![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 68 to 92 of 98. Go back in thread:
Posted by laima on July 22, 2006, at 10:12:03
In reply to Re: Everyone PLEASE share your EMSAM updates? » ZeitGuest, posted by RobertDavid on May 22, 2006, at 0:45:56
I too am utterly confused. My doctor just attended an "EMSAM conference" with other psychiatrists and researchers from the drug company. Part of the info that came out of this is that there is mass confusion about what the doses mean! Also that the 6 is considered too low of a dose to help many, many people. I am moving up from the 6 to the 9- which I hear is far more potent than the 6. The 9, per doctor's report of what the company reps explained, is roughly 60-90mg oral selegeline. That sounds like a lot! I don't get it.
> > One thing I find confusing about the EMSAM literature is the dosing specs. On my box it says, "20mg (6mg/24 hours)." Does that mean that each patch contains 20mg of selegiline, but only 6mg of that total gets metabolized by one's system in a 24-hour period?
>
> That's what I understand from my research on it.
Posted by RobertDavid on July 22, 2006, at 11:39:23
In reply to Re: Everyone PLEASE share your EMSAM updates » RobertDavid, posted by laima on July 22, 2006, at 10:12:03
I think like all medications, EMSAM will be perscribed at different doses as everyones chemistry is different. I believe those with Major Depression Disorter will need higher doses and have the best chance of taking EMSAM as mono therapy (though many will still need to augment it with something for insomnia and agitation).
Some like me who have Social and or Generalized Anxiety disorters may find that EMSAM helps with a milder form of depression, lack of energy and mental fogg that can go with these disorters, but will most likely need other meds to tackle the anxiety such as klonopin. I consider EMSAM to be just an addition to klonopin. For me, klonopin is the SAD and GAD stopper.
I don't think you can really compare oral vs the patch. I'm not the scientist type and perhaps others can answer this better, but it's my understanding that the patch works differently, has different effects and side effects, has a 24 hour stream of medication instead of a very short half live via oral dosing.
But certainly the higher the patch dose, the more selegiline will be in your blood levels which will have a bigger effect on MAO-A which can further kick in the anti depressant benefits and perhaps anti anxiety benefits.
One of the things that has helped me the most is doing daily cardio (treadmill). Before EMSAM I just didn't feel like working out, no energy to do it. I have to say regular exersize is probably the best medicine I'm taking. It's certainly common knowledge that it helps your endorphins/neurotransmitters. Just my take. Rob
Posted by Jost on July 22, 2006, at 17:43:25
In reply to Re: Everyone PLEASE share your EMSAM updates » laima, posted by RobertDavid on July 22, 2006, at 11:39:23
Has anyone had any recommendations for agitation and insomnia?
I've been taking about 9 mg/day for a while, but in the form of 18mg/ 12 hr, then 12 hrs off, on recommendation of pdoc.
I've been thinking that I've experienced a lot of agitation for about a week-ten days.
I don't quite remember when I started with various levels of the drug. I got the 12 mg patch on Jun 27, but it was sometime after that that I started being agitated-- say Jul 12-13.
Earlier my problem was mostly insomnia. Now I have better sleep,but more agitation. So the larger dose for a shorter time is too much.
Hm. I cut down some yesterday, and more today but maybe it also takes more time for the agitation to lessen.
Anyone have any specific ideas about the agitation?
I'm also not going to keep up with seroquel, I get a bad reaction, some tic type stuff, very minor, but enough to be too worrisome. So I have to rely on other things for sleep-- which I'm a bit concerned about. What has anyone used for that, other than seroquel?
But more concerned about the agitation, if it does continue. I'm sure I need more than 6 mg/24hr.
By the way, I'm sure cutting the patches in half is okay, also. My pdoc is very careful and said it's fine.
If you fold the package carefully, and line up the small knicks in the sides, they're very easy to cut in half. Of course, only one half has the fold, where it's easier to apply. But it's easy to manage.
Jost
Posted by laima on July 22, 2006, at 18:34:26
In reply to Re: Everyone PLEASE share your EMSAM updates » RobertDavid, posted by Jost on July 22, 2006, at 17:43:25
Thanks for the cutting-patches report. I never asked my doctor about it- thought of it after my apointment.
