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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 MaddieB on May 8, 2007, at 23:22:09
Hi All;
My pdoc would like to try me on an MAO (after many failures with SSRI, etc.) I looked around and people seem to be having a fair amount of success with EMSAM. She would rather I try Manerix. I read some posts about it and people don't really seem to like Manerix / Aurorix. The worst I've read about EMSAM is that it doesn't work all that well (or at least at low doses.)
I totally like the idea of a patch rather than another pill. I was wondering if anyone could point me in the direction of fodder for presenting a solid arguement for why EMSAM would be a better choice. I am going purely on gut at present and I'd like to have a more cogent arguement. She's pretty tough and I'm not going to get much mileage by saying that the patient discussion boards don't have much positive to say about Manerix. It drives me crazy that that isn't a good enough bit of info, but don't get me started...
Any thought, experiences, research, etc., would be much appreciated.Thanks much,
Maddie
Posted by Quintal on May 8, 2007, at 23:56:17
In reply to EMSAM vs. Manerix / Aurorix (Moclobemide), posted by MaddieB on May 8, 2007, at 23:22:09
__________________________________________________
Many clinicians are finding that the new MAOI (or 'RIMA'), moclobemide, is not an effective antidepressant; this view is substantiated by some clinical trials which constitute evidence that moclobemide is no more effective than placebo. In my opinion it is totally ineffective, I gave up using it years, no decades, ago. The minimal effect it has on neurotransmitters is detailed in my recent review (5).
http://www.psychotropical.com/maois_full.shtml
__________________________________________________Q
Posted by Declan on May 9, 2007, at 2:33:10
In reply to Re: EMSAM vs. Manerix / Aurorix (Moclobemide) » MaddieB, posted by Quintal on May 8, 2007, at 23:56:17
Maddie, moclobemide is no good for recovering alcoholics, because it is agitating.
I don't know where I read that.
Posted by MaddieB on May 9, 2007, at 6:14:25
In reply to Re: EMSAM vs. Manerix / Aurorix (Moclobemide) » MaddieB, posted by Quintal on May 8, 2007, at 23:56:17
Q;Thanks very much for the info. Any thoughts on EMSAM?
Maddie
> Many clinicians are finding that the new MAOI (or 'RIMA'), moclobemide, is not an effective antidepressant; this view is substantiated by some clinical trials which constitute evidence that moclobemide is no more effective than placebo. In my opinion it is totally ineffective, I gave up using it years, no decades, ago. The minimal effect it has on neurotransmitters is detailed in my recent review (5).
> http://www.psychotropical.com/maois_full.shtml
> __________________________________________________
>
> Q
Posted by Honore on May 9, 2007, at 8:41:18
In reply to Re: EMSAM vs. Manerix / Aurorix (Moclobemide), posted by MaddieB on May 9, 2007, at 6:14:25
Has your pdoc given you the arguments for Manerix? Given that it's much less know quantity, I'm surprised she wouldn't use Emsam, whcih at least has a fairly decent year of good results (even if not good sales). I too had heard that Moclobemide wasn't terribly effective, but I'm not very familiar with it My pdoc at one point refused to prescribe oral selegiline, or moclobemide, because he thought neither of them, in that form was really useful. He may have been wrong about the selegiline-- there wasn't much research at the time-- so I'm not sure what that means about moclobemide-- although oral selegiline isn't as effective as the patch.
If I knew a little bit more about what type of depression you have and whether you have a lot of social or general anxiety, how you sleep, how you respond to more stimulating drugs, it might be easier to respond.
But just the success of Emsam, as opposed to relative dormancy of Manerix, even though it's been around much longer, strikes me as a predisposing argument. Unless there's some specific reason.
Honore
Posted by Phillipa on May 9, 2007, at 10:51:52
In reply to Re: EMSAM vs. Manerix / Aurorix (Moclobemide), posted by Honore on May 9, 2007, at 8:41:18
I know I always say this but goggle Robert David on Dr. Bob's google side as he was the first to start EMSAM. I too still at some point like the idea of a patch think I'm waiting for price reductions as medicaire doesn't cover it and it's $500/mth. Love Philliipa
Posted by Quintal on May 9, 2007, at 11:19:44
In reply to Re: EMSAM vs. Manerix / Aurorix (Moclobemide), posted by MaddieB on May 9, 2007, at 6:14:25
I've tried both oral selegiline and moclobemide and I'd be much more inclined to try the EMSAM patch if I needed a stimulating antidepressant than either of them. If you're a somewhat nervous, irritable person (like a recovering alcoholic) I'd say Nardil would be the most likely to suit your temperament. EMSAM and moclobemide are likely to make you feel worse (although some people have felt anxiety relief from EMSAM I've never seen a real-life report of someone doing well on moclobemide alone). Then there's always Parnate if you do need a stimulating antidepressant. I think EMSAM can be a good drug for some people, but to me it seems very expensive for what it is. There are cheaper drugs like Parnate and Nardil that can do the same if not better.
