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Dr. Bob is Robert Hsiung, MD,
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Posted by cecilia on April 9, 2006, at 20:33:28
In reply to Re: EMSAM - Day 2, posted by RobertDavid on April 9, 2006, at 13:25:09
It's interesting that you're having an increase in dreaming, Robert David. The other MAOI's tend to eliminate dreaming. Though of course you haven't been on it very long. I'll be seeing my pdoc at the end of April and hopefully he'll prescribe this, though I'm a little worried about the cardiac effects. I got a copy of my EKG that was done pre-op knee surgery while weaning off Marplan and discovered that not only did the Marplan dramatically lower my heart rate and blood pressure, which I was well aware of, but I also had "premature atrial complexes". It probably had nothing to do with the Marplan itself, but from going off the Atenolol which I've been on for years but had to go off because the Marplan lowered my blood pressure so much. Off the Marplan and back on the Atenolol the premature atrial complexes were gone, but I'm concerned that Emsam will also have an extreme blood pressure lowering effect. Still, I feel I have to give it a try. I have no belief that anything's going to help my depression, life without depression is unimaginable to me, but it's like a compulsion to keep trying..... Cecilia
Posted by Declan on April 9, 2006, at 20:38:53
In reply to Re: EMSAM - question, can someone answer? » ravenstorm, posted by RobertDavid on April 9, 2006, at 18:25:08
Hi Rob
So, you sleep well. 7 hours, was it, of good sleep. On any amount(>4mg/week) of sublingual deprenyl/selegeline my sleep is more disturbed than usual. I don't understand whether avoidance of first pass metabolism makes a difference to the l-amphetamine metabolite, and if so why. And it's possible the sleep affecting properties of selegeline/deprenyl at my dose have nothing to do with that. Anyway it's interesting you sleep so well on Emsam.
Declan
Posted by ravenstorm on April 9, 2006, at 22:17:24
In reply to Selegeline, deprenyl, Emsam, metabolites » RobertDavid, posted by Declan on April 9, 2006, at 20:38:53
So selegeline does metabolite into amphetamine? If that is true, how do people not develope a tolerance to it?
Perhaps Rob is not experiencing insomnia/anxiety due to taking Klonopin?
I'm trying to decide if its worth the risk to try it with my anxiety.
I found a chart that shows selegeline affects MAO-B to a greater effect than MAO-A but the chart doesn't discuss dosage.
Thanks for the input
Posted by RobertDavid on April 10, 2006, at 0:04:42
In reply to Re: Declan, so selegeline does met. into amphetami, posted by ravenstorm on April 9, 2006, at 22:17:24
> Perhaps Rob is not experiencing insomnia/anxiety due to taking Klonopin?
One of the studies suggested that 12% of patients had trouble with insomnia vs 7% with placebo (5% more than placebo).I have taken klonopin for 12 years and even with it have had trouble getting a good nights sleep. Before going on EMSAM I recently went to a overnight sleep study that showed I have trouble going to sleep and staying asleep and that I also don't hit stage 3 or 4 sleep (at least during the study). Sleep is a big issue to me and I have been concerned that klonopin has been part of the problem.
While on klonopin I've done many other anti depressant trials many of which caused significant insomnia, but for some reason not with EMSAM so far. I was quite concerned about it, but so far so good.
My doctor wants me to stay on the klonopin, same dose, for a few months while I stabilize on EMSAM, then slowly taper down, perhaps get off it all together. That's what I'm hoping for.
Anyway, hopefully I'll sleep well again tonight. I'll post tomorrow.
Rob
Posted by Declan on April 10, 2006, at 0:17:06
In reply to Re: Declan, so selegeline does met. into amphetami » ravenstorm, posted by RobertDavid on April 10, 2006, at 0:04:42
So Rob, what you're saying is that so far, only day 2 I know, you've actually slept better? That's really interesting.
A very small amount of l-amphetamine is metabolised from deprenyl. But that does not contribute to its clinical effectiveness. So tolerance should not be an issue. I may be wrong.
Declan
Posted by Caedmon on April 10, 2006, at 0:34:37
In reply to Re: Declan, so selegeline does met. into amphetami, posted by Declan on April 10, 2006, at 0:17:06
> A very small amount of l-amphetamine is metabolised from deprenyl. But that does not contribute to its clinical effectiveness. So tolerance should not be an issue. I may be wrong.>
To l-amphetamine? Shoot, that's not interesting at all! :b L-amphetamine would be the non-psychoactive isomer if I remember right; it won't do anything 'cept maybe clear your sinuses a bit. In the U.S. you can buy l-methamphetamine over the counter in Vick's inhalers. (They put "levmetamfetamine" on the side, lol.)
