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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 20 to 44 of 44. Go back in thread:
Posted by damnthislife on July 15, 2013, at 7:14:23
In reply to Re: Day 5 (6mgs), posted by Beckett on July 13, 2013, at 23:00:02
> You might need to go up to 9mgs to put a dent in depressive symptoms.
>
> Good luck to you.My doctor agrees with you! She too said that we will discuss that this week when we meet (about going up to 9mgs).
Thanks for the luck, I need it!
Posted by Beckett on July 15, 2013, at 13:19:45
In reply to Re: Day 5 (6mgs) » Beckett, posted by damnthislife on July 15, 2013, at 7:14:23
Let us know how it goes if you will. I may be going back on it myself. Good luck to us all!
Posted by damnthislife on July 15, 2013, at 14:10:04
In reply to Re: Day 5 (6mgs), posted by Beckett on July 15, 2013, at 13:19:45
> Let us know how it goes if you will. I may be going back on it myself. Good luck to us all!
I take it you had to go up to the 9mgs to feel anything?
Posted by Beckett on July 15, 2013, at 20:47:07
In reply to Re: Day 5 (6mgs) » Beckett, posted by damnthislife on July 15, 2013, at 14:10:04
Yes, though 6mg is a bit more stimulating. I went to 12 once and constantly felt faint. Maybe I did I not give it enough time. I went back to 9 and stayed there. I did not realize how much it was doing (besides making me cycle) until I went off to start tramadol for neuropathy.
Anyways, I wish you the best. Some people say Emsam is a weak AD. I found it better than any ssri/snri.
Posted by damnthislife on July 19, 2013, at 7:38:01
In reply to Re: Day 5 (6mgs) » damnthislife, posted by Beckett on July 15, 2013, at 20:47:07
I still have nothing new to report, just wanted to add that I met with my pdoc last night. After I'm finished with his round of 6mgs patch, I have a script for the 9mg patch. If that doesn't show any signs of help, she is moving me onto Parnate.
From this point on, I will only report back if there are signs of improvement. If you see nothing on this, assume there is none. I will document however when I start 9mgs patch.
Posted by damnthislife on August 5, 2013, at 10:34:33
In reply to Day 12 (6 mgs), posted by damnthislife on July 19, 2013, at 7:38:01
Today is the 2nd day of wearing the 9mgs patch. First notice, the patch is bigger than the 6mgs. As I said, I wouldn't reply anymore if I had no more improvements, and I didn't. Now, being that I'm on day two, I'm seeing a lot of appetite surpression so far, which I'm greatly enjoying. By now, at lunch time, I would have ate my entire lunch... yet I still have a yogurt and banana left over for late. This is VERY rare and hopefully a good sign. I'm still waiting to see in the next few weeks if my energy slowly starts to return. I will report back here and there with any new info.
Posted by SLS on August 5, 2013, at 16:28:00
In reply to Day 2 (9 mgs), posted by damnthislife on August 5, 2013, at 10:34:33
> Today is the 2nd day of wearing the 9mgs patch. First notice, the patch is bigger than the 6mgs. As I said, I wouldn't reply anymore if I had no more improvements, and I didn't. Now, being that I'm on day two, I'm seeing a lot of appetite surpression so far, which I'm greatly enjoying. By now, at lunch time, I would have ate my entire lunch... yet I still have a yogurt and banana left over for late. This is VERY rare and hopefully a good sign. I'm still waiting to see in the next few weeks if my energy slowly starts to return. I will report back here and there with any new info.
Thanks for the update.
Good luck!!!
- Scott
Posted by damnthislife on August 6, 2013, at 8:18:28
In reply to Re: Day 2 (9 mgs) » damnthislife, posted by SLS on August 5, 2013, at 16:28:00
Continuing to notice appetite supression, which again I must say is great! I'm not craving junk food (carbs, chocolate) like I was before. I'm easily satisfied with the meals I eat and they're becoming more and more healthy. With this, I'm noticing my weight decreasing pretty fast. As of day 3 I still have had no interaction with the patch and no signs of hypertension. I don't however, have any increase in energy. This is a dose that may very well need some time to get into my system. I see my pdoc at the end of this month.
