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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Johann on April 6, 2007, at 1:06:22
Hi, I just came across this forum and saw the questions about EMSAM. I'm a psychologist (using a pseudonym) and have dealt with PTSD and Bi-Polar Spectrum Disorder for many years. I thought I simply had ferocious depressions (which nothing would treat) and extreme anxiety, until a reaction to a tricyclic put me into a suicidal manic depression. Having been treated with lithium (and some other things), my depression has abated significantly and the anxiety has calmed some. Still, lithium is toxic, and EMSAM has shown success with panic disorder (that is, anxiety) and PTSD, as well as depression. I've worked my way up to the 12 mg/24 hour patch (for 2 weeks now) and have experienced no side effects (except maybe once when I ate a lot! of soy sauce). The couple of times I've bumped up the dosage I may have experienced some insomnia.
I am very happy with it (aside from the cost) and find that it works as a sort of emotional governor for me, limiting my reactivity for both anxiety and depression. Until I'm stable for a number of months at full dosage, with no significant external stressors, I'll continue with my other meds (yes to klonopin, but only .5 mg).
I was recently at a talk given by one of the original researchers for EMSAM, and he confirmed my experience. He also said that all the studies have been done at the full 12 mg level with no dietary restrictions or reactions. Because the patch uses a matrix design it can be cut with no loss of effect. I am amazed at how well it stays on (in the shower and steam room, on the tennis court) and the lack of any skin irritation.
Here's wishing us all the best,
Johann
Posted by bassman on April 6, 2007, at 7:49:07
In reply to 3rd month on EMSAM, posted by Johann on April 6, 2007, at 1:06:22
Thanks so much for your post...I had previously been of the option that EMSAM wasn't ever going to be a possibility for me because I thought the lower-dose patches were a marketing thing; the effective dosing would be higher and hence dietary restrictions-so why bother with the price and the patch? I also had concerns about the patch and skin irritation. I have PD, and I didn't realize it was indicated for that. Another thing to think about when my current set of meds completely fail.:>} Best of luck!
Posted by Honore on April 6, 2007, at 8:26:58
In reply to Re: 3rd month on EMSAM » Johann, posted by bassman on April 6, 2007, at 7:49:07
Thanks for the post. I've had pretty much the same experience as you. I've also been reporting that the application to the FDA suggested that 12 mg didn't require dietary restrictions, but have wanted to be cautious in stating that they're aren't a problem
Your post confirms that those who are concerned with the dietary restrictions can relax their concerns even with higher doses.
Also, my experience suggests that Emsam helps anxiety, which I've been trying to stress, but which many have worried is not true.
Honore
Posted by Phillipa on April 6, 2007, at 11:32:24
In reply to Re: 3rd month on EMSAM, posted by Honore on April 6, 2007, at 8:26:58
Everyone's metablism is different. Honore I'm happy for you. Love Phillipa
Posted by UgottaHaveHope on April 6, 2007, at 12:10:44
In reply to 3rd month on EMSAM, posted by Johann on April 6, 2007, at 1:06:22
He's my pdoc. First of all, to my knowledge, there have never been any MAJOR studies of diet restrictions of the Emsam patch performed over 6mg. So you could very well be correct: There is really no proof the diet restrictions are needed at 9mg to 12mg, but they advise you to follow them for liability reasons. Only you will know by trying those foods and checking your BP (although I would never test the OTC meds, please).
I also took Emsam 6mg for three months for anxiety (GAD) with 100 mg of Seroquel and 3mg of Klonopin. Emsam seems to have an energizing affect on me, which did not help the anxiety at first. But over time, combined with the other drugs, I felt like a 6 or 7 at times on a scale of 1-10. Right now, I am trying Nardil for the first time in my life (at 45mg for the sixth day), which is supposed to really hit anxiety. Well, it has hit anxiety but also makes me feel stoned. But these side effects are supposed to lessen with time. We will see. Have you ever tried Nardil or Parnate? I didn't know this was available, but my pdoc took a blood test before I began Nardil, saying he could measure later on how much Nardil was reaching my bloodstream. I wish they could do that with all meds because you would be able to tell if an effective dose is in your system and if it is not working, then that would be proof and give you confidence to move on to the next drug. One other thing: According to my pdoc, who again is one of the founders of Emsam, just for your own knowledge there is no washout between switching from Emsam to Nardil or Parnate or back to Emsam. Sounds like you are doing well on Emsam 12mg, please keep posting because I am very interest in following your situation because it closely resembles mine.
That is very encouraging to read that increasing your dosage of the patch made it more effective in treating anxiety. That is something I may try if Nardil does not work after 2-3 months.
Why are you worried about cost? As a pdoc, you should be able to get endless samples? :) There are plenty of researchers, pdocs and therapists that post on this board. I encourage you to share any of your experiences, and you will find these people very helpful. Welcome to PBabble.
Michael
sportscarvell@yahoo.com
Posted by Johann on April 6, 2007, at 13:31:35
In reply to Re: 3rd month on EMSAM » Johann, posted by bassman on April 6, 2007, at 7:49:07
It's really discouraging, isn't it, not to be able to find an effective combination. I take a number of meds--my psychi keep adding and not taking away, until I reach an eduring stable place--and am never sure what is causing what.
Given your concerns, it seems it might be worth it to give EMSAM a try.
Take care, Johann
Posted by chiron on April 6, 2007, at 13:40:33
In reply to Re: I also know one of the founders of EMSAM » Johann, posted by UgottaHaveHope on April 6, 2007, at 12:10:44
I was on the 6mg for 3 weeks, and have been on 9mg for about 9 days.
