![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 42 to 66 of 86. Go back in thread:
Posted by CrimsonVik on December 18, 2006, at 0:06:13
In reply to Re: Emsam Users, length of time, effects,pros/cons? » stargazer, posted by Phillipa on December 13, 2006, at 19:24:05
> Please keep posting about the EMSAM. So far you are the only one that has posted that didn't develop insomnia or anxiety. Love Phillipa
------------------------------------------------
I never got insomnia on Emsam, just oral Selegiline the first few nights.
Actually I have a couple patchs left and using a bit of both.Vik
Posted by CrimsonVik on December 18, 2006, at 0:26:13
In reply to Emsam Users, length of time, effects,pros/cons?, posted by stargazer on December 13, 2006, at 9:10:19
> Hi, just checking in to update my Emsam post for anyone interested.
>
> Duration: approx 1 month now.
>
> Effects:
> Positive: more motivation, decrease in anxiety, better focus, no dietary restrictions.
>
> Negative: patch falls off sometimes, cost (have samples now but not sure if my insurance will cover it, I will fight if they don't)
>
> I see my pdoc today and although I am feeling better than a few months ago, I don't really feel great. That is one of the problems with depression...being able to judge how you feel and knowing that you are getting some response or not.
>
> I'd like to keep posting and hear from others on Emsam.
>
> P.S. Still take 25 mg of seroquel to sleep prn.
>
> Stargazer
>_________________________________________________
If it's too costly you can get Selegiline pills in Generic. At least in the US.
Vik
Posted by stargazer on December 18, 2006, at 0:39:14
In reply to Re: Emsam Users, length of time, effects,pros/cons? » stargazer, posted by CrimsonVik on December 18, 2006, at 0:26:13
Thanks I was wondering if the two are interchangable? I though others had said they didn't work the same way. Have you found them to be similar? I may have to pay for the Emsam if my insuror doesn't cover it, but I'm allfor the cheapest way to go as it works. Im a firm believer in generics although my pdoc feels otherwise. No sense supporting drug companies that make billions off us every year and most of the drugs don't work and I end up with hundreds (try to avoid this) of pills that never get used.
Stargazer
Posted by CrimsonVik on December 18, 2006, at 4:19:12
In reply to Re: Emsam Users,/Oral Selig-same as Emsam?/Vik, posted by stargazer on December 18, 2006, at 0:39:14
> Thanks I was wondering if the two are interchangable? I though others had said they didn't work the same way. Have you found them to be similar? I may have to pay for the Emsam if my insuror doesn't cover it, but I'm allfor the cheapest way to go as it works. Im a firm believer in generics although my pdoc feels otherwise. No sense supporting drug companies that make billions off us every year and most of the drugs don't work and I end up with hundreds (try to avoid this) of pills that never get used.
>
> Stargazer_________________________________________________
You would have to follow the MAOI diet if you take the 5 mg. tablet more than twice a day (as with 9 and 12 mg. Emsam) but Emsam is Selegiline, like the tablets.
I'm on 10 mg., 2 tabs, morning and night.
If you are on 6 mg. and want to stay on Emsam, there's always 9 and 12.Vicki
Posted by Phillipa on December 18, 2006, at 18:25:30
In reply to Re: Emsam Users,/Oral Selig-same as Emsam?/Vik, posted by CrimsonVik on December 18, 2006, at 4:19:12
So you went off the EMSAM? May I ask the reason? Love Phillipa
Posted by stargazer on December 19, 2006, at 0:15:27
In reply to Re: Emsam Users, length of time, effects,pros/cons? » stargazer, posted by CrimsonVik on December 18, 2006, at 0:26:13
Emsam will not be covered by my insurance so I may not fight them on it but try selegilene. I only have about 6 patches left and I am not due to see my doc until 1/2/07. He gave me a script for Emsam but if I take Selegilene what dose should I take if I'm on the 6 mg patch of Emsam?
I wasn't clear from your post what the conversion is between the patch and the pill.
If it works I don't really care that much as I have been able to heed the dietary restrictions before but I hope the selegilene works like Emsam else I will have to fight my insuror.
Is the 6 mg patch the equivalent of 5 mg pill or 10 mg (2 pills)?
