![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 40. This is the beginning of the thread.
Posted by Phillipa on April 20, 2006, at 0:25:39
I saw my pdoc today and was I ever surprised he is familiar with the ENSAM Patch and said I can try it if I want or even parnate or nardil. He also said if I chose nardil or paranate the diet restrictions were not bad. Goggle Dr. Wallace www.eastoverpsych.com He deals with eating disorders and is a expert in Charlotte. I was surprised I didn't have to search for a doc. Only problem my choice is the patch as if side effects you can remove and the drug is gone in 2-6hours. No more waiting days for side effects to go away. And I don't drink, eat aged chease eat pizza. I am a salad person for diner each night and drink protein for luch and then granola for breakfast with berries. I don't think I have to give anything up. The Patch is expensive trying to get it from his drug rep free as he hasn't been there yet and he knows of pschobabble. I only have to go down by half on luvox and then can start no washout period. Even if it's true and the patch is $440 or over $500 I will save money in the end. So what will it be what do you all think my primary symtom is anxiety and panic attacks. Love Phillipa
Posted by willyee on April 20, 2006, at 6:13:59
In reply to ENSAM Patch, parnate or nardil?, posted by Phillipa on April 20, 2006, at 0:25:39
If your insurance covers id say go with parnate,its more solid to begin with,and you wont have to worrying about cost,will u save over emsam,ooooh yeah even without coverage a new user on parnate at the starting doses is next to nothing.
HOWEVER knowing ur past,and how anxious you get on new medications im afraid you might be to anxious to let parnate work,if you had so much fear on Amtriptplyine if i remeber then youll probuably be psyhing urself out right off the bat on parnate with self worry.
You seem even in the post to trust emsam more,personaly i think emsam needs to be used more by us,and someone needing a solid AD should defintaly go with the standerd at first,if emsam turns out good,youll always have it to taper too,but start with the true and blue first.
So i dunno,if u feel u can take parnate and not worry urself to death,id say go for it,u see the success rate of first users,also it cant even be compared cost wise to emsam.
Also as you know not many docs are even willing to prescribe parnate,probuably much more now for emsam so again emsam aint going anywhere.I cant recomend nardil as i hated it,but obviously its the drug of champions for some i guess.
Posted by Sobriquet Style on April 20, 2006, at 6:53:20
In reply to ENSAM Patch, parnate or nardil?, posted by Phillipa on April 20, 2006, at 0:25:39
>So what will it be what do you all think my primary symtom is anxiety and panic attacks.
I thought the patch was primarly for depression?
Have you tried Neurontin or Pregabalin? They can work well for general anxiety, mixed with a benzo for panic attacks..
~
Posted by SLS on April 20, 2006, at 7:01:02
In reply to ENSAM Patch, parnate or nardil?, posted by Phillipa on April 20, 2006, at 0:25:39
Will you still be taking Valium?
- Scott
Posted by Crazy Horse on April 20, 2006, at 9:01:49
In reply to Re: ENSAM Patch, parnate or nardil?, posted by willyee on April 20, 2006, at 6:13:59
> If your insurance covers id say go with parnate,its more solid to begin with,and you wont have to worrying about cost,will u save over emsam,ooooh yeah even without coverage a new user on parnate at the starting doses is next to nothing.
>
>
> HOWEVER knowing ur past,and how anxious you get on new medications im afraid you might be to anxious to let parnate work,if you had so much fear on Amtriptplyine if i remeber then youll probuably be psyhing urself out right off the bat on parnate with self worry.
>
>
> You seem even in the post to trust emsam more,personaly i think emsam needs to be used more by us,and someone needing a solid AD should defintaly go with the standerd at first,if emsam turns out good,youll always have it to taper too,but start with the true and blue first.
>
>
> So i dunno,if u feel u can take parnate and not worry urself to death,id say go for it,u see the success rate of first users,also it cant even be compared cost wise to emsam.
>
>
> Also as you know not many docs are even willing to prescribe parnate,probuably much more now for emsam so again emsam aint going anywhere.
