![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 8 to 32 of 32. Go back in thread:
Posted by RobertDavid on April 29, 2006, at 16:16:42
In reply to Re: EMSAM (aabag's journal) - Day 2, posted by aabag on April 29, 2006, at 15:46:54
> Social Anxiety and dysthymia. The other drugs I've taken since approximately 1999 are the following.
>
> Prozac: numbing, noticed mood-brightening for about 2-3 days out of 90.
> Buspar: didn't notice much, other than a little dizziness.
> Wellbutrin: Irritability, not at all helpful.
> Serzone: Irritability, but this was the "best" of the those taken thusfar.
> Klonopin: Something that worked, finally. This knocked out the social anxiety in large part, but not dysthymia. Some of the side effects include memory impairment and excessive sleepiness, but this is/was far and away the most effective (and dependency producing) medicine.
> Amisulpride: This did help in areas of motivation/drive, but was inconsistent, requiring holidays of 2 days.
> Provigil: Ineffective for dysthymia. However, combined with amisulpride, and klonopin, was a reasonably effective combination.
> Lexapro: Emotional numbing
> Effexor XR: Ineffective. Insominia, sexual side effects, same numbing as other serotonergic agents (whether or not they inhibit norepiniphrine).
> Cymbalta: Ineffective. Insomnia, sexual side effects, stomach upset.
>
> EMSAM: Good so far, as this is day 4. Only thing I'm "worried" about is where to put the patch the next day :)
I've tried every drug you listed (and more) with similar results. Klonopin was the only one that worked for my social anxiety, but perhaps agrivated my mild depression and certainly impared my concentration. Before EMSAM the only thing that came close to working as a blend with klonopin was provigil, but I could only tolerate low doses between 25 and 50mgs and all it did was give me a slight energy boost.Now into my 4th week on EMSAM I really notice an improvement in mood, energy and general optimisim. The blend of klonopin and EMSAM is certainly working for me, but I'd like to end up on either a lower dose of klonopin or perhaps be off it all together.
Sounds like you're responding well. I hope it continues for you. Rob
Posted by ravenstorm on April 29, 2006, at 19:47:07
In reply to Re: EMSAM (aabag's journal) - Day 2, posted by RobertDavid on April 29, 2006, at 16:16:42
Ok, so you guys do much better on more stimulating things. There is no way I can tolerate provigil etc.
Posted by Donna Louise on April 30, 2006, at 7:33:40
In reply to Re: EMSAM (aabag's journal) - Day 2, posted by RobertDavid on April 29, 2006, at 16:16:42
> > Social Anxiety and dysthymia. The other drugs I've taken since approximately 1999 are the following.
> >
> > Prozac: numbing, noticed mood-brightening for about 2-3 days out of 90.
> > Buspar: didn't notice much, other than a little dizziness.
> > Wellbutrin: Irritability, not at all helpful.
> > Serzone: Irritability, but this was the "best" of the those taken thusfar.
> > Klonopin: Something that worked, finally. This knocked out the social anxiety in large part, but not dysthymia. Some of the side effects include memory impairment and excessive sleepiness, but this is/was far and away the most effective (and dependency producing) medicine.
> > Amisulpride: This did help in areas of motivation/drive, but was inconsistent, requiring holidays of 2 days.
> > Provigil: Ineffective for dysthymia. However, combined with amisulpride, and klonopin, was a reasonably effective combination.
> > Lexapro: Emotional numbing
> > Effexor XR: Ineffective. Insominia, sexual side effects, same numbing as other serotonergic agents (whether or not they inhibit norepiniphrine).
> > Cymbalta: Ineffective. Insomnia, sexual side effects, stomach upset.
> >
> > EMSAM: Good so far, as this is day 4. Only thing I'm "worried" about is where to put the patch the next day :)
>
>
> I've tried every drug you listed (and more) with similar results. Klonopin was the only one that worked for my social anxiety, but perhaps agrivated my mild depression and certainly impared my concentration. Before EMSAM the only thing that came close to working as a blend with klonopin was provigil, but I could only tolerate low doses between 25 and 50mgs and all it did was give me a slight energy boost.
>
> Now into my 4th week on EMSAM I really notice an improvement in mood, energy and general optimisim. The blend of klonopin and EMSAM is certainly working for me, but I'd like to end up on either a lower dose of klonopin or perhaps be off it all together.