Of course I don't know whether these options are open to you.
Q
Posted by Shortstop on May 9, 2007, at 13:12:10
In reply to Re: EMSAM vs. Manerix / Aurorix (Moclobemide) » MaddieB, posted by Quintal on May 9, 2007, at 11:19:44
I've been on the Emsam 6 mg patch for going on six weeks for GAD. (SSRI pills gave me horrible heartburn.) Still no noticeable effect at all. No benefits, no side effects. I may as well be on a placebo -- except that my physiology, evidently, is not easily fooled! Starting the 9 mg patch next Tuesday. I'll be checking in to report on how that goes. Best wishes. SS
Posted by MaddieB on May 9, 2007, at 22:10:42
In reply to Re: EMSAM vs. Manerix )) Maddie B, posted by Shortstop on May 9, 2007, at 13:12:10
Yes, do keep me posted and best wishes in return.
Maddie> I've been on the Emsam 6 mg patch for going on six weeks for GAD. (SSRI pills gave me horrible heartburn.) Still no noticeable effect at all. No benefits, no side effects. I may as well be on a placebo -- except that my physiology, evidently, is not easily fooled! Starting the 9 mg patch next Tuesday. I'll be checking in to report on how that goes. Best wishes. SS
Posted by MaddieB on May 9, 2007, at 22:30:56
In reply to Re: EMSAM vs. Manerix / Aurorix (Moclobemide), posted by Honore on May 9, 2007, at 8:41:18
Thanks Honore;
I'm getting the impression that my pdoc isn't all that into meds...I'm seeing her for therapy but I chose her b/c she could perscribe, too. Anyway I did not ask her why she chose Manerix. She said it was new (and I'm confused now because both you and Q mention that it's been around for a long time.) She also said that it was reversible (which again causes some confusion) but in my very rudimentary understanding, it seems that even the irreversible is not permantnetly irreversible. Anyway, I am atypical depression with ADD so I guess a stimulating AD would make sense. Problem is that I am extremely med sensitive and just about anythning screws up my sleep (doesn't sound like EMSAM will help here either.) And yes, there is a good bit of anxiety, social anxiety, and sleep issues. I was on Zoloft and Dexedrine for a few years and I do not think I slept very long at all during that time. I was hypo manic and pretty irritable. Consequently, I have Chronic Fatigue Syndrome, Fibromyalgia, and adrenal fatigue. I definitely need an AD but have tried many, many SSRI, SNRI, etc. type drugs to no avail. I am pretty deperate to try something new. Q mentioned the other MAOI's and possibly being better than EMSAM. You are kind to answer my post. Thank you. Maddie
Posted by MaddieB on May 9, 2007, at 22:41:10
In reply to Re: EMSAM vs. Manerix / Aurorix (Moclobemide) » MaddieB, posted by Quintal on May 9, 2007, at 11:19:44
Thank you again for your thorough reply. I am atypical depression, ADD, & LD. I test as gifted but you certainly cannot see it through the murky lens that is me. I am also an adoptee who was raised by a depressed mother (family sexual abuse victim.) I do have a good bit of anxiety (especially social) and can be quite irritable at times. I do think the anxiety and depression are seconary to the ADD. I also have word finding difficulties. I have been struggling for years and have managed OK but I really need to get things to a better place. I have an 8 year old son who means the world to me (who is also ADD.)
Thanks again. Maddie> I've tried both oral selegiline and moclobemide and I'd be much more inclined to try the EMSAM patch if I needed a stimulating antidepressant than either of them. If you're a somewhat nervous, irritable person (like a recovering alcoholic) I'd say Nardil would be the most likely to suit your temperament. EMSAM and moclobemide are likely to make you feel worse (although some people have felt anxiety relief from EMSAM I've never seen a real-life report of someone doing well on moclobemide alone). Then there's always Parnate if you do need a stimulating antidepressant. I think EMSAM can be a good drug for some people, but to me it seems very expensive for what it is. There are cheaper drugs like Parnate and Nardil that can do the same if not better.
>
> Of course I don't know whether these options are open to you.
>
> Q
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