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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by yznhymer on August 20, 2008, at 19:55:43
Howdy,
So heres a little EMSAM tale. I'd been on the patch for quite some time, initially at 6mg and then at 9mg. I got a therapeutic benefit at both doses similar to that experienced by others who have posted here. I kind of expected that EMSAM would work since I had a good response to Nardil some 15 years ago, but then the side effects were not manageable. To be sure I expereinced a number of bothersome side effects with EMSAM - brain zaps, jerking movements, copious sweating at the mildest exertion, and insomnia. No weight gain and no sexual dysfunction, though, so I decided I was coming out way ahead. In fact, I lost a good deal of weight - which more than any other external factor lifted my spirits and improved my sociability tremendously.
By and by, I needed to schedule a umbilical hernia repair. Did all the necessary homework, and met with my Pdoc to discuss weaning myself off the EMSAM so I could have the surgery. He could find no information about discontinuing EMSAM or anything about withdrawl symptoms, so he gave me a schedule to incrementally reduce the drug.
The withdrawal symptoms were terrible. Like you have a bad flu and you're going crazy at the same time. Each time I lowered the dose, the symptoms would kick in all over again, which sort of made titrating downward pointless, so I went cold turkey. To make a long story short(er), weeks later I had the ssurgery, it all went great, and I was looking at restarting EMSAM again.
I dragged my feet a bit because it was the first time I'd been antidepressant-free, I was loving sleeping through the night, and I was feeling no worse than I did on the drug. In any case, before I could resume EMSAM, I aggravated a back condition and wound up on vicodin, flexeril, and naproxyn for weeks... maybe 6 in all. That's another long story.
So its been about 3 months without EMSAM and I'd say its a toss up whether I go back on or not, though I have this past week started on 4.5mg - 1/2 a 9mg patch. I miss the energy, the interest, and the sociability I experienced with EMSAM, and I felt like there was a floor below me beneath which I wouldn't spiral in the face of strresss or challenges of an emotional kind. On the other hand, I feel better for the sleep I get, I am relieved not to be sweating like a PIG hog, and I think there are some non-med things that I can continue to do that help me.
The biggest kicker, tho, is the withdrawal symptoms. If I need to stop the med again I am loathe to re-esxperience them. And what if I'm in some kind of accident with no opportunity to take the necessary precautions to avoid contraindicated meds? My back issues and the surgery opened my eyes to the real possibilities here.
Posted by Phillipa on August 20, 2008, at 21:08:27
In reply to EMSAM and Surgery and now what?, posted by yznhymer on August 20, 2008, at 19:55:43
If you feel better than see what happens without it for a while. I know a babbler was on it for energy went off and is fine on just his klonopin. Good luck with your decision. What does your doc suggest?Phillipa
Posted by TexasRVer on August 20, 2008, at 22:04:45
In reply to Re: EMSAM and Surgery and now what? » yznhymer, posted by Phillipa on August 20, 2008, at 21:08:27
> If you feel better than see what happens without it for a while. I know a babbler was on it for energy went off and is fine on just his klonopin. Good luck with your decision. What does your doc suggest?Phillipa
I wish it had given me the energy that others have experienced---and the my pdoc said that it would. I could tell NO difference in energy level, and gained weight. Very disappointed in those things.
I am anxious to get back on it again, but apprehensive at the same time.
Posted by yznhymer on August 20, 2008, at 22:06:13
In reply to Re: EMSAM and Surgery and now what? » yznhymer, posted by Phillipa on August 20, 2008, at 21:08:27
> If you feel better than see what happens without it for a while. I know a babbler was on it for energy went off and is fine on just his klonopin. Good luck with your decision. What does your doc suggest?Phillipa
Hi Phillipa
Doc suggested starting out at 3mg by cutting patches, and taking it off at night, and see how that goes. He did say if it didn't work out all he's got left to suggest is managing the anxiety with a benzo like klonopin.
I still haven't found anybody else reporting this kind of withdrawal from EMSAM.
