![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 10 to 34 of 94. Go back in thread:
Posted by Jost on June 8, 2006, at 0:19:46
In reply to Re: Emsan-Day 30 » cecilia, posted by RobertDavid on June 7, 2006, at 22:36:50
If you're not sleeping at all, that would undermine possible benefits of any AD. Sounds really awful, if you're getting that little sleep.
I'm having trouble sleeping with ensam, also, and find that I'm more obstinate, argumentative, and more closed to things when I'm very tired from it.
I had the feeling it was helping before I got totally exhausted.
My Pdoc suggested the following:
1. clonidine at night. I'm trying it now--and am not exactly asleep yet at 1:00 am. But I often get to sleep late, so I'll see.
2. if that doesn't work, go to the 9 mg patch and take it off at night.
You really need to address the sleep issue--no one can be in a decent mood if they're that sleep deprived. That's so important to focus on-- even if you've have long-term problems with it!
Jost
Posted by cecilia on June 8, 2006, at 3:18:21
In reply to Re: Emsan-Day 30 » cecilia, posted by RobertDavid on June 7, 2006, at 22:36:50
Some people are finding that a small dose works and that's great, but since for me it hasn't, taking it off at night or cutting it in half doesn't make sense. The 6 mg patch is designed to release 6 mg in 24 hours-if you take it off for 8 hours you're only getting a 4 mg dose, and that's assuming you can pull yourself out of bed and put the new patch on in exactly 8 hours, even if you've only slept 2. Which is part of my problem, what the docs like to call poor sleep hygiene, sounds like you don't wash your sheets but really meaning I need to set 3 alarm clocks and force myself out of bed at a set hour whether I've slept or not. Which I just can't make myself do when I don't have to, because there's nothing I have the slightest desire to get up for and I know that even if I've only slept 2 hours I'll still have the insomnia again the next night-it seems to make no difference whether I've slept 2 hours or 12. I actually do take clonazepam, but I'm really not convinced it does anything at all. I've had insomnia since childhood, so it's nothing new. Ambien helps some, temazepam not as much, overhyped Lunesta not at all. Cecilia
Posted by cecilia on June 8, 2006, at 6:21:09
In reply to Re: Emsan-Day 30, posted by cecilia on June 8, 2006, at 3:18:21
Also re taking the patch off at night, someone asked in another thread if due to the med's short half life, wouldn't this be like starting from scratch every morning instead of building up to a therapeutic level? I wondered about that too. Though it can't really have that short a half life, because the 9mg/24 hr package insert says to wait 2 weeks after stopping the med before resuming a normal diet. Surely it would take much less time than that to get blood levels down equivalent to the 6mg/24hr. dose, but I suppose the FDA is just being conservative.
Also, anyone else have the dry eye problem? I hate it. I'm using Thera-tears eye drops many time a day.
Anyway tomorrow (well technically today as it's 4 am), up to the 9mg patch. If I can't stand it I can always trim it. That still seems better than having none in your system for such a long time every night. Maybe I could try that once after a few days on the bigger patch, though It's not like I'm going to fall asleep as soon as I rip off the patch, I still lie awake for many hours when the only psych meds I'm taking are sleeping pills and clonazepam, no AD's. It seems like you'd have to rip it off hours before bedtime for the lower level to have even the slightest effect on your sleep. Cecilia
Posted by pulse on June 8, 2006, at 8:06:42
In reply to Re: Emsan-Day 30, posted by cecilia on June 7, 2006, at 7:57:20
unbelievable! i too am not really hungry, but feel both compelled to eat and to keep going back to the computer.
the only up side to this, WAS, that after having had 2 severe traumas, 3 serious physical illnesses, and sky-rocking anxiety, such as i'd not had in 25 yrs. - i'd ALREADY lost 50 pounds, almost all prior to emsam. at first, the weight loss was such a relief and depression-buster, but now the problem is: i only needed to lose 25-30 of those pounds. i look much too gaunt, depleted, and unhealthy. fyi: years ago i put myself into an eating disorder tx center - their conclusion was that i did NOT have anorexia, 'just' typical depression weight loss. my therapist and i both now agree with them. but, i'm no longer depressed. sheesh...
emsam has a mean weight loss of 1.2 pounds per month. add that up & we're talking around 15 pounds loss per year.
