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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 276 to 300 of 431. Go back in thread:
Posted by strugglingsteve on May 7, 2006, at 17:20:53
In reply to Re: dosage, posted by tygereyes on May 7, 2006, at 12:12:14
> > > > I have had the rage and the sobbing, particulary today when I put it on my thigh, not as emotional as before the patch. I just wanted to see if anyone went up to 9 yet and why they did.
> > >
> > > starting 9 mg on monday - no AD response on 6, have always needed high dose APs to respons.
> >
> > Are you following the maoi diet now?
>
> No. There is limited evidence that there is any need for that, even at the higher doses. See the FDA's report with the original studies.
>
> However, I will be very careful and only eat small amounts of cheese, etc.
>
>So have you had any soy or teriyaki sauce yet??
Posted by tygereyes on May 7, 2006, at 17:57:04
In reply to Re: dosage » tygereyes, posted by strugglingsteve on May 7, 2006, at 17:20:53
> > > > > I have had the rage and the sobbing, particulary today when I put it on my thigh, not as emotional as before the patch. I just wanted to see if anyone went up to 9 yet and why they did.
> > > >
> > > > starting 9 mg on monday - no AD response on 6, have always needed high dose APs to respons.
> > >
> > > Are you following the maoi diet now?
> >
> > No. There is limited evidence that there is any need for that, even at the higher doses. See the FDA's report with the original studies.
> >
> > However, I will be very careful and only eat small amounts of cheese, etc.
> >
> >
>
> So have you had any soy or teriyaki sauce yet??Yes. I had tofu teriyaki two nights ago (but keep in mind I am on 6 mg right now, not 9 mg). I also had a mini-pizza with goat cheese, and a feta cheese omelet recently. No problems at all.
Read the studies. There is very limited evidence for the dietary restrictions. When I go on 9 mg, I will be more careful but even the studies are dubious with that dosage.
Posted by strugglingsteve on May 7, 2006, at 20:38:44
In reply to Re: dosage, posted by tygereyes on May 7, 2006, at 17:57:04
> > > > > > I have had the rage and the sobbing, particulary today when I put it on my thigh, not as emotional as before the patch. I just wanted to see if anyone went up to 9 yet and why they did.
> > > > >
> > > > > starting 9 mg on monday - no AD response on 6, have always needed high dose APs to respons.
> > > >
> > > > Are you following the maoi diet now?
> > >
> > > No. There is limited evidence that there is any need for that, even at the higher doses. See the FDA's report with the original studies.
> > >
> > > However, I will be very careful and only eat small amounts of cheese, etc.
> > >
> > >
> >
> > So have you had any soy or teriyaki sauce yet??
>
> Yes. I had tofu teriyaki two nights ago (but keep in mind I am on 6 mg right now, not 9 mg). I also had a mini-pizza with goat cheese, and a feta cheese omelet recently. No problems at all.
>
> Read the studies. There is very limited evidence for the dietary restrictions. When I go on 9 mg, I will be more careful but even the studies are dubious with that dosage.I am at 6 mg right now but probably will go to 9 in about 10 days if I dont get a response from 6. I am afraid of not keeping the diet as I dont want to have a stroke. The fda said restrictions on 9 and 12 as there isnt enough data, are you willing to risk a stroke??
Posted by tygereyes on May 7, 2006, at 22:03:43
In reply to Re: dosage » tygereyes, posted by strugglingsteve on May 7, 2006, at 20:38:44
> > > > > > > I have had the rage and the sobbing, particulary today when I put it on my thigh, not as emotional as before the patch. I just wanted to see if anyone went up to 9 yet and why they did.
> > > > > >
> > > > > > starting 9 mg on monday - no AD response on 6, have always needed high dose APs to respons.
> > > > >
> > > > > Are you following the maoi diet now?
> > > >
> > > > No. There is limited evidence that there is any need for that, even at the higher doses. See the FDA's report with the original studies.
> > > >
> > > > However, I will be very careful and only eat small amounts of cheese, etc.
