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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by mayzee on July 30, 2006, at 15:11:26
Well, I saw my pdoc yesterday and, as expected, she is unhappy about my problems with low blood pressure. She wants me to back down to the 6mg patch right away. (I only started having the low bp problems after a week or so at the 9mg level. I've had 20 days at the 9mg level, preceded by 7 weeks at 6mg)
The low bp problems are significant for me –lightheadedness, dimmed vision, headache, nausea, heart palpitations when I take a walk (I have to walk my dog twice a day), and extreme fatigue all the time. I have no energy to do anything. (oh, except sit at the computer and read Babble). I can’t live like this. Plus the pdoc said it’s bad for your heart; that low pb puts more of a strain on it.
Despite that I am hesitant to retreat on EMSAM. On days 9, 10, 11 at the 9mg level I felt good; better than I had in ages. (except for that one day –day 6—at 6mg where I felt good) That really got my hopes up that this was going to work. But the low bp stuff really got worse after those 3 days.
My pdoc said ok to me trying 1 more week at 9mg with drinking lots of water, eating salt, etc. to try to help my bp. But she really wants me to back down to 6mg, see if there’s any AD effect and, if not, wash out EMSAM and try a tricyclic. She doesn’t have any experience with MAOIs, and I haven’t ever tried a tricyclic yet.
I think I had such hopes for EMSAM since all the high-power pdocs I’d had consults with over the years had said that MAOIs are best for atypical depression. I’d dragged my feet getting around to trying one, so had my hopes very high. And I hate to give up on any med without going to the max so that I can say I gave it a full trial. (after previous experiences where docs said, oh but you didn’t really go high or long enough. It all takes such a long time!) But I do feel sick with this low bp.
What do you guys think? Does it sound like I gave EMSAM a full enough trial and that it’s time to back off and find something else?
*What would you do if you were me?*
--mayzee
P.S. she did give me klonopin to help with the ensam-induced sleep problems
P.P.S. other drugs I’ve taken without success: zoloft, effexor, prozac, paxil, wellbutrin, luvox, lexapro, cymbalta
Posted by Racer on July 30, 2006, at 15:41:51
In reply to What would you do? EMSAM, posted by mayzee on July 30, 2006, at 15:11:26
>
> *What would you do if you were me?*
>I'd get awfully frustrated and probably give up on meds -- again -- before climbing onto the sofa to cry for a week. At least, that's what I have done in the past...
I guess, with the facts as you've put them forth, I'd probably give it another week. Go out and get a BP cuff, if you don't already have one, to make sure that it really is BP and not something that just mimics the symptoms. (I've had a couple of situations that met that criteria: I thought my BP was low, but that wasn't causing my problems after all. Something else going on.) And, if it really is BP, and it really doesn't go away after a week, I'd give the 6mg patch another shot. See if you keep the AD effects. If not, I'd ask my doctor about trying Florinef to support my BP while going back up to 9mg.
> P.P.S. other drugs I’ve taken without success: zoloft, effexor, prozac, paxil, wellbutrin, luvox, lexapro, cymbaltaThis is really why I'm answering, though... Yes, you could try a TCA, or an MAOI, but have you tried combinations of those meds? Did any of them, at adequate trials at therapeutic doses, offer any improvement? I did OK for a couple of years on Effexor and Prozac, although neither alone helped much. It could be that combining a couple of them would help, even though nothing worked completely on its own.
Good luck.
Posted by Crazy Horse on July 30, 2006, at 21:01:36
In reply to What would you do? EMSAM, posted by mayzee on July 30, 2006, at 15:11:26
What would i do? I would go back to the 9 mg. patch that made you "feel better than you have in ages" and take salt pills..you can get them at Wal-Mart or any drug store. Drink more water and add a lot of salt to your food..that is what i would do.
