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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 4 to 28 of 28. Go back in thread:
Posted by mommyron on February 18, 2010, at 22:41:28
In reply to Re: emsam » mommyron, posted by em_kath on February 18, 2010, at 21:46:25
I tried benzoin tincture prior to application. I tried pounding the patch first. I tried using the hair dyer on it on a low setting prior to peeling adhesive off (to evaporate volatile adhesive vapors). These tricks came from pharmacists and a pdoc in San Jose who has around 200 patients on emsam (I think he prescribes the most in the country). He's not my pdoc, but he consulted with mine as a favor. Yes, I did try oral selegeline and it wasn't as effective and also gave me headaches, not to mention the MAOI diet restrictions came into effect--they were not an issue on the 6 mg emsam. I also saw a dermatologist who prescribed a couple of ointments (steroidal I think) but they did not help. I used a variety of "natural" ointments, including licorice, herbal & aloe. Finally I admitted defeat. But I'll search for any earlier discussion on this site and see what I find... Thank you!
Posted by Willful on February 19, 2010, at 8:06:28
In reply to Re: emsam, posted by mommyron on February 18, 2010, at 22:41:28
Did you try over the counter cortaid, or even a prescription topical steriod (not absorbed through the skin)?
I find that when the batch of patches bother me a lot, even the over the counter cortaid reduces the irritation to an acceptable level. I also try to move the patches every day, so I'm never replacing a patch in the same place as one in the last few days.
There's got to be a way of using emsam if it really helps. Sometimes I do get red areas that I continue to treat with cortaid until they recede.
Willful
Posted by mommyron on February 19, 2010, at 11:28:30
In reply to Re: emsam, posted by Willful on February 19, 2010, at 8:06:28
Yes, I tried over the counter cortaid. I used ice a lot too. I also rotated the patch--it would have been impossible to put it on the same area anyway as it was often irritated to the point of having raw areas. There were some areas that just couldn't tolerate the patch at all, so I had a limited area to work with--each patch left a rash that took about a week (sometimes 10 days to heal), so I was starting to run out of places to put them! I'd really like to use Emsam, it was a big help. I've been on so many, and on so many cocktails. Today I am feeling very defective...
Posted by Willful on February 19, 2010, at 12:55:21
In reply to Re: emsam, posted by mommyron on February 19, 2010, at 11:28:30
Try the prescription cortisone creams.
I find that the patch bothers me less on my upper arms and probably legs (although I rarely put them there). Have you tried those areas?
I wouldn't feel defective. Many people have some reaction to the patch. Is it itchy, or does it just leave a red area? I've had some of those that have lasted much longer than others.
I take it you've tried other Maois?
Willful
Posted by mommyron on February 19, 2010, at 13:30:08
In reply to Re: emsam, posted by Willful on February 19, 2010, at 12:55:21
My dermatalogist followed me, he prescribed various cortisone creams. None helped. Yes, arms were good. Legs NO! Upper back was okay. It would start to burn about an hour after application and continue to heat up, with the area under the patch turning red and thickened. I would ice it until I couldn't tolerate the burning (8 hours was usually my max). After the patch came off, the burning would gradually subside and then there would be alternate burning/itching (this would continue for about a week). The skin where the patch had been red and welted, and in the worst affected areas it would actually be broken and raw. Not a pretty picture! Nah, I feel defective because I need a drug to live. Tried oral selegeline and it wasn't good.
Posted by Willful on February 19, 2010, at 13:58:34
In reply to Re: emsam, posted by mommyron on February 19, 2010, at 13:30:08
Gosh, that sounds awful.
I guess we all just have to hope that something new will come up-- and that our lives will get back on track.
But I do know how bad it feels when nothing works.
Willful
Posted by morganator on February 19, 2010, at 14:41:27
In reply to Re: emsam, posted by mommyron on February 19, 2010, at 11:28:30
I forgot if you mentioned this previously but have you tried Zoloft+Nortriptyline, Savella, or Prozac?
Posted by mommyron on February 19, 2010, at 17:47:23
In reply to Re: emsam, posted by morganator on February 19, 2010, at 14:41:27
All but the Savella. It scares me. On the one hand, it would be good because the two other drugs that have helped me a lot (besides Emsam) were Effexor and Cymbalta, both SNRI's like Savella. But Effexor made me sweat like a monkey and get fat; and Cymbalta made me really nauseous. Anti-emetics didn't even help. Then dc/ing it was a nightmare I will NEVER forget....
