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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 60. This is the beginning of the thread.
Posted by Monica L on November 22, 2009, at 16:16:39
I'm in tears right now, I don't know what to do. This time last year I was in the pysch ward and I feel like I should just just go back again. I had so much hope in the EMSAM, I was so sure it was going to work right away, just like almost everyhting else I've tried has. Then to see that it's worked fairly quickly for others is discouraging when I'm seeing nothing at all, it's as if I'm still doing the washout and on nothing. If anything I'm a little more snappy at my kids and just want to be left alone, NO increase in energy or motivation. I hate that I have to suffer through the holidays like this. I know I just posted about this, but I need to get this out somehow. Is there anything I can take to help me get through this waiting period ? Again, it's only been 3 days, it feels like it's been weeks....I look at this patch on my skin and just laugh, I feel like it just a joke.
Monica
Posted by emmanuel98 on November 22, 2009, at 17:04:56
In reply to Add anything to help with the EMSAM wait...., posted by Monica L on November 22, 2009, at 16:16:39
I tried Emsam last summer, first 6mg then up to 12. It didn't do a thing for me. However parnate worked wonders. Have you tried parnate? Unfortunately, once you're on Ensam, you need a 10-day washout to try anything else.
Posted by Maxime on November 22, 2009, at 18:01:05
In reply to Add anything to help with the EMSAM wait...., posted by Monica L on November 22, 2009, at 16:16:39
(((( Monica )))) You have to give it some time. Plus you can increase the dosage. If EMSAM doesn't work you can always try Nardil or Parnate. You aren't out of options yet. I know it feels that way right now. I can hear the desperation in your writing. I was like that back in October when I was doing the washout for the Parnate.
It will and can get better. EMSAM may help you, or maybe you will have to try Parnate. But things will improve.
Do you feel like you need to be in the hospital right now?
Hang in there.
Posted by Phillipa on November 22, 2009, at 21:15:19
In reply to Re: Add anything to help with the EMSAM wait.... » Monica L, posted by Maxime on November 22, 2009, at 18:01:05
Monica you're on the EMSAM now right? Call your pdoc tomorrow and see if he/she feels you should feel something yet. Seems a bit early. Love Phillipa
Posted by bleauberry on November 23, 2009, at 18:37:08
In reply to Add anything to help with the EMSAM wait...., posted by Monica L on November 22, 2009, at 16:16:39
I don't know. It's really hard. Damn, holiday time and feeling so bad. Man oh man can I relate. My heart hurts reading your post.
If you can manage another 10 days, maybe go for that? If you feel the same then, I personally would ditch it. If anyone gave me a lecture on how the drug needs more time, I would tell them to go to...well, keep it nice...go jump in a lake.
If you aren't feeling any improvement at two weeks, the odds for success...clinically and scientifically proven in several pubmed studies...are already plummeting.
Did you feel this bad before you started? I mean, most people don't talk about it enough, but there is such a thing as deterioration after starting a new med. It could be ensam is making you feel worse? In clinical studies when people withdraw prematurely due to side effects...well, some of those withdrawals were because they got worse. It was called side effects. But the facts were, they were direct effects. The drug made the person worse. That's no side effect.
Just a possibility to consider.
In the years since Deprenyl has been tried as an antidepresant, I have seen ZERO people find it effective for any length of time. When it was reformulated into the Ensam skin patch version, I have seen I think 3 strong success stories, maybe 4 ho-hum not satisfactory stories, and maybe 12 miserable failures.
I have no idea why doctors would go for Ensam when the kings Parnate and Nardil cannot be beat. Even after 5 decades, nothing can top their track record. That's just the way it is. Screw the diet thing. Take a drug with a very long and very strong track record.
Since you have felt jumpy and irritable thus far with ensam, that alone tells me it is doing the wrong stuff for you.
My two cents.