SG
Posted by CrimsonVik on December 19, 2006, at 1:33:53
In reply to Re: Emsam Users,/Oral Selig-same as Emsam?/Vik » CrimsonVik, posted by Phillipa on December 18, 2006, at 18:25:30
> So you went off the EMSAM? May I ask the reason? Love Phillipa
6 mg. patch wasn't helping anymore and at the $45 cost I wanted to try the pills.
I possibly will try the 12 mg. patch down the road, though.Vik
Posted by CrimsonVik on December 19, 2006, at 1:54:29
In reply to Just found out Emsam is nonformulary/Vik, posted by stargazer on December 19, 2006, at 0:15:27
> Emsam will not be covered by my insurance so I may not fight them on it but try selegilene. I only have about 6 patches left and I am not due to see my doc until 1/2/07. He gave me a script for Emsam but if I take Selegilene what dose should I take if I'm on the 6 mg patch of Emsam?
>
> I wasn't clear from your post what the conversion is between the patch and the pill.
>
> If it works I don't really care that much as I have been able to heed the dietary restrictions before but I hope the selegilene works like Emsam else I will have to fight my insuror.
>
> Is the 6 mg patch the equivalent of 5 mg pill or 10 mg (2 pills)?
>
> SG__________________________________________________
From what I get from the insert that came with Emsam, there is only 6 mg. Selegiline in your patch, with 20 being the patch size.
It's just my guess they would still give you two of the 5 mg. per day, one in the morning and one in the aft. That seems to be a common dose for even Parkinson's and I don't think it requires the DIET like the 9 & 12 patch and any oral dose over 10 mg.Vik
Posted by psychobot5000 on December 19, 2006, at 15:08:18
In reply to Just found out Emsam is nonformulary/Vik, posted by stargazer on December 19, 2006, at 0:15:27
It is almost impossible to get an equivalent to 6mg EMSAM from oral selegiling--the doses would be alost absurdly high. --According to my math, you would need not five or ten mg, but 102mg of oral tablets to equal just a 6mg EMSAM patch. This is because the transdermal system is far more effective at getting it into your bloodstream. The oral version has 4.4% bioavailability, compared with about 74% from the patch--about seventeen times higher.
As far as I understand, the normal max-dose for oral pills is 60mg, but that some docs push it to about 85mg. It's still not equivalent to EMSAM, as far as I understand, but you also have to deal with significant levels of amphetamine metabolites that are almost absent in the patch. And there are the dietary restrictions. So basically, the two delivery systems are not really equivalent in terms of their effects.Here's some more of my blather about it:
http://www.dr-bob.org/babble/20061206/msgs/711307.htmlPsychbot
> Is the 6 mg patch the equivalent of 5 mg pill or 10 mg (2 pills)?
>
> SG
Posted by Phillipa on December 19, 2006, at 19:03:31
In reply to Just found out Emsam is nonformulary/Vik, posted by stargazer on December 19, 2006, at 0:15:27
Oh Stargazer I'm so sorry fight them on it you're doing so well. I don't want to see you go off it. If it had been an option for me I was willing to take the 4-5 hundred dollar out of savings. Love Phillipa
Posted by CrimsonVik on December 19, 2006, at 19:19:29
In reply to Oral dosing equivalence is very, very high, posted by psychobot5000 on December 19, 2006, at 15:08:18
> It is almost impossible to get an equivalent to 6mg EMSAM from oral selegiling--the doses would be alost absurdly high. --According to my math, you would need not five or ten mg, but 102mg of oral tablets to equal just a 6mg EMSAM patch. This is because the transdermal system is far more effective at getting it into your bloodstream. The oral version has 4.4% bioavailability, compared with about 74% from the patch--about seventeen times higher.
>
>
> As far as I understand, the normal max-dose for oral pills is 60mg, but that some docs push it to about 85mg. It's still not equivalent to EMSAM, as far as I understand, but you also have to deal with significant levels of amphetamine metabolites that are almost absent in the patch. And there are the dietary restrictions. So basically, the two delivery systems are not really equivalent in terms of their effects.
