![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 37 to 61 of 86. Go back in thread:
Posted by yxibow on December 6, 2006, at 0:29:44
In reply to What is TD??, posted by maryhelen on December 5, 2006, at 16:36:57
> After all of my years of med trials it seems to me that I should know what TD means, but I don't. I am so confused about medications I don't know if I am coming or going half the time. I had a hospitalization for 2 months earlier this year ( about my 8th time as well as 4 treatment centres) and ended up having 13 ECT treatments (third time, ineffective) and was sent home on the following meds:
>
> 50 mg. clomipramine
> 150 mg. trazadone
> 100 mg. seroquel
> 15.0 zopiclone
>
> I still do not sleep well. I am so tired after 25 years of battling this depression. I use to research every med I was ever on ..... I cannot even remember all of them. Now I feel so hopeless as to ever being helped I don't even have the energy to be proactive in my care. I also have a problem with pain medications .... have a lot of physical disabilities. Percocett, for example, or other types of opiates, is the only relief I get from the depression. Of course I have to take too much to be effective and they are not easily available. My psych is working on me going on buprenorphine and a higher than normal dose of an antidepressant. My system metabolizes drugs at an alarming rate. He seems to indicate Effexor something like 600 mg. I am just waiting, as the bupe has not been available in Canada and special permission has been required for approval from the government. However, I understand now that bupe was made available in November here. I read other sites, and there is an indication for bupe being used for refractory depression. My doc told me that it is just indicated for pain management and to stop taking the other opiates. I just do not know anymore. The depression is devastating and I do know that I cannot continue much longer living such a useless and pointless life. Sorry to go off topic. Just got carried away. I don't even know why I continue to take these meds as they are obviously not working or I would not be so depressed. They were prescribed by the psych doc at the hospital whom I do not see anymore. I guess I am just waiting to see what my own doc puts me on. Thanks for listening.
>
> maryhelen
TD is Tardive Dyskinesia, a movement disorder caused by primarily neuroleptic (antipsychotic) medications. It is characterized in severity by the AIMS scale and can consist of stereotypy such as orofacial movements, limb jerks, cogwheel rotation, and other displays. To have definite TD, contradictory to intuition, one generally is not aware (at first) that they even have the motions and generally have to be pointed out. Awareness is included in AIMS exams but is not a primary part of diagnosis necessarily. TD and EPS (a fancy name for side effects of neuroleptic and other agents) are sort of on a sliding scale, TD being a more permanent result and EPS being various ongoing side effects as a result of treatment.
Tricyclics such as clomipramine are slightly more common in rareness than SSRIs to cause TD but this is not a major issue in their usage; side effects such as sedation, sweating and other characteristics of that drug class are far more common side effects.
The Seroquel you are taking, while there have been cases of TD, atypical (new) antipsychotics have varyingly been assigned about a 2% per year risk rate across the board by various studies, and Seroquel itself is probably even below that. It unfortunately is the most sedating of all antipsychotics, new or old.
TD can also be caused by extreme alcoholism, although this is also a rare event, and use of benzodiazepines such as Xanax, which is probably even more rare. Generally TD is most common in old line antipsychotics such as haloperidol.Roughly 30% of patients remit, 30% go no further, and 30% develop further problems. There is ongoing research in attempts to tackle TD but it remains an unfortunate part of treatment for BP and Schizophreniform disorders as well as other conditions with antipsychotics. At least a dozen agents have been tried against it, with some minor results with high dose Vitamin E and high dose BuSpar (which itself is a weak antipsychotic in disguise at high doses). Tetrabenazine has had some luck in some cases at the expense of pseudoparkinsonism (handshaking, etc.)
