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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 340 to 364 of 431. Go back in thread:
Posted by WirelessWally on August 27, 2006, at 12:34:59
In reply to Re: EMSAM - 30 days and beyond, posted by WirelessWally on August 21, 2006, at 18:38:07
I am on my 21st day with EMSAM. I find that I am doing much more activity wise but still feel a lack of joy in my life. Also I am still not very patiant or tolerant of things/others. Will this improve as I gain more time on ENSAM? I also take clonazepam .5mg 4 times a day which seems to help with my agitation. BTW I just checked the response box. Wally
Posted by Mimi321 on September 4, 2006, at 23:44:10
In reply to Re: Emsam Price, posted by Iansf on April 13, 2006, at 16:39:26
Why is everyone using (or wanting to use) Emsam when you can get selegeline in a topical cream from a compounding pharmacist for 50-100 dollars a month depending on how much you shop around. It works the same as a patch, but you rub it on your skin once a day. You get the same options of dosage. Just need a prescription and go to a compounding pharmacist. YOu can find a list of them in your area - just google and poke around.
Here's another option: you can order liquid selegeline on the web with no prescription - its sold as a supplement under the names denepryl, selepril, ceprenyl (spelling may be off). it costs 57-65$ for 300ml which translates into about a months supply (a drop contains one mg, so 6 drops a day is one lowest dose.) YOu can put it under the tongue or rub on skin or use intra-vaginal (good absorption). you just google 'deprenyl' and you'll see it. its not a controlled substance, so its my understanding that its legal to sell in the u.s. Good luck all - I just started the liquid selegeline and will see how it goes.
Posted by Phillipa on September 5, 2006, at 19:43:31
In reply to Re: Emsam Price, posted by Mimi321 on September 4, 2006, at 23:44:10
How come no one has told us of this? The Patch was the big breakthrough. That's how I used hormones from a compounding pharmacy in a cream. Anyone else know of this? Love Phillipa
Posted by SFY on September 6, 2006, at 12:56:29
In reply to Re: Emsam Price, posted by Mimi321 on September 4, 2006, at 23:44:10
The price of Emsam luckily isn't an issue for me since my insurance covers it.
But even if it were, I don't think that a cream would be an adequate substitute for Emsam. While it would have the benefit of delivering selegiline transdermally, the dosage would likely not be delivered in a continuous, constant timed-release fashion over 24 hours. It would probably cause a dosage spike right after the time of application and might require more than one daily application to smooth out the selegiline delivered.
Posted by mimi321 on September 6, 2006, at 13:43:06
In reply to Re: Emsam Price » Mimi321, posted by Phillipa on September 5, 2006, at 19:43:31
> How come no one has told us of this? The Patch was the big breakthrough. That's how I used hormones from a compounding pharmacy in a cream. Anyone else know of this? Love Phillipa
I dunno - I thought of the compounding issue myself and then comtacted compounding pharmacists, and I found out about denepryl (liquid selegeline - the active ingred in emsam) by poking around on the web. Like I say - just google 'denepryl' or liquid selegeline or ceprenil or selephyl (spelling on last 2 might be off) and you will find it for sale by the 300 ml bottle. pass it around - i think emsam is outrageous unless you have insurance that covers. do others a favor - if you are on the other boards (anxiety, etc) feel free to copy the info from my post and put it up so others can see. it breaks my heart to hear that others are spending 400 that they cant afford on monthly meds, or worse - going without.
Posted by dbc on September 8, 2006, at 0:43:16
In reply to Re: Emsam Price, posted by Mimi321 on September 4, 2006, at 23:44:10
I havent seen anyone having much luck with any oral solution. Belive me i really considered it when i saw the insane price of emsam. Redosing is an issue also as the oral solutions only have a half life of 3 to 4 hours and most only come available in very small doses (1mg droppers) that are intended for the nootropic market.
Posted by Jost on September 21, 2006, at 21:28:07
In reply to Re: Emsam Price, posted by SFY on September 6, 2006, at 12:56:29
My pdoc just told me that the company making Emsam doesn't promise constant, time-release absorption of the drug from the patch.