>
> I cant recomend nardil as i hated it,but obviously its the drug of champions for some i guess.Hi Jan,
COOLLLL!!! I'm excited for you young lady.
Willyee makes some very good points, that's why I included his post. You are very sensitive to meds and suggestion, so even though i think Parnate would be the prudent choice because it works so well and it's not too expensive, i'm afraid that you wouldn't give it a long enough trial. That's not a bad thing about you, that's just you. :)Therefore if you can afford it, i think the patch would be a good med for you. Look at all the wonderful things Robert has said about it, and that in only nine days. He has no side effects!
With Parnate, it's super powerful, but you have to work out some of the "bugs"..Know what i mean?
My choice for you is EMSAM...You can do it girl!!Love,
Monte "Wang Man" :)
P.S. Ask Robert about the anxiety question. For me Parnate is excellent for anxiety.
Posted by ravenstorm on April 20, 2006, at 10:25:38
In reply to Re: ENSAM Patch, parnate or nardil?, posted by Crazy Horse on April 20, 2006, at 9:01:49
Phillipa-did your doctor have a suggestion about which would be better for your specific symptoms?
My old pdoc said they always recommended starting with Nardil over parnate with people with panic attacks, however, he wasn't the sharpest doctor I've ever seen so I don't know if that is worth much!
But Nardil has a lot of side effects for some people.
Good luck in whatever you decide to do!
Posted by Phillipa on April 20, 2006, at 11:35:30
In reply to Re: ENSAM Patch, parnate or nardil? » Phillipa, posted by SLS on April 20, 2006, at 7:01:02
Scott he said yes the valium would cover anxiety and sleep. Maybe I'm not ready for this yet. Love Phillipa
Posted by Phillipa on April 20, 2006, at 11:39:35
In reply to Re: ENSAM Patch, parnate or nardil?, posted by Sobriquet Style on April 20, 2006, at 6:53:20
Whaat is pregaabalin? I'm not familiar with that name and he didn't even talk about combining drugs. He had just up the luvox. And then I brought up ENSAM. Love Phillipa
Posted by gardenergirl on April 20, 2006, at 12:00:57
In reply to Re: ENSAM Patch, parnate or nardil? » Sobriquet Style, posted by Phillipa on April 20, 2006, at 11:39:35
Hi Phillipa,
I don't know what to tell you about which, if any MAOI might be right for you. But since you mentioned that anxiety and panic were your primary problems, I wondered if you'd ever tried therapy to augment medications. Maybe you've mentioned before if you have. But CBT has actually been shown to be fairly effective for anxiety and panic for a lot of people. If you haven't tried it before, I'd highly recommend you consider adding this to your treatment plan.Good luck with your decision. And glad you found a pdoc you like.
gg
Posted by Phillipa on April 20, 2006, at 12:25:18
In reply to Re: ENSAM Patch, parnate or nardil? » Phillipa, posted by gardenergirl on April 20, 2006, at 12:00:57
gg are you saying don't try any of them just the CBT? Thanks Love Phillipa
Posted by Phillipa on April 20, 2006, at 12:40:05
In reply to Re: ENSAM Patch, parnate or nardil?, posted by willyee on April 20, 2006, at 6:13:59
Willyee I've only been on the SSRI's and SSNRI's. Right now you'e all scaring me. Anxiety is my primary symtom but I thought this was good for anxiety too? I'm confused again. Very confused. And no no insurance willing to hit my savings if it would work as I am getting old fast not my fault and I'm sick of the fighting cause I'm afraid to be alone or go anywhere and always complaining of being tired. And having the least little thing increase my anxiety to sthe state of panic. I thought these meds were good for anxiety.? Love Phillipa
Posted by Crazy Horse on April 20, 2006, at 13:09:27
In reply to Re: ENSAM Patch, parnate or nardil? » willyee, posted by Phillipa on April 20, 2006, at 12:40:05
> Willyee I've only been on the SSRI's and SSNRI's. Right now you'e all scaring me. Anxiety is my primary symtom but I thought this was good for anxiety too? I'm confused again. Very confused. And no no insurance willing to hit my savings if it would work as I am getting old fast not my fault and I'm sick of the fighting cause I'm afraid to be alone or go anywhere and always complaining of being tired. And having the least little thing increase my anxiety to sthe state of panic. I thought these meds were good for anxiety.? Love Phillipa
Jan,
They are excellent for anxiety, for many, many people, me included. I know you are nervous about trying an maoi, i was too when i tried Nardil in 1997. But if you are going to do it, you must take a leap of faith. Worse case senerio, if you don't like it, go off it..not that big of a deal. My advice, try one, they are all good, and like i said if you respond well, you will be amazed and angry that you didn't try one sooner. Fear is a problem for you (and many of us), only you know if you're ready to try one..and only you should be the one to decide. Myself and many others will be here to support you if and when you do-you know that!
