![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 50. Go back in thread:
Posted by Phillipa on October 27, 2011, at 21:22:43
In reply to Re: Emsam is neuroprotective. » floatingbridge, posted by floatingbridge on October 27, 2011, at 20:33:52
Wow you got great insurance the cost some said when 500 was why emsam didn't become popular. Phillipa
Posted by floatingbridge on October 27, 2011, at 21:52:56
In reply to Re: Emsam is neuroprotective. » floatingbridge, posted by Phillipa on October 27, 2011, at 21:22:43
I can see why it's not popular. It's crazy. I don't know why the technology of these patches is so expensive. If it was not for insurance, I would not be using this formulation. When our insurance changes next year, I have no idea what to expect.
I think transdermals in general are fantastic. I hope more are being engineered. The tolerabity is much greater.
Posted by Phillipa on October 27, 2011, at 23:10:08
In reply to Re: Emsam is neuroprotective. » Phillipa, posted by floatingbridge on October 27, 2011, at 21:52:56
FB I also do as you can actually see the med. So if something happens and you take it off visually you know it's gone and a matter of time before gone from system. Phillipa
Posted by former poster on October 27, 2011, at 23:34:03
In reply to Re: Emsam is neuroprotective. » former poster, posted by floatingbridge on October 27, 2011, at 13:06:15
I have been on 6mg Emsam and 450mg of Bupropion on and off for 1 year. I only started 12mg a week ago. I have tried taking the patch off at bedtime with some success at improving my sleep. I don't notice any difference at 12mg. Putting the patch on right after a morning shower has been my routine. I'll have to try the alcohol..
Posted by floatingbridge on October 28, 2011, at 9:11:10
In reply to Re: Emsam is neuroprotective., posted by former poster on October 27, 2011, at 23:34:03
I noticed the effects of 12mg after two weeks. I think it takes time to accumulate. At first, I thought there was no difference. But there was for me.. You went from 6mg to 12mg? Good luck. I hope this works for you.
Posted by Chairman_MAO on October 31, 2011, at 21:40:00
In reply to Emsam is neuroprotective., posted by former poster on October 27, 2011, at 3:14:46
> I found this site:
>
> http://www.preparemd.com/conditions/emsam-deprenyl-selegiline-depression-neuroprotection/More is not always better. It may well be that low doses of selegiline are better with regard to being neuroprotective.
Posted by floatingbridge on November 2, 2011, at 10:36:33
In reply to Re: Emsam is neuroprotective., posted by former poster on October 27, 2011, at 23:34:03
FP, this link, down towards the bottom, says 12mg patch = 40mg oral if I read that correctly.
Posted by avenarius on November 7, 2011, at 22:14:40
In reply to Re: Emsam is neuroprotective. » former poster, posted by floatingbridge on November 2, 2011, at 10:36:33
I take 40mg selegiline oral per day. It only comes in 5mg tabs so I take 4 in the morning and 4 in the afternoon. (I just filled a 3 month mail order Rx for 720 pills!)
Anyway, the copay is only $5 per month; I think the 12mg patch would be a $75 copay.
Are the side effects much better with the patch? Constipation is a big problem, and sleep is completely impossible without ambien.
MAOIs are the most effective treatment for me by far but I might give up on them due to the sleep issue... the anhedonia is a factor as well.
Posted by floatingbridge on November 7, 2011, at 22:30:53
In reply to Re: Emsam is neuroprotective., posted by avenarius on November 7, 2011, at 22:14:40
I have not taken segiline orally, so I cannot compare. I am currently not experiencing anhedonia, though I think I am taking the equivalent of 30mg. (The 9mg patch)
I cannot report any sx at the 9mg patch. I seem to have a full range of emotion. The patch at this dose feels transparent. Sleep has always been an issue so I have added gabapentin which seems to work, and if that fails I fall back on tenazepam.
If you can afford the co-pay, I would suggest trying the patch and seeing how it is for you.
The 12mg patch certainly had a more typical (from what I have heard) maoi reaction. Hypotension, the beginnings of food reactions, a sense of lethargy. For me that is.
Don't know if this has been helpful. Maybe someone else will respond as well.
Is the oral working for you (besides the insomnia)? I have been instructed to take my patch before sleep. Apparently my pdoc says this is becoming the new protocol for the patch. It seems to help.
Posted by poser938 on November 9, 2011, at 0:09:17
In reply to Re: Emsam is neuroprotective. » floatingbridge, posted by floatingbridge on October 27, 2011, at 20:33:52
is it still "neuroprotective" if it makes you feel like a pile of poop?
