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Dr. Bob is Robert Hsiung, MD,
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Posted by JOP on September 18, 2006, at 0:56:16
In reply to Re: discontonuimg Emsam » Donna Louise, posted by Phillipa on September 17, 2006, at 22:27:13
> Please let me know as I was going to try it and now I'm crying cause I feel out of options and the thread I started last night didn't help. Love Phillipa
Phillipa—
I have been lurking on this board for quite some time and noticed that you are one of the first people to jump in and offer support to others who are dealing with emotional turmoil. However, it seems that you too are struggling with your own emotional turmoil and I would like to be here to support you in any way I can.
I can relate to your hesitation related to trying EMSAM. I too was hesitant and skeptical, as any antidepressant I have tried in the past has done zilch to raise my mood. While you seem to be very sensitive to medications and their side effects, I have the exact opposite problem. Of the 20+ “psychoactive” drugs I have tried over the past 17 years, I received no positive benefits and the only negative side effects were the pesky dry mouth on TCAs, 50 pounds of extra weight from Zyprexa, and some slight itching on EMSAM (so I guess they must be doing “something”—and yes I do realize I am EXTREMELY lucky not to have ventured into side effects hell like so many others on this board).
While I am thinking of increasing the dose of EMSAM, I am also thinking of throwing in the towel on this one and jumping to Parnate since I will have to follow the MAOI diet on a higher dose of EMSAM.
What I am getting at is that I have realized that this mood disorder that I have (chronic treatment resistant mdd) is something that is slowly draining the life out of me and frankly, that pisses me off. Yes, I am angry. I will not let this thing become some sort of terminal illness that I carry around with me for the next odd number of years suffering needlessly waiting for the day it kills me. We all deserve so much more.
So here is my point. Try EMSAM. You can read all of the experiences of others on this board, but those experiences will never be yours. If you are sensitive to medications, cut the patch in half. Cut the patch in quarters. Cut the patch in eights. Go low and slow and see how you react to it. If you start experiencing negative side effects that you can’t tolerate (i.e. increased anxiety) take it off, throw it away and move on to something else.
You will ALWAYS have the support of this board to help in any way we can. Yes, it is scary, but what if this drug helps your mood even slightly? What if it’s a true magic bullet at the lowest dose and gives you excellent relief? You won’t know until you try and if your pdoc is supportive, so is everyone else here.
Unfortunately, pharmacogenomics is not advanced enough at this point to help us out and point us to the right drug at the right dose so all we have right now is the experience of our pdocs and trial and error.
PLEASE don’t give up. We’ll all fight this together until we can wake up happy, go through our day experiencing a full range of healthy emotions, and go to bed and sleep soundly.
We’re all with you.
JOP
Posted by Donna Louise on September 18, 2006, at 5:28:49
In reply to Re: discontonuimg Emsam » Phillipa, posted by JOP on September 18, 2006, at 0:56:16
Posted by Phillipa on September 18, 2006, at 19:43:21
In reply to Re: discontonuimg Emsam » Phillipa, posted by JOP on September 18, 2006, at 0:56:16
Jop not to take away from anyone else I feel much better thinking you think so highly of me that you would post to me as a lurker. You must be a wonderful person. I'd love to know you if you like you can babblemail me and I'll give you my e-mail. As soon as I get over the diverticulitis I will again wean off the luvox and hopefully work up the courage to try the boxes I already have. Love Phillipa that meant so much to me
Posted by willyee on September 18, 2006, at 20:13:06
In reply to Re: discontonuimg Emsam, posted by jealibeanz on September 17, 2006, at 21:03:18
> You think denepryl is really not great for chronic use? Do you have any info/articles about this?
No the opposite actualy,i foolow a group called smart drugs and nutrients,which speaks on the use of both drugs and nutrients and importance of both.
In the book titled actualy so,part two,there is an entire chapter on deprenyls use for depression,there it speaks on the low dosage used for depression.
Also following the group it was just a drug known to be used sparingly since it had such a imapct on dopamine specifcaly.
I can only speak from my own usage,and my worry was the more specific direct impact on dopamine as opposed to all the chemicals that dopamine seemed to work on.
Deprenyl was a parkinson disease drug,as well as recomended for smoking cessation because of its impact on dopamine,i have heard the dose increase would change that more however it still concerned me,having it used it myself i could feel the dopamine accumaltion and the side effects that would occur.