> > > >
> > > >
> > >
> > > So have you had any soy or teriyaki sauce yet??
> >
> > Yes. I had tofu teriyaki two nights ago (but keep in mind I am on 6 mg right now, not 9 mg). I also had a mini-pizza with goat cheese, and a feta cheese omelet recently. No problems at all.
> >
> > Read the studies. There is very limited evidence for the dietary restrictions. When I go on 9 mg, I will be more careful but even the studies are dubious with that dosage.
>
> I am at 6 mg right now but probably will go to 9 in about 10 days if I dont get a response from 6. I am afraid of not keeping the diet as I dont want to have a stroke. The fda said restrictions on 9 and 12 as there isnt enough data, are you willing to risk a stroke??Have you even READ the studies where people were on 9 mg and 12 mg and showed a minimal increase in blood pressure even when eating pounds of cheese?
The FDA said "there is not enough evidence to approve the 9 mg and 12 mg patche without dietary restrictions." That does NOT mean that it is contraindicated. If you read the studies, perhaps then we can have a conversation about this matter.
Posted by strugglingsteve on May 7, 2006, at 22:43:17
In reply to Re: dosage, posted by tygereyes on May 7, 2006, at 22:03:43
> > > > > > > > I have had the rage and the sobbing, particulary today when I put it on my thigh, not as emotional as before the patch. I just wanted to see if anyone went up to 9 yet and why they did.
> > > > > > >
> > > > > > > starting 9 mg on monday - no AD response on 6, have always needed high dose APs to respons.
> > > > > >
> > > > > > Are you following the maoi diet now?
> > > > >
> > > > > No. There is limited evidence that there is any need for that, even at the higher doses. See the FDA's report with the original studies.
> > > > >
> > > > > However, I will be very careful and only eat small amounts of cheese, etc.
> > > > >
> > > > >
> > > >
> > > > So have you had any soy or teriyaki sauce yet??
> > >
> > > Yes. I had tofu teriyaki two nights ago (but keep in mind I am on 6 mg right now, not 9 mg). I also had a mini-pizza with goat cheese, and a feta cheese omelet recently. No problems at all.
> > >
> > > Read the studies. There is very limited evidence for the dietary restrictions. When I go on 9 mg, I will be more careful but even the studies are dubious with that dosage.
> >
> > I am at 6 mg right now but probably will go to 9 in about 10 days if I dont get a response from 6. I am afraid of not keeping the diet as I dont want to have a stroke. The fda said restrictions on 9 and 12 as there isnt enough data, are you willing to risk a stroke??
>
> Have you even READ the studies where people were on 9 mg and 12 mg and showed a minimal increase in blood pressure even when eating pounds of cheese?
>
> The FDA said "there is not enough evidence to approve the 9 mg and 12 mg patche without dietary restrictions." That does NOT mean that it is contraindicated. If you read the studies, perhaps then we can have a conversation about this matter.Where would I find the studies to read? I have no idea how to find them on my own. When are you going to be on 9 mg??? babblemail me if you like...
Posted by tygereyes on May 7, 2006, at 22:50:42
In reply to Re: dosage » tygereyes, posted by strugglingsteve on May 7, 2006, at 22:43:17
click on the link provided there
Posted by jetcity10 on May 8, 2006, at 0:04:54
In reply to Re: dosage, posted by tygereyes on May 7, 2006, at 22:50:42
I was on the EMSAM website and FYI there is a graph that shows a slightly higher plasma concentration for upper body placement vs. upper thigh placement though the wording around the graph says they are the same. So statistically there is probably no difference, but even if it is not statistically significant I am willing to have slightly higher plasma levels by going for the upper torso.
Even though I have bad shoulders I have managed to get the patch on my upper back and it seems to week well there, but it is the first place where there was a rash that lasted more than a few minutes after I took it off. Also it is hard to see how well it appears to be sticking.
But hey, I am going for upper torso for now on. Even if it is statistically insignificant, I will go for all I can get.
