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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 Blossom on January 27, 2009, at 14:35:39
I stopped taking EMSAM about two weeks ago and have a lot of fatigue and brain fog. Has anyone else experienced fatigue on discontinuing Emsam?
The problem is that I don't know for sure that this is because of discontinuation. I stopped because the insomnia was so bad that I was always tired anyway (could not find a good sleeping pill to cut the insomnia). But now after two weeks the insomnia is gone and I sleep great, but I'm still tired and I can't concentrate well.
Just wondering what others have experienced.
Blossom
Posted by RUKynd on February 3, 2009, at 9:53:49
In reply to EMSAM withdrawal and fatigue, posted by Blossom on January 27, 2009, at 14:35:39
Was the fatigue part of your depression symptoms before starting Emsam? Of course, there are different kinds and degrees of fatigue, so if you did have that before, I wonder if it could be a combination of withdrawl and returning depression.
I've been tapering off Emsam for about a month and haven't noticed any side effects yet, but I'm very concerned about stopping it completely. I'd been on TCA's and SSRI's for about 20 years, and I was always able to stop one and start another pretty quickly. With the MAOI, though, I'll have to go without anything for at least 2 weeks. I guess I'm more afraid of the full depression symptoms returning than I am about withdrawl symptoms, but I'm interested in hearing others' experiences with the latter, and I'll be sure to post any of my own, if I have them.
Best of luck to you--hope it passes quickly!
Posted by Timon on February 25, 2009, at 3:23:05
In reply to Re: EMSAM withdrawal and fatigue, posted by RUKynd on February 3, 2009, at 9:53:49
HI. I have been using EMSAM for over 5 years now. I recently discontinued the drug because of local unavailability of the medicine. I am a patient just like you and in no way qualified to make firm conclusions of what happened to me or others, but sadly, we patients are the ones that suffer and experience the results of the withdraw.
I suffered and still suffering severe reactions to the discontinuation of EMSAM. I will be more than happy to exchange information with people suffering from this withdraw. I contacted Bristol and they informed me that they have not conducted any studies pertaining this subject except for a limited experiment in animals plus other shilling remarks.
I really do think that EMSAM is a great choice for people like me that have tried almost everything. I had great results with EMSAM but the withdraw is severe. My Doctor made things worst by prescribing Nardil while I was able to get a supply of EMSAM. HUGE MISTAKE!!!!! Bristol reported this contraindication to the FDA but has not included the information in the package insert nor posted any information for prescribing physicians on their web site. You need to search the FDA database to find it.
I do not want to alarm anyone but the withdraw is SEVERE after taking the 12mg / 24 hrs dosage for over 5 years. Have anyone experienced something like this?
Posted by myco on February 25, 2009, at 20:56:46
In reply to Re: EMSAM withdrawal and fatigue » RUKynd, posted by Timon on February 25, 2009, at 3:23:05
Hi,
Can't you just order/get rx for selegiline pill form? Selegiline is what is in emsam and widely available. Only called emsam when in the patch form.
keep smilin,myco
> HI. I have been using EMSAM for over 5 years now. I recently discontinued the drug because of local unavailability of the medicine. I am a patient just like you and in no way qualified to make firm conclusions of what happened to me or others, but sadly, we patients are the ones that suffer and experience the results of the withdraw.
>
> I suffered and still suffering severe reactions to the discontinuation of EMSAM. I will be more than happy to exchange information with people suffering from this withdraw. I contacted Bristol and they informed me that they have not conducted any studies pertaining this subject except for a limited experiment in animals plus other shilling remarks.
>
> I really do think that EMSAM is a great choice for people like me that have tried almost everything. I had great results with EMSAM but the withdraw is severe. My Doctor made things worst by prescribing Nardil while I was able to get a supply of EMSAM. HUGE MISTAKE!!!!! Bristol reported this contraindication to the FDA but has not included the information in the package insert nor posted any information for prescribing physicians on their web site. You need to search the FDA database to find it.
