Posted by laima on July 22, 2006, at 11:06:28
In reply to EMSAM - 3 weeks - 6mg/24h dose -not working for me, posted by Enigma on May 11, 2006, at 12:50:56
Dear Enigma,I just learned some new stuff about EMSAM, just as I was giving up entirely on it and basically everything else, from my doctor, a psychiatrist/psychopharmacologist/researcher, who just returned from a special EMSAM conference, attended by psychiatrists, researchers, and reps from the drug company. Some of the news he relayed back gave me fresh sparks of real hope, and I'd like to share some of it in hopes you too might feel encouraged by any of the information. They do say MAOIS are ususually most effective treatment foor atypical depression.
I'd like to add that before EMSAM, I tried (with lackluster success) selegeline pills, and before that, stimulants. The stimulants were effective!!! And fast acting!! 1/2 hour to relief from hell! The only one I was able to tolerate was ritalin. I also tried dexedrine, which was a miracle at first, but something odd happened with it, I freaked out, and I won't touch it or the others ever again. But at the higher doses, I could see I behaved a tad strangely at times even with the ritalin, and it turned into a upper/downer regimine. I also ended up more anxious, and the anti-depressent effects of the ritalin waned, though the stimulant effects remain intact.
The 6/24 did nothing for me either, and I'm moving to the 9. Just waiting for it to arrive at the pharmacy.
Most confusingly, the 9 is said to be roughly equivalent to 60-90mg of the oral selegeline- stunning news and as I re-read my package insert- I still just don't comprehend. I am told more efficient metabolism plays a factor--but even so, why do they label as they do??? In any case, perhaps that is why they warn about using two patches at once- sounds like potential for unintential super-HIGH dose. Also, the 9 is said to be far more potent than the 6- but I didn't quite get the details. Is it plausable that a 6 plus half of a 6 is NOT a 9? Didn't ask, don't know, but I am starting to wonder-especially since it is so expensive and i do have 6's left. The 9 will require far more dietary caution- but I was told that a minor goof won't be quite as dangerous as it could be with the oral version. Furthermore, interestingly, the patches, even the higher patches with full restrictions and warnings, are believed by the conference attendees to be superior to the pills because by going straight to the bloodstream and bypassing the digestive system, they are acting via "a more efficient delivery system and are better able to enter the brain".My doctor reports that there seemed to be a consensus at this conference that few patients get much relief from the 6--the dose highly tauted as being nearly restriction free! It's apparently just not turning out to be potent enough to be an effective anti-depressent for most of us. I heard that one doctor stood up and said he has treated successfully about 150 patients already using the 9 and the 12- but rarely bothers with the 6. Could the 6 have been a marketing, attention getting ploy that raised our hopes?
There was an acknowlegment even by the company that insomnia is a huge problem for lots of people using EMSAM.
One other thought- I was told that for some people ssris can disrupt and/or diminish "deep sleep" by being "too activating", causing daytime fatigue. Sure enough, once I quit ssris for good, my sleep finally started to turn around.Finally- I agree with Phillippa- your fatigue sounds frustratingly mysterious, particularly since it began before you started EMSAM in the first place. I am told that EMSAM can for some people lower blood pressure, which can manifest as blah fatique- perhaps in your case, as in mine, even more fatigue. The higher the EMSAM dose, the lower the blood pressure can supposedly go. Though MAOI plus stimulant is a classic no-no, I have been prescribed a very, very low dose of ritalin (5mg 2x daily) to raise my already low blood pressure a teeny tad, and I feel WAY better as a result. My doctor said this practice is gaining in popularity, even though it still freaks most pharmacists out. I am required, however, to keep a blood pressure reader (it was about 50$) and keep an eye on it every day or so.
I guess my post was long. Sorry. I'm still so excited by all this news I just heard from a source that sounds to be the ultimate in credible. I'm starting to feel optimistic again.
In short, I hope you manage to hold on, and I hope that the higher dose of the EMSAM proves helpful and brings relief.
Best Wishes,
Respectfully,
Laima.
> Quick bio
>
> Age: 37
> Height: 5'9"
> Weight: 170 (target for me is 165)
> Sex: hopefully (just kidding, Male)
> Occupation: software engineer on disability
> Family: Married, 3 kids
> Diagnosis: Severe atypical, treatment-resistant depression, some hypo-mania, possible partial OCD
> Treatments: Tried most SSRI's, Nardil+Parnate, ECT (10 treatments), other psychotropics, with little to no success - mostly I just suffer from intense side-effects from meds and get no beneficial effect. (Nardil did help the depression though)
> Also tried vitamins/minerals, fish oil, noni juice, and others to no avail.
>
> Current Status:
>
> Finished 3 weeks of the 6mg/24h dose (still taking it). Been suffering from intense dibillitating fatigue for the same length of time (severe fatigue seemed to start 2 days before starting Emsam)
>
> Anti-depressant effects obtained: Seem to have increased sense of humor (humor is 'normal' for me) and sex drive
>
> Continuing problems:
>
> Still very depressed. Having suicidal ideation, a great deal. At least 1-2 times each day, I'm so depressed that it's almost unbearable. I feel like knocking myself out with a mallet so I don't have to "feel" anymore, at least until I wake up.
>
> "bed time" for me consists of manic type racing thoughts of every kind... Hopelessness, violence, fantasy, worry, stress, etc - most to all, unwanted.
>
> I could easily lie in bed for 2 hours a night with my head spinning like this before falling asleep, just to wake up again in 20 mins for more thought racing.
>
> Lunesta 3mg seems to be working great to stop the racing mind and get me to sleep. Klonpin 1mg seems to help too, but Lunesta works better for me.
>
> I unfortunately need 11-12 hours a sleep a night, and still wake up exhausted. I might sleep more due to the fact I don't like being awake, and hence, depressed, so I hide in "dream land" as long as I can.
>
> During the day, I'm generally exhausted, and can't get much done around the house. All house projects are on hold and have been for a long time.
>
> Also, for some reason, even the slightest activity (like vacuuming a room) will cause me to sweat and need to go back to couch potato mode. Even a hot coffee or medium hot shower will cause me to sweat and keep sweating.
>
> The sweating problem started with Wellbutrin and a couple other meds, but for some reason stayed with me, AND, got WORSE after dicontinuing those meds (beed off them for 1 year). This is very annoying to say the least. Not sure how I'm going to handle the summer, and sadly, I used to be very heat tolerant.
>
> I go back to the doc in 2 weeks (I might move it up a week) and -try- to get the 12mg/24h dose (skipping over the 9mg/24h) dose. Tyramine restrictions do exist at these doses, but I could care less about that.
>
> Oh yeah, on alcohol consumption. I force (seriously) myself to go out once every 1-2 weeks to hang and drink with ex-coworkers, aka "friends" .
> I found drinking to be very difficult on Emsam. I can usually have a 4-6 drink during a night and be fine the next day. On Emsam, I usually get nausea (and other hangover symptoms) a few hours after starting to drink, lasting another 12+ hours, with headaches, etc. So, it's really NOT worth it.
>
> In other words, very bad hangovers. So, I'm going to try and quit drinking alcohol when I go out even though the few hours of drunkeness is a welcome (and needed) break from the depression.
>
> Anyway, that's my update. I might have missed something here and there (like the daily headaches I get), but I hope this info helped someone.
>
> Take care,
>
> -(Dark) Enigma
poster:laima
thread:642628
URL: http://www.dr-bob.org/babble/20060717/msgs/669325.html