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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by tygereyes on April 13, 2006, at 19:40:57
I'm starting on the 9 mg (middle dose) patch.
I spoke to my insurance company on the phone and they will be covering it, at $50 a month (as it is a "non-preferred" medication).
My psychiatrist was involved in clinical trials for the medication. He said there is no reason to have a two week washout between Emsam and Parnate unless we want to be overly cautious, that one week is sufficient, so I'll be actually starting the medication next Wednesday (one week after my last Parnate dose).
He also said that there is no evidence for dietary restrictions and that his subjects never followed the restrictions and never had a hypertensive crisis (in one study, they encouraged those on the 12 mg patch to eat as much non-allowed cheese as possible, up to 100 grams of cheddar and blue cheese, while monitoring their blood pressure and NO ONE on Emsam could eat enough to produce a hypertensive crisis!) but joked that he doesn't want a lawsuit so told me to be careful anyway.
He didn't seem very enthusiastic about the medication, though, for someone who had been involved in the trials. I had to bring it up to him myself and he was reluctant to take me off of Parnate until I told him that looking in the mirror at my acne-covered face was making me feel suicidal. I hope this drug is all it's cracked up to be ....
Posted by tygereyes on April 13, 2006, at 19:47:05
In reply to Got an Emsam script ( some info from my pdoc), posted by tygereyes on April 13, 2006, at 19:40:57
I was afraid to ask my psychiatrist, who is new and clueless as to my complete history, since I "fired" my treatment team for putting me inpatient so many times for anorexia nervosa.
It is well known that psychiatric medications often don't work in low-weight anorectics.
Is it possible that Emsam might work, since it bypasses the gut and directly enters the central nervous system?
Or is the reason that anti-depressants don't work in low-weight anorectics NOT related to digestion but rather to abnormally low levels of monoamines - so low that even ADs can't influence these levels?
Please let me know. My weight is dropping and I'd really like to know if Emsam even stands a chance of working once my BMI drops into the "emaciated" category.
Posted by blueberry on April 13, 2006, at 19:50:18
In reply to Got an Emsam script ( some info from my pdoc), posted by tygereyes on April 13, 2006, at 19:40:57
Cool. I hope it goes well for you. I can't find any detailed information about how effective it was. Just stuff like it "was significantly superior to placebo". But what was the response rate in percentage terms? And the remission rate? Any ideas? The side effect profile looks pretty good.
Posted by SLS on April 14, 2006, at 7:04:44
In reply to A question, Emsam and Anorexia: Ed? Ace? SLS?, posted by tygereyes on April 13, 2006, at 19:47:05
> It is well known that psychiatric medications often don't work in low-weight anorectics.
I wasn't aware of that. I don't know what the physiology behind this phenomenon is.
> Is it possible that Emsam might work, since it bypasses the gut and directly enters the central nervous system?
It is possible that Emsam might work for any number of reasons. It is different from other medications. That is often as much of a rationale as you are going to get to justify trying something new. It is the only propargyl derivative MAOI available. Dennis Murphy, MD at the NIMH thought that this was enough reason to give it a try. Generally speaking, I doubt Emsam will get as many people well as either Parnate or Nardil, but then again, it only needs to get one person well, right?
Is this your first trial of a MAOI?
Have you ever tried a tricyclic?
Are you avoiding Nardil because of the potential weight-gain?
I look forward to hearing some good news. Please keep posting.
- Scott
Posted by Racer on April 14, 2006, at 13:16:21
In reply to A question, Emsam and Anorexia: Ed? Ace? SLS?, posted by tygereyes on April 13, 2006, at 19:47:05
Pretty much you're right about antidepressants not being very effective for anorexics. There are all sorts of variables involved, but a big part of it seems to be related to the lack of energy and dietary precursors available for the ADs to work with.
About the only thing I've read about that seems to have any useful effect in AN before some nutritional rehabilitation is Zyprexa.
Then again, the first focus of treatment for AN is always going to be nutritional restoration. Weight gain, but mostly more normal eating. I know, worst thing you can think of, but true. As long as your weight is that low, you're not going to be able to treat your depression effectively.