>
> I do not want to alarm anyone but the withdraw is SEVERE after taking the 12mg / 24 hrs dosage for over 5 years. Have anyone experienced something like this?
>
Posted by RUKynd on February 26, 2009, at 2:38:20
In reply to Re: EMSAM withdrawal and fatigue » RUKynd, posted by Timon on February 25, 2009, at 3:23:05
The selegiline pills might be a good alternative to the Emsam patch for some, which would be great, as they're relatively affordable (compared to Emsam, anyway!), and if they could prevent withdrawl symptoms or even better, work as a replacement, that would be wonderful. In my case, though, they _really_ didn't work, and though my situation isn's common, the side effects concern me for anyone (maybe they were the reason the extended-release patch form was developed).
My psychiatrist prescribed them the pills when the patch samples stopped coming. By then I had tapered down to one 6 mg. patch every other day (I had been on alternating days of 6 and 12 mg's, using 2 patches for the 12), so rather than taking the 8 pills/day (5 mg. pill) as prescribed, I thought I should work my way back up and started with two, one a.m. and one p.m.. By the third day, I was up to four (spread out through the day as advised by my pharmacist, as they're not long-acting like the patch is), and in addition to the dry mouth and loss of balance, I noticed that my tardive dyskinesia symptoms were getting more severe (briefly, this is a neurological condition causing involuntary movements, usually caused by antipsychotics, but it can also result from taking SSRI's, in my case, Celexa). Turns out, when I looked it up, various dyskinesias were listed as side effects of selegiline pills. I immediately stopped taking them, and my TD symptoms returned to their 'normal' levels by the next day. (Please see separate post re: withdrawl)
I'd advise anyone who switches to the selegiline pill form to watch for any signs of dyskinesia--facial tics such as tooth grinding or tongue flicking, sudden movement or repeated/constant clenching of the feet and/or hands, etc., and if you notice them, please notify your doctor and try to get off the pills ASAP. I didn't associate the development of my involuntary movements with the Celexa, so I didn't mention them to my doctor at first, and when I did, he attributed them to "stress," and I didn't discontinue it until my own research finally revealed the connection. By then, I wasn't one of the lucky folks whose symptoms stop; in my case, it appears to be permanent. I should add that I was on a high dose of Celexa because I was on it for OCD (trichotillomania) as well as depression, and I'd taken it for 7 years. The development of TD is rare with antidepressants, but it's also well documented, in medical journals and more recently in books for the public. Still, most GP's and even psychiatrists either don't know about the connection with SSRI's at all, only with antipsychotics, or seem to dismiss it, as mine did. I had to see a neurolgist before I could get an actual diagnosis and start trying treatments for it (there is no cure).
I'd be glad to answer any questions about any of the above, and since many of them won't fit this thread, maybe we can find one that does, or find a safe way to communicate one-on-one. I'm new here and don't know how this would work, but I do get e-mails letting me know of new posts to this thread.
OK, on to my withdrawl post, which will be much shorter, I promise!
Posted by RUKynd on February 26, 2009, at 4:31:31
In reply to Re: selegiline pill side effect (dyskinesia), posted by RUKynd on February 26, 2009, at 2:38:20
Hi all--I have another atypical situation regarding withdrawl, but again, I hope it helps someone, or at least adds to what little info. seems to exist on stopping Emsam.
Before stopping, I'd tapered down from alternating days of one or two 6 mg. patches. Given the long action, I was basically on 9 mg./day, and over 3 weeks, I had tapered down to one patch every other day, ~3mg./day. Then I took selegiline pills for 3 days, from 10 up to 20 mg/day, then stopped completely due to side effects (in my other post today). That was 2 weeks and 3 days ago.