the eating has not put any weight on me at all. i'm fast approaching the point where this is a real heath concern, and i have no idea how to solve, as i've finally had to acknowledge that i'm lactose intolerant. fatty foods also risky for me - ibs-c. then, add in summer and only wanting cold foods. ach...what to do? at least, if i'd needed a high dose of emsam, i was already not eating any restricted foods, but no way i'll ever need more than 1/4 - 3/8 of the lowest dose patch.
even when one finally finds a solution to their depression and anxiety, always seems some big wrench gets thrown in, eh?
i'll stick with emsam, because there is nothing else left for me.
regards,
pulse
Posted by pulse on June 8, 2006, at 8:27:11
In reply to Re: Emsan-Day 30, posted by cecilia on June 8, 2006, at 6:21:09
so sorry - thinking too much of myself. i'm with you & robert david re: your insomnia. no way are you going to feel well with this little sleep. i also agree with you that lunesta was over-hyped and is useless.
i didn't yet see that post re: small pieces of patch, like i'm doing very well on, being like starting all over each day - and no way to reach a therapuetic level. well, i've already reached a therapeutic level, by doing it just this way.
i'll reiterate that emsam, imo, seems for many to be a very tricky med, requiring the patience of job, and, also perhaps much trial and error....and experimenting. (and it was supposed to be so ULTRA easy!)
my best regards,
pulse
Posted by cecilia on June 8, 2006, at 8:44:44
In reply to Re: Emsan-Day 30 » cecilia, posted by pulse on June 8, 2006, at 8:06:42
Emsam has a mean weight loss of 1.2 lbs a month? Unbelievable-I'll be gaining that much a day if I can't stop the nighttime eating, and believe me, I DON'T need to gain!!! 6:40 am-still up. The thing is, I was suspicious of Emsam before I even started because I knew it was only tested on people with depression and no anxiety-a rare, highly selected group with probably purely biological depression. Yet some of the people at Psychobabble who have had luck with Emsam have been those with primarily social anxiety. I have plenty of social anxiety, but I've never understood in the least how any med can actually help with that-even if it somehow makes you less inhibited, so what, it doesn't change your basic personality, if people don't like you they'll like you even less and you'll have more things to hate yourself about. Just my insomniac rantings..... Cecilia
Posted by cecilia on June 8, 2006, at 9:05:17
In reply to Re: Emsan-Day 30 » cecilia, posted by pulse on June 8, 2006, at 8:27:11
And maybe I really do just need a smaller dose, my HMO approved me for a 3 month trial and since it comes in 30 patch boxes I was originally planning a month of 20 mg, a month of 30 and a month of 40, but if I can't stand the 30 (9mg/24 hr) I'll cut it in half and then in quarters and see what that does. I mean I know it isn't going to work, I've tried everything, I don't have a biological depression that comes in episodes, I have an anxious neurotic depressive personality that I've had since preschool. I've failed therapy, I've failed rTMS, I've failed at least 30 meds, I've failed life. But how do you keep going at all without the hope of the magic
pill or the magic patch? Cecilia
Posted by cecilia on June 8, 2006, at 9:42:09
In reply to Re: Emsan-Day 30 » cecilia, posted by pulse on June 8, 2006, at 8:27:11
Pulse, I don't think that using small pieces of patch would be a problem if that's the therapeutic level a person needs. It's the taking it off altogether that makes me wonder, since it's supposed to be a continuous flow of med into your system. But who know, there's not one single researcher who has any clue how ANY antidepressant works. Maybe an on off system would jolt some neurotransmitter. I wonder if the Emsam people did any research at all into the way real people are using the patch-cutting patches, on-off etc, instead of the way they say in their instructions. I bet not. Of course it was the same with Cymbalta-it sure didn't take long before people were counting out beads instead of swallowing the whole capsule as instructed Cecilia
Posted by pulse on June 8, 2006, at 10:06:27
In reply to Re: Emsan-Day 30, posted by cecilia on June 8, 2006, at 9:05:17
i didn't know before reading here that emsam had been tested on this RARE group with depression only. now, i'm suspicious, too, as i've never known, nor even heard, of one single person with only depression.
quite understandibly, with the way you're feeling, you're being pretty hard on yourself re: your personality. you don't state that you've ever been dxed with a personality disorder, however. if, for instance, you did happen to also have borderline pd, i'd strongly suggest therapy, WAY before ANY meds, but only if it was Dialectical Behavioral Therapy.... that's for sure.