-- Jay
Posted by maryhelen on December 9, 2006, at 21:27:28
In reply to Re: What is TD?? » maryhelen, posted by yxibow on December 6, 2006, at 0:29:44
Hi Jay:
Thank you for your response to my question about TD. Your information is beyond incredible. It is so impressive. Unfortunately, I have to admit that some of it is still hard for me to understand. I have been in psychiatric care for 25 years, and I could not begin to tell you about all the medications I have tried, 3 rounds of shock therapy, four or five treatment centres. So much talk therapy, I cannot stand hearing myself speak anymore. The past is the past, at least for me. Yet, here I sit at 54 years old, disabled still by my depression, hopeless. scared. The only thing I have found that helps to lift my mood is opiates, which are not easy to obtain. Sometimes I do not think I can make it. If it wasn't for my daughter and 4 grandchildren I honestly think I would be gone. I am not proud of this. My life has become useless and pointless. My brain does not work properly. I held a high stress job or 30 years, where you really had to be sharp, think on your feet. I would be incabable to do this now. I even have trouble brushing my teeth. Not being able to work for the last 6 years has been devasating. I used to think that was the worst thing that could happen. Now, it is my inabililty not to be able to see my family.
By the way you described the meds that I told you that I am on now, certainly seem to be indicated for sedation to be able to sleep. Of course this is of major importance. However, they are not helping with the depression and I do not see the doctor who prescribed them at the hospital. I need the depression to be, if not gone, than to get some relief from it. My goodness, this is such a devastating illness.
When I was hosptialized earlier this year, I came to know some of the other patients. What I found disturbing was the way Seroquel was prescribed. It did not seem to matter what diagnosis one had, Seroquel was the first line medication prescribed to almost everyone.... for instance I have depression, either seriously depressed, suicially depressed, depressed, never happy and it is getting worse, I do not have psychosis (don't really know what it is, I do not hear voices, yes I can obesses, and I do take percs for my pain if I can get them, .... although I have unrelenting pain and the opiates help, it is the lift in my mood that drives me to try and get them. At the hopital, I was put on 100 mg. of Seroquel. Another young women, mid twenties presented with bipolar, cocaine addiction, of course the ups and down to suicidal depression. She was on 825 mg. of seroquel. I had never heard anyone on such a high dose. Others hearing voices, talking to the voices inside their head, catotonic patients, eating disordered patients, paranoid, dilusional,etc... all on Sereqouel. How can this be? I understand that it is an antipsycotic med. I really do not know what being antipsychotic means, and except being on it for sleep, it kinda freaks me out. One pill fits all patients ... After all of my years of med trials it seems to me that I should know what TD means, but I didn't. I am so confused about medications I don't know if I am coming or going half the time. During my hospitalization this year (about my 8th time as well as 4 treatment centres) ended up having 13 ECT treatments (third rounds, ineffective). I still do not sleep well. I am so tired after 25 years of battling this depression. I use to research every med I was ever on ..... I cannot even remember all of them. Now I feel so hopeless as to ever being helped I don't even have the energy to be proactive in my care. I also have a problem with pain medications .... have a lot of physical disabilities. Percocett, for example, or other types of opiates, is the only relief I get from the pain and the depression. Of course I have to take too much to be effective and they are not easily available. My psych is working on me going on buprenorphine and a higher than normal dose of an antidepressant. My system metabolizes drugs at an alarming rate. He seems to indicate Effexor something like 600 mg. I am just waiting, as the bupe has not been available in Canada and special permission has been required for approval from the government. However, I understand now that bupe was made available in November here. I read other sites, and there is an indication for bupe being used for refractory depression. My doc told me that it is just indicated for pain management and to stop taking the other opiates. I just do not know anymore. The depression is devastating and I do know if I can continue much longer living such a useless and pointless life. Sorry to go off topic. Just got carried away. I don't even know why I continue to take these meds as they are obviously not working or I would not be so depressed. I guess I will just keep taking them until my psych doc makes a decision on the new meds. I have told thim the best way I know how I am feeling without him having to hospitalize me.
Now that I have the information from you about TD, the only time I could say that I notice it is when I am falling asleep. Sometimes I jerk so bad I think I am two feet off the bed. For any other movement disorder, I live alone so there would be no one around me to notice anything.
