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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Shortstop on April 30, 2007, at 11:44:24
Tomorrow marks the end of my first month on the Emsam 6 mg patch for generalized anxiety disorder with panic. I know what Michael will tell me -- have patience; give it at least 8 weeks -- but I must say that I'm a tad discouraged that I have noticed no benefits (or side effects, for that matter) at all. It's like I got a placebo -- at a $40 a month co-pay! I notice absolutely no difference in my mood, level of general anxiety or proneness to panic attacks. Nor have I had an increase in anxiety or any sleep problems, etc. Simply nothing whatsoever.
As I've mentioned, my pdoc wrote me a scrip to up dosage to 9 mg if there are still no results by the end of six weeks. I'm almost certain I'll be doing that rather than continuing the 6. Really, I should be feeling /something/ by now if I'm going to get any benefits out of this regimen at all over the long haul. If the higher dose fails, our plan is to simply give up on SSRIs (stomach issues) and MAOIs and revert to a straight benzo program. (Klonopin every day, Xanax as needed.)
I'll let this board know how it goes with at least monthly postings. Thanks for listening. It helps me to talk with you all about this!
Posted by Phillipa on April 30, 2007, at 12:26:46
In reply to One Month on Emsam, posted by Shortstop on April 30, 2007, at 11:44:24
Well that's strange. So only a benzo so no depression? Ophray has a doc on who said that 90 or 95% of serotonin goes to the gut. Love Phillipa sorry about the EMSAM as I still have samples.
Posted by Honore on April 30, 2007, at 15:35:57
In reply to One Month on Emsam, posted by Shortstop on April 30, 2007, at 11:44:24
Don't give up without trying the 9 mg patch for at least four weeks or so. You might even try 12 mg-- if you have any positive effects with 9 mg.
Also I use about 2.5 mg abilify/ day with Emsam and find that it has palpable effect in reducing social and overall anxiety. So it's possible that that combination-- or maybe Geodon, or some other atypical at a low dose, might be worth trying before you give up on Emsam altogether. On the other hand, Emsam alone, particularly over a period of three months or so (at 9-12 mg) reduced my anxiety. That wasn't necessarily true at the beginning, although it did improve my mood.
Honore
Posted by football on April 30, 2007, at 19:07:55
In reply to Re: One Month on Emsam, posted by Honore on April 30, 2007, at 15:35:57
Have you tried Nardil and Parnate? If not, then don't give up on MAOIs.
Posted by Shortstop on May 1, 2007, at 0:11:19
In reply to Re: One Month on Emsam, posted by Honore on April 30, 2007, at 15:35:57
Thank you for the encouragement. I will be trying the 9 mg patch at the 6-week point (two weeks from now). I'd switch sooner, but my co-pay is $40. I hate to waste what I've got! :-)
I'm not familiar with Abilify or Geodon. I'll Google those and see what they're about. One thing I'd really prefer not to do is combine ADs, although I don't mind augmenting ADs with benzos.
We shall see. Thanks for the tips.
> Don't give up without trying the 9 mg patch for at least four weeks or so. You might even try 12 mg-- if you have any positive effects with 9 mg.
>
> Also I use about 2.5 mg abilify/ day with Emsam and find that it has palpable effect in reducing social and overall anxiety. So it's possible that that combination-- or maybe Geodon, or some other atypical at a low dose, might be worth trying before you give up on Emsam altogether. On the other hand, Emsam alone, particularly over a period of three months or so (at 9-12 mg) reduced my anxiety. That wasn't necessarily true at the beginning, although it did improve my mood.
>
> Honore
Posted by Shortstop on May 1, 2007, at 0:16:59
In reply to Re: One Month on Emsam, posted by football on April 30, 2007, at 19:07:55
Emsam is my first MAOI. I'm trying it because the two SSRIs I tried -- Lexapro and Zoloft -- both gave me horrible heartburn. (I have a pretty bad problem with digestion; I take 40 mg of Prilosec every day.) Emsam sounded like a Godsend since it comes in a patch, bypassing my poor delicate gut! I tend to think the oral MAOIs wouldn't agree with me much either, plus I don't like the dietary restrictions. I'm thinking that, if Emsam flops for me, I'm back to straight benzos (Klonopin .5 every night before bed; Xanax .5 during the day as needed -- plus Inderol, a beta blocker, when I need to speak publicly or attend a high-pressure meeting or social gathering.)
Thanks for your encouragement, Football!
> Have you tried Nardil and Parnate? If not, then don't give up on MAOIs.
