![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 40 to 64 of 431. Go back in thread:
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....
Posted by RobertDavid on April 11, 2006, at 22:01:08
In reply to Re: Emsam Price, posted by crabwalk on April 11, 2006, at 19:38:46
> do either of you guys have insurance?
I do but they won't cover it, Kaiser Permanente Insurance. They may at some point though, but now now. Rob
Posted by ravenstorm on April 11, 2006, at 22:05:22
In reply to Re: Emsam Price » crabwalk, posted by RobertDavid on April 11, 2006, at 22:01:08
Posted by RobertDavid on April 11, 2006, at 22:06:37
In reply to Re: Emsam Price, posted by strugglingsteve on April 11, 2006, at 20:41:11
> 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....
Great, someone else on the patch. I really look forward to hearing how you do, please post!I have not had patch site irritaion, no redness. By being able to move it to a new location each day any skin irritation should be minimal, hopefully you'll find that to be the case.
Today is my 5th day, the best I've felt so far, like it's really kicked in. I hope it works for you. Good luck! Rob
Posted by RobertDavid on April 11, 2006, at 22:29:47
In reply to EMSAM - insurance and dosage ?s, posted by tygereyes on April 11, 2006, at 21:44:21
> 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?
I found this on the BMS website. Perhaps based on the half life of Parnate you can figure out how long to wait:After stopping treatment with SSRIs; SNRIs; TCAs; MAOIs; meperidine and analgesics such as tramadol,
methadone, and propoxyphene; dextromethorphan; St. John’s wort; mirtazapine; bupropion HCl; or buspirone HCl, a time period equal to 4-5 half-lives (approximately 1 week) of the drug or any active metabolite should elapse before starting therapy with EMSAM.
Otherwise I suppose it's just up to you and your doctor to choose the 20, 30 or 40mg dose. I haven't read anything anywhere that suggests any minimum starting dose. You're not supposed to use more than one patch (and who would want to at that price) so it seems you've just got 3 options. I started at the 20mg dose.Best of luck! Rob
Posted by crabwalk on April 11, 2006, at 23:09:15
In reply to Re: Emsam Price » crabwalk, posted by RobertDavid on April 11, 2006, at 22:01:08
I understand this is could be a breakthrough drug and probably more expensive to make than pills, but $529 for a 30 day supply?! This is a medication, not a luxury item. That price is appalling.
I guess this could open an entire debate on health care...no need to go there right now though I guess.
Posted by Last Chance on April 11, 2006, at 23:54:27
In reply to Re: Emsam Price, posted by crabwalk on April 11, 2006, at 23:09:15
The price is appalling!!!!!! I talked with a pharmacist at Costco today - they don't have a price, but he said I could just order it, and if the price is too high they will send it back. I'll give it a try and post what the price is. I have no health insurance and low income, so unless it is a lot less expensive, I will just have to sit on the sidelines. I have been waiting so long to try it - did not think it could cost this much. Richard
Posted by ravenstorm on April 12, 2006, at 8:41:53
In reply to Re: Emsam Price, posted by Last Chance on April 11, 2006, at 23:54:27
LastChance-
I believe RobertDavid has posted the companies number a few times that people can call to get free samples sent to their doctor. You might want to try that. Its in one of the posts above.
Posted by linkadge on April 12, 2006, at 9:08:29
In reply to Re: no side effects=way cool!!!!!!!!!!! » linkadge, posted by TylerJ on April 11, 2006, at 15:40:20
I'm just studying math.
One of my favorite pages is
www.biopsychiatry.com/refs/
Linkadge
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.