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Dr. Bob is Robert Hsiung, MD,
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Posted by Donna Louise on April 17, 2006, at 9:45:06
In reply to Re: Emsam Price/ Pulse » Last Chance, posted by pulse on April 14, 2006, at 12:20:31
Well, I am freaking out, after waiting all these years, it is here, my insurance company never heard of it...someone posted a help # to call and I can't find it. I feel like I am in an alternate sick joke world.
thanks for helping,Donna
Posted by RobertDavid on April 17, 2006, at 15:08:56
In reply to Re: Emsam Price help #, posted by Donna Louise on April 17, 2006, at 9:45:06
I'm continuing to feel better particularly with mental clarity, memory and mood. It seems I go a few days feeling the same (which is good), then on occation, like today, notice a surge, a change for the better. I'm sleeping better than I did before starting EMSAM, something that has improved from my first week. Perhaps that's do to depression lifting.
One thing I'm noticing is that I'm not so critical about myself, my mental issues or any issue for that matter. I can even tolerat my ex-wife (no offense ladies). I'm less anxious and am more accepting of myself. I'm not beating myself up on a daily basis (which is the norm). For lack of better words it feels like I've taken a "chill pill" or I guess I should say "chill patch."
Yesterday I went to a hot springs where I spent the day relaxing in the sun. I was concerned about being in the water especially hot water. I swam and soaked up the hot water for 5 hours and didn't have issues with it the patch coming off or feeling any different.
My driving anxieties are becoming less noticable. Socially I'm feeling more outgoing. For those just starting who may be feeling some slight increase in anxiety/engery or perhaps some difficulty sleeping I suspect it will ease with time, hang in there and see what happens.
For me, I've never taken a drug without feeling negative side effects. I think I had an irrational concern that EMSAM wasn't going to work, be strong enough because I didn't feel the negative side effects I typically expect when trying a new medicine. Like, how can a drug have be working if you don't feel something weird happening? For the first time in a long time I can read a book and actually remember what I just read. I'm getting to tasks I ordinarily just don't feel like doing.
I've mentioned before I've taken klonopin for 12 years (2mgs) and continue to do so per my doctors advise. Perhaps that's helped with EMSAM side effects though I've had terrible side effects while blending SSRI's, SNRI's and other meds with same dose of klonopin.
The reason I went to EMSAM was that though klonopin really has improved my social anxiety, I've had a lack of zest for life, low energy, poor mood and I still needed some improvement with SAD and GAD. I've done so many med trials, taking weeks, months out of my I was begining to lose hope, that I had only one or two med trials left in me. I just pray this continues, that there's no poop out.
Though my doctor wanted me to stay on klonopin for several months while I adjust to EMSAM, I now feel like starting a slow klonopin taper (.25 at a time) and see if I can get by with a lower dose or get off it. I've tried before, but couldn't, perhaps with EMSAM I can. As this is my first try with an MAOI I'm optimistic as I know how well Parnate and Nardil work for so many of you.
Anyway, sorry for the long post, but I continue to do really well. I know everyone is different, but I believe EMSAM will be the answer many have been looking for. Hopefully EMSAM will also re-open MAOI's in general to all the doctors who don't use them in their arsenal of drug treatments.
Rob
Posted by Last Chance on April 17, 2006, at 15:33:54
In reply to Re: Emsam Price, posted by rvanson on April 16, 2006, at 18:00:30
Costco price - $393.00 - still too much for me. Richard
Posted by Phillipa on April 17, 2006, at 15:39:23
In reply to 11th day, posted by RobertDavid on April 17, 2006, at 15:08:56
Great news
Great news!!!!!!!!I'd say I will E-mail you later but am getting a cast on my arm I won't be able to type if they put it over my fingers and hand. This sure gives me hope. Love Jan
Posted by strugglingsteve on April 17, 2006, at 18:10:48
In reply to 11th day, posted by RobertDavid on April 17, 2006, at 15:08:56
I wish my trial with emsam was going as well as yours is Robert. I have one side effect and its killing me. I have extreme anxiety and agitation and nothing seems to calm it down. I am hoping this is the it gets worse before it gets better routine but I am getting pretty scared right now. I am hoping it eases off soon. My doc wont let me take benzos so I am really stuck. I am going to ask him about lyrica tonight but he doesnt like that either. Good luck to you.