I think the 6mg made me somewhat worse, especially feeling more ‘crazy.’ My questions:
1) Could this CRAZY feeling be temperamental or a sign that this is not for me? It has eased a little, but that is probably because I have had 3 ECTs since I started Emsam to help me get by. I am still going crazy and wondering if all meds just make me worse.
2) How long should I continue to try the 9mg?
I hate ECT, but it does really help me, so I’m debating on giving up on all med trials (I’ve been through most of them anyway). I am so sick and tired of this miserable game.
Posted by Johann on April 6, 2007, at 13:43:58
In reply to Re: I also know one of the founders of EMSAM » Johann, posted by UgottaHaveHope on April 6, 2007, at 12:10:44
Hi Michael,
I am wondering if my affect is getting a little flat, but I am also taking 1 mg of Risperdone, which is blunting, so the combination may not be good.
Mornings have always been the hardest for me, and often agonzing--to sound dramatic--and now they are much better. I still feel waves of mild to moderate anxiety over the day, but the times of being flooded are much less frequent.
Since I'm a psycho ;-) and not a psychi, I have no more access to samples than what my psychi initially offered.
I'm glad I found this board. There aren't too many places to discuss these matters, without boring or troubling or confusing friends.
Best, Johann
> He's my pdoc. First of all, to my knowledge, there have never been any MAJOR studies of diet restrictions of the Emsam patch performed over 6mg. So you could very well be correct: There is really no proof the diet restrictions are needed at 9mg to 12mg, but they advise you to follow them for liability reasons. Only you will know by trying those foods and checking your BP (although I would never test the OTC meds, please).
>
> I also took Emsam 6mg for three months for anxiety (GAD) with 100 mg of Seroquel and 3mg of Klonopin. Emsam seems to have an energizing affect on me, which did not help the anxiety at first. But over time, combined with the other drugs, I felt like a 6 or 7 at times on a scale of 1-10. Right now, I am trying Nardil for the first time in my life (at 45mg for the sixth day), which is supposed to really hit anxiety. Well, it has hit anxiety but also makes me feel stoned. But these side effects are supposed to lessen with time. We will see. Have you ever tried Nardil or Parnate? I didn't know this was available, but my pdoc took a blood test before I began Nardil, saying he could measure later on how much Nardil was reaching my bloodstream. I wish they could do that with all meds because you would be able to tell if an effective dose is in your system and if it is not working, then that would be proof and give you confidence to move on to the next drug. One other thing: According to my pdoc, who again is one of the founders of Emsam, just for your own knowledge there is no washout between switching from Emsam to Nardil or Parnate or back to Emsam. Sounds like you are doing well on Emsam 12mg, please keep posting because I am very interest in following your situation because it closely resembles mine.
>
> That is very encouraging to read that increasing your dosage of the patch made it more effective in treating anxiety. That is something I may try if Nardil does not work after 2-3 months.
>
> Why are you worried about cost? As a pdoc, you should be able to get endless samples? :) There are plenty of researchers, pdocs and therapists that post on this board. I encourage you to share any of your experiences, and you will find these people very helpful. Welcome to PBabble.
>
> Michael
> sportscarvell@yahoo.com
Posted by Johann on April 6, 2007, at 13:49:56
In reply to Re: I also know one of the founders of EMSAM, posted by chiron on April 6, 2007, at 13:40:33
I'm afraid I'm not going to be of much help here: These are questions for a psychi. You've heard a million time, I'm sure, that everyone's reaction will be somewhat different. I still have anxiety, and I'm wondering if my affect is getting flat, maybe in combination with other drugs, but overall I'm feeling better. I hear you, though: It can get very discouraging.
Johann
> I was on the 6mg for 3 weeks, and have been on 9mg for about 9 days.
> I think the 6mg made me somewhat worse, especially feeling more ‘crazy.’ My questions:
> 1) Could this CRAZY feeling be temperamental or a sign that this is not for me? It has eased a little, but that is probably because I have had 3 ECTs since I started Emsam to help me get by. I am still going crazy and wondering if all meds just make me worse.
> 2) How long should I continue to try the 9mg?
> I hate ECT, but it does really help me, so I’m debating on giving up on all med trials (I’ve been through most of them anyway). I am so sick and tired of this miserable game.
Posted by UgottaHaveHope on April 6, 2007, at 16:16:27
In reply to Re: I also know one of the founders of EMSAM, posted by chiron on April 6, 2007, at 13:40:33
It was seven weeks before I felt a dramatic change, so you have a ways to go. If Emsam fails you, consider:
1. Nardil or Parnate
2. Nardil or Parnate with a TCA
3. Ultram
Posted by Honore on April 6, 2007, at 16:42:29
In reply to Re: I also know one of the founders of EMSAM » chiron, posted by UgottaHaveHope on April 6, 2007, at 16:16:27
Some of the information on which the FDA's decision to require food labeling and information with the 9 and 12 mg patches is at the following url. (I could only access the information with HTML; there is also a powerpoint presentation for those with powerpoint on their browers.)
So far as I can see, there is significant evidence that both the 9 and 12 mg doses may not require such labeling. The main concerns are inter=individual differences in response to tyramine challenges, and intra-individual differences, both of which cover a substantial range, but the vast majority of which don't reach the level that would cause a hypertensive reactions.
This particular document seems to be an earlier decision by the FDA than the final one. This decision seems to have been reconsidered and changed, to allow no labeling for the 6 mg dose. This one required labeling for all doses-- on the theory, which it points out, incidentally, that there's very little difference among pressor responses to all doses. That can be read either way I suppose. (I couldn't access other documents, as I say, so the later presentation by Somerset may be accessible to others.)
Even on the 6 mg patch, there is a small chance that some individuals may have hypertensive reactions-- but, on the other hand, there's a large chance that only those individuals would have a hypertensive reaction to the 9 or 12 mg patch.
Honore
This is the end of the thread.
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