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Dr. Bob is Robert Hsiung, MD,
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Posted by Jost on May 21, 2006, at 14:19:42
In reply to Re: Emsam 9 mg patch--foods to be avoided, posted by Jost on May 21, 2006, at 14:11:16
This is the list from the Emsam package insert of acceptable foods, containing little or no tyramine, for those taking 9 mg and 12 mg/24 hours.
1 Meat, Poultry, Fish
-Fresh meat, poultry and fish, including fresh processed meats (such as lunch meats, hot dogs, breakfast sausage and cooked sliced ham)
2. Vegetables
-All other vegetables (except broad beans--see other list)
3. Dairy
-Processed cheeses, mozarella, ricotta cheese, cottage cheese, and yogurt
4. Drinks
-As with other antidepressants, concomitant use of alcohol with Emsam is not recommended. (Bottled and canned beers and wines contain little or no tyramine.)
5. Other
-Brewer's yeast, baker's yeast
-Soy milk
-Pizzas from commercial chain restaurants prepared with cheeses low in tyramine(Note: the unacceptable list applied also to those on 12 mg, of course.)
Jost
Posted by ZeitGuest on May 21, 2006, at 20:12:05
In reply to Re: Everyone PLEASE share your ENSAM updates? (nm), posted by zero on May 17, 2006, at 10:23:10
Day 17 on EMSAM.
So far, no beneficial effects yet.
As for negative effects, just one: I have had a noticeable increase in irritability, which may be my version of anxiety. Little things seem to be irritating me more than usual.
I've always had a proclivity for crankiness. When I was on Prozac (for ten years or so, give or take a few months off here and there in an effort to try new meds), the crankiness/nervousness was definitely mitigated. (I think I'm mildly afflicted by OCD, and pre-poopout Prozac completely irradicated that symptom.) But on EMSAM I've been feeling much more irritable than usual, and feeling more aggravated by mundane frustrations. Not sure if EMSAM itself is causing this, or if the patch (6mg) is just not working and I'm now steeping in my "natural state."
I definitely haven't felt motivated, energized or more sociable, as some on this site have. I was hoping that EMSAM would help me with my social anxiety and mild depression.
I'm wondering if some of the earlier "early adopters" on this site are still experiencing beneficial effects from EMSAM with regard to social anxiety. I believe RobertDavid commented on that effect early in his trial. So, RobertDavid, are you still feeling more socially engaged/motivated on EMSAM?
Posted by lymom3 on May 21, 2006, at 20:47:30
In reply to Re: Everyone PLEASE share your EMSAM updates?, posted by ZeitGuest on May 21, 2006, at 20:12:05
I am crankier too. Some days I think it's getting better, some days I'm not so sure. I know that over doing caffeine has a bad effect...become excessively tired.
I do feel other benefits and I'm on week 3, so I'm going to stick with it...might evaluate adding a med to help with that in a week or two.
Posted by ZeitGuest on May 21, 2006, at 21:43:33
In reply to Re: Everyone PLEASE share your EMSAM updates? » ZeitGuest, posted by lymom3 on May 21, 2006, at 20:47:30
> I am crankier too. Some days I think it's getting better, some days I'm not so sure. I know that over doing caffeine has a bad effect...become excessively tired.
> I do feel other benefits and I'm on week 3, so I'm going to stick with it...might evaluate adding a med to help with that in a week or two.lymom3:
What other benefits are you feeling?
Posted by RobertDavid on May 21, 2006, at 21:57:36
In reply to Re: Everyone PLEASE share your EMSAM updates?, posted by ZeitGuest on May 21, 2006, at 20:12:05
> I'm wondering if some of the earlier "early adopters" on this site are still experiencing beneficial effects from EMSAM with regard to social anxiety. I believe RobertDavid commented on that effect early in his trial. So, RobertDavid, are you still feeling more socially engaged/motivated on EMSAM?
