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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 431. This is the beginning of the thread.
Posted by RobertDavid on April 8, 2006, at 11:15:36
Well, I've just been though my first 24 hours on EMSAM. The patch is a clear color and sticks well to the skin. Some have asked if it could be cut to take a lower dose and though they say not to cut it, it appears it could be cut and still stick just fine. The only question I would have with that is if the drug is evenly spread across the patch so you'd get the same dose each day.
Let me first say that I have SAD/GAD as my primary disorter with dysthimia. I have been taking klonopin (2mgs) for years and am continuing to take it during this EMSAM trial. My doc wants me to keep taking the klonopin for a few months, then assuming EMSAM is working slowly go down on and perhaps off the klonopin. The purpose of trying EMSAM is to see if it can lift my mood, improve my SAD without causing more anxiety.
I've always been treatment resistent to other SSRI's and SNRI's. All I have ever felt was all side effects and no benefit. I know they have helped others, just not me.
That said what I noticed throughout the day yesterday after putting on the patch was that I felt a mild increase in energy (not anxiety). I felt a little sharper mentally, seemed to be more aware of my surroundings. The typical side effects I have had from the anti depressants I have tried before weren't there. None of them.
So I got in my car and drove 3 hours in traffic to my brothers farm where I am now. Normally that would cause me a lot of stress/anxiety, but found I was okay, it wasn't a big deal. Last night at my family gathering several family members asked why I was in such a good mood. I thought to myself "I feel great, this is a good sign".
Last night I had more dreams than normal and woke up early. At first I was concerned about not getting enough sleep, but realized I'm so used to dragging myself out of bed, that perhaps this is how I should feel. I also realized I did sleep 7 hours. I got up, felt fine, and now hours later am writing this post.
So though I recognize one day is not enough to judge this medication, I'm very encouraged and felt great about slapping on the patch after my early shower this morning and am looking forward to seeing if this trend continues. It's my understanding that I might expect a theraputic response within a week. This should be interesting.
I'll post tomorrow. So far so good! Rob
Posted by tygereyes on April 8, 2006, at 11:23:40
In reply to EMSAM - First Day, posted by RobertDavid on April 8, 2006, at 11:15:36
A few questions:
Do you know when insurance companies will be covering most of the cost of the drug?
And do you have to titrate up like you would will pills or can you start out on a higher dose (i.e. a 20 mg patch rather than a 6 mg patch)?
Posted by Racer on April 8, 2006, at 11:24:48
In reply to EMSAM - First Day, posted by RobertDavid on April 8, 2006, at 11:15:36
Thank you!
I'm so glad this is going well for you, even though it's a short time. My pdoc brought EMSAM up yesterday, as the thing we're going to try if the next two or three things in our plan don't work out. I'm wanting to hear that it's helpful, and that people aren't fogging out on it.
And Thank you so much for sharing your experiences with us. That's great.
Posted by ravenstorm on April 8, 2006, at 11:27:01
In reply to EMSAM - First Day, posted by RobertDavid on April 8, 2006, at 11:15:36
I'm glad your first day went so well! Selfishly, though, I wish you weren't on the Klonopin so I could tell how much anxiety this thing will produce! The Klonopin may mitigate any anxiety side effects the patch could produce.
Maybe the patch and the klonopin together will be the perfect combo for you. I personally can't take benzos.
Continued good luck to you and thanks so much for taking the time to post your progress for everyone.
Posted by TylerJ on April 8, 2006, at 15:47:00
In reply to EMSAM - First Day, posted by RobertDavid on April 8, 2006, at 11:15:36
> Well, I've just been though my first 24 hours on EMSAM. The patch is a clear color and sticks well to the skin. Some have asked if it could be cut to take a lower dose and though they say not to cut it, it appears it could be cut and still stick just fine. The only question I would have with that is if the drug is evenly spread across the patch so you'd get the same dose each day.
>
> Let me first say that I have SAD/GAD as my primary disorter with dysthimia. I have been taking klonopin (2mgs) for years and am continuing to take it during this EMSAM trial. My doc wants me to keep taking the klonopin for a few months, then assuming EMSAM is working slowly go down on and perhaps off the klonopin. The purpose of trying EMSAM is to see if it can lift my mood, improve my SAD without causing more anxiety.
>
> I've always been treatment resistent to other SSRI's and SNRI's. All I have ever felt was all side effects and no benefit. I know they have helped others, just not me.
