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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 7 to 31 of 56. Go back in thread:
Posted by laima on August 20, 2006, at 9:11:26
In reply to Males with atypical depression- TCA or MAOI??, posted by Jimmyboy on August 20, 2006, at 8:30:23
Interesting- I never heard that before-You might end up needing to try both to see what ends up working best for yourself-it's not uncommon that the first med one tries isn't the right one.
> Ok, one last thing ... Most of the information I saw concerned women wih atypical depression, and not much on males who have it. Also saw some stuff that said women with atypical depression respond better to MAOI;s and men with it respond better to tricyclics. Does anyone have any information on this? Considering I have never tried either , I just really need to know which course to take here. Thanks
Posted by SFY on August 20, 2006, at 11:54:47
In reply to Re: EMSAM for atypical depression? Does it work? » Jimmyboy, posted by laima on August 20, 2006, at 7:59:51
> It would be the "maoi diet", though I seem to have the impression that it's not QUITE as dire to follow it as strictly as with some of the other maois. The diet basically restricts or forbids anything very fermented- ie, red wine, some types of beer, aged cheeses, over-ripe fruit, excess soy and soy sauce, etc. Some say chocolate, also (but for another reason.) So yes, can be a bummer- in my case the list is identical to all my favorite foods! Others on the thread likely know more about it than I do.
The MAOI diet is clearly and succintly laid out in the package insert for the 9 mg and 12 mg EMSAM patches: http://emsam.com/pdf/medguide.pdf
If you're going to go the oral meds route you would probably be better off trying Parnate which has demonstrated efficacy for atypical depression.
Posted by Phillipa on August 20, 2006, at 12:38:44
In reply to Re: EMSAM for atypical depression? Does it work?, posted by SFY on August 20, 2006, at 11:54:47
It seems like after a few days EMSAM gives people insomnia and rashes some not cleared with cortisone cream and one girl said she swelled up? Love Phillipa
Posted by linkadge on August 20, 2006, at 21:15:36
In reply to Males with atypical depression- TCA or MAOI??, posted by Jimmyboy on August 20, 2006, at 8:30:23
There are some gender differences when it comes to the responce to antidepressants.
Women tend to respond better to SSRI's, (and MAOIs?) while men respond better to TCA's.
I only know of a few studies which have adressed these ideas, but the theory was that it had to do with the way certain neurotransmitters interacted with hormones.
Linkadge
Posted by finelinebob on August 21, 2006, at 0:09:34
In reply to Males with atypical depression- TCA or MAOI??, posted by Jimmyboy on August 20, 2006, at 8:30:23
> Also saw some stuff that said women with atypical depression respond better to MAOI;s and men with it respond better to tricyclics. Does anyone have any information on this?
Only from personal experience. And half the story. Never had to try MAOIs. Nortriptyline turned the tide for me. My PDoc picked it because of all the "dirty" TCAs -- and they're all dirty little drugs, aren't they -- nortrip was seen as the least dirty ... that and imipramine.
Personally, I found SSRIs toxic ... pretty dang dirty to me. On the other hand, I had a few of the typical nortrip side effects for about 2 weeks then other than keeping my weight up (SSRI buffet had already given me an extra 30-40lbs) I've been free of side effects.
The way I see it, the neurochemical reaction that might be a "main effect" for one person can be someone else's "side effect" if you didn't need it. I have no problems with serotonin. I have problems with norepinephrine. I have side effects with SSRIs. I have clean results with TCAs.
Given the dietary restrictions and other concerns with MAOIs, take the easier road first. My $0.02.
