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Dr. Bob is Robert Hsiung, MD,
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Posted by jealibeanz on June 19, 2006, at 4:13:14
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Phillipa on May 27, 2006, at 19:38:11
Are there any updates to this question?
Posted by Donna Louise on June 19, 2006, at 6:41:58
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 19, 2006, at 4:13:14
> Are there any updates to this question?
I don't know about other's but mine is not pleased that my pdoc has put me on it. We had a little talk about it and it seems the problem is he is afraid he will prescribe something that is contraindicated and that I will get sick or die. I told him that I know what I can take, I made it my business to know as I don't expect any other dr.'s to know. For example, he didn't know that demeral is a big no-no. Which scared him. I said but I know it. But I guess most of the patients won't know and neither does he. I told my husband if he wants to try the patch he will need to see my pdoc. I think most family dr.'s are mostly comfortable with just the sri's. At least they feel they can't kill us with those. I told him it was a shame that a milestone drug won't reach many due to ignorance on everyone's part.donna
Posted by jealibeanz on June 19, 2006, at 15:15:31
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 19, 2006, at 6:41:58
really? I'm a little surprised since there's been so much press about it.
Posted by jealibeanz on June 19, 2006, at 17:18:18
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 19, 2006, at 6:41:58
Really? Well that makes me a little discouraged and depressed. I like to think there's hope for my future. Possibly soon. There's no way I'm going to make it past August without help. :(
Posted by Donna Louise on June 19, 2006, at 17:31:03
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 19, 2006, at 17:18:18
> Really? Well that makes me a little discouraged and depressed. I like to think there's hope for my future. Possibly soon. There's no way I'm going to make it past August without help. :(
Oh please, don't let what I said discourage you from asking. That is just the attitude I have encountered and then generalized which may or may not be accurate. It sure doesn't hurt to ask and you could take info from the internet to help plead your case. You could assure hiim that you know which drugs are forbidden and that on the 6mg you don't even need to watch the diet. (I will be finding out it that is true for the 9mg as I suspect you don't need to watch diet on that dose either). Some people go to psychiatric nurse practioners who are usually pretty up to speed on things too. Do you have other dr.'s you could appeal to if your gp turns you down?donna
Posted by jealibeanz on June 19, 2006, at 20:49:24
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 19, 2006, at 17:31:03
Well, actually I was hoping he may have this idea on trying EMSAM on his own, since it's the newest antidepressant to be released. Apparently it may not be terribly attractibe to doctors?
I do think it could possibly help. I'm mood reactive... happy when around happy people and encouraged by others. The second I'm by myself (like even stepping away into the bathroom!) I want to cry. I'm afraid to mention the crying part though, because that may suggest serotonin deficits, right? I don't think I cry because of that. I cry because I know I am unhappy and let my guard down when alone.
Posted by lisa67 on June 20, 2006, at 11:45:36
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 19, 2006, at 20:49:24
My GYN.. prescribed Emsam for me. She was going to put me on an SSRI but I told her my neg. experiences with all SSRI's. I then told HER about Emsam. She had never heard of it but investigated it on her own. She decided it might be worth a try. I pick up my RX soon, had to be ordered. She is making me come in every 2 weeks to have my blood pressure checked. I will be cutting the patch in quarters due to the advice here and removing it at bedtime. So thanks to all for good advice.
Posted by jealibeanz on June 20, 2006, at 12:32:00
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by lisa67 on June 20, 2006, at 11:45:36
Let me know how it goes. What were your experiences with SSRI's? Reactions? Why did you think EMSAM would be a good choice?
My doc's a DO. Aren't they usually in to natural choices? Actually he's pretty prescription happy! Haha! He'll give me a nonstop supply of Xanax or Klonopin. I used to work as a pharm tech. Half the prescripition in the city for Zoloft came from him (at least 30 docs). I hope he reads up! But I reallllly don't know. I'm sure they play it very safe.
In the past I actually have suggested medications, but now that I'm in PA school, I'm not going try to act like I know what I'm talk about! I know no more about pharmacology than I did before, but now I just feel a little awkward.
