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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 33 to 57 of 65. Go back in thread:
Posted by laima on July 22, 2006, at 17:44:46
In reply to Re: emsam 6 mg/24 = ? oral selegiline? - Thanks. » laima, posted by SLS on July 22, 2006, at 12:07:21
Oh no, not lazy at all! I'm simply just not up on all the lingo yet; there seems to be a lot to learn and keep track of around here. Thanks for your response and for your explaining!> > I hope I don't seem stupid- but do you mean thanks for the post? I got a bit carried away there due to excitement, and don't know yet what "nm" means.
> >
> > Thanks.
>
> (nm) = No Message
>
> I was thanking you for the information you provided regarding Emsam 9mg/24 = 60-90mg oral selegiline. I guess I should have made that clear. I was just being lazy.
>
> :-)
>
>
> - Scott
Posted by laima on July 22, 2006, at 17:51:46
In reply to Re: emsam 6 mg/24 = ? oral selegiline?, posted by jealibeanz on July 22, 2006, at 13:50:56
Oh. I'm sorry to hear of your experience. I think a lot of us have had some less than ideal encounters with some psychiatrists. (Whew! I sure have...) They're not all bad, though.Initially, just about 6 weeks ago, no one at my pharmacy had heard of EMSAM, and my script bewildered them. They had to special order it. But they've since reported that they attended a seminar, and they are all very interested and excited. So the good news is that the company seems to be on a huge publicity/education blitz, and more and more is turning up in the media about it. It IS a very new and novel treatment, after all. Hopefully if your doctor doesn't know about it yet, he or she soon will. What if you found something in the media by google and brought it in? Or something off the manufacturer's website? (I think-Glaxo Kline Smith (?)) Good luck.
> I haven't asked my doctor if he's heard of it, just wondering what the likelihood would be that he at least knows of the name and what it is. I'm sure he isn't following any reports, because there really aren't any publications of clinical use. No, I don't have access to a psychiatrist. I found one, had a terrible experience. He was the only I was able to see.
Posted by Jost on July 22, 2006, at 17:54:37
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » SLS, posted by laima on July 21, 2006, at 15:39:23
> So while I wait for my pharmacy to get the 9's in, I wonder if I can or should cut my 6's in half and wear a 6 plus half of a six to equal 9? I wonder if that would be accurate. Whatever, I'll only have to wait for a day or two for the 9's, so maybe I'll just hold off lest I do something really drastic by accident.
>
>
> >
>
>You can definitely cut the 6 in half and use it with another 6, to get 9.
Both my pdoc, and those of other people here have said it's fine to do so.
Also, as you might be aware, there's some evidence that the food restrictions either don't apply, or don't apply very much even with 9 and 12 mg.
There are some other threads where people have been experimenting successfully with disallowed foods. On the other hand, it's good to test with small amounts, until the definitive results are in-- or are in and are formally accepted.
If you check the tyramine challenges that they did, even large amounts of tyramine=rich foods didn't create any tyramine reaction for those with larger doses. But the FDA wants to be careful, so that's where it stands.
The drug interactions are a different story, and there you do have to be careful.
Jost
Posted by jealibeanz on July 22, 2006, at 18:10:55
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » jealibeanz, posted by laima on July 22, 2006, at 17:51:46
I would assume that doctors are aware of new FDA approvals, however, I'm not certain of how every physician practices. He's fairly young and very energetic, so it's not like he's set in his ways.
Do you mean the pharmacists attended a conference? What region of the country are you located in?
Posted by laima on July 22, 2006, at 18:31:03
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » laima, posted by mayzee on July 22, 2006, at 16:26:33
Clueless- all know is that it suddenly seems like the dosing is so complex hardly anyone comprehends it. Is this practice of cutting up 6's working out for you? I'll do the same if you and others have found it to be safe and accurate...I've got a lot of 6's left, and they ARE expensive-even with insurance!
> > So while I wait for my pharmacy to get the 9's in, I wonder if I can or should cut my 6's in half and wear a 6 plus half of a six to equal 9? I wonder if that would be accurate. >
> >
>
> Hi, not sure if anyone else replied to you about this, but I am using 1 1/2 6mg patches to get to 9mg. ...because I was given a big batch of 6mg samples for free and they don't have any 9mg samples to give out. (I don't have insurance to cover it)
>
> If anyone knows any reason this would be a problem, please let me know!
