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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by RobertDavid on July 1, 2006, at 16:07:04
Hello all. I haven't been following the posts, but I thought I give an update and my take on EMSAM.
First let me say that my primary disorters are SAD, GAD and mild depression (in order). I have taken klonopin for SAD & GAD for over 12 years (I'm taking 1.75mgs at night). Klonopin is the only thing I've ever taken that works, and it works good.
But through the years being on klonopin I always felt a litte depressed and didn't have much zest for life, low energy so I tried adding numerous meds without luck (other than some help with low dose provigil 50gs taken as needed). I've always been a little depressed so I'm not sure how much of it was a side effect from my anxiety disorters or how much was agrrivated from taking a benzo. Probably a combo of the two. I guess it doesn't matter as without klonopin, I could hardly leave the house and know that would still be the case without it.
So over the last 3 months I've been on EMSAM. I felt a quick burst of energy taking the 20mg patch 24/7 when I first took it back in April. I got more done, was more upbeat and particularly noticed that my mental clarity improved.
But as it built up in my system I wasn't sleeping as well (but, I have never slept well). When I don't sleep well, I don't feel good, period. At times the lack of sleep made me slightly agitated, but still overall was feeling much better. No doubt klonopin has helped with agitation.
So after talking with my pdoc and writing to Dr. Bodkin, a researcher with the EMSAM studies I decided to play with the patch, cutting it in half and on occation taking it off at night. I did all kinds of variations to try to fine tune it.
I've found all I need is half a 20mg patch. Though I am now sleeping more normally perhaps because my body has adjusted to it as well as the lower 10mg dose, on occation I still take it off at night, usually on the weekends. Doing that doesn't seem to have any effect on the benefits I get from it and I do sleep a little better. I have no longer have the need to take a sleeping pills at night. I also think my sleeping has improved because I work out at the gym more as a result of the increased energy from EMSAM.
My conclusion is that EMSAM will certainly not be for everyone. That it's probably best for those that are dealing primarily with depression and have failed to respond to SSRI's as well as those like me who have primary anxiety disorters who are also taking an adequate dose of klonopin or other benzo as I'm certain the benzo makes EMSAM much more tolerable. I personally feel few with anxiety disorters will do well on EMSAM alone.
Just like pill form medicines, the patch will can be tweeked by taking it at higher/lower doses (cutting it is the only optioin) as well as taking it on and off, just like many do with the timing of taking their other meds in pill form. Certainly some will be just fine with a 20,30 or 40mg patch 24/7.
So other than occation red marks from the patch (which I've come to learn usually results from putting the patch back on a spot I've used within a week) I have mostly benefits, an overall feeling of well being. 10mgs is just enough for me to lift my mood from where it was before, but I doubt that dose would work for anyone with major depression.
I don't deal with any issues from food, I eat anything I want. I have lost about 5 pounds over the last few months most likely do to increased physical activity. My sex drive is as good as it has ever been and I certainly don't mind paying half the price by cutting the patch in half as insurance doesn't cover it.
For now, it's the best option for me to blend with klonopin. Down the road no doubt there will be more options to consider. Klonopin is my #1 medicine and EMSAM is my "cup of coffee." I am back to being busy living life, being productive and less focused on my disorters. A strange feeling for me, but I'm getting used to it.
So I wanted to come back and re-vist all you nice people here at babble and update you on my progress. My hope is that each and every one of you find your answers. I don't think there are any magic bullet out there, but there is always hope that you can get better with the right med or combo of meds.
Don't lose hope and remember that because a med works or fails for one particular indivuidual, everyone is different and use the wonderful insight you get from others here at babble as a source of info to discuss with your doctor, hopefully a doctor with exerience in these lousy disorters, one that will think outside the box.
Thanks very much to all of you who have helped me by sharing your insight over the last year or so. I can't tell you how much help and insight I have gained here that I will take with me. Good luck to everyone....
Rob
Posted by Crazy Horse on July 1, 2006, at 19:01:26
In reply to 3 months on EMSAM - My take on it, posted by RobertDavid on July 1, 2006, at 16:07:04
> Hello all. I haven't been following the posts, but I thought I give an update and my take on EMSAM.
>
> First let me say that my primary disorters are SAD, GAD and mild depression (in order). I have taken klonopin for SAD & GAD for over 12 years (I'm taking 1.75mgs at night). Klonopin is the only thing I've ever taken that works, and it works good.
