![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 13 to 37 of 86. Go back in thread:
Posted by Phillipa on November 18, 2006, at 17:14:56
In reply to Re: ENSAM: DAY 3...No insomnia on seroquel?Phil, posted by stargazer on November 18, 2006, at 0:42:00
Stargazer so other antidepressants have worked for you. None have ever worked for me. Just the benzos. Love Phillipa
Posted by stargazer on November 18, 2006, at 21:10:07
In reply to Re: ENSAM: DAY 3...No insomnia on seroquel?Phil » stargazer, posted by Phillipa on November 18, 2006, at 17:14:56
No major side effects from Emsam. Took only 50 mg seroquel last night and I think tapering it is the way to go. I'm less dizzy which has been the biggest side effect after starting Cymbalta, adding Seroquel, stopping Cymbalta, and then starting Emsam all in the last month and a half.
My mood does not seem much different but I do find that I'm thinking differently, less hopeless, more focused somehow. So I am optimistic at this early state...SG
Posted by Phillipa on November 18, 2006, at 22:04:50
In reply to ENSAM: DAY 4...Uneventful but hopeful, posted by stargazer on November 18, 2006, at 21:10:07
Stargazer that's fantastic. I hope to hear another wonderful report tomorrow. Love Phillipa
Posted by stargazer on November 20, 2006, at 23:17:33
In reply to Re: ENSAM: DAY 4...Uneventful but hopeful » stargazer, posted by Phillipa on November 18, 2006, at 22:04:50
Still on 6 mg patch with some positive results, no fireworks, but much better than recent Cymbalta trial. I am happier with minor improvements, rather than intense SE's and/or a decline in my functioning.
I took a week off from seeing my pdoc so I will see him next Monday,not tomorrow. He was surprised when I suggested waiting two weeks before seeing him. That was an indication that I was feeling better even before starting Emsam, since I just started last Tues or Wed. I think stopping Cymbalta and starting Seroquel pre-Emsam, made me feel better, so it's hard to tell what if anthing, Emsam is doing.
On to Emsam week 2, taking baby steps...SG
Posted by Phillipa on November 21, 2006, at 17:30:13
In reply to ENSAM: DAY 5.. Holding steady./Phillipa, posted by stargazer on November 20, 2006, at 23:17:33
So are you saying the seroquel may have helped? Love Phillipa
Posted by stargazer on November 21, 2006, at 19:52:47
In reply to Re: ENSAM: DAY 5.. Holding steady./Phillipa » stargazer, posted by Phillipa on November 21, 2006, at 17:30:13
Hard to belive it's only been 7 days on Ensam, feel like it's been weeks.
Today I'm tired. I've been going to bed much too late and today I got up before I was really ready to. Tonight I'll be in bed by 11, that's better than 2 or 3.
I had to call my pdoc since I only have 3 patches left and don't see him until Monday. I stopped by to see him and he gave me a sample box which contains 5 patches. When I looked inside there were at least 20 patches. Nice of him to do this for me knowing that my insurance is limited right now. Hell, he must get oodles of samples, but it's the thought that counts.
I told him I was able to do things that I had avoided for the past few months and I did it without much resistence. I told him I wasn't so sure if I was feeling all that much better. He said that EMSAM tends to energize before brightening the mood. So that's something to know, although I am very happy that I can concentrate and make some phone calls I had been avoiding. Boy, when your depression starts to lift, you realize how limited your abilities had been.
Depression is SO subtle, you don't even feel it at times but it is there, lurking and waiting for the right time to reappear, mocking your life until being challenged again...then reluctantly accepting defeat, limping away but planning it's next move, which will occur when the time is right, when it is least expected,...It is incidious and one can not be fooled by it's mere absense, it has no bouundaries.
