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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 30. This is the beginning of the thread.
Posted by lymom3 on May 22, 2006, at 12:25:51
Still weepy and cranky to some degree. Otherwise, I love my Emsam. Have talked with pdoc about possibly adding something else to the mix as a mood stabilizer. What I am afraid of is having that "stupor" come back...the sluggish, drugged feeling that I always had with SSRI's. I am really enjoying being clear headed right now.
Someone here had been on Lamictal and was going to start Emsam..can't remember who, but I'm wondering if any of you have any other thoughts.
Posted by valene on May 22, 2006, at 14:04:17
In reply to Emsam plus??? some kind of mood stabilizer, posted by lymom3 on May 22, 2006, at 12:25:51
Have you considered adding a benzo? They seem to go well with the EMSAM patch from reading on this board. Also I saw a very respected pscyhopharmacologist recently and he said benzos are making a comeback don't be afraid of taking them. (Unless you are drug seeking or addictive behavior of course). I take xanax 1.75mg. and am considering the EMSAM patch. He did tell me that I might need a higher dosage than the 20 mg. though.
Val
Posted by lymom3 on May 22, 2006, at 15:15:35
In reply to Re: Emsam plus??? some kind of mood stabilizer, posted by valene on May 22, 2006, at 14:04:17
No benzo's for me. I don't like them.... too sedating, don't like the glazed over feeling. That is one thing that I like so much about Emsam is no foggy feeling. I guess I'll have to re think that if there really is no better answer, but I want to avoid that at all costs.
Posted by Phillipa on May 22, 2006, at 22:11:13
In reply to Re: Emsam plus??? some kind of mood stabilizer, posted by lymom3 on May 22, 2006, at 15:15:35
Robert David is posting great results on klonopin and EMSAM. Love Phillipa why no benzos?
Posted by RobertDavid on May 22, 2006, at 23:41:46
In reply to Re: Emsam plus??? some kind of mood stabilizer, posted by lymom3 on May 22, 2006, at 15:15:35
I've been on klonopin for 12 years. And though it's been a miracle drug for my anxiety I too disliked the daytime sedation, mental fog you decribed. I was mildly depressed as well.
And the negative side effects I was feeling with klonopin as mono therapy is gone since taking EMSAM. Now I still get the anxiety relief from klonopin, but my mind is sharp, got the energy I like, mood is good. I have tried so many other drugs to blend with klonopin, none really worked to clear my mind up. For me, and I know everyone is different, lamictal screwed up my thinking more than klonopin and didn't tackle the anxiety as well.
I'd consider revisiting klonopin, taking your dose at night as it will help you all day with the long half life, help you sleep and reduce the initial side effects (of which much goes away within a few weeks). It would certainly be a great choice to help with your iritability. And with EMSAM on board you may find that klonopin won't have the same negative effect as before, at least that's what I've experienced.
Perhaps a med like lamictal would help you too, but my vote, my first try would be adding klonopin. You'd only have to invest a few nights to see if you're feeling better and if not, could move on. The great thing about benzo's, they work fast.
Good luck.
Rob
Posted by valene on May 23, 2006, at 9:35:59
In reply to Re: Emsam plus??? some kind of mood stabilizer, posted by lymom3 on May 22, 2006, at 15:15:35
I'd also like to add that I find that xanax is less depressing for me than perhaps klonopin or valium. Xanax is known for its antidepressant properties at the lower doses while I have heard of many people who become depressed while on klonopin. Everyone's different though. Good luck!
Val
Posted by lymom3 on May 23, 2006, at 12:39:11
In reply to Re: Emsam plus??? some kind of mood stabilizer » lymom3, posted by valene on May 23, 2006, at 9:35:59
I don't like benzos. One thing I like about Emsam is that I feel like a person. I don't want that flat feeling back and don't want to feel drugged. I've tried Valium, Xanax and Klonopin in the smallest possible amounts and I always end up feeling like I need to sleep. That is no better, to me, than being a crab. Just was hoping there was a better answer.
Posted by lymom3 on May 23, 2006, at 13:07:23
In reply to Emsam plus??? some kind of mood stabilizer, posted by lymom3 on May 22, 2006, at 12:25:51
I am looking for opinions here. I am on week 3 of Emsam. I love some of the effects and really want to stick with it. The 2 areas that I'm having issues in are, in my opinion, somewhat entertwined. I don't seem to sleep as well at night...not as soundly. I know that before Emsam not getting decent sleep was asking for me to have a bad day. I am by nature not the most pleasant person in the world. Add to that, not getting enough sleep and you've just amplified the problem. I have read, here and on other boards, of increased irritability on Emsam and feel like it might be partly the medication.