Unless anything new happens, I will report back only if there are other symptoms being helped or negative reactions.
Posted by damnthislife on August 9, 2013, at 13:24:15
In reply to Day 12 (6 mgs), posted by damnthislife on July 19, 2013, at 7:38:01
Just a small update...
I still have no symptom relief when it comes to energy/sleeping too much, but I have really noticed that my cravings for junk food is non-existent. Again, this is a HUGE plus! I use to crave chocolate like crazy! We have some good sweets in the house at the moment, and I haven't looked twice at them. I'm also noticing while my appetite seems to be normal and I get hungry after every 3 hours of a normal portioned meal, I do not get the shakes like I need to eat or I'm going to pass out.
Hopefully these are all good signs of things to come.
Posted by damnthislife on August 13, 2013, at 9:38:24
In reply to Day 5 (9 mgs), posted by damnthislife on August 9, 2013, at 13:24:15
Still no continued relief from major depression symptoms of lethargy and fatigue. I still have zero cravings for chocolate/sweets/junk food. I was out to dinner recently and my family ordered a mixture of desserts. I didn't even look twice at them, where normally I would have helped finish all of them. I'm also noticing that my heart will start to race after a cup of coffee. On that note, I will be switching to either decaf or decaf tea.
Still hoping for relief from my main symptom of excessive sleepiness. Seeing my doctor in 3 more weeks to review my response to Emsam as a whole and discuss switching to Parnate if this doesn't work.
Posted by Phillipa on August 13, 2013, at 20:34:40
In reply to Day 8 (9mgs), posted by damnthislife on August 13, 2013, at 9:38:24
Not that great. You are still able to go out and function and socialize though? Phillipa
Posted by damnthislife on August 14, 2013, at 9:01:50
In reply to Re: Day 8 (9mgs) » damnthislife, posted by Phillipa on August 13, 2013, at 20:34:40
Yeah, it's not what I was hoping for, honestly.
I'm still able to socialize and function... just exhausted still.
Starting to question if this really is depression. I'm running out of options.
Posted by Phillipa on August 14, 2013, at 20:46:08
In reply to Re: Day 8 (9mgs), posted by damnthislife on August 14, 2013, at 9:01:50
If not depression thoughts on what it is? Infection? Phillipa
Posted by damnthislife on August 15, 2013, at 7:48:13
In reply to Re: Day 8 (9mgs) » damnthislife, posted by Phillipa on August 14, 2013, at 20:46:08
I wish I knew the answer to that. I feel like I'm searching for a tear drop in the middle of an ocean.
Posted by damnthislife on August 23, 2013, at 7:49:28
In reply to Re: Day 8 (9mgs) » Phillipa, posted by damnthislife on August 15, 2013, at 7:48:13
Almost 3 weeks now on 9mgs of Emsam. I still have no relief from daytime fatigue. I still continue to see reduced carb/sugar cravings and from this I have lost 13 lbs since starting emsam. I'm happy about that, but disappointed in the lack of boost I was hoping to get. I see my Pdoc next Thursday and we will be moving to Parnate.
Posted by damnthislife on August 27, 2013, at 8:36:22
In reply to Day 2 (9 mgs), posted by damnthislife on August 5, 2013, at 10:34:33
I'm at the closing days of my Emsam experience. I have about 5 patches left after today (9mgs) but I still see no benefit for taking this. I continue to have reduced cravings for sugar/carbs and that is probably the dopamine effect. No increase in energy, no relief from daytime sleepiness.
I see my pdoc on thursday and that will probably be my last day on Emsam. I will be switching to Parnate after this.
All in all, Emsam did not work for me, but that is not to say it won't for you. The price for me was expensive, around $600 for a month supply. That 6mg and 9mg. If you want my opinion, have your doctor write you a script (if you only need the 6mg patch) for the 12mg patch, and cut it in half. You will save money, and have 2 months supply since they all cost the same amount.