>
> But through the years being on klonopin I always felt a litte depressed and didn't have much zest for life, low energy so I tried adding numerous meds without luck (other than some help with low dose provigil 50gs taken as needed). I've always been a little depressed so I'm not sure how much of it was a side effect from my anxiety disorters or how much was agrrivated from taking a benzo. Probably a combo of the two. I guess it doesn't matter as without klonopin, I could hardly leave the house and know that would still be the case without it.
>
> So over the last 3 months I've been on EMSAM. I felt a quick burst of energy taking the 20mg patch 24/7 when I first took it back in April. I got more done, was more upbeat and particularly noticed that my mental clarity improved.
>
> But as it built up in my system I wasn't sleeping as well (but, I have never slept well). When I don't sleep well, I don't feel good, period. At times the lack of sleep made me slightly agitated, but still overall was feeling much better. No doubt klonopin has helped with agitation.
>
> So after talking with my pdoc and writing to Dr. Bodkin, a researcher with the EMSAM studies I decided to play with the patch, cutting it in half and on occation taking it off at night. I did all kinds of variations to try to fine tune it.
>
> I've found all I need is half a 20mg patch. Though I am now sleeping more normally perhaps because my body has adjusted to it as well as the lower 10mg dose, on occation I still take it off at night, usually on the weekends. Doing that doesn't seem to have any effect on the benefits I get from it and I do sleep a little better. I have no longer have the need to take a sleeping pills at night. I also think my sleeping has improved because I work out at the gym more as a result of the increased energy from EMSAM.
>
> My conclusion is that EMSAM will certainly not be for everyone. That it's probably best for those that are dealing primarily with depression and have failed to respond to SSRI's as well as those like me who have primary anxiety disorters who are also taking an adequate dose of klonopin or other benzo as I'm certain the benzo makes EMSAM much more tolerable. I personally feel few with anxiety disorters will do well on EMSAM alone.
>
> Just like pill form medicines, the patch will can be tweeked by taking it at higher/lower doses (cutting it is the only optioin) as well as taking it on and off, just like many do with the timing of taking their other meds in pill form. Certainly some will be just fine with a 20,30 or 40mg patch 24/7.
>
> So other than occation red marks from the patch (which I've come to learn usually results from putting the patch back on a spot I've used within a week) I have mostly benefits, an overall feeling of well being. 10mgs is just enough for me to lift my mood from where it was before, but I doubt that dose would work for anyone with major depression.
>
> I don't deal with any issues from food, I eat anything I want. I have lost about 5 pounds over the last few months most likely do to increased physical activity. My sex drive is as good as it has ever been and I certainly don't mind paying half the price by cutting the patch in half as insurance doesn't cover it.
>
> For now, it's the best option for me to blend with klonopin. Down the road no doubt there will be more options to consider. Klonopin is my #1 medicine and EMSAM is my "cup of coffee." I am back to being busy living life, being productive and less focused on my disorters. A strange feeling for me, but I'm getting used to it.
>
> So I wanted to come back and re-vist all you nice people here at babble and update you on my progress. My hope is that each and every one of you find your answers. I don't think there are any magic bullet out there, but there is always hope that you can get better with the right med or combo of meds.
>
> Don't lose hope and remember that because a med works or fails for one particular indivuidual, everyone is different and use the wonderful insight you get from others here at babble as a source of info to discuss with your doctor, hopefully a doctor with exerience in these lousy disorters, one that will think outside the box.
>
> Thanks very much to all of you who have helped me by sharing your insight over the last year or so. I can't tell you how much help and insight I have gained here that I will take with me. Good luck to everyone....
>
> RobHi Rob,
I have recently started EMSAM 6mgs., been on it for 15 days today and so far i like it. I also have soc. anx. disorder, GAD, and depression probs. I would really like to stay on the low 6 mg. patch if possible and so far it has relieved my depression. My pdoc as just recently (per my request) switched me from Ativan 6 mgs daily to Klonopin 2 mgs daily. Is 2 mgs a day enough to help with moderate social anxiety? How much Klonopin do you take daily (if you don't mind sharing)? My pdoc says .50 Klonopin is approx equivilent to 2 mgs of ativan...is this correct in your opinion? I just want to make sure that 2 mgs. of Klonopin is an effecient amount to improve SAD symptoms. Your answers to these questions is very much appreciated. Thank you.
Monte
Posted by RobertDavid on July 1, 2006, at 19:15:14
In reply to Re: 3 months on EMSAM - My take on it » RobertDavid, posted by Crazy Horse on July 1, 2006, at 19:01:26
It's my opinion that klonopin is the best first try benzo for SAD. It works great for GAD too, but it really is the go to benzo for SAD in my and my pdoc's opinion. Long acting and once your been on it a few weeks and your blood levels get stable and it really kicks in, knocks out social anxiety.