More likely, absorption varies considerably. First of all, it varies from person to person. But also, it varies within 24 hours.
The most the company claims is that you'll get about 6 mg (actually probably between 4-6 mg) from the 6 mg patch every twenty-four hours. But there's a good chance, for example that the highest absorption could be at the beginning right after application of the patch.
I'm not sure this matter so much, under good conditions, as long as you replace the patch every 24 hours.
Jost
Posted by WeeWilly on September 21, 2006, at 22:55:11
In reply to Re: Emsam: constant dosing?, posted by Jost on September 21, 2006, at 21:28:07
> My pdoc just told me that the company making Emsam doesn't promise constant, time-release absorption of the drug from the patch.
>
> More likely, absorption varies considerably. First of all, it varies from person to person. But also, it varies within 24 hours.
>
> The most the company claims is that you'll get about 6 mg (actually probably between 4-6 mg) from the 6 mg patch every twenty-four hours. But there's a good chance, for example that the highest absorption could be at the beginning right after application of the patch.
>
> I'm not sure this matter so much, under good conditions, as long as you replace the patch every 24 hours.
>
> JostInteresting. I have been on Emsam for about 1 month. 2 weeks or so on 12mg. I have been leaving each patch on for 48 hrs. I wear 2 patches. So far my response has been disapointing. Seeing my Pdoc 9/26 tues and I am leaning toward discontinuing Emsam and maybe trying Marplan. Many years ago when I first tried Parnate my response was complete within a 1/2 hour it remained great for 3 months then abruptly quit. Increased the dose to 100 mg's with no luck. Every year since then I have returned to Parnate for 3 months per year. Usually the response is quick and last 3 months. Last spring it was not quite so good, likely because of my being on Nardil a few months before the parnate. Nardil was not as effecatious as Parnate. It also lost its effectiveness after 3 months. I sure thought I would stumble onto a treatment long ago but providence has'nt provided that. At one time I responded great to sleep deprivation, but not anymore. If you knew my existence you would not believe how strange it is. Oh well, thems the cards I have been dealt. I often wonder if I am playing them the best possible way. I think so. Of course if I did'nt have the disableing symptoms of this disorder I could be more organized in recording factors in my condition and analyzing the best course of action then do it. I would like to hook up with an influential research scientist at NIMH or similar place. I think I have unique information that I have accumulated that would illuminate disorders such as mine. I'm running on here so I'll just wish you all the best fortune. Thanks for listening.
Posted by Jost on September 22, 2006, at 3:35:00
In reply to Re: Emsam: constant dosing? » Jost, posted by WeeWilly on September 21, 2006, at 22:55:11
Hi. Do you use two 12 mg patches for 48 hours to achieve the same dose as 12 mg?
Why the 48 hours? The patch apparently is set up for 24-hour use. Although there's enough emsam for more than 6 mg (on the 6 mg patch), I'm not sure there's any claim by the company that you'd get any particular amount in the second 24 hours.
From what my pdoc said, if you use any size for 24 hours, there's real chance you're getting most of the drug absoption in the first hours, and then less for the latter part of the period. This could be even more so in a 48 hour period.
So if some of the effect is from the amphetamine, you'd be possibly getting much less of that after the first some hours-- leading to a shifting dose.
Did you and your pdoc come to the conclusion that a high emount for a few hours every 48 hours and lesser amounts for the rest was a better rhythm for you?
Jost
Posted by WeeWilly on September 22, 2006, at 15:05:03
In reply to Re: Emsam: constant dosing? » WeeWilly, posted by Jost on September 22, 2006, at 3:35:00
> Hi. Do you use two 12 mg patches for 48 hours to achieve the same dose as 12 mg?
>
> Why the 48 hours? The patch apparently is set up for 24-hour use. Although there's enough emsam for more than 6 mg (on the 6 mg patch), I'm not sure there's any claim by the company that you'd get any particular amount in the second 24 hours.
>
> From what my pdoc said, if you use any size for 24 hours, there's real chance you're getting most of the drug absoption in the first hours, and then less for the latter part of the period. This could be even more so in a 48 hour period.