>
> Thanks,
> mayzee
Posted by laima on July 22, 2006, at 18:37:05
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » laima, posted by Jost on July 22, 2006, at 17:54:37
There's so much conflicting info out there about EMSAM! Very confusing. If people have found that the dietary restrictions with the 9 and 12 are exaggerated, maybe that's the drug company and doctors being hyper-cautious??? I'm gonna go check out those threads you refer to. Thank you.> > So while I wait for my pharmacy to get the 9's in, I wonder if I can or should cut my 6's in half and wear a 6 plus half of a six to equal 9? I wonder if that would be accurate. Whatever, I'll only have to wait for a day or two for the 9's, so maybe I'll just hold off lest I do something really drastic by accident.
> >
> >
> > >
> >
> >
>
> You can definitely cut the 6 in half and use it with another 6, to get 9.
>
> Both my pdoc, and those of other people here have said it's fine to do so.
>
> Also, as you might be aware, there's some evidence that the food restrictions either don't apply, or don't apply very much even with 9 and 12 mg.
>
> There are some other threads where people have been experimenting successfully with disallowed foods. On the other hand, it's good to test with small amounts, until the definitive results are in-- or are in and are formally accepted.
>
> If you check the tyramine challenges that they did, even large amounts of tyramine=rich foods didn't create any tyramine reaction for those with larger doses. But the FDA wants to be careful, so that's where it stands.
>
> The drug interactions are a different story, and there you do have to be careful.
>
> Jost
Posted by laima on July 22, 2006, at 18:39:54
In reply to Re: emsam 6 mg/24 = ? oral selegiline?, posted by jealibeanz on July 22, 2006, at 18:10:55
One would sure HOPE doctors keep up on new approvals!!!I live in Chicago, and the pharmacists at my pharmacy attended some kind of educational seminar about EMSAM shortly after it was approved. My Doctor, on the other hand, attended a full-blown conference.
> I would assume that doctors are aware of new FDA approvals, however, I'm not certain of how every physician practices. He's fairly young and very energetic, so it's not like he's set in his ways.
>
> Do you mean the pharmacists attended a conference? What region of the country are you located in?
Posted by jealibeanz on July 22, 2006, at 18:52:22
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » jealibeanz, posted by laima on July 22, 2006, at 18:39:54
Was the conference in your area?
Posted by laima on July 22, 2006, at 19:17:42
In reply to Re: emsam 6 mg/24 = ? oral selegiline?, posted by jealibeanz on July 22, 2006, at 18:52:22
> Was the conference in your area?
Clueless. I get the impression it was a national event, though.
I might add, after thinking about recent posts, that even these so-called expert doctors appear to be a tad confused, just like us. I wonder if that was an inspiration for such a conference to even be held.
Posted by jealibeanz on July 22, 2006, at 19:26:42
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » jealibeanz, posted by laima on July 22, 2006, at 19:17:42
I was just wondering if it were something that was widely advertised. Confusion? Oh no! Not a good thing. Maybe I'll just settle for an SSRI, which I'm sure I'll end up hating b/c of side effects.
Posted by mayzee on July 22, 2006, at 21:19:20
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » mayzee, posted by laima on July 22, 2006, at 18:31:03
>
> Is this practice of cutting up 6's working out for you? I'll do the same if you and others have found it to be safe and accurate...
>Seems to be working fine for me. Safe, yes. "accurate"? who knows?!
In going up to the higher dose I got a rebound on some of the side effects I'd had when starting at 6 (insomnia, GI distress).
I seem to have more orthostatic hypotension at 9mg; feel more spacey at times. I guess I should get a blood pressure monitor as I tend to have low bp anyway.
But I also seem to be starting to feel better at this dose too (knock wood) I'm in my 2nd week at 9mg, and just a few days ago started to notice an improvement. (I'm scared I'll jinx it!)Best of luck to you with it!!!
Posted by Jost on July 22, 2006, at 22:45:57
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » Jost, posted by laima on July 22, 2006, at 18:37:05
Laima, this is a powerpoint demonstration given to the FDA by Somerset, which describes the tyramine challenges and the reactions on those taking parnate vs emsam.
if the link doesn't work, I always find it by searching on google for "Lawrence Blob" the MD who made the presentation for Somerset.
www.fda.gov/ohrms/dockets/ac/05/slides/2005-4186S2_03_Somerset-EMSAM.ppt
Jost
Posted by laima on July 23, 2006, at 8:53:52
In reply to Re: emsam 6 mg/24 = ? oral selegiline?, posted by jealibeanz on July 22, 2006, at 19:26:42
I doubt it was heavily advertised- if you mean the conference I recently heard about. I got the impression it was specifically targeted to certain psychiatrists, only- meaning- those who specialize in drug research. Definately not open to us in the public or to other doctors. I think the company had an interest in getting feedback from people they considered experts (?). I think it was also quite academic. My doctor, who attended, is a medical professor and specializes in drugs, drug chemistry, etc. He consults and gives feedback to the companies as they develope new drugs. I'm sure that is why he was there.