I haven't experienced the agitation, can't comment. Hopefully someone else will.
> Has anyone had any recommendations for agitation and insomnia?
>
> I've been taking about 9 mg/day for a while, but in the form of 18mg/ 12 hr, then 12 hrs off, on recommendation of pdoc.
>
> I've been thinking that I've experienced a lot of agitation for about a week-ten days.
>
> I don't quite remember when I started with various levels of the drug. I got the 12 mg patch on Jun 27, but it was sometime after that that I started being agitated-- say Jul 12-13.
>
> Earlier my problem was mostly insomnia. Now I have better sleep,but more agitation. So the larger dose for a shorter time is too much.
>
> Hm. I cut down some yesterday, and more today but maybe it also takes more time for the agitation to lessen.
>
> Anyone have any specific ideas about the agitation?
>
> I'm also not going to keep up with seroquel, I get a bad reaction, some tic type stuff, very minor, but enough to be too worrisome. So I have to rely on other things for sleep-- which I'm a bit concerned about. What has anyone used for that, other than seroquel?
>
> But more concerned about the agitation, if it does continue. I'm sure I need more than 6 mg/24hr.
>
> By the way, I'm sure cutting the patches in half is okay, also. My pdoc is very careful and said it's fine.
>
> If you fold the package carefully, and line up the small knicks in the sides, they're very easy to cut in half. Of course, only one half has the fold, where it's easier to apply. But it's easy to manage.
>
> Jost
>
>
Posted by Last Chance on July 24, 2006, at 14:20:08
In reply to Re: Everyone PLEASE share your EMSAM updates » Jost, posted by laima on July 22, 2006, at 18:34:26
Hello - I am still doing half a 6mg patch and only leaving it on during the day - much less agitation this way - sleep is ok, but still not long, only 5 or 6 hrs. Strong cup of coffee in the morning and one in the afternoon - .25 klonapin in morning and evening - and I have been taking .25 Xanax under my tongue when I will be heading to some kind of social situation. So this is working pretty good - general depression and anxiety are definitely better, with the occasional exception. So that's my regimen now - oh, I do not have as much motivation and evergy as I did on a higher dose, but as hot as it has been lately that is probably a good thing. Richard
Posted by laima on July 24, 2006, at 15:53:08
In reply to Re: Everyone PLEASE share your EMSAM updates, posted by Last Chance on July 24, 2006, at 14:20:08
> I have been taking .25 Xanax under my tongue
Why under your tongue? Does it work better or different that way than when you swallow it?
Thanks.
Posted by mayzee on July 24, 2006, at 19:57:51
In reply to Re: Everyone PLEASE share your EMSAM updates, posted by Last Chance on July 24, 2006, at 14:20:08
> Hello - I am still doing half a 6mg patch and >only leaving it on during the day
>Last Chance,
Do you mind telling me your diagnosis? Is anxiety your primary problem (vs. MDD?) I just read Robert David's post saying he is also using only half the 6mg patch, and taking it off at night.
I am taking emsam for MDD. So far I am at the 9mg patch 24 hrs. Last week I had 3 good days in a row, but now seem to be back to being super fatigued and down again, with even more orthostatic hypotension.
Thanks for sharing your experience. And glad to hear that it is working well for you!
mayzee
Posted by laima on July 24, 2006, at 20:11:34
In reply to Re: Everyone PLEASE share your EMSAM updates » Last Chance, posted by mayzee on July 24, 2006, at 19:57:51
Dear Mayzee,Are you saying "low blood pressure" when you say "orthostatic hypotension"? I heard EMSAM can lower blood pressure, and my doctor added a teeny amount of ritalin to my regimine to boost my blood pressure back up a touch. It's been working out great! Do you suppose your doctor would consider something like that if you asked? Maybe it would be helpful for you, too.
Sincerely,
Laima
> I am taking emsam for MDD. So far I am at the 9mg patch 24 hrs. Last week I had 3 good days in a row, but now seem to be back to being super fatigued and down again, with even more orthostatic hypotension.