Thank you again Jay, I hope I wasn't too much off track trying to understand.
maryhelen
Posted by stargazer on December 13, 2006, at 9:10:19
In reply to Thank you for your response Jay about TD...., posted by maryhelen on December 9, 2006, at 21:27:28
Hi, just checking in to update my Emsam post for anyone interested.
Duration: approx 1 month now.
Effects:
Positive: more motivation, decrease in anxiety, better focus, no dietary restrictions.Negative: patch falls off sometimes, cost (have samples now but not sure if my insurance will cover it, I will fight if they don't)
I see my pdoc today and although I am feeling better than a few months ago, I don't really feel great. That is one of the problems with depression...being able to judge how you feel and knowing that you are getting some response or not.
I'd like to keep posting and hear from others on Emsam.
P.S. Still take 25 mg of seroquel to sleep prn.
Stargazer
Posted by Phillipa on December 13, 2006, at 19:24:05
In reply to Emsam Users, length of time, effects,pros/cons?, posted by stargazer on December 13, 2006, at 9:10:19
Please keep posting about the EMSAM. So far you are the only one that has posted that didn't develop insomnia or anxiety. Love Phillipa
Posted by stargazer on December 15, 2006, at 8:44:29
In reply to Re: Emsam Users, length of time, effects,pros/cons? » stargazer, posted by Phillipa on December 13, 2006, at 19:24:05
About a month now on Emsam 6 mg patch. Little side effects, depression seems relatively quiet now. No great highs or lows but I have interest in doing things, don't seem comatose, often hard to tell how it's working in the early phases.
My pdoc wanted me to increase the Seroquel which I occasionally taken if I can't sleep. I told him I was reluctant to do this now since I want to see how another month or so goes before messing with the Emsam alone. He was oK with this plan.
That's it...slow, uneventful course w Emsam.
Stargazer
Posted by CrimsonVik on December 18, 2006, at 0:06:13
In reply to Re: Emsam Users, length of time, effects,pros/cons? » stargazer, posted by Phillipa on December 13, 2006, at 19:24:05
> Please keep posting about the EMSAM. So far you are the only one that has posted that didn't develop insomnia or anxiety. Love Phillipa
------------------------------------------------
I never got insomnia on Emsam, just oral Selegiline the first few nights.
Actually I have a couple patchs left and using a bit of both.Vik
Posted by CrimsonVik on December 18, 2006, at 0:26:13
In reply to Emsam Users, length of time, effects,pros/cons?, posted by stargazer on December 13, 2006, at 9:10:19
> Hi, just checking in to update my Emsam post for anyone interested.
>
> Duration: approx 1 month now.
>
> Effects:
> Positive: more motivation, decrease in anxiety, better focus, no dietary restrictions.
>
> Negative: patch falls off sometimes, cost (have samples now but not sure if my insurance will cover it, I will fight if they don't)
>
> I see my pdoc today and although I am feeling better than a few months ago, I don't really feel great. That is one of the problems with depression...being able to judge how you feel and knowing that you are getting some response or not.
>
> I'd like to keep posting and hear from others on Emsam.
>
> P.S. Still take 25 mg of seroquel to sleep prn.
>
> Stargazer
>_________________________________________________
If it's too costly you can get Selegiline pills in Generic. At least in the US.
Vik
Posted by stargazer on December 18, 2006, at 0:39:14
In reply to Re: Emsam Users, length of time, effects,pros/cons? » stargazer, posted by CrimsonVik on December 18, 2006, at 0:26:13
Thanks I was wondering if the two are interchangable? I though others had said they didn't work the same way. Have you found them to be similar? I may have to pay for the Emsam if my insuror doesn't cover it, but I'm allfor the cheapest way to go as it works. Im a firm believer in generics although my pdoc feels otherwise. No sense supporting drug companies that make billions off us every year and most of the drugs don't work and I end up with hundreds (try to avoid this) of pills that never get used.