Posted by ravenstorm on April 17, 2006, at 20:13:27
In reply to Re: 11th day-envy you, posted by strugglingsteve on April 17, 2006, at 18:10:48
I am so sorry things are not going well for you. I suspect that emsam is going to be way too agitating for me as well.
However, you did state in an earlier post (I believe) that you felt agitated at first on WB and then adjusted to it. Could that be the case this time?
Unfortunately for me, I had the opposite reaction to WB. At the beginning of the trial it made me very tired and sick, then I felt good for a very brief time and then the extreme, crawling out of my skin agitation began and NOTHING the pdoc threw at it could stop it. I had to stop taking the WB and it took a month or two to regroup (no withdrawal syndrome, though, which was nice for once!)
I will keep my fingers crossed for you!
Posted by strugglingsteve on April 17, 2006, at 20:32:28
In reply to Re: 11th day-envy you struggling steve, posted by ravenstorm on April 17, 2006, at 20:13:27
> I am so sorry things are not going well for you. I suspect that emsam is going to be way too agitating for me as well.
>
> However, you did state in an earlier post (I believe) that you felt agitated at first on WB and then adjusted to it. Could that be the case this time?
>
> Unfortunately for me, I had the opposite reaction to WB. At the beginning of the trial it made me very tired and sick, then I felt good for a very brief time and then the extreme, crawling out of my skin agitation began and NOTHING the pdoc threw at it could stop it. I had to stop taking the WB and it took a month or two to regroup (no withdrawal syndrome, though, which was nice for once!)
>
> I will keep my fingers crossed for you!I just talked to my doc and he said to hang in there. He said if I am bipolar then it wont get better but if its just depression and anxiety, then give it a couple weeks and it may get better. He has a lot of experience with MAOI's so I best wait it out and see. I asked him about lyrica but he didnt want to mix two new drugs together so I have to grin and bear it. My close friend thinks I will get better in that time frame and to just hang on. Who knows, I could be a trail blazer for some who come after me, so I guess I have to try to survive one day and one hour at a time. I am self employed and managed to do some work today so that was a good thing.
Posted by ravenstorm on April 18, 2006, at 8:18:29
In reply to Re: 11th day-envy you struggling steve, posted by strugglingsteve on April 17, 2006, at 20:32:28
Wait, are you saying your doctor is going to assume you are bipolar if you have anxiety and agitation from an antidepresant that is known to be on the activating side??!
My doctor didn't say I was bipolar because I couldn't take the agitation/anxiety from Wellbutrin.
Is your doctor aware that the patch is more activating than the other MAOI's because it affects more MAOI B than MAOI A?
Posted by ravenstorm on April 18, 2006, at 9:26:36
In reply to Re: 11th day-envy you struggling steve, posted by ravenstorm on April 18, 2006, at 8:18:29
Found this on another site. Discouraging for those of us who also couldn't tolerat WB. :(
Attempt Ends in Failure
My Emsam Attempt Ends in Failure
15. Apr 2006 at 03:48 I was just prescribed the Emsam patch for treatment-resistant atypical depression and anxiety. I may be avoidant personality disorder or borderline-- it is a matter of some debate.
In any case, my recent attempt to use Emsam ended in failure.
About 12 hours after applying Emsam, I noticed increasted energy, a pleaseant physical agitation, wanting to move-- all very different and much improved from depression.
About 18 hours, I started getting very scared, very agitated; crying spells, feelings of hopelessness, abandonment, confused thinking. Waves of anger (which is unusual for me).
Doping myself with variations of Klonopin, Seroquel and Ambien allowed me to endure the symptoms for another day or two.
At 72 hours, I had a phone consultation and a decision was made to discontinue.
------------
I probably should have anticipated thse problems. These symptoms very closely paralleled my experience with Wellbutrin-- I had drug-induced psychosis when I was on it. Apparently my brain doesn't like increasing dopamine.