Most seem to land between 1 and 4mgs for SAD as a rule, but I know of several that go up to 6. For me around 2mgs has been the right amount. I've been higher and lower. You have to try different doses to find the best one. I believe in taking the lowest dose that's effective, but I think many have failed trials on klonopin by never taking a high enough dose.
Switching to 2mgs klonopin sounds right for you. You should give yourself a little time for the adjustment after stoppin Ativan. I think after a few weeks you'll know a lot more about the 2mg dose. Most side effects of sedation diminish, but the anti anxiety benefits are on going.I really believe you'll get better relief from klonopin than you did on Ativan.
Many take the benzos via split doses, but I believe when you get to daily higher dose above 1mg just taking it at bedtime is best. It's got a long half life and will last through the day once blood levels go up. I won't go into a long take on this, but buy BRAND, pay the money if you can afford it. There is a difference, at least with klonopin.
By far the best med I've ever tried for SAD and I had it bad. Good luck!
Posted by Phillipa on July 1, 2006, at 20:02:35
In reply to Re: 3 months on EMSAM - My take on it » Crazy Horse, posted by RobertDavid on July 1, 2006, at 19:15:14
Robert so glad you're still doing well. And please don't forget me. And don't lose my E-mail address. Love Jan
Posted by Donna Louise on July 1, 2006, at 22:16:25
In reply to Re: 3 months on EMSAM - My take on it » RobertDavid, posted by Phillipa on July 1, 2006, at 20:02:35
Well Rob, that sounded like a goodbye letter. And that would mean you are doing so well you don't need to come here, at least for now. And that is great! But I will miss you, I so appreciate all your help and kindness.
I have had to go to the 12(40) mg patch as the depression, although not nearly as bad and still better than all the other drugs I have tried) was still not in full remission. That may not be possible for me, maybe this will do it. I have decreased the provigil by half, doubled the klonopin and started lamictal. The lamictal is helping alot with the irritation (to put it mildly) that I had even on the smallest patch. But it will be awhile before I get to a high enough dose to get stablized. So, I am still hopeful, still doing much better than usual, still working at it. It is not time for me to leave pbabble..
I hope for you continued success and a long and happy life.Your friend,
donna
Posted by RobertDavid on July 1, 2006, at 23:53:07
In reply to Re: 3 months on EMSAM - My take on it, posted by Donna Louise on July 1, 2006, at 22:16:25
Donna:
I'm so glad you have improvement. No doubt the lamictal and or klonopin is helping with your agitation. You'll get there, you got to just keep tweeking, blending, finding the right meds at the right doses. I'm so glad you're feeling better. As I said, I don't think there is any silver bullet with any of these meds, but life can be manageable, better, good. I think you're on your way.
Jan, thanks for the nice post. FYI, I'm not bailing for good and will check in with you from time to time both here at babble and via email.
But yes, life is so much better for me in all ways. I'll keep in touch and remember, don't lose hope, that's all any of us have!
Rob
Posted by Jakeman on July 2, 2006, at 0:45:56
In reply to 3 months on EMSAM - My take on it, posted by RobertDavid on July 1, 2006, at 16:07:04
Rob,
Thanks for your informative post. I've been on 6 mg Emsam for about 5 weeks. Also taking klonipin and restoril at night and 50 mg Lyrica in the early evening. The Emsam is not working as well as it did at first, I still get an energy boost but minimum antidepressant effect. My blood pressure has gone up and I'm not sure what to attribute that to. I'm under a lot a stress and sometimes use evening cocktails to relax although I know alcohol is not advised. I'm going back to the PA Monday to re-evaluate.
But to my question. If I remember correctly you tried Lyrica for a while. At first I found Lyrica to be great for SAD with as well as helping with mood. But now those effects have diminished. Was that your experience with Lyrica? I was presribed Lyrica to help with getting more deep sleep..it may be helping there but I'm not sure.
Warm regards, Jake
Posted by RobertDavid on July 2, 2006, at 2:25:17
In reply to Re: 3 months on EMSAM - My take on it » RobertDavid, posted by Jakeman on July 2, 2006, at 0:45:56
I did not do well on Lyrica. It didn't help my "social anxiety" at all. Not only was I anxious, but I just felt weird, cloudy headed, out of it. But, everyone is differnt so???
Anyway, how much klonopin are you taking? If it were me, I'd go up on it. With klonopin the key is finding the right dose which is different for everyone. I didn't think it was much good till I hit 2mgs, then it worked like magic for me. Some go up to 4 even 6 mgs a day.