Posted by Phillipa on July 24, 2006, at 20:19:28
In reply to Re: Everyone PLEASE share your EMSAM updates » Last Chance, posted by mayzee on July 24, 2006, at 19:57:51
There's a thread today down the board between Scott and Robert David I think you all would enjoy reading. Love Phillipa
Posted by mayzee on July 24, 2006, at 22:50:16
In reply to Re: Everyone PLEASE share your EMSAM updates » mayzee, posted by laima on July 24, 2006, at 20:11:34
>
> Are you saying "low blood pressure" when you say "orthostatic hypotension"? I heard EMSAM can lower blood pressure, and my doctor added a teeny amount of ritalin to my regimine to boost my blood pressure back up a touch. It's been working out great! Do you suppose your doctor would consider something like that if you asked? Maybe it would be helpful for you, too.
>Laima,
I haven't been able to take a reading on my blood pressure yet. I have been experiencing dizziness, lightheadedness, headache, blurred or dimmed vision at various times. Originally it was only when changing position (e.g. bending over then standing up) but lately it happens just when walking up a slight incline. I do tend to have low bp, so should get it checked out. I tried to see the pdoc today but she was out sick. I don't have medical insurance at the moment so am very limited in my doctor visits :(
Thank you for your suggestion. I'll try to follow up on it.
I have been hoping that this side effect will go away. Maybe the low blood pressure side effect doesn't though? I'm in my 15th day at 9mg. Didn't have this at 6mg.
Best,
mayzee
Posted by laima on July 25, 2006, at 0:57:46
In reply to Re: Everyone PLEASE share your EMSAM updates » laima, posted by mayzee on July 24, 2006, at 22:50:16
Hi Mayzee,
Wow, well maybe the matter of low blood pressure could be the problem then? I'm told that EMSAM really does lower blood pressure for many people, and some of us are more suseptable.
What you describe about fatigue, dizziness, lightheadedness are classsic signs that may indicate lower than ideal blood pressure.
Especially the part about changing position being an aggrevator...I am no medical expert, no doctor-I might be very wrong-but it's my understanding that blood pressure wont just go up on it's own spontaneously, particularly if there is a drug involved.
I've always had low blood pressure too-even befiore going on EMSAM 6. Now that I'm switching to 9, and still using the small amount of ritalin, I was told to keep an eye on where it is going. Apparently the higher dose could make it dip even lower. I got a blood pressure reader at Walgreens drug store for less than 50$.-not cheap, but not as bad as I expected.
I hope you have better luck with your doctor on your next appointment, and that he or she is open to exploring this possibility. The stimulant/maoi is a classic "no-no" (because maoi plus stimulant can cause blood-pressure crisis)- but my doctor reports that in reality, it can be absolutely fine, with restraint of course, for many, many patients-particularly if they keep an eye on what their blood pressure is doing, at least until they understand it.
I wish very good luck to you- I hope you find relief from the problem you describe, despite the unfair obstacles you face, in terms of insurance, I mean.
Best wishes,
Laima
> Laima,
>
> I haven't been able to take a reading on my blood pressure yet. I have been experiencing dizziness, lightheadedness, headache, blurred or dimmed vision at various times. Originally it was only when changing position (e.g. bending over then standing up) but lately it happens just when walking up a slight incline. I do tend to have low bp, so should get it checked out. I tried to see the pdoc today but she was out sick. I don't have medical insurance at the moment so am very limited in my doctor visits :(
>
> Thank you for your suggestion. I'll try to follow up on it.
>
> I have been hoping that this side effect will go away. Maybe the low blood pressure side effect doesn't though? I'm in my 15th day at 9mg. Didn't have this at 6mg.
>
> Best,
> mayzee
>
Posted by theo on July 25, 2006, at 17:11:53
In reply to Re: Everyone PLEASE share your EMSAM updates » laima, posted by RobertDavid on July 22, 2006, at 11:39:23
Are you still taking 1/2 of a 9mg patch? Are you leaving on full time or just putting on in the morning and taking off at night? Also, have you found locations for the placement of the patch working better than others?
Thanks
Posted by theo on July 25, 2006, at 17:15:21
In reply to Re: Everyone PLEASE share your EMSAM updates » laima, posted by RobertDavid on July 22, 2006, at 11:39:23
I meant 1/2 of a 6mg patch.