Posted by strugglingsteve on May 8, 2006, at 0:05:40
In reply to Re: dosage, posted by tygereyes on May 7, 2006, at 22:50:42
> << http://www.fdaadvisorycommittee.com/FDC/AdvisoryCommittee/Committees/Psychopharmacologic+Drugs/102605_emsam/102605_EmsamP.htm >>
>
> click on the link provided thereThat does not say much about 30 and 40. Is that what you are relying on? I am not that comfortable going to 30 and chancing it. Let me know when you get to 30. I will probably get there a week from this coming Wednesday when I see my doc unless the 20 mg patch starts to work for me
Posted by jetcity10 on May 8, 2006, at 0:19:33
In reply to EMSAM: patch placement, posted by jetcity10 on May 8, 2006, at 0:04:54
I just read a little further and saw this:
Dermal Adhesion
Dermal adhesion of EMSAM was examined after application of 6 mg/24 hours selegiline patches for 10 days
to the upper torso. Approximately 88%-89% of 6 mg/24 hours selegiline patches applied to the upper torso
exhibited <10% lift with approximately 6%-7% of patches becoming detached.OK, at the price per patch, it seems like they should give you an extra one for free for when they fall off...
Posted by Phillipa on May 8, 2006, at 0:28:10
In reply to Re: EMSAM: patch placement, posted by jetcity10 on May 8, 2006, at 0:19:33
Where is the ENSAM website? Can you post a link. thanks Phillipa
Posted by jetcity10 on May 8, 2006, at 0:31:11
In reply to Re: EMSAM: patch placement » jetcity10, posted by Phillipa on May 8, 2006, at 0:28:10
> Where is the ENSAM website? Can you post a link. thanks Phillipa
www.emsam.com
Look under full prescribing information
Posted by spooly on May 8, 2006, at 2:47:50
In reply to Re: EMSAM: patch placement » Phillipa, posted by jetcity10 on May 8, 2006, at 0:31:11
Hi - new here and I've been waiting for emsam for some time. Thanks all for this thread and your experiences.
I have a primary diagnosis of innatentive type ADD with comorbid dysthemia and anxiety although I've never been convinced this an accuratee diagnosis as anxiety (particularly social with some relatively constant (and nebulous) GAD features.
I currently take adderall and it is somewhat effective for concentration and (temporarily) for depression and motivation (of which I have very little). I also take a small dose of xanax prn when I can't deal.
I think my problems are highly dopamine related but when I attempted to use wellbutrin it made me, basically, nuts. More importantly I tried oral selegilene and while the antideepresent effect was relatively dramatic there was accompanying anxiety and a weird agitation that caused me to have to discontinue it. (I wasn't on a benzo at the time - in fact I had just come off one a month prior.)
I'm curious if anyone here has a simialiar set of symtoms and/or has had similiar responses to wellbutrin or, more importantly, oral selegilene and has found emsam to be effecctive. Is response to oral selegilene any indicator of potential successs/failure with emsam?
The antidepressent effect with oral selegilene was rapid and unlike any AD response I've ever had (and I've tried a bunch) - I'm just concerned with the anxiety side effects and whether or not they improve with time.
Thanks!!
Posted by lymom3 on May 8, 2006, at 6:30:48
In reply to Emsam, ADD-Anxiety-Dysthemia, posted by spooly on May 8, 2006, at 2:47:50
For what it's worth, I am ADHD also. I have been on Wellbutrin twice...both times with disatrous results so I'm with you on that. I also have had anxiety problems and obviously the "turd" as I call it (treatment resistant depression).
I totally remember the days of constant anxiety and just how crappy it can make you feel. My particular problem was agoraphobia and there were a lot of years that I didn't take a stimulant because I couldn't handle the extra "kick".
I am still in my first week of Emsam, but I have not had any anxiety symptoms. I know from reading here that others have though. I'll give you one vote for no anxiety. In fact, I've had no negative symptoms at all except the darn rash where the patches are. Mine last for about 2 days. They don't hurt, but the site is red.
