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Dr. Bob is Robert Hsiung, MD,
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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?
Posted by germanium on April 10, 2006, at 23:20:11
In reply to Selegeline, deprenyl, Emsam, metabolites » RobertDavid, posted by Declan on April 9, 2006, at 20:38:53
I have taken oral selegiline before & am about to start again & for the first 2 to3 days had no effects whatsoever then it hits me 3rd or 4th day much more energy, less anxiety but my sleep went down the tube for about 2 weeks but then normalized again but still had more energy than before.
Posted by RobertDavid on April 11, 2006, at 11:33:22
In reply to Re: Selegeline, deprenyl, Emsam, metabolites, posted by germanium on April 10, 2006, at 23:20:11
Last night was probably the best nights sleep I've had in some time . Less dreaming and woke up feeling rested.
Side effects remain to be void for me. Unless something changes, side effects won't be a reason for me to discontinue.
Though benefits are not profound at this point, I do notice suttle differences, slight increase in energy, not as fatigued in the late afternoon as before, I'm getting more done at work, concentration is improving, I seem a little more outgoing, appetite is slightly lower.
There is definately no swings, ups or downs. It's seems consistent thoughout the day. I assume it's the steady stream of selegiline delivery via the patch.
From what I've read some start to see benefits as early as 7 days. It will be interesting to see where I go from here as I put the patch on for the 5th day.
All said, so far best start to any med I've tried. Though certainly to soon to come to any conclusions, I think theres reason to be optimistic about EMSAM being an option, particularly for other treatment resistent individuals like me. We'll see.
Rob
Posted by ravenstorm on April 11, 2006, at 11:38:34
In reply to EMSAM-Day 4, posted by RobertDavid on April 11, 2006, at 11:33:22
Posted by linkadge on April 11, 2006, at 15:20:09
In reply to Re: no side effects=way cool!!!!!!!!!!! (nm), posted by ravenstorm on April 11, 2006, at 11:38:34
Even if Ensam metabolizes to amphetamine I don't know the degree to which this figures into the antidepressant effect. Kindof like how nicotine often doesn't fully replace the effects of smoking (ie smoking affects MAO levels)
I think that emsam should be affecting MAO-A at these doeses. Of course it will affect MAO-B more, but the ratio may be benificial for certain types of depression.
MAO-B is responsible for demeniating PEA, a trace amine which seems to have significant antidepressant effect. The combination of selegeline and phenylethylamine has been proven similar to imipramine in a few studies. So there is possible room here for augmentation if necessary.The combination of ENSAM and exercise might be very significant. Exercise causes a significant release in the levels of phenylethylamine. In some people 45 minautes of exercise can increase PEA output by something like 7x. Taking ensam would reduce the level of PEA metabolized. Be carefully if you have paranoid schizophrenia!
Very high levels of PEA have been found in hyperreligiosity (I will look for that study). So be carefull if you start to feel an intense need to start preaching on the streets. (Not that there is anything wrong with that ~(?))I remember combining exercise and parnate, and that was very strong. I remember after about 30 minautes of jogging I would look around and everything would look *totally* different. It felt strange and otherworldly, like I had entered a different dimention. Everything looked so foreign, I had seen that lamppost a million times yet never like this. It literally turned on circutry that I didn't know existed. It was intense, kindof scarry too. (Now I know everybody isn't like me)
Exercise exercise with caution :)
Linkadge
Posted by TylerJ on April 11, 2006, at 15:40:20
In reply to Re: no side effects=way cool!!!!!!!!!!!, posted by linkadge on April 11, 2006, at 15:20:09
> Even if Ensam metabolizes to amphetamine I don't know the degree to which this figures into the antidepressant effect. Kindof like how nicotine often doesn't fully replace the effects of smoking (ie smoking affects MAO levels)
>
> I think that emsam should be affecting MAO-A at these doeses. Of course it will affect MAO-B more, but the ratio may be benificial for certain types of depression.
>
>
> MAO-B is responsible for demeniating PEA, a trace amine which seems to have significant antidepressant effect. The combination of selegeline and phenylethylamine has been proven similar to imipramine in a few studies. So there is possible room here for augmentation if necessary.
>
> The combination of ENSAM and exercise might be very significant. Exercise causes a significant release in the levels of phenylethylamine. In some people 45 minautes of exercise can increase PEA output by something like 7x. Taking ensam would reduce the level of PEA metabolized. Be carefully if you have paranoid schizophrenia!
> Very high levels of PEA have been found in hyperreligiosity (I will look for that study). So be carefull if you start to feel an intense need to start preaching on the streets. (Not that there is anything wrong with that ~(?))
>
> I remember combining exercise and parnate, and that was very strong. I remember after about 30 minautes of jogging I would look around and everything would look *totally* different. It felt strange and otherworldly, like I had entered a different dimention. Everything looked so foreign, I had seen that lamppost a million times yet never like this. It literally turned on circutry that I didn't know existed. It was intense, kindof scarry too. (Now I know everybody isn't like me)
>
> Exercise exercise with caution :)
>
>
>
> Linkadge
>
>
>
>Yea, For me exercise with Parnate is great..you/I get that amphetamine feeling back. If i feel afternoon fatigue the best thing for me to do is exercise, even if it's just mowing the lawn.Hey Linkadge, how do you know so much about psychopharmacology? You're only 22 if I remember correctly, it really is impressive how much you know. You, Scott and Ed are all extremely knowledgeable when it comes to meds. What are you studying in School? I'm being totally sincere when i say you are one smart young man, and you could go a long way with your intellect.