Posted by Phillipa on November 21, 2006, at 20:43:49
In reply to Re: ENSAM: DAY 7. Feels much longer, posted by stargazer on November 21, 2006, at 19:52:47
Stargazer I'm starting to get my confidence back in trying EMSAM as the positive results don't get posted. Still have my two boxes with the 6mg patches in them. And I'm only on 25mg of luvox and the valium and added the l2.5mg of seroquel at bedtime. So you're doc said a five day washout? Mine said two weeks. I wonder if the shorter washout period could make a difference? Love Phillipa
Posted by stargazer on November 21, 2006, at 22:19:57
In reply to Re: ENSAM: DAY 7. Feels much longer » stargazer, posted by Phillipa on November 21, 2006, at 20:43:49
Well actually my pdoc said 2 weeks and after reading the insert, it said 5 days unless you were taking Prozac or Buspar, long half lives, I think. But if I stopped Emsam to go back to another med, God forbid, the thought...there would be a 14 day washout period before starting a new med unless it was compatible with Ensam.
It's in the pkg insert, but not easily found, of course, the pkg insert is so poorly categorized, you would never be sure that what you read is accurate. I had to read it multipletimes before being clear about the washout period. Clear as mud...SG
Posted by Phillipa on November 21, 2006, at 22:23:04
In reply to Re: ENSAM: DAY 7. Feels much longer/Phillipa, posted by stargazer on November 21, 2006, at 22:19:57
You also need glasses even if you don't wear them. Wonder if the print is so small to discourage you from reading it? Love Phillipa So glad it's going well.
Posted by want2breal on November 22, 2006, at 21:38:51
In reply to Re: ENSAM: DAY 7. Feels much longer » stargazer, posted by Phillipa on November 21, 2006, at 20:43:49
Glad to hear of your progress.
I'm starting my ensam patch Friday....
I will be 5 days without my Lexapro (10mg.). I also take 5 mg. ambien EVERY night to sleep. Psych. said I could continue that no problem.
Will keep everyone posted.
Happy Thanksgiving!!!!!
Posted by elanor roosevelt on November 22, 2006, at 21:57:12
In reply to Re: ENSAM: DAY 7. Feels much longer/Phillipa, posted by stargazer on November 21, 2006, at 22:19:57
not brightened yet?
Posted by stargazer on November 22, 2006, at 22:35:44
In reply to Re: ENSAM: DAY 7. Feels much longer, posted by want2breal on November 22, 2006, at 21:38:51
Welcome to you joining me on Friday. I will be a week and a few days ahead of you so I can advise you if I am able to. I have not had any terrible side effects and I can be sensitive to medications, so don't worry too much.
The patches are easy to use and I have put them on a variety of locations including upper chest, lower abdomen, upper back, upper buttocks and upper arms and each site has a Left and right, so that makes about 10 sites. Supposedly the site can have a skin reaction, but I have not.
I was taking Seroquel when I started Emsam but I have tapered down from 200 to 50 mg. I'm extremely worried about taking too much medication so that was done of my own accord, but I'll let my pdoc know on Monday. I saw him briefly yesterday to pick up some more samples and I told him what I had done. He's pretty cool with my adjustments of meds since I am so cautious and if there was anything I thought might be a big No-NO, I wouldn't do it without calling him first.
Well have a great T-day, everyone. Yeah, no dietary restrictions on EMSAM!
Stargazer
Posted by stargazer on November 27, 2006, at 11:30:11
In reply to Re: ENSAM: DAY 8 or 9/ Welcome newbie, posted by stargazer on November 22, 2006, at 22:35:44
I'm trying to movethis post to the latest listings so that others will post their Emsam trials with me...Stargazer
Posted by want2breal on November 27, 2006, at 17:00:46
In reply to Re: ENSAM: DAY 10+ and counting, posted by stargazer on November 27, 2006, at 11:30:11
Glad you are doing so well, Stargazer.
I am on day 4 of EMSAM, and I'm not feeling too well.
I posted today, but can't find it anywhere on the board.
I am on Emsam 6 mg. patch, and take Ambien 10 mg......last night I did not sleep AT ALL!!!!
Seriously, I will not be able to stay on this if I can't sleep. This is starting to feel like Concerta and the diet pill I was once on. I had 3 good days, and then by day 4 couldn't sleep, got sick, and then got off!
Don't know if I can cut this thing in half or what.
If I have another bad night I will call my dr. tomorrow.
Take care!