Posted by Donna Louise on June 20, 2006, at 13:00:14
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 19, 2006, at 20:49:24
> Well, actually I was hoping he may have this idea on trying EMSAM on his own, since it's the newest antidepressant to be released. Apparently it may not be terribly attractibe to doctors?
>
> I do think it could possibly help. I'm mood reactive... happy when around happy people and encouraged by others. The second I'm by myself (like even stepping away into the bathroom!) I want to cry. I'm afraid to mention the crying part though, because that may suggest serotonin deficits, right? I don't think I cry because of that. I cry because I know I am unhappy and let my guard down when alone.The crying thing just means you are sad or grief stricken or depressed. EMSAM effects all the monoamines, seratonin, norepinephrine, dopamine. So it is not a negative to let him know how you are feeling. On the contrary, it may indicate to him your need for an intervention. If you don't want to take an sri or have had bad experiences with them, just tell him that. And tell him you want to try EMSAM. Nothing to fear here. And there is nothing about "acting" like you know something when you do know something. That is not acting. A good dr. is not put off by an informed patient.
I wish you the best of luck and courage, you can take care of yourself!donna
Posted by jealibeanz on June 20, 2006, at 13:14:16
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 20, 2006, at 13:00:14
I know there's nothing wrong with being an informed patient, but there are just so many sensitive and personal issues when dealing with anxiety and depression. It makes it so much harder to be assertive with symptoms and treatment.
I thought EMSAM doesn't have anything to do with SE at the doses currently available, only at very high amounts. I'm put off by serotonin because I suspect that it may have something to do with the weight gain side effect. I know that it has been reported on EMSAM, but it wasn't reported on Wellbutrin, which made me gain quite a bit. I am completely clueless as to how/why it actually occurs. Does it have something to due with the liver? stomach? brain? metabolism? I just don't get it!
Posted by Donna Louise on June 20, 2006, at 13:46:22
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 20, 2006, at 13:14:16
> I know there's nothing wrong with being an informed patient, but there are just so many sensitive and personal issues when dealing with anxiety and depression. It makes it so much harder to be assertive with symptoms and treatment.
>
> I thought EMSAM doesn't have anything to do with SE at the doses currently available, only at very high amounts. I'm put off by serotonin because I suspect that it may have something to do with the weight gain side effect. I know that it has been reported on EMSAM, but it wasn't reported on Wellbutrin, which made me gain quite a bit. I am completely clueless as to how/why it actually occurs. Does it have something to due with the liver? stomach? brain? metabolism? I just don't get it!
>
>I am rife with anxiety and depression. I know exactly how it feels. (Currently I am not as the EMSAM is working for me.) So I do understand it is hard to be assertive but you can do it.
It is confusing about the EMSAM dosage. It says 6mg but that is not the same as 6mg orally as the transdermal delivery system skips first pass metabolism, 20 mg worth (or there abouts) actually gets in the blood stream. Orally, it is metabolized much more in the liver and therefore you have lower levels of the parent compound (selegiline) and much higher levels of amphetamine metabolites. They have a diagram of it in the info sheet that comes with the rx, on line too.
So, the 6mg patch actually delivers an amount that is no longer MAO-B selective. It does catabolize MAO-A too which allows higher levels of seratonin. But I do not believe there is much of chance of weight gain on EMSAM although anything is possible. Someone reported an actual statistical weight loss.
Hope that is not just more confusing.donna
Posted by jealibeanz on June 20, 2006, at 17:16:28
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 20, 2006, at 13:46:22
Donna, what dose are you on? How long have you been on it? What else have you tried? Are you on anything else?
It's strange that something that is stimulating for some can control anxiety for others. I'd really like to find something longterm. I don't like the idea of continuous Xanax and I have always had recurrent depressions.
I thought that the 6 mg was supposed to be MAOI B selective, 9 mg was questionable, and 12 mg was both MAOI A and B. I can't remember where I read that. I could be wrong. The literature could be wrong to for that matter!