Posted by jedi on August 21, 2006, at 2:47:41
In reply to Males with atypical depression- TCA or MAOI??, posted by Jimmyboy on August 20, 2006, at 8:30:23
> Ok, one last thing ... Most of the information I saw concerned women wih atypical depression, and not much on males who have it. Also saw some stuff that said women with atypical depression respond better to MAOI;s and men with it respond better to tricyclics. Does anyone have any information on this? Considering I have never tried either , I just really need to know which course to take here. Thanks
Hi,
I have treatment resistant atypical depression with social anxiety. Currently I take 75mg Nardil augmented with 1mg clonazepam. I have tried over 35 different combinations of medications for my atypical depression. Nardil is the only medication that has worked for me. I am male. Most PDOCs are going to take you through several SSRIs, a trial of at least one TCA, probably one of the SNRIs(Serotonin/Norepinepherine) and Wellbutrin or another newer med before they will let you try the MAOIs. If you get the right doctor they may let you skip a step or two. The wrong doctor will not even consider a MAOI.I have read a lot of research on MAOIs and atypical depression. The irreversible MAOIs seem to be the gold standard for treatment of this disease. I haven't read enough about EMSAM to say if it would work for some people. I don't know if the research has been done.
Nardil is going to be more expensive than the TCAs, most of which are out in generic. The market for Nardil is just to small for a generic company to get it approved in the US. I've read that a generic Parnate was just approved by the FDA and should be shipping.
Good Luck,
JediStudies:
Columbia atypical depression. A subgroup of depressives with better response to MAOI than to tricyclic antidepressants or placebo.
Link: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=8217065&query_hl=8&itool=pubmed_docsumResponse to phenelzine and imipramine in placebo nonresponders with atypical depression. A new application of the crossover design.
Link: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=2009033&query_hl=10&itool=pubmed_docsumPhenelzine versus imipramine in the treatment of probable atypical depression: defining syndrome boundaries of selective MAOI responders.
Link:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=3278631&query_hl=20&itool=pubmed_docsumDeprenyl in atypical depressives.
Link:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=6430257&query_hl=20&itool=pubmed_docsum
Posted by SFY on August 21, 2006, at 12:35:00
In reply to Re: EMSAM for atypical depression? Does it work? » SFY, posted by Phillipa on August 20, 2006, at 12:38:44
> It seems like after a few days EMSAM gives people insomnia and rashes some not cleared with cortisone cream and one girl said she swelled up? Love Phillipa
EMSAM (like alll MAOIs) exacerbates my early morning awakening problem but 25 mg of diphenhydramine (generic Benadryl) takes care of it for the most part. I've had no skin rashes or irritation from the patch and I only switch it back and forth from one upper arm to the other.
Posted by Phillipa on August 21, 2006, at 13:40:10
In reply to Re: EMSAM for atypical depression? Does it work? » Phillipa, posted by SFY on August 21, 2006, at 12:35:00
Is there a site put out by the company or any other sites that have EMSAM comments? And my own pdoc put one lady one EMSAM and said the rash became blistering even with cortisone cream so she had to take her off it even though it was helping. They tried all sorts of meds none worked for the rash. And if you've been on benzos for over 30yrs what would help with the early morning wakenings? And some say no side effects till around day nine. Love Phillipa
Posted by Jimmyboy on August 21, 2006, at 16:31:03
In reply to Re: EMSAM for atypical depression? Does it work? » Phillipa, posted by SFY on August 21, 2006, at 12:35:00
I am starting the 6 mg EMSAM patch tomm. what would the equivalent oral dose be for the 6 mg patch? Is that theoretically in the range that people will have aresponse to? How long does it take for EMSAM to start working?
Does anyone know if Lithium is " synergistic" with EMSAm, like it is purported to be with other AD's?
JB
Posted by Jimmyboy on August 21, 2006, at 17:21:27
In reply to Re: EMSAM 6 mg patch = what oral dose?, posted by Jimmyboy on August 21, 2006, at 16:31:03
Oh yeah, also wondering if you can combine EMSAM w/ DLPA . I had success for a time on low dose selegiline (5mg) and DLPA. Just wondering if that was an option as an add on with EMSAM.
Posted by laima on August 21, 2006, at 20:34:26
In reply to Re: EMSAM 6 mg patch = what oral dose?, posted by Jimmyboy on August 21, 2006, at 16:31:03
The information floating around seems a bit unclear, though there is some consensus that the "6" patch is roughly equivalent to 20 mg oral selegeline. Others may beg to differ. Unfortunately, several weeks may pass before you can tell if it is working for you or not.Good luck!