>
> Here's some more of my blather about it:
> http://www.dr-bob.org/babble/20061206/msgs/711307.html
>
> Psychbot
>
>
> > Is the 6 mg patch the equivalent of 5 mg pill or 10 mg (2 pills)?
> >
> > SG
>
>
_________________________________________________I will ask my Dr. next week what the closest oral dose to the 6 mg. patch is and report back.
I think my dose of 20 mg. is stronger than SG wants. At first it's like a diet pill...it hits you fast, unlike the patch.Vik
Posted by laima on December 21, 2006, at 0:43:19
In reply to Oral dosing equivalence is very, very high, posted by psychobot5000 on December 19, 2006, at 15:08:18
Yet, my knowledgeable doctor told me that the 6mg Emsam was roughly equivalent to 20 mg oral selegeline- which is what I was using before starting Emsam. The switch was very smooth. If anything, I found the oral version of 20 mg to be more potent. I eventually had to start the 9mg Emsam.> It is almost impossible to get an equivalent to 6mg EMSAM from oral selegiling--the doses would be alost absurdly high. --According to my math, you would need not five or ten mg, but 102mg of oral tablets to equal just a 6mg EMSAM patch. This is because the transdermal system is far more effective at getting it into your bloodstream. The oral version has 4.4% bioavailability, compared with about 74% from the patch--about seventeen times higher.
>
>
> As far as I understand, the normal max-dose for oral pills is 60mg, but that some docs push it to about 85mg. It's still not equivalent to EMSAM, as far as I understand, but you also have to deal with significant levels of amphetamine metabolites that are almost absent in the patch. And there are the dietary restrictions. So basically, the two delivery systems are not really equivalent in terms of their effects.
>
> Here's some more of my blather about it:
> http://www.dr-bob.org/babble/20061206/msgs/711307.html
>
> Psychbot
>
>
> > Is the 6 mg patch the equivalent of 5 mg pill or 10 mg (2 pills)?
> >
> > SG
>
>
Posted by psychobot5000 on December 21, 2006, at 2:17:30
In reply to Re: Oral dosing equivalence is very, very high » psychobot5000, posted by laima on December 21, 2006, at 0:43:19
>
> Yet, my knowledgeable doctor told me that the 6mg Emsam was roughly equivalent to 20 mg oral selegeline- which is what I was using before starting Emsam. The switch was very smooth. If anything, I found the oral version of 20 mg to be more potent. I eventually had to start the 9mg Emsam.It's hard to know with certainty, but I used to think that 20mg oral was equivalent to 6mg transdermal--I now believe this to be a misunderstanding. You see, the 6mg patch actually contains 20mg selegiling, but if you wear it for 24 hours, an estimated 30%, or about 6 mg, will actually be absorbed. This is where the 6/20 mg equivalence comes from, I believe.
However, with the oral selegiline you have the amphetamines, and they are (often) beneficial for mood and motivation, so there is that added benefit. Also, the blood-levels spike suddenly, and maybe that's good too. I took 20mg oral selegiline daily for many months, and definitely found it beneficial. But a doc I spoke to once (who worked with developing EMSAM) explained to me that the blood-levels were not nearly as high from 20mg oral tablets as they would be from any EMSAM patch.
Glad to hear that the oral was a good replacement for you!
Posted by CrimsonVik on December 21, 2006, at 2:39:56
In reply to Re: Oral dosing equivalence is very, very high » psychobot5000, posted by laima on December 21, 2006, at 0:43:19
Laima, if you have been on the 6 mg. patch and 20 mg. oral as we both seem to have, it is stronger to the patient than a patch. Especially at first.
I think 10 mg. feels more like the 6 mg. patch.
V.
Posted by laima on December 21, 2006, at 10:49:30
In reply to Re: Oral dosing equivalence is very, very high » laima, posted by psychobot5000 on December 21, 2006, at 2:17:30
I used the oral first, then moved to Emsam when it became available. Actually though, I'm not convinced that the transdermal delivery is very even, because heat affects it, how well it sticks affects it, sometimes it rumples up- I even wonder if different kinds of skin on different parts of the body affect how well it is absorbed. Sometimes it just plain falls off, especially in summer. I definately agree that the oral version is more stimulating. But my doctor felt very strongly that the Emsam would do more and be "more available" than the oral version of selegeline. I use a small amount of adderall with it, and that wasn't necessary with the oral. He had some remote hand in reviewing Emsam, too-sounds like a lot of consultants involved! Small world. Interestingly, the longer it's been out, the less sure anyone seems to be about what the exact equivalence between the oral and patch is.