Posted by jealibeanz on June 20, 2006, at 17:20:21
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 20, 2006, at 13:14:16
Does anyone know the answer to this question?
Posted by Donna Louise on June 20, 2006, at 18:39:34
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 20, 2006, at 17:20:21
> Does anyone know the answer to this question?
I was hoping what I wrote earlier about the difference between oral and transdermal delivery and skipping first pass metabolism so that more of the parent drug (selegiline) enters the blood, would answer that question for you. What is 6mg orally is about 20mg transdermally. I don't know how else to say it. Anyone else able to explain it better? Help.
I take the 9mg patch which is equal to about 30mg of actual selegiline due to the bypass of metabolism in the liver the first time around. I took 6 mg for about 4 weeks and have been on 9 for about 4 weeks I think. I am much better on the 9mg. It is a stimulating drug due to the increased norepinephrine and dopamine levels and also in part by the amphetamine metabolites (although these are much less because there is less metabolism in the liver to create them. More parent compound, less metabolites with the transdermal system. The increase in serotonin helps the anxiety. But because I have ALOT of anxiety I also take klonopin .25 twice a day and either .25 or .5 at night before bed. I take 100mg provigil twice a day which is half the dose I took before the patch. I find it mood elevating and socially enhancing. I just added lamictal, I am only at 25 mg but it has from the get go made a huge difference in my irritability. That may be all the higher dose I need to take. That is all. I am feeling better than I have in a long time. I have taken all the sri's, wellbutrin, strattera, buspar, I can't remember what all. No TCA;s and this is my first MAOI. I will not go back to those others again.
I hope you can get a med or combo of meds that works for you.donna
Posted by jealibeanz on June 20, 2006, at 21:41:37
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 20, 2006, at 18:39:34
It really does seem worthy of a trial for me. I was worried that it would be negated since I've taken, actually still take, Straterra, which is a NE and DA reuptake inhibitor. This does help with my concentration, but not so much with the depression. It probably does with the motivation to a small degree. I keep trucking myself through life (a very challeging one , academically and socially, at that!)when I'd love to sleep all day, avoid people, and never work a day in my life. I'm miserable, but try to hid it to further myself.
Did you ever have problems with insomnia previously to EMSAM or with EMSAM? I've dealt with it for the past year and take Lunesta. I had a 2 week period when starting Straterra where I couldn't sleep. How did the SSRI's, SNRI's affect you (depression/anxity relief, weight, apathy, motivation, nausea)? Do you have any noticeable side affects with EMSAM? Is this the best you've ever felt?
Posted by Donna Louise on June 20, 2006, at 22:17:59
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 20, 2006, at 21:41:37
> It really does seem worthy of a trial for me. I was worried that it would be negated since I've taken, actually still take, Straterra, which is a NE and DA reuptake inhibitor. This does help with my concentration, but not so much with the depression. It probably does with the motivation to a small degree. I keep trucking myself through life (a very challeging one , academically and socially, at that!)when I'd love to sleep all day, avoid people, and never work a day in my life. I'm miserable, but try to hid it to further myself.
>
> Did you ever have problems with insomnia previously to EMSAM or with EMSAM? I've dealt with it for the past year and take Lunesta. I had a 2 week period when starting Straterra where I couldn't sleep. How did the SSRI's, SNRI's affect you (depression/anxity relief, weight, apathy, motivation, nausea)? Do you have any noticeable side affects with EMSAM? Is this the best you've ever felt?Let's see if I can answer all the questions without forgetting one. First thing I want to say is that you can't take an MAOI with Strattera. You would have to do a week's washout before starting the patch.