Posted by RobertDavid on July 25, 2006, at 18:51:01
In reply to Re: Everyone PLEASE share your EMSAM updates » RobertDavid, posted by theo on July 25, 2006, at 17:11:53
> Are you still taking 1/2 of a 9mg patch? Are you leaving on full time or just putting on in the morning and taking off at night? Also, have you found locations for the placement of the patch working better than others?
>
> ThanksI'm taking half the 6mg patch. I take it off at night, seems to be all I need to help with energy and mood, klonopin does the rest for anxiety. As for placement I have found if I put the patch on the same spot within about 4 days or so it can get a little red and irritated so I move it around, mostly on my arms, chest and upper back. Hope that helps.....Rob
Posted by Donna Louise on July 25, 2006, at 20:34:12
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by jkshrews on May 16, 2006, at 23:56:13
> > I have been posting nearly everyday, they are just coming out all over the board, I guess. I am not real savy on thread starting, ect. I just write after someone wrote something I want to respond to. so there is some stuff there, basically I have been talking about problems with the thing not sticking. And somewhere on here I talked about how I have not had a great two days past. and rambled a bunch of speculation. It is on here somewhere. I have had some rage, and alot of sobbing, basically how I am untreated. I think my happy effexor withdrawal rebound is over and the EMSAM has not kicked in enough to to overcome these particular symptoms, probably i am not getting enough medicine. But I have no trouble sleeping, I am sleeping less hours per night and that is a good thing because I get hypersomnulant. I feel rested and wanting to do more and get out more. But I still feel worn out from the effexor withdrawal so not doing as much as I would if I felt better. I am worried about all this irritability but I am not blaming it on the patch, this is normal unmedicated hell for me. It has only been a week and I do have alot of moments of feeling depression free. Oh, I do take klonopin, I know that helps with the anxiety. I dont know how anxious I would be if I didn't take it. I can say this, I don't feel any more anxious than usual, maybe less, except for the irritablity which I know is anxiety in another one of its entertaining forms.
> > I will post more later. I am having a hard time typing now. I also have alot of real life stuff going on so I can't say this is all endogenous.
> >
> > Donna
>
>
> Donna,
>
> If by your "happy effexor withdrawl rebound" you mean that you had an episode of euphoria (or irritation) after suddenly stopping the Effexor without tapering it down slowly, I think that is usually considered a strong indication that you may have bipolar disorder. It is called a "hypomania," and will often happen after suddenly stopping an antidepressant, if you have bipolar disorder.
>
> Being hypersomnolent is an indication of "atypical depression," and the EMSAM patch should help with that. But many authorities consider atypical depression to be a kind of bipolar disorder, and your mention of irritability might be taken to confirm that somewhat. The EMSAM addresses the depression aspects of the disorder, but not the euphoria/dysphoria (irritabilility) aspect. You might think about trying to get some Lithium to go along with your EMSAM. That may help with the irritability problems. The only way to know is to try it.
>
> jkshrewsHey jkshres,
I don't know how I missed your post to me before but I just now read it. Weird. But not really so weird for me. I aggee with you 100% abou the bipolar symptoms and have talked to the pdoc about it more than once. She seems to think that since I haven't had a period where I couldn't sleep or sleep that much that it rules it out. She doesn't say that exactly, it is an inference since I don't know that she ever says anything that definitive. Its like she leaves all the doors open but I think she didn't think too much about it.She doesn't get hung up finding the right lable like I do. She probably knows better that to get into that kind of discourse with me. She would be participating in my rumination problems. I told her I must take some lamictal for this irritablity thing and she agreed and it has helped so much. But now, alot is differeny in the way I feel so it is way past time for an udate. I have been on 12mg for at least a month, longer probably. And I know longer have all that energy and less need for sleep. I am back to getting 8 hours and a nap midday if I want. I have no more of that irritability or OCD like behavior I was having. I am also having no depression and very little anxiety. I take 1mg klonopin, ..25 in moring and afternoon and .50 at bedtime. I am back up to 400mg provigil. I had dropped it to 100mg during all the speedy irritablity. I have been taking provigil for at least 4 years and I notice a big differenc with a lower dose. It really as an antidepressant and antianxiety effect for me. And the 50mg of lamictal. That seems to be plenty. I had gone to 100mg but only for a few days because my memory got worse and I started dropping things and had a meltdown. So all is good just at 50mg. So for now, I have the best combo I have had since I started pdoc prescribed meds in 1990. I am not numbed out like I was on all the other types of AD's I have taken over the years. I have had to relearn coping skills that I haven't had to use in 16 years.
