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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by UgottaHaveHope on January 15, 2007, at 0:16:04
This post is probably long and boring if you don't take Emsam. But if you do, or are thinking about taking it, you'll probably read every word, just like I do with other posts on Emsam.
Here's my story: Been on Emsam for 11 days. During the first five days, I had major sleeping problems. I tried to combat this by taking 200-400mg of Seroquel, 1-2 mg of Klonopin and two tablets of Benadryl, and I would sleep three hours, and then have choppy sleep for a few more hours. It really affected me, because I don't know about you, but if I don't get my sleep, that gets the day started off on the wrong foot and makes it hard to recover.
Finally on the fifth day, I took off the patch just before bed (after wearing for 12 hours), took 200mg of Seroquel and slept like a champ. I told the pdoc about this the next day, because he was about to prescibe something else, and he just said to continue taking off the patch, which I have and had a return to satisfactory sleeping patterns. I know common sense would say that this drug does not leave your system immediately, so how could it have any effect on your sleep by taking it off? You know, I don't know why or how any of these meds work. But this has worked for me so far.
Emsam reminded me of Seroquel in one regard: You feel it immediately. With Seroquel, when you first take it, you fall asleep before you can count to 1,000. With Emsam, I felt a boost of energy within hours of putting on the patch. I don't know if that is a good thing for me because I have Generalized Anxiety Disorder or "free-floating fear" and the last thing I thought I needed was extra energy. However in days 7-10, I have felt some relief from the anxiety. I don't know if that is due to coming to terms with my anxiety of taking a MAOI, the lasting blunting effect from Seroquel from the night, or Emsam reaching a theraputic level. My pdoc told me people can really start feeling the effects as early as 9 days and as late 6 weeks. I hope I am on the front of the scale.
Here is my background: I'm 36 year-old male and have been challenged by anxiety for 10 years. I wake up and just have this rush of overwhelming nervous energy out of nowhere, can't explain it. It's like walking through a haunted house and knowing you are going to get scared, but not know where or when. Or it's like a fire alarm is going off in my brain and my mind is scanning everything to figure out what is wrong. And when the fire alarm is quieted, my mind is scanning everything to figure out why it is no longer going off. I worry about worry. I fear fear. In the beginning I would think this fear was coming from some physical symptom, such as tightness in my chest or scalp soreness, but that is just the way anxiety manifests itself in my body. It is me vs. the anxiety.
Where did this anxiety come from? In recent weeks, I have thought long and hard about this and I think it is from my childhood. My biological father abandoned me, made promises but gave up visitation in exchange for not having to pay child supports. My stepfather was emotionally abusive. For reasons he can only explain, he viewed me as a rival for my mom's love. He was a ticking time bomb and anything and everything could set him off. I don't know why my mom hung in there when she saw all of this happening, but she says she was too scared to be divorced again with two children. Part of me wants to say she was completely selfish and cowardly to let her kids be exposed to this evil, while the other wants to forgive and understand her because she was scared to death of having to support her kids on her own. What do you think?
Back to Emsam: I didn't like taking meds in the beginning because I felt that was "weak." But then my Sunday school teacher who was chief surgeon at a local hospital said that "God gives doctors the knowledge to make meds to help people" and I've been taking them ever since.
I have tried around 15 over the last 10 years, most notably Serzone, Paxil, and Adderall, and none of them had any effect. In August I finally found the first med that really hit that racing energy and it was Seroquel. It made me sleepy and groggy, but it was worth it to take away some of that unrelenting fear. I felt like I was on the road to recovering for the ensuing four months, but then I had some other nagging sickness (dry cough) that put me on the edge. What was wild is that I had worked myself all the way down from 400mg of Seroquel to 12.5 (and still felt just tired) over the months. And when my mind started cranking up again over the cough, 500mg of Seroquel would not faze me.
OK, that leads me to seeing a new pdoc who works at a research hospital. At first he said take 400mg of Seroquel and go to intense CBT therapy. I started the therapy, but as you know, it is hard for any therapy to have any effect if your mind is racing out of control. So then he gave me samples of the Emsam patch and told me "One of my other patients told me today that it saved his life."
I had always wanted to try a MAOI because of the results I have read about on this board and other places. The dietary restrictions concerned me, but hey what's the fun in eating lobster tails if you feel terrible. Fortunately there is the Emsam patch which does not have any food restrictions at 6mg. I eat everything but cough drops without any hesitations.
The only thing annoying about the patch is that it is a patch. Sometimes I wish for a pill that you could just take and forget about it. This patch you feel throughout the day when you move. It doesn't hurt unless you put it in the same place within 3-4 days.