My temper has been awful, but that was one of the ways my depression manifested. It was at its worst the first week after stopping and has improved some, but I don't know if it's a withdrawl symptom. I once stopped Paxil cold turkey (a VERY bad idea), and I had definite withdrawl symptoms, from tingling in my extremities to sudden, frequent bursts of despair and crying. I haven't had anything like that, either while tapering off or since I stopped, but for the latter, another drug may be covering any withdrawl symptoms--morphine as MS-Contin.
The third and last day I was on the selegiline pills, my balance was off (side effect of pills), we had an ice storm, and I fell and chipped my tailbone. Two days later, my doc had the x-ray results, and I've been on 15 mg. of MS-Contin 2x/day (and on a hemorrhoid donut) since then. Although I no longer have the euphoric (manic?) feelings it gave me the first few days, I can't help but wonder if it's masking any withdrawl symptoms I'd be having otherwise. Also, by the time they switch me to a less powerful pain killer (next week, I think), I may be beyond the withdrawl period. Can anyone tell me how long this was or has been for them?
It's also possible that the tapering-down period was enough for me, as I'd only been on the higher, alternating dose for about six months. Before that, I used one 6 mg. patch/day for just under two years.
Sorry--longer than I'd planned ('verbal diarrhea' being an MS side effect), and given the unusual situation, perhaps not very helpful. For anyone who knows the brain chemistry effects of opiates (beyond endorphins, e.g. on serotonin, dopamine, etc.), it might be useful, if there's a psyciatric drug with similar effects that could help with the transition.
To Timon and anyone else going through Emsam withdrawl, I'd be interested in what the symptoms are (or, I hope, _were_ by the time you read this!) and how long they last. My psychiatrist just submitted a request to have my Emsam paid for, but I'm not sure how much it really helped me or whether I want to go back on it, as I'm sure I'd stop it again at some point and I defintitely don't plan to break another bone to get through the withdrawl! Thanks, and best wishes to all.
Posted by myco on February 26, 2009, at 11:34:37
In reply to Re: Emsam/selegiline withdrawl, posted by RUKynd on February 26, 2009, at 4:31:31
So selegiline isn't one that you'd recommend for others? You said it never really worked for you. Did you get nothing at all from it? Social anxiety improvement etc..? Are you atypical dep? Being atypical with severe anxiety and having good success on nardil i'm very interested in learning as much as I can, from others also, on the various maoi options.
Posted by Timon on February 27, 2009, at 15:21:07
In reply to Re: Emsam/selegiline withdrawl » RUKynd, posted by myco on February 26, 2009, at 11:34:37
I am amazed of the level of sophistication and knowledge of you all on this topic. This information has been very helpful to me on this extreme troublesome time for me and my family. For that I thank you.
I will first apologize for the long post and for not being perhaps completely consistent throughout my description of events. I am still feeling very bad physically and mentally. Im still hospitalized at home trying to recover.
As for the withdraw symptoms the more incapacitating effect I experienced were: impaired speech, vertigo, chills, tremor, restlessness, blurred vision, sudden rise or fall of blood pressure, palpitations, tachycardia, anxiety, insomnia, delirium, muscle cramps, confusion, depression, sudoration, twitching. I will ask my wife to help me compile a complete list for you as soon as I get better.
Besides suffering from these incapacitating episodes or effects, I experienced other interesting SIDE EFFECTS but first I will like to let you know that I am a Crohns / Colitis patient. Before using EMSAM I tried many TCAs, almost all (if not all) the SSRIs available to me, EFFEXOR up to 600 mg daily (yes crazy MD and crazy me for believing) and others, combined with other psychotropic drugs to increase the potency of the antidepressants, including Ritalin 40 Mg. I use plural because for example, my MD prescribed for some time Prozac 80 Mg, Paxil 40 Mg, Wellbutrin 150 Mg and Effexor 75 Mg and Ritalin 40 Mg concurrently (yes, I know, I was very desperate and stupid).
Imagine having to ingest all these medicines with active Crohns / Colitis. Is painful to say the least.