>
> So if some of the effect is from the amphetamine, you'd be possibly getting much less of that after the first some hours-- leading to a shifting dose.
>
> Did you and your pdoc come to the conclusion that a high emount for a few hours every 48 hours and lesser amounts for the rest was a better rhythm for you?
>
> Jost
Hello Jost,I use 12mg patches. Each one stays on 48 hours. In the morning I take off the patch that has been on 48 hrs and put a new one on. So each morning I start with a new 12mg patch and the one that has been on for 24 hrs. Maybe the patch totally depletes in 24 hrs, I don't know.
Emsam on its own is not producing much of a response in me. If I add 15 or 20mg of Adderall, there is some response but not great. I would like to use Emsam alone for awhile to see its effecacy alone. But I need to accomplish some projects right now and for this past month on Emsam I have done so little.
I am sort of on my own in my treatment plan. I would have to travel 4 to 5 hrs to a large city to possibly find a Psychopharmacologist that would treat my condition out side the box like is needed. Finding a doc to prescribe treatments like stimulants with MAOI's or other legitimate aggressive coctails is very diffucult in this area of the country and probably most places. You read of people struggling to find a doc who will prescribe MAOI's alone. It's so ridiculous.
Are you doing quite well with the Emsam? I'm sure I have read how long and what dose you are currently on, but could you update me on this and what if anything you are adding to it. Thanks and best wishes.
Posted by Jost on September 22, 2006, at 19:16:14
In reply to Re: Emsam: constant dosing?, posted by WeeWilly on September 22, 2006, at 15:05:03
I'm doing really well-- at least until a recent problem-- but I'm planning to start again.
I must be lucky-- I have a pdoc who's really dedicated to finding what works. He'll do maois and other things --. He did that for me- He's extremely careful-- and keeps up with all the developments, but really cares about helping patients to find the best treatment available.
If he thinks the combo is potentially okay, but potentially not--and knows you'll be careful and keep him informed of any problems that arise-- he''ll go ahead-- and then pull back, very firmly, if any adverse reactions arise. I always check with him, if I have any doubt about what's happening-- I'm pretty careful myself if things don't feel right.
I was doing 12 mg of emsam, and taking it off at night, for 5-6 hours, and then putting it on and sleeping a few more hours. Seems to work really well- but I've had a good response to emsam. -- That amounted to about 9 mg (approximately).
I was using it with provigil (about 200 mg a day, sometimes more), and possibly ritalin-- although I'm not sure if the ritalin will work-- I had an adverse reaction--I'm sure to the Emsam, but don't know if the ritalin played a role. It remains to be seen when I start up again.
I might not need ritalin, though. I'll stick with the provigil, however. Ensam has given me a lot more energy, and a much better outlook-- I'm much less depressed, and easily thrown by situations, more confident, and less prone to negative ruminations.
At the beginning, after using 6 mg and feeling like I needed more than 6--but also having bad insomnia, I switched to 18 mg for 12 hours a day. After a while, I noticed was getting much more irritable, easily upset, and prone to constant agitation. It was extremely uncomfortable and oppressive, until I thought about the amount-- and went down to 12 mg, taken off at night for 6 hours or so. I felt much better pretty quickly--and also slept better, too.My sense is that you have to accommodate fairly slowly and make sure not to go up too quickly. Going up too quickly on the assumption that, as with most ADs, you'll reach a therapeutic dose, over time, by doing that-- might be a bad strategy with Emsam.
But then I'm not a pdoc-- and probably the data aren't in. I just worry that maybe some people are missing a good drug because taking too much, esp. too soon, is counterproductive-- ? I could be wrong, though.
Jost
Posted by WeeWilly on September 22, 2006, at 22:14:14
In reply to Re: Emsam: constant dosing? » WeeWilly, posted by Jost on September 22, 2006, at 19:16:14
> I'm doing really well-- at least until a recent problem-- but I'm planning to start again.