Posted by lymom3 on May 8, 2006, at 6:34:59
In reply to EMSAM: patch placement, posted by jetcity10 on May 8, 2006, at 0:04:54
I'm only on my 5th day of Emsam, but the first 4 days I put the patch on my breastbone area and the area breastbone area. The patches stuck great. Yesterday I put the patch on the outside part of my arm slightly down from my shoulder and it didn't come off, but it didn't stick as well there so I'm back to the chest area.
No matter where I put it though, I end up with a red rash that lasts 2 days. It stings to remove the patch too, that's for sure, but I'm not giving it up. I've actually started using my treadmill again which is big for me...
Posted by Donna Louise on May 8, 2006, at 6:36:16
In reply to Re: dosage, posted by tygereyes on May 7, 2006, at 22:50:42
> << http://www.fdaadvisorycommittee.com/FDC/AdvisoryCommittee/Committees/Psychopharmacologic+Drugs/102605_emsam/102605_EmsamP.htm >>
>
> click on the link provided thereThank you for providing this link, Tigereyes. I seriously doubt that there would be diet problems with this delivery system but just in the small small chance that you do would you please let us know? The only food that would be a remotely possible problem is soy and the occasional pizza, I can't have alot anyway or I would eat nohting else and get big as a house. I have no intention of going to 9mg yet, just can always use all info.
thanks so much for your contibution,
donna
Posted by Donna Louise on May 8, 2006, at 6:43:22
In reply to Emsam, ADD-Anxiety-Dysthemia, posted by spooly on May 8, 2006, at 2:47:50
> Hi - new here and I've been waiting for emsam for some time. Thanks all for this thread and your experiences.
>
> I have a primary diagnosis of innatentive type ADD with comorbid dysthemia and anxiety although I've never been convinced this an accuratee diagnosis as anxiety (particularly social with some relatively constant (and nebulous) GAD features.
>
> I currently take adderall and it is somewhat effective for concentration and (temporarily) for depression and motivation (of which I have very little). I also take a small dose of xanax prn when I can't deal.
>
> I think my problems are highly dopamine related but when I attempted to use wellbutrin it made me, basically, nuts. More importantly I tried oral selegilene and while the antideepresent effect was relatively dramatic there was accompanying anxiety and a weird agitation that caused me to have to discontinue it. (I wasn't on a benzo at the time - in fact I had just come off one a month prior.)
>
> I'm curious if anyone here has a simialiar set of symtoms and/or has had similiar responses to wellbutrin or, more importantly, oral selegilene and has found emsam to be effecctive. Is response to oral selegilene any indicator of potential successs/failure with emsam?
>
> The antidepressent effect with oral selegilene was rapid and unlike any AD response I've ever had (and I've tried a bunch) - I'm just concerned with the anxiety side effects and whether or not they improve with time.
>
> Thanks!!
>
>
>I absolutely cannot take Wellbutring under any of its extended or non extended release forms and I have tried over and over expecting different results out of despiration to get off the couch and it always made me rageful and socially paranoid. But this is so not the case with the Patch. If anyone can go by my personal experience, please don't let a wellbutrin failure/disaster stop you from trying the patch. I had the same worry and it is groundless for me.
donna
Posted by RobertDavid on May 8, 2006, at 12:46:44
In reply to Re: dosage » tygereyes, posted by Donna Louise on May 8, 2006, at 6:36:16
A couple of points from some of the previous posts:
I too had terrible luck with Wellbutrin, more anxiety and more socially withdrawn. Not the case with EMSAM to this point though.
Though I had no redness initially, lately I have noticed a few red marks here and there that last about 2 days. Seems I get them on my chest and arms, but not my back. Certainly not a big issue for me. Today I put it on top of my shoulders towards my neck. Perhaps it's just in my mind, but lately I have noticed a slight increase in energy when I place the patch on my upper body compared to my stomach area. It's probably just in my head, but?