Posted by Phillipa on August 21, 2008, at 19:49:03
In reply to Re: EMSAM and Surgery and now what? » Phillipa, posted by yznhymer on August 20, 2008, at 22:06:13
Neigher have I. Eigher it works and they stay on it or if not go off it. Robert David in the long Emsam Thread Didn't seem to have withdrawal problems maybe cause he was using it for energy???? Sorry google search maybe? Phillipa
Posted by yznhymer on August 21, 2008, at 20:01:36
In reply to Re: EMSAM and Surgery and now what? » yznhymer, posted by Phillipa on August 21, 2008, at 19:49:03
> Neigher have I. Eigher it works and they stay on it or if not go off it. Robert David in the long Emsam Thread Didn't seem to have withdrawal problems maybe cause he was using it for energy???? Sorry google search maybe? Phillipa
I tried that first then headed back here.
I'm also wondering if I was getting too much EMSAM on the 9mg patch? Do many people get by with 6mg? If I take off the patch at night to help me sleep, could I use a larger patch during the day to compensate? How quickly does the medication absorbed by the skin start working in the brain? I've since learned that excessive talkativeness is a byproduct of meth use, and I experienced that same compulsion/inhibition on EMSAM. What exactly is the story on the amphetamine metabolites of this drug?
Posted by Merge on August 21, 2008, at 20:15:36
In reply to EMSAM and Surgery and now what?, posted by yznhymer on August 20, 2008, at 19:55:43
I just wanted to address the emergency thing...
I had been taking Parnate for several years when I needed to have emergency surgery (I went to the ER with pain and had my gall bladder removed that day). Obviously I didn't have the opportunity to go off the Parnate - and I came through the surgery just fine. I'm really not sure what extra precautions they take - I do remember that the anesthesiologist spent quite a bit of time with me - but surgery when taking an MAOI can certainly be done.
I'm no longer taking an MAOI but I wore a medical alert bracelet for 4 years - it was engraved with "this person takes an MAOI" on the back, as I also had concerns about being in an accident and not being able to tell anyone that I was on Parnate.
I don't really have any advice about whether or not to stay on EMSAM - unfortunately it seems like with any antidepressant that provides relief, there is going to be some sort of trade off, some sort of side effects. But, I hope you can at least worry a bit less about the emergency/surgery thing.
Posted by yznhymer on August 21, 2008, at 20:24:21
In reply to Re: EMSAM and Surgery and now what?, posted by Merge on August 21, 2008, at 20:15:36
> I just wanted to address the emergency thing...
>
> I had been taking Parnate for several years when I needed to have emergency surgery (I went to the ER with pain and had my gall bladder removed that day). Obviously I didn't have the opportunity to go off the Parnate - and I came through the surgery just fine. I'm really not sure what extra precautions they take - I do remember that the anesthesiologist spent quite a bit of time with me - but surgery when taking an MAOI can certainly be done.
>
> I'm no longer taking an MAOI but I wore a medical alert bracelet for 4 years - it was engraved with "this person takes an MAOI" on the back, as I also had concerns about being in an accident and not being able to tell anyone that I was on Parnate.
>
> I don't really have any advice about whether or not to stay on EMSAM - unfortunately it seems like with any antidepressant that provides relief, there is going to be some sort of trade off, some sort of side effects. But, I hope you can at least worry a bit less about the emergency/surgery thing.
The anesthesiologist told me they do have drugs to use that do not interact with EMSAM. In fact, he used those with me even though I stopped taking EMSAM about 8 weeks previously, for extra safety. The bracelet is a good idea - I will look into it since that scenario is a little worrisome. Maybe a tattoo?
Posted by Phillipa on August 22, 2008, at 0:52:18
In reply to EMSAM and Surgery and now what?, posted by yznhymer on August 20, 2008, at 19:55:43
Boy people experience things so different googled the original link and the first guy on it went off with no side effects but I believe he was cutting the patches first. I still e-mail with him. If questions maybe he will answer. He's a great guy. Phillipa
This is the end of the thread.
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