-----
Posted by RobertDavid on April 18, 2006, at 16:07:31
In reply to Re: agitation post from another board, posted by ravenstorm on April 18, 2006, at 9:26:36
Here is some info regarding side effects from one of the pre-approval trials.
Among 817 depressed patients who received EMSAM at doses of either 3mg/24hours (151 patients), 6mg/24hours (550 patients) or 6mg/24hours, 9mg/24hours, and 12mg/24hours (116 patients) in placebo-controlled trials of up to 8 weeks in duration, 7.1% discontinued treatment due to an adverse event as compared with 3.6% of 668 patients receiving placebo. The only adverse event associated with discontinuation, in at least 1% of EMSAM -treated patients at a rate at least twice that of placebo, was application site reaction (2% EMSAM vs. 0% placebo).
I think it's notable that only 3.5% more people stopped taking EMSAM than those taking a placebo. Also, application site reaction was the only side effect where the drop out rate was twice that of placebo. Hopefully those that experience some side effects will not be significant enough to have to stop taking EMSAM before being able to determine if it will work for them.Everyone is so different. I have had such terrible side effects from other anti depressants like Wellbutrin, SSRI's, SNRI's and tricyclics, yet others do fine with them. As I've been posting, so far EMSAM is all benefit with no negative side effects. Just shows you that there's no making sence of which meds will or won't work for you. It's pretty much trial and error.
Rob
Posted by germanium on April 18, 2006, at 21:24:38
In reply to Re: 11th day » RobertDavid, posted by Phillipa on April 17, 2006, at 15:39:23
It appears that Selegiline is best for people that have at worst only a small problem with anxiety and suffer low energy all the time like me. Yes the agitation is there for me to but it actually helps me to a degree as I tend to be very very anergic if left in the natural state & very depressed as well.
Since starting Selegiline I have started exorcizing & I haven't done that in years but now I have the energy & motivation that I sorely lacked before.
Posted by strugglingsteve on April 18, 2006, at 23:51:19
In reply to Re: 11th day, posted by germanium on April 18, 2006, at 21:24:38
How do you know it will only be good for people with low anxiety? There is no clinical data to base that statement on. I have bad anxiety and am hoping it calms me down.
Posted by Phillipa on April 19, 2006, at 0:08:44
In reply to EMSAM side effect info, posted by RobertDavid on April 18, 2006, at 16:07:31
I thought it was supposed to be great for anxiety and depression. Insomnia can be a problem . So where did you hear that Emsan is not for anxiety? Love Phillipa with anxiety hoping to try Ensam
Posted by RobertDavid on April 19, 2006, at 0:49:10
In reply to Re: EMSAM side effect info, posted by Phillipa on April 19, 2006, at 0:08:44
All I can say is anxiety (both generalized anxiety and social anxiety) are my number one issues. From there I deal with a mild depression or perhaps I should say, low energy, low motivation, trouble sleeping and poor concentration.
I know everyone is different, but so far I've had no side effects on EMSAM with anxiety. I had only a couple nights where I slept less in terms of hours, but still woke up feeling refreshed.
I'm more outgoing, more relaxed, more focused, more upbeat. The increased energy I feel is unlike the energy I used to get from a cup of coffee or provigil, it's smooth and suttle, no edge. I don't come crashing down later in the day.
Certainly everyone will respond differently to it just like all the other meds out there. My sense is that it's at the very least a good option, worth a try, for those that have failed to respond or have not been able to tolerate the side effects of other anti depressants whether for depression or anxiety.
Before trying it I read a lot that suggested it wouldn't be a good choice for someone like me. I'm just thankful my doctor thought it was worth a try. I just know there are others out there like me that will have success with it (though I'll be the first to admit that 12 days is not enough for conclusions).
Rob
Posted by germanium on April 19, 2006, at 6:41:09
In reply to Re: EMSAM side effect info, posted by Phillipa on April 19, 2006, at 0:08:44
Sounds like I opened a can of worms here It was just a statement based on what others seem to be experiencing & may not be correct but it appears theat some of the people are seeming to have a problem with emsam & extreme agitation. I myself sense an increase in energy + slight agitation which I'm actually taking advantage of to motivate myself to get into better shape.