I'm thinking the patch will be milder with less side effects than Nardil or Parnate so it's the one i would choose for you. Of course your doc knows better then me or anyone here. Sweetie, i want you to feel great and will support you whatever you decide! :)Love, Monte
Posted by RobertDavid on April 20, 2006, at 14:26:20
In reply to ENSAM Patch, parnate or nardil?, posted by Phillipa on April 20, 2006, at 0:25:39
Jan:
I so know how you feel. I too have dealt with fear and anxiety. I hate trying new meds, I've had so many side effects without benefits. I've postponed trying an MAOI for 15 years because they just plain scared me. Instead, I wasted a lot of time and put myself through hell trying meds that just didn't work for me.
Everyone here has good points with MAOI's and CBT therapy (which can be good with or without meds in my opinion).
That said, since you're not satisfied with how your doing now and since you haven't had much luck with SSRI's or SNRI's I would say it would make sense and give an MAOI a try.
So assuming you decide to try one, the tough part is picking one, they all work differently for different people. I made my choice based on my doctors recomdation (he knows me well after 15 years). Since I typically feel every side effect he thought EMSAM should be my first try. He felt the side effects would be less than that of SSRI's and possibly other MAOI's, that it could help my problem areas such as lack of energy, motivation, poor moods as well as anxiety SAD and GAD.
And as you know I'm having a terrific response. I just feel better overall, like I'm "normal" for the first time. Perhaps I'd feel the same way if I was on either Parnate or Nardil.
My doc seemed to think that if I was going to try an MAOI and then decide later to switch to another MAOI it would be best to start with EMSAM. For some reason he felt that would be an easier transition than from Nardil to EMSAM or Parnate to EMSAM. That was part of my decision to try EMSAM first. Otherwise he recomended Nardil before Parnate (he uses Parnate with other patients, but for some reason thought for me Nardil would be the better of the two as a first try).
So as you know I chose EMSAM, it was my doctors recomendation and I felt most comfortable with it. I have to say the lack of food restrictions, once a day patch and potential for lack of other negative side effects such as as weight gain and decreased libido (Nardil) entered into my decision. It just seemed to make sense to me.
Sleep is an issue for me, I know it is for you as well. I think staying on valium (I'm on klonopin) will help with that and possibly other initial side effects regardless of your choice. Perhaps in time neither of us will need a benzo blend (which I'm hoping for)if were on the right MAOI. I noticed a few nights during the first week where I slept less, but not insomnia. As time goes on (2 weeks now) I'm sleeping fine.
Those that take Parnate could answer this better than I but it's my understanding Parnate is very activating and good for those with depression, but can cause some insomnia. That Nardil works best for those with anxiety disorters like SAD, but again, I'd defer that to those that take Nardil.
Regardless, If I do fail for some reason on EMSAM, I'd exchange side effects for quality of life now that I've had a taste of it. I'd try all three if I fail on any individual one. Hopefully that won't be the case and EMSAM will continue to be my answer. I certainly know it won't be for everyone and can only post my experience.