Even if it were psychoactive, and the amphetamine were a part of its effectiveness, I wouldn't worry about it. People w/ ADD take stimulants for years with little problems with tolerance - sometimes they might need a holiday but the tolerance is not always so profound as the media might have you believe.
- C
(course, maybe you shouldn't believe me, I'm prone to being very liberal wrt to the "fun" medications)
Posted by RobertDavid on April 10, 2006, at 0:43:11
In reply to Re: Declan, so selegeline does met. into amphetami, posted by Declan on April 10, 2006, at 0:17:06
> So Rob, what you're saying is that so far, only day 2 I know, you've actually slept better? That's really interesting.
The first night, lots of dreams woke up early but slept good. Last night a slept better than I have for a long time. Today I even took a half our nap, woke up felt great.Certainly to early to come to any conclusions, but yes, I'm sleeping better. Perhaps it's because I'm feeling better. I know depression can cause insomnia. I understand EMSAM can work quickly, but didn't think it would work this fast. I really feel good.
Rob
Posted by Declan on April 10, 2006, at 6:39:14
In reply to Re: Declan, so selegeline does met. into amphetami » Declan, posted by Caedmon on April 10, 2006, at 0:34:37
It's not psychoactive at all? I dunno. (I took Benzedrine once) But maybe it would keep you awake?
The regulations of the USA are liberal with stimulants and tough on opiates, in keeping with the ethic of achievement perhaps?
Declan
Posted by ravenstorm on April 10, 2006, at 8:34:41
In reply to Re: Declan, so selegeline does met. into amphetami » Caedmon, posted by Declan on April 10, 2006, at 6:39:14
Thanks for all the input everybody! I feel quite a bit better about the whole amphetamine thing (although still partially concerned--have seen people really burned out on ADD drugs).
Sounds like this does not have the affect of the ADD "speed". (?) I guess I could try to contact the company to know for sure.
Robertdavid: Thanks for going into more detail. Obviously can't be the klonopin if you were having sleep problems before on it and did other drug trials with it and still suffered insomnia. This earns a big whoooooooooohooooooooooo! Emsam seems to be improving your quality of sleep. How marvelous! I know its early, but at this point you must feel like you've won the proverbial lottery. Congrats!
Posted by ravenstorm on April 10, 2006, at 11:01:53
In reply to Re: Declan, so selegeline does met. into amphetami, posted by ravenstorm on April 10, 2006, at 8:34:41
Found an article that indirectly states that it does metabolize into amphetamine:
"Unlike selegiline, the novel irreversible selective MAO-B-inhibitor rasagiline (Agilect, Azilect) is not metabolised to methamphetamine or amphetamine."
Concerned about this.
Posted by RobertDavid on April 10, 2006, at 11:25:02
In reply to Re: amphetamine/selegeline, posted by ravenstorm on April 10, 2006, at 11:01:53
Yesterday I completed day 3 on EMSAM. It was basically more of the same. No real side effects, good mood, improved concentration, pretty relaxed. Very suttle. Nothing negative to report with continued slight improvements.
As for sleep, last night back to what seemed to be lots of dreaming (though who knows how long I was actually in dream states). The dreams were the action type, like little adventures, I remember them.
When I woke up I was laughing as a result of a funny situation I was in while dreaming. I have no idea what to make of all that, just posting my experience. Other than waking up at 4:30 to use the restroom I slept through the night.
Today is my 4th day. Putting the patch on now just seems to be a casual part of my morning routine. From what I understand some people start to see a theraputic in as little as 7 days. It will be interested to see how I'm doing over the next few weeks. I'll post....
Rob
Posted by aabag on April 10, 2006, at 14:37:44
In reply to Day 3, posted by RobertDavid on April 10, 2006, at 11:25:02
I'm very pleased to see the lack of side effects. This has been a big turn-off for SSRIs, not to mention the emotional blunting, or better yet, emotional anaesthesic effect, and the fact that they just plain didn't work for me. I should be starting up somewhere near the end of April, so I'm looking forward to it. As far as the MAOI diet on the 9 and 12 dose is concerned, were it deemed necessary, I'd eat chicken and rice period if it meant an end to the low energy, low mood, general unease, so on.
Posted by crabwalk on April 10, 2006, at 14:52:38
In reply to Re: Day 3, posted by aabag on April 10, 2006, at 14:37:44
Hi, I'm currently taking about 10mg of stablon (tianeptine) a day (dissolved in water). I'd like to try emsam, but I'm wondering how long I should wait after I quit the tianeptine to start. On Servier's website (co. that makes Stablon) it says drug interactions with nonspecific MAOI's, but that seems like it's a 'just in case' kind of thing so that they don't get sued. Anybody have any thoughts? I plan on trying the lowest dose patch.