i can't relate to sp at all, so can't respond - except to agree that many sp-ers here are seemingly having success with emsam for that. i agree that one can't change their basic nature, but i don't see that sp folks would be considered unlikeable.
yes, emsam has a 1.2 pound per month weight loss. i'm also doing some night-time eating, but mostly just dry cereal - carbs to help a little with the much lesser than before insomnia... that i still have.
another thing as a possibility for your insomnia: did you see the posts talking about releasing - by december - the 1, 3, and 6 mg. doxepin/ sinequan ...just for sleep? i have a compounding pharmacy available and 1 refill left of sinequan, and they've agreed to do (at first) a few 1 mgs. for me. not that any real compounding is necessary, i guess - just extracting an accurate 1 mg. and putting it in a plain capsule. no way i could do that myself - i've sorta tried...no dice. i figure/ hope 1 mg. can't give me constipation and reflux, although with my guts, who knows?
for 25 yrs, all pdocs have really pushed that my mdd was 100% endogenous. my therapist has finally felt it was time that i could accept that, no, quite abit of it is from the fact that i have a severely narcissistic personality disordered father; then, of course, i gravitated to same or similar men in adult life - even when i was SO sure they were the exact 'opposite.'...and not 1 second older than me. so it goes. things are getting better for me re: this bit also. it can be very devastating. out of the 4 clients she has with dad's like mine, i am 1 of 2 who has never made an active suicide attempt.
pulse
Posted by pulse on June 8, 2006, at 10:15:04
In reply to Re: Emsan-Day 30, posted by cecilia on June 8, 2006, at 9:42:09
welp, i'm cutting it AND taking the patch off, after 4 hrs. - tops.
it's working for me so well i can't believe it. granted, it's still fairly early in this 5th attempt of mine, but, before, the longest i could tolerate the patch was 4 days!
pulse
Posted by Last Chance on June 8, 2006, at 12:23:40
In reply to Re: Emsan-Day 30, posted by pulse on June 8, 2006, at 10:15:04
Hi - yes the patch seems very tricky to find out what works - I still haven't. I am on day 12? Started with 1/2 patch 24 hr's. Not so bad, a bit more anxiety, more difficulty sleeping. Then I put on the whole patch 6mg and had a very energetic, and happy? day accomplishing a lot here on the farm - I did not interact socially, just stayed at home. That night could not sleep and was going nuts with anxiety, so I ripped off the patch at 2 or 3 in the morning. 2 hr's sleep that night and a very depressed next day. I have upped my Klonapin to .5mg per day, and yesterday I did 2/3 of a 6mg and took off 2 hrs. before bedtime - I slept pretty normally. Yes I posted once before I didn't see how one could keep a constant level and get to a therapeudic dose by taking off - seem's like the answer to that is still not clear. I am not sure what approach I will take today? maybe the whole thing and take off before bed? SP has been my major problem my whole life as far back as I can remember, and the depression has crept in the last 20+ years and progressively gotten worse. Richard
Posted by RobertDavid on June 8, 2006, at 12:31:21
In reply to Re: Emsan-Day 30, posted by Last Chance on June 8, 2006, at 12:23:40
Richard:
Have you considered going up on klonopin? That is one of the most effective meds for SP. EMSAM may help some for increasing mood/sociablity, but I feel it's primary benefit is for depression. I take 2mgs of klonopin and it knocks out SP. Until I got to a high enough dose it just gave minor anxiety relief. That said, the blend of klonopin and EMSAM has been the answer for me, but without klonopin, I doubt I'd be able to leave the house and work. Just a thought.
Posted by RobertDavid on June 8, 2006, at 13:05:22
In reply to Re: Emsan-Day 30, posted by pulse on June 8, 2006, at 10:15:04
It would appear, like most meds, it's trial and error with EMSAM. Some particularly with depression will be fine with the patch 24/7, some don't need and can't tolerate the 20mg patch and less will work best. Only option there is cutting the patch which Dr. Bodkin has indicated is okay to do.
Perhaps some will cut it in quarters. Some may just wear it in the day. I believe even if you just wear it in the day you will still have selegiline in your body as it takes 14 days to wash out, but you'll get less streamining into you're system at night which in my personal experimentation has worked.
