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Dr. Bob is Robert Hsiung, MD,
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Posted by jkshrews on May 16, 2006, at 23:56:13
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by Donna Louise on May 6, 2006, at 21:38:24
> I have been posting nearly everyday, they are just coming out all over the board, I guess. I am not real savy on thread starting, ect. I just write after someone wrote something I want to respond to. so there is some stuff there, basically I have been talking about problems with the thing not sticking. And somewhere on here I talked about how I have not had a great two days past. and rambled a bunch of speculation. It is on here somewhere. I have had some rage, and alot of sobbing, basically how I am untreated. I think my happy effexor withdrawal rebound is over and the EMSAM has not kicked in enough to to overcome these particular symptoms, probably i am not getting enough medicine. But I have no trouble sleeping, I am sleeping less hours per night and that is a good thing because I get hypersomnulant. I feel rested and wanting to do more and get out more. But I still feel worn out from the effexor withdrawal so not doing as much as I would if I felt better. I am worried about all this irritability but I am not blaming it on the patch, this is normal unmedicated hell for me. It has only been a week and I do have alot of moments of feeling depression free. Oh, I do take klonopin, I know that helps with the anxiety. I dont know how anxious I would be if I didn't take it. I can say this, I don't feel any more anxious than usual, maybe less, except for the irritablity which I know is anxiety in another one of its entertaining forms.
> I will post more later. I am having a hard time typing now. I also have alot of real life stuff going on so I can't say this is all endogenous.
>
> Donna
Donna,If by your "happy effexor withdrawl rebound" you mean that you had an episode of euphoria (or irritation) after suddenly stopping the Effexor without tapering it down slowly, I think that is usually considered a strong indication that you may have bipolar disorder. It is called a "hypomania," and will often happen after suddenly stopping an antidepressant, if you have bipolar disorder.
Being hypersomnolent is an indication of "atypical depression," and the EMSAM patch should help with that. But many authorities consider atypical depression to be a kind of bipolar disorder, and your mention of irritability might be taken to confirm that somewhat. The EMSAM addresses the depression aspects of the disorder, but not the euphoria/dysphoria (irritabilility) aspect. You might think about trying to get some Lithium to go along with your EMSAM. That may help with the irritability problems. The only way to know is to try it.
jkshrews
Posted by jkshrews on May 17, 2006, at 0:44:56
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by Donna Louise on May 16, 2006, at 6:36:03
> Seems like it is time for another update although it was just a couple of days ago..This is day 17 and I have had no more or that irritable rage kinda thing. I seriously doubt it had anything to do with the patch as that is a major problem I have always had. I have started taking a whole .5mg klonopin at night and .25 mg midday and maybe another .25mg in there somewhere but the main difference is the whole .5mg at night as suggested by Robert David. And my mood is really really good too. I am so sorry that others are having some really bad side effects, I know that hell from most of the other drugs I have taken. I am just having none on this drug at all, just I am tempted to say, moving towards what feels like a total remission. Dare I say that out loud??? oh dear lord, let me knock on some wood..
>
> DonnaDonna,
The Klonopin has such a long half life, 18 to 50 hours, I am curious how breaking the dose up could have much real effect. I think one can take it all at bedtime to get the sedative effect, and get the antianxiety effect the next day with no problem. The antianxiety effect is associated with the blood concentration, which is very constant due to the very long elimination half life of the drug.
I think it is wonderful that your "irritable rage" thing is diminishing with EMSAM. I think usually people will need Lithium as an adjunct medication to deal with this. But if you are having good success with just the MAOI, that is super!
