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Dr. Bob is Robert Hsiung, MD,
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Posted by Donna Louise on May 13, 2006, at 21:53:25
In reply to Re: Everyone PLEASE share your ENSAM updates? » Donna Louise, posted by RobertDavid on May 13, 2006, at 11:54:28
> Donna:
>
> A lot of what I hear you describe sounds like anxiety, feeling pressured, late, etc. I understand you take a low dose of klonopin which has been helpful for you. May I ask how low the dose is?
>
> Klonopin was a life saver for me. But I had to get up to 2mgs for it to fix the anxiety problem. When I was taking lower doses I was ready to throw in the towel and move to something else, was still edgy, anxious, but my Dr. had me go up on the dose which did the trick.
>
> And since starting EMSAM the issues I was having with Klonopin as mono therapy are gone, I'm more alert, clear headed, getting more done and happier. I suspect some of the issues I was having with mood, energy and slight mental fog was partially due to the anxiety disorter and perhaps partially the 2mg dose of klonopin.
>
> Anyway, have you considered going up a little bit on klonopin, perhaps just for a short while to see if some of your anxiety issues improve? My guess is that since your taking EMSAM you can more easily deal with an increased klonopin dose and the combo may just be the ticket. If it works, you won't need to do other med trials.
>
> I don't know the dose you take of klonopin or when, but if you decided to go up you might just consider taking the increase at bedtime. I take my full dose then and with the long half life it's always lasted through the next day (and with less daytime side effects).
>
> Just some food for thought. Sounds like your headed in the right direction. Perhaps with more time on EMSAM the other issues will get resolved, but in the mean time you might consider upping klonopin, it wouldn't take much time to figure out if it helps and of not, just drop back down.
>
> RobI think it is anxiety too, I was afraid though it was a hypomanic manifestation. I have always called it anxiety and who knows what the difference is anyway, it is whatever helps it GO AWAY that matters. I do take a low dose of klonopin and some days it is lower than others. Usually, I will take 1/4 of a pill in the morning, and 1/2 in the afternoon, maybe another 1/2 at bedtime. so that is just 1 1/4 pill. .625mg? not even a whole mg. There are days when I may take 1/2 in the am, another 1/2 in the pm and then a whole one at night. That at least gets me up to 1mg. I am a recovering drug addict and have been afraid for years to take a benzo but started gradually doing it a few years back and have acclerated to this humonguous dosage..:-)) I am over being a benzophobe I thought but maybe I still have some residual fear or I would take more. I could try taking a whole pill at night and then 1/4 or 1/2 inthe am and pm as a matter of course instead of just on bad days and see if that doesn't level me out. More than 1/4 in the morning makes me sleepy but not so in the afternoon and that is usually when I get the most wound up. I will take your suggestion as I like that alot better than any other and as you say, as time goes on, maybe I will not get the irritables so bad. What are they saying about how long it takes for the patch to reach peak efficacy? Is it 4-8 weeks like the others? And of course I am on the lowest dose of EMSAM too. And I still feel way better than I can remember just like I am now.
Donna
Posted by RobertDavid on May 14, 2006, at 22:00:14
In reply to Re: Everyone PLEASE share your ENSAM updates? » RobertDavid, posted by Donna Louise on May 13, 2006, at 21:53:25
Donna:
When I have taken klonopin during the day it did make me a little foggy headed. I will on rare occation take a small dose if I'm going to get on a plane or have something real stressful, but otherwise just stick to my bedtime dose. But I suspect that once a day/bedtime dosing works for me because I'm taking a larger dose and may not for those taking less than 1mg, but?
I don't think I'd be to conserned about your past drug issues and the use of klonopin to treat anxiety. People that have anxiety disorters are not know to abuse benzos/escalate dose. There's no real high with it, at least not for most people and most the sedation and other side effects go away in time.
As far as how long it takes EMSAM to work I suspect full theraputic benenfits don't come until your on it 6 to 8 weeks, though I got an immediate possitive response which got better as the weeks have gone by. I'm 6 weeks on EMSAM now.
Sounds like you've got a good start. Perhaps the slight klonopin adjustment will help. I think it's a good strategy.
Rob
Posted by Donna Louise on May 14, 2006, at 22:37:42
In reply to Re: Everyone PLEASE share your ENSAM updates? » Donna Louise, posted by RobertDavid on May 14, 2006, at 22:00:14
> Donna:
>
> When I have taken klonopin during the day it did make me a little foggy headed. I will on rare occation take a small dose if I'm going to get on a plane or have something real stressful, but otherwise just stick to my bedtime dose. But I suspect that once a day/bedtime dosing works for me because I'm taking a larger dose and may not for those taking less than 1mg, but?
>
> I don't think I'd be to conserned about your past drug issues and the use of klonopin to treat anxiety. People that have anxiety disorters are not know to abuse benzos/escalate dose. There's no real high with it, at least not for most people and most the sedation and other side effects go away in time.
>
> As far as how long it takes EMSAM to work I suspect full theraputic benenfits don't come until your on it 6 to 8 weeks, though I got an immediate possitive response which got better as the weeks have gone by. I'm 6 weeks on EMSAM now.
>
> Sounds like you've got a good start. Perhaps the slight klonopin adjustment will help. I think it's a good strategy.
>
> Roblast night I took a whole .5mg pill and during the day I took a late a.m. .25mg and then mid afternoon another .25mg. I did not have the same level of irritability, it was much better, however still there for about an hour in the late afternoon. Much improved though. I just took a whole .5mg as I am going to bed here in a minute. I am feeling positive about this move. I would much rather do this than a mood stabilizer if possible. And amazingly, even though I am a drug addict, recovering, I have not abused this drug at all. I have not escalated or used to get a "buzz". It has been nearly two years now so I guess I can almost relax about it....
thanks so much for your concern and suggestions.Donna
Posted by RobertDavid on May 14, 2006, at 23:13:12
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by Donna Louise on May 14, 2006, at 22:37:42
> last night I took a whole .5mg pill and during the day I took a late a.m. .25mg and then mid afternoon another .25mg. I did not have the same level of irritability, it was much better, however still there for about an hour in the late afternoon. Much improved though. I just took a whole .5mg as I am going to bed here in a minute. I am feeling positive about this move. I would much rather do this than a mood stabilizer if possible. And amazingly, even though I am a drug addict, recovering, I have not abused this drug at all. I have not escalated or used to get a "buzz". It has been nearly two years now so I guess I can almost relax about it....
> thanks so much for your concern and suggestions.
Donna:That sounds great. I think you'll find you'll continue to feel better with the increase in dose. It won't take long to find out. If you improve, but don't get as much relief as you'd like, I'd consider upping the dose again. Konopin is a great med and I think all you need to do is play with the dose until you get to a truly thearputic level. Keep us posted!
Rob
Posted by cecilia on May 15, 2006, at 5:59:35
In reply to Re: Everyone PLEASE share your ENSAM updates? » Donna Louise, posted by RobertDavid on May 14, 2006, at 23:13:12
I tend to think that most people who get a "buzz" from clonazepam must be having a placebo effect, as it has such a long half-life and takes so long to kick in. Of course, I've only taken the generic clonazepam, not the real Klonopin. 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. I was expecting the nasty red splotches, since just regular bandaids give me those, but so far that hasn't been an issue. Cecilia
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.
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