Overall I'd think that would just mean you're at a slightly lower dose than the full patch dose, that you won't lose all theraputic benefits by taking it off. Perhpas some will want a higher dose say a 30 mgs patch in the day, and will take that off before bedtime to help with sleep while keeping a slightly higher dose during the day.
Also, so many of us know it's the blend of other meds that's the solution. I agree that the simplistic thinking that you just put it on and and you'll be fine is unrealistic for many, but for some that will work okay. For those that have had no success with other meds, playing with EMSAM dose, tweeking it, cutting it, taking it off at night, trying various techniques will be needed.
With pills, you can easily cut them in half, quarters, do multiple dosing. With the patch, the only way to do that is to cut it and take it on and off. For me, one with SP as a primary issue, I believe it's just helpful as a blend with 2mgs of klonopin.
I think it's klonopin that knocks out my SP and EMSAM gives me the energy and mood elivation (which helps me be more social). Klonopin alone was not the answer nor would EMSAM alone be. Just some food for thought.
Posted by Last Chance on June 8, 2006, at 19:14:54
In reply to Re: Emsan-Day 30, posted by RobertDavid on June 8, 2006, at 13:05:22
Rob, hi - I know you have been taking the klonapin for 12 years - now with Emsam do you still have some tired times during the day, lethargy? I drink a cup of coffee in the morning and one in the afternoon, and still have times with no energy. I realize this could be my depression, so I am concerned that more Klonopin will make me more drowsy. My .5 mg is already 4 times what I have been taking for the last 2 months. Thanx, Richard
Posted by RobertDavid on June 8, 2006, at 21:12:37
In reply to Re: Emsan-Day 30 » RobertDavid, posted by Last Chance on June 8, 2006, at 19:14:54
> Rob, hi - I know you have been taking the klonapin for 12 years - now with Emsam do you still have some tired times during the day, lethargy? I drink a cup of coffee in the morning and one in the afternoon, and still have times with no energy. I realize this could be my depression, so I am concerned that more Klonopin will make me more drowsy. My .5 mg is already 4 times what I have been taking for the last 2 months. Thanx, Richard
Richard:
I am taking 2mgs of klonopin every night. I didn't start there. As I recall I started at .5 for about a week. During that time I was wiped out, tired, some anxiety relief, but just no energy. Didn't think klonopin was right for me. But I was paying big bucks to see a Dr. that was supposed to be an expert on anxiety disorters and decided I would do my best to hang in there as long as I could on any trial he put me on. I had a tendancy before to bail quickly on med trials, but looking back did have some quacky doctors giving me the wrong meds and advise.
He soon recognized that I was very sensitive to meds, I can feel everything, am one of those that never could get up high enough on meds for them to work (or to see if they would work) because my side effects were terrible even at baby doses.
So after a week about a week he brought me slowly up in .25mg increments and as I recall I stayed at 1mg for about a month. The increased sedation which was my primary side effect of klonopin improved typically after about 2 weeks with each increase in dose. So I found myself feeling better, more social, less anxiety, but not where I wanted to be. My doctor wanted me to be close to 100% and taught me that there is "normal anxiety" in everyday living, to exect that. I/we just wanted to get rid of the SAD and GAD disorter part and he assured me in time the sedation would most likely disapear, but not the anxiety benefits. That did turn out to be the case.
Utimately the sedation and most of the mental foggyness went away, I was functioning better, but again, not quite where I wanted to be. Long story long, I moved all the way up to 3mgs, stayed there for a month. Things improved socially and I was feeling like I had never felt before, but unlike my past dose increases some of the sedation that typically went away was staying.
So I slowly dropped down and found 2mgs was the majic number for me. It took me about a year to figure that out. I've been there since and without giving you boaring details of my life, klonopin single handedly wiped out just about all my social anxiety. In fact, I had no quality of life before it, couldn't leave the house, now own a business and employ others.
Lastly, to reduce daytime sedation my doctor advised me only to take klonopin at night and suggested that with it's long half life it would give me anxiety coverage through the day, particularly once I had been taking it a while since blood levels would build up. I believe many that take klonopin in split doses should try taking the full dose at night (unless used as needed). Problem is that they try it and judge the results after only a few days, feel out of it and quit. It takes a week or more for you to get adjusted to it.
