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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 86. This is the beginning of the thread.
Posted by stargazer on November 15, 2006, at 13:44:49
Well I applied the first patch today. I stopped Cymbalta about 7 days ago. I informed my doc that the washout period is 5 days according to the package insert, not 14 days as he had thought.
I am on Seroquel 100 at night and have been feeling lightheaded for a few weeks. My pdoc want me to continue on the Seroquel for now. Since Ensam is a MAO inhibitor, what affect will there be between Seroquel and ENSAM. I have read both package inserts and neither one says that Ensam should not be given with seroquel, but for those of you who get the pharmodynamics behind the drugs, what can be expected between a MAI inhibitor (Ensam) and a multiple neurotransmittor antagonistlike Seroquel.
Do the two compete with one another and leave you at square one. I want to make sure this drug trial has the best chance to succeed. My pdoc does not get say the two are contraindicated but they may be competitive, right?
Thanks for any insight into taking both of these and whether I should get off of Seroquel completely or perhaps just reducing the dose for now.
SG
Posted by med_empowered on November 15, 2006, at 14:58:26
In reply to ENSAM: DAY 1...6 mg/24 hr...w seroquel, OK?.., posted by stargazer on November 15, 2006, at 13:44:49
back in the day there used to be a combo drug (I think this may still be around in parts of Europe) that combined an MAOI (old one) and phenothiazine-type neuroleptic. I think the idea was that the neuroleptic would soothe any agitation from the antidepressant and ease anxiety, while the antidepressant would lift the patient's spirits. I imagine it would also be a useful combo for anxious depressives and agitated depression....so, anyway, the combo's been done before. As long as Seroquel doesn't do any serious re-uptake inhibition (I don't think it does, but you might wanna check it out), you should be good to go. The seroquel might make the antidepressant work better, or at least reduce unwated stimulant side effects.
If you think the seroquel is causing problems, could you discontinue it?
Posted by Phillipa on November 15, 2006, at 18:18:41
In reply to Re: ENSAM: DAY 1...6 mg/24 hr...w seroquel, OK?.., posted by med_empowered on November 15, 2006, at 14:58:26
Oh Stargazer you started. I'm so excited for you. And know that you have a good pdoc from where you live. Is there a reason it's seroquel just asking as the first EMSAM users always used klonopin . Hummm maybe that's why it failed. Love Phillipa
Posted by Phillipa on November 15, 2006, at 18:20:59
In reply to Re: ENSAM: DAY 1...6 mg/24 hr...w seroquel, OK?.., posted by Phillipa on November 15, 2006, at 18:18:41
Stargazer that sounded not right as I do know someone on EMSAM doing well now Darn I wish I had your E-mail I could put the two of you together. Think she may take an antipsychotic with it too. Love Phillipa
Posted by stargazer on November 15, 2006, at 22:13:16
In reply to Re: ENSAM: DAY 1...6 mg/24 hr...w seroquel, OK?.., posted by Phillipa on November 15, 2006, at 18:20:59
Phillipa,
I will send you my email in Babblemail today.
The only reason I was put on Seroquel was that my depression got so much worse when I tried Cymbalta and my pdoc thought it would help override the negative effects of Cymbalta and it did. It got me out of the depression while I tapered off Cymbalta (stopped it after 2 days and bit the bullet with side effects of dizziness, not too bad, since I was only on it perhaps 2 weeks at 30 mg, since 60 mg made my head almost blow off).
So my only concern is not knowing if Seroquel can minimize my reaction to Ensam or not, since Ensam blocks the enzyme that metabolizes Dopamine and I think Seroquel blocks the action of Dopamine (Dopamine antagonist). To me they sound like they compete with one another but I read the package insert and there was no contraindication listed. I did get a response in my Emsam thread from someone who thought using and AP was OK with Emsam.
The main reason I would like to get off Seroquel is to have a pure effect from the Emsam. Neater and tidier than having other reactions and not knowing what drug is the cause. Two meds is not too bad though.
I'm going to post over at the other Emsam thread now then go to bed. Too many nights up 'til 2 or 3 can't help my sleep/wake cycle.
