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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 140 to 164 of 431. Go back in thread:
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
Posted by jetcity10 on April 21, 2006, at 0:07:45
In reply to Re: 11th day » jetcity10, posted by RobertDavid on April 20, 2006, at 22:24:32
> 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! RobThanks for the info as well as your earlier posts. Your posts have been encouraging and have given me hope during this transitional process. There is very little info available on Emsam and both my doc and the pharmacist want me to tell them all I can.
I had been doing the morning thing but I was unsure if it would be better or worse to take it in the evenings depending on which side effects one might want to avoid. Though theoretically with the patch, that is probably moot.
I am also on Klonipin (1.5mg) in the evenings to help with sleep and two cardiac meds for "inappropriate sinus tachycardia". I am taking the psych meds primarily for "suicidal ideation". Due, it is felt, to moderate to major depression and fairly significant anxiety.
I have tried just about everything else through the years with little success and lots of side-effects. I am a little concerned that I may be developing some cardiac side effects but since I have a history of cardiac issues it is hard to tell if this is something new or just regular/irregular cardiac irregularity. Theoretically Emsam is not contraindicated with my cardiac meds and I would be really ticked to have to stop after forking over the $200 not covered by my insurance. But I am still willing to be patient and to wait and see. I have had orthostatic hypotension with mutiple meds in the past and it is something I can deal with (as long as I don't stand up to quickly and pass out in public). I will keep an eye on it- luckily I used to work in the emergency medical field in my younger years.
Thanks again.
Posted by RobertDavid on April 21, 2006, at 1:13:03
In reply to Re: 11th day, posted by jetcity10 on April 21, 2006, at 0:07:45
> I had been doing the morning thing but I was unsure if it would be better or worse to take it in the evenings depending on which side effects one might want to avoid. Though theoretically with the patch, that is probably moot.
>
> I am also on Klonipin (1.5mg) in the evenings to help with sleep and two cardiac meds for "inappropriate sinus tachycardia". I am taking the psych meds primarily for "suicidal ideation". Due, it is felt, to moderate to major depression and fairly significant anxiety.
>
> I have tried just about everything else through the years with little success and lots of side-effects. I am a little concerned that I may be developing some cardiac side effects but since I have a history of cardiac issues it is hard to tell if this is something new or just regular/irregular cardiac irregularity. Theoretically Emsam is not contraindicated with my cardiac meds and I would be really ticked to have to stop after forking over the $200 not covered by my insurance. But I am still willing to be patient and to wait and see. I have had orthostatic hypotension with mutiple meds in the past and it is something I can deal with (as long as I don't stand up to quickly and pass out in public). I will keep an eye on it- luckily I used to work in the emergency medical field in my younger years.
>
> Thanks again.
Thanks for the info. Sounds like the standing low blood pressure issue is not out of the ordinary for you. And if there aren't drug interactions which appears to be the case it would seem you may get past that or hopefully at worst it will be a minor issue.As far as when is best to put it on, like you said, I'm not sure it matters as it's supposed to trickle steadily for 24 hours, I just like putting it on in the morning. It's just part of my routine now, I think nothing of it.
There are a few people I know personally that are not here on psycho babble that have started taking it without side effect issues, though no conclusions can be made after just a few days. But for me, 2 weeks out, I'm getting more and more convinced it's my answer. I've never felt so good, motivated, happy.
I'm very intersested in hearing how you're doing and am hopeful that you'll start to feel better. Please keep posting how you're doing, many here need feedback from you and others.
I wish you the best of luck! Rob
Posted by Crazy Horse on April 21, 2006, at 8:39:33
In reply to Re: 11th day » jetcity10, posted by RobertDavid on April 21, 2006, at 1:13:03
> > I had been doing the morning thing but I was unsure if it would be better or worse to take it in the evenings depending on which side effects one might want to avoid. Though theoretically with the patch, that is probably moot.
> >
> > I am also on Klonipin (1.5mg) in the evenings to help with sleep and two cardiac meds for "inappropriate sinus tachycardia". I am taking the psych meds primarily for "suicidal ideation". Due, it is felt, to moderate to major depression and fairly significant anxiety.
> >
> > I have tried just about everything else through the years with little success and lots of side-effects. I am a little concerned that I may be developing some cardiac side effects but since I have a history of cardiac issues it is hard to tell if this is something new or just regular/irregular cardiac irregularity. Theoretically Emsam is not contraindicated with my cardiac meds and I would be really ticked to have to stop after forking over the $200 not covered by my insurance. But I am still willing to be patient and to wait and see. I have had orthostatic hypotension with mutiple meds in the past and it is something I can deal with (as long as I don't stand up to quickly and pass out in public). I will keep an eye on it- luckily I used to work in the emergency medical field in my younger years.
> >
> > Thanks again.
>
>
> Thanks for the info. Sounds like the standing low blood pressure issue is not out of the ordinary for you. And if there aren't drug interactions which appears to be the case it would seem you may get past that or hopefully at worst it will be a minor issue.
