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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 bearfan on August 27, 2010, at 19:21:19
I searched some of the archives and noticed quite a few people tried Emsam back in 2006. I also tried it for one or two days (got light-headed and low blood pressure which scared me off to discontinue). My doctor and I were thinking about trying it recently. My main problems being GAD/Depression. It seemed to be that most people got mixed results and had to titrate up to the 9mg dose for it to be effective. Are there some users still using it and having great success with it?
Posted by Maxime on August 27, 2010, at 19:57:37
In reply to People still getting help/using Emsam?, posted by bearfan on August 27, 2010, at 19:21:19
I don't know about EMSAM, but Parnate works well on anxiety and depression. Did you decide not to try it afterall?
Posted by Phillipa on August 27, 2010, at 21:59:58
In reply to Re: People still getting help/using Emsam? » bearfan, posted by Maxime on August 27, 2010, at 19:57:37
I know one who used to post here and is still doing well on 9mg of EMSAM. Phillipa
Posted by bearfan on August 27, 2010, at 22:27:59
In reply to Re: People still getting help/using Emsam? » bearfan, posted by Maxime on August 27, 2010, at 19:57:37
The Doc said I can try either kind, but he'd prefer me to try Emsam safer due to the safety profile and not having to adhere to the diet
Posted by proudfoot on August 27, 2010, at 22:59:25
In reply to People still getting help/using Emsam?, posted by bearfan on August 27, 2010, at 19:21:19
> I searched some of the archives and noticed quite a few people tried Emsam back in 2006. I also tried it for one or two days (got light-headed and low blood pressure which scared me off to discontinue). My doctor and I were thinking about trying it recently. My main problems being GAD/Depression. It seemed to be that most people got mixed results and had to titrate up to the 9mg dose for it to be effective. Are there some users still using it and having great success with it?
My shrink tried to push me towards using Emsam when I broached the idea of a switch to an MAOI (I was taking Cymbalta 120 mg, Geodon 40 mg, and Dexedrine 5 mg daily), but I didn't like the idea of using a patch, particularly when I still might have to adhere to the dietary restrictions even using Emsam, which is supposed to have that advantage over the oral pill formulations.
I figured that since I'm used to taking daily pills, I might as well go for a pill version that would have a lower co-payment with my insurance company too. We settled on Nardil, which I'm now almost a week into taking, and so far it's all I'd hoped it would be.
Granted, I have atypical depression with a strong component of social anxiety disorder, so I'm the poster child for Nardil, but this stuff is making me feel the best I've ever felt on any antidepressant or other psychotropic I've taken in the past - which includes Zoloft, Paxil, Prozac, Celexa, Lexapro, Wellbutrin, Cymbalta, Abilify, Geodon, Ritalin, Adderall, Dexedrine, lithium carbonate, and Lamictal.
If the Nardil successfully replaces the Cymbalta, Geodon, and Dexedrine all by itself I will be ecstatic. Anyhow, IMHO I say go for it and get yourself an MAOI if your current regimen isn't working. The diet thingie is still a learning curve for me, but it appears the benefits of the Nardil will far outweigh its risks for me. The future's looking bright right now...
Good luck!
Doug
Posted by europerep on August 28, 2010, at 5:14:36
In reply to People still getting help/using Emsam?, posted by bearfan on August 27, 2010, at 19:21:19
didn't you just start parnate? I'd personally recommend to you what I recommended to Laney a while ago, to decide to try one med and then go for it, not coming on babble and read stories of people who failed on it, etc.. you opened dozens of threads lately but it seems to me you are not nearing a conclusion. don't get me wrong please, this is not directed against you at all, it's just that you might yourself stand in the way of progress toward feeling better, you know?
Posted by bearfan on August 28, 2010, at 15:34:45
In reply to Re: People still getting help/using Emsam? » bearfan, posted by proudfoot on August 27, 2010, at 22:59:25
How long have you been on the Nardil? I've heard it works on a broad number of conditions, but that there could be side effects long term.
Posted by proudfoot on August 28, 2010, at 16:06:17
In reply to Re: People still getting help/using Emsam?, posted by bearfan on August 28, 2010, at 15:34:45
> How long have you been on the Nardil? I've heard it works on a broad number of conditions, but that there could be side effects long term.
I've only been on the Nardil for a week, and have luckily avoided some of the more commonly listed side effects like dizziness from low blood pressure, and insomnia OR excessive sleepiness.