Posted by want2breal on November 27, 2006, at 17:23:29
In reply to Re: ENSAM: DAY 10+ and counting, posted by stargazer on November 27, 2006, at 11:30:11
I think it may be too strong for me.
Can I take it off before bedtime, and if so, like what time? I am SO very sensitive to everything, I cannot handle any kind of caffeine or decongestants...everything keeps me awake.ANd...I know this is probably a question for the doctor, but what about cutting the thing in half or quarters?
Thanks so much, and glad you're doing well, Stargazer.
If I don't start getting some sleep, I will not be able to stay on it....PS....WHERE in the heck do my posts go....????
I can't find where I posted last....
Posted by Phillipa on November 27, 2006, at 19:32:56
In reply to Can I take it off before bed and/or cut it in half, posted by want2breal on November 27, 2006, at 17:23:29
Hey you two hooked up that' great. I know the answer to cutting the patch you can. My pdoc said if I try it I might just need a quarter of a patch. Just don't get it on your hands. Carefully cut it. I think someone said the were scored? Not sure. And yes you can take it off at night. Did you google EMSAM at the bottom on Dr. Bob's side? Love Jan/Phillipa
Posted by stargazer on November 28, 2006, at 10:05:49
In reply to Re: Can I take it off before bed and/or cut it in half » want2breal, posted by Phillipa on November 27, 2006, at 19:32:56
Real...
I'm taking a very small dose of seroquel (25-50 mg) at night to help with insomnia. Pdoc gave me loads of samples of these.
Seroquel may help more than Ambien for insomnia. May want to discuss with your pdoc B4 giving up on EMSAM. Alot of times the sleep meds stop working after being on them for awhile.
Are you still having heart palpitations or other symptoms of anxiety during the day?
SG
Posted by mindevolution on November 29, 2006, at 1:10:39
In reply to EMSAM......2 WKS.... Seroquel for imsomnia? /Real, posted by stargazer on November 28, 2006, at 10:05:49
> Real...
>
> I'm taking a very small dose of seroquel (25-50 mg) at night to help with insomnia. Pdoc gave me loads of samples of these.
>
> Seroquel may help more than Ambien for insomnia. May want to discuss with your pdoc B4 giving up on EMSAM. Alot of times the sleep meds stop working after being on them for awhile.
>
> Are you still having heart palpitations or other symptoms of anxiety during the day?
>
> SGhave to be careful of antipsychotic side effects so I wouldn't recommend it, who wants tardive dyskinesia from a sleep med???
Posted by SLS on November 29, 2006, at 6:24:59
In reply to EMSAM......2 WKS.... Seroquel for imsomnia? /Real, posted by stargazer on November 28, 2006, at 10:05:49
> Real...
>
> I'm taking a very small dose of seroquel (25-50 mg) at night to help with insomnia. Pdoc gave me loads of samples of these.In the past, there was a tendency to be scared of using antipsychotics for fear of developing tardive dyskinesia. More recently, the tendency is to be less scared of using the newer ones, known as the atypicals, particularly Seroquel. Unfortunately, there is still a tendency to be scared of using benzodiazepines. Ativan worked particularly well for me when I had to deal with MAOI-induced insomnia. The fear of benzodiazepines revolves around the word "addiction", when the true issues are of tolerance and dependence. Sometimes you need to adjust the dosage upwards to retain the beneficial effect - big deal. Isn't that what we have to do with the antidepressants? Discontinuing the benzodiazepines often involves a managed tapering of dosage - big deal. Isn't that what we have to do with the antidepressants? What there usually is not is the tendency to compulsively use and crave the benzodiazepines to obtain a psychotropic effect - to get "high". This would be addiction.
I am currently taking an antipsychotic, Abilify, to help mitigate the symptoms of severe bipolar depression. I would not be so afraid to take Seroquel at dosages between 25-50mg for sleep. However, I think I would try a benzodiazepine first. It is a hard decision to make, though. As to which one to choose, there are so many, I can't keep up with them all. I favor Ativan. Restoril isn't quite strong enough for me.
Ed_UK or Yxibow might be able to better help you choose a benzodiazepine for sleep.
