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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by floatingbridge on August 21, 2011, at 16:17:18
I am at 9mg. I imagine that I would go to 6mg, then nothing. This could take two or more weeks.
I'll need to see the pdoc sooner than I had hoped, and will call tomorrow.
I really don't know what to do. I usually have a plan in hand.
This is very disheartening. I need to disengage from my bed.
Posted by Dinah on August 21, 2011, at 17:36:36
In reply to I think Emsam gets the boot., posted by floatingbridge on August 21, 2011, at 16:17:18
What were you hoping for? What would a medication working look like to you? You recently raised the dose of Ensam. Was it working before well enough for you to hope that raising the dose would be beneficial?
Posted by floatingbridge on August 21, 2011, at 17:55:11
In reply to Re: I think Emsam gets the boot. » floatingbridge, posted by Dinah on August 21, 2011, at 17:36:36
Dinah, I think I was looking for something like Dexedrine without the 'push'. Like the lights turned up a bit, and feeling like getting out of bed. The dysphoria I had attributed to risperidone has not abated. I did increase to 9mg at the same time I added the risperdone. Because I was desperate then. So I was desperate after two weeks at 6mg. Desperation is not a good place from which to consider treatment.
I was hoping for less anxiety. Oddly, Dexedrine decreased
anxiety overall, though it would spike from time to time.To just feel that mythicv o.k. and to decrease negative thoughts.
Maybe 6mg was better than 9mg.
Thanks for checking in.
Posted by floatingbridge on August 21, 2011, at 18:01:18
In reply to Re: I think Emsam gets the boot. » floatingbridge, posted by Dinah on August 21, 2011, at 17:36:36
> What were you hoping for? What would a medication working look like to you? You recently raised the dose of Ensam. Was it working before well enough for you to hope that raising the dose would be beneficial?
I forgot one of your questions which is a good one. The 6mg felt transparent. A great word for medical treatment. Yet, I look back, and there were stomach aches then. Not the IBS type, but tension.... I think that was behind the impulse to raise the dose and push it into an maoi a. I already take Xanax xr and do not want to increase even if given permission.
Posted by Phillipa on August 21, 2011, at 19:18:49
In reply to Re: I think Emsam gets the boot. » Dinah, posted by floatingbridge on August 21, 2011, at 18:01:18
FB sounds like the stimulant types meds work better for you. You have been on wellbutrin right? Maybe add back the dex with it? Xanax isn't all that bad especially now when it does work for you? Phillipa
Posted by policebox on August 22, 2011, at 0:05:37
In reply to I think Emsam gets the boot., posted by floatingbridge on August 21, 2011, at 16:17:18
From what I've read about it EMSAM hasn't impressed me that much. As MAOis go, EMSAM (selegiline) are pretty mild. If you are wanting to take an MAOi that might offer some stimulating effects, I suggest Parnate. If anxiety is the larger factor in your depressive symptoms, many people find the MAOi Nardil works best for them. When comparing Nardil and Parnate head to head, most people would say Parnate is more stimulating than Nardil and Nardil is associated with more incidence of weight-gain than Parnate.
> I am at 9mg. I imagine that I would go to 6mg, then nothing. This could take two or more weeks.
>
> I'll need to see the pdoc sooner than I had hoped, and will call tomorrow.
>
> I really don't know what to do. I usually have a plan in hand.
>
> This is very disheartening. I need to disengage from my bed.
Posted by floatingbridge on August 22, 2011, at 8:54:44
In reply to Re: I think Emsam gets the boot., posted by policebox on August 22, 2011, at 0:05:37
policebox, how is parnate going for you? Do you feel edgy or just stimulated? You have gotten it smoothed out, yes? Was /is anxiety a factor for you?
I had heard Emsam is mild, and it really is. I thought it was very nice except there was a kind of restless anxiety that I began to associate with risperdone. But with risperdone out of the picture, the anxiety became more pronounced.
I would not let my experience dissuade others. Guess I am more edgy that I thought.....
> From what I've read about it EMSAM hasn't impressed me much. As MAOis go, EMSAM (selegiline) are pretty mild. If you are wanting to take an MAOi that might offer some stimulating effects, I suggest Parnate. If anxiety is the larger factor in your depressive symptoms, many people find the MAOi Nardil works best for them. When comparing Nardil and Parnate head to head, most people would say Parnate is more stimulating than Nardil and Nardil is associated with more incidence of weight-gain than Parnate.