Posted by RobertDavid on April 10, 2006, at 14:53:34
In reply to Re: Day 3, posted by aabag on April 10, 2006, at 14:37:44
> As far as the MAOI diet on the 9 and 12 dose is concerned, were it deemed necessary, I'd eat chicken and rice period if it meant an end to the low energy, low mood, general unease, so on.
I thought I should mention that I'm eating anything I want and am not paying any attention to food restrictions at the 20mg dose (but will pay attention to drug interactions).
That said, my doctor said that even if I ultimately went to the 30 or 40mg patch that food interactions were not likely and that the warning is there only because money was not spent by the BMS to do studies on it at higher doses. I'm not suggesting that everyone just ignore it, but if I go up I'll unlikely follow a food restricted diet.
Rob
Posted by crabwalk on April 10, 2006, at 15:00:33
In reply to Day 3, posted by RobertDavid on April 10, 2006, at 11:25:02
Robert,
I realized you've been on klonopin a long time, but when your anxiety started, were there a lot of somatic effects (e.g. indigestion, lump in the throat, restlessness) to go with it? Or was it more of the worrying type of anxiety?
I'd like to try emsam but i'm not sure if it would mix well with my particular type of anxiety, which is marked by somatic symptoms. I have downright severe and chronic insomnia (wake early and often), indigestion, inability to relax, can't take naps, lots of bodily tension, etc. If you have any thoughts on this as you learn about your own reactions, I'd appreciate it.
Also, one last thing, if there is any positive effect on libido/pleasurable sensation, could you let us know? I haven't recovered these things since quitting prozac over a year ago. Thanks!
Posted by Declan on April 10, 2006, at 15:18:44
In reply to Re: Day 3 » RobertDavid, posted by crabwalk on April 10, 2006, at 15:00:33
The patches have names like the 20mg patch and so on. Does this tell you anything about the daily dose of selegeline that you absorb? Does it mean you absorb 20mg/d?
Declan
Posted by RobertDavid on April 10, 2006, at 15:37:09
In reply to Re: Day 3 » RobertDavid, posted by crabwalk on April 10, 2006, at 15:00:33
> Robert,
>
> I realized you've been on klonopin a long time, but when your anxiety started, were there a lot of somatic effects (e.g. indigestion, lump in the throat, restlessness) to go with it? Or was it more of the worrying type of anxiety?
>
> I'd like to try emsam but i'm not sure if it would mix well with my particular type of anxiety, which is marked by somatic symptoms. I have downright severe and chronic insomnia (wake early and often), indigestion, inability to relax, can't take naps, lots of bodily tension, etc. If you have any thoughts on this as you learn about your own reactions, I'd appreciate it.
>
> Also, one last thing, if there is any positive effect on libido/pleasurable sensation, could you let us know? I haven't recovered these things since quitting prozac over a year ago. Thanks!I've had Social and Generalized anxiety all my life. I had terrible social anxiety and at one point was practially house bound. Secondarily I had generalized anxiety, just plain hyper, edgy, restless. Lastly I was dysthimic, but I'm sure that had/has something to do with my anxiety disorters.
So to answer your first question, I had both physical and mental syptoms, fear, worry as well as inability to relax, be calm, etc. The klonopin did wonders for that, much more than any medicine I tried before. Nothing else I tried came close, but it hasn't been the total solution as mono therapy as I still was somewhat edgy and dysthimic (but klonopin did get me functional).
As to your second question sleep is and has always been an issue for me. I was concerned about it with EMSAM. So far I'm actually sleeping better than before, but I also am still taking klonopin and I've only been on EMSAM 3 nights, to soon to tell. One of the reasons I went to EMSAM is I've never tried an MAOI and know that they do help many people with anxiety disorters.
I wanted my first try to be with EMSAM because it was my understanding the side effects would be less than SSRI's, not to mention the elimination of food restrictions (20 mg dose). That MAOI's typically work good for those that don't respond well to other anti depressants. So far so good, but still, to early to conclude.
Lastly, libido was something I have not been willing to give up. When I tried paxil and certain other meds I couldn't have sex if my life depended on it, nor did I have any interest in it. But as mentioned in an earlier post that I was feeling "frisky" on EMSAM. I can't say that I'm "Mr. Horny", but there are no negative sexual side effects on it as of now. Before trying EMSAM I did read a study that suggested that libido did improve on EMSAM vs placebo. I'd say that's true for me to this point.
The question I hope I'll ultimately be pondering is if EMSAM will be the answer as mono therapy or if I'll need it as a combo with a benzo like klonopin for additional help with anxiety. Time will tell, but considering the miserable trials I've had on other medications, I'm getting optimistic. If nothing else, I haven't had any negative side effects to this point. That's amazing in of itself to me.