He's pretty much everything I have experienced since going on EMSAM 6 weeks ago:Quick response to mental clarity in particular. That contiues for me, I'm just sharper, have better consentration and my energy remains high. Over the last 2 weeks it's been pretty much the same, most came within 4 weeks for me.
When I first started EMSAM I dreamed a lot, though I am not dreaming quite as much as in the beginning, I'm still dreaming more than before. Initially I wasn't sleeping as many hours, but I woke up with more energy. I still have more energy, pehaps not quite the amount I felt in the beginning.
I've always dealt with insomnia. I'm still not sleeping like I want to and am working on ways to improve it. EMSAM overall isn't a medicine I'd suggest will help people sleep should they have insomnia. My doctor and I looked at some options like adding 12.5 mgs seroquel. I did sleep, but I was zonked the next day and seroquel brought back the foggy headed feeling I got rid of with EMSAM. Lunesta helps some on occation. A few nights I took the patch off at bedtime and did sleep a little better, but then after putting the patch back on in the morning it would take till about noon to get the energy I like.
Since I do not deal with major depression (SAD & GAD primary disorters) I suspect that an even smaller dose of EMSAM, say a 10 or 15mg patch would be ideal. I get more than enough of what I'm looking for with the 20 mgs, it's really good, but perhaps a smaller dose would still be enough, but help with sleeping, not sure.
I have written to Dr. Alexander Botkin who I understand was one of the leading reaserchers in the EMSAM studies to discuss the issues with cutting the patch in half, to find out if it leaks selegiline as some have suggested, to find out if there would be an uneven dose by cutting the patch in half or to just see if the drug companies don't want people to cut patches to save money such as someone getting a 40mg patch, cutting it in half to make a two 20mg patchs to save money (which I suspect, not sure). It also seems to me that there were smaller patch doses in the original study and wonder if there are plans to release one, maybe for Parkinsons patients who only need a small dose. It's just something I'm looking into as I'm a firm believer in playing with dose till you find the right med(s) at the right doses.
I do feel EMSAM is stimulating, but that's what I wanted to lift me from my mental fog, mild depression that perhaps klonopin aggrivated, not sure, but klonopin certainly tackles my social and generalized anxiety. Other stimulants I have tried were just to stimulating (even provigil) and made me more anxious in the long run. With EMSAM I seem to get the energy and mood boost without the anxiety, I'd just like to find a way to sleep better. When I sleep good, I feel my best.
I did notice that when I added EMSAM to the 2mgs of klonopin (taking for 12 years) I was more social. It might have been do to the fact that I have more energy which makes me more social and since I take klonopin I can't really say how much EMSAM specifically has improved my social anxiety or what it would have been like for me if I wasn't takingn klonopin. I can say I get around more, do more things, feel better.
What I have learned is that for me, caffeine does not go well with EMSAM. I have never been a big coffee drinker as it has increased my anxiety before, but now I get jacked up quick, real quick and come crashing down. I have wasted a couple of days after drinking coffee and have sworn it off.
In my quest to try to find the right dose for me, I've lowered down on klonopin from 2 mgs to 1.5. That has caused some issues (during the tapering) that is normal for me to feel when lowering klonopin dose (increased insmonia for several days, slight increase in anxiety for a week along with being irritable). I'm going to stay at the 1.5 dose for a while and see how I feel. I felt so good so fast I probably jumped to gun to try to conclude if EMSAM will be effective without klonopin.
So I'm better, much better overall. I have no doubt I'm on the best med I've ever tried for mild depression, energy, mental clarity. I would like to see how effective a smaller dose of EMSAM would be for me, but not sure if that's possible, but am looking into it.
I know I'm doing well as I'm no longer focusing on other meds I once considered trying. I'm just focusing on the dose these two meds. The answer for me is probably a long term klonopin/EMSAM combo. At some point I'm going to settle on dose and go on with my life until the next potential breakthrough that may come out to be a better solution.