Stargazer
Posted by CrimsonVik on December 18, 2006, at 4:19:12
In reply to Re: Emsam Users,/Oral Selig-same as Emsam?/Vik, posted by stargazer on December 18, 2006, at 0:39:14
> Thanks I was wondering if the two are interchangable? I though others had said they didn't work the same way. Have you found them to be similar? I may have to pay for the Emsam if my insuror doesn't cover it, but I'm allfor the cheapest way to go as it works. Im a firm believer in generics although my pdoc feels otherwise. No sense supporting drug companies that make billions off us every year and most of the drugs don't work and I end up with hundreds (try to avoid this) of pills that never get used.
>
> Stargazer_________________________________________________
You would have to follow the MAOI diet if you take the 5 mg. tablet more than twice a day (as with 9 and 12 mg. Emsam) but Emsam is Selegiline, like the tablets.
I'm on 10 mg., 2 tabs, morning and night.
If you are on 6 mg. and want to stay on Emsam, there's always 9 and 12.Vicki
Posted by Phillipa on December 18, 2006, at 18:25:30
In reply to Re: Emsam Users,/Oral Selig-same as Emsam?/Vik, posted by CrimsonVik on December 18, 2006, at 4:19:12
So you went off the EMSAM? May I ask the reason? Love Phillipa
Posted by stargazer on December 19, 2006, at 0:15:27
In reply to Re: Emsam Users, length of time, effects,pros/cons? » stargazer, posted by CrimsonVik on December 18, 2006, at 0:26:13
Emsam will not be covered by my insurance so I may not fight them on it but try selegilene. I only have about 6 patches left and I am not due to see my doc until 1/2/07. He gave me a script for Emsam but if I take Selegilene what dose should I take if I'm on the 6 mg patch of Emsam?
I wasn't clear from your post what the conversion is between the patch and the pill.
If it works I don't really care that much as I have been able to heed the dietary restrictions before but I hope the selegilene works like Emsam else I will have to fight my insuror.
Is the 6 mg patch the equivalent of 5 mg pill or 10 mg (2 pills)?
SG
Posted by CrimsonVik on December 19, 2006, at 1:33:53
In reply to Re: Emsam Users,/Oral Selig-same as Emsam?/Vik » CrimsonVik, posted by Phillipa on December 18, 2006, at 18:25:30
> So you went off the EMSAM? May I ask the reason? Love Phillipa
6 mg. patch wasn't helping anymore and at the $45 cost I wanted to try the pills.
I possibly will try the 12 mg. patch down the road, though.Vik
Posted by CrimsonVik on December 19, 2006, at 1:54:29
In reply to Just found out Emsam is nonformulary/Vik, posted by stargazer on December 19, 2006, at 0:15:27
> Emsam will not be covered by my insurance so I may not fight them on it but try selegilene. I only have about 6 patches left and I am not due to see my doc until 1/2/07. He gave me a script for Emsam but if I take Selegilene what dose should I take if I'm on the 6 mg patch of Emsam?
>
> I wasn't clear from your post what the conversion is between the patch and the pill.
>
> If it works I don't really care that much as I have been able to heed the dietary restrictions before but I hope the selegilene works like Emsam else I will have to fight my insuror.
>
> Is the 6 mg patch the equivalent of 5 mg pill or 10 mg (2 pills)?
>
> SG__________________________________________________
From what I get from the insert that came with Emsam, there is only 6 mg. Selegiline in your patch, with 20 being the patch size.
It's just my guess they would still give you two of the 5 mg. per day, one in the morning and one in the aft. That seems to be a common dose for even Parkinson's and I don't think it requires the DIET like the 9 & 12 patch and any oral dose over 10 mg.Vik
Posted by psychobot5000 on December 19, 2006, at 15:08:18
In reply to Just found out Emsam is nonformulary/Vik, posted by stargazer on December 19, 2006, at 0:15:27
It is almost impossible to get an equivalent to 6mg EMSAM from oral selegiling--the doses would be alost absurdly high. --According to my math, you would need not five or ten mg, but 102mg of oral tablets to equal just a 6mg EMSAM patch. This is because the transdermal system is far more effective at getting it into your bloodstream. The oral version has 4.4% bioavailability, compared with about 74% from the patch--about seventeen times higher.