I am not opposed to adding something to the mix to help these problems, but sleeping meds and benzos just knock me out. I did take Seroquel for a little bit when I had trouble sleeping before and quartered the smallest does pill and could still hardly be awake enough to function the next day. I have tried Valium, Klonopin and Xanax in equally as small doses over the years and the same thing. Being in a drugged stupor or half comatose is not a better option than being a crab is.
I really do feel more motivated on Emsam, getting things done. Even when I am being crabby, it's not to the extreme that I do usually carry it. I might still flip off the driver that cuts me off but not yell expletives too or I might get irritated more easily at my kids for not doing things that they are supposed to do, but I'm not as extreme about it. Being less b**chy more of the time isn't a great option either but I do see some improvement in the mood swings. I am thinking that if I could resolve the sleep issue that maybe some of the irritation factor would go away.
I just don't know what to try. I have a pdoc appt next week. I am his only patient on Emsam he knows that I am not a "drama queen". I just don't want to go back to being "fuzzy" like I always have been on SSRI's. Anybody have suggestions, opinions?
Posted by Phillipa on May 23, 2006, at 13:41:01
In reply to Maybe this clarifies it a little???, posted by lymom3 on May 23, 2006, at 13:07:23
Gee lymon I take valium too. For some reason it doesn't make me fuzzy. I have a high tolerance for benzos as anxiety is my primary diagnosis. There is a new supplement out now with tyramine(calming)called Teanine Serene with Relora and Gaba from Source Naturals. Maybe that? Goggle vitaminShoppe and look it up and read about it. Hope that may help. Love Phillipa
Posted by SFY on May 23, 2006, at 15:58:50
In reply to Re: Maybe this clarifies it a little??? » lymom3, posted by Phillipa on May 23, 2006, at 13:41:01
I know that the EMSAM insert clearly and specifically states that one should not take a tricyclic like Nortriptyline while on it. Similarly, the warnings I got with my last Nort refill proscribe taking any MAOI in tandem with it.
However, there are a number of studies that show few, if any, problems mixing MAOI's and TCA's. This is especially true when one has been on a TCA and then adds an MAOI to it.
I'm currently taking 75 mg. of Nortriptyline and it seems to be doing a good job of keeping me from sinking too deeply into depression. However, it's done nothing for my social anxiety and avoidance, amotivation, anhedonia, and generally blunted emotions. A recent trial with Requip did nothing at all for me.
My next step was to try Emsam because I had a good response to Nardil in the past (but the side effects, esp. the insomnia, became a problem). But I'm wary of having to go off the Nortriptyline and being without any support for my depression until (and if) the EMSAM kicks in. This is especially true as I'm dealing with some current emotional issues that have the potential to send me into a tailspin if my depression comes back full-blown.
I'm just wondering if this is doable. I know I've read about people here taking an MAOI/TCA combo in the past and I'd be interested in any of those experiences as well.
Posted by RobertDavid on May 23, 2006, at 17:30:55
In reply to Maybe this clarifies it a little???, posted by lymom3 on May 23, 2006, at 13:07:23
When I asked about better sleep my doctor told me to take the patch off just before bedtime and put it back on in the morning. You could try that just one night and see if it works for you. You'll basically be wearing the patch 16 hours a day and you'll still have enough selegiline in your blood to be theraputic, but just a lower amount at night to help you sleep. Just a thought. If it works for you, no need for other meds. Good luck
Posted by ZeitGuest on May 23, 2006, at 19:56:08
In reply to Re: Emsam plus??? some kind of mood stabilizer » valene, posted by lymom3 on May 23, 2006, at 12:39:11
I'm with you, lymom: I'm now in my third week of taking EMSAM (6mg patch), and increased irritability is definitely a side effect I am experiencing. I too would love to try some kind of mood stabilizer to smooth out my EMSAM agitation, but I definitly do not want to try a benzo or other sedating drug as a first option. I hate feeling groggy and fuzzy, and I need to remain mentally alert. Plus, a benzo like Klonapin may increase depression, which rules it out for me.
