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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by yesac on December 5, 2006, at 12:37:04
I went off EMSAM about a month ago because I didn't think it was working and it caused severe insomnia. But since then, I have really crashed. I mean, not to say that I was doing well on the drug, because I wasn't, but now I'm doing even worse. Really really bad, like every second is excrutiatingly unbearable.
Anyways, my psychiatrist suggested oral selegiline. He said it might not cause such severe insomnia. Also it's a hell of a lot cheaper, which was another issue I had with EMSAM ($50 copay).
If it was actually working, I think maybe I could try pushing up the dose. I was only using the 6mg patches.
Can anyone share any experiences with oral selegiline? Any thoughts at all would be appreciated.
Posted by Quintal on December 5, 2006, at 13:38:24
In reply to Anyone tried oral selegiline?, posted by yesac on December 5, 2006, at 12:37:04
I've tried oral sellegiline a few times and had no beneficial response to it. Generally it made me feel highly strung and agitated but hardly touched my mood. I think it is a weak antidepressant at best.
Q
Posted by yesac on December 5, 2006, at 13:57:52
In reply to Re: Anyone tried oral selegiline? » yesac, posted by Quintal on December 5, 2006, at 13:38:24
> I've tried oral sellegiline a few times and had no beneficial response to it. Generally it made me feel highly strung and agitated but hardly touched my mood. I think it is a weak antidepressant at best.
Hmmm. Interesting. Why would oral selegiline not be as effective an antidepressant as the EMSAM patch? Have you tried the patch?I would agree with you that it's a weak antidepressant. My response to the patch was almost nothing. It's just that I seem to have gotten worse since being off it, so now I'm wondering if it was doing something, even if it was very minimal.
But just to clarify-- I've never had a good response to any antidepressant, so my response to EMSAM is not surprising. I probably wouldn't make a good poster girl for success with antidepressants. I'm not one of the smiling people in the Wellbutrin and Cymbalta commercials.
Posted by Quintal on December 5, 2006, at 15:39:56
In reply to Re: Anyone tried oral selegiline? » Quintal, posted by yesac on December 5, 2006, at 13:57:52
>Why would oral selegiline not be as effective an antidepressant as the EMSAM patch? Have you tried the patch?
There is a difference between the two, something to do with amphetamine metabolites I think. I've not paid much attention to the EMSAM patch given my poor response to oral selegiline so I can't really comment on that.
>It's just that I seem to have gotten worse since being off it, so now I'm wondering if it was doing something, even if it was very minimal.
Oh I do think it has some positive effect, but nothing useful to me personally. I'm in a similar situation to you with regards to poor antidepressant response so I'm not trying to discourage anyone from trying it. Just doesn't seem an outstanding med for treatment resistant patients.
Have you tried Nardil, or Parnate plus Lamictal as an augmentor?
Q
Posted by blueberry on December 5, 2006, at 16:57:57
In reply to Anyone tried oral selegiline?, posted by yesac on December 5, 2006, at 12:37:04
I tried oral seleginline years ago, just for a few days. Doses were only 2mg. The first day was awesome. Tolerance set in already by the second day. After that it turned into relentless energy and restlessness and agitation, and toward the end was almost like a paranoia or something. I don't think it was the drug's fault, I think my brain just couldn't take all that dopamine buildup, even though it did feel great the first day.
Posted by Phillipa on December 5, 2006, at 23:31:37
In reply to Re: Anyone tried oral selegiline?, posted by blueberry on December 5, 2006, at 16:57:57
Your depression is worse since coming off EMSAM? Any others Love Phillipa ps I was hoping for the wonder drug
Posted by RN320 on December 6, 2006, at 8:26:36
In reply to Anyone tried oral selegiline?, posted by yesac on December 5, 2006, at 12:37:04
I've been on EMSAM since June and had really good results. I was deemed "treatment resistant" for 5 years previously. I found out recently that I'm not going to be able to afford it with changes to my medicare drug plan starting Jan 1st, so I talked to my pdoc yesterday about the possibility of switching over to the oral selegeline. His response was interesting. He said that the oral version is not effective in treating depression because you cannot give a high enough dose safely. Because of EMSAM's transdermal absorption you're able to absorb more of the med than if you took it orally. I may have to now go on Nardil or Parnate, and it's a real drag to even think about that since the EMSAM worked so well for me. I don't qualify for any "assistance programs" so I think I'm screwed. The manufacturer has made it pretty clear to pdocs that their ability to obtain samples is limited, so I doubt that route will work for me as it has done with other meds in the past. My only advice to you is to make sure that you have the means to afford this drug if you decide to try it- it's about $500 at my dose.
Good luck to you.
Posted by laima on December 6, 2006, at 9:43:12
In reply to Re: Anyone tried oral selegiline?, posted by RN320 on December 6, 2006, at 8:26:36
I used to take the oral version for about 2 months, before Emsam came out. I did find it reasonably effective, even though my highest dose with it was 25mg. (Emsam came out as it was slowly being bumped up to the 30-40mg neighborhood.) As for safety, once you get over 10-20mg, you have to follow the usual MAOI diet and drug guidelines. (At lower doses, you don't.) Maybe that is why your doctor called it "unsafe" ? The diet and drug restrictions scare a lot of people.