I know how stressed you are, confussed what to try, been there done that. Since you seem to have the best comfort level with EMSAM I'd recomend trying it. You're the consumer and if your doctor thinks it's okay, I'd go with it. Even if it's not for you ultimately I doubt you will have any where near the side effects you've probably been through on other meds and as you say you can just take the patch off.
Regarless, I know both of us have read countless stories from others that wish they tried an MAOI years before. Life is passing by fast and I wish it didn't take 49 years for me to try one.
Just my 2 cents worth Jan. I'm thinking about you and hope you give one a try. Like others have suggested, if it doesn't work, you can just stop taking it, but if you don't try you may always wonder. I'd go for it! I think you have something to look forward to......
Rob
Posted by gardenergirl on April 20, 2006, at 14:33:10
In reply to Re: ENSAM Patch, parnate or nardil? » gardenergirl, posted by Phillipa on April 20, 2006, at 12:25:18
> gg are you saying don't try any of them just the CBT? Thanks Love Phillipa
Not necessarily saying that. But psychotherapy, whether it's CBT or some other type, is not likely to lead to adverse physical side effects in the same way that a medication might. Also, therapy and meds together can be a very good approach in many cases. If you haven't tried therapy before, I think if it were me I'd give it a try before trying an MAOI. Especially if you are getting partial relief from your current medication regimen.
If you were to do try both at the same time (an MAOI and therapy), it might be hard to figure out which one is helping if you find signficant relief.
gg
Posted by Phillipa on April 20, 2006, at 14:50:25
In reply to Re: ENSAM Patch, parnate or nardil? » Phillipa, posted by gardenergirl on April 20, 2006, at 14:33:10
GG didn't you once say that you chose an MAOI first because you wanted to avoid the side effects of the others subtypes of AD's? And I have an LSW that I just started working with. Biggest problem is that I have only been in the area since Novemeber so no knows me well. But I can't spend my life on the computer out of fear of the outside world. And she wants to do relaxation theraphy. Love Phillipa
Posted by Crazy Horse on April 20, 2006, at 14:56:08
In reply to Re: ENSAM Patch, parnate or nardil? » Phillipa, posted by RobertDavid on April 20, 2006, at 14:26:20
> Jan:
>
> I so know how you feel. I too have dealt with fear and anxiety. I hate trying new meds, I've had so many side effects without benefits. I've postponed trying an MAOI for 15 years because they just plain scared me. Instead, I wasted a lot of time and put myself through hell trying meds that just didn't work for me.
>
> Everyone here has good points with MAOI's and CBT therapy (which can be good with or without meds in my opinion).
>
> That said, since you're not satisfied with how your doing now and since you haven't had much luck with SSRI's or SNRI's I would say it would make sense and give an MAOI a try.
>
> So assuming you decide to try one, the tough part is picking one, they all work differently for different people. I made my choice based on my doctors recomdation (he knows me well after 15 years). Since I typically feel every side effect he thought EMSAM should be my first try. He felt the side effects would be less than that of SSRI's and possibly other MAOI's, that it could help my problem areas such as lack of energy, motivation, poor moods as well as anxiety SAD and GAD.
>
> And as you know I'm having a terrific response. I just feel better overall, like I'm "normal" for the first time. Perhaps I'd feel the same way if I was on either Parnate or Nardil.
>
> My doc seemed to think that if I was going to try an MAOI and then decide later to switch to another MAOI it would be best to start with EMSAM. For some reason he felt that would be an easier transition than from Nardil to EMSAM or Parnate to EMSAM. That was part of my decision to try EMSAM first. Otherwise he recomended Nardil before Parnate (he uses Parnate with other patients, but for some reason thought for me Nardil would be the better of the two as a first try).
>
> So as you know I chose EMSAM, it was my doctors recomendation and I felt most comfortable with it. I have to say the lack of food restrictions, once a day patch and potential for lack of other negative side effects such as as weight gain and decreased libido (Nardil) entered into my decision. It just seemed to make sense to me.