-SG
Posted by stargazer on November 15, 2006, at 22:33:01
In reply to Re: ENSAM: DAY 1...6 mg/24 hr...w seroquel, OK?.., posted by stargazer on November 15, 2006, at 22:13:16
Now I know I've been on PB too much lately. I just got lost and thought I posted on another thread when I was right here. Now I know I have to go to sleep before 12 tonight to recharge the neurons...
Today's effect of Emsam were mostly an exacerbation of the dizziness that I have had on Seroquel alone. A little patch irritation noted (have to be vigilent about that since that has the greatest % (22) of adverse effects) but really nothing else.
Did you realize that the cost of the patch is aroung $500!!!Seroquel is also very expensive,$500-1000, depending on dose. If I have to pay out of pocket there's no way I could be on both of these unless insurance will cover them (was waiting to look for a new job once depression was better). I think Nardil is around $50/month so that is always a possibility, but if Emsam works then I have to find a way to get it.
Who else is on and having some success with EMSAM? Hope it is working for some of you.
-SG
Posted by Phillipa on November 15, 2006, at 22:36:49
In reply to Re: ENSAM: DAY 1...6 mg/24 hr..Others on Emsam?, posted by stargazer on November 15, 2006, at 22:33:01
I wrote one person I know who was on it at least one week ago and loving it. I hope she sees this and responds or e-mails me back. love Phillipa nighty night
Posted by stargazer on November 16, 2006, at 20:32:45
In reply to Re: ENSAM: DAY 1...6 mg/24 hr..Others on Emsam? » stargazer, posted by Phillipa on November 15, 2006, at 22:36:49
NO real effect from Emsam but I was not overwhelmingly depressed when I started Emsam. I had already started Seroquel to counteract an increase in depression that Cymbalta triggered.
My goals for Emsam are a feeling of normalcy which I once experienced on Nardil and Marplan. This includes an ability to read and focus, increased self confidence and the desire to resume working. I would also like to be able to be more resilient to stressful events and not be completely disabled.
SG
Posted by Phillipa on November 16, 2006, at 20:53:42
In reply to Re: ENSAM: DAY 2...Minor dizziness from seroquel?, posted by stargazer on November 16, 2006, at 20:32:45
You have been on Nardil? Was it sedating? Two people I know are doing well on EMSAM. Love Phillipa
Posted by stargazer on November 17, 2006, at 10:18:52
In reply to Re: ENSAM: DAY 2...Minor dizziness from seroquel? » stargazer, posted by Phillipa on November 16, 2006, at 20:53:42
Going to bed too late, will try and get to bed by 12 AM to prevent sleep cycle disruption. Will also taper seroquel from 100 mg at night to perhaps 50 mg. No Insomnia for me while taking Seroquel.
Phillipa/ I took Nardil in 1991-1994, but it stopped working. I wanted to try Nardil again before EMSAM but I deferred to my pdoc who thought I should try Emsam first (no food interactions). One reason I wanted to go with Nardil was the cost. If it works you never have to worry about paying for it since it is almost free (approx $50/month) and Emsam is like a car (Lexus type) payment. The dietary restrictions never really bothered me since I hate alot of those foods high in tyramine (figs,beer,red wine, etc.) except cheese.
If Emsam fails I will ask to try Nardil next. Not really sedating that I can remember but a feeling of "normalcy" which for me is the ideal drug! And to only take one drug, perhaps two, that is my goal...SG/
Posted by Phillipa on November 17, 2006, at 19:06:15
In reply to Re: ENSAM: DAY 3...No insomnia on seroquel?Phil, posted by stargazer on November 17, 2006, at 10:18:52
Where did you find a doc willing to use an MAOI? I think you have a great doc and don't mess that up with thinking someone else may be better. Love Phillipa
Posted by stargazer on November 18, 2006, at 0:42:00
In reply to Re: ENSAM: DAY 3...No insomnia on seroquel?Phil » stargazer, posted by Phillipa on November 17, 2006, at 19:06:15
I've had depression so long the MAOI's were very common then since that was pre-Prozac, imagine that. Nardil was only the second med I was ever on after Elavil. The doc that prescibed it was great, I think I only saw her a few times then she went up to Dartmouth and I never saw her again. At that time I thought you treated depression then you were "cured". Boy, have I learned the truth over the ensuing 25 years. Then when it recurred, I got a real 'beut' of a doc. I'll tell you about her another time, too late now. My current doc is actually the 3rd psych in 25 years so not too bad. Talk therapy before the 1st pdoc wasfor about 3 years until I insisted I needed meds,no more talking about things, just give me a drug and luckily, for the first time in my life I felt normal and it happened in about a week. Too tired to talk anymore, again I'm breaking my rules to go to bed by midnight! I'm a mess.