As far as I understand, the normal max-dose for oral pills is 60mg, but that some docs push it to about 85mg. It's still not equivalent to EMSAM, as far as I understand, but you also have to deal with significant levels of amphetamine metabolites that are almost absent in the patch. And there are the dietary restrictions. So basically, the two delivery systems are not really equivalent in terms of their effects.Here's some more of my blather about it:
http://www.dr-bob.org/babble/20061206/msgs/711307.htmlPsychbot
> Is the 6 mg patch the equivalent of 5 mg pill or 10 mg (2 pills)?
>
> SG
Posted by Phillipa on December 19, 2006, at 19:03:31
In reply to Just found out Emsam is nonformulary/Vik, posted by stargazer on December 19, 2006, at 0:15:27
Oh Stargazer I'm so sorry fight them on it you're doing so well. I don't want to see you go off it. If it had been an option for me I was willing to take the 4-5 hundred dollar out of savings. Love Phillipa
Posted by CrimsonVik on December 19, 2006, at 19:19:29
In reply to Oral dosing equivalence is very, very high, posted by psychobot5000 on December 19, 2006, at 15:08:18
> It is almost impossible to get an equivalent to 6mg EMSAM from oral selegiling--the doses would be alost absurdly high. --According to my math, you would need not five or ten mg, but 102mg of oral tablets to equal just a 6mg EMSAM patch. This is because the transdermal system is far more effective at getting it into your bloodstream. The oral version has 4.4% bioavailability, compared with about 74% from the patch--about seventeen times higher.
>
>
> As far as I understand, the normal max-dose for oral pills is 60mg, but that some docs push it to about 85mg. It's still not equivalent to EMSAM, as far as I understand, but you also have to deal with significant levels of amphetamine metabolites that are almost absent in the patch. And there are the dietary restrictions. So basically, the two delivery systems are not really equivalent in terms of their effects.
>
> Here's some more of my blather about it:
> http://www.dr-bob.org/babble/20061206/msgs/711307.html
>
> Psychbot
>
>
> > Is the 6 mg patch the equivalent of 5 mg pill or 10 mg (2 pills)?
> >
> > SG
>
>
_________________________________________________I will ask my Dr. next week what the closest oral dose to the 6 mg. patch is and report back.
I think my dose of 20 mg. is stronger than SG wants. At first it's like a diet pill...it hits you fast, unlike the patch.Vik
Posted by laima on December 21, 2006, at 0:43:19
In reply to Oral dosing equivalence is very, very high, posted by psychobot5000 on December 19, 2006, at 15:08:18
Yet, my knowledgeable doctor told me that the 6mg Emsam was roughly equivalent to 20 mg oral selegeline- which is what I was using before starting Emsam. The switch was very smooth. If anything, I found the oral version of 20 mg to be more potent. I eventually had to start the 9mg Emsam.> It is almost impossible to get an equivalent to 6mg EMSAM from oral selegiling--the doses would be alost absurdly high. --According to my math, you would need not five or ten mg, but 102mg of oral tablets to equal just a 6mg EMSAM patch. This is because the transdermal system is far more effective at getting it into your bloodstream. The oral version has 4.4% bioavailability, compared with about 74% from the patch--about seventeen times higher.
>
>
> As far as I understand, the normal max-dose for oral pills is 60mg, but that some docs push it to about 85mg. It's still not equivalent to EMSAM, as far as I understand, but you also have to deal with significant levels of amphetamine metabolites that are almost absent in the patch. And there are the dietary restrictions. So basically, the two delivery systems are not really equivalent in terms of their effects.
>
> Here's some more of my blather about it:
> http://www.dr-bob.org/babble/20061206/msgs/711307.html
>
> Psychbot
>
>
> > Is the 6 mg patch the equivalent of 5 mg pill or 10 mg (2 pills)?