How about a med or supplement that boosts GABA? From what I've read, Nardil boosts GABA and I wonder if that has something to do with its anxiolytic, and more specifically, its social-anxiety-reversing qualities. Are there any effective GABA-boosting agents that might not be contraindicated for use with EMSAM?
Posted by Phillipa on May 23, 2006, at 20:02:23
In reply to Re: Emsam plus??? some kind of mood stabilizer, posted by ZeitGuest on May 23, 2006, at 19:56:08
I don't think you can take two MAOI's at the same time. Love Phillipa
Posted by Jakeman on May 23, 2006, at 20:15:42
In reply to Re: Emsam plus??? some kind of mood stabilizer, posted by lymom3 on May 22, 2006, at 15:15:35
Have you considered Lyrica or Nuerontin? I believe Lyrica has been approved for GAD in some countries.
warm regards, Jake
> No benzo's for me. I don't like them.... too sedating, don't like the glazed over feeling. That is one thing that I like so much about Emsam is no foggy feeling. I guess I'll have to re think that if there really is no better answer, but I want to avoid that at all costs.
Posted by jedi on May 24, 2006, at 3:15:36
In reply to EMSAM Plus Nortriptyline - Possible?, posted by SFY on May 23, 2006, at 15:58:50
>
> My next step was to try Emsam because I had a good response to Nardil in the past (but the side effects, esp. the insomnia, became a problem). But I'm wary of having to go off the Nortriptyline and being without any support for my depression until (and if) the EMSAM kicks in. This is especially true as I'm dealing with some current emotional issues that have the potential to send me into a tailspin if my depression comes back full-blown.
>
> I'm just wondering if this is doable. I know I've read about people here taking an MAOI/TCA combo in the past and I'd be interested in any of those experiences as well.Hi SFY,
I'm currently back to my old mix of nortriptyline plus Nardil. I haven't tried EMSAM yet but didn't think I had the time to experiment as I was falling back into the pit after being off of Nardil for about four months. During that time I was on high dosage of Omega-3s, 300mg bupropion, then 150mg nortriptyline. None of these held off the major depression which was rearing it's ugly head again, after being off Nardil for a few months. I dropped the dosage of nortriptyline back to 75mg and have now worked the Nardil back up to 90mg as of today. Now, I'll have a three or four-week period of sheer HELL while I wait for the MAOI to kick in again. It better kick in again! It has never failed me in the past. I have atypical double depression with social and generalized anxiety disorder. I also take 1mg of clonazepam daily for the anxiety. When I stabilize again I may try to talk my MD into trying EMSAM, but I can't risk being back in the pit right now. I have too many financial problems from ten plus years fighting this disease to be sick now. I saved up several months of Nardil when I last went off of it. It is the only med that has pulled me out of major depression. Now I get the joyful task of telling my MD that I went back on the Nardil without asking him, and trying to get him to re-write the script for it. Oh what a tangled web we weave...Anyway, back to the point. I have added Nardil to nortriptyline in the past with no problems. I don't expect to have any this time except for the politics involved in using meds that are officially contraindicated. Good luck in your search for a workable combination of meds.
Take care,
Jedi
Posted by jedi on May 24, 2006, at 3:32:02
In reply to Re: Emsam plus??? some kind of mood stabilizer, posted by ZeitGuest on May 23, 2006, at 19:56:08
> I'm with you, lymom: I'm now in my third week of taking EMSAM (6mg patch), and increased irritability is definitely a side effect I am experiencing. I too would love to try some kind of mood stabilizer to smooth out my EMSAM agitation, but I definitly do not want to try a benzo or other sedating drug as a first option. I hate feeling groggy and fuzzy, and I need to remain mentally alert. Plus, a benzo like Klonapin may increase depression, which rules it out for me.
>
> How about a med or supplement that boosts GABA? From what I've read, Nardil boosts GABA and I wonder if that has something to do with its anxiolytic, and more specifically, its social-anxiety-reversing qualities. Are there any effective GABA-boosting agents that might not be contraindicated for use with EMSAM?Hi,
Don't rule out clonazepam because of someone elses experience with the medication. I have been taking 1mg for years for my social and generalized anxiety. Clonazepam is not depressing to all people and the initial fuzzyness and somnolence side effects wore off years ago for me. Along with Nardil, I believe it is a very good medication for social anxiety and atypical depression. Yes, they both affect GABA.