>
> I must be lucky-- I have a pdoc who's really dedicated to finding what works. He'll do maois and other things --. He did that for me- He's extremely careful-- and keeps up with all the developments, but really cares about helping patients to find the best treatment available.
>
> If he thinks the combo is potentially okay, but potentially not--and knows you'll be careful and keep him informed of any problems that arise-- he''ll go ahead-- and then pull back, very firmly, if any adverse reactions arise. I always check with him, if I have any doubt about what's happening-- I'm pretty careful myself if things don't feel right.
>
> I was doing 12 mg of emsam, and taking it off at night, for 5-6 hours, and then putting it on and sleeping a few more hours. Seems to work really well- but I've had a good response to emsam. -- That amounted to about 9 mg (approximately).
>
> I was using it with provigil (about 200 mg a day, sometimes more), and possibly ritalin-- although I'm not sure if the ritalin will work-- I had an adverse reaction--I'm sure to the Emsam, but don't know if the ritalin played a role. It remains to be seen when I start up again.
>
> I might not need ritalin, though. I'll stick with the provigil, however. Ensam has given me a lot more energy, and a much better outlook-- I'm much less depressed, and easily thrown by situations, more confident, and less prone to negative ruminations.
>
>
> At the beginning, after using 6 mg and feeling like I needed more than 6--but also having bad insomnia, I switched to 18 mg for 12 hours a day. After a while, I noticed was getting much more irritable, easily upset, and prone to constant agitation. It was extremely uncomfortable and oppressive, until I thought about the amount-- and went down to 12 mg, taken off at night for 6 hours or so. I felt much better pretty quickly--and also slept better, too.
>
> My sense is that you have to accommodate fairly slowly and make sure not to go up too quickly. Going up too quickly on the assumption that, as with most ADs, you'll reach a therapeutic dose, over time, by doing that-- might be a bad strategy with Emsam.
>
> But then I'm not a pdoc-- and probably the data aren't in. I just worry that maybe some people are missing a good drug because taking too much, esp. too soon, is counterproductive-- ? I could be wrong, though.
>
> Jost
>
>
>
>
>
Hey Jost,I envy your relationship with your Pdoc. From my experience with many docs and what I read of others it seems that the wellfare of the patient is way down on the priority list. Could you elaborate on the adverse reaction you had? Do you think Emsam has a chance to work as monotherapy for you without the Provigil? I am hopeing it will work well enough on its own for me. There are so many draw backs to polypharmacy. Anyway I sure wish you the best of fortune. Thanks for the update.
Posted by Jost on September 24, 2006, at 10:41:29
In reply to Re: Emsam: constant dosing? » Jost, posted by WeeWilly on September 22, 2006, at 22:14:14
I do think Emsam would work as monotherapy. I had used provigil for a long time because of insomnia, and insomnia was a problem when I first started the Emsam, and for quite a while. It has started to get better, and I have no more problem than before I started. It's really a good idea, if you have insomnia, to take the patch off for five or six hours (or even more) at night. It helped me stay with the Emsam, because the insomnia was quite bad. I often wake up anyway, and so I put it on toward the end of my sleep-- and can sleep a few more hours without much trouble.
My pdoc said he has eight patients on Emsam, who are doing well. I don't know if they're also had insomnia problems, but that's been mentioned here pretty frequently.
The energy I get from Emsam helps a lot, even on days without quite enough sleep, so I wouldnt necessarily need the provigil either. But on some days, it helps.
Provigil a pretty benign drug, from what I've seen and has some AD effects, too. Nothing like the stronger stimulants like adderall, or dexedrine.
My recent problem was from what seems to be an overdose, possibly from defective packets, and exercising in the heat. I don't think the dose I got would be a normal thing-- but be cautious about heat, such as baths, hottubs, saunas, heating pads. Heat seems to increae the dose quite a bit, especially if you absorb the drug easily. (The delivery system doesn't have a precise target amount, but rather a range of absorption.)
Maybe your pdoc would be more open to provigil. If not, I'd try the Emsam anyway. My advice (which might not be right for you, of course) would be not to go up too quickly on the dose for Emsam, esp. if you get irritability or the insomnia.
Good luck! I hope it works out for you.