None of them worked or the side effects were too much for me to handle. You have no idea the how EMSAM helped me. I have to admit that EMSAM has been the more effective antidepressant I have used. Also Bristol-Myers helped me with the economical burden. The cost of one months supply of EMSAM is well in the four figures even with the best Health Insurance money can buy here.
Having said that, I had some very interested side effects that developed over the last 24 to 36 hours.
Since my Doctor has no experience using MAOIs of any kind I found myself without help and without any explanation for my symptoms from any of the MDs consulted. Running out of options I decided to contact Bristol-Myers directly. They were of no help since they referred me back to my physician. I tried to find another MD with experience using EMSAM or other MAOI and asked Bristol for help. Bristol refused because of company policies (I assume legal reasons also); BUT they were very interested in what happened to me and they documented everything. I felt frustrated because of the lack of options and for the little knowledge of the several well paid MDs I consulted. My only options are: to fly 1,400 miles and get help from a competent MD in Florida or in a less serious note, use my wife advise and print an ad in the papers Looking for Medical Doctor with experience using EMSAM.
Bristol contacted my physician. At that time she had not answered any of my calls and messages pertaining this effects or symptoms. My guess is that she was not very happy having me looking for information. She then made one of the dumbest mistakes I have witnessed. She called me playing the victim stating that she felt uncomfortable being my treating physician and that I was more than welcome to get a full copy of my medical file.
If I may ask, how will you feel under these circumstances? What would you do?
I do not think is fair to continue to bore you with my story but your input will be greatly appreciated.
Again thanks!
Posted by myco on February 27, 2009, at 15:34:36
In reply to Re: Emsam/selegiline withdrawl » myco, posted by Timon on February 27, 2009, at 15:21:07
I will post again shortly, on my way out, but keep this in mind....like I said emsam = selegiline (with no patch). It's the same med. serious. It's just introduced via the mouth in pill form. It's been around ages...perhaps dr's will be more familiar with it if you call it selegiline not emsam. Try asking about that and see what they say. You can get a rx for it anywhere and it's "dirt" cheap compared to the patch form. We have emsam here in Canada but it's not fully approved yet by health canada so it's close to 1200 bucks for a month of effective dose...selegiline one month effective dose is about $80 if I remember. Ask! lol serious
myco
> I am amazed of the level of sophistication and knowledge of you all on this topic. This information has been very helpful to me on this extreme troublesome time for me and my family. For that I thank you.
>
> I will first apologize for the long post and for not being perhaps completely consistent throughout my description of events. I am still feeling very bad physically and mentally. Im still hospitalized at home trying to recover.
>
> As for the withdraw symptoms the more incapacitating effect I experienced were: impaired speech, vertigo, chills, tremor, restlessness, blurred vision, sudden rise or fall of blood pressure, palpitations, tachycardia, anxiety, insomnia, delirium, muscle cramps, confusion, depression, sudoration, twitching. I will ask my wife to help me compile a complete list for you as soon as I get better.
>
> Besides suffering from these incapacitating episodes or effects, I experienced other interesting SIDE EFFECTS but first I will like to let you know that I am a Crohns / Colitis patient. Before using EMSAM I tried many TCAs, almost all (if not all) the SSRIs available to me, EFFEXOR up to 600 mg daily (yes crazy MD and crazy me for believing) and others, combined with other psychotropic drugs to increase the potency of the antidepressants, including Ritalin 40 Mg. I use plural because for example, my MD prescribed for some time Prozac 80 Mg, Paxil 40 Mg, Wellbutrin 150 Mg and Effexor 75 Mg and Ritalin 40 Mg concurrently (yes, I know, I was very desperate and stupid).
>
> Imagine having to ingest all these medicines with active Crohns / Colitis. Is painful to say the least.
>
> None of them worked or the side effects were too much for me to handle. You have no idea the how EMSAM helped me. I have to admit that EMSAM has been the more effective antidepressant I have used. Also Bristol-Myers helped me with the economical burden. The cost of one months supply of EMSAM is well in the four figures even with the best Health Insurance money can buy here.