Good Luck,
Jedi
Posted by RobertDavid on May 24, 2006, at 17:07:33
In reply to Re: Emsam plus??? some kind of mood stabilizer, posted by ZeitGuest on May 23, 2006, at 19:56:08
> I'm with you, lymom: I'm now in my third week of taking EMSAM (6mg patch), and increased irritability is definitely a side effect I am experiencing. I too would love to try some kind of mood stabilizer to smooth out my EMSAM agitation, but I definitly do not want to try a benzo or other sedating drug as a first option. I hate feeling groggy and fuzzy, and I need to remain mentally alert. Plus, a benzo like Klonapin may increase depression, which rules it out for me.
I too did not like the side effects from klonopin you mention of feeling groggy and fuzzy. But EMSAM completely rid me of it. I've never been so alert, sharp and I still get the anti anxiety benefits from klonopin. Klonopin on it's own was not the total solution for me.I gues my point is that even if you've tried a benzo before (not sure if you have), you may not have the groggy side effects since your now on EMSAM. And at least it wouldn't take a month to find out if it works better now, you'd know right away. If you still get the old side effects you can stop after one day.
I too can not deal with being fuzzy headed as I own a mortgage business and all day I crunch numbers, write advertising, manage others and just have to be creative to figure out how to get loans to fly. I had to have klonopin to work, but I'm much more effective now since adding EMSAM. Anyway, just a thought. Best of luck. Rob
Posted by ZeitGuest on May 25, 2006, at 0:58:02
In reply to Re: Emsam plus??? some kind of mood stabilizer » ZeitGuest, posted by RobertDavid on May 24, 2006, at 17:07:33
Thanks Rob. For me, Klonapin is indeed be worth considering. And you are correct: I have never tried a benzo before. However, I do have to admit that I am less worried about any sleepy/foggy side effects (after all, the half life is short enough for me get the med out of my system in a day or so) than I am about the potential for addiction or difficult withdrawal if I were to take Klonopin for a sustained period of time.
Posted by RobertDavid on May 25, 2006, at 1:24:01
In reply to Re: Emsam plus??? some kind of mood stabilizer, posted by ZeitGuest on May 25, 2006, at 0:58:02
> Thanks Rob. For me, Klonapin is indeed be worth considering. And you are correct: I have never tried a benzo before. However, I do have to admit that I am less worried about any sleepy/foggy side effects (after all, the half life is short enough for me get the med out of my system in a day or so) than I am about the potential for addiction or difficult withdrawal if I were to take Klonopin for a sustained period of time.
I think there are misconceptions about "addiction" to benzo's like klonopin. Those that take it for anxiety disorders aren't known to abuse it, escalate dose. They just take what they need to treat their anxiety. There is no real "high" with it. Even many with other addictions such as abusing alcohol don't abuse klonopin. I have a drinking problem and from time to time abuse alcohol. I hate it. But in 12 years of taking klonopin I've never wanted to or had the desire to take more klonpin than the 2mgs I take every night. I believe that's typical.
And you can stop taking it when you want. It's one of the easier benzos to taper off compared to xanax or ativan as it has a long half life. Most people just do a slow taper to minimize withdrawl symptoms. I've gotten off of it before just to prove to myself that I could, the problem was that all my anxiety returned. I need it, it works, it's changed my life, I'm social now. I have no plans to ever stop taking it unless there is some new breakthrough. My doctor feels the same way, I can take it the rest of my life. He says "take it, think of it as your vitamin pill, if you had diabetes you'd need insulin. You have anxiety and you need klonopin." He's right. And the good think is that for most people the anti anxiety benefits do not go away with time, but many of the other side effects will.
For some, they are troubled with some mild depression or a foggy headed feeling. Much of that improves but many, like me, blend something with it to get both anxiety benefits and energy, mood elivation. Benzos also are compatible with many other meds which is a plus. You can take them with SSRI's, MAOI's and many other meds.
Benzos are great drugs, they really help a lot of people. I believe they are the best choice for anxiety and anxiety disorters particuarly SAD. Like my doctor told me, I'm much more healthy without anxiety than I am with it. I will live longer (most likely) taking klonopin than I would if I didn't because anxiety and stress are killers. Anxiety runs in my family. My 84 year old mother takes 1mg of klonopin as well. She was having troubles with her gut probably from anxiety and since taking klonopin it has gone away. Her gut doctor told her to keep taking the klonopin. She has much less anxiety and blends it with Celexa which does the trick for her.