>
>
> > I am at 9mg. I imagine that I would go to 6mg, then nothing. This could take two or more weeks.
> >
> > I'll need to see the pdoc sooner than I had hoped, and will call tomorrow.
> >
> > I really don't know what to do. I usually have a plan in hand.
> >
> > This is very disheartening. I need to disengage from my bed.
>
>
Posted by floatingbridge on August 22, 2011, at 9:00:01
In reply to Re: I think Emsam gets the boot. » floatingbridge, posted by Dinah on August 21, 2011, at 17:36:36
Well Dinah, apparently risperdone was not the culprit of the inner restlessness. In desperation I took a dose last night, and the painful, repetitive thinking eased up and drifted away.
Posted by sigismund on August 22, 2011, at 9:52:58
In reply to Re: I think Emsam gets the boot., posted by policebox on August 22, 2011, at 0:05:37
The problem with Nardil is (presumably mainly) the side effects.
You can always give it up, I guess.
Posted by sigismund on August 22, 2011, at 9:57:35
In reply to Re: I think Emsam gets the boot. » Dinah, posted by floatingbridge on August 21, 2011, at 18:01:18
> The 6mg felt transparent. A great word for medical treatment. Yet, I look back, and there were stomach aches then. Not the IBS type, but tension.... I think that was behind the impulse to raise the dose and push it into an maoi a.
This makes me wonder whether you think raising the dose was the right decision.
Posted by floatingbridge on August 22, 2011, at 10:02:10
In reply to Re: I think Emsam gets the boot. » floatingbridge, posted by sigismund on August 22, 2011, at 9:57:35
> > The 6mg felt transparent. A great word for medical treatment. Yet, I look back, and there were stomach aches then. Not the IBS type, but tension.... I think that was behind the impulse to raise the dose and push it into an maoi a.
>
> This makes me wonder whether you think raising the dose was the right decision.I don't think it was a great decision.
Posted by sigismund on August 22, 2011, at 10:17:42
In reply to Re: I think Emsam gets the boot., posted by floatingbridge on August 22, 2011, at 10:02:10
You can't go back to 6?
Posted by floatingbridge on August 22, 2011, at 10:25:58
In reply to Re: I think Emsam gets the boot., posted by sigismund on August 22, 2011, at 10:17:42
6mg wasn't so great this time around. Not after the withdrawal. Today, 6mg definitely. And a call to this year's hired expert. If only to convince him I really am nuts.
Posted by Dinah on August 22, 2011, at 14:27:32
In reply to Re: I think Emsam gets the boot. » Dinah, posted by floatingbridge on August 21, 2011, at 17:55:11
I guess I worry that you consider that initial mild hypomanic reaction one sometimes gets with medications to be your goal. It does feel good, no doubt about it. But I'm not sure it's sustainable on a long term basis. And I worry that there might be unintended side effects for those who have a tendency towards anxiety and agitation.
But I might be projecting.
Posted by floatingbridge on August 22, 2011, at 16:07:41
In reply to Re: I think Emsam gets the boot. » floatingbridge, posted by Dinah on August 22, 2011, at 14:27:32
I'm not sure. It could be both looking for that 'benign' hypomania that was discussed earlier, but there is also dull fatigue and the feeling I am on a forced march (or one of those forced swim tests).
I feel very dim and anergetic (low low energy) with anxiety as well. I am struggling with feeling of being beyond the pale of psychiatry right now. I could be ill with depression.
I remember your post about the hypomania, and I think the observations you made are still very valid. I'm not sure I could physically withstand being hypo. But to feel a little will would be great.
I am, in the midst of this, considering lamictal not only for mood stability, but it is, I think, a glutamate suppressor. Fibromyalgia tends to create a sensitivity to and excess of glutamate. Something
that will inhibit (or not create too much) NE might be beneficial as well, given the ptsd. Oddly, ptsd, as my understanding
of the current research goes has a high sensitivity to NE and low cortisol levels.I might jettison the idea of an AD, which I find a sad thought, for a stabilizer and something like proszin (sp?) for sleep. It is an NE antagonist.