I have always slept alot, never had problems there. I have not with EMSAM but I am the only one on the board that I know of that has not had problems with it. At first, I did not sleep as well as usual but now I do so I think it is something that you adjust to after awhile if you do get insomnia, and you hang in there, I think it may pass. I do take klonopin at night and that probably helps but I do sleep like a log. I feel like you do when I am depressed. Just want to sleep and avoid people and not work, can't work. When I first started taking ssri's in 1990, prozac worked great for me and later so did paxil. But when I quit paxil for sexual side effects and tried wellbutrin, I got almost psychotically paranoid. And when I tried going back to paxil it didn't work anymore. Before, I really had no side effects other than the sexual one. After the wellbutrin experiment, I had wait gain, apathy and anhedonia, very zombie like. Some weight gain but not that much. No nausea, I have a cast iron stomach. Stomach and sleep are my assets. I just felt depressed in a different way than before. Effexor was a little stimulating at first and then back to wanting to sleep all day and all night.
The only noticable side effect with I had with EMSAM was irritability but that has is not an issue any longer either because I went to 9mg and hence more serotonin effects for anxiety or because of the lamictal. Or both. Yes, this is the best I have felt maybe in my whole life. since I have always had anxiety and then later depression too.donna
Posted by Phillipa on June 20, 2006, at 23:15:46
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 20, 2006, at 22:17:59
I talked to Robert David tonight via E-mail. He is still doing great on the EMSAM. Still taking klonopin. And you you have problems remove the patch for sleep or cut it in pieces. It's working for him it can work for you too. Love Phillipa
Posted by ZeitGuest on June 20, 2006, at 23:30:08
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 20, 2006, at 22:17:59
> I have always slept alot, never had problems there. I have not with EMSAM but I am the only one on the board that I know of that has not had problems with it.
>I haven't had any insomnia problems on Emsam, either. I've been "patching it" for six and half weeks now. Since going from the 6mg patch to the 9mg patch last week, my irritability (the worst side effect) seems to be on the wane -- probably because of the 9mg patch's increased inhibition of MAO-A, which boosts serotonin levels. I do feel a bit less depressed than I did a week and a half ago, but I can't say the drug's effect has been dramatic. I tried a bit of Klonapin (.25mg a day) a few times last week. Taking it before bed did nothing for me the next day. And taking it in the morning just made me drowsy for most of the day. So I stopped taking it. I seem to be better off without it for now.
Posted by jealibeanz on June 21, 2006, at 3:56:19
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 20, 2006, at 22:17:59
Donna what week is this for you now? Are you certain that I need a week washout from the Straterra, since there is no Serotonin syndrome risk involved? I thought that was the reasoning behand the washout period.
We seem very similar is our medication trials and reactions. I actually have never tried Prozac. I'd rather not at this point. What kind of reaction did you have to Straterra?
So you don't believe you're experiencing weight gain with EMSAM? With me, it was always immediate, constant, and very noticeable. Do you have more or less energy? I can't afford a decrease. I'm afraid dropping the Straterra will drop my energy. What am I saying. I don't have this drug. I prbably never will. I'll never get up the guts to bring up the depression with my super positive doc, let along suggest a medication that he would have no experience with and most likely say flot out no to.
Posted by Donna Louise on June 21, 2006, at 7:27:13
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 21, 2006, at 3:56:19
> Donna what week is this for you now? Are you certain that I need a week washout from the Straterra, since there is no Serotonin syndrome risk involved? I thought that was the reasoning behand the washout period.
>
> We seem very similar is our medication trials and reactions. I actually have never tried Prozac. I'd rather not at this point. What kind of reaction did you have to Straterra?
>
> So you don't believe you're experiencing weight gain with EMSAM? With me, it was always immediate, constant, and very noticeable. Do you have more or less energy? I can't afford a decrease. I'm afraid dropping the Straterra will drop my energy. What am I saying. I don't have this drug. I prbably never will. I'll never get up the guts to bring up the depression with my super positive doc, let along suggest a medication that he would have no experience with and most likely say flot out no to.No, I am not certain you would need a washout. You are right, it would not be a serotonin issue but a norepinephrine one. Could be problems with hypertension. But I am not certain, I just wouldn't take a chance. And it is not even an issue of your dropping it if you don'thave an rx for EMSAM in your hand.