Posted by floatingbridge on November 9, 2011, at 0:39:55
In reply to Re: Emsam is neuroprotective., posted by poser938 on November 9, 2011, at 0:09:17
Poser, did it really make you feel bad?
Posted by former poster on November 9, 2011, at 1:34:42
In reply to Re: Emsam is neuroprotective. » poser938, posted by floatingbridge on November 9, 2011, at 0:39:55
I feel like crap on Emsam too. I'm on my 3rd week of the 12mg patch. It's making me lethargic, fatigued and just plain ill. Not to mention sleep is impossible. I don't remember feeling this way on Nardil.
Posted by floatingbridge on November 9, 2011, at 6:43:38
In reply to Re: Emsam is neuroprotective. » floatingbridge, posted by former poster on November 9, 2011, at 1:34:42
Former Poster, well, I am sorry, too. I moved back down from 12mg to 9mg. I felt terrible on 12mg. 9mg is working well for me, fingers crossed. I was warned ahead of time not too expect much from emsam however. I guess it has a reputation as not being a very good AD. I think it has taken about two months for me to level out and feel the effect.
Will you go back to Nardil?
Posted by former poster on November 9, 2011, at 10:46:53
In reply to Re: Emsam is neuroprotective. » former poster, posted by floatingbridge on November 9, 2011, at 6:43:38
Will I go back on Nardil?? I think not. Cymbalta worked almost as good as Nardil for me, so I will chemically castrate myself with it again (an equitable trade) in exchange for sanity.
Posted by floatingbridge on November 9, 2011, at 12:47:23
In reply to Re: Emsam is neuroprotective. » former poster, posted by floatingbridge on November 9, 2011, at 6:43:38
Posted by Phillipa on November 9, 2011, at 17:37:23
In reply to Re: Emsam is neuroprotective. » floatingbridge, posted by former poster on November 9, 2011, at 10:46:53
Cymbalta works as well as Nardil for you? First time I heard someone post this. What doseage as when new 60mg was maximum dose now they dose to 120mg. Phillipa
Posted by former poster on November 9, 2011, at 20:58:22
In reply to Re: Emsam is neuroprotective. » former poster, posted by Phillipa on November 9, 2011, at 17:37:23
I took the 60mg dose Cymbalta combined with Bupropion and Clonazepam which was quite effective. Then took 60mg Cymbalta with 10mg of Dextroamphetamine. The later combo was as effective for social anxiety as Nardil and I never developed a tolerance to the Dex, however I had to stop the Dex because of immigration issues when traveling. I also stopped the Cymbalta because of sexual side effects.
At the time I was on Cymbalta I was told 60mg was the highest dose.
I guess its time to say goodbye willie, forget about sex and just enjoy good mental health. But I know this is an impossible equation because I can't be happy as an eunuch.
I have a relative on Cymbalta 120mg alone and it works like a miracle for his depression/social anxiety.
Posted by Avenarius on November 9, 2011, at 22:21:00
In reply to Re: Emsam is neuroprotective. » avenarius, posted by floatingbridge on November 7, 2011, at 22:30:53
> I have not taken segiline orally, so I cannot compare. I am currently not experiencing anhedonia, though I think I am taking the equivalent of 30mg. (The 9mg patch)
>
> I cannot report any sx at the 9mg patch. I seem to have a full range of emotion. The patch at this dose feels transparent. Sleep has always been an issue so I have added gabapentin which seems to work, and if that fails I fall back on tenazepam.
>
> If you can afford the co-pay, I would suggest trying the patch and seeing how it is for you.
>
> The 12mg patch certainly had a more typical (from what I have heard) maoi reaction. Hypotension, the beginnings of food reactions, a sense of lethargy. For me that is.
>
> Don't know if this has been helpful. Maybe someone else will respond as well.
>
> Is the oral working for you (besides the insomnia)? I have been instructed to take my patch before sleep. Apparently my pdoc says this is becoming the new protocol for the patch. It seems to help.your post was very helpful actually.
yes, oral selegiline is working; i'm not at all depressed but i've still got anxiety. it's completely flattened my emotions though. i'm going to reduce the dose to 30mg and see how that goes.
so, if you take off the patch you can sleep without the help of any meds?
Posted by floatingbridge on November 9, 2011, at 22:32:29
In reply to Re: Emsam is neuroprotective. » floatingbridge, posted by Avenarius on November 9, 2011, at 22:21:00
I always need meds to sleep. 12 plus years of sleep aides. However, taking the patch off allows the sleep aides to work better, and I need less of them. Right now, just gabapentin and a few tenazepam throughout the week.
I can see that emsam might not take care of anxiety. I use gabapentin and that really reduces anxiety. I also take .5mg of Xanax XR, but right now, that is mainly because I am dependent. I think gabapentin alone would be enough. Not that I think it's a med for everyone.