I do wish you a smooth day and wish to heck there was something any of us could do to improve things right now. The best I can do is say I'm with you, don't let it get worse, stop if you have to. You would not be the first person to say you felt better after stopping ensam. All I know is I felt irritable and crappy on it, a lot better beginning the third day after stoppin it. Would it have ever worked if I had stuck with it? Do I really care? I'm alive and doing better with other things. I wouldn't have been if I didn't stop. I can name several drugs that would have killed me if I didn't abort them.
So you've been on a lot of drugs? And in the hospital? And never been on parnate or nardil? I don't get that. You were a highly qualified candidate for those a long time ago.
Posted by Monica L on November 23, 2009, at 19:23:35
In reply to Re: Add anything to help with the EMSAM wait...., posted by bleauberry on November 23, 2009, at 18:37:08
> I don't know. It's really hard. Damn, holiday time and feeling so bad. Man oh man can I relate. My heart hurts reading your post.
>
> If you can manage another 10 days, maybe go for that? If you feel the same then, I personally would ditch it. If anyone gave me a lecture on how the drug needs more time, I would tell them to go to...well, keep it nice...go jump in a lake.
>
> If you aren't feeling any improvement at two weeks, the odds for success...clinically and scientifically proven in several pubmed studies...are already plummeting.
>
> Did you feel this bad before you started? I mean, most people don't talk about it enough, but there is such a thing as deterioration after starting a new med. It could be ensam is making you feel worse? In clinical studies when people withdraw prematurely due to side effects...well, some of those withdrawals were because they got worse. It was called side effects. But the facts were, they were direct effects. The drug made the person worse. That's no side effect.
>
> Just a possibility to consider.
>
> In the years since Deprenyl has been tried as an antidepresant, I have seen ZERO people find it effective for any length of time. When it was reformulated into the Ensam skin patch version, I have seen I think 3 strong success stories, maybe 4 ho-hum not satisfactory stories, and maybe 12 miserable failures.
>
> I have no idea why doctors would go for Ensam when the kings Parnate and Nardil cannot be beat. Even after 5 decades, nothing can top their track record. That's just the way it is. Screw the diet thing. Take a drug with a very long and very strong track record.
>
> Since you have felt jumpy and irritable thus far with ensam, that alone tells me it is doing the wrong stuff for you.
>
> My two cents.
>
> I do wish you a smooth day and wish to heck there was something any of us could do to improve things right now. The best I can do is say I'm with you, don't let it get worse, stop if you have to. You would not be the first person to say you felt better after stopping ensam. All I know is I felt irritable and crappy on it, a lot better beginning the third day after stoppin it. Would it have ever worked if I had stuck with it? Do I really care? I'm alive and doing better with other things. I wouldn't have been if I didn't stop. I can name several drugs that would have killed me if I didn't abort them.
>
> So you've been on a lot of drugs? And in the hospital? And never been on parnate or nardil? I don't get that. You were a highly qualified candidate for those a long time ago.
Thanks for taking the time to respond to my post. I dont' know if I feel worse because I expected so much from Emsam or what. I expected for it to work fairly quickly for me, everything I have tried in the past has kicked in that way. And as far as what I have tried, I have tried it ALL, over a period of almost 5 years. I have been hosp. once and all they did was put me on about 5 different meds. I wouldn't say I was depressed, more of just lacking interested in anything, no motivation or drive and little energy. I know all those things sound like depression, but I'm not really SAD. I'm actually more talkative and outgoing and laugh more since I've been off all meds., but still no motivation, drive or energy, no dopamine. Then I start thinking about how the Emsam is not working and get very discouraged, things shouldnt be this hard to do, I used to do things without thinking whenever meds were working for me. I looked forward to things and felt like I had a purpose.So I called the doc today and of course he didnt get back with me, I'm sure they were busy though being monday and all. The guy that takes the msg will I'm sure get back with me tomorrow. I'm thinking of just telling him to tell my doc that I'm going to stop the Emsam so I can start Parnate. Do you know how long the washout would be? I hate when they bring up the diet as if they think you wouldnt try the drug because of it. If they understood what this feels like, they would know I'd be willing to sacrifice not eating certain foods, anything to not feel this way and feel normal again. I'm tired of waiting, I'm trying to hang in there, nothing matters more to me than my mental health, I wish the docs could understand that.