I just think there are some misconceptions about benzos such as the addiction and withdrwal issues. You can stop taking it if you want to, but since it works so good I'm not sure why anyone would really want to. Just my 2 cents worth. Best of luck. Rob
Posted by theo on May 25, 2006, at 12:21:32
In reply to Re: Emsam plus??? some kind of mood stabilizer » ZeitGuest, posted by RobertDavid on May 25, 2006, at 1:24:01
Hello,
Have you been on Emsam for a while? I have had a filled prescription for about 3 weeks now and have been anxiety ridden about trying another med.
How is it going so far? Does it make you feel weird like the SSRI's when starting it? SSRI's made me feel uncomfortable around people because I always felt "drugged" and thought I might act or say something stupid.
Posted by RobertDavid on May 25, 2006, at 13:02:43
In reply to Re: Emsam plus??? some kind of mood stabilizer » RobertDavid, posted by theo on May 25, 2006, at 12:21:32
> Hello,
>
> Have you been on Emsam for a while? I have had a filled prescription for about 3 weeks now and have been anxiety ridden about trying another med.
>
> How is it going so far? Does it make you feel weird like the SSRI's when starting it? SSRI's made me feel uncomfortable around people because I always felt "drugged" and thought I might act or say something stupid.
The SSRI's made me feel wuncomfortable and weird as well. In addtion I didn't get any mood elivation from them. I'm on my 7th week of EMSAM. I felt much more mentally alert, more social and the foggy headed feeling I had is gone. Some call it the "smart drug", that's the best way I can describe my response to it.I feel if I were to take need to take a test, I'd get a higher grade now. My comprehension and mental clarity is much better. I have not had that drugged feeling. The only issue I delt with was after a few weeks I stayed mentally alert when I should be sleeping. I did get some sleep, but would wake up here and there totally awake.
My doctor recommended I take the patch off at bedtime which has helped with the sleep issue. When I don't sleep well regarles of what med I'm taking I don't have as much energy.
Anyway, EMSAM will certainly work differently for everyone, but it seems those that have not had luck with SSRI's are good candidates. Some here who have not had a good response to EMSAM did previously have positive responses to prozac and other SSRI's. I'm not sure, but perhaps there is something to that. Good luck! Rob
Posted by pulse on May 25, 2006, at 15:41:09
In reply to Re: Emsam plus??? some kind of mood stabilizer » theo, posted by RobertDavid on May 25, 2006, at 13:02:43
don't know if, WITH Emsam, it would cause a reaction/ be contraindicated, but i also have had sleep success with l-theanine - in my case, 'Suntheanine' by Phytopharmica.
note, though that it might cause you some constipation.
Posted by pulse on May 25, 2006, at 15:47:11
In reply to Re: Emsam plus??? some kind of mood stabilizer » theo, posted by RobertDavid on May 25, 2006, at 13:02:43
excerpt from your above post:
"Anyway, EMSAM will certainly work differently for everyone, but it seems those that have not had luck with SSRI's are good candidates. Some here who have not had a good response to EMSAM did previously have positive responses to prozac and other SSRI's. I'm not sure, but perhaps there is something to that. Good luck! Rob"
i now think there IS something to that.
regards,
pulse
Posted by theo on May 25, 2006, at 17:20:59
In reply to Re: Emsam plus??? some kind of mood stabilizer » theo, posted by RobertDavid on May 25, 2006, at 13:02:43
Did you mention you have cut a patch in half? I was thinking about trying this just to ease my anxiety by starting low versus full 6mg patch.
Posted by RobertDavid on May 25, 2006, at 17:55:04
In reply to Re: Emsam plus??? some kind of mood stabilizer » RobertDavid, posted by theo on May 25, 2006, at 17:20:59
> Did you mention you have cut a patch in half? I was thinking about trying this just to ease my anxiety by starting low versus full 6mg patch.
Yes, I have been cutting the patch for several days. I cut it right down the middle. I contacted one of the reaserchers in the initial EMSAM study and asked his advise. Though the packaging says differently he said there would be no issues with cutting it, in fact that's what they did with test animals. Selegiline would not leak out and it would be an even distribution of medicine. I haven't had any issues since doing it and seem's I'm still getting the congnitive improvement I like. It very well might be a good way for others to start EMSAM, then work up to higher doses. Good luck.
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