>
> Sleep is an issue for me, I know it is for you as well. I think staying on valium (I'm on klonopin) will help with that and possibly other initial side effects regardless of your choice. Perhaps in time neither of us will need a benzo blend (which I'm hoping for)if were on the right MAOI. I noticed a few nights during the first week where I slept less, but not insomnia. As time goes on (2 weeks now) I'm sleeping fine.
>
> Those that take Parnate could answer this better than I but it's my understanding Parnate is very activating and good for those with depression, but can cause some insomnia. That Nardil works best for those with anxiety disorters like SAD, but again, I'd defer that to those that take Nardil.
>
> Regardless, If I do fail for some reason on EMSAM, I'd exchange side effects for quality of life now that I've had a taste of it. I'd try all three if I fail on any individual one. Hopefully that won't be the case and EMSAM will continue to be my answer. I certainly know it won't be for everyone and can only post my experience.
>
> I know how stressed you are, confussed what to try, been there done that. Since you seem to have the best comfort level with EMSAM I'd recomend trying it. You're the consumer and if your doctor thinks it's okay, I'd go with it. Even if it's not for you ultimately I doubt you will have any where near the side effects you've probably been through on other meds and as you say you can just take the patch off.
>
> Regarless, I know both of us have read countless stories from others that wish they tried an MAOI years before. Life is passing by fast and I wish it didn't take 49 years for me to try one.
>
> Just my 2 cents worth Jan. I'm thinking about you and hope you give one a try. Like others have suggested, if it doesn't work, you can just stop taking it, but if you don't try you may always wonder. I'd go for it! I think you have something to look forward to......
>
>
> Rob
>
>
>
> Jan,
I would listen to Rob,(no disrespect to gg, she makes a good point as well) He's another who wishes he would have tried an maoi long ago. Counceling is good, but if your brain is not getting the neurotransmitters it needs to function normally, all the counciling in the world won't help. I advise both. I don't think your Luvox is helping you like you would like it to. So a new approach of EMSAM, valium and CBT could be a super fantastic effective combo for you. You deserve to feel well Jan...and if you are an MAOI responder, you will be blown away at how well you feel. :)Love, Monte
Posted by valene on April 20, 2006, at 15:13:14
In reply to Re: ENSAM Patch, parnate or nardil? » willyee, posted by Phillipa on April 20, 2006, at 12:40:05
Hi Phillipa,
I am wondering about the EMSAM also. I seem to be in your age group and also on a benzo as you are, and I have had lots of anxiety. I'm on xanax and reduced it from 3mg to 1.5 - 1.75mg. daily but I think I am having tolerance withdrawal - maybe you have it also from your valium? Just a thought. I also get very anxious about going out especially without my husband. Could we talk?
Via babblemail?
Best regards,
Val> Willyee I've only been on the SSRI's and SSNRI's. Right now you'e all scaring me. Anxiety is my primary symtom but I thought this was good for anxiety too? I'm confused again. Very confused. And no no insurance willing to hit my savings if it would work as I am getting old fast not my fault and I'm sick of the fighting cause I'm afraid to be alone or go anywhere and always complaining of being tired. And having the least little thing increase my anxiety to sthe state of panic. I thought these meds were good for anxiety.? Love Phillipa
Posted by gardenergirl on April 20, 2006, at 15:48:37
In reply to Re: ENSAM Patch, parnate or nardil? » gardenergirl, posted by Phillipa on April 20, 2006, at 14:50:25
> GG didn't you once say that you chose an MAOI first because you wanted to avoid the side effects of the others subtypes of AD's?
Not exactly. I had taken several SSRI's over the years, as well as trying Wellbutrin with an SSRI. None really helped that much. Once I got the diagnosis of atypical depression and learned that MAOI's were the "gold standard" for treatment of this type of depression, I decided to go this route versus try other SSRI's or TCA's.
>And I have an LSW that I just started working with. And she wants to do relaxation theraphy.
That sounds like a good plan. I hope this turns out to be a helpful thing for you.
>Biggest problem is that I have only been in the area since Novemeber so no knows me well. But I can't spend my life on the computer out of fear of the outside world.
It's so hard meeting new friends when you're in a new place, isn't it? Especially as we get older, I think.