Sorry I wrote so much..
Monica
Posted by bleauberry on November 24, 2009, at 5:05:07
In reply to Re: Add anything to help with the EMSAM wait...., posted by Monica L on November 23, 2009, at 19:23:35
Monica,
If you are going to do a washout, I believe one week would be sufficient. I am not a doctor or rocket scientist, just common sense. I think it would also be important to start Parnate, if you do, at a very low dose for the first week...5mg, half of a 10mg pill, as an introduction. Then week two begin ramping up. I was suprised even a mere 5mg once every other day helped me quite a bit, contrary to the posts of so many people who say they felt nothing at much larger doses. Sometimes I wonder if less is more, as I've seen so often in various topics of life. In any case, as ensam washes out, introduce parnate lowly.
Your symptoms sound more like anhedonia, which is a syndrome that is usually a component of depression, but which can also be a stand-alone syndrome without depression, usually be confused as depression. That might be possible with you?
My primary symptom has always been the same as yours. When ADs worked, I was still lifeless and joyless. No depression when the meds worked, but no life and no joy either.
Some things I found helpful:
Either Adrafinil, Provigil, or Ritalin added to a very low dose of your favorite SSRI.
Low dose Milnacipran, with possible Ritalin addition.
10mg prozac (enough to ease depression but not enough to worsen the AD emotional numbness thing), 300mg Adrafinil, and 25mg Amisulpride, was a decent combo.
The best single agent I've ever tried, Amisulpride 25mg once every other day. Begins working on day 2 or 3.
Amisulpride and Adrafinil are both international meds available mailorder. Adrafinil is a quasi-stimulant, Amisulpride is an antipsychotic at doses higher than 50mg, but an anti-anhedonia antidepressant at lower doses.
And my very short trial of Parnate at tiny doses was positive. I have Lyme complications of low blood pressure, cold body temperature, and easily provoked numbness/tingling of extremeties, all of which got much worse on Parnate. Too bad.
In the natural arena, people who have stuck with it and experimented to find their exact dosing have had great success with combinations of 5htp (usually lower doses than suggested on the bottle) combined with Tyrosine.
You have lots of options, so if there is no other reason to smile today, hold on to hope! :-)
Anhedonia requires a different approach than the generic term depression. While we assume anhedonia is dopamine, it really involves at complex interaction of all the neurotransmitters, but dopamine and/or norepinephrine are the biggest players.
On paper it is often suggested to take dopamine agonists for anhedonia. I don't like that option. Very troublesome side effects, and longterm outcomes are poor or worse than baseline.
If I were meeting with a friend who was trying to make a list of things for his/her anhedonia, the list of ingredients for mono agents or combos would be:
Low dose prozac. (not more than 10mg)
Low dose Milnacipran (Savella) (12.5mg bid)
Ritalin. As needed.
Adrafinil. 300mg - 600mg per day.
Amisulpride. 25 mg once every two days.
Parnate 5mg - 80mg.
Tyrosine.
5htp.Anything not on that list, waste of time. Of course I realize we are all different. The list is not just my own, but a gathering from various people at various forums of various diseases where anhedonia happened to be the issue.
>
> Thanks for taking the time to respond to my post. I dont' know if I feel worse because I expected so much from Emsam or what. I expected for it to work fairly quickly for me, everything I have tried in the past has kicked in that way. And as far as what I have tried, I have tried it ALL, over a period of almost 5 years. I have been hosp. once and all they did was put me on about 5 different meds. I wouldn't say I was depressed, more of just lacking interested in anything, no motivation or drive and little energy. I know all those things sound like depression, but I'm not really SAD. I'm actually more talkative and outgoing and laugh more since I've been off all meds., but still no motivation, drive or energy, no dopamine. Then I start thinking about how the Emsam is not working and get very discouraged, things shouldnt be this hard to do, I used to do things without thinking whenever meds were working for me. I looked forward to things and felt like I had a purpose.