Personally, i am do very well on EMSAM 9 mg. patch, BP is a little lower, but not too low. Whatever you do i wish you the best. Lyrica (High dose 600 mgs.) has also helped me tremendously with depression, anxiety, social anxiety and insomnia. i wish you well. :)Monte
Posted by Jost on July 30, 2006, at 21:02:13
In reply to What would you do? EMSAM, posted by mayzee on July 30, 2006, at 15:11:26
Well, I personally, would stick the with emsam, maybe trying taking it off for a while during the day, or at night--
What was your blood pressure? I may misremember, but it was about 90/50 or so? My is always about 98/55--but that's me-- if you're lightheaded and have no energy, that's not going to work. Mine was lower for a few days at the beginning --about 85/50 and I felt lousy, but only a few days Maybe you'll accommodate. I could be wrong, but I can't imagine a few weeks of low blood pressure would hurt you, unless there's some special reason.
Are you sleeping okay? Because maybe there are contributing factors to your being so exhausted? (Just hoping.)
I noticed that you hadn't tried Parnate or Nardil. How about one of them? The Maoi thing really isn't that bad, you just have to get used to a few restrictions, like soy sauce, aged cheese, etc, and not using certain decongestants, and demerol--the drug restrictions are the same with emsam, I think.
If your pdoc isn't experiencef with Maois, she may be hesitant, but maybe she could look into it more. With a good reaction to emsam, it might be worth it. I took Parnate for about three years, and although I like emsam much better, I think maois are well worth whatever trouble, if nothing else works. (My stopping the Parnate was for other reasons, not to take emsam.)
Jost
Posted by Phillipa on July 30, 2006, at 22:02:42
In reply to Re: What would you do? EMSAM » mayzee, posted by Jost on July 30, 2006, at 21:02:13
She said low blood pressure would hurt your body? Only if your on the verge of shock would it hurt you. For short periods of time. Think I'll good low bp and see what it says. Love Phillipa
Posted by silvercoin on July 31, 2006, at 8:09:04
In reply to What would you do? EMSAM, posted by mayzee on July 30, 2006, at 15:11:26
> Well, I saw my pdoc yesterday and, as expected, she is unhappy about my problems with low blood pressure. She wants me to back down to the 6mg patch right away. (I only started having the low bp problems after a week or so at the 9mg level. I've had 20 days at the 9mg level, preceded by 7 weeks at 6mg)
>
> The low bp problems are significant for me –lightheadedness, dimmed vision, headache, nausea, heart palpitations when I take a walk (I have to walk my dog twice a day), and extreme fatigue all the time. I have no energy to do anything. (oh, except sit at the computer and read Babble). I can’t live like this. Plus the pdoc said it’s bad for your heart; that low pb puts more of a strain on it.
>
> Despite that I am hesitant to retreat on EMSAM. On days 9, 10, 11 at the 9mg level I felt good; better than I had in ages. (except for that one day –day 6—at 6mg where I felt good) That really got my hopes up that this was going to work. But the low bp stuff really got worse after those 3 days.
>
> My pdoc said ok to me trying 1 more week at 9mg with drinking lots of water, eating salt, etc. to try to help my bp. But she really wants me to back down to 6mg, see if there’s any AD effect and, if not, wash out EMSAM and try a tricyclic. She doesn’t have any experience with MAOIs, and I haven’t ever tried a tricyclic yet.
>
> I think I had such hopes for EMSAM since all the high-power pdocs I’d had consults with over the years had said that MAOIs are best for atypical depression. I’d dragged my feet getting around to trying one, so had my hopes very high. And I hate to give up on any med without going to the max so that I can say I gave it a full trial. (after previous experiences where docs said, oh but you didn’t really go high or long enough. It all takes such a long time!) But I do feel sick with this low bp.
>
> What do you guys think? Does it sound like I gave EMSAM a full enough trial and that it’s time to back off and find something else?