I dont discourage anyone from it though,its new,novel,fairly safe,in fact i told a specific person im not sure why they are waiting so long to try it,everyone is different and the only sure thing is to try it urself.I having used it was just offering advice on tapering down since i had to do so myself.
I hardly ever discourage anyone from seeking help,seeking alone shows you are willing to keep trying.
Posted by Donna Louise on September 18, 2006, at 20:28:15
In reply to Re: discontonuimg Emsam, posted by willyee on September 18, 2006, at 20:13:06
> > You think denepryl is really not great for chronic use? Do you have any info/articles about this?
>
> No the opposite actualy,i foolow a group called smart drugs and nutrients,which speaks on the use of both drugs and nutrients and importance of both.
>
> In the book titled actualy so,part two,there is an entire chapter on deprenyls use for depression,there it speaks on the low dosage used for depression.
>
> Also following the group it was just a drug known to be used sparingly since it had such a imapct on dopamine specifcaly.
>
> I can only speak from my own usage,and my worry was the more specific direct impact on dopamine as opposed to all the chemicals that dopamine seemed to work on.
>
>
> Deprenyl was a parkinson disease drug,as well as recomended for smoking cessation because of its impact on dopamine,i have heard the dose increase would change that more however it still concerned me,having it used it myself i could feel the dopamine accumaltion and the side effects that would occur.
>
>
> I dont discourage anyone from it though,its new,novel,fairly safe,in fact i told a specific person im not sure why they are waiting so long to try it,everyone is different and the only sure thing is to try it urself.
>
> I having used it was just offering advice on tapering down since i had to do so myself.
>
> I hardly ever discourage anyone from seeking help,seeking alone shows you are willing to keep trying.
>
>The big appeal to me that the patch offered was bypassing first pass metabolism so much more of the parent compound was available and much less of the amphetamine metabolites than with oral route. Theoretically, these patches are non selective and should deanimate serotonin and norepinephrine as well as dopamine, as only dopamine is deanimated with the oral selegiline at the low mg. So I am suprised to find it still so activating,. I am liking and needing the activation, that isn't the problem, is just does not seem to working as an AD for me and has made all these soft bipolar nightmares very apparant. But that is just me. I had a good day today except for the meltdown in the middle of the day. Cycling? just insufficiently treated? All I know is if it works like I would think it should, it would be an awesome drug. so like Willyee says, try it, it could be the best thing you have had yet.
Donna
Posted by jealibeanz on September 18, 2006, at 21:03:03
In reply to Re: discontonuimg Emsam, posted by willyee on September 18, 2006, at 20:13:06
Oh, I think I misunderstood. You're saying it is an effective AD? Just that it's normally at a lower dose?
Posted by Phillipa on September 18, 2006, at 21:09:24
In reply to Re: discontonuimg Emsam » willyee, posted by Donna Louise on September 18, 2006, at 20:28:15
Well if EMSAM is like wellbutrin I can't take it it put me in the hospital my pdoc at the time though I was manic. Love Phillipa
Posted by willyee on September 19, 2006, at 8:06:49
In reply to Re: discontonuimg Emsam » Donna Louise, posted by Phillipa on September 18, 2006, at 21:09:24
> Well if EMSAM is like wellbutrin I can't take it it put me in the hospital my pdoc at the time though I was manic. Love Phillipa
No i dident find it to be like wellbutrin,its a LOT nicer of course in my eyes,if that is a comparison basis then parnate is more like it,however still deprenyl is quite unique,and the best way to tell and the most effective way is to try it,i think you have enough information from what i alone seen you particpate in,are you possably letting your anxiety stop you again,if so maybe you should let your anxiety work for you,and set a date,and say to urself u HAVE TO start the med on this date,trick your thinking if you have to,but in all honesty research and questions will take u so far down the road,and sooner or later you have to get out the car and go inside for yourself,its really the only way unless you decide for sure your not going too.