>
> Sounds like you're responding well. I hope it continues for you. RobYou guys have the same meds and results as myself. Mostky all of them but tricyclics and oral MAOI's and the only relief being a combo of klonopin and provigil. I gotta tell you, I am so happy for you both that it makes me cry. (I am vey emotionally labile right now since I am off the numb drugs) and am on my first day of EMSAM. I hope it means it will work for me as it is for the two of you. Oh, to have hope again, I am so scared of another disappointment. You guys give me great big hope. Thanks.
Donna
Posted by ravenstorm on April 30, 2006, at 9:20:13
In reply to Re: EMSAM (aabag's journal) - Day 2, posted by ravenstorm on April 29, 2006, at 19:47:07
God, I wish I could take a benzo and the slap the patch on. I have a paradoxical reaction to benzos, so I can't take anything activating with the hope of adding one later to squash the anxiety.
Sucks.
Posted by RobertDavid on April 30, 2006, at 14:20:25
In reply to Re: EMSAM (aabag's journal) - Day 2, posted by Donna Louise on April 30, 2006, at 7:33:40
> You guys have the same meds and results as myself. Mostky all of them but tricyclics and oral MAOI's and the only relief being a combo of klonopin and provigil. I gotta tell you, I am so happy for you both that it makes me cry. (I am vey emotionally labile right now since I am off the numb drugs) and am on my first day of EMSAM. I hope it means it will work for me as it is for the two of you. Oh, to have hope again, I am so scared of another disappointment. You guys give me great big hope. Thanks.
>
> Donna
Donna:
Like you, I was so used to disappointments with every med I tried (other than klonopin). I'd followed EMSAM since 1999 and though I was very optimistic that it would be my best chance for a good response (as it was my first MAOI try), but I too was still concerned it would flop like the rest of the meds I've tried as it was just what I learned to expect.
I very much hope that it will do for you what it has done for me (so far), my life has suddenly changed, I'm finally experiencing what I only envied in other "normal" people. I'll be looking for your posts and look forward to see how you do.
Perhaps there is a link between those that have similar experiences with the same medications. My gut is telling me you have a lot to look forward to! Keep us posted. Rob
Posted by Donna Louise on April 30, 2006, at 22:10:40
In reply to Re: EMSAM (aabag's journal) - Day 2 » Donna Louise, posted by RobertDavid on April 30, 2006, at 14:20:25
> > You guys have the same meds and results as myself. Mostky all of them but tricyclics and oral MAOI's and the only relief being a combo of klonopin and provigil. I gotta tell you, I am so happy for you both that it makes me cry. (I am vey emotionally labile right now since I am off the numb drugs) and am on my first day of EMSAM. I hope it means it will work for me as it is for the two of you. Oh, to have hope again, I am so scared of another disappointment. You guys give me great big hope. Thanks.
> >
> > Donna
>
>
> Donna:
>
> Like you, I was so used to disappointments with every med I tried (other than klonopin). I'd followed EMSAM since 1999 and though I was very optimistic that it would be my best chance for a good response (as it was my first MAOI try), but I too was still concerned it would flop like the rest of the meds I've tried as it was just what I learned to expect.
>
> I very much hope that it will do for you what it has done for me (so far), my life has suddenly changed, I'm finally experiencing what I only envied in other "normal" people. I'll be looking for your posts and look forward to see how you do.
>
> Perhaps there is a link between those that have similar experiences with the same medications. My gut is telling me you have a lot to look forward to! Keep us posted. Rob
>
>You keep making me cry, it is wonderful, it is so long since I have felt that joy of connection, of empathy and gratitude. whew.
Anyway, I bet you are onto something there with the similar med profile thing. It must be the way we are wired but I also think this drug is going to work for just about everyone, I don'tknow why it wouldn't if my first day is any indication. It was just like yours, energy, wanting to do thngs like leave the house. I laughed so hard at something silly I about busted my gut. I don't think it is coincidence. I think I will go ahead and let the hope really begin.
I will keep everyone posted. And also, I hope people that have bad reactions to other drugs don't think this is similar like wellbutrin for example and let that stop them. I can't tolerate wellbutrin for one day and this is polar opposite from that. ok, time for this tired girl to hit the sack.donna
Posted by aabag on May 1, 2006, at 0:08:34
In reply to EMSAM (aabag's journal), posted by aabag on April 26, 2006, at 21:34:54
Yet another good day. Without going into particulars, I was out doing. It just felt good to want to go participate in life, the world, and not to want to want that, if you get my drift. In particular, adding exercise to the regimen only seems to enhance the effectiveness, probably because of the PEA sparing effect.