SG
Posted by Phillipa on November 18, 2006, at 17:14:56
In reply to Re: ENSAM: DAY 3...No insomnia on seroquel?Phil, posted by stargazer on November 18, 2006, at 0:42:00
Stargazer so other antidepressants have worked for you. None have ever worked for me. Just the benzos. Love Phillipa
Posted by stargazer on November 18, 2006, at 21:10:07
In reply to Re: ENSAM: DAY 3...No insomnia on seroquel?Phil » stargazer, posted by Phillipa on November 18, 2006, at 17:14:56
No major side effects from Emsam. Took only 50 mg seroquel last night and I think tapering it is the way to go. I'm less dizzy which has been the biggest side effect after starting Cymbalta, adding Seroquel, stopping Cymbalta, and then starting Emsam all in the last month and a half.
My mood does not seem much different but I do find that I'm thinking differently, less hopeless, more focused somehow. So I am optimistic at this early state...SG
Posted by Phillipa on November 18, 2006, at 22:04:50
In reply to ENSAM: DAY 4...Uneventful but hopeful, posted by stargazer on November 18, 2006, at 21:10:07
Stargazer that's fantastic. I hope to hear another wonderful report tomorrow. Love Phillipa
Posted by stargazer on November 20, 2006, at 23:17:33
In reply to Re: ENSAM: DAY 4...Uneventful but hopeful » stargazer, posted by Phillipa on November 18, 2006, at 22:04:50
Still on 6 mg patch with some positive results, no fireworks, but much better than recent Cymbalta trial. I am happier with minor improvements, rather than intense SE's and/or a decline in my functioning.
I took a week off from seeing my pdoc so I will see him next Monday,not tomorrow. He was surprised when I suggested waiting two weeks before seeing him. That was an indication that I was feeling better even before starting Emsam, since I just started last Tues or Wed. I think stopping Cymbalta and starting Seroquel pre-Emsam, made me feel better, so it's hard to tell what if anthing, Emsam is doing.
On to Emsam week 2, taking baby steps...SG
Posted by Phillipa on November 21, 2006, at 17:30:13
In reply to ENSAM: DAY 5.. Holding steady./Phillipa, posted by stargazer on November 20, 2006, at 23:17:33
So are you saying the seroquel may have helped? Love Phillipa
Posted by stargazer on November 21, 2006, at 19:52:47
In reply to Re: ENSAM: DAY 5.. Holding steady./Phillipa » stargazer, posted by Phillipa on November 21, 2006, at 17:30:13
Hard to belive it's only been 7 days on Ensam, feel like it's been weeks.
Today I'm tired. I've been going to bed much too late and today I got up before I was really ready to. Tonight I'll be in bed by 11, that's better than 2 or 3.
I had to call my pdoc since I only have 3 patches left and don't see him until Monday. I stopped by to see him and he gave me a sample box which contains 5 patches. When I looked inside there were at least 20 patches. Nice of him to do this for me knowing that my insurance is limited right now. Hell, he must get oodles of samples, but it's the thought that counts.
I told him I was able to do things that I had avoided for the past few months and I did it without much resistence. I told him I wasn't so sure if I was feeling all that much better. He said that EMSAM tends to energize before brightening the mood. So that's something to know, although I am very happy that I can concentrate and make some phone calls I had been avoiding. Boy, when your depression starts to lift, you realize how limited your abilities had been.