Other than that,you will continue to swing like a pendalum as even the best considered drugs here are still debated,none i dont believe carry a solid sense of security that it will work or not possably worsen an individual
Posted by SLS on September 19, 2006, at 8:14:22
In reply to Re: discontonuimg Emsam » willyee, posted by Donna Louise on September 18, 2006, at 20:28:15
> Theoretically, these patches are non selective and should deanimate serotonin and norepinephrine as well as dopamine, as only dopamine is deanimated with the oral selegiline at the low mg. So I am suprised to find it still so activating,
Remember, the selegiline molecule itself might be acting as a stimulant. From what I have been able to find on Medline, and have previously posted about, it is.
I am sorry it is not doing the job for you as an antidepressant.
Have you tried any other MAOIs?
- Scott
Posted by Donna Louise on September 19, 2006, at 13:15:43
In reply to Re: discontonuimg Emsam » Donna Louise, posted by SLS on September 19, 2006, at 8:14:22
> > Theoretically, these patches are non selective and should deanimate serotonin and norepinephrine as well as dopamine, as only dopamine is deanimated with the oral selegiline at the low mg. So I am suprised to find it still so activating,
>
> Remember, the selegiline molecule itself might be acting as a stimulant. From what I have been able to find on Medline, and have previously posted about, it is.
>
> I am sorry it is not doing the job for you as an antidepressant.
>
> Have you tried any other MAOIs?
>
>
> - Scottyes, from what i have read, the selegiline molecule is of an activating nature. I really like the activation as everything else i have taken makes me sleep all the time and zero motivation, lots of apathy. I would hate to lose that aspect of this drug. And I do feel better now that I am just taking 6mg as opposed to 12mg. the 150 of lamictal may be getting a chance to help too but I would sure feel better about it if I didn't have that meltdown yesterday. Intense rage then a bunch of sobbing. Then within an hour after taking ,5mg klonopin, felt fine again. I have actually been able to take two walks, one with partially jogging even since i went down to 6mg. I have an emergency appt with the pdoc Thursday and then I will be out of town until Sunday so will be unable to update those of you who are interested (which I am on my knees grateful for).
After all that long windedness (which is what I had originally at 6mg, longwindedness..) to answer your question, no I have not been on other MAOI's. But from what is being suggested and what I am reading, it sounds like Parnate would be a good choice with the klonopin and lamictal. I am such a good sleeper I don't worry about insomnia. Has anyone heard of a bipolor II or any other bipolar type that is a good sleeper all the time?
Thanks Scott,Donna
Posted by jealibeanz on September 19, 2006, at 18:45:07
In reply to Re: discontonuimg Emsam » SLS, posted by Donna Louise on September 19, 2006, at 13:15:43
Donna, are you discontinuing the EMSAM? I have anxiety, as well as depression, and insomnia. Right now I am taking Provigil, 400 mg due to excessive daytime sleepiness. My anxiety increased when I began, so my doctor allowed my to increase my Xanax to 1mg t.i.d. I also take Lunesta. I'd like to ask my doc about giving EMSAM a try, but worry it may increase anxiety. However, I'm thinking that if I drop the Provigil, the Xanax may counter it.
Posted by Phillipa on September 19, 2006, at 20:48:18
In reply to Re: discontonuimg Emsam, posted by jealibeanz on September 19, 2006, at 18:45:07
Jelly you sound like me and you're asking the same questions with the same concerns. Another concern of mine is that when I get to l2.5mg of luvox my crying starts and then back to 25mg which seems to stop it. So how do you go through a two week wash out period without going insane?And is it true that even if you take off the patch the meds are in your body for 9 days? And then another two week wait to try something else? Love Phillipa
Posted by Donna Louise on September 28, 2006, at 5:42:05
In reply to discontonuimg Emsam, posted by Donna Louise on September 16, 2006, at 5:40:39
Well, I took the plunge and pulled the patch. Nice alliteration if I do say so myself...
I am on my 3rd day and so far no withdrawal unless these headaches are part of it. I doubt it, they started when I went up to 200mg lamictal. I am going to see if they don't go away, I have migraine medicine I take. And right now i feel better than I have for the past month. But I know that never lasts...unless this time I can get some mileage out of just the lamictal, klonopin and provigil. but even with the new understanding that i probably have bipolar II, I get such bad depression I can't imagine that I can get away with it and at some point will have to take yet another AD. I keep thinking that if I took a tiny dose of oral selegiline I could keep the energy and lose the mixed state..