Posted by RobertDavid on May 1, 2006, at 1:16:27
In reply to Re: EMSAM (aabag's journal) - Day 2, posted by Donna Louise on April 30, 2006, at 22:10:40
Donna:
Great start. I look forward to hearing more good news from you. Like you I had a positive quick response. I bet you have a lot to look forward to. Keep us posted! Rob
Posted by theo on May 1, 2006, at 17:07:03
In reply to Re: EMSAM (aabag's journal) - Day 2, posted by aabag on April 29, 2006, at 15:46:54
Can you put the patches an inch or two off from where the diagrams show? I'm waiting to start and have the patch, but freaking out on placing them.
Posted by Phillipa on May 1, 2006, at 17:45:19
In reply to Re: EMSAM (aabag's journal) - Day 2 » aabag, posted by theo on May 1, 2006, at 17:07:03
Theo you're starting the patch too? Love Phillipa
Posted by aabag on May 1, 2006, at 23:07:18
In reply to Re: EMSAM (aabag's journal) - Day 2 » aabag, posted by theo on May 1, 2006, at 17:07:03
Missing the supposed "exact positioning" is not going to make or break EMSAM for you. The pictures are generally illustrative, and given the variety of body shapes and sizes, you don't need to worry about getting out a measuring tape (upper thigh is fine, for example). Personally, I just trade them after a morning shower, a process about the difficulty level of putting on a band-aid. Wishing you the best, for all its biochemically worth.
Posted by theo on May 2, 2006, at 17:09:15
In reply to Re: EMSAM (aabag's journal) - Day 2 » theo, posted by aabag on May 1, 2006, at 23:07:18
Posted by aabag on May 5, 2006, at 12:52:42
In reply to EMSAM (aabag's journal), posted by aabag on April 26, 2006, at 21:34:54
EMSAM is doing something right. Exercising more, more social, more interested in the "pursuit of happiness" would describe its effect. Paid no special attention to diet, other than to try and eat healthy, and am looking forward to this weekend. Who knows, I may try to re-kindle something w/ a former girlfriend. Point is, EMSAM (in combination w/ the placebo effect) has been a genuine antidepressant to this point.
Posted by Donna Louise on May 6, 2006, at 6:12:17
In reply to Re: EMSAM (aabag's journal) - Day 10, posted by aabag on May 5, 2006, at 12:52:42
> EMSAM is doing something right. Exercising more, more social, more interested in the "pursuit of happiness" would describe its effect. Paid no special attention to diet, other than to try and eat healthy, and am looking forward to this weekend. Who knows, I may try to re-kindle something w/ a former girlfriend. Point is, EMSAM (in combination w/ the placebo effect) has been a genuine antidepressant to this point.
I love hearing this! I got a little scared last night. Well, I never get a "little" anything, but I was having one of my cute anxious rages I am glad no one was around to be subjected to. Over a little confusion and pressure. Ugh. So of course I start with the it won't work thinking. But I seem ok now, today is another day. I know better than to expect a steady uphill climb. Today is the 7th day, which theoretically should not even be enough time to tell although I have felt so much better. And it is only a little over two weeks of effexor withdrawal. Well, when I write that down and look at it that way, I am doing pretty darn good.
Donna
Posted by aabag on May 9, 2006, at 21:09:12
In reply to EMSAM (aabag's journal), posted by aabag on April 26, 2006, at 21:34:54
Depression continues to abate at the two week mark. I haven't really noticed any difference between placement on the upper body vs lower body, the effect seems the same. As far as side effects are concerned, there has been a little headache, but nothing arduous or worth taking a head-ache medicine for. Its been great getting involved in more activities, as well as plain being plain happier, particularly in looking to the positive side of personal encounters, rather than dwelling on negative, or "What could go wrong?"
I've not dropped the Klonopin dose, which may account for why the anxiety hasn't gone up as other posters have noted. I guess I'll never known on that one. My intention is not to be on klonopin forever, but if its actually synergistic w/ EMSAM, I may drop to reduced dose, somewhat like the route RobertDavid is on. I don't recommend throwing klonopin in for good measure, since klonopin is likely to produce dependency.