>
> That said what I noticed throughout the day yesterday after putting on the patch was that I felt a mild increase in energy (not anxiety). I felt a little sharper mentally, seemed to be more aware of my surroundings. The typical side effects I have had from the anti depressants I have tried before weren't there. None of them.
>
> So I got in my car and drove 3 hours in traffic to my brothers farm where I am now. Normally that would cause me a lot of stress/anxiety, but found I was okay, it wasn't a big deal. Last night at my family gathering several family members asked why I was in such a good mood. I thought to myself "I feel great, this is a good sign".
>
> Last night I had more dreams than normal and woke up early. At first I was concerned about not getting enough sleep, but realized I'm so used to dragging myself out of bed, that perhaps this is how I should feel. I also realized I did sleep 7 hours. I got up, felt fine, and now hours later am writing this post.
>
> So though I recognize one day is not enough to judge this medication, I'm very encouraged and felt great about slapping on the patch after my early shower this morning and am looking forward to seeing if this trend continues. It's my understanding that I might expect a theraputic response within a week. This should be interesting.
>
> I'll post tomorrow. So far so good! RobYea...I would say that's a hellava good first day!!
Tyler
Posted by Sarah T. on April 8, 2006, at 16:19:01
In reply to Re: EMSAM - First Day » RobertDavid, posted by TylerJ on April 8, 2006, at 15:47:00
Hi. Thank you so much for telling us about your experiences with EMSAM.
I was wondering about cutting the patch to make the dose smaller, but as you mentioned, it is uncertain whether the medicine is distributed uniformly over the tape.
I was also wondering about getting the patch wet. What about taking a shower or going swimming? Can you take the patch off and put the same one back on?
Thanks again for your help.
Posted by ravenstorm on April 8, 2006, at 17:29:16
In reply to Re: EMSAM - First Day » TylerJ, posted by Sarah T. on April 8, 2006, at 16:19:01
At the 20mg patch strength, are you getting only effects on MAOI B or both MAOI A too? At any dose, the patch is going to be more MAOI B than A right? Which means more activating (?) If anybody can clear this up it would be great.
I tell you if it was more heavily weighted towards MAOI A instead, I would have the thing on me already!!!! I just have NOT had good reactions to anything affecting norepenephrine.
Posted by Phillipa on April 8, 2006, at 18:38:00
In reply to Re: EMSAM - First Day, posted by ravenstorm on April 8, 2006, at 17:29:16
Okay if it is so expensive the the doctors are all so afraid of the side effects of nardil and parnate do you think they will jump on the bandwagon since they are SSRI and SSNRI indoctrinated? I wonder if they even know what ENSAM is? And do you think they will want to give away the money from the above for the patch. I too would like to try it but I don't know if a doc will ever try it here. They laugh at me even when I bring in something I have printed and brought with me and this is the biggest practice here and both big hospitals I mean 600beds for psych pts both are the practices working there. Love Phillipa
Posted by aabag on April 8, 2006, at 18:45:01
In reply to EMSAM - First Day, posted by RobertDavid on April 8, 2006, at 11:15:36
Well, the GP changed his mind, or more likely, formed an opinion on EMSAM, and decided against prescribing it. So no script for EMSAM, despite years of depression and anxiety. Basically, he told me he had read that studies, and this was an "MAOI" (emphasis not added). Thought that you'd need to be on the MAOI diet on all doses ( not correct ). Thought that MAOIs had been discontinued some while ago ( not correct). So, given the level of knowledge, I think he's probably right, find someone who realizes what the entire point of this medication is: MAOI efficacy without the fear of killing your patient. Its just disappointing, that I have to find a psychiatrist who basically says, how are you feeling today, as opposed to a GP who asks the same thing.
Posted by aabag on April 8, 2006, at 18:58:25
In reply to Re: EMSAM - First Day, posted by Phillipa on April 8, 2006, at 18:38:00
Phillipa, that's exactly what experienced today (association of transdermal MAOI w/ oral MAOI and hence no script). Unfortunately, I don't carry the FDA presentation with me, the GP was uncomfortable with prescribing EMSAM, since it was a new MAOI. Never mind the delivery mechanism, never mind the safety factor, never mind selegiline's marketing approval for a decade, never mind that the FDA indicated no MAOI diet required on the lowest dose, and the studies showing the order of magnitude difference between oral and transdermal as to the "pressor effect". I simply need to find someone who is informed, which Bristol presumably will want to do.