> >
> > Yet, my knowledgeable doctor told me that the 6mg Emsam was roughly equivalent to 20 mg oral selegeline- which is what I was using before starting Emsam. The switch was very smooth. If anything, I found the oral version of 20 mg to be more potent. I eventually had to start the 9mg Emsam.
>
> It's hard to know with certainty, but I used to think that 20mg oral was equivalent to 6mg transdermal--I now believe this to be a misunderstanding. You see, the 6mg patch actually contains 20mg selegiling, but if you wear it for 24 hours, an estimated 30%, or about 6 mg, will actually be absorbed. This is where the 6/20 mg equivalence comes from, I believe.
>
> However, with the oral selegiline you have the amphetamines, and they are (often) beneficial for mood and motivation, so there is that added benefit. Also, the blood-levels spike suddenly, and maybe that's good too. I took 20mg oral selegiline daily for many months, and definitely found it beneficial. But a doc I spoke to once (who worked with developing EMSAM) explained to me that the blood-levels were not nearly as high from 20mg oral tablets as they would be from any EMSAM patch.
>
> Glad to hear that the oral was a good replacement for you!
Posted by laima on December 21, 2006, at 11:04:24
In reply to Re: Oral dosing equivalence is very, very high » laima, posted by CrimsonVik on December 21, 2006, at 2:39:56
It seems to get more confusing all the time about those equivalencies. Maybe it's like comparing apples and oranges, as the saying goes. If Emsam cuts out the amphetamine aspect that oral selegeline has, maybe it's not even really the same drug anymore (?) I definately believe I "felt" the oral stronger, I wonder if that has to do with the amphetamine involved. However, I have discovered a "magic combo"- Emsam with tiny amount of adderall. This is definately working better than either the oral or the Emsam alone! (Or maybe it's working like a much larger dose of the oral?) It's a new development for me: I had been using small amount of ritalin to raise my very low blood pressure, and that was ok. One of my doctor's colleagues consulted with my case, and voiced his clinical observation that a lot of people do really well with Emsam plus adderall- that the two appear to work synergistically. So I was switched fairly recently, and it works! Amazing! So now it's Emsam 9 plus 5 mg adderall, twice a day.
> Laima, if you have been on the 6 mg. patch and 20 mg. oral as we both seem to have, it is stronger to the patient than a patch. Especially at first.
> I think 10 mg. feels more like the 6 mg. patch.
> V.
Posted by CrimsonVik on December 21, 2006, at 13:10:00
In reply to Re: Emsam enhancement » CrimsonVik, posted by laima on December 21, 2006, at 11:04:24
I'm being troubled by low blood pressure too and my Dr. is out of town. I was already on hypertension medicine so it's confusing.
I feel bad and weak on the oral now..possibly going back to Emsam, probably.
I asked him about ADD before and that I had some symptoms like short attention span: didn't seem to believe it. I'd love to try Adderall though.
> It seems to get more confusing all the time about those equivalencies. Maybe it's like comparing apples and oranges, as the saying goes. If Emsam cuts out the amphetamine aspect that oral selegeline has, maybe it's not even really the same drug anymore (?) I definately believe I "felt" the oral stronger, I wonder if that has to do with the amphetamine involved. However, I have discovered a "magic combo"- Emsam with tiny amount of adderall. This is definately working better than either the oral or the Emsam alone! (Or maybe it's working like a much larger dose of the oral?) It's a new development for me: I had been using small amount of ritalin to raise my very low blood pressure, and that was ok. One of my doctor's colleagues consulted with my case, and voiced his clinical observation that a lot of people do really well with Emsam plus adderall- that the two appear to work synergistically. So I was switched fairly recently, and it works! Amazing! So now it's Emsam 9 plus 5 mg adderall, twice a day.