I've been on it 12 years and it saved my life. My opinion is that klonopin is the go to med for SAD. Others have luck with Nardil, but seem to really stuggle with side effects. Don't know, never tried it.
I think you just may find what you're looking for by uping the dose. It took me months to figure what that was and have never had to adjust it since.
Good luck!
Posted by Jakeman on July 2, 2006, at 3:20:01
In reply to Re: 3 months on EMSAM - My take on it » Jakeman, posted by RobertDavid on July 2, 2006, at 2:25:17
Lyrica and Neurotin have both caused some of the clouded head feeling. But Lyrica was better overall. I was originally was prescirbed klonipin to take at night for sleep. 1/2 to 1 mg.
Maybe I should go up on the klonipin, and use it during the day as well. My fear is that it may contribute to my depression. I'm also thinking of a low dose beta blocker like Inderal until I can get out of my stressful work situation.
I appreciate you input and good luck to you- Jake
> I did not do well on Lyrica. It didn't help my "social anxiety" at all. Not only was I anxious, but I just felt weird, cloudy headed, out of it. But, everyone is differnt so???
>
> Anyway, how much klonopin are you taking? If it were me, I'd go up on it. With klonopin the key is finding the right dose which is different for everyone. I didn't think it was much good till I hit 2mgs, then it worked like magic for me. Some go up to 4 even 6 mgs a day.
>
> I've been on it 12 years and it saved my life. My opinion is that klonopin is the go to med for SAD. Others have luck with Nardil, but seem to really stuggle with side effects. Don't know, never tried it.
>
> I think you just may find what you're looking for by uping the dose. It took me months to figure what that was and have never had to adjust it since.
>
> Good luck!
Posted by ZeitGuest on July 2, 2006, at 3:41:21
In reply to Re: 3 months on EMSAM - My take on it » Jakeman, posted by RobertDavid on July 2, 2006, at 2:25:17
Hi Robert,
Glad to hear that things are going so well for you on Emsam and Klonopin.
I'm still on Emsam (week 8, the past two weeks at the 9mg dose), but it's not really doing much for me, other than causing anxiety and irritability and anger outbursts. This week I began adding Klonopin (25mg/day, taken at bedtime), but so far it's merely made me feel drowsy and slow-witted during the day. I'm planning on increasing the dose, and hoping that the foggy effect will subside in time.
You referred to Klonopin as the go-to drug for social anxiety. I'm still not clear on the precise effect Klonopin has on S.A. In other words, I'd like to know whether its main action is simply a matter of dampening the fear response in social situations, or whether it also has a separate, positive effect on verbal fluency, word recall, and verbal reaction time -- all of the verbal cognition skills that allow sociable people to easily engage in the give-and-take of human interaction.
Here's why I ask: One of my big problems in social situations is that my brain just doesn't make neural connections quickly enough for me to participate in conversational badinage, small talk, and all the other cues necessary for social participation. When I first tried Prozac (prior to poop-out), I really did experience what Peter Kramer in his book, Listening to Prozac, referred to as increased "quickness of thought." It was definitely an amazing and thrilling phenomenon, to suddenly be able to joke with my co-workers, attract new friends, make smalltalk with strangers, *connect.* I'm convinced that the Prozac effect was much more than the med simply reducing my social fear response and thereby freeing up my formerly nervous mind to think more quickly and creatively. I believe that my neurons were actually firing faster, making more connections, reacting to verbal stimuli more quickly than before. (I've read testimonials from people on Nardil -- which I've never tried -- who have experienced a similar effect.)
Unfortunately, Emsam has done nothing to increase my thinking speed. In fact, it seems to have done quite the opposite: hampering my short-term memory and verbal fluency. I now often find myself struggling to summon the right word to complete a sentence. (Wellbutrin had the same effect on me, so maybe too much dopamine is not a good thing for my brain). BTW, these congnitive troubles began before I started taking Klonopin, so I'm fairly certain the culprit is Emsam.
So, Robert, I'm wondering whether Klonopin at your optimal dose affects you as Prozac early on affected me--i.e., not just dampening your social fear response, but actually enhancing your cognative social skills, i.e., "quickness of thought," word recall, verbal fluency, mental elasticity, etc.
Thanks in advance for your response.
Zeitguest
Posted by Jakeman on July 2, 2006, at 3:48:29
In reply to Re: 3 months on EMSAM - My take on it, posted by ZeitGuest on July 2, 2006, at 3:41:21
From you post it seems prozac was helping. Did it poop out?
Warm regards, Jake
Posted by ZeitGuest on July 2, 2006, at 19:12:24
In reply to Re: 3 months on EMSAM - My take on it » ZeitGuest, posted by Jakeman on July 2, 2006, at 3:48:29
> From you post it seems prozac was helping. Did it poop out?