I hope this thread helps some, though my experience was few and far in between. Do I have Atypical Depression? I still continue to wonder this. If my Parnate experience (which I too will document on this site) doesn't help, I will be left with the conclusion that depression is not the reason for my fatigue/sleepiness and rather another symptoms of another illness.
For the record, I have been tested for everything under the sun through blood work, allergy testing, infectious disease, sleep studies (very mild sleep apnea). I have tried everything. You name the doctor/specialist and I have been to them. Supplements, and prescriptions... more than you can imagine.
If this is not a mental disorder, I am left to believe that possibly my very mild sleep apnea is causing this and I will find another sleep speicalist. After that, I will be left with nothing more than accepting that this will be my quality of life (age 31).
Good luck to all future Emsam users!
Posted by Tomatheus on August 27, 2013, at 11:28:32
In reply to Emsam Fail, posted by damnthislife on August 27, 2013, at 8:36:22
Hi Damnthislife,
I just wanted to say that I'm sorry to hear that your Emsam trial didn't work out. It sounds like you gave the medication plenty of time to work, but that it just didn't seem to help you where you needed it the most. I wish you luck with Parnate, and I hope you ultimately find a treatment intervention that brings you relief.
T.
Posted by damnthislife on August 27, 2013, at 12:37:01
In reply to Re: Emsam Fail » damnthislife, posted by Tomatheus on August 27, 2013, at 11:28:32
Thanks, Tomatheus! I appreciate that!
I know we have talked before... but did you ever find relief for your hypersomnia/CF related issues? If I recall correctly, you were on Nardil and it worked great, but you had an issue with hypertension?
Posted by Tomatheus on August 27, 2013, at 13:45:31
In reply to Re: Emsam Fail » Tomatheus, posted by damnthislife on August 27, 2013, at 12:37:01
Hi Damnthislife,
Thank you for your post and for asking about my hypersomnia and chronic fatigue. Yes, I did take Nardil several years back with good results, at least for as long as they lasted (a few months altogether). Ultimately, though, it wasn't hypertension that cut my Nardil trial short, but a sudden loss of effectiveness along with extreme agitation that made continuing with the medication unbearable. I've suspected that I might have received a bad batch of Nardil from my pharmacy and that that's why the way I responded to the medication suddenly shifted course, but it's always hard to know if a bad batch was to blame or if it was something else.
Anyway, I'm taking vitamin D again now. I was found to have an insufficient level of the vitamin through a blood test that I had several months ago, and this is the second time I've tried supplementing with vitamin D since then. The first time, if I recall correctly, I had a decent response that involved improvement in my energy and concentration and a reduction in my hypersomnia, but my response seemed to die out after about two weeks. I ended up stopping my trial with vitamin D at that point, even though I was only taking 400 IU for most of my trial, which I also didn't allow to last for nearly as long as I should have.
So, now I'm taking vitamin D again, and this time I plan on getting my dose up to 4,000-5,000 IU and continuing to supplement with the vitamin for at least six to nine months. A study that I came across (Vieth et al., 2004) found that the "greatest biochemical responses" to vitamin D supplementation didn't occur in individuals taking the vitamin until they had supplemented with it for more than six months, and the study also mentioned that previous studies had found that vitamin D levels tend to plateau some five months after starting supplementation. Consistent with this, the results of studies of vitamin D supplementation for clinical depression have been mixed, with the one study that found supplementation to be beneficial (Jorde et al., 2008) lasting for a year. So, it seems that if I'm going to respond to vitamin D, I'm probably going to need to take it for at least several months before I start to see the long-term benefits. I'm in the process of slowly increasing my dose of vitamin D (I'm at 1,200 IU now), and I'm increasing the dose slowly because the vitamin seemed to increase the severity of my psychotic symptoms when I tried it before I was on Abilify, and I don't want to overwhelm my system with something that could possibly make my psychosis worse. At present, I seem to be noticing a little something from the vitamin D that I'm taking, but somehow I don't think that the response that I'm noticing now is necessarily characteristic of how I'm going to respond to the vitamin in the long run. I think I've just got to be patient and see what my response is going to look like several months down the line.