Rob
Posted by RobertDavid on April 10, 2006, at 15:48:38
In reply to Doseage Question, posted by Declan on April 10, 2006, at 15:18:44
> The patches have names like the 20mg patch and so on. Does this tell you anything about the daily dose of selegeline that you absorb? Does it mean you absorb 20mg/d?
> The patches have names like the 20mg patch and so on. Does this tell you anything about the daily dose of selegeline that you absorb? Does it mean you absorb 20mg/d?
Perhaps this info from the BMS website will answer your question, I still dont'completely understand it:EMSAM® (selegiline transdermal system) is a transdermally administered antidepressant. When applied to intact skin, EMSAM is designed to continuously deliver selegiline over a 24-hour period.
EMSAM systems are transdermal patches that contain 1 mg of selegiline per cm2 and deliver approximately 0.3 mg of selegiline per cm2 over 24 hours. EMSAM systems are available in three sizes: 20 mg/20 cm2,30 mg/30 cm2, and 40 mg/40 cm2 that deliver, on average, doses of 6 mg, 9 mg or 12 mg, respectively, of
selegiline over 24 hours.Absorption
Following dermal application of EMSAM to humans, 25%-30% of the selegiline content on average is delivered systemically over 24 hours (range ~ 10%-40%). Consequently, the degree of drug absorption may be 1/3 higher than the average amounts of 6 to 12 mg per 24 hours. Transdermal dosing results in substantially higher exposure to selegiline and lower exposure to metabolites compared to oral dosing, where extensive first-pass
metabolism occurs (Figure 2). In a 10-day study with EMSAM administered to normal volunteers, steady-state selegiline plasma concentrations were achieved within five days of daily dosing. Absorption of selegiline is similar when EMSAM is applied to the upper torso or upper thigh.
Posted by strugglingsteve on April 10, 2006, at 18:09:26
In reply to Re: Day 3 » crabwalk, posted by RobertDavid on April 10, 2006, at 15:37:09
How big is the patch sizewise????
Posted by RobertDavid on April 10, 2006, at 18:13:51
In reply to Re: Day 3, posted by strugglingsteve on April 10, 2006, at 18:09:26
> How big is the patch sizewise????
It's clear and is about 1 inch x 1.5 inches with rounded corners. You can hardly see it. Rob
Posted by strugglingsteve on April 10, 2006, at 18:55:35
In reply to Re: Day 3 » strugglingsteve, posted by RobertDavid on April 10, 2006, at 18:13:51
I just dropped my prescription off at the pharmacy and they said they would have it tomorrow. I am coming off a tricyclic so have to wait till Wednesday to start. I am depression and bad anxiety so hoping for a little miracle of sorts with emsam. Robert did your doc say to put the patch on a different body location each day of the week?
Posted by RobertDavid on April 10, 2006, at 19:22:18
In reply to Re: Day 3, posted by strugglingsteve on April 10, 2006, at 18:55:35
> I just dropped my prescription off at the pharmacy and they said they would have it tomorrow. I am coming off a tricyclic so have to wait till Wednesday to start. I am depression and bad anxiety so hoping for a little miracle of sorts with emsam. Robert did your doc say to put the patch on a different body location each day of the week?
There are instructions in the insert with pictures showing where you can place it on the body. They recomend you put it in different places daily to avoid skin site reactions. You have several options including top of arms, upper left and right side of chest & back, thighs (outside leg), and left/right side of lower back and abs. I've had no issue with skin site reactions so far and have moved it around daily. Good luck, be sure and post how you do! Rob
Posted by cecilia on April 10, 2006, at 19:40:22
In reply to Re: Doseage Question » Declan, posted by RobertDavid on April 10, 2006, at 15:48:38
Anyone know how long the drug stays in your system after the patch is removed? Since I suspect the company probably tells you not to cut the patch in half, would wearing it 12 hours a day at 1st be a good option for a lower dose for those who are drug sensitive, or would you just have immediate withdrawal? Cecilia
Posted by ravenstorm on April 10, 2006, at 21:26:30
In reply to Re: Emsam question, posted by cecilia on April 10, 2006, at 19:40:22
Selegiline has a short half life of 2-10 hours.
Posted by ravenstorm on April 10, 2006, at 21:29:32
In reply to Re: Emsam question/cecelia, posted by ravenstorm on April 10, 2006, at 21:26:30
I just wanted to thank you for your description of somatic anxiety. I have never been very good at conveying that my anxiety is very, very physical and agitated, not just mental. You did a very good job of conveying the difference.
Please do post when you try the patch. It sounds like we have very similar anxiety and I will be curious to see how you fair on the patch.
Is your insurance going to pay for any of it?
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