I feel like a sensitive canary with meds :-/
Yeah. So I don't know, Dinah. Thanks for
speaking up.
Posted by policebox on August 22, 2011, at 19:11:51
In reply to Re: I think Emsam gets the boot. » policebox, posted by floatingbridge on August 22, 2011, at 8:54:44
Thank you for asking. Parnate is going alright for me. I think it's helped me my depressive symptoms as far as mood goes, meaning the thought of being alive another day seems like a good thing rather than a burden.
However, the symptoms which bother me the most are the reversed vegetative ones (ie carbohydrate cravings/overeating, severe fatigue, leaden paralysis) and those really aren't any better for me. My sleep cycle is a mess, sleeping an average of 10-12 hours a sleep broken into 2 or 3 hour segments all through the day. Of course, this makes going to school and having a job very difficult.
Social anxiety/avoidant personality disorder is something else I deal with. Of course, the fact I can't accomplish much but sleep doesn't help me feel very good about myself, or worthwhile of other peoples' attention.
Anyway, sorry to start venting about my problems. To answer your question, Parnate has helped with my mood a great deal. My main concern about taking it was having to adopt the MAOi diet, but honestly it's easier to adhere to than you might imagine.
I've asked my doctor for some meds to help with the daytime fatigue (suggested Provigil and he's thinking about it) and anxiety (I suggested Lyrica or Xanax and he opted for 10 days of Xanax).
> policebox, how is parnate going for you? Do you feel edgy or just stimulated? You have gotten it smoothed out, yes? Was /is anxiety a factor for you?
>
> I had heard Emsam is mild, and it really is. I thought it was very nice except there was a kind of restless anxiety that I began to associate with risperdone. But with risperdone out of the picture, the anxiety became more pronounced.
>
> I would not let my experience dissuade others. Guess I am more edgy that I thought.....
>
> > From what I've read about it EMSAM hasn't impressed me much. As MAOis go, EMSAM (selegiline) are pretty mild. If you are wanting to take an MAOi that might offer some stimulating effects, I suggest Parnate. If anxiety is the larger factor in your depressive symptoms, many people find the MAOi Nardil works best for them. When comparing Nardil and Parnate head to head, most people would say Parnate is more stimulating than Nardil and Nardil is associated with more incidence of weight-gain than Parnate.
> >
> >
> > > I am at 9mg. I imagine that I would go to 6mg, then nothing. This could take two or more weeks.
> > >
> > > I'll need to see the pdoc sooner than I had hoped, and will call tomorrow.
> > >
> > > I really don't know what to do. I usually have a plan in hand.
> > >
> > > This is very disheartening. I need to disengage from my bed.
> >
> >
>
>
Posted by creepy on August 28, 2011, at 15:59:13
In reply to I think Emsam gets the boot., posted by floatingbridge on August 21, 2011, at 16:17:18
Even at 9mg you have to wonder if it does a whole lot to serotonin, which is the reason for the washout period.
Did emsam feel like just taking adderall? Or were there any other effects? Did you have a good effect that pooped out, like a stimulant?
Posted by floatingbridge on August 28, 2011, at 22:30:22
In reply to Re: I think Emsam gets the boot., posted by creepy on August 28, 2011, at 15:59:13
> Even at 9mg you have to wonder if it does a whole lot to serotonin, which is the reason for the washout period.
> Did emsam feel like just taking adderall? Or were there any other effects? Did you have a good effect that pooped out, like a stimulant?
>Creepy, my experience w/ Emsam was checkered. My first trial, it was more stimulating. Not like dex (never had adder all) but more energy and mental sharpness. I was required to withdraw. When I restarted, no such luck to date, but a slo
w improvement. It might be very hard on my sleep, so I don't know. I'm giving it A very full trial before I decide.Could be a ticket for you....
Posted by jessess on August 31, 2011, at 17:05:54
In reply to Re: I think Emsam gets the boot. » Dinah, posted by floatingbridge on August 21, 2011, at 18:01:18
Started 6mg patch 11 days ago. Feeling much better. This is first med of over dozens that has had a good effect. I have had some headaches.
just one more piece of data
This is the end of the thread.
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