Posted by Phillipa on April 8, 2006, at 19:08:07
In reply to Re: EMSAM - First Day, posted by aabag on April 8, 2006, at 18:45:01
Where do you live? Babblemail me your E-mail address since your light is not on and I won't post my E-mail address. Maybe we can work together to find a doc who will. Love Phillipa ps my ligt is on
Posted by RobertDavid on April 8, 2006, at 20:16:08
In reply to Re: EMSAM - First Day, posted by tygereyes on April 8, 2006, at 11:23:40
> A few questions:
>
> Do you know when insurance companies will be covering most of the cost of the drug?
>
> And do you have to titrate up like you would will pills or can you start out on a higher dose (i.e. a 20 mg patch rather than a 6 mg patch)?I think every insurance company is different with new medicines, not sure how that will work. I paid cash for my first script, but hope my Kaiser insurance will pay for part once I'm on it.
The doses are 6mg (20mg patch), 9mg (30mg patch) and 12mg (40mg patch). I am taking the 20mg patch which may be all I need, time will tell. So far so good. Rob
Posted by Racer on April 8, 2006, at 20:19:36
In reply to Re: EMSAM - First Day » TylerJ, posted by Sarah T. on April 8, 2006, at 16:19:01
Extrapolating from nicotine patches, you may be able to leave it on. I know I could leave on nicotine patches to shower, and I'd bet it's pretty similar.
Obviously, I'm only guessing, of course.
Posted by RobertDavid on April 8, 2006, at 20:31:49
In reply to Re: EMSAM - First Day » TylerJ, posted by Sarah T. on April 8, 2006, at 16:19:01
> I was also wondering about getting the patch wet. What about taking a shower or going swimming? Can you take the patch off and put the same one back on?
It's my understanding that the issue with the patch is primarily when it gets hot, such as in a jacuzzi or say if you put a heat pad on it as when it get's hot it may deliver the selegiline quicker.
I don't think getting it wet is and issue such as a normal shower or swimming. I didn't read that anywhere or hear it from my doctor. And from seeing how good it sticks to the skin I doubt any water would get under it. I suppose I could call BMS customer service and find out, probably should.
I don't think they recomend taking it off and putting it back on, probably affects the delivery, not sure.
Posted by gardenergirl on April 8, 2006, at 23:18:42
In reply to EMSAM - First Day, posted by RobertDavid on April 8, 2006, at 11:15:36
Sounds good so far. And I can totally relate to initially worrying about waking up early. I oversleep when depressed, too. I have all my life, so when Nardil started kicking in for me, I had the same thoughts.
Thanks for posting your experience. I look forward to hearing more.
gg
Posted by RobertDavid on April 9, 2006, at 13:25:09
In reply to Re: EMSAM - First Day, posted by gardenergirl on April 8, 2006, at 23:18:42
Today is is the beggining of my 3rd day. Last night though I continued to have an increase in dreaming, I slept like a rock and woke up refreshed, something I'm not used to.
I continue to have a slight smooth increase in energy (not anxiety) and mood. I seem more alert, had lots of laughs with my family yesterday. I stayed up later than usual last night without fatigue. I did notice I was quite "frisky", more than normal.
As far as side effects go, I just haven't felt any. So far none of the typical side effects I have gotten from other anti depressants such as an increase in anxiety or fatigue, insomnia, headache, confusion, none of it. I'm one of those that feels everything, I'm med sensitive, but I feel none of it.
It's weird to feel more "normal" if you will, I'm not used to it. After all I heard that selegiline (oral) would not be good for those with anxiety even in patch form (a primary concern of mine) I'm quite pleased.
The only negative thing I can say is the cost, but I hopefully the price will go down or insurance will pay part of the cost. Lastly I'm having no issues with skin site reactions. It's real simple to change, no redness and sticks good, not a hassle. Since I am going in a hot tub today I put the patch high on my chest so that it wouldn't be soaking in "hot" water, as heat is an issue.
Again, way to soon to make judgements, but this is the best start I've had with a medicine to relieve my energy/mood issues an hopefully more of my social anxiety. I hate to post such a positive post because I don't want to put the "wami" on it and know this could be temporary. I'm really looking forward to seeing where I am in a week.