Lastly, my doctor mentioned that at the 30 & 40mg patch dose he didn't think there would be issues with diet restrictions, that the FDA just didn't get enough info to approve it that way. That if I needed to go to a higher dose to just "test" the worst food offenders. That most likely there won't be issues. Certainly the drug interactions are there for all doses.
Just my 2 cents worth. Still doing great on EMSAM. Rob
Posted by Jost on May 8, 2006, at 15:17:07
In reply to Re: dosage, posted by RobertDavid on May 8, 2006, at 12:46:44
I posted this on another thread, but maybe this is a better place to ask.
I'm interested in EMSAM, esp. whether it's a lot more effective than selegiline. My psych doctor originally was against selegiline, on the basis that it wasn't effective; now he's high on EMSAM.
I'm confused, because I could have taken high doses of selegiline, probably, because I was on v. high dose of Parnate without any hypertensive problems. My biggest problem with Parnate was that, rather unusually, it put me to sleep. That's why I needed the high dose--otherwise I was basically asleep all the time.
It wasn't in retrospect a very good idea, but nothing else so far has worked. Except for the cymbalta--which was okay, worth it, but not really great.
I'm just wondering, basically, if selegiline is a rather weak Maoi, why would Emsam be so great-- if the issue of dose is taken out of the picture. And how much of a difference does the larger dose make?
Jost.
Posted by tygereyes on May 8, 2006, at 17:41:33
In reply to Re: dosage » tygereyes, posted by strugglingsteve on May 8, 2006, at 0:05:40
> > << http://www.fdaadvisorycommittee.com/FDC/AdvisoryCommittee/Committees/Psychopharmacologic+Drugs/102605_emsam/102605_EmsamP.htm >>
> >
> > click on the link provided there
>
> That does not say much about 30 and 40. Is that what you are relying on? I am not that comfortable going to 30 and chancing it. Let me know when you get to 30. I will probably get there a week from this coming Wednesday when I see my doc unless the 20 mg patch starts to work for meYou obviously didn't see the studies (and the incredible graph) where they showed the pressor response to cheese in fluoxetine, tranylcypromine, and EMSAM at the three different doses. Tranylcypromine produced a pressor response after one bite of cheese.
AT 40 MGS OF EMSAM, THE SUBJECTS COULD NOT PRODUCE A PRESSOR RESPONSE; there was a slight increase in BP.
AND did you see the studies where it said that NONE of the subjects, REGARDLESS of dose, did NOT follow the MAOI diet and NO ONE had a hypertensive crisis?
Posted by tygereyes on May 8, 2006, at 17:43:28
In reply to Re: dosage » tygereyes, posted by Donna Louise on May 8, 2006, at 6:36:16
> > << http://www.fdaadvisorycommittee.com/FDC/AdvisoryCommittee/Committees/Psychopharmacologic+Drugs/102605_emsam/102605_EmsamP.htm >>
> >
> > click on the link provided there
>
> Thank you for providing this link, Tigereyes. I seriously doubt that there would be diet problems with this delivery system but just in the small small chance that you do would you please let us know? The only food that would be a remotely possible problem is soy and the occasional pizza, I can't have alot anyway or I would eat nohting else and get big as a house. I have no intention of going to 9mg yet, just can always use all info.
>
> thanks so much for your contibution,
>
> donnaDonna,
For most people, pizza is not a problem as long as it is not made with "exotic" cheeses. I ate MANY slices of pizza on 90 mgs Parnate and NEVER had a crisis occur. :)
Posted by spooly on May 8, 2006, at 18:27:18
In reply to Re: Emsam, ADD-Anxiety-Dysthemia » spooly, posted by Donna Louise on May 8, 2006, at 6:43:22
Lymom and DonnaLouise thank you both. Very, very, encouraging.
I had the same exact response to all forms of wellbutrin. The stuff was like LSD. The package insert should have had directions to the trip-out tent.