As for my pharmacists- they made it sound like the EMSAM folks are going around trying to do an education blitz for pharmacists- so very likely your pharmacists will get this chance, too. I think the company is acknowlegeing that loads of people, even pharmacists, are uttery confused.
I do think it would be nice of the company to do more education to help us regular people figure out this confusing medication, Itotally agree with that. And I think they should have sessions for ordinary or more general psychiatrists and doctors- i bet they will.
On the positive side- they appear to be acknowledging our general mass confusion, and to be on a campaign to address it. I haven't checked their website, but i wonder if they might not have a feedback form somewhere there. I can tell you when my enthusiastic doctor put me on the phone with them, they were beside themselves to hear what I had to say about EMSAM, what my opinions were, all in excruciating detail. AND they have put a questionaire in the mail, which I am expecting soon, for even more feedback. I'm not special- I bet they will listen to any of us. We just need to find the channel.
As for confusion, what i gather from reading everyone's posts and from what i heard at the doctor's office- most of it seems to revolve around what on earth the doses mean, and are certain foods ok or not on the diffrent doses.
Oh ssris- easy, sure. If they work for you-lucky you. Prozac was a miracle for me once until it utterly "pooped out" after approximately 10 years. No ssri has ever worked for me ever again. Nor has any other anti-depresswent I ever tried. Scary. Did something happen to my brain? Is it because my depression can be described as "atypical" and ssris not famous for being super helpful with that?? I know I could be headed for a similar scenario with EMSAM- but I don't know if I have much choice.
> I was just wondering if it were something that was widely advertised. Confusion? Oh no! Not a good thing. Maybe I'll just settle for an SSRI, which I'm sure I'll end up hating b/c of side effects.
Posted by laima on July 23, 2006, at 9:01:11
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » laima, posted by mayzee on July 22, 2006, at 21:19:20
Oh thank you for your response, it's so hopeful and encouraging!! As for blood pressure- yes, maybe it would be worth looking in to for you, too. I'd been told a few times that the EMSAM can cause it to really dip in lots of people. When I started EMSAM, my main problem was I was l-e-t-h-a-r-g-i-c, dizzyish, all that. I'm actually on a teeny amount of ritalin (5mg 2xday) now for purpose to boost it up. Seems to be working out great. Best of luck to you, too!> >
> > Is this practice of cutting up 6's working out for you? I'll do the same if you and others have found it to be safe and accurate...
> >
>
> Seems to be working fine for me. Safe, yes. "accurate"? who knows?!
>
> In going up to the higher dose I got a rebound on some of the side effects I'd had when starting at 6 (insomnia, GI distress).
> I seem to have more orthostatic hypotension at 9mg; feel more spacey at times. I guess I should get a blood pressure monitor as I tend to have low bp anyway.
> But I also seem to be starting to feel better at this dose too (knock wood) I'm in my 2nd week at 9mg, and just a few days ago started to notice an improvement. (I'm scared I'll jinx it!)
>
> Best of luck to you with it!!!
Posted by SLS on July 23, 2006, at 9:01:59
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » jealibeanz, posted by laima on July 23, 2006, at 8:53:52
> Oh ssris- easy, sure. If they work for you-lucky you. Prozac was a miracle for me once until it utterly "pooped out" after approximately 10 years.
Can you ascribe to this a particular life event or series of stressors? What about changes in hormonal biology? What about intense physical exercise? How old were you when this happened?
- Scott
Posted by jealibeanz on July 23, 2006, at 9:25:46
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » jealibeanz, posted by laima on July 23, 2006, at 8:53:52
I don't actually think SSRI's would help, but maybe I could bring it up as an option, I'm afraid to though. I really don't think I'll ever be properly medicated. It seems the harder I've ever pursued, the worse treatment I got (with new docs and a psychiatrist). They seem to not take me seriously, make me feel like a horrible messed up human being who's just a little kid and isn't having the perfect fantasy life and therefore wants drugs, and then they turn me away saying I have no depression or anxiety.