Take care,
gg
Posted by linkadge on April 20, 2006, at 17:33:33
In reply to Re: ENSAM Patch, parnate or nardil? » willyee, posted by Phillipa on April 20, 2006, at 12:40:05
The emsam patch never claimed to have anxiolitic properties. While it might help some forms of anxiety, it is far from being concluded as an effective antianxiety/antipanic agent.
You may get more help from nardil in that regard, but even nardil isn't right for everbody.
Linkadge
Posted by linkadge on April 20, 2006, at 17:40:53
In reply to Re: ENSAM Patch, parnate or nardil? » Phillipa, posted by gardenergirl on April 20, 2006, at 15:48:37
If anxiety and panic attacks are your primary concern then I wouldn't necessarily think that trying emsam is your best next option.
I think that caution is a good thing. I was gung ho to try a MAOI and it ended up with me in a hospital and loosing a semester in school.
Now, this is not really about horror stories, but I think it is a good thing to consider all options.
Linakdge
Posted by Crazy Horse on April 20, 2006, at 18:00:56
In reply to Re: ENSAM Patch, parnate or nardil?, posted by linkadge on April 20, 2006, at 17:40:53
> If anxiety and panic attacks are your primary concern then I wouldn't necessarily think that trying emsam is your best next option.
>
> I think that caution is a good thing. I was gung ho to try a MAOI and it ended up with me in a hospital and loosing a semester in school.
>
> Now, this is not really about horror stories, but I think it is a good thing to consider all options.
>
> Linakdge
>
>
>
Now that you are totally confused and way to afraid to try an maoi, my advice is this Jan-LISTEN TO YOUR DOCTOR! Don't listen to 8 different people telling you completely contradicting stories/opinions. Even though we all mean well and want the best for you, PLEASE LISTEN TO YOUR DOCTOR FIRST AND FOREMOST! And if you don't trust your pdoc, it's time to find another one.
I am sorry if i have confused you Jan...I truly want what's best for YOU!Love, Monte
Posted by Sobriquet Style on April 20, 2006, at 18:02:29
In reply to Re: ENSAM Patch, parnate or nardil? » Sobriquet Style, posted by Phillipa on April 20, 2006, at 11:39:35
>Whaat is pregaabalin?
Pregabalin is the generic name of brand Lyrica. Its a more potent derivative of Gabapentin - Neurontin. There was recently a thread above by SLS about it being approved for generalized anxiety disorder in Europe. I take Neurontin at present and find it effective for general anxiety. I'm happy with the drug all in all. Buut have been keeping my eye on Lyrica for some time as its a stronger substance and very similar to Neurontin. Some reprts at remedyfind.com have said Lyrica has been better than xanax. Some report here have said its been good, some have said its pooped out or not been effective. As i'm a responder of Neurontin I think it would work for me. If you're a person who may respond to the antianxiety effects of Neurontin, its a very safe drug to take with little side effects and some antidepressants effects + mild mood stabilizing. I guess my point is, it can be a good option for anxiety "if" it works. I may try it in the future, at the moment the Neurontin does its job, so if ain't broke etc.
~
Posted by Crazy Horse on April 20, 2006, at 18:13:41
In reply to Re: ENSAM Patch, parnate or nardil? » linkadge, posted by Crazy Horse on April 20, 2006, at 18:00:56
Posted by linkadge on April 20, 2006, at 18:15:33
In reply to Sorry, my above post not intended for Linkadge (nm), posted by Crazy Horse on April 20, 2006, at 18:13:41
No thats cool. Listen to your doctor is good advice, (unless your doctor is my doctor in which case it is not so good advice)
Linkadge
Posted by Crazy Horse on April 20, 2006, at 19:27:52
In reply to Re: Sorry, my above post not intended for Linkadge » Crazy Horse, posted by linkadge on April 20, 2006, at 18:15:33
> No thats cool. Listen to your doctor is good advice, (unless your doctor is my doctor in which case it is not so good advice)
>
> LinkadgeLOL!
Monte
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