In my opinion EMSAM is something that should give many hope, another option, it will work for some, not all. As I've always said it's just trial and error with this meds. Rob
Posted by RobertDavid on May 22, 2006, at 0:13:34
In reply to Re: Everyone PLEASE share your EMSAM updates?, posted by RobertDavid on May 21, 2006, at 21:57:36
In a follow up to my above post I just recieved an email from Dr. Alexander J. Bodkin, MD, an EMSAM reasercher involved in the studies.
Anyway, I specifically asked him if the patch could be cut in half and if so what effects cutting it might have such as selegiline leaking, uneven dose delivery or other possible issues. The following was his response:
"No harm in carefully cutting them in half. Wash you hands afterward. Nothing will ooze out. Many lab animals got their EmSam that way over the years. If its good enough for lab animals its good enough for people. Lab scientists are very careful about dosage precision.
Good luck to you."Interesting. May give some options to those trying to fine tune their dose. FYI Rob
Posted by strugglingsteve on May 22, 2006, at 0:24:58
In reply to Re: Emsam 9 mg patch--acceptable foods, posted by Jost on May 21, 2006, at 14:19:42
As far as cheese goes, does that include fresh whole milk mozzarella or just the processed kind from dominoes? As to lunch meat, what about bologna??
> This is the list from the Emsam package insert of acceptable foods, containing little or no tyramine, for those taking 9 mg and 12 mg/24 hours.
>
> 1 Meat, Poultry, Fish
>
> -Fresh meat, poultry and fish, including fresh processed meats (such as lunch meats, hot dogs, breakfast sausage and cooked sliced ham)
>
> 2. Vegetables
>
> -All other vegetables (except broad beans--see other list)
>
> 3. Dairy
>
> -Processed cheeses, mozarella, ricotta cheese, cottage cheese, and yogurt
>
> 4. Drinks
>
> -As with other antidepressants, concomitant use of alcohol with Emsam is not recommended. (Bottled and canned beers and wines contain little or no tyramine.)
>
> 5. Other
>
> -Brewer's yeast, baker's yeast
> -Soy milk
> -Pizzas from commercial chain restaurants prepared with cheeses low in tyramine
>
> (Note: the unacceptable list applied also to those on 12 mg, of course.)
>
> Jost
Posted by ZeitGuest on May 22, 2006, at 0:27:56
In reply to Re: Everyone PLEASE share your EMSAM updates?, posted by RobertDavid on May 21, 2006, at 21:57:36
Thanks for the update, Rob.
One thing I find confusing about the EMSAM literature is the dosing specs. On my box it says, "20mg (6mg/24 hours)." Does that mean that each patch contains 20mg of selegiline, but only 6mg of that total gets metabolized by one's system in a 24-hour period?
Posted by ZeitGuest on May 22, 2006, at 0:31:49
In reply to Re: Everyone PLEASE share your EMSAM updates?, posted by ZeitGuest on May 22, 2006, at 0:27:56
Does anyone know at what dosing level EMSAM begins to inhibit MAO-A?
Posted by strugglingsteve on May 22, 2006, at 0:33:50
In reply to Re: Everyone PLEASE share your EMSAM updates?, posted by RobertDavid on May 22, 2006, at 0:13:34
I am well into my 6th week on emsam, about 4 days into being on the 9 mg patch. I am seeing some improvement in my agitation level and I am not quite as depressed as I was a couple days ago. I am still really depressed but any little improvement I will take. The bigger patch is more noticable and I miss the 6 mg patch cause I never even felt it at all when I was on it. I take zyprexa too and that is why I get sleep for I have a feeling the emsam is making it more difficult for me to sleep. My libido is still non existant and I am hoping emsam doesnt have anything to do with it. I was almost normal sexually the first two weeks on emsam but then it went down thereafter so I am hoping its the illness and not the med on that one since the trials had almost no sexual side effect problems.