>
> Having said that, I had some very interested side effects that developed over the last 24 to 36 hours.
>
> Since my Doctor has no experience using MAOIs of any kind I found myself without help and without any explanation for my symptoms from any of the MDs consulted. Running out of options I decided to contact Bristol-Myers directly. They were of no help since they referred me back to my physician. I tried to find another MD with experience using EMSAM or other MAOI and asked Bristol for help. Bristol refused because of company policies (I assume legal reasons also); BUT they were very interested in what happened to me and they documented everything. I felt frustrated because of the lack of options and for the little knowledge of the several well paid MDs I consulted. My only options are: to fly 1,400 miles and get help from a competent MD in Florida or in a less serious note, use my wife advise and print an ad in the papers Looking for Medical Doctor with experience using EMSAM.
>
> Bristol contacted my physician. At that time she had not answered any of my calls and messages pertaining this effects or symptoms. My guess is that she was not very happy having me looking for information. She then made one of the dumbest mistakes I have witnessed. She called me playing the victim stating that she felt uncomfortable being my treating physician and that I was more than welcome to get a full copy of my medical file.
>
> If I may ask, how will you feel under these circumstances? What would you do?
>
> I do not think is fair to continue to bore you with my story but your input will be greatly appreciated.
>
> Again thanks!
Posted by Timon on February 27, 2009, at 17:58:16
In reply to Re: Emsam/selegiline withdrawl » Timon, posted by myco on February 27, 2009, at 15:34:36
Myco, I thought about that. My Doctor refuses to acknowledge that there is a pill with the same active ingredient as EMSAM. No surprise there.
What surprises me is that without asking, the Bristol-Myers representative the initially took my call mentioned that 3 weeks are needed between the time the EMSAM is discontinued and the use of oral selegiline. She was very specific and told me that this was contraindicated.
I am lost. Maybe there is a contraindication between Tylenol and acetaminophen.(lol)
Posted by myco on March 3, 2009, at 14:18:53
In reply to Re: Emsam/selegiline withdrawl » myco, posted by Timon on February 27, 2009, at 17:58:16
Hi,
It's typical to have to wait between a switch in maois...I didnt realize it was so long though from emsam to selegiline. This makes sense to me to some degree now that I think about it though.
Here is one logical theory based on metabolism:
As is known, the selegiline in Emsam patch goes straight into blood and bypasses the "first pass mechanism" of the liver allowing the med to go pretty much 'unaltered' to where it's needed. Now...first pass happens when you ingest a med and it has to be absorbed via stomach or intestine. It means that it goes into the blood then to the liver for 'processing' (like a 'pass' through the liver). The liver then metabolizes selegiline to an "active form" that is then sent back out into the blood to be used where needed. The metabilism also produces secondary compounds, some of which are passed back through the liver (second pass) and others not. These secondary compounds "hang out" in the body and may have additional unwanted effects, such as side effects etc. So it could be that there would be a reaction of some of these secondary metabolites with emsam selegiline that makes it "safer" to wait a few weeks.
It's also possible that selegiline oral or emsam have different effects on things like blood pressure and switching too quick could result in a bad 'synergistic' effect (i.e. 1 + 1 = 10)
Other than these, sounds like a possible lack of education/knowledge from the person you talked to. Some company reps, hell even pharmacists i've spoken to, have little/no idea about meds apart from what is "written" on product monographs.
myco
> Myco, I thought about that. My Doctor refuses to acknowledge that there is a pill with the same active ingredient as EMSAM. No surprise there.
>
> What surprises me is that without asking, the Bristol-Myers representative the initially took my call mentioned that 3 weeks are needed between the time the EMSAM is discontinued and the use of oral selegiline. She was very specific and told me that this was contraindicated.
>
> I am lost. Maybe there is a contraindication between Tylenol and acetaminophen.(lol)
>
>
This is the end of the thread.
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