(I'll add "Savella" to this thread name, and see what other members post....)
I am considering going back on Emsam and just tolerating the patch for 4 hours...the medication delivered in that time would still be more than none at all...
Posted by emmanuel98 on February 19, 2010, at 18:09:45
In reply to Emsam? Savella?, posted by mommyron on February 19, 2010, at 17:47:23
Have you thought about just taking an oral MAOI like Parnate? If Ensam is effective, parnate should be too. The dietary restrictions are minimal and easy to live with.
Posted by mommyron on February 19, 2010, at 18:44:53
In reply to Re: Emsam? Savella?, posted by emmanuel98 on February 19, 2010, at 18:09:45
I just don't think I could live with the dietary restrictions...I eat a lot of fermented/cultured foods for nutritional reasons. Yogurt, kombucha and sardines are a big part of my diet....
Posted by Phillipa on February 19, 2010, at 19:06:03
In reply to Re: Emsam? Savella?, posted by mommyron on February 19, 2010, at 18:44:53
How absolutely frustating this must be. I know my pdoc tried emsam on one woman and the rash was so bad she had to discontinue it I think she was on an oral MAOI and went back to it. I still say there has to be a way? Phillipa
Posted by morganator on February 19, 2010, at 22:37:23
In reply to Re: Emsam? Savella?, posted by mommyron on February 19, 2010, at 18:44:53
I don't think dietary restrictions are what people think they are.
Posted by AlexZ on February 20, 2010, at 10:13:35
In reply to Re: Emsam? Savella?, posted by morganator on February 19, 2010, at 22:37:23
Hi mommyron,
I'm new here, but I have been really touched by your plight. I've been thinking about your message all night.
I am borderline and bipolar, and I've been on so many different medications. My psychiatrist is suggesting an MAOI. I'm in the process of going off Cymbalta, Tegretol, and Wellbutrin, and going on Topamax and a little Abilify in order to go on Emsam. I'm hoping Emsam will finally be the miracle drug for me that it seems it's been for you. My biggest problem seems to be with rejection, and MAOIs are proven to help with atypical depression, which I guess is what I have.
To hear about your problems with the adhesive is so dismaying! Reading that you've tried so many things...that you've struggled so much, and that you attempt so hard to endure the discomfort when you've found something that works so well is heartbreaking.
I have a salve that I've been thinking might help. It's helped me with other similar problems I've had. It's not available through normal stores or pharmacies (but it's legal, don't worry). I'll mail you some.
I'll trust you to give you my real info if you'll trust me to give me yours. :) Babble-mail me. Looks like you'll have to set your Babble-mail settings at least temporarily to ON.
http://www.dr-bob.org/babble/faq.html#babblemail
And if you decide not to, that's okay, I understand.
Posted by Roslynn on February 20, 2010, at 11:38:45
In reply to emsam, posted by mommyron on February 18, 2010, at 17:07:49
Hi,
I had to discontinue Emsam due to the skin reactions. It was working somewhat for me at 6mg. But eventually I was covered with red welts even with the use of cortaid and a variety of other things. I could not find a solution. That does not mean you will not be successful though.
Please advise if you find anything out..
Thank you,
Roslynn
> I have not gone back on Lamictal, and I hesitate to. I have been on so many over the years...Emsam worked remarkably well if not for the skin irritation from the patch itself. I tried many tricks, but none worked and I ended up looking like a patchwork quilt. Does anyone know of a trick?
Posted by bleauberry on February 20, 2010, at 18:10:03
In reply to emsam, posted by mommyron on February 18, 2010, at 17:07:49
I can understand your hesitation on going back to lamictal. I happen to despise that med, though admittedly some people like it for a while.
I think what you need to do is schedule an appointment with a Dermatologist (after restarting Ensam) so you can show a skin specialist what you are dealing with. They will probably have some more ideas to try that you don't know about.
Another option would be to try taking medium-high dose of oral Deprenyl, and watch the tyramine diet.
If you feel real well on Ensam, it makes sense to get some expert help on the skin problems so that you can continue taking it and either lessen or eliminate the skin complications.