>
> So I called the doc today and of course he didnt get back with me, I'm sure they were busy though being monday and all. The guy that takes the msg will I'm sure get back with me tomorrow. I'm thinking of just telling him to tell my doc that I'm going to stop the Emsam so I can start Parnate. Do you know how long the washout would be? I hate when they bring up the diet as if they think you wouldnt try the drug because of it. If they understood what this feels like, they would know I'd be willing to sacrifice not eating certain foods, anything to not feel this way and feel normal again. I'm tired of waiting, I'm trying to hang in there, nothing matters more to me than my mental health, I wish the docs could understand that.
>
> Sorry I wrote so much..
>
> Monica
Posted by maxime on November 24, 2009, at 15:39:53
In reply to Re: Add anything to help with the EMSAM wait...., posted by Monica L on November 23, 2009, at 19:23:35
If I remember correctly, it's a one week washout period. I think you should try Parnate. :) It has worked wonder on me and it didn't take too long to kick in once I got to 40 mg. I am now on 80 mg and feeling really good.
Posted by floatingbridge on November 26, 2009, at 15:44:29
In reply to Add anything to help with the EMSAM wait...., posted by Monica L on November 22, 2009, at 16:16:39
Hi Monica,
I'm sorry to hear that you're in distress and that your hoped for relief has not arrived yet.
Hugs your way,
fb
Posted by inanimate peanut on November 28, 2009, at 18:53:11
In reply to Add anything to help with the EMSAM wait...., posted by Monica L on November 22, 2009, at 16:16:39
I'm on day 8 of Emsam and in total hell. I don't know whether I can survive just keeping waiting to see whether it works or whether I should try to switch to Nardil or ECT. This is torture.
Posted by inanimate peanut on November 28, 2009, at 18:55:23
In reply to Re: Add anything to help with the EMSAM wait...., posted by emmanuel98 on November 22, 2009, at 17:04:56
Do you have to have a wash out between Emsam and other MAOIs like Parnate and Nardil?
Posted by floatingbridge on November 28, 2009, at 18:56:52
In reply to Re: Add anything to help with the EMSAM wait...., posted by Monica L on November 23, 2009, at 19:23:35
Monica,
I'm sorry the emsam seems to be a bust. How are you doing? Will you withdraw? I thought the washout was two weeks, but what do I know? I hope it is only one.
best wishes,
fb
Posted by floatingbridge on November 28, 2009, at 18:59:05
In reply to Re: Add anything to help with the EMSAM wait...., posted by inanimate peanut on November 28, 2009, at 18:53:11
> I'm on day 8 of Emsam and in total hell. I don't know whether I can survive just keeping waiting to see whether it works or whether I should try to switch to Nardil or ECT. This is torture.
Is it just not working, or are you having side effects? Someone on the thread said one week washout--I heard two. Good luck to you!
fb
Posted by inanimate peanut on November 28, 2009, at 19:02:49
In reply to Re: Add anything to help with the EMSAM wait.... » inanimate peanut, posted by floatingbridge on November 28, 2009, at 18:59:05
It's just not working and I'm on the verge of going to the hospital. I don't know whether to keep giving it a chance or to go back on Wellbutrin and Pristiq (which I was horribly depressed on but not this bad), but that requires a wash out, or to try Nardil, or to try ECT. I just know I need to feel better soon before I go completely crazy.
Posted by Monica L on November 28, 2009, at 19:18:47
In reply to Re: Add anything to help with the EMSAM wait.... » floatingbridge, posted by inanimate peanut on November 28, 2009, at 19:02:49
> It's just not working and I'm on the verge of going to the hospital. I don't know whether to keep giving it a chance or to go back on Wellbutrin and Pristiq (which I was horribly depressed on but not this bad), but that requires a wash out, or to try Nardil, or to try ECT. I just know I need to feel better soon before I go completely crazy.
