been on Emsam for a while successfully and can you talk with them?)
friends, cf
Posted by Lindenblüte on October 31, 2006, at 13:32:27
In reply to Re: Trying Emsam. » SLS, posted by corafree on October 31, 2006, at 13:22:43
Hey Scott,
changing meds makes me feel things too. Can you try and give it a week? I really hope that this is just a temporary side effect that will fade. Some of it might be anxiety about starting a new medicine or about the bad lyrica experience.please give yourself a good chance. You owe it to yourself to give it a real trial, otherwise you might always wonder.
hang in there, and keep posting. I felt pretty awful the first week after starting cymbalta, and again for a few days every time my dose was increased. It ended up working out well for me though.
still cheering you on, hoping the dysphoria fairy comes and takes all your bad thoughts away. You have to be really quiet though, otherwise she gets scared. She's a pretty timid little thing. She can handle your bad thoughts though- she just waves her magic wand and they start shrinking and becoming quieter and quieter. Eventually you won't even be able to hear bad thoughts or see bad things.
-Li
Posted by SLS on October 31, 2006, at 14:25:57
In reply to Re: Trying Emsam. » SLS, posted by corafree on October 31, 2006, at 13:22:43
Hi CF.
> You've been pondering this drug for a while, and 'all the hype' might also be causing some you to 'over-examine' your feelings.
I know. I'll try not to over-think things.
> Don't know if you work or not. Hope don't right now and have a close friend/family there.
This illness makes it difficult to maintain relationships. I do have a few friends, and I'm blessed to have some family in the area.
> If not, well 'the whole of babble' is pretty much sittin' on your couch.
Another blessing.
> If I were really there, I'd do a crazy rain dance and jump around 'whooping and hollering' in your living room and make you laugh, and make 'you' feel 'too' normal! ;)
Woohoo!
> (Whose been on Emsam for a while successfully and can you talk with them?)
I don't know of any.
Thanks, CF.
- Scott
Posted by SLS on October 31, 2006, at 14:56:22
In reply to Re: Trying Emsam., posted by Lindenblüte on October 31, 2006, at 13:32:27
Hi Li.
> changing meds makes me feel things too. Can you try and give it a week?
I'll try. Right at this exact moment, I'm not feeling so bad that I would have to abort the trial.
> I really hope that this is just a temporary side effect that will fade.
The thing is, how long is long enough? How long do you put yourself through hell to wait for untoward effects to disappear in the hopes for a big pay-off?
> Some of it might be anxiety about starting a new medicine or about the bad lyrica experience.
You are right. These are contributors.
> please give yourself a good chance. You owe it to yourself to give it a real trial, otherwise you might always wonder.
I probably would.
> hang in there, and keep posting. I felt pretty awful the first week after starting cymbalta, and again for a few days every time my dose was increased. It ended up working out well for me though.
That's good news. What dosage did you settle on?
> still cheering you on, hoping the dysphoria fairy comes and takes all your bad thoughts away. You have to be really quiet though, otherwise she gets scared. She's a pretty timid little thing. She can handle your bad thoughts though- she just waves her magic wand and they start shrinking and becoming quieter and quieter. Eventually you won't even be able to hear bad thoughts or see bad things.It's hard to quiet my mind when the world seems so unmanageable and the future so bleak. There are demands being placed on me by my family to help take care of my 96 year old grandmother, who just broke her hip. I really don't do that much, but just leaving the house is often more than I have the mental energy to accomplish. I feel trapped. I need to remain functional enough to help her. Can I afford to allow Emsam to make me feel worse? Not really. But, if not now, when? You know?
- Scott
Posted by corafree on October 31, 2006, at 15:27:38
In reply to Re: Trying Emsam. » Lindenblüte, posted by SLS on October 31, 2006, at 14:56:22
There always seems to be some IRL incident/situation keeping us from giving ourselves the best care we can. Don't think there is ever a right time.
I feel like not getting dressed to go over to help daughter w/ t-or-treeturds, butt will force myself.
I have to remind myself, often, 'I don't have to look perfect' to go out the front door.
Also, these peeps I'd be going to see, love me, 'not how I look'; I imagine just like your grandmother loves you.
Hope that helps some.
cf
Posted by SLS on October 31, 2006, at 15:33:11
In reply to Re: Trying Emsam. » linkadge, posted by zeugma on October 30, 2006, at 16:06:38
> I am curious to know if Emsam has any subjectively similar effects to clorgyline (a structurally related MAO-A inhibitor).
In 2000, Dennis Murphy, MD at the NIH recommended I try selegiline based upon my positive response to clorgyline. I understood the chemical relationship, but wasn't sure of his rationale given the differences in selectivity. I guess we'll have to see. I don't know what my doctor has in mind regarding the rate of titration of Emsam.
- Scott
Posted by Lindenblüte on October 31, 2006, at 17:32:42
In reply to Re: Trying Emsam. » Lindenblüte, posted by SLS on October 31, 2006, at 14:56:22
> Hi Li.
Hey Scott,
> > changing meds makes me feel things too. Can you try and give it a week?
>
> I'll try. Right at this exact moment, I'm not feeling so bad that I would have to abort the trial.Okay, well that's good. you hang in there. Treat yourself extra kindly, okay?
> > I really hope that this is just a temporary side effect that will fade.
>
> The thing is, how long is long enough? How long do you put yourself through hell to wait for untoward effects to disappear in the hopes for a big pay-off?AD is not a big payoff. it's a very slowly accumulating pile of quarters. You play the slot machine that is hopefully rigged in your favor. After a week or three, you look down, and there's a pile of quarters in the tray, so you keep playing, and after a while you realize that it's been a couple of days since you lost money.