Also, for a while, the night dose will help to sleep, though in time sedation should improve concerably and I don't really think it is a factor to help me sleep any more. I used to pray that I would never have an emergency at night thinking I would be so out of it from taking all the klonopin at night, like a walking zombie, but I found that not to be the case at all. I'm in no way drugged if I have to get up during the night.
So if you're asking my opinion on why your so much more sedated now and what to do about it I'd suggest hang in there another week or two and suspect that a lot of your sedation will disapear, particularly with such a small dose. If you're taking klonopin for social anxiety then you have to find a theraputic dose or you will think the med isn't working. Most seem to end up somewhere between 1 and 4mgs if they take it for SAD and or GAD. Like other meds, you just have to deal with side effects for an initial period. For me, the majority of the out of it feeling went away and by far out weighed the benefit I was getting from anxiety relief.
Though everyone is different, EMSAM should help with energy particularly as you adjust to higher doses of klonopin. I tried to take coffee with klonopin to help with what I call the initial sedation period and some lingering sedation, but I'm so fricking sensitive that coffee makes feel amped for a few hours, then I crash and feel extreamly anxious, swear I'll never do it again.
Before EMSAM the best solution I found when I wanted some additional energy was to take a small dose of provigil (25 to 50mgs) which can be taken on a prn basis, just as needed, works day 1.
One last thing. Sleeping. If I don't sleep, it doesn't matter what I'm taking, doing, eating, work out activities, I feel tired and like crap. So I do everything I can to get sleep, as much as possible.
Anyway, I'd really consider staying at your .5mg dose for a little strech, say a week or two more and see if you're sedation improves. If it does, I'd keep going up in .25 increments until you feel the full benefit of it. It's some work and I understand just how you feel as I once did at the .5mg dose, but would hope like me, in time, you'll adjust and your world will open up (I'm assuming you're dealing primarily with anxiety and secondarily with depression).
I would be okay if I was on klonopin alone. Life would be fine. What I got from EMSAM was just the extra energy and mental clarity, treatment of a lifetime of mild depression. It's the blend that really fine tuned things.
All that said, if I had to give one up, I'd give up EMSAM. Sorry to rattle on, hope some of this is of help to you.......Rob
Posted by Jakeman on June 8, 2006, at 21:20:33
In reply to Emsan-Day 30, posted by cecilia on June 7, 2006, at 6:27:10
Hi Cecilia,
I appreciate your reports because I don't know where I'm going either with this drug. I don't have any recommedations, I just wanted to throw out some comments. It being a new drug (at least a new delivery method) I have the impression that most doctors are reluctant to recommend anything outside the manufacturer's instructions. Fortunately there is a lot of data out there about selegiline and possible augmention strategies. I think that's where we are headed eventually. There are some studies that show that l-phenylaline enhances the effect. I've had good results with combining it with Lyrica to help with sleep and anxiety. Benzos have been helpful for some people. I think we are the guinea pigs in a way. I imagine pyschiatrists and pharma reps are looking at these anecdotal reports with a lot of interest.
I also wanted to mention that I have not found Lunesta to be useless as some have mentioned. My sleep doctor has me cycling back and forth between Restoril and Lunesta. As I mentioned in a thread above, I've also benefited from taurine and tryptophan.
best of luck and warm regards, Jake
Posted by rustynail on June 9, 2006, at 7:57:02
In reply to Re: Emsan-Day 30 » cecilia, posted by Jakeman on June 8, 2006, at 21:20:33
Probably one of the biggest mistake we make in trying to adjust our meds is thinking that the dose it too low, or in this case the delivery method is not working. I dont have the luxury of trying Emsan in Australia, but i have tried nicotine patches.( They have a pretty full on way of delivering nicotine to the blood) Currently I am on Selegiline 5 mgs reduced from 15 and then 10. Less is more with this drug I am convinced. I built up from 1.25 mg to 15 mg over 2 weeks. Being very particular on watching side effects. This drug is my last hope. I have had severe insomnia all my life. Before I started to take Selegiline I was at the bottom of the bottom ready to give up. By increasing to 15 mg, one dose in the morning I was anxious in the evening and could not sleep even with Tamazapam which works well for me.I experimented with the dose and stopped cold turkey for 2 days( with side effects, dissorientation and mood swings) then went to 10MG. All the time keeping an open mind but secretly hoping the tuning I was doing was working. I had dry eyes yes.. red eyes yes for some reason??? Anyway I used the drug and decided 5 mg was a good level to keep the anxiety and the insomnia on an acceptable level.Not saying there is no anxiety but it is defiantley better and tolerable. I take tamaz every 3rd night and it definatley affects the reaction for the next day. I thought about benzo for the anxiety but I think that would defeat the purpose.The main reason I take this drug is to enable a general level of functionality and while there is not a complete feeling of wellbeing it has enbled me to function. I have learned to live with this illness and sometimes I just accept that some functionality is better than none at all. I think this is a very powerful drug and it should be treated with caution. I feel about as normal as I think I could. I also think the way the drug works is the secret and also believe that it take 4 to 8 weeks to change the chemicals in the brain. It could actually be a drug that could be used for a long term. Then again everyone is different but the other drugs that we take and even the food we eat will have some sort of effect on the outcome.