That's so weird that you just posted to my thread. I'm looking up hospitals on the internet right now. I don't know what's making me feel this way, is it the holidays or what? I've been off EMSAM for almost a week now, cause I dont' have what it takes to give it time unless I'm in the hospital. I'm tired of having my kids see me like this and having my husband take over everything. I'm so thankful that he's so supportive of me and has been for the past 5 yrs that Ive been through this. I've tried ECT and felt that it did help, but I still struggle with low dopamine. It's too the point that because of the low dopamine and inability to function is making me depressed. I dont' know where to turn anymore, I took some ritalin earlier and I felt better for about 4 hrs and then of course it wears off. I'm sorry you are struggling too, I know how you feel.
Posted by Monica L on November 28, 2009, at 19:27:03
In reply to Re: Add anything to help with the EMSAM wait.... » Monica L, posted by floatingbridge on November 28, 2009, at 18:56:52
> Monica,
>
> I'm sorry the emsam seems to be a bust. How are you doing? Will you withdraw? I thought the washout was two weeks, but what do I know? I hope it is only one.
>
> best wishes,
>
> fbI'm not doing to good, I spent all week trying to get in touch with my pdoc, he never returned my call. I left messages with the patient coordinator that I wanted off the emsam and wanted to try something else. I don't understand how he puts me on 6 mg emsam and suggests he sees me in a month to see how I'm doing. One month is a long time when to follow up when you start a new med, with no increase in the dosage and during that month just hope it works. So I stopped the emsam on my own and so far no withdrawls except maybe just feeling worse. I'm think I',m going to see my reg dr on monday, explain whats been going on and see if she will prescribe the parnate. At this point though I'm afraid to try anything because I feel nothing will work. I'm willing to give it two weeks in PILL form, the patch drove me crazy, it never stuck completely.
Anyways, sorry I wrote so much....
Posted by Monica L on November 28, 2009, at 19:29:02
In reply to Re: Add anything to help with the EMSAM wait...., posted by emmanuel98 on November 22, 2009, at 17:04:56
> I tried Emsam last summer, first 6mg then up to 12. It didn't do a thing for me. However parnate worked wonders. Have you tried parnate? Unfortunately, once you're on Ensam, you need a 10-day washout to try anything else.
How long did it take for the parnate to kick in?
Thanks
Posted by floatingbridge on November 28, 2009, at 20:50:52
In reply to Re: Add anything to help with the EMSAM wait...., posted by Monica L on November 28, 2009, at 19:27:03
> I'm not doing to good, I spent all week trying to get in touch with my pdoc, he never returned my call. I left messages with the patient coordinator that I wanted off the emsam and wanted to try something else. I don't understand how he puts me on 6 mg emsam and suggests he sees me in a month to see how I'm doing. One month is a long time when to follow up when you start a new med, with no increase in the dosage and during that month just hope it works. So I stopped the emsam on my own and so far no withdrawls except maybe just feeling worse. I'm think I',m going to see my reg dr on monday, explain whats been going on and see if she will prescribe the parnate. At this point though I'm afraid to try anything because I feel nothing will work. I'm willing to give it two weeks in PILL form, the patch drove me crazy, it never stuck completely.
>
> Anyways, sorry I wrote so much....Monica, I'm glad you posted. Frankly, that your pdoc just left you on your own, esp. given your history, is irresponsible and bad medicine--I'm really sorry. Will you try segeline in pill, or just go for the parnate? Whichever, I hope you achieve some success. And I hope your gp will give you the parnate if that's what you decide. Sound very rough, Monica. Keep us posted. Many experienced people here w/ parnate to draw advice from.
my best wishes for you,fb
>
>
Posted by emmanuel98 on November 29, 2009, at 0:33:26
In reply to Re: Add anything to help with the EMSAM wait.... » emmanuel98, posted by Monica L on November 28, 2009, at 19:29:02
Parnate worked within a couple of days. I mean I literally went from severe, in the hospital, suidical depression to fine within 48 hours of starting parnate. Emsam did nothing for me.
But this is my experience and everyone responds differently.