Posted by RobertDavid on May 22, 2006, at 0:44:54
In reply to Re: Everyone PLEASE share your EMSAM updates?, posted by strugglingsteve on May 22, 2006, at 0:33:50
Studies would suggest it shouldn't have a negative effect on sex drive. Here is a quote from one article:
The sexual dysfunction rate with Emsam was similar to that with placebo, and mean weight change from baseline was "minimal."
Posted by RobertDavid on May 22, 2006, at 0:45:56
In reply to Re: Everyone PLEASE share your EMSAM updates?, posted by ZeitGuest on May 22, 2006, at 0:27:56
> Thanks for the update, Rob.
>
> One thing I find confusing about the EMSAM literature is the dosing specs. On my box it says, "20mg (6mg/24 hours)." Does that mean that each patch contains 20mg of selegiline, but only 6mg of that total gets metabolized by one's system in a 24-hour period?That's what I understand from my research on it.
Posted by ttee on May 22, 2006, at 16:31:22
In reply to Re: Everyone PLEASE share your EMSAM updates?, posted by RobertDavid on May 22, 2006, at 0:13:34
What I want to know is how did they shave those poor animals to get the EmSam patch on them? They must have made some Tinie Tiny patches for the test vermin.
Posted by laima on July 22, 2006, at 10:12:03
In reply to Re: Everyone PLEASE share your EMSAM updates? » ZeitGuest, posted by RobertDavid on May 22, 2006, at 0:45:56
I too am utterly confused. My doctor just attended an "EMSAM conference" with other psychiatrists and researchers from the drug company. Part of the info that came out of this is that there is mass confusion about what the doses mean! Also that the 6 is considered too low of a dose to help many, many people. I am moving up from the 6 to the 9- which I hear is far more potent than the 6. The 9, per doctor's report of what the company reps explained, is roughly 60-90mg oral selegeline. That sounds like a lot! I don't get it.
> > One thing I find confusing about the EMSAM literature is the dosing specs. On my box it says, "20mg (6mg/24 hours)." Does that mean that each patch contains 20mg of selegiline, but only 6mg of that total gets metabolized by one's system in a 24-hour period?
>
> That's what I understand from my research on it.
Posted by RobertDavid on July 22, 2006, at 11:39:23
In reply to Re: Everyone PLEASE share your EMSAM updates » RobertDavid, posted by laima on July 22, 2006, at 10:12:03
I think like all medications, EMSAM will be perscribed at different doses as everyones chemistry is different. I believe those with Major Depression Disorter will need higher doses and have the best chance of taking EMSAM as mono therapy (though many will still need to augment it with something for insomnia and agitation).
Some like me who have Social and or Generalized Anxiety disorters may find that EMSAM helps with a milder form of depression, lack of energy and mental fogg that can go with these disorters, but will most likely need other meds to tackle the anxiety such as klonopin. I consider EMSAM to be just an addition to klonopin. For me, klonopin is the SAD and GAD stopper.
I don't think you can really compare oral vs the patch. I'm not the scientist type and perhaps others can answer this better, but it's my understanding that the patch works differently, has different effects and side effects, has a 24 hour stream of medication instead of a very short half live via oral dosing.
But certainly the higher the patch dose, the more selegiline will be in your blood levels which will have a bigger effect on MAO-A which can further kick in the anti depressant benefits and perhaps anti anxiety benefits.
One of the things that has helped me the most is doing daily cardio (treadmill). Before EMSAM I just didn't feel like working out, no energy to do it. I have to say regular exersize is probably the best medicine I'm taking. It's certainly common knowledge that it helps your endorphins/neurotransmitters. Just my take. Rob
Posted by Jost on July 22, 2006, at 17:43:25
In reply to Re: Everyone PLEASE share your EMSAM updates » laima, posted by RobertDavid on July 22, 2006, at 11:39:23
Has anyone had any recommendations for agitation and insomnia?