Even though selegiline is a MAO type B inhibitor it also blocks the reuptake of Dopamine similar to Wellbutrin. It is this that may be causing the agitation. MAO type B main substance that it breaks down is phenylethylemine which is a chatecholamine activity enhancer which tends to boost ones energy. this is the same chemical found in chocolate & is referred to as the chocolate amphetamine & it is probably this plus the reuptake blocking of dopamine that is responsible for its antidepressant action. unfortunately it does not work for everyone but yes it does help some with social anxiety as I know from personal experience so my statement on the anxiety issue may be wrong & there is probably some other cause to the extreme agitation such as possibly the increase of dopamine in the brain for example. Again for some people like me who are very very anergic without selegiline it may work really well as it does for me.
Posted by linkadge on April 19, 2006, at 17:39:46
In reply to Re: EMSAM side effect info, posted by germanium on April 19, 2006, at 6:41:09
PEA can make some people very nervous. It is a very strong CNS stimulant. It can also lead to acute relapses in people with psychotic disorders.
I think that the term "anxiety" can mean very different things for different people, and that different biochemical imbalances may cause the same symptoms. So to say that a drug does or doesn't help anxiety may not be descriptive enough.
Some people with ADHD say that stimulants help their anxiety, which may be caused by a lack of attention, and they may be nervous about things pertaining to concentration. OTOH, if I am worried about how my microwave is giving me cancer, then a stimulant like medication may make this worse.
If anxiety for you is GI problems, then an SSRI might not be good, and if anxiety for you is heart palpatitions then a TCA might not be good.
So, I think it depends on what kind of anxiety you have.
Linakdge
Posted by linkadge on April 19, 2006, at 17:47:10
In reply to Re: EMSAM side effect info, posted by linkadge on April 19, 2006, at 17:39:46
I would not compare wellbutrin to emsam. For starters, Wellbutrin's effects on dopamine seem insufficiant to explain its antidepressant effects. Wellbutrin seems to work more with the noradrenergic system, it has only minimal effects on the dopamine transporter.
I would not equate a wellbutrin failure to an ensam failure, or anxiety on wellbutrin to anxiety on ensam.
Linkadge
Posted by Donna Louise on April 19, 2006, at 19:27:01
In reply to Re: EMSAM side effect info, posted by linkadge on April 19, 2006, at 17:47:10
Ok, my insurance will pay, I have the rx. Now the pdoc wants me to do a 2 week washout from the effexor. I have read that only one week is necessary. What do you guys think? I do not want to be in withdrawal hell one second longer than necessary. Also, before I have been able to avoid this in the past by switching to another seratonergic drug. Since the mechanism of effect is so different, do you think that once I am on the EMSAM the withdrawal will stop or will I have to endure withdrawals for god only knows how long??? I am down to 75mg from 225 and I can tell you I have had withdrawal with each dose reduction so this is going to be a nightmare. She wants me to do a week of 37.5 but I want to just get it over with because it is going to be awful anyway. Any body experience this yet or have an idea what I can expect once I start the EMSAM? Don't you think a week's washout is long enough?? Please, any and all feedback here would be ever so greatly much appreciated!!! I have been waiting years to start this drug.
Donna
Posted by strugglingsteve on April 19, 2006, at 20:01:16
In reply to Switching to EMSAM from Effexor, posted by Donna Louise on April 19, 2006, at 19:27:01
I did a one week washout from a tca and that was sufficient but no idea about the half life of effexor. If the half life is long then you best take a longer washout period. It also may help you in assessing where your side effects come from, coming off effexor or onto emsam. I didnt want to wait at all but glad I did. I have one side effect and I know its from emsam and its ok. Hope this helps.....