Posted by mommyron on February 20, 2010, at 19:10:32
In reply to Re: emsam, posted by bleauberry on February 20, 2010, at 18:10:03
Alas bleauberry, I have done that! My dermatologist observed my various skin battle zones while I was on emsam the last time--he did his best to help me but couldn't. Also tried the oral selegiline (deprenyl) but it didn't work as well and I got bad headaches.
Everyone on this site is so wonderful. I am going to try curcumin (I know, I am probably asking for a miracle...) and then if not doing well, I think I'll wear emsam for a few hours a day--some is better than none.
I have to keep in mind my situational factors are players in the whole picture too, and meds can only do so much: blended family, miserable marriage, teenagers, youngest child (the "ours") fighting cancer; she's tumor-free right now, but with the spectre of recurrence looming and a host of behavioral/physical limitations resulting from the cancers. Maybe I should get emsam for the whole family?????
Posted by Phillipa on February 20, 2010, at 19:24:51
In reply to Re: emsam, posted by mommyron on February 20, 2010, at 19:10:32
Oh I just remembered try pure tea tree oil. It's good. Google it. Love Phillipa
Posted by Arlena on February 21, 2010, at 20:54:00
In reply to Re: emsam » mommyron, posted by Phillipa on February 20, 2010, at 19:24:51
Hi everybody. I'm new to this site and very happy to have found it. I can't believe how relevant and informative it is. I could very much empathize with the posters who were distraught about not being able to continue the Emsam patch due to the skin reaction. I have a very long history of depression that would not respond to any drugs. I've tried practically all of the SSRIs and countless other medications. When the Emsam patch came out (I belive it was about two years ago now) it was miraculous to me. I finally felt like a "normal person". Then the skin reactions started. I too tried "everything." Switching the site, creams, iceing etc. I went to dermatologists and allergists , called the company numerous times. Nothing helped. I finally had to give it up when I was covered all over with raw red patches. It took about six months for my skin to finally heal. My ps says she doesn't even prescibe it anymore since the reactions are so common. I recently went on oral seligiline, 30 mlls daily, divided in three doses, and it does help the depression but the side effects are pretty bad. Bad insomnia even with ambien, lunseta etc. and a general jitterness all day. I will try my best to stay on it since nothing else works at all. (Parnate was even worse)If anyone finds a solution to the skin problems with EMSAM I would very much appreciate their sharing it. I called the company and they are aware of the reactions but have no intention of making it with another adhesive. (The problem ingredient is vinyl acetate or something like that. It's a known irritant)The patch is not enough of a money maker for them to bother with it.I wonder if it would work if you just put it on for several hours a day? I hate feeling so helpless! Sorry this post was so long. Thanks to all of you for being here!
Posted by Phillipa on February 21, 2010, at 21:37:35
In reply to Re: emsam » Phillipa, posted by Arlena on February 21, 2010, at 20:54:00
Arlena welcome to babble. I wonder how do they get other types of medicinal patches to stick? There Are A Lot of Patch meds out there. For instance Estrogen patches? So why can't they change to what they use on them? Many heart meds and scopalamine for seasickness? This to me isn't a very good answer from the drug company is it? Love Phillipa
Posted by mommyron on February 21, 2010, at 23:12:09
In reply to Re: emsam » Phillipa, posted by Arlena on February 21, 2010, at 20:54:00
Arlena, that is exactly my plan for if I go back on Emsam...to keep it on for just a few hours. I'll still get red fiery areas, but I won't keep it on as many hours as before. The most I could ever last was 8. I figure even a few hours' of drug is better than none. My pdoc is a bit timid with it (I'm his only pt on it), but I'm going to see if he thinks we could use a stronger patch (9 mg maybe) since I'll be taking it off sooner. Then of course, the food issues come up...but if it's only on for a few hours, is the dose being delivered going to warrant the MAOI diet, or would it be in the 6 mg range since the patch won't be on all day???? Questions for him to ask the company I suppose...they certainly weren't much help when I called them!
