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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 56 to 80 of 431. Go back in thread:
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
Posted by RobertDavid on April 12, 2006, at 9:53:45
In reply to Re: no side effects=way cool!!!!!!!!!!! » TylerJ, posted by linkadge on April 12, 2006, at 9:08:29
Day 5 was by far my best since starting EMSAM. I felt significantly better than I have for probably years. As the day wore on I wondered if it was that both MAOI-A and MAOI-B effects were starting to kick in. Just know that I haven't been so upbeat (not manic), clear headed "normal" in a long time.
As far as sleep goes insomnia hasn't been an issue for me to this point. In fact, when I got home from work I lied down for a moment and ended up taking a quick nap, then got up, watched a baseball game on tv wound down and got a good nights sleep.
Side effects yesterday, none (again, I'm super sensitive to them). I feel like I'm a broken record here, but by far the best start to any med I've tried. Prior to EMSAM I was begining to doubt any of these anti depressants really worked enough to justify the side effects, at least for me (though I've never tried an MAOI before).
My concern in posting is that this is just my experience, everyone is different. I hope everyone who tries it has the response I'm having. And of course being only my 6th day really isn't enough time to judge, but damn, I couldn't have asked for a better start.
I'm really looking forward to seeing posts from those of you who giving it a try.
Rob
Posted by Enigma on April 12, 2006, at 11:26:49
In reply to EMSAM-Day 5, posted by RobertDavid on April 12, 2006, at 9:53:45
Thank you for posting your results.
I hightly look forward to starting Ensam, someday, hopefully if my insurance covers it. Even though everyone's results can be different, it's still good too read positive results, especially from another side-effect sensitive person.
I'm quitting Celexa today. Been on it for 3 weeks, and I felt semi-suicidal last night. I feel horrible today (depression, apathy, and worse). The drug is definately making me feel WORSE. I won't take another SSRI, and I'm still in shock this "doctor" even precribed it for me (after having and reading my med history literally in her hands).
Thanks again for posting your results. They are very encouraging. Maybe Emsam will work for me too, and I'll be able to get my life back.
I'm doing a phone interview with social security in less than an hour. Fun. (not)
Posted by strugglingsteve on April 12, 2006, at 15:14:13
In reply to EMSAM-Day 5, posted by RobertDavid on April 12, 2006, at 9:53:45
From the research I have done, I thought it took a couple weeks for MAO inhibition to take place and mood to improve. Do you know something I dont?? No side effects for me so far which is unheard of.
Posted by RobertDavid on April 12, 2006, at 15:41:49
In reply to Re: EMSAM-Day 5-Too early??, posted by strugglingsteve on April 12, 2006, at 15:14:13
> From the research I have done, I thought it took a couple weeks for MAO inhibition to take place and mood to improve. Do you know something I dont?? No side effects for me so far which is unheard of.
Same for me, no side effects, amazing. As far as MAO inhibition and or response time I read in the initial studies and else where that some individuals reported anti depressant benefits in as little as a week. I don't remember where, but I also read responses did occur with some individuals in as little as 5 days, that both MAOI-A and B would start to kick in. That said I think it will take at least 3 to 4 weeks to really see how well EMSAM works, what to expect.
It's my understanding it just works faster via the patch, going staight to the blood opposed to going through the gut. One reason side effects are minimized. I don't have the scientific explanation as to why, perhaps others here can elaborate on it.
All I know is this is my 6th day and I'm noticing a significant improvement. I'm looking forward to seeing how things are a month from now. Certainly lack of side effects is a good sign for both of us.
We'll see. Post how your doing and good luck! Rob
Posted by strugglingsteve on April 12, 2006, at 19:25:45
In reply to Re: EMSAM-Day 5-Too early?? » strugglingsteve, posted by RobertDavid on April 12, 2006, at 15:41:49
Where did you read about responses in 5 days? I may take longer and need a higher dose because I tried nardil and was at 45 mg for at least 2 and maybe 3 weeks and didnt get a response. I did read in one post on here that is about 5 years old from a dude named adam who was in the trials that it took him 5 weeks until it started to work for him. I worry that since nardil didnt work for me in that short trial that this wont but got to stay optimistic. I guess every drug is different. I am hoping that I only need the low dose patch so I dont have to worry about the diet. Man this gets complicated.....