My thoughts now are whether this will completely replace klonopin or whether it will be the belnd I have been looking for, time will tell. As this is my first try with an MAOI I'll just say from what I can tell, they rock! I've always been envious of those that have had such great resposes to Nardil and Parnate, but I'm starting to understand their enthusiasm. I'll continue to post my results. Rob
Posted by TylerJ on April 9, 2006, at 14:30:38
In reply to Re: EMSAM - Day 2, posted by RobertDavid on April 9, 2006, at 13:25:09
> Today is is the beggining of my 3rd day. Last night though I continued to have an increase in dreaming, I slept like a rock and woke up refreshed, something I'm not used to.
>
> I continue to have a slight smooth increase in energy (not anxiety) and mood. I seem more alert, had lots of laughs with my family yesterday. I stayed up later than usual last night without fatigue. I did notice I was quite "frisky", more than normal.
>
> As far as side effects go, I just haven't felt any. So far none of the typical side effects I have gotten from other anti depressants such as an increase in anxiety or fatigue, insomnia, headache, confusion, none of it. I'm one of those that feels everything, I'm med sensitive, but I feel none of it.
>
> It's weird to feel more "normal" if you will, I'm not used to it. After all I heard that selegiline (oral) would not be good for those with anxiety even in patch form (a primary concern of mine) I'm quite pleased.
>
> The only negative thing I can say is the cost, but I hopefully the price will go down or insurance will pay part of the cost. Lastly I'm having no issues with skin site reactions. It's real simple to change, no redness and sticks good, not a hassle. Since I am going in a hot tub today I put the patch high on my chest so that it wouldn't be soaking in "hot" water, as heat is an issue.
>
> Again, way to soon to make judgements, but this is the best start I've had with a medicine to relieve my energy/mood issues an hopefully more of my social anxiety. I hate to post such a positive post because I don't want to put the "wami" on it and know this could be temporary. I'm really looking forward to seeing where I am in a week.
>
> My thoughts now are whether this will completely replace klonopin or whether it will be the belnd I have been looking for, time will tell. As this is my first try with an MAOI I'll just say from what I can tell, they rock! I've always been envious of those that have had such great resposes to Nardil and Parnate, but I'm starting to understand their enthusiasm. I'll continue to post my results. Rob
Wow...I am very impressed! And, very happy for you Rob. Here's to continued effectiveness of EMSAM!!Tyler
Posted by ravenstorm on April 9, 2006, at 17:05:48
In reply to Re: EMSAM - Day 2 » RobertDavid, posted by TylerJ on April 9, 2006, at 14:30:38
OK, I just read on another message board that selegeline metabolizes to amphetamine. Is that true???? If it is true, wouldn't you develope a tolerance for it and need more. Or wouldn't you "burn out" on it? Any assistance with this question would be appreciated.
Also, at the lowest patch dose, are you getting an affect on MAO-A at all, or is it all MAO-B?
Thanks and sorry if these questions are stupid.
Posted by RobertDavid on April 9, 2006, at 18:25:08
In reply to Re: EMSAM - question, can someone answer?, posted by ravenstorm on April 9, 2006, at 17:05:48
> OK, I just read on another message board that selegeline metabolizes to amphetamine. Is that true???? If it is true, wouldn't you develope a tolerance for it and need more. Or wouldn't you "burn out" on it? Any assistance with this question would be appreciated.
>
> Also, at the lowest patch dose, are you getting an affect on MAO-A at all, or is it all MAO-B?As for the first part of your question I don't have the answer, just know that I don't do well at all with any amphetamine drugs, they give me more of what I don't want, anxiety. My doc didn't want me taking oral selegiline, I asked, he said the side effects would probably be more than I could stand at high enough doses to be theraputic (to get both MAOI-A and B) and even then it wouldn't work like the patch. Perhaps others can shed more light light on this.