jkshrews
Posted by cecilia on May 17, 2006, at 5:46:07
In reply to Re: Everyone PLEASE share your ENSAM updates? » cecilia, posted by pulse on May 16, 2006, at 3:05:19
Sorry if I phrased that wrong. I meant that, so far, compared to many of the drugs I've tried, Emsam hasn't had terrible side effects for me, and that was why I was going to continue the trial. I know every drug has terrible side effects for some people, I have tried virtually everything and most I would NEVER try again because of side effects. Everyone is different, science is still in the dark ages. Sorry if I offended by not making it clear that I was just speaking of my own personal reactions. I'm on day 8 and definitely getting more anxious, irritable and stressed as the drug builds up in my system, but will continue for now. Cecilia
Posted by zero on May 17, 2006, at 10:23:10
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by cecilia on May 15, 2006, at 5:59:35
Posted by SFY on May 17, 2006, at 12:37:50
In reply to Emsam 9 mg patch, posted by strugglingsteve on May 16, 2006, at 17:07:33
> I am not on the 9 mg patch as of tomorrow morning. 5 weeks at the 6 mg patch did nothing for me. I am researching the diet so I can really decide what to eat and what not to eat, anyone out there with experience please babblemail me!!
The Sunnybrook Health Science Center MAOI Diet as published in Gardner DM, Shulman KI, Walker SE, Tailor SA. The making of a user friendly MAOI diet. J Clin Psychiatry. 1996 Mar;57(3):99-104, is a good, fact-based summary of how to follow a MAOI diet.
I typed it up and tried to copy the formatting as closely as possible as the original. You can download it from here:
http://s93235047.onlinehome.us/Sunnybrook.doc
Posted by lymom3 on May 17, 2006, at 12:46:50
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by cecilia on May 15, 2006, at 5:59:35
Day 15...still doing well. Had pdoc appt today and discussed the fact that I am still a little too irritable and weepy. We are going to give it 3 more weeks are re assess whether I might increase dosage or add another medication. I have noticed my crankiness getting better (I think...maybe should ask my family!!)
No negatives here...didn't even get my usual PMS migraine this month...hope that continues as well.
Lisa
Posted by pulse on May 17, 2006, at 15:08:55
In reply to Emsam Side Effects_Pulse, posted by cecilia on May 17, 2006, at 5:46:07
Thank so much for your clarification!
Even at the ultra low time - 1-2 hrs. at one setting that I've had no choice but to do - now I'm only applying Emsam ONCE per day, BTW (vs. nearly everyone else 24 hrs.), I'm sorry to report I still get all the side-effects I've mentioned in my "Anyone Emsam at night?" thread. This, still, at over one month, and my 4 attempts/ "solutions."
Also, my anxiety is definitely increased within a short time of applying until I take the patch off, and the half-life then winds down.
My therapist, also a nurse, told me that Emsam will indeed show up as amphetamine in any drug test for work, as someone earlier mentioned. I'm a former stimulant "addict," but only cocaine; no cocaine for almost 9 years, now. Unlike, perhaps (?), the majority (?!) of stim. "addicts", I have always hated speed, and haven't done it since 1970; then only twice. I've gotta be honest, Emsam feels like simple old-time speed to me, and that is about all. I can't imagine how it's having calming and no insomnia effects for others, even if they are on klonopin.
It' sure looking like, for me, I will soon be at the point of ONLY keeping Emsam "in my back pocket," in case I find I must apply it occasionally to avoid a complete descent into Major Depression.
pulse
Posted by bulldog2 on May 18, 2006, at 8:18:48
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by jkshrews on May 16, 2006, at 23:37:55
I'm on my third day of emsam. I apply the patch after my shower at night. So far no real side effects. Anxiety has been some what less the first three days. The first two days the depression was actually a little worse but today I woke up and felt like my mood had improved. I guess it's far to early to see how this will turn out. At two weeks I usually get a feeling wether an antidepressant is going to work.
Posted by sweetnlow on May 18, 2006, at 17:58:36
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by bulldog2 on May 18, 2006, at 8:18:48
I'm on day 3 also. Years ago, I responded wonderfully to Nardil (another MAOI), so I am optimistic about Ensam.
So far, no effects. That's O.K., it's early.