just my 2 cents worth...
Posted by cecilia on June 11, 2006, at 20:47:43
In reply to Re: Emsan-Day 30, posted by rustynail on June 9, 2006, at 7:57:02
30 days of the 20mg (6mg/24 h) patch, 3 days of the 30 mg (9mg/24h). I've given up any hope of being able to stand the 30 mg dose, or the 20 mg dose for that matter, but I just want to stick it out for 6 weeks on 20 mg just so I can tell myself I gave it a full try. I tried Robert David's trick last night, pulling off the 30 mg patch at 3:30 am and setting my alarm so I could put a new patch on at 11:30, so as to get equivalent to the 6mg/24 h. (16 hours of a 9mg/24h patch). Of course, I couldn't sleep, the stuff is still in your system, so I took an extra sleeping pill and finally got to sleep around 7:30, put the new patch on at 11:30. Taking it off before bedtime obviously isn't going to work, I'm sure it must take at least 8 hours before the blood level drops at all, there was certainly still plenty in my system when my alarm went off at 11;30. I might try taking it off 8 hours before bedtime, slapping on a new patch at bedtime along with a sleeping pill and see if that works. Then I'll try two thirds of a 30 mg patch 24 hours a day to see which way works best to get my 20 mg day, after that hopefully it'll be close enough to the 6 week mark so I can in good conscience start weaning off this lousy stuff, I'll go half a patch, 3rd of a patch, quarter of a patch etc until I'm done with this expensive box of 30 mg patches, searching along the way for any "less is more" moment when I feel less depressed, though I'm not sure how I'd know, I have no concept in my mind as to what not being depressed would feel like, though I know for sure I'll feel better once I get this horrible Emsam out of my system. It's just so discouraging, I just can't help getting my hopes up with each new med, even though I know perfectly well it's going to fail like everything else. Cecilia
Posted by Last Chance on June 12, 2006, at 11:03:56
In reply to Re: Emsan-Day 34, posted by cecilia on June 11, 2006, at 20:47:43
Cecilia - this is day 16? for me - I am having mixed and interesting results. I have been trying different dosing - it seems like really powerful stuff and at this time I cannot forsee taking more than the 20 but who knows. I have tried half patch 24 hrs - full patch 24 hrs., impossible to sleep - other combos. Now for 2 days I have been cutting a third off, putting the 2/3 on one side of my chest just below the collar bone, and the other 1/3 on opposite side. About 3 hrs. before I go to bed I remove the 2/3 and leave the 1/3 on overnight. Both nights I have slept about seven hrs., 6 without waking up - usually an impossibility for me. Good effects so far - I do feel a slight lessening of depression. It doesn't take me hrs. to wake up in the morning and I still have an expresso right away and another in the afternoon - addicted to coffee. I definitely have more focus to complete tasks, even starting them - that also has been next to impossible. More social, conversational, but with anxiety. Worst thing - I have these periods of being highly irritable - cat meows and I want to kill her. This jumpy, extremely negative anxiety has happened several times, and that is kind of scary. Road rage at that time would be really bad. Dry eyes, but not so bad that I have done anything about it. I take .25 Klonapin in the morning and evening. So I will keep trying this method for awhile and see if I stable out. Slight rise in blood pressure, also. So not bad enough to quit, and not good enough to feel like I have found the one. Richard
Posted by RobertDavid on June 12, 2006, at 12:39:20
In reply to Re: Emsan-Day 34 » cecilia, posted by Last Chance on June 12, 2006, at 11:03:56
Richard:
Perhaps you could try going up slightly on your bedtime klonopin dose to ease the agitation. Just a thought.