Depression is SO subtle, you don't even feel it at times but it is there, lurking and waiting for the right time to reappear, mocking your life until being challenged again...then reluctantly accepting defeat, limping away but planning it's next move, which will occur when the time is right, when it is least expected,...It is incidious and one can not be fooled by it's mere absense, it has no bouundaries.
Posted by Phillipa on November 21, 2006, at 20:43:49
In reply to Re: ENSAM: DAY 7. Feels much longer, posted by stargazer on November 21, 2006, at 19:52:47
Stargazer I'm starting to get my confidence back in trying EMSAM as the positive results don't get posted. Still have my two boxes with the 6mg patches in them. And I'm only on 25mg of luvox and the valium and added the l2.5mg of seroquel at bedtime. So you're doc said a five day washout? Mine said two weeks. I wonder if the shorter washout period could make a difference? Love Phillipa
Posted by stargazer on November 21, 2006, at 22:19:57
In reply to Re: ENSAM: DAY 7. Feels much longer » stargazer, posted by Phillipa on November 21, 2006, at 20:43:49
Well actually my pdoc said 2 weeks and after reading the insert, it said 5 days unless you were taking Prozac or Buspar, long half lives, I think. But if I stopped Emsam to go back to another med, God forbid, the thought...there would be a 14 day washout period before starting a new med unless it was compatible with Ensam.
It's in the pkg insert, but not easily found, of course, the pkg insert is so poorly categorized, you would never be sure that what you read is accurate. I had to read it multipletimes before being clear about the washout period. Clear as mud...SG
Posted by Phillipa on November 21, 2006, at 22:23:04
In reply to Re: ENSAM: DAY 7. Feels much longer/Phillipa, posted by stargazer on November 21, 2006, at 22:19:57
You also need glasses even if you don't wear them. Wonder if the print is so small to discourage you from reading it? Love Phillipa So glad it's going well.
Posted by want2breal on November 22, 2006, at 21:38:51
In reply to Re: ENSAM: DAY 7. Feels much longer » stargazer, posted by Phillipa on November 21, 2006, at 20:43:49
Glad to hear of your progress.
I'm starting my ensam patch Friday....
I will be 5 days without my Lexapro (10mg.). I also take 5 mg. ambien EVERY night to sleep. Psych. said I could continue that no problem.
Will keep everyone posted.
Happy Thanksgiving!!!!!
Posted by elanor roosevelt on November 22, 2006, at 21:57:12
In reply to Re: ENSAM: DAY 7. Feels much longer/Phillipa, posted by stargazer on November 21, 2006, at 22:19:57
not brightened yet?
Posted by stargazer on November 22, 2006, at 22:35:44
In reply to Re: ENSAM: DAY 7. Feels much longer, posted by want2breal on November 22, 2006, at 21:38:51
Welcome to you joining me on Friday. I will be a week and a few days ahead of you so I can advise you if I am able to. I have not had any terrible side effects and I can be sensitive to medications, so don't worry too much.
The patches are easy to use and I have put them on a variety of locations including upper chest, lower abdomen, upper back, upper buttocks and upper arms and each site has a Left and right, so that makes about 10 sites. Supposedly the site can have a skin reaction, but I have not.
I was taking Seroquel when I started Emsam but I have tapered down from 200 to 50 mg. I'm extremely worried about taking too much medication so that was done of my own accord, but I'll let my pdoc know on Monday. I saw him briefly yesterday to pick up some more samples and I told him what I had done. He's pretty cool with my adjustments of meds since I am so cautious and if there was anything I thought might be a big No-NO, I wouldn't do it without calling him first.
Well have a great T-day, everyone. Yeah, no dietary restrictions on EMSAM!
Stargazer
Posted by stargazer on November 27, 2006, at 11:30:11
In reply to Re: ENSAM: DAY 8 or 9/ Welcome newbie, posted by stargazer on November 22, 2006, at 22:35:44
I'm trying to movethis post to the latest listings so that others will post their Emsam trials with me...Stargazer
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