ok, long post but it has been a long time since I posted. I hope this gives others hope.donna
Posted by mayzee on July 25, 2006, at 21:16:38
In reply to Re: Everyone PLEASE share your EMSAM updates » mayzee, posted by laima on July 25, 2006, at 0:57:46
Hi Laima,
I went to see my internist today; didn't want to wait till the next pdoc appt. He confirmed the low blood pressure: 80/60, but said it's only a problem if the symptoms are a problem to me (which they are when I have the fatigue, dizziness, darkened vision, etc.) And he tested for and confirmed the orthostatic hypotension. But he doesn't want to give me anything for it. Just said to drink lots of water, eat more salt, and talk to my pdoc.
Same drill for the insomnia/sleep fragmentation. He didn't want to give me anything for that either. Said I should try vigorous physical exercise. Of course that makes sense, but even before I had all the dizziness, etc. I could never get myself to exercise even though I know it will help. Too depressed & no energy. Now I'd be afraid I'd fall over! Anyway, I will bring these up with the pdoc next week.
I was always someone who couldn't imagine taking more drugs to deal with drug-induced side effects, but I'm starting to catch on. If I could feel like I did on those 3 good days last week it would definitely make the side effects worth it!
--Mayzee
Posted by laima on July 26, 2006, at 9:49:33
In reply to Re: Everyone PLEASE share your EMSAM updates » laima, posted by mayzee on July 25, 2006, at 21:16:38
Hi Mayzee,Wow, I'm surprised how doctors' philosophies can differ. They are all different I guess. Your blood pressure sure does sound low, did he/she not think the symptoms you described were of sufficient severity to address? They sound like they are interfering with your ability to function well.
If this might be of any help, I was told potasium, ie eating (firm, not mushy) bananas would help keep water in the body, hence helping keep blood pressure a bit higher. (The firm bananas, I was told, do not pose the same dietary danger as mushy ones for those of us on an maoi.) I too was advised to eat salt, one doc even said, "You're not on one of those low-salt diets, I hope! Eat it, you need it."
I can conceive of your doctor being reluctant to easily prescribe a sleep aid- they can sometimes end up causing problems, too-such as dependency. I've also heard talk that some believe they are being handed out too freely. But sometimes we need them, and ENSAM is known to cause insomnia.
I understand what you mean about vigourous excercise being hard in such a state. I managed to start a pretty good habit some years back for purpose of boosting my mood and it does help- but during a low, low blood pressure spell it feels near impossible. But I did discover that vigourous cardio excercise , with music, can, for me, be a near guarenteeed method of getting my head into a different place, at least temporarily, if I can get through the first 10-15 minutes. After that point, it seems like energy materializes out of nowhere. Doing this out in the sun is even better. In the winter, I fess up to enjoying the cheesy spin classes at my gym, led by peppy athletes who love to constantly exclaim things like, "you can do it! way to go! you are all way stronger than you realize! Looking awesome! You all are taking care of your bodies and deserve applause!!!!" After an hour of that, well! It's not so bad. That kind of enthusiasm feels contagious.
Unfortunately, I am not convinced excercise done much for my sleep issues.
In any case, your idea of revisiting your important concerns with pdoc sounds like a pretty good idea, in my opinion. He or she might have a different view or understanding of what you are experiencing, being a specialist-and-I presume, the one who prescribed EMSAM in the first place?
I wish you very good luck in getting through the wait for your appointment, and with the appointment itself.
Me- on day 2 of the EMSAM 9, still hoping it kicks in.
Best Wishes,
Laima
> Hi Laima,
>
> I went to see my internist today; didn't want to wait till the next pdoc appt. He confirmed the low blood pressure: 80/60, but said it's only a problem if the symptoms are a problem to me (which they are when I have the fatigue, dizziness, darkened vision, etc.) And he tested for and confirmed the orthostatic hypotension. But he doesn't want to give me anything for it. Just said to drink lots of water, eat more salt, and talk to my pdoc.
