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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 70 to 94 of 431. Go back in thread:
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
Posted by ravenstorm on April 13, 2006, at 13:13:47
In reply to Re: Tricare coverage!, posted by tgo on April 13, 2006, at 12:56:54
Thats GREAT news!! Hopefully as more news about the patch gets out there, more insurances will start covering it.
Also, I am assuming that most people trying (or considering trying) the patch are in the treatment resistant/treatment intolerant camp and even though many insurance plans may not put the patch on their formularies, you may still be able to get coverage if you have a doctor willing to go to bat for you and petition the insurance.
Posted by pulse on April 13, 2006, at 13:45:05
In reply to Re: Emsam Price, posted by Last Chance on April 11, 2006, at 23:54:27
> 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
Richard,
I just called my Costco in SW Ohio, and the pharmacist told me Emsam was not even listed with their supplier- McKesson. She said McKesson tells them to not give out their phone number. If you don't mind saying, where are you located? (I'm paying $540 at Walgreens, all out of pocket.)
FYI, people, I am on day #2 on Emsam. Experiencing exactly same as Robert, i.e., NO SIDE EFFECTS! + alertness, and those feelings of being easily capable of social interaction, or anything, for that matter - * EXCEPT I am having poor sleep - only 5 disruptive hours on night #1. I am also on Klonopin, and due to 2 very traumatic abuse situations, within 2 weeks, 6 months ago, (both of which I'm completely away from) I have had to titrate up from 1 or 1.5 mg. to a whopping 4 mg/day. Am not happy about that, as I well know, after the first month on ANY dosage of klonopin, it loses it's sleep 'help', and from there on foreward works against sleep.
BTW, I'm not treatment resistant, I'm side-effect/s intolerant of - now - every single oral antidepression, much less combos - all classes, and I've tried almost every one, if not every one. (Other than Remeron, which is the only one I can tolerate re my issues: upper and lower GI problems. But Remeron doesn't give me full remission, and causes a weight gain of 1 pound every 2 days. The higher dosages not only make me angry and lose their sleep help, but I actually gain MORE weight.)
Robert, please, at what pharmacy did you find that low price for Emsam? TIA.
pulse
Posted by JaclinHyde on April 13, 2006, at 14:28:54
In reply to Re: Tricare coverage!, posted by tgo on April 13, 2006, at 12:56:54
Yeah you do. Either active duty or retired.
JH
Posted by RobertDavid on April 13, 2006, at 15:45:43
In reply to Re: Emsam Price/ Ricard AND Robert, posted by pulse on April 13, 2006, at 13:45:05
> Robert, please, at what pharmacy did you find that low price for Emsam? TIA.
I bought EMSAM at a small private pharmacy in Riverside, CA. I paid $440 for 30 20mg patches. I contacted the pharmacist (Vijay) and we talked for some time about EMSAM, he's very interested in it.I mentioned this board and that others are having trouble finding it at my price. He said he would be happy to fill anyones scripts from the board (perhaps he'll include shipping - he also may ship outside the U.S.) at my $440 price.
If you're interested you can email him at vjpate@hotmail.com or call 951-686-7373 (Spencers Pharmacy, 6942 Brockton Ave., Riverside CA 92506).
Rob
Posted by RobertDavid on April 13, 2006, at 15:54:01
In reply to Re: Emsam Price/ Ricard AND Robert, posted by pulse on April 13, 2006, at 13:45:05
> FYI, people, I am on day #2 on Emsam. Experiencing exactly same as Robert, i.e., NO SIDE EFFECTS! + alertness, and those feelings of being easily capable of social interaction, or anything, for that matter - * EXCEPT I am having poor sleep - only 5 disruptive hours on night #1.
I can't tell you how happy I am that your getting a similar positive response!!! Hopefully your sleep issues will improve. It's still not a problem for me and I'm a guy that can't buy a good nights sleep! Good luck! Rob
Posted by Iansf on April 13, 2006, at 16:39:26
In reply to Re: Emsam Price, posted by crabwalk on April 11, 2006, at 19:38:46
$540, $440 - good grief! Many new meds are expensive, but this is truly outrageous. And what's the justification? Selegiline had already been developed, so there were none of the high development costs associated with most meds. All they did was put it on a patch, and it's not difficult to figure out how to do that, considering that compounding pharmacists were already able to put just about any med on a patch. They had to run tests, sure, but the costs are still a lot lower than developing a new drug from scratch.
The pricing isn't simply outrageous - it's IMMORAL. I shouldn't be shocked, but I am. This kind of pricing should be criminal. At the moment I get my meds for free through a city clinic, but I can't imagine the city's going to spring for a med this expensive. And even if it does, all that means is that the city will have to cut back on some other services to cover it, either by reducing the number of people eligible for coverage, firing people and loading more work on the remaining staff or limiting access to other treatment. This is just WRONG, WRONG, WRONG. At the moment I feel ashamed to call myself a US citizen.