I have more energy during the day than before, and am sleeping more soundly at night than I've been in a long time. I don't take any sleeping pills or other meds for anxiety right now. Had been taking dexedrine for ADD as well, but with how I'm feeling right now, don't think we'll need to add that back on either. My motivation is the best it's felt in a long time. I'm wishing we'd tried this a long time ago, but hindsight is always 20/20.
Am doing a lot more reading about the Nardil and MAOIs in general, and I've learned that over time the Nardil will reduce the effects of epinephrine and norepinephrine such that the low blood pressure could become a problem (see the second paragraph of section 2.1 at the following link: http://wapedia.mobi/en/Phenelzine ). I'm going to bring that issue up when I see my shrink again in a couple weeks as we might need to resume the dexedrine or cymbalta that was stopped to start the Nardil.
So far as long-term side effects go, guess I figure that's par for the course with any of these drugs (even the newer SSRIs - see the posts on this site about post-SSRI syndromes), and that life is really a constant balancing of risks versus benefits in all the choices we make. If the Nardil makes me start to gain too much weight, for example, I'm gonna have to use the newfound motivation and energy to force myself to exercise more and try to reduce the amount of food I'm eating.
The scientific articles I've reviewed show that the MAOIs and the older TCAs seem to offer the most benefitis for the long haul in the treatment of treatment-resistant depression when dosed at an appropriate dose. Too many docs under-dose a patient and then deem it a treatment failure when in fact they never took the drug to a high enough dose in the first place.
Anyhow, I know that no drug is THE wonder drug for everyone, but if other treatments have not been successful when used appropriately for you, it's time for your psychiatrist to revisit the question of the older agents which have proven track records with the right patient.
Let me know what happens. I've got my fingers crossed that the Nardil doesn't start to cause too many bad side effects as time goes on, but I'm realistic that something will likely give at some point. Til then, though, one day at a time.
Doug
Posted by ed_uk2010 on August 29, 2010, at 13:20:04
In reply to Re: People still getting help/using Emsam? » bearfan, posted by proudfoot on August 28, 2010, at 16:06:17
>we might need to resume the dexedrine or cymbalta that was stopped to start the Nardil.
Take care. Combining Cymbalta with Nardil would most likely result in a severe toxic reaction (serotonin syndrome). Nardil + SSRIs/SNRIs can in some causes be fatal. There are no circumstances in which it is OK to combine Nardil with SSRIs or SNRIs.
Dexedrine + Nardil sometimes (unpredictably) leads to severely elevated blood pressure. Other people take this combination effectively. If Dexedrine is added to Nardil, the initial dose of Dexedrine must be extremely low, with very regular BP monitoring and careful titration.
Posted by proudfoot on August 29, 2010, at 13:42:03
In reply to Re: People still getting help/using Emsam? » proudfoot, posted by ed_uk2010 on August 29, 2010, at 13:20:04
> >we might need to resume the dexedrine or cymbalta that was stopped to start the Nardil.
>
> Take care. Combining Cymbalta with Nardil would most likely result in a severe toxic reaction (serotonin syndrome). Nardil + SSRIs/SNRIs can in some causes be fatal. There are no circumstances in which it is OK to combine Nardil with SSRIs or SNRIs.
>
> Dexedrine + Nardil sometimes (unpredictably) leads to severely elevated blood pressure. Other people take this combination effectively. If Dexedrine is added to Nardil, the initial dose of Dexedrine must be extremely low, with very regular BP monitoring and careful titration.
>
>You're quite right about the Cymbalta (SNRI). I wasn't thinking clearly when I included that as I have already read about the danger of combining an SSRI/SNRI with an MAOI. My psychiatrist and I had already talked, and if the dexedrine were to be resumed, it would be at 1/4 of the 5 mg pill, or 1.25 mg. It's virtually impossible to cut the pill smaller than that for a consistent dose. Hopefully it won't even be necessary...
Thanks for catching my mistake. Can I blame it on the Nardil??? :)
Doug
Posted by ed_uk2010 on August 29, 2010, at 15:15:15
In reply to Re: People still getting help/using Emsam? » ed_uk2010, posted by proudfoot on August 29, 2010, at 13:42:03
>if the dexedrine were to be resumed, it would be at 1/4 of the 5 mg pill, or 1.25 mg. It's virtually impossible to cut the pill smaller than that for a consistent dose. Hopefully it won't even be necessary...
That sounds like a good idea. I wouldn't worry about cutting the pill into four precise pieces. It just needs to be a small dose to begin with, whether it's 1mg, 1.25mg, 1.5mg or 2mg probably doesn't matter too much.
This is the end of the thread.
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