>
> Same drill for the insomnia/sleep fragmentation. He didn't want to give me anything for that either. Said I should try vigorous physical exercise. Of course that makes sense, but even before I had all the dizziness, etc. I could never get myself to exercise even though I know it will help. Too depressed & no energy. Now I'd be afraid I'd fall over! Anyway, I will bring these up with the pdoc next week.
>
> I was always someone who couldn't imagine taking more drugs to deal with drug-induced side effects, but I'm starting to catch on. If I could feel like I did on those 3 good days last week it would definitely make the side effects worth it!
>
> --Mayzee
Posted by mayzee on July 26, 2006, at 21:26:43
In reply to Re: Everyone PLEASE share your EMSAM updates » mayzee, posted by laima on July 26, 2006, at 9:49:33
>
> Your blood pressure sure does sound low, did he/she not think the symptoms you described were of sufficient severity to address?
>I think basically he just wanted me to follow up with the whoever prescribed the Emsam in the first place. I understand that. I just wanted to check to see if it was something so serious that i had to address it immediately and he didn't say that.
> If this might be of any help, I was told potasium, ie eating (firm, not mushy) bananas would help keep water in the body, hence helping keep blood pressure a bit higher. (The firm bananas, I was told, do not pose the same dietary danger as mushy ones for those of us on an maoi.)
>Thanks, I'll try the bananas for potassium. (someone also recommended Gatorade because that way you get water/potassium/sodium all at once). Question though... I thought only banana peels were dangerous; I hadn't heard that mushy bananas were a problem. Is that right?
> I understand what you mean about vigourous excercise being hard in such a state. I managed to start a pretty good habit some years back for purpose of boosting my mood and it does help
>If there's one thing I wish I could get myself to do, it's exercise. It's a no-brainer, and yet I have never been able to make myself do it. (even when not depressed, I'd pay the gym membership and then not go)
>
> In any case, your idea of revisiting your important concerns with pdoc sounds like a pretty good idea, in my opinion. He or she might have a different view or understanding of what you are experiencing, being a specialist-and-I presume, the one who prescribed EMSAM in the first place?
>Unfortunately my pdoc is at the free clinic and while very nice, has no experience with MAOIs let alone Emsam. I'm very fortunate that she was willing to try it with me, and give me free samples. But she's very nervous that I went up to the 9mg level. So I'm a little nervous to tell her about my side effects 'cause I'm afraid she'll push for me to stop. I really want to give Emsam a full trial. On the other hand, at the clinic they don't seem shy about adding drugs to deal with side effects, so she may be willing to give me something for sleep. We shall see!
Posted by Iansf on July 30, 2006, at 1:37:44
In reply to Re: Everyone PLEASE share your EMSAM updates, posted by mayzee on July 26, 2006, at 21:26:43
> Thanks, I'll try the bananas for potassium. (someone also recommended Gatorade because that way you get water/potassium/sodium all at once). Question though... I thought only banana peels were dangerous; I hadn't heard that mushy bananas were a problem. Is that right?
>Overripe bananas can have high levels of tyramine, but firm bananas shouldn't be a problem, especially with Emsam as opposed to an oral MAOI. As for banana peels, you should never eat them, even if you're not taking an MAOI - all bananas sold in the US (and most other countries too, I presume) are doused with highly poisonous sprays to kill bugs and spiders. It could make you very sick.
Posted by laima on July 30, 2006, at 8:40:01
In reply to Re: Everyone PLEASE share your EMSAM updates, posted by Iansf on July 30, 2006, at 1:37:44
If you are lucky, sometimes you'll find organic bananas show up at Whole Foods or other health food stores....but oddly, some are still stamped "Dole".
> > Thanks, I'll try the bananas for potassium. (someone also recommended Gatorade because that way you get water/potassium/sodium all at once). Question though... I thought only banana peels were dangerous; I hadn't heard that mushy bananas were a problem. Is that right?
> >
>
> Overripe bananas can have high levels of tyramine, but firm bananas shouldn't be a problem, especially with Emsam as opposed to an oral MAOI. As for banana peels, you should never eat them, even if you're not taking an MAOI - all bananas sold in the US (and most other countries too, I presume) are doused with highly poisonous sprays to kill bugs and spiders. It could make you very sick.