As an aside, I think you pointed out in a response to one of my posts that one thing that stuck out about what I had written was that my vitamin D level was low, and I said that I would think about giving the vitamin another try. I'd like to thank you for writing what you did, because if you didn't, I very well might not have decided to start this current vitamin D trial. I'm not sure how beneficial supplementing with vitamin D is going to be in the long run for me, but I'm rather optimistic about it, given the fact that my vitamin D level is low and that there does seem to be some evidence that low vitamin D levels may at least be related to clinical depression and schizophrenia.
I know that you just wrote that you've had a lot of tests done, but since I just wrote what I did about vitamin D, I figure that I should just check to make sure that you've had your vitamin D level checked. Have you?
Take care,
T.==
REFERENCES
Jorde, R., Sneve, M., Figenschau, Y., Svartberg, J., & Waterloo, K. (2008). Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomized double blind trial. Journal of Internal Medicine, 264, 599-609. Article: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2008.02008.x/full
Vieth, R., Kimball, S., Hu, A., & Walfish, P.G. (2004). Randomized comparison of the effects of the vitamin D3 adequate intake versus 100 mcg (4000 IU) per day on biochemical responses and the wellbeing of patients. Nutrition Journal, 3, 8. Article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC506781/
Posted by damnthislife on August 27, 2013, at 14:24:25
In reply to Re: Emsam Fail » damnthislife, posted by Tomatheus on August 27, 2013, at 13:45:31
Tomatheus,
Have you considered trying Nardil again, perhaps Parnate? If your response was a positive, you might be right with your thoughts of a bad batch. That does happen!
In regards to the vitamin D response, you are quite welcome! I try to help as much as I can with the experiences I have been through myself. I too had low vitamin D levels through blood work. I believe I was 22? They say you should be around 55-70 for good health. Most life guards, constructions works (your guys in the sun all day) have a level of 85-90+ Vitamin D CAN be toxic, but you would need to tax excess of 20,000 iu's for a long period before it can become toxic. There is a documentation of a toxic reaction a user had, but I cannot find it.
I took 10,000 IU of vitamin D3 for the period of about 3-4 months. After 6 weeks on this dose, my level was at 70. I stopped taking 10,000 ius and went to 5,000 iu's daily. Testing again I was still around 65. They say it can take a while for your body to use up the D3, since it is known as a hormone and we only get it from the sun. Obviously, you could just spend 10-15 minutes a day in the sun without sunblock on and possibly get a good amount, but I do agree, 400iu is not going to get your levels up to where you need to be.
Another thing you should check... your calcium levels. If your vitamin D is low, and your calcium levels are high, you might have what is known as a hypoparathyroidism. The parathyroid gland controls the amount of calcium in your blood and bones. If this is too high, you will get the symptoms of CFS/FM. If you have blood work handy when they did your vitamin D workup, they should have done a standard CBC and your calcium levels will be on there with the rest of your electrolytes. If your calcium is above 10.4 or 10.5 and your vitamin D is low, you might have a parathyroid issues. You can find out more by going to http://www.parathyroid.com/
Tons of great information is on that site, including the best doctor in the world for removing the tumor associated with causing the issue. Just something else to look into, incase you haven't. Normally, calcium level will fluctuate from time to time and will show different level on your labs. So if it does show 10.3 on your labs, don't freak out... go get another one done. If it shows you're under 10 (like I was 9.5) you're fine.
I wish you luck with the vitamin D! It is a very essential part of our body and can definitely cause the symptoms we see/speak of here. Keep in touch!
Posted by Tomatheus on August 27, 2013, at 15:15:10
In reply to Re: Emsam Fail » Tomatheus, posted by damnthislife on August 27, 2013, at 14:24:25
Damnthislife,
Thank you for your response. Your post contained a lot of helpful information, and I appreciate the fact that you took the time to write what you did.
I checked the results of my blood tests (from when I saw an orthomolecular psychiatrist), and they said that my calcium level was 9.9. So, my calcium doesn't seem to be too high, but I think it's good that you brought the issue of possible hypoparathyroidism to my attention in case that might have been an issue.