Posted by strugglingsteve on May 18, 2006, at 21:03:16
In reply to Re: Everyone PLEASE share your ENSAM updates? » bulldog2, posted by sweetnlow on May 18, 2006, at 17:58:36
I started the 9 mg patch today. It is alot bigger than the 6 mg patch such that you notice it now whereas before I didnt. Hopefully it will work......
Posted by Breeze on May 19, 2006, at 8:49:49
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by cecilia on May 15, 2006, at 5:59:35
Just put the patch on for the first time an hour ago. When I opened the package this morning I looked inside and said, "Nuts, I got an empty packge, there's nothing in here", but on checking further I saw it. I guess I didn't expect a clear patch, I was thinking it would be the color of a band-aid. I was also surprised at how small it was.
I've been waiting to put on the Emsam patch since August 2005. Let's hope it works for all us!
Breeze
Posted by gibber on May 19, 2006, at 11:26:09
In reply to Re: Emsam 9 mg patch » strugglingsteve, posted by SFY on May 17, 2006, at 12:37:50
The best information about the diet specific to EMSAM is at http://www.fda.gov/ohrms/dockets/ac/05/briefing/2005-4186B2_02_01-FDA-Emsam.pdf
The jist is that no special diet is required at any dosage, however the FDA is not in agreement with that and any doctor would say you need to obey the diet.
Posted by pulse on May 19, 2006, at 13:32:07
In reply to Everyone PLEASE share your ENSAM updates?, posted by UgottaHaveHOPE on May 5, 2006, at 13:30:01
Hi All,
Emsam has failed me. I am DONE! I could not overcome the major GI problems, much less the increased anxiety, urinary retension, and insomnia.
There was no improvement whatsoever in depression; it only felt like being on way too much speed, a feeling I hate.
My therapist and I must now conclude that my first (great) day on Emsam was merely the placebo effect, afterall.
Continued good luck to those doing well.
pulse
Posted by sweetnlow on May 19, 2006, at 13:33:50
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by pulse on May 19, 2006, at 13:32:07
Pulse--
What dosage of Emsam were you on?
> Hi All,
>
> Emsam has failed me. I am DONE! I could not overcome the major GI problems, much less the increased anxiety, urinary retension, and insomnia.
>
> There was no improvement whatsoever in depression; it only felt like being on way too much speed, a feeling I hate.
>
> My therapist and I must now conclude that my first (great) day on Emsam was merely the placebo effect, afterall.
>
> Continued good luck to those doing well.
>
> pulse
>
>
Posted by pulse on May 19, 2006, at 15:52:57
In reply to Re: Everyone PLEASE share your ENSAM updates?, posted by sweetnlow on May 19, 2006, at 13:33:50
6 mg.
The longest I could ever apply (other than 24 hrs.,those 1st four days, i.e. attempt #1) (attempt #2 was every other day, for 24 hrs.) ....was 4 hours (1/6 of time others are handling.) Attempt 3, I may forget now, but probably 2-3-4 hrs., applied no more than 3 times (usually only twice) a day, at intervals, but WAY before bedtime, as the teeth-clenching & insomnia were as bad, if not worse, than Zoloft.
Attempt #4 - the waterloo it was more than obvious I was fast approaching- was 1-2 hours (may have forgotten and left on 3 hrs once) ONCE a day!
None of this was done as some kind of goofy parlor trick...it was absolutely necessary. Still, the result was that I simply couldn't handle Emsam.
Now, if they'd made, say, a 2mg. patch, maybe...who knows? I'm fairly sure BMS will put no further expense into lower dosages, though.
pulse
Posted by strugglingsteve on May 19, 2006, at 17:41:35
In reply to Re: Emsam 9 mg patch, posted by gibber on May 19, 2006, at 11:26:09
I just read most of that link and where do you get the idea that no diet is needed at the higher patch strengths? What I got was they were pretty adamant about needing the diet at the higher patch strengths....
> The best information about the diet specific to EMSAM is at http://www.fda.gov/ohrms/dockets/ac/05/briefing/2005-4186B2_02_01-FDA-Emsam.pdf
>
> The jist is that no special diet is required at any dosage, however the FDA is not in agreement with that and any doctor would say you need to obey the diet.