> > I tried Emsam last summer, first 6mg then up to 12. It didn't do a thing for me. However parnate worked wonders. Have you tried parnate? Unfortunately, once you're on Ensam, you need a 10-day washout to try anything else.
>
> How long did it take for the parnate to kick in?
>
> Thanks
Posted by Monica L on November 29, 2009, at 8:46:26
In reply to Re: Add anything to help with the EMSAM wait.... » Monica L, posted by emmanuel98 on November 29, 2009, at 0:33:26
> Parnate worked within a couple of days. I mean I literally went from severe, in the hospital, suidical depression to fine within 48 hours of starting parnate. Emsam did nothing for me.
>
> But this is my experience and everyone responds differently.
>
>
> > > I tried Emsam last summer, first 6mg then up to 12. It didn't do a thing for me. However parnate worked wonders. Have you tried parnate? Unfortunately, once you're on Ensam, you need a 10-day washout to try anything else.
> >
> > How long did it take for the parnate to kick in?
> >
> > Thanks
>
>Thanks for the response, one more question if you don't mind, do you know if you take the generic parnate or the brand name?
Thanks Again
Posted by inanimate peanut on November 29, 2009, at 12:46:57
In reply to Re: Add anything to help with the EMSAM wait...., posted by Monica L on November 28, 2009, at 19:18:47
It's horrible to feel like this. I'm glad your husband is supportive. I had a supportive boyfriend but he left last time I was like this so now I'm all alone trying to deal with this. I have family but they live 2 hours away. I feel so alone and don't know what to do. I'm sorry you're feeling so bad too. I just wish there was something to help us. Do you know what you're going to try next?
Posted by Monica L on November 29, 2009, at 14:29:26
In reply to Re: Add anything to help with the EMSAM wait.... » Monica L, posted by inanimate peanut on November 29, 2009, at 12:46:57
> It's horrible to feel like this. I'm glad your husband is supportive. I had a supportive boyfriend but he left last time I was like this so now I'm all alone trying to deal with this. I have family but they live 2 hours away. I feel so alone and don't know what to do. I'm sorry you're feeling so bad too. I just wish there was something to help us. Do you know what you're going to try next?
Well first thing tomorrow morning I'm going to try and get an appointment with my regular Dr. My next appointment with the Pdoc isn't until the 14 of Dec., which I think is ridiculous, I cannot wait that long. I'm going to tell her that the emsam isn't working out for me and that I want to try parnate. I've been taking 40 mg of ritalin though, I don't know if that would prevent me from trying the parnate right away. If she does prescribe it, I'm going to start it regardless. I dont' know what else to do. My husband and I were talking about whether or not I should admit myself to the hospital and wait everything out there, for the medication to work basically. I'm sorry that you have to go through this alone and away from family. Do you work during the day, or have something to keep your mind busy during the day? It's hard for me because I stay home, and I really need something to keep me busy during the day. Being like this and being a homemaker do not mix well. Are you still on the emsam? The washout to start another maoi is 10 days or a week, I'm not sure but I'm going with the 10 days. Well, let me know how you're doing and hang in there..
Posted by inanimate peanut on November 29, 2009, at 14:53:46
In reply to Re: Add anything to help with the EMSAM wait...., posted by Monica L on November 29, 2009, at 14:29:26
I hope it works out for you to switch to Parnate. I too am wondering whether I should go in the hospital. I'm just not sure. I have a job but am too sick to work right now so I'm home alone all day. This is really too horrible for words. I'm just trying to get through each minute...
Posted by emmanuel98 on November 29, 2009, at 16:04:08
In reply to Re: Add anything to help with the EMSAM wait.... » emmanuel98, posted by Monica L on November 29, 2009, at 8:46:26
I take generic tranylcypromine.
> Thanks for the response, one more question if you don't mind, do you know if you take the generic parnate or the brand name?
>
> Thanks Again
Posted by ColoradoSnowflake on November 30, 2009, at 21:40:43
In reply to Re: Add anything to help with the EMSAM wait...., posted by emmanuel98 on November 29, 2009, at 16:04:08
I take generic Parnate, also. Gayle
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