> Warm regards, JakeYes, it did poop out, although the decline took several years.
Posted by theo on July 3, 2006, at 16:31:16
In reply to 3 months on EMSAM - My take on it, posted by RobertDavid on July 1, 2006, at 16:07:04
When you say you are taking half of a 20mg patch, do you mean the 6mg patch, the lowest dose patch?
Posted by RobertDavid on July 3, 2006, at 16:40:51
In reply to Re: 3 months on EMSAM - My take on it » RobertDavid, posted by theo on July 3, 2006, at 16:31:16
> When you say you are taking half of a 20mg patch, do you mean the 6mg patch, the lowest dose patch?
Yes, I cut the lowest dose 20mg (6mg) patch in half..
Posted by Phillipa on July 3, 2006, at 22:14:05
In reply to Re: 3 months on EMSAM - My take on it » theo, posted by RobertDavid on July 3, 2006, at 16:40:51
Will one of you do me a favor? Please answer stuggleingsteves thread at the bottom of the page . Please give him some hope. Thanks Phillipa
Posted by sdb on July 4, 2006, at 16:37:47
In reply to Re: 3 months on EMSAM - My take on it, posted by ZeitGuest on July 2, 2006, at 3:41:21
>This week I began adding Klonopin (25mg/day, taken >at bedtime),
did you mean adding 25mg or 2.5mg of Klonopin? -My bell rings because of seizure problems
starting such a dosage all at once.
Posted by ZeitGuest on July 4, 2006, at 17:44:28
In reply to Re: 3 months on EMSAM - My take on it } Zeitguest, posted by sdb on July 4, 2006, at 16:37:47
> >This week I began adding Klonopin (25mg/day, taken >at bedtime),
>
> did you mean adding 25mg or 2.5mg of Klonopin? -My bell rings because of seizure problems
> starting such a dosage all at once.Oops. Forgot the decimal. I meant to type .25 mg (a very low dose).
Posted by Crazy Horse on July 5, 2006, at 10:24:00
In reply to Re: 3 months on EMSAM - My take on it, posted by Phillipa on July 3, 2006, at 22:14:05
> Will one of you do me a favor? Please answer stuggleingsteves thread at the bottom of the page . Please give him some hope. Thanks Phillipa
I answered Steve, Jan. Thanks for bringing his thread to my attention. You are a great person Jan..it does my heart good to see someone like you who genuinely cares so deeply about others...this is your gift! :)
Love, Monte
Posted by Phillipa on July 5, 2006, at 19:07:53
In reply to Re: 3 months on EMSAM - My take on it » Phillipa, posted by Crazy Horse on July 5, 2006, at 10:24:00
Thanks guess that was why I was such a good nurse. Love Jan
Posted by RobertDavid on July 7, 2006, at 2:29:14
In reply to Re: 3 months on EMSAM - My take on it, posted by ZeitGuest on July 2, 2006, at 3:41:21
> So, Robert, I'm wondering whether Klonopin at your optimal dose affects you as Prozac early on affected me--i.e., not just dampening your social fear response, but actually enhancing your cognative social skills, i.e., "quickness of thought," word recall, verbal fluency, mental elasticity, etc.
>
Hmmm. For me, klonopin just made the fear go away, it's just gone. I still have normal anxiety that I think anyone would in some social situations which is good as i don't want to just be knumb to the world. Hard to explain, I can just say that I think this is how I would feel without SAD.You mentioned you felt a little out of it at a small dose. But that goes away with time, but the anti anxiety benfefits don't, they've lasted over 12 years for me at the same dose (2mgs). To treat SAD the key is to get up to a high enough dose and take it daily (usually 1 to 4mgs). Just go up slowly and expect to feel a little out of it/sedated for a week or two each time you go up.
I believe if you can find your right dose you have a high probability of ridding yourself of the majority if not all your social anxiety with klonopin alone. I don't think EMSAM is the answer for SAD other that to be taken with a benzo or other med to help some improve mood. Otherwise you might try klonopin and provigil (klonopin at night, provigil in the morning). I do know that benzos like klonopin work on GABA but all of them in different ways.
If your interested in that part, do some google searches on klonopin and GABA and you'll get a ton of info. Anyway, that's just my take on it, everyone is different, but if I were a doctor (which I'm not) and if a patient failed to respond to SSRI's for SAD (most do), I'd go straight to klonopin as my first try and keep them there till they got to a theraptuic dose as long as there weren't sever side effects that made it impossible. Just my 2 cents worth. Good luck!
This is the end of the thread.
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