Jost
Posted by WirelessWally on September 24, 2006, at 14:35:45
In reply to Re: Emsam: constant dosing? » WeeWilly, posted by Jost on September 24, 2006, at 10:41:29
> I do think Emsam would work as monotherapy. I had used provigil for a long time because of insomnia, and insomnia was a problem when I first started the Emsam, and for quite a while. It has started to get better, and I have no more problem than before I started. It's really a good idea, if you have insomnia, to take the patch off for five or six hours (or even more) at night. It helped me stay with the Emsam, because the insomnia was quite bad. I often wake up anyway, and so I put it on toward the end of my sleep-- and can sleep a few more hours without much trouble.
>
> My pdoc said he has eight patients on Emsam, who are doing well. I don't know if they're also had insomnia problems, but that's been mentioned here pretty frequently.
>
> The energy I get from Emsam helps a lot, even on days without quite enough sleep, so I wouldnt necessarily need the provigil either. But on some days, it helps.
>
> Provigil a pretty benign drug, from what I've seen and has some AD effects, too. Nothing like the stronger stimulants like adderall, or dexedrine.
>
> My recent problem was from what seems to be an overdose, possibly from defective packets, and exercising in the heat. I don't think the dose I got would be a normal thing-- but be cautious about heat, such as baths, hottubs, saunas, heating pads. Heat seems to increae the dose quite a bit, especially if you absorb the drug easily. (The delivery system doesn't have a precise target amount, but rather a range of absorption.)
>
> Maybe your pdoc would be more open to provigil. If not, I'd try the Emsam anyway. My advice (which might not be right for you, of course) would be not to go up too quickly on the dose for Emsam, esp. if you get irritability or the insomnia.
>
> Good luck! I hope it works out for you.
>
> JostJost, Just read your post. I have been on EMSAM for about 7wks. now. I am also on Risperdal (.5mg/day). I started the fist month at the 6mg dosage and at the third week found I had a ton of energy but lacked much joy in my life. At the 4mo. period the doc moved me up to the 9mg patch. At this dose I have been on for three weeks. I have lost much of my energy and seem more mellow. I do have joy in my life but miss the energy I had at the 6mg dosage. I have not heard of Provigil and wonder if that would help me gain some energy back. My blood pressure has dropped dramatically at this dose and no longer take any BP meds. It seems that I have also lost the laughter and joking around I used to do. I wonder if any of this will return the longer I stay at this dosage. No real insomnia but i do wake up early (6:00am) So far I like the way I emotionally feel but miss the energy. I feel like I have had a personality change of sorts because I used to always be joking and laughing even when depressed, it just felt forced or false. I have been thinking about going back to the 6mg dose but will wait it out if the energy and laughter would return in due time. I see the doc on the 6th of Oct and do not yet know what direction to take. The doc is open to my suggustions as long as they are within reason. Your Thoughts? Wally
Posted by teddi52 on October 3, 2006, at 8:00:57
In reply to Re: Emsam: constant dosing? » Jost, posted by WeeWilly on September 21, 2006, at 22:55:11
Has anyone experienced severe neck and upper back pain on EMSAM. I have cervical dystonia, and cannot continue EMSAM because of the pain I am experiencing. Any suggestions. I was on 6 mg for 2 weeks with minor pain, then 12 mg for two weeks with severe pain. Thanks
Posted by crimsonvik on November 1, 2006, at 15:09:04
In reply to Re: EMSAM - First Day -- what to try for insomnia?, posted by ttee on July 21, 2006, at 0:11:54
My Dr. says I CAN take Benadryl on the patch. Yaah!
Posted by Jeffy on November 26, 2006, at 18:03:08
In reply to Re: Emsam Price, posted by SFY on September 6, 2006, at 12:56:29
Hi.
Do you REALLY have to be off SSRI's BEFORE you take Selegiline or Tianeptine?
Grateful for any insight, thanks!
- Jeffy.