> >
> > SG
>
>
Posted by psychobot5000 on December 21, 2006, at 2:17:30
In reply to Re: Oral dosing equivalence is very, very high » psychobot5000, posted by laima on December 21, 2006, at 0:43:19
>
> Yet, my knowledgeable doctor told me that the 6mg Emsam was roughly equivalent to 20 mg oral selegeline- which is what I was using before starting Emsam. The switch was very smooth. If anything, I found the oral version of 20 mg to be more potent. I eventually had to start the 9mg Emsam.It's hard to know with certainty, but I used to think that 20mg oral was equivalent to 6mg transdermal--I now believe this to be a misunderstanding. You see, the 6mg patch actually contains 20mg selegiling, but if you wear it for 24 hours, an estimated 30%, or about 6 mg, will actually be absorbed. This is where the 6/20 mg equivalence comes from, I believe.
However, with the oral selegiline you have the amphetamines, and they are (often) beneficial for mood and motivation, so there is that added benefit. Also, the blood-levels spike suddenly, and maybe that's good too. I took 20mg oral selegiline daily for many months, and definitely found it beneficial. But a doc I spoke to once (who worked with developing EMSAM) explained to me that the blood-levels were not nearly as high from 20mg oral tablets as they would be from any EMSAM patch.
Glad to hear that the oral was a good replacement for you!
Posted by CrimsonVik on December 21, 2006, at 2:39:56
In reply to Re: Oral dosing equivalence is very, very high » psychobot5000, posted by laima on December 21, 2006, at 0:43:19
Laima, if you have been on the 6 mg. patch and 20 mg. oral as we both seem to have, it is stronger to the patient than a patch. Especially at first.
I think 10 mg. feels more like the 6 mg. patch.
V.
Posted by laima on December 21, 2006, at 10:49:30
In reply to Re: Oral dosing equivalence is very, very high » laima, posted by psychobot5000 on December 21, 2006, at 2:17:30
I used the oral first, then moved to Emsam when it became available. Actually though, I'm not convinced that the transdermal delivery is very even, because heat affects it, how well it sticks affects it, sometimes it rumples up- I even wonder if different kinds of skin on different parts of the body affect how well it is absorbed. Sometimes it just plain falls off, especially in summer. I definately agree that the oral version is more stimulating. But my doctor felt very strongly that the Emsam would do more and be "more available" than the oral version of selegeline. I use a small amount of adderall with it, and that wasn't necessary with the oral. He had some remote hand in reviewing Emsam, too-sounds like a lot of consultants involved! Small world. Interestingly, the longer it's been out, the less sure anyone seems to be about what the exact equivalence between the oral and patch is.
> >
> > Yet, my knowledgeable doctor told me that the 6mg Emsam was roughly equivalent to 20 mg oral selegeline- which is what I was using before starting Emsam. The switch was very smooth. If anything, I found the oral version of 20 mg to be more potent. I eventually had to start the 9mg Emsam.
>
> It's hard to know with certainty, but I used to think that 20mg oral was equivalent to 6mg transdermal--I now believe this to be a misunderstanding. You see, the 6mg patch actually contains 20mg selegiling, but if you wear it for 24 hours, an estimated 30%, or about 6 mg, will actually be absorbed. This is where the 6/20 mg equivalence comes from, I believe.
>
> However, with the oral selegiline you have the amphetamines, and they are (often) beneficial for mood and motivation, so there is that added benefit. Also, the blood-levels spike suddenly, and maybe that's good too. I took 20mg oral selegiline daily for many months, and definitely found it beneficial. But a doc I spoke to once (who worked with developing EMSAM) explained to me that the blood-levels were not nearly as high from 20mg oral tablets as they would be from any EMSAM patch.
>
> Glad to hear that the oral was a good replacement for you!
Posted by laima on December 21, 2006, at 11:04:24
In reply to Re: Oral dosing equivalence is very, very high » laima, posted by CrimsonVik on December 21, 2006, at 2:39:56
It seems to get more confusing all the time about those equivalencies. Maybe it's like comparing apples and oranges, as the saying goes. If Emsam cuts out the amphetamine aspect that oral selegeline has, maybe it's not even really the same drug anymore (?) I definately believe I "felt" the oral stronger, I wonder if that has to do with the amphetamine involved. However, I have discovered a "magic combo"- Emsam with tiny amount of adderall. This is definately working better than either the oral or the Emsam alone! (Or maybe it's working like a much larger dose of the oral?) It's a new development for me: I had been using small amount of ritalin to raise my very low blood pressure, and that was ok. One of my doctor's colleagues consulted with my case, and voiced his clinical observation that a lot of people do really well with Emsam plus adderall- that the two appear to work synergistically. So I was switched fairly recently, and it works! Amazing! So now it's Emsam 9 plus 5 mg adderall, twice a day.