Posted by SFY on May 20, 2006, at 10:24:31
In reply to Re: Everyone PLEASE share your ENSAM updates? » sweetnlow, posted by pulse on May 19, 2006, at 15:52:57
> 6 mg.
>
> The longest I could ever apply (other than 24 hrs.,those 1st four days, i.e. attempt #1) (attempt #2 was every other day, for 24 hrs.) ....was 4 hours (1/6 of time others are handling.) Attempt 3, I may forget now, but probably 2-3-4 hrs., applied no more than 3 times (usually only twice) a day, at intervals, but WAY before bedtime, as the teeth-clenching & insomnia were as bad, if not worse, than Zoloft.
>
> Attempt #4 - the waterloo it was more than obvious I was fast approaching- was 1-2 hours (may have forgotten and left on 3 hrs once) ONCE a day!
>
> None of this was done as some kind of goofy parlor trick...it was absolutely necessary. Still, the result was that I simply couldn't handle Emsam.
>
> Now, if they'd made, say, a 2mg. patch, maybe...who knows? I'm fairly sure BMS will put no further expense into lower dosages, though.
>
> pulseIf you're looking for a lower dose, why not try oral selegiline? At doses up to 10 to 15 mg./day, there are no dietary restrictions.
Posted by Last Chance on May 20, 2006, at 12:42:11
In reply to Re: Everyone PLEASE share your ENSAM updates? » pulse, posted by SFY on May 20, 2006, at 10:24:31
I am still waiting for my patches. I have tried oral Selegeline, but only for 2 weeks - started at five and went to 10mg. It just made me agitated - maybe I should have hung in there longer - Easy to say in retrospect. Richard
Posted by pulse on May 20, 2006, at 15:23:45
In reply to Re: Everyone PLEASE share your ENSAM updates? » pulse, posted by SFY on May 20, 2006, at 10:24:31
Thank you for your suggestion of oral selegiline, but I believe my response would be the same as Last Chance's, i.e. agitation only.
MY BIG concern from get-go was: not taking ANY oral med - as it passes right through the gut.
Until this year, my main problem/ dx was always Major Depression. Of course as one p-doc said, "with MDD, who wouldn't have anxiety ...never knowing - even on meds for it - when the next episode might hit me. I personally think they go hand in hand, if you have MDD, in nearly everyone, especially the more depressed you become. Now that I've thought of this, I must REALLY wonder how they found enough people with ONLY MDD for all their studies. I'm skeptical in a big way re: this.
End of last year, I went through 2 very traumatic events within 2 weeks of each other. My best guess is that this is why I'm still having so much more anxiety than ever before - PTSD commonly hitting within weeks to months AFTER events of this kind.
Having to go back on Zelnorm for constipation due entirely to Emsam, perhaps, after my washout is complete, I will be able to again tolerate Prozac (?).
Quitting the patch has made my tummy immediately MUCH better.BTW, I recently found out that some people get sick from the gelatin in capsules. Then, I found out that, unfortunately, brand name Prozac has stopped making their 10 mg. tablet. I can still get the generic in 10 mg. tablets. There is no other option left for me; I've tried all other ADs, in all classes (except Nardil, and I'm not willing to), and many, many combos. (I also can't tolerate ANY mood stabilizer GI-wise, for any additional help toward full remission).
pulse
Posted by Phillipa on May 20, 2006, at 18:55:44
In reply to Re: Everyone PLEASE share your ENSAM updates? » SFY, posted by pulse on May 20, 2006, at 15:23:45
Well what if the episode never ends it's been l0years for me. What started out as panic attacks has bencome MDD with agoraphobia , panic, fear of even my kids(grown) And going anywhere alone and being alone. What do I do take? Love Phillipa
Posted by pulse on May 20, 2006, at 23:39:23
In reply to Re: Everyone PLEASE share your ENSAM updates? » pulse, posted by Phillipa on May 20, 2006, at 18:55:44
My history seems quite different from yours, and I'm not that familiar with your story, as I only pop in here from time to time.