My family practitioner is the only person who ever acts at all interested. That is why I'm with him right now. I'm so thankful that he's willing to give me Xanax, without making me feel like an addict. And, he did increase my dosage to .5 mg 3xdaily. That's actually going to be a little much, but maybe I won't tell him that. I fear that I need to hoard the medication, because once I move farther, or god forbid he moves, I'll never get it again.
The depression is bad though, and he doesn't know it. It's not that it's always terrrible, but it's knowing that it's recurrent (definitely seasonal and other times too) since I was 15 and willlll come back that makes it so tough to have a positive outlook. I feel weak for not be happy with my life and for complaining to my doc. I have a good family, friends, and wonderful opportunities and experiences. I should be happy, yet I'm sitting here crying as I write this.
I don't sleep right now more than 3-4 hours a night for the past few months. So that doesn't help. But I don't want to write my depression off as being caused by insomnia and anxiety. They're just comorbidities or symptoms of the depression in my opinion.
Posted by laima on July 23, 2006, at 10:24:57
In reply to Re: emsam 6 mg/24 = ? oral selegiline?, posted by Jost on July 22, 2006, at 22:45:57
Thank you.
> Laima, this is a powerpoint demonstration given to the FDA by Somerset, which describes the tyramine challenges and the reactions on those taking parnate vs emsam.
>
> if the link doesn't work, I always find it by searching on google for "Lawrence Blob" the MD who made the presentation for Somerset.
>
> www.fda.gov/ohrms/dockets/ac/05/slides/2005-4186S2_03_Somerset-EMSAM.ppt
>
> Jost
Posted by laima on July 23, 2006, at 10:34:39
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » laima, posted by SLS on July 23, 2006, at 9:01:59
Good questions- no one had an easy answer, but my doctor said in fact, reports of the phenomena, known as "prozac poop-out" have started to show up in med journals.I was on it for about 10 years, great at first, and then it slid off somehow. I've never managed to get it to work again- no incrreased dose, nothing. No other ssris, either. Some brief relief from Wellbutrin, before that faded too. Now I'm doing a drastic change by going with the EMSAM, fingers crossed.
Honestly am unable to come up with any life event which could have triggered my response to flop. I've always been a vigourous excersiser. I started prozac when it first came out-I think that was 1988 89? and used until almost 2000. So- mostly during my 20's until about 30. Then zoloft one year, with tepid respponse, even to highest allowed dose, then that fizzled after less than a year. Trouble ever since.
Hormones? Unsure. I've been through a zillion blood tests, though.
> > Oh ssris- easy, sure. If they work for you-lucky you. Prozac was a miracle for me once until it utterly "pooped out" after approximately 10 years.
>
> Can you ascribe to this a particular life event or series of stressors? What about changes in hormonal biology? What about intense physical exercise? How old were you when this happened?
>
>
> - Scott
>
>
Posted by SLS on July 23, 2006, at 10:55:08
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » SLS, posted by laima on July 23, 2006, at 10:34:39
Thanks for the response.
Significant changes occur in the body at age 30 and again at age 40. It is interesting that poop-out for you occured at age 30 when nothing else could account for it.
Just trying to figure things out...
Good luck with Emsam. You have the right idea using a completely different angle of attack. I hope it works for you.
- Scott
Posted by laima on July 23, 2006, at 12:10:29
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » laima, posted by SLS on July 23, 2006, at 10:55:08
I thank you, too. Good points about body changes at ages 30 and 40. I do know I am absolutely too young for menopause or anything like that, (unless I am going through some unusually early pre-menopause stage?), but perhaps something else is going on. No doctor ever mention the possibility of hormonal changes as a possible reason-but that doesn't mean it's not a plausable explanation. I'll add that the real slide hit me by age 28. Dose was increased to maximum allowed, but provided no improvement. Just around 30, even the highest allowed dose was utterly ineffective. I asked, "did my brain change from long-term use of the drug?" Answer-"Possible- unlikely- but definately possible". Does this mean I'm more depressed or developed new issues? Same answer. And so on. I guess the existence of the "poop out" phenomena is debated by "the experts", and doesn't necessarily happen to everyone. But even those who believe it don't seem to be able to explain it.
If you google, you'll seee there are lots of med abstracts and other writings about this troubeling topic. I saw one which suggested ssris might plausabley deplete dopamine while they are busy boosting seratonin. (??) I hope that's not true.