- Scott
Posted by stargazer on November 29, 2006, at 9:18:49
In reply to Seroquel for imsomnia? Ed_UK or Yxibow for BZD, posted by SLS on November 29, 2006, at 6:24:59
I was originally put on Seroquel for depression, not insomnia. My depressions tend to be the
hypersomnic type, almost never have had insomnia, but when I did have it, I know what a hellish experience that is."Seroquel as a Monotherapy for Depression", my original posting, did not completely work for me, but DID pull me out of a downward spiral straight into hell, which for me seemed to be precipitated by Cymbalta.
The only reason I stayed on Seroquel after I stopped Cymbalta, was to prevent me from crashing during the washout period before starting EMSAM.
Once I started EMSAM, I asked my pdoc if I could get off Seroquel and he was reluctant to do that, I think from fear of having me relapse. Being aware of all the negatives associated with AP's including TD, I elected to SLOWLY taper myself. This is where I'm at, last night took 25 mg and did not wake up during the night.
Interestingly, my pdoc NEVER said that Seroquel could cause TD and he expressed NO reluctance in prescribing it. He's usually very forthcoming with warnings. I was very reluctant to try it since I have a thing about using meds for other diagnoses (psychoses,schizo) for depression, although it seems to have become the norm, at least here. I'll have to ask him about why he didn't mention TD as a risk. He was very gungho about using Seroquel as a monotherapy for depression. Perhaps at a higher dosage it may have worked.
How common is TD with atypicals? Since my pdoc never mentioned it, I'm thinking the incidence of it may be overblown. My pdoc wanted me to go higher than 200 mg, but the SE's of vertigo (4 falls in the last few months) was too great and I resisted any increase in dosage.
I'll probably be off it in a matter of days. If anyone knows me, I'm a big proponent of only taking what one absolutely needs and at the lowest dose possible. Drug companies hate my type since I'm too conservative for them.
Stargazer
Posted by yxibow on November 29, 2006, at 17:36:36
In reply to Re: Seroquel for imsomnia? Ed_UK or Yxibow for BZD, posted by stargazer on November 29, 2006, at 9:18:49
> I was originally put on Seroquel for depression, not insomnia. My depressions tend to be the
> hypersomnic type, almost never have had insomnia, but when I did have it, I know what a hellish experience that is.
>
> "Seroquel as a Monotherapy for Depression", my original posting, did not completely work for me, but DID pull me out of a downward spiral straight into hell, which for me seemed to be precipitated by Cymbalta.
>
> The only reason I stayed on Seroquel after I stopped Cymbalta, was to prevent me from crashing during the washout period before starting EMSAM.
>
> Once I started EMSAM, I asked my pdoc if I could get off Seroquel and he was reluctant to do that, I think from fear of having me relapse. Being aware of all the negatives associated with AP's including TD, I elected to SLOWLY taper myself. This is where I'm at, last night took 25 mg and did not wake up during the night.
>
> Interestingly, my pdoc NEVER said that Seroquel could cause TD and he expressed NO reluctance in prescribing it. He's usually very forthcoming with warnings. I was very reluctant to try it since I have a thing about using meds for other diagnoses (psychoses,schizo) for depression, although it seems to have become the norm, at least here. I'll have to ask him about why he didn't mention TD as a risk. He was very gungho about using Seroquel as a monotherapy for depression. Perhaps at a higher dosage it may have worked.
>
> How common is TD with atypicals? Since my pdoc never mentioned it, I'm thinking the incidence of it may be overblown. My pdoc wanted me to go higher than 200 mg, but the SE's of vertigo (4 falls in the last few months) was too great and I resisted any increase in dosage.I'm sorry to hear you've had falls -- I take Seroquel and I'm not sure if its vertigo or not but I take it at night and I have to be in bed when it is effective because it tends to cause orthostatic hypotension (low blood pressure), hence no sharp up and down movements. So that type of situation is not uncommon I would imagine.
It's unknown but the aggregate statistics in one study put atypicals at 2% per year as opposed to a much higher percentage for old line drugs. But, this isn't meant to scare you away -- it still isn't known entirely and though there have been cases, they may not have the severity of old line drugs. TD and EPS exist on a sort of continuum and are at least partially dose related.