It's odd that I do not feel flattened on this. I got off Pristiq and Cymbalta and years of snri's and personally felt so much better. Pristiq and Cymbalta really blocked me up emotionally. And made me cycle as well.
Are you doing or trying to do mono therapy with segiline? I'm curious what you would like to see you treatment look like.
Posted by Phillipa on November 10, 2011, at 18:36:23
In reply to Re: Emsam is neuroprotective. » Phillipa, posted by former poster on November 9, 2011, at 20:58:22
Friend of next door neighbor just here from Florida is on 60mg of cymbalta and xanax at bedtime says she now has no anxiety that the cymbalta did it maybe should have continued it longer than three months. It was new then and found this board seemed a lot of failures so I ditched it. Did work for back pain as when went off discovered I had it. Phillipa
Posted by Avenarius on November 10, 2011, at 21:32:18
In reply to Re: Emsam is neuroprotective. » Avenarius, posted by floatingbridge on November 9, 2011, at 22:32:29
Along with selegiline I take 0.5 to 1.0mg klonopin as needed, and ambien for sleep. (I also take synthroid for my hypothyroid condition.)
My diagnosis is textbook Atypical depression (though at least 10 doctors over 20 years failed
to recognize this).I have been on just about every antidepressant except remeron. Paxil helped somewhat for about 12 yrs, then I added Wellbutrin, and later switched to Effexor before having to give up ssri's and snri's altogether due to severe anticholinergic (mostly GI) side effects. I've been searching for a replacement for about 3 to 4 years. Selegiline is the first effective treatment in that time that hasn't given me severe pain and GI problems.
All of the AD's blunted my emotions but 50mg seleginine is the most severe in that regard. I think the dose was just too high. I'll see how it goes with 30mg and then perhaps try to augment if necessary with something dopaminergic like abilify.
If I give up on MAOIs I'll try remeron.
I was on a low dose of Cymbalta for a while and I thought it was pretty good relative to effexor or paxil, but that's not saying much. I don't know how anyone sticks it out long term on ssri's and snri's... just horrible side effects.
Posted by floatingbridge on November 10, 2011, at 22:11:57
In reply to Re: Emsam is neuroprotective. » floatingbridge, posted by Avenarius on November 10, 2011, at 21:32:18
An anticolinergic effect is GI upset? I have never understood the term anticolinergic, but I have certainly felt the GI effect from snri's, most prominently from Cymbalta which was a shame because I deal with fibromyalgia, and it reduced my peripheral neuropathy greatly, but gave me debilitating gastritis.
Well, it has taken aboutt three months to stabilize on Emsam after trying three doses. I don't recall how long you have been taking the segiline. I hope you can give it time. I'd be
interested to know how it goes for you if you care to update. I wish you the best.
Posted by Chairman_MAO on November 11, 2011, at 8:01:36
In reply to Re: Emsam is neuroprotective., posted by avenarius on November 7, 2011, at 22:14:40
> MAOIs are the most effective treatment for me by far but I might give up on them due to the sleep issue... the anhedonia is a factor as well.Both problems are treatable. Which MAOIs have you tried?
Posted by former poster on November 17, 2011, at 15:00:23
In reply to Emsam is neuroprotective., posted by former poster on October 27, 2011, at 3:14:46
I found out yesterday that L-Theanine will interact with MAOI's, so now I have to give up green tea which was doing wonders for my prostate gland. I used to be on a lot of supplements before increasing Emsam to the 12mg dose. I don't know which supplements are safe now. My Dr. said take Melatonin to help sleep. Has anyone tried this? He says to not put the patch on at bedtime in case of hypertensive crisis when you are sleeping. So how do I sleep now? This is getting so complicated for me.
I had to give up Sam-e so I could take Emsam 12mg. Now I'm getting severe joint pain from stopping Sam-e.
My Dr. has increased from 12mg to 18mg of Emsam daily now? and said I have to be even more vigilant of hypertensive crisis at that dose.
Another complication: I often need to travel to Japan and Emsam was banned there. What are the legal ramifications of bringing a month supply of Emsam there?
Sorry if I sound like I'm whining. Maybe its time to just give up on Emsam?
My B.P. was 94/42 this morning. Probably due to the MAOI effect? I didn't feel any dizziness. But concerned about it being so low.
Any advice appreciated. Steve.
Posted by Phillipa on November 17, 2011, at 21:22:48
In reply to Re: Emsam is neuroprotective. » former poster, posted by former poster on November 17, 2011, at 15:00:23
Sounds like one big headache for you. Was the other med working for you? Phillipa
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.