Posted by strugglingsteve on April 19, 2006, at 20:06:15
In reply to Re: EMSAM side effect info, posted by linkadge on April 19, 2006, at 17:47:10
I have no idea about wellbutrin but it stopped my insane anxiety and bad depression, just too many side effects for me. So I have no understanding of how the emsam will or will not help me. All I can do is hope that it works as well as wellbutrin did as I only have one side effect so far which is agitation and that is better than it was two days ago. My doc is very experienced with maoi's and he thinks emsam will help people with some forms of depression and anxiety, it is just a matter of if you are one of the ones it will help and the only way to find out is to try.
> I would not compare wellbutrin to emsam. For starters, Wellbutrin's effects on dopamine seem insufficiant to explain its antidepressant effects. Wellbutrin seems to work more with the noradrenergic system, it has only minimal effects on the dopamine transporter.
>
> I would not equate a wellbutrin failure to an ensam failure, or anxiety on wellbutrin to anxiety on ensam.
>
> Linkadge
Posted by Donna Louise on April 19, 2006, at 21:25:31
In reply to Re: Switching to EMSAM from Effexor, posted by strugglingsteve on April 19, 2006, at 20:01:16
> I did a one week washout from a tca and that was sufficient but no idea about the half life of effexor. If the half life is long then you best take a longer washout period. It also may help you in assessing where your side effects come from, coming off effexor or onto emsam. I didnt want to wait at all but glad I did. I have one side effect and I know its from emsam and its ok. Hope this helps.....
Yes, Steve,it does help, and you are right, I do not want withdrawals and start up side effects at the same time. My fear is that the withdrawals will last for months. I think effexor has a short half life, that is why I start getting sick the same day I do a dose reduction, and why it is so awful. But whatever it takes. I am so glad for all of you that this is helping, we have waited a long time.
Donna
Posted by linkadge on April 20, 2006, at 8:05:00
In reply to Re: Switching to EMSAM from Effexor, posted by Donna Louise on April 19, 2006, at 21:25:31
Swiching from effexor to emsam might not be that easy. The ratio of effect on serotonin to catecholamines is likely much higher with effexor, so it is possible to be experiencing side effects related to serotonergic withdrawl for a little while.
To be honest, it might even take a few weeks for you to know what is emsam and what is effexor withdrawl.
Linkadge
Posted by jetcity10 on April 20, 2006, at 19:32:15
In reply to 11th day, posted by RobertDavid on April 17, 2006, at 15:08:56
I just started Emsam yesterday. I was curious as to whether you have found the best time of day to apply the patch? Also I have noticed a mild side effect of mild orthostatic hypotention.
Posted by Donna Louise on April 20, 2006, at 21:36:04
In reply to Re: Switching to EMSAM from Effexor » Donna Louise, posted by linkadge on April 20, 2006, at 8:05:00
> Swiching from effexor to emsam might not be that easy. The ratio of effect on serotonin to catecholamines is likely much higher with effexor, so it is possible to be experiencing side effects related to serotonergic withdrawl for a little while.
>
> To be honest, it might even take a few weeks for you to know what is emsam and what is effexor withdrawl.I am not sure what you are saying, Link, but it doesn't sound like fun. But it is good to know what to expect. Do you think the ratio thing of which you speak makes it dangerous to wait only a week before starting the patch? I can live with side effects and withdrawals but I can't live with dying....at least I still have a little sense of humor.
thanks for your talking to me.Donna
>
> Linkadge
>
Posted by RobertDavid on April 20, 2006, at 22:24:32
In reply to Re: 11th day, posted by jetcity10 on April 20, 2006, at 19:32:15
> I just started Emsam yesterday. I was curious as to whether you have found the best time of day to apply the patch? Also I have noticed a mild side effect of mild orthostatic hypotention.
I put it on every morning after I take a shower. Though they say to put it on at the same time each day I'm not exact about it, just put it on before noon each day.How noticable is your standing low blood pressure? Hopefully that will just be a side effect that goes away after your body adjusts. How else are you feeling? What are you taking it for? Are you taking any other meds?
Today is my 14th day. I just continually keep feeling better. I'm not having any side effect issues, just improved mood, energy, mental clarity. I'm also feeling more outgoing, less anxiety. I hope you have a similar response. Please post how you do and good luck! Rob
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