>
> *What would you do if you were me?*
>
> --mayzee
>
> P.S. she did give me klonopin to help with the ensam-induced sleep problems
>
> P.P.S. other drugs I’ve taken without success: zoloft, effexor, prozac, paxil, wellbutrin, luvox, lexapro, cymbalta
I would stay on the 9 mg patch and add some other agent to raise BP. I take Marplan and have some of the same issues but have apparently strengthened my cardiovascular system enough through vigorous exercise to minimize them (I have a BP cuff and have discovered my problem has more to do with low heart rate than low BP). Stimulants can cautiously be used with MAOIs to raise BP and would also help with your fatigue symptoms--I would suggest trying Ritalin first rather than amphetamine for safety reasons. There are non-stimulants available that will also raise BP, but try to determine exactly what yours is first. If it's much below 100/60 and your heart rate is also below 60, I would cautiously add something to boost your cardiovascular system. It is worth pointing out that tricyclics can also lower BP, sometimes severely, but they do not usually lower heart rate as do MAOIs.Todd
Posted by mayzee on July 31, 2006, at 10:31:25
In reply to Re: What would you do? EMSAM, posted by Racer on July 30, 2006, at 15:41:51
> Go out and get a BP cuff, if you don't already have one, to make sure that it really is BP and not something that just mimics the symptoms.
I finally got the energy to go out this morning to buy a BP monitor; now I have to figure out how to use it. While at Walmart I used their BP monitor and measured 80/42.
> If not, I'd ask my doctor about trying Florinef to support my BP while going back up to 9mg
Have you ever taken Florinef? I'll have to get a different doc; neither my internest nor pdoc wanted to give me something for the low bp since it seems to be clearly caused by the EMSAM
> have you tried combinations of those meds? Did any of them, at adequate trials at therapeutic doses, offer any improvement? ...It could be that combining a couple of them would help, even though nothing worked completely on its own.The only improvement I got was that I didn't cry as easily. I was still depressed and very fatigued; hypersomnia & anhedonia were my biggest problems. The only combo I tried was Paxil + Wellbutrin: my pdoc hoped the Wellbutrin would be energizing, but it didn't work that way for me.
Thanks for your input & good wishes. I really appreciate it.
mayzee
Posted by mayzee on July 31, 2006, at 10:36:54
In reply to Re: What would you do? EMSAM » mayzee, posted by Crazy Horse on July 30, 2006, at 21:01:36
> What would i do? I would go back to the 9 mg. patch that made you "feel better than you have in ages" and take salt pills..you can get them at Wal-Mart or any drug store. Drink more water and add a lot of salt to your food..that is what i would do.
I went down to 6mg yesterday & today because I was feeling so bad and want to see if it gets my bp down. I had to go to 4 different stores before I could find salt pills! (my walmart & walgreens didn't have them) Have been drinking more water and eating more salt for the past week but no change yet. I think if my bp goes down at 6mg, I might try going up with a quarter patch rather than adding back the half patch.
Thanks for your suggestions!!!
Posted by mayzee on July 31, 2006, at 10:49:38
In reply to Re: What would you do? EMSAM » mayzee, posted by Jost on July 30, 2006, at 21:02:13
> Well, I personally, would stick the with emsam, maybe trying taking it off for a while during the day, or at night--
Yeah, I haven't tried removing the patch part of the time yet. So far I've always left it on 24 hrs. So that is something to try.
> What was your blood pressure?
Last Tuesday the doctor measured me at 80/60. Today at Walmart my reading was 80/42. I've felt so crummy that I backed down to 6mg yesterday & today to see if I can get some relief.> Maybe you'll accommodate. I could be wrong, but I can't imagine a few weeks of low blood pressure would hurt you, unless there's some special reason.
I was really hoping that this side effect would go away or ease up too. I'd been at 9mg for 20 days. Not sure how long it might take to ease up.
> Are you sleeping okay? Because maybe there are contributing factors to your being so exhausted? (Just hoping.)