Posted by Crazy Horse on July 30, 2006, at 9:57:04
In reply to Re: Everyone PLEASE share your EMSAM updates » Iansf, posted by laima on July 30, 2006, at 8:40:01
I'm on the 9 mg EMSAM patch and doing well. For the insomnia problem 200 mgs of trazodone and 50 mgs of lyrica at bedtime have eliminated all insomnia probs for me. I was having rash probs..they were lasting 3-4 days and itched pretty bad, Hydrocortisone cream has eliminated this prob. So i'm doing quite well on "The Patch" also in combination w/600 mgs. of lyrica a day which i think/know is helping A LOT.
Also, (I'm certainly not recommending this!) yesterday i ate a sub sandwich with cheddar cheese..and had no ill effects at all..BP was not elevated. So anyway...that's my story :)Monte
Posted by jkshrews on August 7, 2006, at 11:19:03
In reply to Re: Everyone PLEASE share your EMSAM updates » mayzee, posted by laima on July 24, 2006, at 20:11:34
One of the traditional rememdies for low blood pressure caused by MAOIs is salt pills to increase your blood volume. The ones I am familiar with are Thermotabs. The drug store generally carries them only during the summer, so if they work for you, stock up. They are a mix of Sodium and Potassium chloride.
>
> Dear Mayzee,
>
> Are you saying "low blood pressure" when you say "orthostatic hypotension"? I heard EMSAM can lower blood pressure, and my doctor added a teeny amount of ritalin to my regimine to boost my blood pressure back up a touch. It's been working out great! Do you suppose your doctor would consider something like that if you asked? Maybe it would be helpful for you, too.
>
> Sincerely,
>
> Laima
>
>
> > I am taking emsam for MDD. So far I am at the 9mg patch 24 hrs. Last week I had 3 good days in a row, but now seem to be back to being super fatigued and down again, with even more orthostatic hypotension.
>
>
>
Posted by jkshrews on August 7, 2006, at 11:27:44
In reply to Re: Low Blood Presure, posted by jkshrews on August 7, 2006, at 11:19:03
I am on the 12 mg patch, and the sexual apparatus has ceased to function. I don't know if it's the EMSAM or if it's all the clonazapam I have to take to be able to get a night's sleep. I'm thinking of switching sleep meds to Rameltheon, since bipolars like myself usually have screwed-up Circadian rhythm, to see if the sexual side effects improve. Does anyone have any experience with this problem?
Posted by mayzee on August 7, 2006, at 14:51:45
In reply to Re: Low Blood Presure, posted by jkshrews on August 7, 2006, at 11:19:03
> One of the traditional rememdies for low blood pressure caused by MAOIs is salt pills to increase your blood volume. The ones I am familiar with are Thermotabs. The drug store generally carries them only during the summer, so if they work for you, stock up. They are a mix of Sodium and Potassium chloride.
>Thanks jkshrews, I did get some Thermotabs, but that & the extra water didn't do enough, so I had to back down to 6mg Emsam.
I haven't noticed any sexual side effects yet, good or bad. Sorry I can't be more of a help.
Good luck!
--mayzee
Posted by Donna Louise on August 8, 2006, at 8:54:02
In reply to Chemically Castrated, posted by jkshrews on August 7, 2006, at 11:27:44
> I am on the 12 mg patch, and the sexual apparatus has ceased to function. I don't know if it's the EMSAM or if it's all the clonazapam I have to take to be able to get a night's sleep. I'm thinking of switching sleep meds to Rameltheon, since bipolars like myself usually have screwed-up Circadian rhythm, to see if the sexual side effects improve. Does anyone have any experience with this problem?
Yes, I have trouble with this. and have for a long time. There could be alot of reasons in my case, menapause, hepatitis to name a few. But I first noticed function loss with paxil and then later came the loss of libido too. I have noticed it more so on the 12 mg patch than when I was on the lower doses. I think once I get enough seratonin action from an AD, I get the accompanying side effect of sexual nonexistance.
It has been this way for years, I have about given up on ever having it back without stopping the meds and then it isn't worth the depression. I take klonopin too, I don't know if it adds to the problem or not, I am more inclined to think it is the seratonin in the higher mg patch. But I need that much for it to be effective. It is a terrible trade off but I chose to not be depressed and the AD's that are not supposed to cause this don't work for me, again, no or not enough seratonin.
sorry you have it too. sigh.donna
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