Posted by Donna Louise on June 12, 2006, at 20:49:16
In reply to Re: Emsan-Day 34 » cecilia, posted by Last Chance on June 12, 2006, at 11:03:56
> Cecilia - this is day 16? for me - I am having mixed and interesting results. I have been trying different dosing - it seems like really powerful stuff and at this time I cannot forsee taking more than the 20 but who knows. I have tried half patch 24 hrs - full patch 24 hrs., impossible to sleep - other combos. Now for 2 days I have been cutting a third off, putting the 2/3 on one side of my chest just below the collar bone, and the other 1/3 on opposite side. About 3 hrs. before I go to bed I remove the 2/3 and leave the 1/3 on overnight. Both nights I have slept about seven hrs., 6 without waking up - usually an impossibility for me. Good effects so far - I do feel a slight lessening of depression. It doesn't take me hrs. to wake up in the morning and I still have an expresso right away and another in the afternoon - addicted to coffee. I definitely have more focus to complete tasks, even starting them - that also has been next to impossible. More social, conversational, but with anxiety. Worst thing - I have these periods of being highly irritable - cat meows and I want to kill her. This jumpy, extremely negative anxiety has happened several times, and that is kind of scary. Road rage at that time would be really bad. Dry eyes, but not so bad that I have done anything about it. I take .25 Klonapin in the morning and evening. So I will keep trying this method for awhile and see if I stable out. Slight rise in blood pressure, also. So not bad enough to quit, and not good enough to feel like I have found the one. Richard
That is my chief complaint to, the hyper, jumpy easily agitated irritability. The thing is, I have this without medicine so I can't blame the patch, I think since it doesn't numb me out like the other drugs do, I still have my emotions. I just don't like this one at all. I have lost track how long I have been on. I think 4 weeks at 6mg and 2 weeks at 9mg. I forget about food restrictions so I haven't followed any diet although I don't eat much of anything on the bad food list anyway. I felt like I was still depressed on 6mg and I feel better on 9. I don't feel as wonderful as I did the first couple of weeks but I always feel wonderful when I first go off a drug and I had just gotten off effexor. Overall though, I love having some energy, and it is helping with both the depression and anxiety, I like it better than other all the others. I also continue to take klonopin and provigil as I think they help too. But sometimes I feel afraid and desperate because I expected to feel 100% and I don't. I see the pdoc Wed. I wonder if she is thinking lamictal like I am.
Donna
Posted by Jakeman on June 12, 2006, at 23:34:03
In reply to Re: Emsan-Day 34 » Last Chance, posted by Donna Louise on June 12, 2006, at 20:49:16
Donna,
I saw my dr. today and she mentioned the possibility of adding lamictal. But we decided to hold off until I see my sleep doctor who has me a a low dose of Lyrica...and get his opinion about maybe raising it. She also mentioned that Seroquel might be an option for sleep if it insomnia is a major problem.
I feel that Emsam has pulled me from the depths of a major depression. I tend to have an agitated depression...some of the side effects are troubling but more of just a nuisance at this point. I'm just so glad to have to some energy. Maybe I do need to get mad at times. My therapist seems to think that I much less respressed. It has not blunted my sex drive or emotions. I'm just riding the wave for now. I'm going with it for now, but I may change for whatever helps me. A work in progress? I appreciate your posts
good luck, Jake
> That is my chief complaint to, the hyper, jumpy easily agitated irritability. The thing is, I have this without medicine so I can't blame the patch, I think since it doesn't numb me out like the other drugs do, I still have my emotions. I just don't like this one at all. I have lost track how long I have been on. I think 4 weeks at 6mg and 2 weeks at 9mg. I forget about food restrictions so I haven't followed any diet although I don't eat much of anything on the bad food list anyway. I felt like I was still depressed on 6mg and I feel better on 9. I don't feel as wonderful as I did the first couple of weeks but I always feel wonderful when I first go off a drug and I had just gotten off effexor. Overall though, I love having some energy, and it is helping with both the depression and anxiety, I like it better than other all the others. I also continue to take klonopin and provigil as I think they help too. But sometimes I feel afraid and desperate because I expected to feel 100% and I don't. I see the pdoc Wed. I wonder if she is thinking lamictal like I am.