I've been taking about 9 mg/day for a while, but in the form of 18mg/ 12 hr, then 12 hrs off, on recommendation of pdoc.
I've been thinking that I've experienced a lot of agitation for about a week-ten days.
I don't quite remember when I started with various levels of the drug. I got the 12 mg patch on Jun 27, but it was sometime after that that I started being agitated-- say Jul 12-13.
Earlier my problem was mostly insomnia. Now I have better sleep,but more agitation. So the larger dose for a shorter time is too much.
Hm. I cut down some yesterday, and more today but maybe it also takes more time for the agitation to lessen.
Anyone have any specific ideas about the agitation?
I'm also not going to keep up with seroquel, I get a bad reaction, some tic type stuff, very minor, but enough to be too worrisome. So I have to rely on other things for sleep-- which I'm a bit concerned about. What has anyone used for that, other than seroquel?
But more concerned about the agitation, if it does continue. I'm sure I need more than 6 mg/24hr.
By the way, I'm sure cutting the patches in half is okay, also. My pdoc is very careful and said it's fine.
If you fold the package carefully, and line up the small knicks in the sides, they're very easy to cut in half. Of course, only one half has the fold, where it's easier to apply. But it's easy to manage.
Jost
Posted by laima on July 22, 2006, at 18:34:26
In reply to Re: Everyone PLEASE share your EMSAM updates » RobertDavid, posted by Jost on July 22, 2006, at 17:43:25
Thanks for the cutting-patches report. I never asked my doctor about it- thought of it after my apointment.
I haven't experienced the agitation, can't comment. Hopefully someone else will.
> Has anyone had any recommendations for agitation and insomnia?
>
> I've been taking about 9 mg/day for a while, but in the form of 18mg/ 12 hr, then 12 hrs off, on recommendation of pdoc.
>
> I've been thinking that I've experienced a lot of agitation for about a week-ten days.
>
> I don't quite remember when I started with various levels of the drug. I got the 12 mg patch on Jun 27, but it was sometime after that that I started being agitated-- say Jul 12-13.
>
> Earlier my problem was mostly insomnia. Now I have better sleep,but more agitation. So the larger dose for a shorter time is too much.
>
> Hm. I cut down some yesterday, and more today but maybe it also takes more time for the agitation to lessen.
>
> Anyone have any specific ideas about the agitation?
>
> I'm also not going to keep up with seroquel, I get a bad reaction, some tic type stuff, very minor, but enough to be too worrisome. So I have to rely on other things for sleep-- which I'm a bit concerned about. What has anyone used for that, other than seroquel?
>
> But more concerned about the agitation, if it does continue. I'm sure I need more than 6 mg/24hr.
>
> By the way, I'm sure cutting the patches in half is okay, also. My pdoc is very careful and said it's fine.
>
> If you fold the package carefully, and line up the small knicks in the sides, they're very easy to cut in half. Of course, only one half has the fold, where it's easier to apply. But it's easy to manage.
>
> Jost
>
>
Posted by Last Chance on July 24, 2006, at 14:20:08
In reply to Re: Everyone PLEASE share your EMSAM updates » Jost, posted by laima on July 22, 2006, at 18:34:26
Hello - I am still doing half a 6mg patch and only leaving it on during the day - much less agitation this way - sleep is ok, but still not long, only 5 or 6 hrs. Strong cup of coffee in the morning and one in the afternoon - .25 klonapin in morning and evening - and I have been taking .25 Xanax under my tongue when I will be heading to some kind of social situation. So this is working pretty good - general depression and anxiety are definitely better, with the occasional exception. So that's my regimen now - oh, I do not have as much motivation and evergy as I did on a higher dose, but as hot as it has been lately that is probably a good thing. Richard
Posted by laima on July 24, 2006, at 15:53:08
In reply to Re: Everyone PLEASE share your EMSAM updates, posted by Last Chance on July 24, 2006, at 14:20:08
> I have been taking .25 Xanax under my tongue
Why under your tongue? Does it work better or different that way than when you swallow it?