Posted by ed_uk on April 13, 2006, at 17:00:32
In reply to Re: Emsam Price, posted by Iansf on April 13, 2006, at 16:39:26
>This is just WRONG, WRONG, WRONG
It's amazing how much prices vary. I work in a pharmacy in England. When we buy generic fluoxetine (generic Prozac) from our wholesaler, a box of thirty 20mg caps costs 39 pence (68 US cents). A box of twenty-eight Zyprexa 10mg costs £79.45 (about $139.22)
Ed
Posted by Last Chance on April 13, 2006, at 21:06:27
In reply to Re: Emsam Price/ Ricard AND Robert, posted by pulse on April 13, 2006, at 13:45:05
Pulse, hi. I am in Portland Oregon. Funny about McKesson - they are the supplier for my local Pharmacy, and I got a price of $444.00. As soon as I score from Costco, if I do, I will post the price. Richard
Posted by pulse on April 14, 2006, at 1:41:46
In reply to Re: Emsam Price/ Ricard AND Robert » pulse, posted by RobertDavid on April 13, 2006, at 15:45:43
Robert,
This info re: your pharmacist and his being willing to fill others' scripts is no less than amazing! I have made a note on all.
So VERY kind of you to post this, and thanks, also, for your encouragement in your post following.
BTW, my main lifelong diagnoisis is, and has remained - until now, hopefully! - Major Depressive Illness, recurrent. Moderate to very severe. I have HAD to be off an antidepressant for 6 months! - longest I've ever gone, and, due, wholly, to my unbearble GI problems on the pill-form antidepressants passing through the gut. The last 2 months have been VERY scary. (What I think of as abit lesser and/ or "breakthrough"/ waxing and waning diagnoses are: GAD, PTSD, and OCD.) So, I am taking the Emsam, first and foremost, for MDD.
However, it surely seems to be helping the GAD and PTSD for me also already; not so sure about the OCD (yet).
Went to my therapist today (my day #2), and she is beyond amazed. I was going to have to start EMDR again; now she feels no need to. Says she's never seen me, over this last decade/+ with her, so focused and able to stay on topic. She does not feel there is anyway all this can be a placebo effect.
Thanks again!
'
Posted by pulse on April 14, 2006, at 1:55:32
In reply to Re: Emsam Price/ Pulse, posted by Last Chance on April 13, 2006, at 21:06:27
Richard,
(BTW, sorry for leaving out the "h" in your name when I started posting. So glad you caught my post to you!)
Thanks for this info re: Costco/ McKesson/ and price in Oregon. (FYI: I was thinking of moving there, several months ago. May still, as this is further incentive.)
Let me just say that SW Ohio often runs about 5 years behind the rest of the nation. I'm going to now call my Costco back and be VERY insistent. The pharmacist almost laughed at me. Sheesh. She will be getting a REAL taste of my relentlessness now.
Posted by ravenstorm on April 14, 2006, at 8:29:40
In reply to Re: Emsam Price/ Pulse » Last Chance, posted by pulse on April 14, 2006, at 1:55:32
I really feel for you. I am in the exact same boat. I have been unable to even try any more med trials (although the only thing left to try was cymbalta and the traditional MAOI's) because of severe stomach problems. I have been off of meds for nine months.
Posted by elkat on April 14, 2006, at 10:35:32
In reply to EMSAM-Day 5, posted by RobertDavid on April 12, 2006, at 9:53:45
Thanks for your reports. It sounds very interesting. It also sounds very expensive, and my HMO still considers Wellbutrin XL a "non-formulary" and doesn't provide the usual benefits for it, so it will probably be 2025 before EMSAM is covered, but I'm still very curious.
Posted by Last Chance on April 14, 2006, at 10:45:44
In reply to Re: Emsam Price/ Pulse » Last Chance, posted by pulse on April 14, 2006, at 1:55:32
Pulse - Oregon's health plan was once considered an example for the U.S. Now it is almost non-existent. There is no $$$$$ here, and you have to be pregnant or over 63 and pennyless for them to even accept an application. That is the sad reality about the OHP. About Costco and Emsam - the Pharmacist here said he showed no price, but that if I ordered it he could get it - if it was too expensive he said he would send it back. So now I'm waiting and expect it on Monday. He did make a guess, though - since it is $444.00 at my pharmacy, he said probably about $300.00. That would be better, of course, but I would still have to beg, borrow or STEAL! So we'll just have to wait and see. Richard
Posted by Last Chance on April 14, 2006, at 10:57:31
In reply to Re: Emsam Price/ Pulse, posted by Last Chance on April 14, 2006, at 10:45:44
There is a poster, NY Marine, on The Anxiety Community - he is on day 6 of Emsam, and says that he feels "agitated, anxious, nausea". Maybe it is not the miracle that some of us are hoping for. Richard
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