Posted by Arlena on February 21, 2010, at 23:16:59
In reply to Re: emsam » Arlena, posted by Phillipa on February 21, 2010, at 21:37:35
Thanks for your reply Phillipa. Your question is exactly what those of in this situation have shaken our heads at. I use an estrogen patch that uses a different adhesive. No problem. The adhesive they have chosen to use is a known irritant. The company admits to a 20% reaction rate. It's actually much larger from what I hear. Why would they use this adhesive when there are so many other choices? A person from the company I spoke to told me they can't change the adhesive now because they got FDA approval with that ingredient and if they changed it they would have go through the approval process again. I don't know if this is true. I would really appreciate a reply from anyone who does know.
I was wondering; are there profesionals such as doctors and pharmacists that frequent this web site and respond to posts? I understand Dr. Bob does. How active is he as far as responses go?
Thanks again Phillipa.
Posted by em_kath on February 22, 2010, at 0:05:27
In reply to Re: emsam, posted by mommyron on February 21, 2010, at 23:12:09
>My pdoc is a bit timid with it (I'm his only pt on it), but I'm going to see if he thinks we could use a stronger patch (9 mg maybe) since I'll be taking it off sooner. Then of course, the food issues come up...but if it's only on for a few hours, is the dose being delivered going to warrant the MAOI diet, or would it be in the 6 mg range since the patch won't be on all day????
If it's any comfort, I have been on the 9mg patch for a couple months with no food issues whatsoever. When I first started this dose I was very careful, but gradually I started reintroducing "forbidden" foods to my diet and honestly, I don't even get mild headaches. I eat most cheeses, soy, etc. I know the official word is that you have to follow the diet on 9mg, but from my own experience and the research I've done (partly asking others on this site) the diet seems to be just a precaution. My understanding is the medication never goes through your intestines so there's no reason that dietary tyramine would be a problem, and it's just a legal thing that they want people to follow the diet. My pdoc is kind of worried about the diet thing too, since like you I think I'm his first and only patient on it, but I asked around and researched it couldn't find any reported incidents of hypertensive crisis on higher doses of the patch. I suppose everyone reacts differently, but I wouldn't worry about it if I were you, especially if you're only wearing it part of the day. Since the 9mg in each patch is released steadily throughout a 24 hour period, if you only wear it 8 hours, it seems like you'd be getting about 3mg per day.
Posted by em_kath on February 22, 2010, at 0:17:21
In reply to Re: emsam » Phillipa, posted by Arlena on February 21, 2010, at 20:54:00
>When the Emsam patch came out (I belive it was about two years ago now) it was miraculous to me. I finally felt like a "normal person". Then the skin reactions started.
I am sorry to hear about your experience! I have also tried many, many medications for my depression without success. I feel better on Emsam, but I'm not ready to call it a miracle just yet. I'm curious, how long were you on it before the skin reactions started? I have relatively mild skin irritation, and I have been on it for about 2 1/2 months without it getting worse, but I am worried now! I am somewhat surprised that I am not one of the many people getting these intense skin reactions, since generally I have very sensitive skin. But you were on it long enough for it to become effective before you experienced problems? It did not become at all effective for me until around the 7-8 week point. My skin doesn't get raw, just red for 2-3 days and itchy at times. Was it like that for you at one point as well?
Posted by mommyron on February 22, 2010, at 11:48:50
In reply to Re: emsam » Arlena, posted by em_kath on February 22, 2010, at 0:17:21
Hey em-kath, I think you're all clear if you haven't had skin reactions by now! Damn, you're lucky! Mine started right away, and got steadily worse.
Posted by Arlena on February 22, 2010, at 13:07:20
In reply to Re: emsam » Arlena, posted by em_kath on February 22, 2010, at 0:17:21
I found it effective within about 2 or 3 weeks. I don't remember exactly when the skin reaction started but, not to scare you or anything, they did start off mild and become steadily worse. Since you are aware of the possibility of it getting worse your lucky in that you can take precautions. Some ideas: Keep changing the site where you apply the patch. Never put a new one on a site that still has some irritation. Try a cortisone cream on the irritated areas. Try everything you can think of on the irritated areas(someone said tea tree oil)Another thing I thought of after it was too late is to try a pharmaceutical grade adhesive remover when you take the patch off so the adhesive spends as little time as possible on your skin. Sounds like you'll be OK with it but I would be cautious. I was on the patch when it first came out so I had no warning. If you find something that takes the irritation away I'd love to hear about it.Good luck!
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