I am concerned that I was amongst the first people to get prozac- got it the very month it was approved and hailed as a miracle. No one knew the long term effects, if any, at the time- but I was so unbelievabley grateful for the dramatic, rapid relief that I didn't care. I was 18, I think. Before that, I went through the whole gamut of trycyclics (or however that's spelled), and they all caused me horrible side effects, like sleeping 20 hours per day, groggy beyond belief, fast weight gain, migrainish headache, nausea, general "oddness", and I'm told, strange facial expression--and little, if any, relief. Prozac literally gave me my life back-for awhile. Truely, what a dramatic and rapid miracle it was. Can't possibly exaggerate.
Meanwhile, I am waiting for my new, higher dose EMSAM to arrive at the pharmacy, not in stock as I am their first customer to ever get it, but I've got my hopes up.
> Thanks for the response.
>
> Significant changes occur in the body at age 30 and again at age 40. It is interesting that poop-out for you occured at age 30 when nothing else could account for it.
>
> Just trying to figure things out...
>
> Good luck with Emsam. You have the right idea using a completely different angle of attack. I hope it works for you.
>
>
> - Scott
Posted by Phillipa on July 23, 2006, at 20:45:56
In reply to Re: more on prozac poop-out phenom » SLS, posted by laima on July 23, 2006, at 12:10:29
You know doctors dismiss hormones too quickly. And did you know that peri-menopause lasts l0-l5yrs? I only just learned this. And this the time period when all my problems began with anxiety and depression getting out of hand. I asked to have them checked when my FSH reached 50 as that means you're starting menopause but the docs wouldn't do it. I hear now that the OB-GYN's are doing hormone testing. I'm due in a few months for my annual so I will be asking for hormone tests even though I've gone through Menopause. You do still produce some and may need hormones. Years ago women didn't live til menopause. Love Phillipa
Posted by laima on July 23, 2006, at 21:14:10
In reply to Re: more on prozac poop-out phenom » laima, posted by Phillipa on July 23, 2006, at 20:45:56
Very interesting points and info. Thank you, Phillipa.
> You know doctors dismiss hormones too quickly. And did you know that peri-menopause lasts l0-l5yrs? I only just learned this. And this the time period when all my problems began with anxiety and depression getting out of hand. I asked to have them checked when my FSH reached 50 as that means you're starting menopause but the docs wouldn't do it. I hear now that the OB-GYN's are doing hormone testing. I'm due in a few months for my annual so I will be asking for hormone tests even though I've gone through Menopause. You do still produce some and may need hormones. Years ago women didn't live til menopause. Love Phillipa
Posted by jealibeanz on July 24, 2006, at 20:24:18
In reply to Re: emsam 6 mg/24 = ? oral selegiline?, posted by jealibeanz on July 23, 2006, at 9:25:46
He does think primary concern is social anxiety. Honestly, I feel it's much much stronger general constant nonstop anxiety than social anxiety, but not aware that depression is current, or organic in the past. He thought I was taking Effexor by his PA just because of drug induced crying spells (Adderall + Klonopin). Anyway, MAOI's are known as the "Gold Standard" for social anxiety. I know that although he doesn't have a problem with me taking Xanax for anxiety right now, he sorta mentioned that hopefully I'd be able to make it on my own without it. I think that's because we both know my future career may be in jeopardy if I'm taking daily Xanax. Maybe he'll come up with the idea of an MAOI, which I believe is looked upon more favorable (in terms of being drug-seeking, drug-dependent) by employers.
Posted by mayzee on July 24, 2006, at 22:34:10
In reply to Re: emsam 6 mg/24 = ? oral selegiline?, posted by jealibeanz on July 24, 2006, at 20:24:18
> Maybe he'll come up with the idea of an MAOI, which I believe is looked upon more favorable (in terms of being drug-seeking, drug-dependent) by employers.
>Hi jealibeanz,
My ongoing question with your posts is -- why won't you just ask your GP for Emsam? The way you describe him is that he's very caring and understanding. And you seem so knowledgable about yourself and about meds. I just want to say to you Sweetie, please just ask him. I feel bad that you seem so anxious about it. Sounds from your posts like he would be very open to hearing what you have to suggest. No? I don't mean to downplay your anxiety; just hate to hear you worry so much about it. So just wanted to be encouraging to give it a try to ask him.
Wishing you the best!!!
mayzee
Posted by jealibeanz on July 25, 2006, at 11:22:55
In reply to Re: emsam 6 mg/24 = ? oral selegiline? » jealibeanz, posted by mayzee on July 24, 2006, at 22:34:10
Yes, I am doing quite a bit of worrying about the matter. Obviously asking him directly would be the most sensible thing to do. I just feel silly/pretentious coming home after my first semester and acting like I now know everything about medicine, as ifI think I'm ready to start writing prescriptions myself.
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