Posted by Phillipa on November 26, 2006, at 19:27:11
In reply to SSRI waiting time?, posted by Jeffy on November 26, 2006, at 18:03:08
Someone who just started EMSAM said one week on the leaflet in the box after stopping an SSRI. But my pdoc said two weeks. Google the site to be safe Love Phillipa
Posted by Jeffy on November 26, 2006, at 20:35:55
In reply to Re: SSRI waiting time? » Jeffy, posted by Phillipa on November 26, 2006, at 19:27:11
Thanks, P - anyone else? - Jeff.
> Someone who just started EMSAM said one week on the leaflet in the box after stopping an SSRI. But my pdoc said two weeks. Google the site to be safe Love Phillipa
Posted by stargazer on November 27, 2006, at 12:16:53
In reply to Re: SSRI waiting time? » Phillipa, posted by Jeffy on November 26, 2006, at 20:35:55
According to EMSAM package insert, a time period equal to 4-5 half lives (approx 1 week) of treatment with SSRI's, SNRI's, TCA's, MAOI's, meperidine and other analgesics (listed in package insert) should elapse before starting Emsam.
The exception is for prozac where you should wait 5 weeks due to it's long half life. Buspar requires 2 week washout. Those are the only two exceptions to the 1 week rule.
Stargazer (Ensam day 10+)
Posted by Jeffy on November 27, 2006, at 12:23:55
In reply to Re: SSRI waiting time?, posted by stargazer on November 27, 2006, at 12:16:53
Thanks Stargazer and best of luck with the patch. Anyone else on waiting time? - Jeffy.
Posted by Jeffy on November 27, 2006, at 12:24:23
In reply to Re: SSRI waiting time?, posted by stargazer on November 27, 2006, at 12:16:53
Thanks Stargazer and best of luck with the patch. Anyone else on waiting time? - Jeffy.
Posted by ryanz on January 2, 2007, at 16:43:16
In reply to Re: EMSAM - First Day -- what to try for insomnia? » mayzee, posted by SFY on July 20, 2006, at 13:51:19
According to what I've read, benadryl is technically not supposed to be used with MAOI's, nor is Tylenol according to at least one source.
(Benadryl is the active ingredient in over-the-counter sleep aids as well, for those who weren't aware of this).It seems like it would go doubly so for Benadryl, because it also acts as an SSRI, although most people do not know this. And SSRI's are also contraindicated while taking MAO inhibitors.
But, has anyone taken benadryl as a sleep aid or for allergies with EMSAM, and did you have any problems? Thanks.
Posted by CrimsonVik on January 2, 2007, at 16:51:54
In reply to Re: EMSAM: taking it with benadryl/diphenhydramine, posted by ryanz on January 2, 2007, at 16:43:16
Benadryl is about the only medication of that type we can use. I use it all the time when I don't have Ambien.
If you're concerned, check Benadryl's label. There is no MAOI warning on it.
My Dr. told me all this initially.
Vik> According to what I've read, benadryl is technically not supposed to be used with MAOI's, nor is Tylenol according to at least one source.
> (Benadryl is the active ingredient in over-the-counter sleep aids as well, for those who weren't aware of this).
>
> It seems like it would go doubly so for Benadryl, because it also acts as an SSRI, although most people do not know this. And SSRI's are also contraindicated while taking MAO inhibitors.
>
> But, has anyone taken benadryl as a sleep aid or for allergies with EMSAM, and did you have any problems? Thanks.
Posted by ryanz on January 2, 2007, at 17:33:19
In reply to Re: EMSAM: taking it with benadryl/diphenhydramine » ryanz, posted by CrimsonVik on January 2, 2007, at 16:51:54
> Benadryl is about the only medication of that >type we can use. I use it all the time when I >don't have Ambien.
> If you're concerned, check Benadryl's label. >There is no MAOI warning on it.
> My Dr. told me all this initially.
> Vik
>You're probably right, but to be fair:
I checked for a drug interaction between parnate and benadryl at drugs.com and it shows a moderate drug interaction (basic warning about taking Benadryl and other antihistamines with MAOI's).
Also, Benadryl does reportedly potently block the reuptake of serotonin, although most psychiatrists and pharmacists probably don't even know this.
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