> I am starting the 6 mg EMSAM patch tomm. what would the equivalent oral dose be for the 6 mg patch? Is that theoretically in the range that people will have aresponse to? How long does it take for EMSAM to start working?
>
> Does anyone know if Lithium is " synergistic" with EMSAm, like it is purported to be with other AD's?
>
> JB
Posted by laima on August 21, 2006, at 20:37:07
In reply to Re: EMSAM + DLPA?, posted by Jimmyboy on August 21, 2006, at 17:21:27
Technically no, but practically probably yes. I am using some l-phenylalanine, and it's working well together. I understand that the danger may be a rise in blood pressure..so if you try, do so VERY VERY VERY conservatively.
> Oh yeah, also wondering if you can combine EMSAM w/ DLPA . I had success for a time on low dose selegiline (5mg) and DLPA. Just wondering if that was an option as an add on with EMSAM.
Posted by Phillipa on August 21, 2006, at 21:13:26
In reply to Re: EMSAM + DLPA? » Jimmyboy, posted by laima on August 21, 2006, at 20:37:07
laima are you still on EMSAM and what dose and side effects. We need a journal like Scott has from all the EMSAM users. Day l Day 2 and what happens on those days. Love Phillipa
Posted by laima on August 21, 2006, at 21:51:47
In reply to Re: EMSAM + DLPA? » laima, posted by Phillipa on August 21, 2006, at 21:13:26
Yes, I'm still on the "9" and I owe you an email. It's working out reasonably well. For the first few weeks I considered it to be nothing but unsticky scotch-tape, but now that I went up on the dose I think it's doing something. I've also recently been "unofficially" been experimenting with using teeny amount of l-phenylalanine with it (breaking the 500mg capsule and using about a 5th of it) and that seems to have made a colassal difference. But don't tell my doctor...Main side effect that I've been grappeling with is unstable, meaning usually VERY low blood pressure (like 90 over 60) -that means weakness and sleepiness. I was using 15 mg ritalin while using the 6, but doctor took that away once I went up to the 9 because he thought it was contributing to anxiety. But it seems to me that my blood pressure and anxiety went way up during a recent heat spell that we had here were I live. I'm going to talk to him about wanting to go back to using perhaps a smaller amount of ritalin, because it kept my blood pressure up to a livable and stable level. Basically, having gone up on the Emsam, I think I should go DOWN on ritalin, not cut it altogether. If he agrees, I'll probably dump the phenylalanine.
> laima are you still on EMSAM and what dose and side effects. We need a journal like Scott has from all the EMSAM users. Day l Day 2 and what happens on those days. Love Phillipa
Posted by Phillipa on August 21, 2006, at 22:39:35
In reply to Re: EMSAM + DLPA? » Phillipa, posted by laima on August 21, 2006, at 21:51:47
Laima I'm really glad to hear you're still doing well. But a common denominator I've picked up on EMSAM users is that they start doing and taking meds they shouldn't and get into trouble. Not you others I know of. Please don't okay? Love Phillipa
Posted by laima on August 21, 2006, at 22:53:59
In reply to Re: EMSAM + DLPA? » laima, posted by Phillipa on August 21, 2006, at 22:39:35
Thank you Phillipa, I assure you I am actually very, very conservative- no matter how it looks. I saw some studies that indicated phenylalanine boosted the effects of selelegeline- but I consede, you warning is absolutely valid. You are pointing out something important. I just get desperate for relief... I have a doctor appointment in couple of days, I will talk about my low blood pressure/severe fatigue problem.Thank you for your concern though- it really does feel nice and reassuring to have someone concerned about me :)
Laima
> Laima I'm really glad to hear you're still doing well. But a common denominator I've picked up on EMSAM users is that they start doing and taking meds they shouldn't and get into trouble. Not you others I know of. Please don't okay? Love Phillipa
Posted by Jimmyboy on August 22, 2006, at 8:49:30
In reply to Re: EMSAM + DLPA? » Phillipa, posted by laima on August 21, 2006, at 22:53:59
Just wondering...