Anyway, that is my update.donna
Posted by Jost on September 28, 2006, at 12:03:35
In reply to Re: discontonuimg Emsam, posted by Donna Louise on September 28, 2006, at 5:42:05
Not wanting to bring in anything from left field, but is it possible you were getting too high a dose of Emsam, and a low dose, or even a lower dose kept on only part of the time, would have worked for you.
There may be some aspects of the delivery of the drug that aren't yet known. For example, did you apply the patch to the same spot every day, or alternate spots? If you alternated, how many days in a row did you put it in the same place?
How many separate spots did you use?
I'm curious because of a question about how long the emsam from the patch can remain unabsorbed, but capable of absorption, after the patch is removed.
Thanks, Jost
Posted by SLS on September 28, 2006, at 15:13:43
In reply to Re: discontonuimg Emsam, posted by Donna Louise on September 28, 2006, at 5:42:05
Hi Donna.
> Well, I took the plunge and pulled the patch. Nice alliteration if I do say so myself...
Show off.
> And right now i feel better than I have for the past month.
Discontinuation rebound improvement. I get that from Nardil.
> But I know that never lasts...
Me too.
> unless this time I can get some mileage out of just the lamictal, klonopin and provigil.
Hey, it just might be.
> but even with the new understanding that i probably have bipolar II, I get such bad depression I can't imagine that I can get away with it and at some point will have to take yet another AD.
Probably.
> I keep thinking that if I took a tiny dose of oral selegiline I could keep the energy and lose the mixed state..
Ever try Wellbutrin or Parnate? Are you a partial responder to either?
> Anyway, that is my update.
:-)
- Scott
Posted by Phillipa on September 28, 2006, at 18:52:04
In reply to Re: discontonuimg Emsam » Donna Louise, posted by SLS on September 28, 2006, at 15:13:43
Donna please answer Jost's question as it's very important. As my pdoc if I'd tried it said only use 1/4 of a patch. And are you the one who could only use the area above her breasts to apply. Thanks Phillipa
Posted by Donna Louise on September 29, 2006, at 5:32:20
In reply to Re: discontonuimg Emsam » Donna Louise, posted by Jost on September 28, 2006, at 12:03:35
> Not wanting to bring in anything from left field, but is it possible you were getting too high a dose of Emsam, and a low dose, or even a lower dose kept on only part of the time, would have worked for you.
>
> There may be some aspects of the delivery of the drug that aren't yet known. For example, did you apply the patch to the same spot every day, or alternate spots? If you alternated, how many days in a row did you put it in the same place?
>
> How many separate spots did you use?
>
> I'm curious because of a question about how long the emsam from the patch can remain unabsorbed, but capable of absorption, after the patch is removed.
>
>
> Thanks, JostI don't know, I tried all the different dose sizes, at the end I was using half a nine. Too little and I was rageful, more and I was depressed. It took awhile for all this to show up, at least the depression took a while, I was easily aggravated and enraged early on. I was enjoying the energy so much I thought that this was it. It is really disappointing. I had been trying to find the right dose since April.
I was alternating hips, a little different spot on each hip every other day. Anywhere else I put it would either come off with sweat or something would knock it off, like a tree limb. That sounds odd doesn't it. No, I have not regressed and climbing trees, I run through narrow trails on horses and had more than one hanging from a branch. They always stayed on my hip.
My pdoc and i tried everything we could think of and finally I had to throw in the towel. sighdonna
Posted by Donna Louise on September 29, 2006, at 5:41:04
In reply to Re: discontonuimg Emsam » Donna Louise, posted by SLS on September 28, 2006, at 15:13:43
> Hi Donna.
>
> > Well, I took the plunge and pulled the patch. Nice alliteration if I do say so myself...
>
> Show off.
>
> > And right now i feel better than I have for the past month.
>
> Discontinuation rebound improvement. I get that from Nardil.
>
> > But I know that never lasts...
>
> Me too.
>
> > unless this time I can get some mileage out of just the lamictal, klonopin and provigil.
>
> Hey, it just might be.
>
> > but even with the new understanding that i probably have bipolar II, I get such bad depression I can't imagine that I can get away with it and at some point will have to take yet another AD.
>
> Probably.
>
> > I keep thinking that if I took a tiny dose of oral selegiline I could keep the energy and lose the mixed state..