>
Posted by laima on December 21, 2006, at 13:33:40
In reply to Re: Emsam enhancement » laima, posted by CrimsonVik on December 21, 2006, at 13:10:00
You might be a perfect candidate then, just like me! I am told that the reason selegeline (or other MAOI) plus stimulant is "officially" a no-no is because of the possibility of over-stimulation and dangerously high blood pressure- but my doctor and his colleagues say they've cautiously used such combinations countless times without incident. I've gotten notes to take to the pharmacy before saying it's ok- but they are used to me and my weird prescriptions at this point. I do have to have a blood pressure reader, and have been instructed to monitor my blood pressure this month- before and after taking the adderall, and if I feel strange, to be sure of what's going on. I'm very impressed with this adderall plus Emsam combo- can't gush enough! I don't believe there is any study to prove or disprove it though- just the one guy's hunches and clinical observations. Makes sense to me- I wonder if it's got anything to do with replacing the amphetamine that Emsam lacks? (Is that why ritalin helps, but not nearly as much? Because though it boosts blood pressure, it's not an amphetamine?) That, and of course, low blood pressure can make a person blahhhh, which is in itself depressing. And Emsam can lower blood pressure... I wonder if regular selegeline can lower blood pressure? I think it can. Maybe if your doctor has trouble with understanding your attention span and other ADD symptoms, he or she could understand low blood pressure if you emphasized that angle. (I know they like to say that poor attention is a symptom of the depression.)Good luck!
> I'm being troubled by low blood pressure too and my Dr. is out of town. I was already on hypertension medicine so it's confusing.
> I feel bad and weak on the oral now..possibly going back to Emsam, probably.
> I asked him about ADD before and that I had some symptoms like short attention span: didn't seem to believe it. I'd love to try Adderall though.
>
>
>
>
> > It seems to get more confusing all the time about those equivalencies. Maybe it's like comparing apples and oranges, as the saying goes. If Emsam cuts out the amphetamine aspect that oral selegeline has, maybe it's not even really the same drug anymore (?) I definately believe I "felt" the oral stronger, I wonder if that has to do with the amphetamine involved. However, I have discovered a "magic combo"- Emsam with tiny amount of adderall. This is definately working better than either the oral or the Emsam alone! (Or maybe it's working like a much larger dose of the oral?) It's a new development for me: I had been using small amount of ritalin to raise my very low blood pressure, and that was ok. One of my doctor's colleagues consulted with my case, and voiced his clinical observation that a lot of people do really well with Emsam plus adderall- that the two appear to work synergistically. So I was switched fairly recently, and it works! Amazing! So now it's Emsam 9 plus 5 mg adderall, twice a day.
> >
>
Posted by stargazer on December 21, 2006, at 17:43:27
In reply to Re: Emsam enhancement » CrimsonVik, posted by laima on December 21, 2006, at 13:33:40
This is all very interesting and I thank you for your experiences with Ensam, selegiline and Adderall.
I think, don't know for sure, that Ensam will be covered by insurance so I may not have to take Selegiline but I will print out your posts if I need to know equivalents. It sounds as though either 10 or 20 mg will be good starting point if I need to go there. I have taken Adderall in combination with Wellbutrin and Celexa and felt it helped with my symptoms of disorganization and lack of focus. When I stopped it I felt like it contributed to my downward spiral as I got more and more disorganized and eventually life seemed to get very overwhelming.
My pdoc will say it is not allowed with Emsam but it may be helpful down the road. I also have suffered with hypotension, although recently it seemed more WNL.
All of this information is very helpful. The 6 mg patch which I have been on for a month may not be enough since I'm starting to lose my energy level so perhaps I need an increase?