Posted by Phillipa on August 22, 2006, at 19:56:17
In reply to Has ANYONE had success on just 6mg EMSAM?, posted by Jimmyboy on August 22, 2006, at 8:49:30
I need to know too. Love Phillipa
Posted by laima on August 22, 2006, at 20:05:41
In reply to Re: Has ANYONE had success on just 6mg EMSAM? » Jimmyboy, posted by Phillipa on August 22, 2006, at 19:56:17
> I need to know too. Love Phillipa
I've heard from my doctor that he went to an "Emsam conference" (for doctors) and that one guy stood up and said he treated over 150 people successfully with the 9 and 12, but almost no one with just "6". So I want to know too- is this true? Or what?
I'm getting more of a low blood pressure tank on 9 now than I've ever experienced before in my life...
Posted by Phillipa on August 22, 2006, at 20:34:08
In reply to Re: Has ANYONE had success on just 6mg EMSAM?, posted by laima on August 22, 2006, at 20:05:41
laima do you have anxiety? Now and before EMSAM? Love Phillipa
Posted by laima on August 22, 2006, at 20:45:07
In reply to Re: Has ANYONE had success on just 6mg EMSAM? » laima, posted by Phillipa on August 22, 2006, at 20:34:08
> laima do you have anxiety? Now and before EMSAM? Love Phillipa
Yes, it's been a problem. My depression has always has some kind of stress/not coping well with stress component to it. The meds can balance it out nicely, but they can get knocked off balance easily. It's so frustrating. A few small events over past few days- insignificant things really, really stressed me to ridiculous levels. Ie, ran into old boss who made a snide comment. Hope to get back to an equilibrium soon!
Posted by Jimmyboy on August 22, 2006, at 20:45:58
In reply to Re: Has ANYONE had success on just 6mg EMSAM?, posted by laima on August 22, 2006, at 20:05:41
Hey Laima,
STarted the EMSAM today and tried the miniscule dose of DLPA with it and immediately felt better and felt alot better after exercising.
Do you know how much DLPA you could safely add? Because it seems to add a good kick to the EMSAM.
JB
Posted by laima on August 22, 2006, at 20:53:51
In reply to EMSAM - DLPA laima, posted by Jimmyboy on August 22, 2006, at 20:45:58
So true! Isn't it amazing? Astonishing actually. But no, I have no idea. The studies I googled up and examined were quite different from using Emsam- ie, they involved something like 5-10 mg oral selegeline with 500mg or so of phenylalanine. So, very, very ,very conservative experimenting seem crucial to avoid any possible spike in blood pressure. The "6" patch is said to be roughly /vaguely equivalent to 20mg of oral selegeline. No accidents wanted...> Hey Laima,
>
> STarted the EMSAM today and tried the miniscule dose of DLPA with it and immediately felt better and felt alot better after exercising.
>
> Do you know how much DLPA you could safely add? Because it seems to add a good kick to the EMSAM.
>
> JB
Posted by mayzee on August 22, 2006, at 21:10:31
In reply to EMSAM - DLPA laima, posted by Jimmyboy on August 22, 2006, at 20:45:58
JB or Laima,
Could you please explain what DLPA is?
Thanks,
mayzee
(on the 6mg EMSAM patch, about to start adding Ritalin)
Posted by laima on August 22, 2006, at 21:11:08
In reply to EMSAM - DLPA laima, posted by Jimmyboy on August 22, 2006, at 20:45:58
Just want to say again, please be careful-I almost feel guilty to have mentioned it lest it end up causing a problem for anyone. Please google and use your own safety judgement! But it sure is effective...
> Hey Laima,
>
> STarted the EMSAM today and tried the miniscule dose of DLPA with it and immediately felt better and felt alot better after exercising.
>
> Do you know how much DLPA you could safely add? Because it seems to add a good kick to the EMSAM.
>
> JB
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