>
> Ever try Wellbutrin or Parnate? Are you a partial responder to either?
>
> > Anyway, that is my update.
>
> :-)
>
>
> - ScottI wish I knew how or had a Mac or something so I could respond line by line like you and some others do. it is like having a conversation. I would tell you that I can't help but be poetic, I am just so artistic that way... not.
I get psychotic on wellbutrin, hiding from cars when I was jogging (gotta get back to that, jogging I mean, not hiding from cars). And the social phobia was like paranoia. yick and yuck.
I have not tried Parnate, I was considering it after some of you suggested it. My pdoc thinks I will get the awful mixed state again. Maybe all the anxiety is just not going to let me do well on a stimulating med. I really did well on paxil a million years ago before i became mummifed in front of the tv.
I have been thinking about revisiting strattera. I got alot done when I was on it before and lord knows i could use some focus. I don't know why I quit taking it. It is a good thing my pdoc takes copious notes.donna
Posted by Donna Louise on September 29, 2006, at 5:46:33
In reply to Re: discontonuimg Emsam, posted by Phillipa on September 28, 2006, at 18:52:04
> Donna please answer Jost's question as it's very important. As my pdoc if I'd tried it said only use 1/4 of a patch. And are you the one who could only use the area above her breasts to apply. Thanks Phillipa
Nope, not me, I am not the breast lady. I think I may have tried that spot once but it sweated off. I am very active outside in the summer, even if I am in a coma, as I am on my way to being again without the patch.donna
Posted by SLS on September 29, 2006, at 6:09:48
In reply to Re: discontonuimg Emsam » SLS, posted by Donna Louise on September 29, 2006, at 5:41:04
Then Nardil?
- Scott
Posted by jealibeanz on September 29, 2006, at 10:28:33
In reply to Re: discontonuimg Emsam, posted by Donna Louise on September 29, 2006, at 5:46:33
So have you officially been diagnosed with Bipolar?
Posted by Donna Louise on September 29, 2006, at 13:09:12
In reply to Re: discontonuimg Emsam » Donna Louise, posted by SLS on September 29, 2006, at 6:09:48
> Then Nardil?
>
>
> - ScottI apologize for the exteme vanity, but I am terrified I would gain weight. I don't think any positive effects would offset the agony of weight gain out of my control.
BTW, the patch put on about 5lbs that I could live with..barely...and it is magically coming off since I quit. I didn't think a drug with so amphetamine metabolites, albeit, not nearly as with the transdermal absorbtion but there you go, you just never know. What is with the poetry??? A new aspect of rebound?
Posted by Donna Louise on September 29, 2006, at 13:14:52
In reply to Re: discontonuimg Emsam, posted by jealibeanz on September 29, 2006, at 10:28:33
> So have you officially been diagnosed with Bipolar?
i am not sure what would qualify as official since there are no PET scans or anything that can scientifically prove any of these afflictions. My pdoc thinks so if that can be considered official. I considered myself to have many manifestations of soft bipolar for many years and it may be that the patient, if they can still think, may be the best one to know. My pdoc didn't think so until I responded so well to the lamictal because I sleep like a log for many hours. Insomnia is a major hallmark of bipolar and I just don't have that, never had. I slept like a rock as a baby.
Posted by Phillipa on September 29, 2006, at 13:24:08
In reply to Re: discontonuimg Emsam » jealibeanz, posted by Donna Louise on September 29, 2006, at 13:14:52
Insomnia is a hallmark of bipolar? Never heard that before. All types of things to my knowledge(limited) like excessive stress can cause insomnia to my knowledge. Love Phillipa
Posted by SLS on September 29, 2006, at 14:53:28
In reply to Re: discontonuimg Emsam » jealibeanz, posted by Donna Louise on September 29, 2006, at 13:14:52
> Insomnia is a major hallmark of bipolar
This is true in the manic phase of the illness or during a mixed-state - and then not always.
> and I just don't have that, never had. I slept like a rock as a baby.
Me too, in my depressed state. Mania is another story. The few times I had it, I could exist on 3-4 hour of sleep without really missing it.
Phillipa is right about insomnia being a component of some forms of unipolar depression. In fact, it was part of the original diagnosis.
In other words, you can sleep or oversleep and still be bipolar.
- Scott
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