Sincerely, Tyler
>
>
>
Posted by cecilia on April 11, 2006, at 18:10:24
In reply to Re: no side effects=way cool!!!!!!!!!!! » linkadge, posted by TylerJ on April 11, 2006, at 15:40:20
I called my local pharmacy to find out the cost of Emsam-$552.79 for a box of 30 patches (i.e.$18.42/day)!!!!!!! And you apparently can't buy it in quantities of less than 30; so no way to try it and see if you tolerate it. And of course, I'll pay, even though the chance of my being able to tolerate it (I don't do well with stimulating meds), let alone it working are probably one in a million. I certainly would never put down that kind of money at a roulette table, but these greedy drug companies know that depression hurts so bad, we'll pay anything for the remote possibility of help. I'm not sure how they're really any different ethically than a heroin dealer....Not that I have a clue how much heroin or any other illegal drug costs, and $552 is nothing compared to all the money I wasted on useless therapy. but it still seems outrageous...Cecilia
Posted by RobertDavid on April 11, 2006, at 18:35:06
In reply to Emsam Price, posted by cecilia on April 11, 2006, at 18:10:24
> I called my local pharmacy to find out the cost of Emsam-$552.79 for a box of 30 patches (i.e.$18.42/day)!!!!!!! And you apparently can't buy it in quantities of less than 30; so no way to try it and see if you tolerate it.
I paid $440 for thirty, I think if you shopped around you'll find it for less.
Secondly, you may be able to have your doctor call BMS and get samples. The BMS # for your doctor is 800-631-5244, they can just follow the prompts and ask for samples. Otherwise your doctor could call his/her BMS rep and see if they can get some samples for you.
Good luck! Rob
Posted by Caedmon on April 11, 2006, at 19:03:20
In reply to Re: no side effects=way cool!!!!!!!!!!! » linkadge, posted by TylerJ on April 11, 2006, at 15:40:20
> Hey Linkadge, how do you know so much about psychopharmacology? You're only 22 if I remember correctly, it really is impressive how much you know. You, Scott and Ed are all extremely knowledgeable when it comes to meds. What are you studying in School? I'm being totally sincere when i say you are one smart young man, and you could go a long way with your intellect.
>
> Sincerely, Tyler>I know. I count myself not a *total* ignoramus, but you guys are amazingly sharp.
BTW I am starting up a jogging routine at the same time as Parnate - started 2 weeks ago actually. I am hoping (suspecting) that the two will go very well together! :)
- C
Posted by crabwalk on April 11, 2006, at 19:38:46
In reply to Re: Emsam Price » cecilia, posted by RobertDavid on April 11, 2006, at 18:35:06
do either of you guys have insurance?
Posted by Phillipa on April 11, 2006, at 19:44:58
In reply to Emsam Price, posted by cecilia on April 11, 2006, at 18:10:24
Same here it will have to come out of savings as I am on Disability haven't been able to nurse in l0years and my goal is to go back to nursing and I'm already 60. Love Phillipa
Posted by strugglingsteve on April 11, 2006, at 20:41:11
In reply to Emsam Price, posted by cecilia on April 11, 2006, at 18:10:24
I picked up my prescription today and it was $529.00 and will submit to my insurance company for reimbursement so am curious to see how that will go. Hey Robert, did the skin where your patch is get a little red? My patch has been on a few hours and its a little red. Now the wait begins to see if this will get rid of my depression and anxiety. Let the games begin....
Posted by tygereyes on April 11, 2006, at 21:44:21
In reply to Re: Emsam Price, posted by strugglingsteve on April 11, 2006, at 20:41:11
Are all insurance companies forcing you to submit it for reimbursement or will some pharmacies take insurance up front? I called United Health Care and they told me it would be $50 but didn't say anything about reimbursement. Even Ambien CR and Rozerem were covered from the very beginning without reimbursement (though I needed prior approval).
Also, how long do I have to be off of Parnate before I start Emsam? I'm having such a hard time getting off of Parnate. I am truly addicted to it. I will be the first person to defend psychotropic medication (after all, I am studying to be a psychiatrist!) as generally non-addictive but I can no longer kid myself here. I can't take Parnate just like I can't take benzodiazepines - I will abuse the hell out of it. I don't know how I'm going to be able to stay off of it for two weeks, when I still have so many pills here and start feeling that "crashing" feeling every time I stop taking it. How bad would it be, exactly, if I didn't have a wash-out period between Parnate and Emsam?
And finally, what dose of Emsam is comparable to 80 mg Parnate? I have always needed to take higher doses of anti-depressants than recommended by the FDA - will I actually be able to start out at a higher dose or (like with oral medications) will I need to start on a lower patch and then go up higher gradually?
Thanks for all your help.
> I picked up my prescription today and it was $529.00 and will submit to my insurance company for reimbursement so am curious to see how that will go. Hey Robert, did the skin where your patch is get a little red? My patch has been on a few hours and its a little red. Now the wait begins to see if this will get rid of my depression and anxiety. Let the games begin....
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