Posted by Shortstop on May 1, 2007, at 0:24:28
In reply to Re: One Month on Emsam, posted by Honore on April 30, 2007, at 15:35:57
Honore, those are for bipolar disorder. Not my issue! I've got generalized anxiety with panic. I function at a very high level -- none of my co-workers know I struggle with this issue and my work as an editor on constant deadline is unimpeded -- so I plan to use the least powerful drugs I need, and at the lowest doses, to even out my anxiety spells (dizziness, racing thoughts, dissociation, head rushes, etc.). My symptoms are not debilitating -- just demoralizing, tiresome and joy-robbing :-)
Posted by Shortstop on May 1, 2007, at 0:30:16
In reply to Re: One Month on Emsam » Shortstop, posted by Phillipa on April 30, 2007, at 12:26:46
Phillipa, 90 to 95% of seratonin going to the gut makes sense. I expect that's why it turned my belly into an acid factory! The reflux on Zoloft and Lexapro was terrible, some of the worst I've ever experienced, and that's saying something.
I guess I have very minor depression and it mainly comes from being in a constant state of generalized anxiety. But anxiety is definitely my primary issue, and has been for years, so it's stable this way. The minor depression surely flows from feeling beat up by anxiety. Benzos help but they do make me a tad tired. Plus, as everyone knows, they're really "band aid" treatments. They hide the symptoms rather than allowing you to address the root causes via CBT and exposure and such. I think!
Posted by Honore on May 1, 2007, at 1:05:01
In reply to Abilify and Geodon, posted by Shortstop on May 1, 2007, at 0:24:28
Treatment for Bipolar Disorder was the original on-label us for Abilify and Geodon, but as with many medications there are off-label, uses, that can, in many instances, become widespread.
They're doing studies now about Abilify and Geodon, I think (I'd have to look it up, to say which atypicals are under investigation) for generalized anxiety disorder. Not at the same dose as for biopolar, but at much lower doses, and as augmenting agents or alone.
That's how I"m using the abilify at 2. 5 mg/day. The usual dose for bipolar disorder is at least 15 mg/day, or more.
It's not necessarily for you, but it's something some people may find useful.
Honore
Posted by UgottaHaveHope on May 1, 2007, at 3:34:53
In reply to One Month on Emsam, posted by Shortstop on April 30, 2007, at 11:44:24
SS: First of all, let me tell you I was big doubter, too. And my pdoc is one of the founders of Emsam. But out of nowhere, right around week 6-7, something kicked in.
I like your plan. If you do not feel any response by week six, then going up to 9 or 12 is a good idea. I just hope you give the patch at least 9-10 total weeks, whatever dose.
And your pdoc should have some samples of the 9-12 to give you for at least two weeks. Ask for them.
The only thing I ask for this: Please dont focus on this drug not working, because sometimes if you do that you will fail to notice any improvement even if there is. Just keep an open mind, and tell yourself "I'm going to make it through these next two weeks and evaluate everything then."
Proud of you for hanging in there.
Posted by Shortstop on May 1, 2007, at 9:16:20
In reply to I like your Emsam plan » Shortstop, posted by UgottaHaveHope on May 1, 2007, at 3:34:53
Thanks Michael. I guess I do need the encouragement, as I'm a tad discouraged at the lack of discernible results. (Just yesterday I had a pretty strong panic episode.) And you might be right to say that, if I'm too skeptical, I may miss or overlook any subtle but promising improvements in my mood or in the severity and duration of my anxiety and panic.
"I'm going to make it through these next two weeks and evaluate everything then." Yes. Just so! Thanks again.
Shortstop
> SS: First of all, let me tell you I was big doubter, too. And my pdoc is one of the founders of Emsam. But out of nowhere, right around week 6-7, something kicked in.
>
> I like your plan. If you do not feel any response by week six, then going up to 9 or 12 is a good idea. I just hope you give the patch at least 9-10 total weeks, whatever dose.
>
> And your pdoc should have some samples of the 9-12 to give you for at least two weeks. Ask for them.
>
> The only thing I ask for this: Please dont focus on this drug not working, because sometimes if you do that you will fail to notice any improvement even if there is. Just keep an open mind, and tell yourself "I'm going to make it through these next two weeks and evaluate everything then."
>
> Proud of you for hanging in there.
Posted by UgottaHaveHope on May 1, 2007, at 10:16:02
In reply to Re: I like your Emsam plan, posted by Shortstop on May 1, 2007, at 9:16:20
SS: Are you taking any other meds with Emsam? My pdoc approved up to 4mg of Klonopin and that really helped. Plus I took 100mg of Seroquel at night, which also seemed to help.
I am sorry that you had a bump in the road on Emsam last nite. I really think no med is perfect and you could feel perfect on say Nardil for 10 years then have a rough day with anxiety and then feel just fine for another long period. Thats just the way it goes.
But YES. Dont make any pre-determined decisions about Emsam. Just commit to yourself: I am taking this two more weeks and then I am going evaluate where I stand.
Proud of you. I really am. It takes a lot of GUTS and COURAGE to try and then stick it out on meds that may or may not be helping. Most ppl quit after four weeks if they dont feel completely changed by that time period (which is so unrealistic and unfortunate).