>
> Donna
>
>
Posted by cecilia on June 13, 2006, at 0:25:30
In reply to Re: Emsan-Day 34 » Donna Louise, posted by Jakeman on June 12, 2006, at 23:34:03
Well, I'm still experimenting-yesterday I cut off half the patch at bedtime and then put on a whole new patch when I got up. The Emsam folks would have a cow if they knew how many of us are experimenting with cutting patches when their drug insert says not to. (Of course I'm sure the main reason they wrote that was because they definitely don't want people saving money by cutting 40 mg patches in half to get a 2 month supply for the price of one.) All the Emsam reps reading this-we're depressed, not dumb!Emsam definitely makes me irritable, but how do you determine if that's an effect of the drug itself or the lack of sleep it causes? Cecilia
Posted by Jakeman on June 13, 2006, at 0:42:01
In reply to Re: Emsan-Day 35, posted by cecilia on June 13, 2006, at 0:25:30
> Well, I'm still experimenting-yesterday I cut off half the patch at bedtime and then put on a whole new patch when I got up. The Emsam folks would have a cow if they knew how many of us are experimenting with cutting patches when their drug insert says not to. (Of course I'm sure the main reason they wrote that was because they definitely don't want people saving money by cutting 40 mg patches in half to get a 2 month supply for the price of one.) All the Emsam reps reading this-we're depressed, not dumb!Emsam definitely makes me irritable, but how do you determine if that's an effect of the drug itself or the lack of sleep it causes? Cecilia
I don't know. Lack of sleep does not cause me irritiblity so much. I feel dumbed down, in slow motion. I suspect the irritabilty effect may relate to increased dopamine. I feel stuff like: Go ahead, get with it, Your're wasting my time. Plus increased libido.
~Jake
Posted by Donna Louise on June 13, 2006, at 12:02:46
In reply to Re: Emsan-Day 34 » Donna Louise, posted by Jakeman on June 12, 2006, at 23:34:03
.> Donna,
>
> I saw my dr. today and she mentioned the possibility of adding lamictal. But we decided to hold off until I see my sleep doctor who has me a a low dose of Lyrica...and get his opinion about maybe raising it. She also mentioned that Seroquel might be an option for sleep if it insomnia is a major problem..
depression. I tend to have an agitated depression...some of the side effects are troubling but more of just a nuisance at this point. I'm just so glad to have to some energy. Maybe I do need to get mad at times. My therapist seems to think that I much less respressed. It has not blunted my sex drive or emotions. I'm just riding the wave for now. I'm going with it for now, but I may change for whatever helps me. A work in progress? I appreciate your posts
>
> good luck, Jake
>
>
> > That is my chief complaint to, the hyper, jumpy easily agitated irritability. The thing is, I have this without medicine so I can't blame the patch, I think since it doesn't numb me out like the other drugs do, I still have my emotions. I just don't like this one at all. I have lost track how long I have been on. I think 4 weeks at 6mg and 2 weeks at 9mg. I forget about food restrictions so I haven't followed any diet although I don't eat much of anything on the bad food list anyway. I felt like I was still depressed on 6mg and I feel better on 9. I don't feel as wonderful as I did the first couple of weeks but I always feel wonderful when I first go off a drug and I had just gotten off effexor. Overall though, I love having some energy, and it is helping with both the depression and anxiety, I like it better than other all the others. I also continue to take klonopin and provigil as I think they help too. But sometimes I feel afraid and desperate because I expected to feel 100% and I don't. I see the pdoc Wed. I wonder if she is thinking lamictal like I am.
> >
> > Donna
> >
> >
>
>Damn, I just wrote this long post and lost it somehow. What did I say... oh, awhile back my pdoc suggested a microscopic dose of seroquil at bedtime for anxiety. I said no at the time, I was afraid of a neuroleptic. She thought if I took it at night the anti anxiety effects would last throughout the day. I think I would be a zombie throughout the day but maybe I should try it and I can always stop if I don't like it. I haven't had trouble sleeping but I am an oversleeper (like something from Seinfeld) but I have started taking .25mg klonopin at night since starting the patch and that may be helping, I used to just take the k during the day.
I definately agree that the dopamine is exagerating my irritability even though I have it anyway. I had expected it to help with my non existent libido but it hasn't and that is a huge disappointment.
I really appreciate your posts too, it is such a comfort to have folks in the same boat with me, not feeling alone.donna
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