So, I wouldn't presume to tell you what to take.
Regards,
pulse
Posted by Jost on May 21, 2006, at 14:11:16
In reply to Re: Emsam 9 mg patch » strugglingsteve, posted by SFY on May 17, 2006, at 12:37:50
The Emsam package insert proscribes the following for those on the 9mg/24 hours. (This list is the full list, directly copied):
1. Meat, poultry, fish
- air dried, aged and fermented meats, sausages and salamis
- pickled herring
-any spoiled or improperly stored meat, poultry and fish. These are foods that have a change in color, odor, or become moldy.
-spoiled or improperly stored animal livers2. Vegetables
- broad bean pods (fava bean pods)
3. Dairy (milk products)
-aged cheeses
4. Drinks
-all tap beers and other beers that have not been pasteurized
5. Other
-concentrated yeast extract (such as Marmite)
-sauerkraut
-most soybean products (including soy sauce and tofu)
-over-the-counter supplements containing tyramineWill post acceptable foods in separate message. This will especially include drinks and cheeses that are acceptable.
Jost
Posted by Jost on May 21, 2006, at 14:19:42
In reply to Re: Emsam 9 mg patch--foods to be avoided, posted by Jost on May 21, 2006, at 14:11:16
This is the list from the Emsam package insert of acceptable foods, containing little or no tyramine, for those taking 9 mg and 12 mg/24 hours.
1 Meat, Poultry, Fish
-Fresh meat, poultry and fish, including fresh processed meats (such as lunch meats, hot dogs, breakfast sausage and cooked sliced ham)
2. Vegetables
-All other vegetables (except broad beans--see other list)
3. Dairy
-Processed cheeses, mozarella, ricotta cheese, cottage cheese, and yogurt
4. Drinks
-As with other antidepressants, concomitant use of alcohol with Emsam is not recommended. (Bottled and canned beers and wines contain little or no tyramine.)
5. Other
-Brewer's yeast, baker's yeast
-Soy milk
-Pizzas from commercial chain restaurants prepared with cheeses low in tyramine(Note: the unacceptable list applied also to those on 12 mg, of course.)
Jost
Posted by ZeitGuest on May 21, 2006, at 20:12:05
In reply to Re: Everyone PLEASE share your ENSAM updates? (nm), posted by zero on May 17, 2006, at 10:23:10
Day 17 on EMSAM.
So far, no beneficial effects yet.
As for negative effects, just one: I have had a noticeable increase in irritability, which may be my version of anxiety. Little things seem to be irritating me more than usual.
I've always had a proclivity for crankiness. When I was on Prozac (for ten years or so, give or take a few months off here and there in an effort to try new meds), the crankiness/nervousness was definitely mitigated. (I think I'm mildly afflicted by OCD, and pre-poopout Prozac completely irradicated that symptom.) But on EMSAM I've been feeling much more irritable than usual, and feeling more aggravated by mundane frustrations. Not sure if EMSAM itself is causing this, or if the patch (6mg) is just not working and I'm now steeping in my "natural state."
I definitely haven't felt motivated, energized or more sociable, as some on this site have. I was hoping that EMSAM would help me with my social anxiety and mild depression.
I'm wondering if some of the earlier "early adopters" on this site are still experiencing beneficial effects from EMSAM with regard to social anxiety. I believe RobertDavid commented on that effect early in his trial. So, RobertDavid, are you still feeling more socially engaged/motivated on EMSAM?
Posted by lymom3 on May 21, 2006, at 20:47:30
In reply to Re: Everyone PLEASE share your EMSAM updates?, posted by ZeitGuest on May 21, 2006, at 20:12:05
I am crankier too. Some days I think it's getting better, some days I'm not so sure. I know that over doing caffeine has a bad effect...become excessively tired.
I do feel other benefits and I'm on week 3, so I'm going to stick with it...might evaluate adding a med to help with that in a week or two.
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