> I've been on EMSAM since June and had really good results. I was deemed "treatment resistant" for 5 years previously. I found out recently that I'm not going to be able to afford it with changes to my medicare drug plan starting Jan 1st, so I talked to my pdoc yesterday about the possibility of switching over to the oral selegeline. His response was interesting. He said that the oral version is not effective in treating depression because you cannot give a high enough dose safely. Because of EMSAM's transdermal absorption you're able to absorb more of the med than if you took it orally. I may have to now go on Nardil or Parnate, and it's a real drag to even think about that since the EMSAM worked so well for me. I don't qualify for any "assistance programs" so I think I'm screwed. The manufacturer has made it pretty clear to pdocs that their ability to obtain samples is limited, so I doubt that route will work for me as it has done with other meds in the past. My only advice to you is to make sure that you have the means to afford this drug if you decide to try it- it's about $500 at my dose.
> Good luck to you.
Posted by med_empowered on December 6, 2006, at 12:09:18
In reply to Re: Anyone tried oral selegiline? » RN320, posted by laima on December 6, 2006, at 9:43:12
I think the appeal of EMSAM is 1) its new 2) its super-high tech and 3) it (largely) by-passes traditional MAOI diet restrictions. That said..oral selegiline is a pretty standard treatment for Alzheimer's, so I don't think that the problem is that oral doses dont work or can't work as well as the patch; the problem is that higher oral dosages will require the MAOI diet, and the MAOI diet is a pretty scary thing.
This may sound stupid but...wouldn't homemade transdermal selegiline be possible? I remember reading that some chemist somewhere had made a xanax hand lotion that helped anxiety, but largely prevented tolerance/addiction. Instead of a patch, couldn't one use a gel/cream ? I'm not encouraging experimentation, but it seems that you'd just need selegiline, alcohol, and maybe propeylene glycol or glycerin.
Posted by yesac on December 6, 2006, at 12:24:00
In reply to Re: Anyone tried oral selegiline?, posted by med_empowered on December 6, 2006, at 12:09:18
> I think the appeal of EMSAM is 1) its new 2) its super-high tech and 3) it (largely) by-passes traditional MAOI diet restrictions. That said..oral selegiline is a pretty standard treatment for Alzheimer's, so I don't think that the problem is that oral doses dont work or can't work as well as the patch; the problem is that higher oral dosages will require the MAOI diet, and the MAOI diet is a pretty scary thing.
I agree. My psychiatrist said that the main reason why people never used selegiline as an antidepressant is because people were/are afraid of the diet.I'm not afraid of the diet (I did it with Parnate), but I'm not excited about it either.
Posted by linkadge on December 6, 2006, at 15:14:03
In reply to Re: Anyone tried oral selegiline? » med_empowered, posted by yesac on December 6, 2006, at 12:24:00
What is the cost of oral selegiline?
Say...a month at 5mg ?
Linkadge
Posted by Jimmyboy on December 6, 2006, at 16:36:12
In reply to Re: Anyone tried oral selegiline? » med_empowered, posted by yesac on December 6, 2006, at 12:24:00
Also remember if you are taking oral Selegiline, the absorbtion is much much better if you take it with food rather than an empty stomach, so keep that in mind.
Posted by Declan on December 6, 2006, at 17:30:56
In reply to Re: Anyone tried oral selegiline?, posted by Jimmyboy on December 6, 2006, at 16:36:12
You can always put the tablets under your tongue, too.
Posted by laima on December 6, 2006, at 17:46:46
In reply to Re: Cost of oral selegiline, posted by linkadge on December 6, 2006, at 15:14:03
Not sure- but I've seen two different generic versions in addition to the brand name Eldypryl. I'm sure that they are all much, much cheaper than Emsam. I suspect much of Emsam's cost is to pay for all of their years of research and tweaking, because, of all things, it was rejected at least once by the FDA for being ineffective.
> What is the cost of oral selegiline?
>
> Say...a month at 5mg ?
>
> Linkadge
Posted by Phillipa on December 6, 2006, at 18:57:46
In reply to Re: Anyone tried oral selegiline?, posted by med_empowered on December 6, 2006, at 12:09:18
Med no the appeal to me is that you can see it and being med phobic knew I could take it off if bad side effects and in my mind if you swallow it it's in your body. Oh I know it is too with EMSAM but it was like the bioidentical cream hormones I took I rubbed them into my skin and wasn't afraid the oral ones I couldn't tolerate. The cream I used for years. Love Phillipa
Posted by psychobot5000 on December 7, 2006, at 21:45:35
In reply to Re: Cost of oral selegiline » linkadge, posted by laima on December 6, 2006, at 17:46:46
" I suspect much of Emsam's cost is to pay for all of their years of research and tweaking, because, of all things, it was rejected at least once by the FDA for being ineffective."