As for the second part it's my understanding that at the 20mg patch dose both MAOI-A and MAOI-B are affected. Again, perhaps others can shed more light on it. So far (which is to soon to judge) no anxiety as a side effect. Rob
Posted by cecilia on April 9, 2006, at 20:33:28
In reply to Re: EMSAM - Day 2, posted by RobertDavid on April 9, 2006, at 13:25:09
It's interesting that you're having an increase in dreaming, Robert David. The other MAOI's tend to eliminate dreaming. Though of course you haven't been on it very long. I'll be seeing my pdoc at the end of April and hopefully he'll prescribe this, though I'm a little worried about the cardiac effects. I got a copy of my EKG that was done pre-op knee surgery while weaning off Marplan and discovered that not only did the Marplan dramatically lower my heart rate and blood pressure, which I was well aware of, but I also had "premature atrial complexes". It probably had nothing to do with the Marplan itself, but from going off the Atenolol which I've been on for years but had to go off because the Marplan lowered my blood pressure so much. Off the Marplan and back on the Atenolol the premature atrial complexes were gone, but I'm concerned that Emsam will also have an extreme blood pressure lowering effect. Still, I feel I have to give it a try. I have no belief that anything's going to help my depression, life without depression is unimaginable to me, but it's like a compulsion to keep trying..... Cecilia
Posted by Declan on April 9, 2006, at 20:38:53
In reply to Re: EMSAM - question, can someone answer? » ravenstorm, posted by RobertDavid on April 9, 2006, at 18:25:08
Hi Rob
So, you sleep well. 7 hours, was it, of good sleep. On any amount(>4mg/week) of sublingual deprenyl/selegeline my sleep is more disturbed than usual. I don't understand whether avoidance of first pass metabolism makes a difference to the l-amphetamine metabolite, and if so why. And it's possible the sleep affecting properties of selegeline/deprenyl at my dose have nothing to do with that. Anyway it's interesting you sleep so well on Emsam.
Declan
Posted by ravenstorm on April 9, 2006, at 22:17:24
In reply to Selegeline, deprenyl, Emsam, metabolites » RobertDavid, posted by Declan on April 9, 2006, at 20:38:53
So selegeline does metabolite into amphetamine? If that is true, how do people not develope a tolerance to it?
Perhaps Rob is not experiencing insomnia/anxiety due to taking Klonopin?
I'm trying to decide if its worth the risk to try it with my anxiety.
I found a chart that shows selegeline affects MAO-B to a greater effect than MAO-A but the chart doesn't discuss dosage.
Thanks for the input
Posted by RobertDavid on April 10, 2006, at 0:04:42
In reply to Re: Declan, so selegeline does met. into amphetami, posted by ravenstorm on April 9, 2006, at 22:17:24
> Perhaps Rob is not experiencing insomnia/anxiety due to taking Klonopin?
One of the studies suggested that 12% of patients had trouble with insomnia vs 7% with placebo (5% more than placebo).I have taken klonopin for 12 years and even with it have had trouble getting a good nights sleep. Before going on EMSAM I recently went to a overnight sleep study that showed I have trouble going to sleep and staying asleep and that I also don't hit stage 3 or 4 sleep (at least during the study). Sleep is a big issue to me and I have been concerned that klonopin has been part of the problem.
While on klonopin I've done many other anti depressant trials many of which caused significant insomnia, but for some reason not with EMSAM so far. I was quite concerned about it, but so far so good.
My doctor wants me to stay on the klonopin, same dose, for a few months while I stabilize on EMSAM, then slowly taper down, perhaps get off it all together. That's what I'm hoping for.
Anyway, hopefully I'll sleep well again tonight. I'll post tomorrow.
Rob
Posted by Declan on April 10, 2006, at 0:17:06
In reply to Re: Declan, so selegeline does met. into amphetami » ravenstorm, posted by RobertDavid on April 10, 2006, at 0:04:42
So Rob, what you're saying is that so far, only day 2 I know, you've actually slept better? That's really interesting.
A very small amount of l-amphetamine is metabolised from deprenyl. But that does not contribute to its clinical effectiveness. So tolerance should not be an issue. I may be wrong.
Declan
Posted by Caedmon on April 10, 2006, at 0:34:37
In reply to Re: Declan, so selegeline does met. into amphetami, posted by Declan on April 10, 2006, at 0:17:06
> A very small amount of l-amphetamine is metabolised from deprenyl. But that does not contribute to its clinical effectiveness. So tolerance should not be an issue. I may be wrong.>
To l-amphetamine? Shoot, that's not interesting at all! :b L-amphetamine would be the non-psychoactive isomer if I remember right; it won't do anything 'cept maybe clear your sinuses a bit. In the U.S. you can buy l-methamphetamine over the counter in Vick's inhalers. (They put "levmetamfetamine" on the side, lol.)
Even if it were psychoactive, and the amphetamine were a part of its effectiveness, I wouldn't worry about it. People w/ ADD take stimulants for years with little problems with tolerance - sometimes they might need a holiday but the tolerance is not always so profound as the media might have you believe.
- C
(course, maybe you shouldn't believe me, I'm prone to being very liberal wrt to the "fun" medications)
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