Interestingly, my vitamin D level was almost exactly what yours was, with my level being 21.9. Did you notice any improvement at all in your depressive symptoms during the time that you spent taking vitamin D supplements? Are you still on the 5,000-IU dose? I wonder if it might take more than six months at least a moderate dose of vitamin D (such as 5,000 IU) for antidepressant effects to become apparent, given what the research article that I mentioned said about the "greatest biochemical responses" occurring after six months of supplementation.
I guess I haven't completely closed the door on possibly trying Nardil or Parnate again, but I'd be somewhat hesitant about trying it, given the fact that I've now got psychotic symptoms to contend with, which will probably make getting a prescription for any MAOI more difficult. Having said this, if my trial with vitamin D doesn't work out, it might not be such a bad idea to go back to the only medication that seemed to significantly relieve my symptoms for more than a few days at a time (that medication being Nardil).
Thanks again for your post. I hope that it will only be a matter of time before both of us find some sort of treatment strategy that will significantly reduce the severity of the symptoms we experience.
T.
Posted by damnthislife on August 30, 2013, at 7:31:53
In reply to Re: Emsam Fail » damnthislife, posted by Tomatheus on August 27, 2013, at 15:15:10
Tomatheus,
You're most welcome!
Yes, that blood level is listed as normal, however the next time you get it checked, see if it bounced .5-.7 higher/lower. That will be a sign that you could still have a problem. Did you have your PTH tested in your labs??
Nah, I stopped taking the vitamin D after it did nothing for me. I will probably start taking it again, since the benefits of having higher D levels WAY out weigh the cost. Even though the cost of a few hundred pills of 5,000iu is only 8-10 bucks (lol).
I think I took 10,000 iu for about 6 weeks until my levels hit 70, then backed down until 5,000iu and re-ran my labs again 6 weeks later and they were right around 65, I believe. I took it for another month or so, but never saw any benefit from it. I was pretty bum'd.
I would consider Parnate this time, perhaps. I just spoke with my pdoc yesterday. I'm starting Parnate tomorrow. I would have started it today, but the pharmacy I go to didn't have it in stock (no biggie, what is one day?). So tomorrow, I start. I have high hopes of this med, since many of those that I talk to with our symptoms (esp the the chronic fatigue/excessive sleepiness) is one of the main things it knocked out.
I will be taking 10mgs 3x daily (30mgs) to start and meet back with her in 1 month to decide if we need to go higher. I will also start a journal for Parnate, as well.
Posted by Tomatheus on August 30, 2013, at 11:08:31
In reply to Re: Emsam Fail, posted by damnthislife on August 30, 2013, at 7:31:53
Damnthislife,
Thank you for your post. It's good to hear that you're going to start Parnate tomorrow, and I wish you luck with it. I'll certainly read the updates that you post in your journal.
I didn't have my parathyroid levels tested when I had my vitamin D level and other tests done back several months ago. Maybe it's something that I should think about getting done, especially if I get another CMP test done and it shows high serum calcium.
Anyway, here's to hoping that you'll get at least some of the benefits that you're looking for from Parnate.
T.
Posted by damnthislife on August 30, 2013, at 11:18:08
In reply to Re: Emsam Fail » damnthislife, posted by Tomatheus on August 30, 2013, at 11:08:31
Thank you, Sir!! I need all the luck I can get! We all do!
Yes, that's not a bad idea! I would honestly recommend maybe going to a Endocrinologist. Have them run your stand CBC, plus the PTH as well as a full thyroid and testosterone workup to include...
Cortisol 24 hours (probably Urine)
TSH
Free T4
Free T3
Thyroid Antibodies
Total Testosterone
Free Testosterone
Vitamin Dand anything else they want to throw at yah.
Then, go back 3-4 weeks later and have the same tests ran again. I did this about 3 times with the same doctor to make sure my hormones were good.
Posted by Tomatheus on August 30, 2013, at 11:40:26
In reply to Re: Emsam Fail » Tomatheus, posted by damnthislife on August 30, 2013, at 11:18:08
Thanks, Damnthislife. I'll keep those tests in mind.
T.
This is the end of the thread.
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