And that's coming from an anorexic who is pretty well horrified by the regained weight, and miserable about her body most of the time, and all the rest -- but even I will admit, depression is slightly better, and anxiety is HUGELY improved.
Sorry. Good luck with the EMSAM, but do think about recommitting yourself to recovery from AN.
Posted by Racer on April 15, 2006, at 1:58:12
In reply to Anorexia and antidepressants... » tygereyes, posted by Racer on April 14, 2006, at 13:16:21
OK, so as soon as I wrote that ADs aren't that great with AN, I read another article that I missed along the way. It suggested that drugs affecting NE might work better for AN than those that affect serotonin.
So, maybe one of the TCAs? I had good depression relief from nortriptyline years back, started when I was anorexic. (I guess I should say something else, like "actively anorexic" maybe? Well, during a period when I was thin...)
Also, Strattera might be an option? I don't know that's a great one ,though...
Posted by SLS on April 15, 2006, at 7:27:24
In reply to WHOOPS! Just read something else about this, posted by Racer on April 15, 2006, at 1:58:12
> OK, so as soon as I wrote that ADs aren't that great with AN, I read another article that I missed along the way. It suggested that drugs affecting NE might work better for AN than those that affect serotonin.
>
> So, maybe one of the TCAs?Yes. There is evidence that TCAs are helpful in AN. Unfortunately, I don't see much attention being paid to this. I saw TCAs work well when I was a patient at the NIH. Unfortunately, one person later relapsed because there wasn't enough supportive follow-up psychotherapy. This was in 1992. I don't know the extent to which these drugs have been forgotten.
- Scott
Posted by Racer on April 15, 2006, at 11:37:16
In reply to Re: WHOOPS! Just read something else about this, posted by SLS on April 15, 2006, at 7:27:24
> >
> Yes. There is evidence that TCAs are helpful in AN. Unfortunately, I don't see much attention being paid to this. I saw TCAs work well when I was a patient at the NIH. Unfortunately, one person later relapsed because there wasn't enough supportive follow-up psychotherapy. This was in 1992. I don't know the extent to which these drugs have been forgotten.
>
>
> - ScottI don't know about forgotten, exactly, but they're not used all that often. I think, frankly, it's fear of potential cardiotoxicity in someone who's severely malnourished. Also, TCAs would tend to increase some of the GI problems with AN, especially constipation.
But the study I just read about was published in 2002, from NZ, I think. Maybe it's going to put the TCAs and other noradrenergic drugs back on the map? Although, really, the only psychopharm articles I"ve read about meds for AN these days are about Zyprexa. Think someone thinks he's clever for finding a benefit to the weight gain? {rolls eyes}
The other thing is that the treatment guidelines are putting a bit more emphasis on follow up care these days. Now, just as soon as the insurance companies start to allow the doctors to prescribe treatment...
Posted by tygereyes on April 15, 2006, at 12:24:44
In reply to WHOOPS! Just read something else about this, posted by Racer on April 15, 2006, at 1:58:12
I can't take tricyclics ... I have borderline personality disorder and they exacerbate the mood lability associated with that disorder.
Posted by SLS on April 15, 2006, at 12:32:04
In reply to Re: WHOOPS! Just read something else about this » SLS, posted by Racer on April 15, 2006, at 11:37:16
> > I don't know the extent to which these drugs have been forgotten.
> I don't know about forgotten, exactly, but they're not used all that often. I think, frankly, it's fear of potential cardiotoxicity in someone who's severely malnourished. Also, TCAs would tend to increase some of the GI problems with AN, especially constipation.Ah. I see.
Thanks!
- Scott
Posted by tygereyes on April 15, 2006, at 14:12:19
In reply to Re: WHOOPS! Just read something else about this » Racer, posted by SLS on April 15, 2006, at 12:32:04
Oh man ... I was on Nortriptyline during one episode of AN, Desipramine during another ... it was not abnormal for me to go two weeks without a bowel movement. Ugggh.
Posted by Racer on April 15, 2006, at 21:04:34
In reply to Re: WHOOPS! Just read something else about this, posted by tygereyes on April 15, 2006, at 14:12:19
I can completely relate. Paxil did it for me, too. Once on a good week, otherwise two weeks at a time.
Ugh. No wonder we get depressed!
This is the end of the thread.
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