Posted by RobertDavid on April 12, 2006, at 19:52:52
In reply to Re: EMSAM-Day 5-Too early??, posted by strugglingsteve on April 12, 2006, at 19:25:45
> Where did you read about responses in 5 days? I may take longer and need a higher dose because I tried nardil and was at 45 mg for at least 2 and maybe 3 weeks and didnt get a response. I did read in one post on here that is about 5 years old from a dude named adam who was in the trials that it took him 5 weeks until it started to work for him. I worry that since nardil didnt work for me in that short trial that this wont but got to stay optimistic. I guess every drug is different. I am hoping that I only need the low dose patch so I dont have to worry about the diet. Man this gets complicated.....
I'll do some searching about the quick response time to EMSAM and post it when I find it.If I go to higher doses I'm not likely to pay much attention to food interatctions. My doctor seems to think that the only reason there warnings at with the 30/40 mg patch is that BMS didn't spend money for studies to get it approved nor will that at this point. That by avoiding the gut it probably will not be an issue. Here's a blurb from BMS it mentioning "limiting data":
EMSAM is an irreversible MAO inhibitor. As a class, these compounds have been associated with
hypertensive crises caused by the ingestion of foods containing high amounts of tyramine. In its entirety, the data for EMSAM 6 mg/24 hours support the recommendation that a modified diet is not required at this dose. Due to the more limited data available for EMSAM 9 mg/24 hours and 12 mg/24 hours, patients receiving these
doses should follow Dietary Modifications Required for Patients Taking EMSAM 9 mg/24 hours and 12 mg/24 hours.I'm not telling anyone not to follow the advise here, just that I feel that it won't be an issue and will probably eat what I want/don't anticipate issues should I go to higher patch doses. Rob
Posted by ravenstorm on April 12, 2006, at 21:54:53
In reply to Re: EMSAM-Day 5-Too early?? » strugglingsteve, posted by RobertDavid on April 12, 2006, at 19:52:52
I would definitely not throw in the towel until the "obligatory" 6 weeks. I'm glad you brought up Adam's experience during the trial. I remember those posts. He was sure he wasn't going to respond and then finally did in week 5.
Sucks to wait, I know. But wasting a drug trial by not seeing it through is worse.
By the way, how med sensitive are you? I am sensitive to the point where trying to start up on SSRIs induces nausea to the point of puking, vertigo/dizzyness and either more depression or horrendous anxiety. Just trying to see where you fall in the med sensitive spectrum to judge the no side effect thing.
Congratulations on not having any side effects!!
And a general question to anybody out there: does this drug cause withdrawal symptoms? If so, how bad?
Posted by cecilia on April 12, 2006, at 22:28:32
In reply to Re: Last Chance-ask for samples!!!!!!!!!!, posted by ravenstorm on April 12, 2006, at 8:41:53
Unfortunately, my HMO has a policy against doctors accepting samples. Well. actually it's generally a good policy, set up of course to protect the HMO's bottom line by not getting people started on expensive new drugs, but also protecting people from unknown side effects of brand new drugs pushed by drug reps bearing gifts. But I'm also VERY med sensitiive, so it would be nice to be able to try a few days worth of samples. Of course my HMO isn't about to put something costing as much as Emsam on their formularly, but my doctor says he can request it, they'll turn me down, and then I can appeal and probably get approved since I've tried so many drugs already. It's great that Robert David has had such good results, but I'll be more optimistic once I've heard from someone like me who HAS tried all the other MAOI's, with poor results. Cecilia
Posted by cecilia on April 12, 2006, at 22:52:13
In reply to Re: EMSAM-Day 5-Too early?? Struggling Steve, posted by ravenstorm on April 12, 2006, at 21:54:53
I don't know about withdrawal effects, but I'm sure we'll be hearing about them in a month or two! I wish this patch came in more than 3 sizes, to make it easier to ramp up or wean down the dose. Especially if it's true everywhere, as it was at the one store I called, that you have to buy this in boxes of 30. I haven't even tried Emsam yet, but I'm already pretty angry at the drug company tactics. Well. if it works, I'll forgive them anything. Someone mentioned cutting the patches in half, of course the drug company's literature said no, do any of the biochemical geniuses out there know if this is really a definite no-no? Cecilia
Posted by lemon68 on April 13, 2006, at 0:04:03
In reply to Re: Emsam Price, posted by Last Chance on April 11, 2006, at 23:54:27
I was curious if anyone knows whether the price of the patch changes according to dose - that's something I haven't heard yet. For example, I've been taking Adderal XR for a few months now, and since I pay for it myself I was surprised to learn that 10, 20, or 30 mg are the same price ( "you're paying for the treatment, not the dose" said the pharmo).