Posted by RobertDavid on May 9, 2006, at 21:34:12
In reply to Re: EMSAM (aabag's journal) - two weeks, posted by aabag on May 9, 2006, at 21:09:12
It's great to hear that you're doing so well. Because we both are on klonopin I have to wonder about the link there as far as lack of side effects. I have to think the anti depressant effects are solely from EMSAM as klonopin sure doesn't improve mood.
I dropped klonopin from 2mgs to 1.75mgs about 2 weeks ago. I went through some insomina (which happens every time I ever lower klonopin) but now don't notice a difference. I'm going to slow down the klonopin taper to .125 every 2 to 3 weeks and perhaps sit tight for a while at 1.5mgs.
My recomendation to you is to enjoy the ride for a while, not lower the klonopin until some time goes by and you settle into EMSAM. I'm re-thinking my rush to lower klonopin as it's just nice to feel good for the first time.
Again, great to hear you're doing well. Rob
Posted by Donna Louise on May 9, 2006, at 23:18:09
In reply to Re: EMSAM (aabag's journal) - two weeks » aabag, posted by RobertDavid on May 9, 2006, at 21:34:12
> It's great to hear that you're doing so well. Because we both are on klonopin I have to wonder about the link there as far as lack of side effects. I have to think the anti depressant effects are solely from EMSAM as klonopin sure doesn't improve mood.
>
> I dropped klonopin from 2mgs to 1.75mgs about 2 weeks ago. I went through some insomina (which happens every time I ever lower klonopin) but now don't notice a difference. I'm going to slow down the klonopin taper to .125 every 2 to 3 weeks and perhaps sit tight for a while at 1.5mgs.
>
> My recomendation to you is to enjoy the ride for a while, not lower the klonopin until some time goes by and you settle into EMSAM. I'm re-thinking my rush to lower klonopin as it's just nice to feel good for the first time.
>
> Again, great to hear you're doing well. Rob
Rob and Abaag, my journey mirrors yours. I too take klonopin. I have not taken as much as I don't seem to need it since the patch has started working so well. (Since I started putting it on my breastbone and it has been sticking). I have actually forgotten to take it. As I was detoxing from the Effexor is when I used the most and I was up to .25mg twice a day and then a whole .5 at bedtime. I have pretty much dropped the bedtime dose and am just taking the .25 twice a day as I don't want to mess around with a good thing. I am content to do this forever. I have alot of energy and am a litte, ahem, maybe alot, unfocused but I think I always am that way, it is just hard to tell when I am not doing much. Now that I am doing alot comparatively speaking, there is alot more to be doing at the same time if that makes any sense. I don't care, I am just glad to be off the couch and away from the tv.
To continued success! Seems too good to be true. Ugh, I hope I didn't jinx us all....I guess I am not above still having a little anxiety..donna
Posted by aabag on May 17, 2006, at 0:02:37
In reply to EMSAM (aabag's journal), posted by aabag on April 26, 2006, at 21:34:54
Three weeks into EMSAM (of the 8 weeks I had allocated) and still going strong. Depression/amotivation continue to abate. I heard Donna mention the word remission and I'm not there yet, but I can "feel" it. Its funny, but on EMSAM, I simply do. Tell myself that I'll work out 20 minutes a day, and I've done so. Put my mind into something @ work, and just plain get it done. Go mountain biking on the weekend. Still taking about 1 mg klonopin, split into .5x1,.25x2. I could say more, but I don't want to jinx myself :)
Posted by RobertDavid on May 17, 2006, at 0:11:07
In reply to Re: EMSAM (aabag's journal) - three weeks, posted by aabag on May 17, 2006, at 0:02:37
> Three weeks into EMSAM (of the 8 weeks I had allocated) and still going strong. Depression/amotivation continue to abate. I heard Donna mention the word remission and I'm not there yet, but I can "feel" it. Its funny, but on EMSAM, I simply do. Tell myself that I'll work out 20 minutes a day, and I've done so. Put my mind into something @ work, and just plain get it done. Go mountain biking on the weekend. Still taking about 1 mg klonopin, split into .5x1,.25x2. I could say more, but I don't want to jinx myself :)
That sounds like a very positive response. Very similar to mine, just started getting more stuff done, feeling better. I'm 6 weeks out now and wonder if it will still get better with more time. It seems many are having luck with both klonopin and EMSAM. Anyway, I hope the trend continues for you!