Shoot, YOU are an inspiration for ME.
Posted by Shortstop on May 1, 2007, at 12:14:21
In reply to Re: Sorry about your panic episode » Shortstop, posted by UgottaHaveHope on May 1, 2007, at 10:16:02
For the past couple of years I've been taking .5 Klonopin every night before bed. Klono stays in your system a long time, so this way I'm not tired the next day, having slept through the "peak" period, but I do get the calming effects of having it in my system. As needed I'll take a .5 Xanax during the day, or a beta blocker, or both, depending on what I have going on. My hope is that the Emsam will gradually let me wean off the benzos for the simple reason that I can't see taking both. If I were full-blown agoraphobic I would throw everything I can at this thing, but as I said, I'm high functioning -- just living in a constant state of semi-agitation and feeling on the edge of a panic episode.
There are some real good cognitive-behavior-therapy resources out there and they help as well even if they don't cure the condition, as some promise (the Lucinda Bassett tapes, for example, promise total remission). Probably my favorite is The Panic Attack Workbook by David Carbonell. I need to revisit it often when stress is high. It's as good a coping tool as any drug. Exercise helps a ton, too. I'm a big outdoor walker when the long days are here. Thank God they finally are!
You know, a decade or so ago, when all this started with a massive out-of-the-blue panic attack (in my mid-30s), I never could have imagined that panic and anxiety were anything other than "all in your head." I'm sure I would have said as much to anyone who told me they had such a condition. I know better now. Barring a miracle, I'll be managing GAD for the rest of my days.
Thanks again for the kind words of encouragement, Michael Hope. I can see you're blessed with a real spirit of encouragement; on this board you're giving good support to a lot of people you don't even know. God bless you!
> SS: Are you taking any other meds with Emsam? My pdoc approved up to 4mg of Klonopin and that really helped. Plus I took 100mg of Seroquel at night, which also seemed to help.
>
Posted by Johann on May 2, 2007, at 0:25:39
In reply to One Month on Emsam, posted by Shortstop on April 30, 2007, at 11:44:24
Over a number of months I went from 6 mg to 12 and am doing well, with 1 1/2 mg of klonopin per day. Almost all the research was done at the 12 mg level. My experience is that it's a gradual build up, and I did have a few peaks of anxiety along the way. Two actually.
It's been about 5 months for me. I encourage you to hang in there. And the lack of side effects is a good thing.
Johann
Posted by UgottaHaveHope on May 2, 2007, at 4:33:24
In reply to Re: Sorry about your panic episode, posted by Shortstop on May 1, 2007, at 12:14:21
SS: Glad to provide encouragement, and glad to see you provide encouragement to others. Maybe there is a greater purpose in all of this for both of us, despite the fact that I hate that we both have GAD. We can offer encouragement for those like us, or worse case, just let them know there are other ppl who have the same thing. When you know you are NOT alone with this emotional issue, it changes everything.
I will be monitoring your progress very closely, as I may switch from Nardil back to Emsam after 10-12 weeks. The best book I have ever read is "The Anxiety Workbook" by Edmund Bourne. Glance at it next time youre in a bookstore.
http://www.booksamillion.com/ncom/books?pid=1572244135&ad=FGLBKS
Yes, I think a med can take you to a 6-7 and then CBT can add another point or two or three.
Posted by Shortstop on May 2, 2007, at 13:17:47
In reply to Re: One Month on Emsam, posted by Johann on May 2, 2007, at 0:25:39
> I did have a few peaks of anxiety along the way. Two actually.
How long did the peaks last, and how intense were they? Were they enough to cause you to consider quitting the Emsam? Did you have any days where you either skipped or took off your patch early due to anxiety? An inquiring Emsamian wants to know!
Posted by Shortstop on May 2, 2007, at 13:19:23
In reply to Re: I'll be managing GAD too » Shortstop, posted by UgottaHaveHope on May 2, 2007, at 4:33:24
> The best book I have ever read is "The Anxiety Workbook" by Edmund Bourne. Glance at it next time youre in a bookstore.
Ah yes. I've considered it at Amazon but haven't ordered it. Yet! I'll give it a second look.
Posted by Johann on May 2, 2007, at 17:22:34
In reply to Re: One Month on Emsam )) Johann, posted by Shortstop on May 2, 2007, at 13:17:47
One lasted a night and the other a day or two, but it was clearly triggered by something. Neither made me consider stopping EMSAM. As I think I mentioned, adding Klonopin has helped smooth out my mood.
> > I did have a few peaks of anxiety along the way. Two actually.
>
> How long did the peaks last, and how intense were they? Were they enough to cause you to consider quitting the Emsam? Did you have any days where you either skipped or took off your patch early due to anxiety? An inquiring Emsamian wants to know!
>
This is the end of the thread.
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