I think this is week 9. LIke ZeitGuest, I feel better on 9mg probably due to increased MAOI. I have had no weight gain. Yes, I have a ton more energy, I am not sleepy all day.
I did not especially like strattera. It did improve focus and energy somewhat, but I became impatient with others and more introverted. I have a few friends who weren't real pleased with me during that time. I took in conjunction with some sri or other.
I wish I could ask your dr. for you. What is the worst that could happen? Do you think he would shame you? Is it possible your fear has to do with your illness and is not truly reflective of the situation? Don't say Never! You can do it.donna
Posted by Donna Louise on June 21, 2006, at 7:58:55
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 20, 2006, at 21:41:37
Click here: Strattera Overdose, Contraindications and Information - Atomoxetine HCl - RxList Monographs
I cannot figure out how to put something in here you can just click on to go to. I am computer stupid. Anyway, this says you can get neuroleptic malignant syndrome combining strattera with an MAOI. You can google "Strattera and MAOI combination" and a bunch of stuff will appear.
donna
Posted by Porky on June 21, 2006, at 12:22:22
In reply to Are Family Doctors prescribing EMSAM?, posted by jealibeanz on May 24, 2006, at 6:33:46
> Has anyone been prescribed or told of EMSAM from a general practitioner? I know a lot of people on here see pdocs. I'd like to give it a try, but only see my GP.
Yes, my family doctor prescribed EMSAM for me. I doubt she would have even considered it but for the fact that she recognizes that I'm someone who is pretty well educated on Psychiatric drugs and such. When I came into her office that day to ask for the prescription, she had never even heard of the drug. She also has never prescribed an MAOI before. She is only in her early-to-mid 30s I think so MAOIs were not popularly used after she got out of med school, according to her.
I also brought along a printout of the full prescribing information for EMSAM which I obtained from the BMS website for her perusal.
If it weren't for the fact that I was educated on the matter and the fact that I brought the prescribing information, I highly doubt she would have prescribed it. But yes, at least in my case, Family Doctors DO prescribe EMSAM.
Posted by jealibeanz on June 21, 2006, at 21:35:58
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Porky on June 21, 2006, at 12:22:22
Oh I know they have the authority. I'm just wondering whether or not they are considering it to be risky or not. I'm actually surprised some may not know about it. I'm sure I'd be my doc's first on it if I were to get EMSAM in August. That makes me feel doubtful. I want him to suggest it, not me! I also want him to have confidence in it, not me to convince him! I'm the distressed patient! God... It'll be a wonder if I make it through this school alive and well. I can't believe there aren't frequent med school student suicides. It's so tough academically, socially, physically, mentally. Then, just thinking about the future of your practice and dealing with lives jeeeeeeez! I'm a nut to begin with. Haha, I think most of the students are too.
Posted by Donna Louise on June 22, 2006, at 4:57:30
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 21, 2006, at 21:35:58
> Oh I know they have the authority. I'm just wondering whether or not they are considering it to be risky or not. I'm actually surprised some may not know about it. I'm sure I'd be my doc's first on it if I were to get EMSAM in August. That makes me feel doubtful. I want him to suggest it, not me! I also want him to have confidence in it, not me to convince him! I'm the distressed patient! God... It'll be a wonder if I make it through this school alive and well. I can't believe there aren't frequent med school student suicides. It's so tough academically, socially, physically, mentally. Then, just thinking about the future of your practice and dealing with lives jeeeeeeez! I'm a nut to begin with. Haha, I think most of the students are too.
You know, this very experience you are having will make you a good, caring and sensitive dr. One of those things that in hindsight will serve you well.
donna
Posted by jealibeanz on June 22, 2006, at 5:45:30
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 22, 2006, at 4:57:30
I don't think I'm gonna get that far without some more help. Asking is tough. Asking several times after failure is even tougher. You think you are weak and crazy. Some doctors do too. They'll hand out SSRI's like candy. If those are perfect, then you just must be a feak.
I'm not sure how to present myself to my doc. What to say...
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