Depression is an insidious illness. It creeps up on you, if you're not watching out. Well, it has to creep off too. I wish AD were as immediate and fast acting as a stimulant, or a beta blocker, or one those other hundred classes of drug that you are so clever knowing :)
You gotta regenerate some neurons and synapses. Takes time. Takes sleep. Takes amino acids. If you're not vegetarian, I think you should treat yourself to a nice steak dinner. next time you go to the market, get a 16 oz NY strip. who cares if it costs 8 bucks? you deserve it. salt and pepper both sides, sear in an oiled skillet 3-6 mins per side. it's fast. and before you know it you have a lovely amino acid supplement.
> > Some of it might be anxiety about starting a new medicine or about the bad lyrica experience.
>
> You are right. These are contributors.> > please give yourself a good chance. You owe it to yourself to give it a real trial, otherwise you might always wonder.
>
> I probably would.I know a lot of babblers would!
> > hang in there, and keep posting. I felt pretty awful the first week after starting cymbalta, and again for a few days every time my dose was increased. It ended up working out well for me though.
>
> That's good news. What dosage did you settle on?Um, I settled on 90 mg for about 4 months. then I unsettled and now I'm on my 4th day at 120mg. so, I've got a few side effects going too. Nothing like the first time though. Just annoying things like my digestion is somewhat um. yeah. and other private matters which are also less than ideal. and my muscles are twitchier than usual, and I'm feeling more hyper-vigilant/exxagerated startle than usual. and more nappish than usual. *yawn* but it's okay. got to have hope. If this won't work, I'm going to have to switch AD. oh goody...
> > still cheering you on, hoping the dysphoria fairy comes and takes all your bad thoughts away. You have to be really quiet though, otherwise she gets scared. She's a pretty timid little thing. She can handle your bad thoughts though- she just waves her magic wand and they start shrinking and becoming quieter and quieter. Eventually you won't even be able to hear bad thoughts or see bad things.
>
> It's hard to quiet my mind when the world seems so unmanageable and the future so bleak. There are demands being placed on me by my family to help take care of my 96 year old grandmother, who just broke her hip. I really don't do that much, but just leaving the house is often more than I have the mental energy to accomplish. I feel trapped. I need to remain functional enough to help her. Can I afford to allow Emsam to make me feel worse? Not really. But, if not now, when? You know?You can only do so much. Tell yourself that Scott fell and broke his limbic system (or make up something silly). When you get a good afternoon or a good morning, or even a burst of anxiety- HARNESS it and use it as ENERGY to get out, call your grandmother, go shopping. Eat ice cream.
Don't be shy to call your friends and ask them to maybe pick up a gallon of milk and a couple of frozen pizzas on their way over to watch HOUSE tonight at your place. (better be House. I'm sick of baseball!) Your friends would no doubt like to help out, but they don't know what you need.
Tell us more about your grandmother-- that's major stress, especially if your family is placing pressure on you to hold things together on your end. That sounds SO tough. You are hurting right now because you are HUMAN, and you can only handle so much. I think these life events are more relevant that g-protein coupled receptors anyways. But that's my bias ;)
(((((hugs for you)))))
hope you get an hour or two where you can get some peace and some Scott-Time ((((((rest))))))If you find yourself in trouble this evening, and need some distraction or discussion, come hang out on babble-chat. I found that if I log in, even if there's no one there, within 10-15 mins someone will pop in and say hi. chat is so slow that the time really flies by, and then, before you know it, it's bedtime.
((((more hugs for you))))
-Li
> - Scott
Posted by johnnyj on October 31, 2006, at 20:42:09
In reply to Re: Trying Emsam. » zeugma, posted by SLS on October 31, 2006, at 15:33:11
Scott:
I am praying and pulling for you. I hear the advice people are giving you and agree, give it some time. I will do the same. Hang in there.
johnnyj
Posted by Jost on October 31, 2006, at 21:19:02
In reply to Re: Trying Emsam., posted by SLS on October 31, 2006, at 11:22:15
Have you had that reaction to stimulants in the past? because it seems awfully early to pull the plug on an AD unless the reaction is consistent with other things in the past.
Given that someone knowledgeable recommended it, I wonder if it isn't too soon to draw any firm conclusions.
That depends on how acute the dysphoria or anxiety is, though. But it could be transient or likely to moderate.
There is the nocebo effect too-- because you seemed pretty disbelieving of its possible efficacy even before you started.
Maybe it's not the best time to try. Later when there's more evidence about how good Emsam is (or isn't), you could approach it with more optimism--or conviction that it could help, which might give it a chance to work (beyond also any placebo effect, too).
I don't know. I by no means think it's magic, or "the" answer-- but I also feel that Emsam has gotten a bit of a bad rap here.
Maybe I'm a negative (or non-) indicator, but it seemed good to me.
Jost
Posted by Phillipa on October 31, 2006, at 22:33:28
In reply to Re: Trying Emsam., posted by Jost on October 31, 2006, at 21:19:02
Scott I know of one person and haven't spoken to him in a while. His main symptom was anxiety. Klonopin 2mg stopped it and he is/was taking EMSAM for additional energy. I don't know if he will answer an e-mail after this time as he was only on babble to research EMSAM. Last I heard from him he was still doing great. Maybe you need a benzo? Love Phillip I will send him an e-mail now as I just got home
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.