Stargazer
Posted by laima on December 21, 2006, at 19:14:57
In reply to Re: Emsam enhancement/Helpful suggestions, posted by stargazer on December 21, 2006, at 17:43:27
Do you know, when I tried the 12mg Emsam, my blood pressure absolutely tanked, so I had to go back to 9. (It was something like 92/61, even when I was moving around in the middle of the day! I felt pretty faint. I haven't felt any agitation from Emsam, as others have reported. In other words, as it was increased, I became more sluggish, to say the least.) With the 9, a grand total of 10 mg adderall per day is sufficient to keep my blood pressure at the low end of normal (in the neighborhood of 110/70 when moving around moderately), and it boosts my energy and mood as well as focus, etc. If I understand correctly what my doctor was saying and what I was reading, selegeline can somehow increase a stimulant's effects, so "less acts like more". Sounds like it could get dicey fast for someone with high blood pressure. Perhaps if your doctor wavers, you might offer to get a blood pressure reader and promise to monitor yourself? That would seem prudent anyway until you are very sure how you react. 10 mg adderall a day is a pretty low dose, I believe--but pretty effective with the Emsam. Interestingly, before I started using selegeline oral version, I was giving wellbutrin a fair trial, with the same doctor. I tried ritalin with it for awhile for ADD and sleepiness, but the combination left me pretty frazzled so it was stopped. Another interesting discovery is that my overall anxiety seems to have gone way down as I gave up klonopin and now added the adderall- go figure.> This is all very interesting and I thank you for your experiences with Ensam, selegiline and Adderall.
>
> I think, don't know for sure, that Ensam will be covered by insurance so I may not have to take Selegiline but I will print out your posts if I need to know equivalents. It sounds as though either 10 or 20 mg will be good starting point if I need to go there. I have taken Adderall in combination with Wellbutrin and Celexa and felt it helped with my symptoms of disorganization and lack of focus. When I stopped it I felt like it contributed to my downward spiral as I got more and more disorganized and eventually life seemed to get very overwhelming.
>
> My pdoc will say it is not allowed with Emsam but it may be helpful down the road. I also have suffered with hypotension, although recently it seemed more WNL.
>
> All of this information is very helpful. The 6 mg patch which I have been on for a month may not be enough since I'm starting to lose my energy level so perhaps I need an increase?
>
> Stargazer
Posted by CrimsonVik on December 21, 2006, at 19:28:53
In reply to Re: Emsam enhancement/Helpful suggestions, posted by laima on December 21, 2006, at 19:14:57
He gave me Cytomel for thyroid/depression, SG. Dr. said I could NOT take Wellbutrin with an MAOI. It possibly would be harmless but I'm scared of that combo.
V.
Posted by laima on December 21, 2006, at 19:34:25
In reply to Re: Emsam enhancement/Helpful suggestions, posted by CrimsonVik on December 21, 2006, at 19:28:53
I think wellbutrin + Maoi might cause seratonin syndrome!
I wouldn't risk it if I were you.> He gave me Cytomel for thyroid/depression, SG. Dr. said I could NOT take Wellbutrin with an MAOI. It possibly would be harmless but I'm scared of that combo.
> V.
Posted by laima on December 21, 2006, at 19:50:33
In reply to Re: Emsam enhancement/Helpful suggestions, posted by laima on December 21, 2006, at 19:14:57
I should clarify part of what I just posted- when I tried the 12 Emsam, it was because I still felt pretty un-ok and going downhill, so an increase seemed like a good thing to try. I believe I was using 15 mg ritalin per day at the time- might have been 20, but I can't remember. When I started the 12, immediately my blood pressure went way down, my pulse went way up- like 97! I was afraid to use the ritalin- and I had klonopin- but that didn't seem like a hot idea either. I didn't know what to do, and was pretty freaked out over what was happening. So I pulled of the patch and went to see the doctor the next day. He said that when the heart rate goes way up while blood pressure goes way down, that means the heart is working much harder to try to keep up. Not good. So, decrease of Emsam, elimination of ritalin, and start of klonopin withdrawal all at once. And why klonopin withdrawal- because we both agreed that after 4 years it probably wasn't doing much of anything for my anxiety, and probably contributing to both it and depression. At end of November, 10 mg ritalin reintroduced, and I felt better- but still blah, and quite discouraged. That's when I had the consultation with the other guy who had ideas about adderall. So now, just the Emsam 9 and the 10 mg adderall seems like the formula for me. I feel better than I have in a long while, my mood is greatly improved, and no more weird blood pressure or heart rate fluctuations. I'm not feeling jittery anymore, either, and I sleep much better. A lot of changes, rocky for a couple weeks-still not perfect- but overall much better and so worth it now.I haven't used wellutrin for over a year, and I had to let it flush out for awhile before starting any selegeline. Sorry if I wrote that in a confusing way.