Posted by aabag on September 4, 2006, at 17:47:22
In reply to EMSAM (aabag's journal), posted by aabag on April 26, 2006, at 21:34:54
I'm wondering, what is everyone else doing for insomnia and EMSAM (whether or not its "working" for you?)
Now, to introductions. Hello all. Here's how the EMSAM experiment is going. I'm currently on 9mg, and have been since July 20th, 2006, or 75 days, having started on April 26th at 6 mg for the first 55 days.
Emsam continues to be stimulating (and I still drink coffee). For the most part, I am more socialable on it, which is the antidote to my primary dx, social anxiety.
I say for the most part, because the insomnia is very difficult to master. Its a bit of a rock and a hard place. For me, the efficacy point is somewhere between 6-9 mg. On the 9mg, I noted insomia issues within 10 days of upping to that dose, and have been trying to manage that vexing problem with marginal success.
Going to be at 2:30AM or later because you're body/mind can't fall asleep would prevent any anti-depressant from working, and certainly, its a slippery slope practice. Then with the lack of sleep, there comes a simultaneous drop in blood pressure, and increase in heart rate, and it seems the two are related. No sleep leads to lower blood pressure.
So, something has got to change. If I can get enough sleep, EMSAM works. So, I'm going to attempt using CES (0.5 Hz), as well a magnesium taurate before bedtime, along with removing 2/3 of the patch. Any other augmentation suggestions welcome. I realize the people perusing the board are probably the ones having difficulty with EMSAM, but perhaps this can do us all some good.
Posted by mayzee on September 6, 2006, at 21:16:49
In reply to Re: EMSAM (aabag's journal) - 130 days, posted by aabag on September 4, 2006, at 17:47:22
> I'm wondering, what is everyone else doing for insomnia and EMSAM (whether or not its "working" for you?) ...
> So, I'm going to attempt using CES (0.5 Hz), as well a magnesium taurate before bedtime, along with removing 2/3 of the patch.Hi aabag,
What is CES?
My sleep has been disrupted by EMSAM... not really insomnia, but being more alert when it's bedtime so I stay up too late, then waking up several times during the night. Sometimes I take .5 mg generic klonopin; sometimes I take the patch off before bed (usually though that's more due to infrequent itchiness or irritation) I don't have a routine yet.
Please keep us posted on how things go for you.
Laima, SFY, Denise, et al., how are you sleeping on EMSAM?
Thanks,
mayzee
Posted by SFY on September 7, 2006, at 15:45:34
In reply to Re: EMSAM (aabag's journal) - 130 days » aabag, posted by mayzee on September 6, 2006, at 21:16:49
> Laima, SFY, Denise, et al., how are you sleeping on EMSAM?
>
> Thanks,
> mayzeeMy sleep (which has been problematical in the past) has definitely been more disturbed by Emsam (I'm on the 9 mg. patch now). I have a little bit of trouble falling asleep and have frequent early morning awakenings. This despite my usual bedtime dose of 75 mg of semi-sedating Nortriptyline (which I think I need to discontinue because of sexual side effects) plus an additional 25 mg of diphenhydramine.
Plus I'm getting a bit of mid-afternoon fatigue where I sometimes have to struggle to keep my head up. I think I'm going to try removing the patch at night and see if that helps any.
Posted by sound on September 8, 2006, at 9:39:25
In reply to Re: EMSAM (aabag's journal) - 130 days, posted by aabag on September 4, 2006, at 17:47:22
I would try blue light (like this: www.apollolight.com ) - I will try that myself soon, although I'll be building my own light. Should be a lot more useful than conventional SAD lights.
Posted by mogger on September 8, 2006, at 12:43:38
In reply to Re: EMSAM (aabag's journal) - 130 days, posted by aabag on September 4, 2006, at 17:47:22
my sister was in the same situation, her doctor added depakote and it has worked wonders at bed time, she can now finally sleep.
mogger
Posted by Last Chance on September 12, 2006, at 11:43:44
In reply to Re: EMSAM (aabag's journal) - 130 days, posted by mogger on September 8, 2006, at 12:43:38
I have finally decided to give up on Emsam, but I could use some advice about that. Using 1/2 of 6mg and taking off at night. I did try 9 mg but it put me into a heavy depression - actually it is impossible to know, it could have been coincidence. It has been several months and I'm feeling just about as bad as I ever get. I guess my question is - how should I taper, or are people just stopping. Thanks, Richard
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.