> Laima, if you have been on the 6 mg. patch and 20 mg. oral as we both seem to have, it is stronger to the patient than a patch. Especially at first.
> I think 10 mg. feels more like the 6 mg. patch.
> V.
Posted by CrimsonVik on December 21, 2006, at 13:10:00
In reply to Re: Emsam enhancement » CrimsonVik, posted by laima on December 21, 2006, at 11:04:24
I'm being troubled by low blood pressure too and my Dr. is out of town. I was already on hypertension medicine so it's confusing.
I feel bad and weak on the oral now..possibly going back to Emsam, probably.
I asked him about ADD before and that I had some symptoms like short attention span: didn't seem to believe it. I'd love to try Adderall though.
> It seems to get more confusing all the time about those equivalencies. Maybe it's like comparing apples and oranges, as the saying goes. If Emsam cuts out the amphetamine aspect that oral selegeline has, maybe it's not even really the same drug anymore (?) I definately believe I "felt" the oral stronger, I wonder if that has to do with the amphetamine involved. However, I have discovered a "magic combo"- Emsam with tiny amount of adderall. This is definately working better than either the oral or the Emsam alone! (Or maybe it's working like a much larger dose of the oral?) It's a new development for me: I had been using small amount of ritalin to raise my very low blood pressure, and that was ok. One of my doctor's colleagues consulted with my case, and voiced his clinical observation that a lot of people do really well with Emsam plus adderall- that the two appear to work synergistically. So I was switched fairly recently, and it works! Amazing! So now it's Emsam 9 plus 5 mg adderall, twice a day.
>
Posted by laima on December 21, 2006, at 13:33:40
In reply to Re: Emsam enhancement » laima, posted by CrimsonVik on December 21, 2006, at 13:10:00
You might be a perfect candidate then, just like me! I am told that the reason selegeline (or other MAOI) plus stimulant is "officially" a no-no is because of the possibility of over-stimulation and dangerously high blood pressure- but my doctor and his colleagues say they've cautiously used such combinations countless times without incident. I've gotten notes to take to the pharmacy before saying it's ok- but they are used to me and my weird prescriptions at this point. I do have to have a blood pressure reader, and have been instructed to monitor my blood pressure this month- before and after taking the adderall, and if I feel strange, to be sure of what's going on. I'm very impressed with this adderall plus Emsam combo- can't gush enough! I don't believe there is any study to prove or disprove it though- just the one guy's hunches and clinical observations. Makes sense to me- I wonder if it's got anything to do with replacing the amphetamine that Emsam lacks? (Is that why ritalin helps, but not nearly as much? Because though it boosts blood pressure, it's not an amphetamine?) That, and of course, low blood pressure can make a person blahhhh, which is in itself depressing. And Emsam can lower blood pressure... I wonder if regular selegeline can lower blood pressure? I think it can. Maybe if your doctor has trouble with understanding your attention span and other ADD symptoms, he or she could understand low blood pressure if you emphasized that angle. (I know they like to say that poor attention is a symptom of the depression.)Good luck!
> I'm being troubled by low blood pressure too and my Dr. is out of town. I was already on hypertension medicine so it's confusing.
> I feel bad and weak on the oral now..possibly going back to Emsam, probably.
> I asked him about ADD before and that I had some symptoms like short attention span: didn't seem to believe it. I'd love to try Adderall though.