No, my sleep has been disrupted ever since starting Emsam. And I had also been very fatigued. (With the exception of those 3 days at 9mg & 1 day at 6mg) Fatigue has always been one of my biggest issues with my depression anyway. BUt I really notice a difference in the fatigue I felt at 6mg and the fatigue I've felt since having the low bp symptoms; it's worse. But my pdoc did just give me a script for klonopin so I can try that for the sleep problems.
> I noticed that you hadn't tried Parnate or Nardil. How about one of them? The Maoi thing really isn't that bad, you just have to get used to a few restrictions, like soy sauce, aged cheese, etc, and not using certain decongestants, and demerol--the drug restrictions are the same with emsam, I think.
>I agree, and think if I really want to do that I'd have to get a different pdoc. She really wants my next trial to be a tricyclic. I guess since she's more familiar with them. Since I've never tried them, I guess that would be OK too.
It's hard for me to say that I responded to Emsam, since I really only had that 3-day stretch out of 71 days so far.
Thank you so much for your suggestions. I really appreciate it!
mayzee
Posted by mayzee on July 31, 2006, at 10:52:59
In reply to Re: What would you do? EMSAM, posted by Phillipa on July 30, 2006, at 22:02:42
> She said low blood pressure would hurt your body? Only if your on the verge of shock would it hurt you. For short periods of time. Think I'll good low bp and see what it says. Love Phillipa
Thanks for your reply, Phillipa,Well, she mentioned that low blood pressure puts extra strain on the heart; and I have noticed the feeling of heart flutters or palpitations that I never noticed before. Otherwise I'm really healthy and hadn't ever had any heart problems. I've always had low blood pressure which I thought was a good thing. But this is the first time I've had the dizzyness, dimmed vision, etc., etc.
mayzee
Posted by mayzee on July 31, 2006, at 11:02:54
In reply to Re: What would you do? EMSAM, posted by silvercoin on July 31, 2006, at 8:09:04
> I would stay on the 9 mg patch and add some other agent to raise BP. ...Stimulants can cautiously be used with MAOIs to raise BP and would also help with your fatigue symptoms--I would suggest trying Ritalin first rather than amphetamine for safety reasons.
I think laima also recommended Ritalin. Racer suggested Florinef. Have you used either of these yourself to increase blood pressure? (neither of my docs want to give me a drug to deal with the blood pressure, so I'd have to go to a different doc)
> There are non-stimulants available that will also raise BP, but try to determine exactly what yours is first. If it's much below 100/60 and your heart rate is also below 60, I would cautiously add something to boost your cardiovascular system.
The 2 times I had my bp measured this week it was 80/60 & 80/42; not positive but I think my pulse was in the 80s.
> It is worth pointing out that tricyclics can also lower BP, sometimes severely, but they do not usually lower heart rate as do MAOIs.
I'm I right in thinking that all the MAOIs lower bp too? I didn't know that MAOIs usually lower heart rate. My pdoc told me that due to the low bp, my heart rate would be increased.
Todd, thanks so much for your input!!!
mayzee
Posted by silvercoin on July 31, 2006, at 12:47:24
In reply to Re: What would you do? EMSAM » silvercoin, posted by mayzee on July 31, 2006, at 11:02:54
>
> I think laima also recommended Ritalin. Racer suggested Florinef. Have you used either of these yourself to increase blood pressure? (neither of my docs want to give me a drug to deal with the blood pressure, so I'd have to go to a different doc)
>
>
> The 2 times I had my bp measured this week it was 80/60 & 80/42; not positive but I think my pulse was in the 80s.
>
>
> I'm I right in thinking that all the MAOIs lower bp too? I didn't know that MAOIs usually lower heart rate. My pdoc told me that due to the low bp, my heart rate would be increased.
>
> Todd, thanks so much for your input!!!