Posted by ryanz on January 15, 2007, at 0:31:28
In reply to EMSAM (6mg) on Day 11, posted by UgottaHaveHope on January 15, 2007, at 0:16:04
Yeah, well, I had insomnia on many nights the first two to three weeks with Emsam as well and it wans't unexpected. But eventually I adjusted to it. I guess I was taking into consideration what would be best for me in the "long term" and toughed it out. I'd rather have insomnia for a few weeks than continue to feel suicidal for the rest of my life, basically. It's typical for the side effects to be worst the first couple of weeks while starting an antidepressant, and it can take up to six weeks for an antidepressant to start working. Ambien CR might work better for you than what you're taking now for insomnia. It also helps to preserve stage 3 and 4 sleep, while Benadryl actually adversely affects the amount of time you spend in different sleep stages such that eight hours of sleep on benadryl is nothing at all like a natural eight hours of sleep. Sleep studies reveal that benadryl is literally the worst sleep aid you can take. It seriously interferes with the amount of time you spend in different sleep stages, and in many people leaves them feeling hung over for over half the day afterwards. Some people like and defend Benadryl, though.
Posted by stargazer on January 15, 2007, at 9:54:12
In reply to EMSAM (6mg) on Day 11, posted by UgottaHaveHope on January 15, 2007, at 0:16:04
Hi Ugotta...overall your response sound like a positive one considering how difficult anxiety is to treat.
Are you still combining it still with Seroquel or benadryl or have you been sleeping without any other medication? It's intersting that no matter how much or little Seroquel you took, it had minimal effect on your anxiety and just made you sleepy (side effect, not an effective treatment). This is what I have experienced with many meds....you keep increasing the dose and realize there seems to be little benefit despite the dosage, yet your pdoc feels you should keep taking it. And this can go on for months with little benefit unless you insist on a "new plan" or you a "crisis" which forces reevaluation of the meds. It just reminds me that most of this "treatment" is "experimentation". I had the same problem with Lamictal and Seroquel, no real result, just MD thought it was doing "something".
I am now trying to be more proactive in treatment to avoid wasting my life anymore. I believe I know more about what can work and need to be more vocal about this with my pdoc. I thought I had been, but realize I was more hopeful for him to come up with a solution, than myself, but this has not proven to be true. And still I like him andrespect him as a doctor. It just proves they do not have all the answers for us.
Wishing you continued success On Emsam... SG
Posted by Phillipa on January 15, 2007, at 10:10:04
In reply to Re: EMSAM (6mg) on Day 11/Ugotta, posted by stargazer on January 15, 2007, at 9:54:12
Hey Michael that's so great about the EMSAM still thinking about it but unlike you haven't had the nerve to try it yet. Continued success. Love Phillipa
Posted by UgottaHaveHope on January 15, 2007, at 10:51:29
In reply to Re: EMSAM (6mg) on Day 11/Ugotta, posted by stargazer on January 15, 2007, at 9:54:12
Ryanz: How long have you been taking Emsam? Do you mind sharing some of your experience?
SG: I have been reading all of your posts. No more Benardyl, just Seroquel (200mg) and I do believe it may be helping me with sleep AND anxiety (by blunting). When I am calm, and I do feel more calm now, it always helps. When I am worked up, it does nothing. What is the latest with you on Emsam? How long have you been taking it? What dose and does it still feel like it is working as good?
Jan: Thanks as always for your encouragement. Michael
Posted by stargazer on January 15, 2007, at 16:19:39
In reply to Re: EMSAM - Stargazer and Ryanz, posted by UgottaHaveHope on January 15, 2007, at 10:51:29
Ugotta...Started Emsam 6 mg on 11/15 so today is 2 month anniversary!!!!!
Well...it is hard to say what it is doing but after an initial boost of energy,which was needed after relapsing on Cymbalta, it has steadily plateaued and my belief is that there is a large unresolved compononet to my depression which has never been treated adequately. So...
Currently I have added Amphetamine to Emsam and my pdoc has sanctioned me to try different doses of this to see what happens to my mood, motivation and overall sense of improvement.
I feel somewaht better on the stims, not sure if generic short acting amphetamine is the right stim but should know better after another week or two of trying differnt doses/times, and keeping notes for my next pdoc appt. since my memory is not something I have been able to rely on.
But I do have more optimism that this combination may be doing something that Emsam alone was not doing. I may have to go higher on the Emsam too but I wanted to try the stims before doing that to see what impact they have first.
I weaned off Seroquel, although I don't think I ever got higher than 100, maybe 150, since I thought it was making me too groggy.
StarGazer
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