>
>
>
>
> > It seems to get more confusing all the time about those equivalencies. Maybe it's like comparing apples and oranges, as the saying goes. If Emsam cuts out the amphetamine aspect that oral selegeline has, maybe it's not even really the same drug anymore (?) I definately believe I "felt" the oral stronger, I wonder if that has to do with the amphetamine involved. However, I have discovered a "magic combo"- Emsam with tiny amount of adderall. This is definately working better than either the oral or the Emsam alone! (Or maybe it's working like a much larger dose of the oral?) It's a new development for me: I had been using small amount of ritalin to raise my very low blood pressure, and that was ok. One of my doctor's colleagues consulted with my case, and voiced his clinical observation that a lot of people do really well with Emsam plus adderall- that the two appear to work synergistically. So I was switched fairly recently, and it works! Amazing! So now it's Emsam 9 plus 5 mg adderall, twice a day.
> >
>
Posted by stargazer on December 21, 2006, at 17:43:27
In reply to Re: Emsam enhancement » CrimsonVik, posted by laima on December 21, 2006, at 13:33:40
This is all very interesting and I thank you for your experiences with Ensam, selegiline and Adderall.
I think, don't know for sure, that Ensam will be covered by insurance so I may not have to take Selegiline but I will print out your posts if I need to know equivalents. It sounds as though either 10 or 20 mg will be good starting point if I need to go there. I have taken Adderall in combination with Wellbutrin and Celexa and felt it helped with my symptoms of disorganization and lack of focus. When I stopped it I felt like it contributed to my downward spiral as I got more and more disorganized and eventually life seemed to get very overwhelming.
My pdoc will say it is not allowed with Emsam but it may be helpful down the road. I also have suffered with hypotension, although recently it seemed more WNL.
All of this information is very helpful. The 6 mg patch which I have been on for a month may not be enough since I'm starting to lose my energy level so perhaps I need an increase?
Stargazer
Posted by laima on December 21, 2006, at 19:14:57
In reply to Re: Emsam enhancement/Helpful suggestions, posted by stargazer on December 21, 2006, at 17:43:27
Do you know, when I tried the 12mg Emsam, my blood pressure absolutely tanked, so I had to go back to 9. (It was something like 92/61, even when I was moving around in the middle of the day! I felt pretty faint. I haven't felt any agitation from Emsam, as others have reported. In other words, as it was increased, I became more sluggish, to say the least.) With the 9, a grand total of 10 mg adderall per day is sufficient to keep my blood pressure at the low end of normal (in the neighborhood of 110/70 when moving around moderately), and it boosts my energy and mood as well as focus, etc. If I understand correctly what my doctor was saying and what I was reading, selegeline can somehow increase a stimulant's effects, so "less acts like more". Sounds like it could get dicey fast for someone with high blood pressure. Perhaps if your doctor wavers, you might offer to get a blood pressure reader and promise to monitor yourself? That would seem prudent anyway until you are very sure how you react. 10 mg adderall a day is a pretty low dose, I believe--but pretty effective with the Emsam. Interestingly, before I started using selegeline oral version, I was giving wellbutrin a fair trial, with the same doctor. I tried ritalin with it for awhile for ADD and sleepiness, but the combination left me pretty frazzled so it was stopped. Another interesting discovery is that my overall anxiety seems to have gone way down as I gave up klonopin and now added the adderall- go figure.> This is all very interesting and I thank you for your experiences with Ensam, selegiline and Adderall.
>
> I think, don't know for sure, that Ensam will be covered by insurance so I may not have to take Selegiline but I will print out your posts if I need to know equivalents. It sounds as though either 10 or 20 mg will be good starting point if I need to go there. I have taken Adderall in combination with Wellbutrin and Celexa and felt it helped with my symptoms of disorganization and lack of focus. When I stopped it I felt like it contributed to my downward spiral as I got more and more disorganized and eventually life seemed to get very overwhelming.
>
> My pdoc will say it is not allowed with Emsam but it may be helpful down the road. I also have suffered with hypotension, although recently it seemed more WNL.
>
> All of this information is very helpful. The 6 mg patch which I have been on for a month may not be enough since I'm starting to lose my energy level so perhaps I need an increase?
>
> Stargazer
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.