>
> As far as when is best to put it on, like you said, I'm not sure it matters as it's supposed to trickle steadily for 24 hours, I just like putting it on in the morning. It's just part of my routine now, I think nothing of it.
>
> There are a few people I know personally that are not here on psycho babble that have started taking it without side effect issues, though no conclusions can be made after just a few days. But for me, 2 weeks out, I'm getting more and more convinced it's my answer. I've never felt so good, motivated, happy.
>
> I'm very intersested in hearing how you're doing and am hopeful that you'll start to feel better. Please keep posting how you're doing, many here need feedback from you and others.
>
> I wish you the best of luck! RobHi Rob,
I just wanted to tell you that i am very happy for you. :) Your story is similar to mine with Parnate. It's a breath of fresh air to see someone like you doing so well on EMSAM...I think, like me, and many others here, you have suffered way too much, and way too long! Isn't it nice to finally feel GOOD!? You have been an inspiration to so many hopeless people here..I particular like what you wrote to Phillipa yesterday. Anyway, CONGRATULATIONS, keep up the good work, and may God continue to bless the "New Rob" on EMSAM! :)Monte
Posted by pederspd on April 21, 2006, at 9:05:20
In reply to Re: EMSAM-Day 5-Too early?? » RobertDavid, posted by Sarah T. on April 15, 2006, at 3:59:41
I am glad to see that people are doing well on Emsam. I was in a clinical trial for it almost 6 years ago and have been waiting for it to finally become available. During the 1st week of the trial I felt normal for the first time in my life. My only side effect was heartburn. All other anti-depressants had never worked and gave me horrible side effects. I received my prescription yesterday and am looking to have it filled in the Chicago area. CVS told me that they may have it in 3 or 4 months! My local Costco doesn't have it yet. I appreciate the name and number of the pharmacy in CA. I will order from there if I have to. Has anyone found a place to fill it in this area?
Posted by Donna Louise on April 21, 2006, at 9:41:54
In reply to Re: EMSAM-Day 5-Too early??, posted by pederspd on April 21, 2006, at 9:05:20
> I am glad to see that people are doing well on Emsam. I was in a clinical trial for it almost 6 years ago and have been waiting for it to finally become available. During the 1st week of the trial I felt normal for the first time in my life. My only side effect was heartburn. All other anti-depressants had never worked and gave me horrible side effects. I received my prescription yesterday and am looking to have it filled in the Chicago area. CVS told me that they may have it in 3 or 4 months! My local Costco doesn't have it yet. I appreciate the name and number of the pharmacy in CA. I will order from there if I have to. Has anyone found a place to fill it in this area?
I am in Fla. and they have it in Walgreens. I don't know if Chicago has a Walgreens or not. I thought for an afternoon that I had the rx in my hand finally but had nowhere to go with it. My pdoc says they have not been to her with samples yet either. But they ordered it for me at Walgreens and had it ready the next day. Now I have to finsh this washout...
Posted by RobertDavid on April 21, 2006, at 13:38:21
In reply to Re: EMSAM-Day 5-Too early??, posted by pederspd on April 21, 2006, at 9:05:20
> I am glad to see that people are doing well on Emsam. I was in a clinical trial for it almost 6 years ago and have been waiting for it to finally become available. During the 1st week of the trial I felt normal for the first time in my life. My only side effect was heartburn. All other anti-depressants had never worked and gave me horrible side effects. I received my prescription yesterday and am looking to have it filled in the Chicago area. CVS told me that they may have it in 3 or 4 months! My local Costco doesn't have it yet. I appreciate the name and number of the pharmacy in CA. I will order from there if I have to. Has anyone found a place to fill it in this area?
I filled my perscription at Spencers Pharmacy in Riverside CA. The pharmacist said he'd mail perscriptions to people outside the area. I paid $440 and I think some of the bigger pharmacies are charging a little less, maybe he is now too. Anyway, If you want to order it thier number is 951-686-7373.I'd love to hear about your experience with EMSAM during the clinical trial. How long were you on it, what dose, how did you do, side effects, benefits? How did others do in the trial? Please elaborate. I'm assuming you want a perscription because you did well. Did you try other meds such as oral selegiline after the trial? It would be great to hear you're impute!
Thanks Rob
Posted by RobertDavid on April 21, 2006, at 14:00:59
In reply to Re: EMSAM-Day 5-Too early?? » pederspd, posted by RobertDavid on April 21, 2006, at 13:38:21
I'm probably sounding like a broken record here, just wanted to report that I continue to do well and am not experiencing side effects. I can tell/feel that my energy has increased, my mood is better, I feel like doing more things (going to disnyland tomorrow), just overall more upbeat. I sleep good and my anxiety is fine. I've never really had a positive response before to an anti depressant so this is all new for me. I'm looking forward to hearing others experience with it...
Rob
Posted by crabwalk on April 21, 2006, at 14:18:00
In reply to Re: EMSAM-Day 15, posted by RobertDavid on April 21, 2006, at 14:00:59
Rob, have you (or anyone else) noticed any affect on libido? I'm very much hoping for a positive one myself. Probably starting the patch tomorrow.
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