> I'll probably be off it in a matter of days. If anyone knows me, I'm a big proponent of only taking what one absolutely needs and at the lowest dose possible. Drug companies hate my type since I'm too conservative for them.Actually most reasonable psychopharmacologists are in favour of what is known as the MED (minimum effective dose) of any medication. So you're not at all off kilter there. So are a couple of the leading experts in TD (Drs. Wirshing and Wirshing) in favour of using the least amount of neuroleptic needed.
>
> Stargazer
Posted by yxibow on November 29, 2006, at 17:43:11
In reply to My day 4 not so good, posted by want2breal on November 27, 2006, at 17:00:46
> Glad you are doing so well, Stargazer.
> I am on day 4 of EMSAM, and I'm not feeling too well.
> I posted today, but can't find it anywhere on the board.
> I am on Emsam 6 mg. patch, and take Ambien 10 mg......last night I did not sleep AT ALL!!!!It's possible to take Ambien up to 20mg for sleep. This is obviously up to your doctor and health plan but its now known that it can be taken long term. I've switched back to Lunesta to try it again at 4mg but Lunesta still is somewhat weaker at keeping one asleep than Ambien, for me anyhow.
Otherwise, there are all the usual offlabel antidepressants but I don't particularly favour those concepts, especially Trazodone. Remeron is allright but one would really need to monitor weight.
There's Restoril, but I believe it is more habituating than the pseudobenzodiazepines (Ambien, Lunesta, etc.)
Some also believe in a 25-50mg dose of Seroquel -- the risk of TD is probably in the extreme noise level. I don't know if it would be my first choice before upping the dose of Ambien but you'll have to discuss these choices with your doctor.
> Seriously, I will not be able to stay on this if I can't sleep. This is starting to feel like Concerta and the diet pill I was once on. I had 3 good days, and then by day 4 couldn't sleep, got sick, and then got off!
> Don't know if I can cut this thing in half or what.
> If I have another bad night I will call my dr. tomorrow.
> Take care!
>
Posted by stargazer on December 1, 2006, at 15:16:11
In reply to Re: EMSAM......2 WKS.... Seroquel for imsomnia? /Real, posted by mindevolution on November 29, 2006, at 1:10:39
I will not be posting on my Emsam trial for the next week and a half as I will be on vacation, so the final word is I think it's doing something, mostly enabling me to be functional and regain some of my lost abilities, specifically with motivation and focus. Also my exteme depressed mood has brightened a bit. Stay tuned, I will update post when I return. Good luck to the other Emsam users, new and seasoned vets. P.S I do have residual dizziness but not incapacitating, so hopefully will diminish further.
Stargazer
Posted by maryhelen on December 5, 2006, at 16:36:57
In reply to Re: My day 4 not so good » want2breal, posted by yxibow on November 29, 2006, at 17:43:11
After all of my years of med trials it seems to me that I should know what TD means, but I don't. I am so confused about medications I don't know if I am coming or going half the time. I had a hospitalization for 2 months earlier this year ( about my 8th time as well as 4 treatment centres) and ended up having 13 ECT treatments (third time, ineffective) and was sent home on the following meds:
50 mg. clomipramine
150 mg. trazadone
100 mg. seroquel
15.0 zopicloneI still do not sleep well. I am so tired after 25 years of battling this depression. I use to research every med I was ever on ..... I cannot even remember all of them. Now I feel so hopeless as to ever being helped I don't even have the energy to be proactive in my care. I also have a problem with pain medications .... have a lot of physical disabilities. Percocett, for example, or other types of opiates, is the only relief I get from the depression. Of course I have to take too much to be effective and they are not easily available. My psych is working on me going on buprenorphine and a higher than normal dose of an antidepressant. My system metabolizes drugs at an alarming rate. He seems to indicate Effexor something like 600 mg. I am just waiting, as the bupe has not been available in Canada and special permission has been required for approval from the government. However, I understand now that bupe was made available in November here. I read other sites, and there is an indication for bupe being used for refractory depression. My doc told me that it is just indicated for pain management and to stop taking the other opiates. I just do not know anymore. The depression is devastating and I do know that I cannot continue much longer living such a useless and pointless life. Sorry to go off topic. Just got carried away. I don't even know why I continue to take these meds as they are obviously not working or I would not be so depressed. They were prescribed by the psych doc at the hospital whom I do not see anymore. I guess I am just waiting to see what my own doc puts me on. Thanks for listening.