I guess it doesn't matter as that price is horrendously out of my range... was looking forward to trying this one, but sheesh!!
Posted by strugglingsteve on April 13, 2006, at 0:37:13
In reply to Re: EMSAM-Day 5-Too early?? Struggling Steve, posted by ravenstorm on April 12, 2006, at 21:54:53
I am really med sensitive and could not tolerate most any drug given to me. Either it was horrid anxiety or terrible physical problems like skin, or nausea or prostate problems or just pick one from the PI sheet and I had it. That is why this is so amazing and I know its only two days but not a problem yet and I am wondering what will happen over the next week. So to answer your question, YES I am med sensitive in a big way. So you remember Adam's posts from 5 years ago? That made me feel a little better since I was on nardil for 3 weeks at 45 mg with no response and was attaching them to emsam in the its not gonna work thinking and being depressed all the time its like adding gasoline to a fire.
> I would definitely not throw in the towel until the "obligatory" 6 weeks. I'm glad you brought up Adam's experience during the trial. I remember those posts. He was sure he wasn't going to respond and then finally did in week 5.
>
> Sucks to wait, I know. But wasting a drug trial by not seeing it through is worse.
>
> By the way, how med sensitive are you? I am sensitive to the point where trying to start up on SSRIs induces nausea to the point of puking, vertigo/dizzyness and either more depression or horrendous anxiety. Just trying to see where you fall in the med sensitive spectrum to judge the no side effect thing.
>
> Congratulations on not having any side effects!!
>
> And a general question to anybody out there: does this drug cause withdrawal symptoms? If so, how bad?
Posted by Last Chance on April 13, 2006, at 8:48:56
In reply to Re: Last Chance-ask for samples!!!!!!!!!!, posted by cecilia on April 12, 2006, at 22:28:32
Cecilia, thank you - I will try - heading to the big city, Portland OR., today. I will also go ahead and order from Costco and post the price when it comes in. If the patch works for my SP like Nardil did, 10 years ago, without the side effects - well, it would be a miracle. Robert's success so far is incredible - and for me, at 61, I would like to start having a life for the time I have left here. Richard
Posted by ravenstorm on April 13, 2006, at 8:50:33
In reply to Ravenstorm, posted by strugglingsteve on April 13, 2006, at 0:37:13
Posted by RobertDavid on April 13, 2006, at 12:13:50
In reply to Re: thanks StrugglingSteve! (nm), posted by ravenstorm on April 13, 2006, at 8:50:33
Today is my 7th day on EMSAM (20mgs). To this point I have felt absolutely no side effects. As mentioned I'm med sensitive and typically have trouble making it the first 30 days on any med, in fact, I had to bail in just a few days on remeron and serzone.
I do feel better and if this is the best I get on EMSAM I'll continue taking it. I feel more stable, more upbeat, better concentration and a little more outgoing. It's certainly all I could hope for especially in such a short time.
Since it's only been one week it's my hope that it will just get better as my blood levels of selegiline increase.
I too remember reading Adams posts with extreme interest. I was amazed with his response, then sad to read about him doing poorly when he had to switch to oral selegiline . Then he stopped posting. I wonder how he is today, if he's back on EMSAM now that it's out.
As far as EMSAM, we're all different and certainly those who try it will have different responses. I'm treating SAD/GAD with dysthimia, others for other disorters. I'm blending it (for now) with klonopin and others may blend it with something else or as mono therapy. That will certainly play into results and response times.
Anyway, I found psycho babble by seeking info on EMSAM and other social anxiety medications when ran across one of Adams posts on google. That ultimately led me to joining the board about 6 months ago. I just want to say that since joining I've learned so much and am thankful to all of you sincere, savvy and considerate people here. Rob
Posted by JaclinHyde on April 13, 2006, at 12:54:34
In reply to Emsam Price, posted by cecilia on April 11, 2006, at 18:10:24
My hubby is retired military and I just called Tricare and they have it on their formulary!
Ready for this?? 30 days for $9
Now THAT'S a bargain!
JH
Posted by tgo on April 13, 2006, at 12:56:54
In reply to Tricare coverage!, posted by JaclinHyde on April 13, 2006, at 12:54:34
Do you have to be ex military to get that price?
Tgo
> My hubby is retired military and I just called Tricare and they have it on their formulary!
>
> Ready for this?? 30 days for $9
>
> Now THAT'S a bargain!
>
> JH
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Dr. Bob is Robert Hsiung, MD,
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