> Do you know, when I tried the 12mg Emsam, my blood pressure absolutely tanked, so I had to go back to 9. (It was something like 92/61, even when I was moving around in the middle of the day! I felt pretty faint. I haven't felt any agitation from Emsam, as others have reported. In other words, as it was increased, I became more sluggish, to say the least.) With the 9, a grand total of 10 mg adderall per day is sufficient to keep my blood pressure at the low end of normal (in the neighborhood of 110/70 when moving around moderately), and it boosts my energy and mood as well as focus, etc. If I understand correctly what my doctor was saying and what I was reading, selegeline can somehow increase a stimulant's effects, so "less acts like more". Sounds like it could get dicey fast for someone with high blood pressure. Perhaps if your doctor wavers, you might offer to get a blood pressure reader and promise to monitor yourself? That would seem prudent anyway until you are very sure how you react. 10 mg adderall a day is a pretty low dose, I believe--but pretty effective with the Emsam. Interestingly, before I started using selegeline oral version, I was giving wellbutrin a fair trial, with the same doctor. I tried ritalin with it for awhile for ADD and sleepiness, but the combination left me pretty frazzled so it was stopped. Another interesting discovery is that my overall anxiety seems to have gone way down as I gave up klonopin and now added the adderall- go figure.
>
> > This is all very interesting and I thank you for your experiences with Ensam, selegiline and Adderall.
> >
> > I think, don't know for sure, that Ensam will be covered by insurance so I may not have to take Selegiline but I will print out your posts if I need to know equivalents. It sounds as though either 10 or 20 mg will be good starting point if I need to go there. I have taken Adderall in combination with Wellbutrin and Celexa and felt it helped with my symptoms of disorganization and lack of focus. When I stopped it I felt like it contributed to my downward spiral as I got more and more disorganized and eventually life seemed to get very overwhelming.
> >
> > My pdoc will say it is not allowed with Emsam but it may be helpful down the road. I also have suffered with hypotension, although recently it seemed more WNL.
> >
> > All of this information is very helpful. The 6 mg patch which I have been on for a month may not be enough since I'm starting to lose my energy level so perhaps I need an increase?
> >
> > Stargazer
>
>
Posted by CrimsonVik on December 21, 2006, at 19:55:30
In reply to Re: Emsam enhancement » CrimsonVik, posted by laima on December 21, 2006, at 13:33:40
I never felt like I had low bp on the 6 mg. patch. On oral 10 mg.dose Monday it was like 65/40 till it increased.
I wonder if it's safe to go from MAOI to MAOI. He gave me Nardil earlier and when I quit that he (Dr.) said to go straight to Selegiline...I napped, woke up, and the room was spinning. I could not get up. I've just always wondered afterward if there isn't a waiting period between MAOI'S, you know?
V.
Posted by stargazer on December 21, 2006, at 22:58:15
In reply to Re: Emsam enhancement/clarification of previous » laima, posted by laima on December 21, 2006, at 19:50:33
Laima,
It all just tells me there is no formula for figuring this stuff out. So much of what works is one doctor's suggestion and you willingtotry something,which I usually am as long as it's at tiny doses. I did resist when my psoc suggested the antipsychotics initially, but I eventually tried Risperdal, Zyprexa and seroquel. I thought if I took an AP, it meant I had psychosis, even though he said it had worked for some of his pts with TRD. Never felt they did much of anything though.
The effects of Emsam 6 mg are starting to fade so I'm wondering what to do next. My pdoc is away until 1/2/07 so I'll prob have to wait until then. It's not like with pills how you can just increase the dose on your own if you think you need a higher dose. That was something that I felt I could always do before seeing my pdoc. He trusted me to do that and I trusted myself to do it.
I have Adderall left but I don't think I should experiment with adding that, besides it's the 20 mg capsules, so I guess I'll wait to ask him about that. He may just want me to increase from 6 to 9 mg Emsam. Perhaps I'm just having a tired, sluggish couple of days, you can't feel good everyday, can you?
Do people that aren't depressed have mostly good, productive days or do they struggle with bad days on and off?
SG
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