>
> mayzee
I guess I would tend to question your doctors' unwillingness to help you with the low BP given that the EMSAM is helping with your depression, which is the whole point of this exercise. My impression is that they seem to be taking a dim view of MAOIs in general compared to tricyclics, which doesn't really make a lot of sense to me. There is a lot of hysteria over MAOI dietary restrictions, but the dietary restrictions in the prescribing directions at the EMSAM site are accurately spelled out and are also applicable to the other MAOIs. There are just not that many foods that are of any real concern.I've taken three different tricyclics and three different MAOIs, and my own experience is that tricyclics have much worse side effects than do MAOIs, particularly, constipation and dry mouth. Nortriptyline and desipramine are the two with the fewest side effects, but nortriptyline is a relatively sedating drug, while constipation, dry mouth, urinary hesitation, and tachycardia are all relatively common with desipramine; although, these effects are less severe than seen with most of the other tricyclics.
I have never taken anything to boost low BP while on either tricyclics or MAOIs, but it might have been wise in some instances, as I have come perilously close to fainting, particularly, the first time I was on Nardil. All of the MAOIs tend to lower both BP and heart rate, but this can vary. I'm not experiencing low BP on 50 mg Marplan, but my heart rate has declined from 60 to below 50, which occasionally causes problems. Tricyclics can either raise or lower BP, but it is probably more common to see a lowering, especially at higher dosages. I've experienced hypertension of 160/100 on a low dose of desipramine but then seen BP decline with escalating dosage and the passage of time down to perhaps 95/65. However, tricyclics do typically increase heart rate, and mine was very commonly 90-110 on both desipramine and Vivactil; although, I cannot say that this caused me any ill effects personally.
My own opinion is that MAOIs are superior antidepressants to tricyclics, and with the exception of hypotension and insomnia, they also have fewer side effects. I would suggest seeing if you cannot exert some pressure on your doctors to help you make a go of it on the EMSAM.
Todd
Posted by Crazy Horse on July 31, 2006, at 13:35:30
In reply to Re: What would you do? EMSAM » Crazy Horse, posted by mayzee on July 31, 2006, at 10:36:54
> > What would i do? I would go back to the 9 mg. patch that made you "feel better than you have in ages" and take salt pills..you can get them at Wal-Mart or any drug store. Drink more water and add a lot of salt to your food..that is what i would do.
>
> I went down to 6mg yesterday & today because I was feeling so bad and want to see if it gets my bp down. I had to go to 4 different stores before I could find salt pills! (my walmart & walgreens didn't have them) Have been drinking more water and eating more salt for the past week but no change yet. I think if my bp goes down at 6mg, I might try going up with a quarter patch rather than adding back the half patch.
>
> Thanks for your suggestions!!!Good Idea..quarter patch..why didn't i think of that? ha ha :) Just REALLY increase your salt intake and i think you'll be fine. God Bless You!
Monte
Posted by Phillipa on July 31, 2006, at 21:36:50
In reply to Re: What would you do? EMSAM, posted by Crazy Horse on July 31, 2006, at 13:35:30
Monte guess what!!!My pdoc prescribed EMSAM at 6mg for me today. Said I would probably need only a quarter of a patch. And said continue the lamictal as I am and keep on the valium. But divide it and take maybe 5mg split in two doses during the day. Oh now I have to wean off the luvox. No problem as I've already gone from l50mg to 50 in a week. No side effects. So now we are related by meds. Love Jan
Posted by Crazy Horse on August 1, 2006, at 12:17:01
In reply to Re: What would you do? EMSAM » Crazy Horse, posted by Phillipa on July 31, 2006, at 21:36:50
> Monte guess what!!!My pdoc prescribed EMSAM at 6mg for me today. Said I would probably need only a quarter of a patch. And said continue the lamictal as I am and keep on the valium. But divide it and take maybe 5mg split in two doses during the day. Oh now I have to wean off the luvox. No problem as I've already gone from l50mg to 50 in a week. No side effects. So now we are related by meds. Love Jan
I AM SOOO HAPPY FOR YOU JAN!!! Read my post to you below :)
Love, your chemical brother, Monte ;)
This is the end of the thread.
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