___
I don't understand why it's so expensive, but I feel I should mention that EMSAM was never rejected because of efficacy--as I understand it, the concerns were over the labeling guidelines concerning the dietary restrictions. When they eventually got enough data on it, the FDA and the manufacturers settled on the issue, and it was released, with the manufacturers successfully convincing the FDA to drop the dietary recommendations at the 6mg dose, but not 9 and 12.That said, since this group is largely treatment-resistant depressives of varying sorts, efficacy is frequently going to be a problem. As for cost, from what I remember, the cost of 5mg/day of oral selegiline runs about 30$/month, assuming you are uninsured. However, a doc who had done research in this area told me 'oral selegiline does not become an effective AD until 30mg.' While 30mg or even 65mg of oral selegiline might be an effective AD, though, it is not in practice exactly the same drug as EMSAM, because of amphetamine and other metabolites exerting other psychopharmacological effects, and thus changing the picture.
As for the difference between the oral version and EMSAM, it runs like this as far as I understand it: The transdermal patch allows for 74% bioavailability, meaning (as I understand it) it's in the blood and active. It's steadily absorbed over the whole 24 hour cycle, so no peaks or lows. You get a much higher concentration of the parent drug in the bloodstream than is possible with the oral version, which has a (according to studies) 4.4% bioavailability. When you digest the pills in your gut, the vein carrying the drug into the bloodstream leads into liver first, meaning that most of the drug is processed into metabolites, and (as I understand it) it's just that 4 or 5% that's left. The metabolites include several isomers of amphetamine, meaning you may (theoretically) feel more energized with the oral selegiline, but may have more trouble sleeping and have other such s/e, etc etc. Also, the pill is digested within an hour or two, and the blood levels spike and then disappear as the drug is eliminated. Because EMSAM doesn't undergo this 'first pass metabolism,' before getting to you, the balance of the parent drug to the amphetamine metabolites is much higher, which could be good or bad, I suppose, depending on what you are after.
Oral selegiline is an effective AD, but not as effective as EMSAM (as I understand it), because you'd have to take so much more to get the same effective levels in your blood. If you did, you'd have high levels of stimulant amphetamines in your bloodstream, too.
From what I understand, EMSAM is also a rather different drug at 9mg and 12mg than at 6. Some patients need the 9mg patch to begin feeling substantial benefit, from what I have read.
I can't vouch for this being completely accurate, because I don't understand all of the background necessary, but I feel confident that my sources are good.
P-bot
> > What is the cost of oral selegiline?
> >
> > Say...a month at 5mg ?
> >
> > Linkadge
>
>
Posted by laima on December 7, 2006, at 22:27:46
In reply to Monthly cost, oral vs. EMSAM, efficacy, posted by psychobot5000 on December 7, 2006, at 21:45:35
My mistake then- I could have sworn it was over effectiveness. Thanks for clarifying.> " I suspect much of Emsam's cost is to pay for all of their years of research and tweaking, because, of all things, it was rejected at least once by the FDA for being ineffective."
> ___
> I don't understand why it's so expensive, but I feel I should mention that EMSAM was never rejected because of efficacy--as I understand it, the concerns were over the labeling guidelines concerning the dietary restrictions. When they eventually got enough data on it, the FDA and the manufacturers settled on the issue, and it was released, with the manufacturers successfully convincing the FDA to drop the dietary recommendations at the 6mg dose, but not 9 and 12.
Posted by psychobot5000 on December 8, 2006, at 11:06:04
In reply to Re: Monthly cost, oral vs. EMSAM, efficacy » psychobot5000, posted by laima on December 7, 2006, at 22:27:46
I believe there was some misreporting about it at the time--I know I spent a while knowing that talks were under way, and being under the vague, uncertain impression it was over efficacy, before eventually reading that it was over the labeling guidelines. I guess we can never really -know- what happened unless we were involved.
Best,
P-bot
Posted by laima on December 8, 2006, at 11:13:15
In reply to Re: Monthly cost, oral vs. EMSAM, efficacy » laima, posted by psychobot5000 on December 8, 2006, at 11:06:04
That makes sense. Perhaps it was blurry, such as how "effective" was it at eliminating the need for the MAOI diet.> I believe there was some misreporting about it at the time--I know I spent a while knowing that talks were under way, and being under the vague, uncertain impression it was over efficacy, before eventually reading that it was over the labeling guidelines. I guess we can never really -know- what happened unless we were involved.
>
> Best,
> P-bot
Posted by CrimsonVik on December 12, 2006, at 23:44:37
In reply to Re: Cost of oral selegiline » linkadge, posted by laima on December 6, 2006, at 17:46:46
>
> Not sure- but I've seen two different generic versions in addition to the brand name Eldypryl. I'm sure that they are all much, much cheaper than Emsam. I suspect much of Emsam's cost is to pay for all of their years of research and tweaking, because, of all things, it was rejected at least once by the FDA for being ineffective.
>
>
> > What is the cost of oral selegiline?
> >
> > Say...a month at 5mg ?
> >
> > Linkadge
>
>$15 Generic.
This is the end of the thread.
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