maryhelen
Posted by yxibow on December 6, 2006, at 0:29:44
In reply to What is TD??, posted by maryhelen on December 5, 2006, at 16:36:57
> After all of my years of med trials it seems to me that I should know what TD means, but I don't. I am so confused about medications I don't know if I am coming or going half the time. I had a hospitalization for 2 months earlier this year ( about my 8th time as well as 4 treatment centres) and ended up having 13 ECT treatments (third time, ineffective) and was sent home on the following meds:
>
> 50 mg. clomipramine
> 150 mg. trazadone
> 100 mg. seroquel
> 15.0 zopiclone
>
> I still do not sleep well. I am so tired after 25 years of battling this depression. I use to research every med I was ever on ..... I cannot even remember all of them. Now I feel so hopeless as to ever being helped I don't even have the energy to be proactive in my care. I also have a problem with pain medications .... have a lot of physical disabilities. Percocett, for example, or other types of opiates, is the only relief I get from the depression. Of course I have to take too much to be effective and they are not easily available. My psych is working on me going on buprenorphine and a higher than normal dose of an antidepressant. My system metabolizes drugs at an alarming rate. He seems to indicate Effexor something like 600 mg. I am just waiting, as the bupe has not been available in Canada and special permission has been required for approval from the government. However, I understand now that bupe was made available in November here. I read other sites, and there is an indication for bupe being used for refractory depression. My doc told me that it is just indicated for pain management and to stop taking the other opiates. I just do not know anymore. The depression is devastating and I do know that I cannot continue much longer living such a useless and pointless life. Sorry to go off topic. Just got carried away. I don't even know why I continue to take these meds as they are obviously not working or I would not be so depressed. They were prescribed by the psych doc at the hospital whom I do not see anymore. I guess I am just waiting to see what my own doc puts me on. Thanks for listening.
>
> maryhelen
TD is Tardive Dyskinesia, a movement disorder caused by primarily neuroleptic (antipsychotic) medications. It is characterized in severity by the AIMS scale and can consist of stereotypy such as orofacial movements, limb jerks, cogwheel rotation, and other displays. To have definite TD, contradictory to intuition, one generally is not aware (at first) that they even have the motions and generally have to be pointed out. Awareness is included in AIMS exams but is not a primary part of diagnosis necessarily. TD and EPS (a fancy name for side effects of neuroleptic and other agents) are sort of on a sliding scale, TD being a more permanent result and EPS being various ongoing side effects as a result of treatment.
Tricyclics such as clomipramine are slightly more common in rareness than SSRIs to cause TD but this is not a major issue in their usage; side effects such as sedation, sweating and other characteristics of that drug class are far more common side effects.
The Seroquel you are taking, while there have been cases of TD, atypical (new) antipsychotics have varyingly been assigned about a 2% per year risk rate across the board by various studies, and Seroquel itself is probably even below that. It unfortunately is the most sedating of all antipsychotics, new or old.
TD can also be caused by extreme alcoholism, although this is also a rare event, and use of benzodiazepines such as Xanax, which is probably even more rare. Generally TD is most common in old line antipsychotics such as haloperidol.Roughly 30% of patients remit, 30% go no further, and 30% develop further problems. There is ongoing research in attempts to tackle TD but it remains an unfortunate part of treatment for BP and Schizophreniform disorders as well as other conditions with antipsychotics. At least a dozen agents have been tried against it, with some minor results with high dose Vitamin E and high dose BuSpar (which itself is a weak antipsychotic in disguise at high doses). Tetrabenazine has had some luck in some cases at the expense of pseudoparkinsonism (handshaking, etc.)
-- Jay
Go forward in 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.