Posted by lymom3 on May 8, 2006, at 18:28:43
In reply to Re: dosage, posted by tygereyes on May 8, 2006, at 17:41:33
I don't understand why you have to be so hostile about it. Everyone is here looking for information. None of us are experts. Obviously we all have issues here or we wouldn't be looking for a medication to make us feel better. We aren't all suicidal either and people have a right to be cautious with their health without being talked down to like they are idiots. Please can't we be nice?
Posted by strugglingsteve on May 8, 2006, at 18:29:13
In reply to Re: dosage, posted by tygereyes on May 8, 2006, at 17:41:33
> > > << http://www.fdaadvisorycommittee.com/FDC/AdvisoryCommittee/Committees/Psychopharmacologic+Drugs/102605_emsam/102605_EmsamP.htm >>
> > >
> > > click on the link provided there
> >
> > That does not say much about 30 and 40. Is that what you are relying on? I am not that comfortable going to 30 and chancing it. Let me know when you get to 30. I will probably get there a week from this coming Wednesday when I see my doc unless the 20 mg patch starts to work for me
>
> You obviously didn't see the studies (and the incredible graph) where they showed the pressor response to cheese in fluoxetine, tranylcypromine, and EMSAM at the three different doses. Tranylcypromine produced a pressor response after one bite of cheese.
>
> AT 40 MGS OF EMSAM, THE SUBJECTS COULD NOT PRODUCE A PRESSOR RESPONSE; there was a slight increase in BP.
>
> AND did you see the studies where it said that NONE of the subjects, REGARDLESS of dose, did NOT follow the MAOI diet and NO ONE had a hypertensive crisis?I didnt see the studies, where are they? I have read plenty on emsam but not seen that yet. Yes I did read where no one followed the diet but I dont know what they ate. I suppose someone ate chinese didnt they? :)
Posted by spooly on May 8, 2006, at 18:43:51
In reply to Re: dosage, posted by Jost on May 8, 2006, at 15:17:07
He was originally against it before the pharmaceutical salesman offered him a free round at Pebble Beach where he confirmed, with several colleagues, over a complementary Martini, that it was indeed, effective :)
ahhh...I'm a cynic..sorry.
There were relatively few studies on selegilene til emsam (I know - I scoured the web)and my guess is that not many doctors wanted to open themselves up to litigation to prescribe an "anti-parkinsons" MAOI off-label. They also had little solid evidence.
> I posted this on another thread, but maybe this is a better place to ask.
>
> I'm interested in EMSAM, esp. whether it's a lot more effective than selegiline. My psych doctor originally was against selegiline, on the basis that it wasn't effective; now he's high on EMSAM.
>
> I'm confused, because I could have taken high doses of selegiline, probably, because I was on v. high dose of Parnate without any hypertensive problems. My biggest problem with Parnate was that, rather unusually, it put me to sleep. That's why I needed the high dose--otherwise I was basically asleep all the time.
>
> It wasn't in retrospect a very good idea, but nothing else so far has worked. Except for the cymbalta--which was okay, worth it, but not really great.
>
> I'm just wondering, basically, if selegiline is a rather weak Maoi, why would Emsam be so great-- if the issue of dose is taken out of the picture. And how much of a difference does the larger dose make?
>
> Jost.
Posted by Jost on May 8, 2006, at 20:50:33
In reply to Re: dosage, posted by spooly on May 8, 2006, at 18:43:51
> He was originally against it before the pharmaceutical salesman offered him a free round at Pebble Beach where he confirmed, with several colleagues, over a complementary Martini, that it was indeed, effective :)
>
> ahhh...I'm a cynic..sorry.
>
Thanks, Spooly. .I did some reading on it a while back--but it was mostly a person here or there recommending it. Maybe not a large enough sample.
So maybe he was just being cautious-- or hadn't met the right drug rep. ---
Although my doctor would never take one of those junkets to paradise. He's utterly beyond any breath of such doings.... I'm sure.....
Jost
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Dr. Bob is Robert Hsiung, MD,
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