Thanks.
Posted by mayzee on July 24, 2006, at 19:57:51
In reply to Re: Everyone PLEASE share your EMSAM updates, posted by Last Chance on July 24, 2006, at 14:20:08
> Hello - I am still doing half a 6mg patch and >only leaving it on during the day
>Last Chance,
Do you mind telling me your diagnosis? Is anxiety your primary problem (vs. MDD?) I just read Robert David's post saying he is also using only half the 6mg patch, and taking it off at night.
I am taking emsam for MDD. So far I am at the 9mg patch 24 hrs. Last week I had 3 good days in a row, but now seem to be back to being super fatigued and down again, with even more orthostatic hypotension.
Thanks for sharing your experience. And glad to hear that it is working well for you!
mayzee
Posted by laima on July 24, 2006, at 20:11:34
In reply to Re: Everyone PLEASE share your EMSAM updates » Last Chance, posted by mayzee on July 24, 2006, at 19:57:51
Dear Mayzee,Are you saying "low blood pressure" when you say "orthostatic hypotension"? I heard EMSAM can lower blood pressure, and my doctor added a teeny amount of ritalin to my regimine to boost my blood pressure back up a touch. It's been working out great! Do you suppose your doctor would consider something like that if you asked? Maybe it would be helpful for you, too.
Sincerely,
Laima
> I am taking emsam for MDD. So far I am at the 9mg patch 24 hrs. Last week I had 3 good days in a row, but now seem to be back to being super fatigued and down again, with even more orthostatic hypotension.
Posted by Phillipa on July 24, 2006, at 20:19:28
In reply to Re: Everyone PLEASE share your EMSAM updates » Last Chance, posted by mayzee on July 24, 2006, at 19:57:51
There's a thread today down the board between Scott and Robert David I think you all would enjoy reading. Love Phillipa
Posted by mayzee on July 24, 2006, at 22:50:16
In reply to Re: Everyone PLEASE share your EMSAM updates » mayzee, posted by laima on July 24, 2006, at 20:11:34
>
> Are you saying "low blood pressure" when you say "orthostatic hypotension"? I heard EMSAM can lower blood pressure, and my doctor added a teeny amount of ritalin to my regimine to boost my blood pressure back up a touch. It's been working out great! Do you suppose your doctor would consider something like that if you asked? Maybe it would be helpful for you, too.
>Laima,
I haven't been able to take a reading on my blood pressure yet. I have been experiencing dizziness, lightheadedness, headache, blurred or dimmed vision at various times. Originally it was only when changing position (e.g. bending over then standing up) but lately it happens just when walking up a slight incline. I do tend to have low bp, so should get it checked out. I tried to see the pdoc today but she was out sick. I don't have medical insurance at the moment so am very limited in my doctor visits :(
Thank you for your suggestion. I'll try to follow up on it.
I have been hoping that this side effect will go away. Maybe the low blood pressure side effect doesn't though? I'm in my 15th day at 9mg. Didn't have this at 6mg.
Best,
mayzee
Posted by laima on July 25, 2006, at 0:57:46
In reply to Re: Everyone PLEASE share your EMSAM updates » laima, posted by mayzee on July 24, 2006, at 22:50:16
Hi Mayzee,
Wow, well maybe the matter of low blood pressure could be the problem then? I'm told that EMSAM really does lower blood pressure for many people, and some of us are more suseptable.
What you describe about fatigue, dizziness, lightheadedness are classsic signs that may indicate lower than ideal blood pressure.
Especially the part about changing position being an aggrevator...I am no medical expert, no doctor-I might be very wrong-but it's my understanding that blood pressure wont just go up on it's own spontaneously, particularly if there is a drug involved.
I've always had low blood pressure too-even befiore going on EMSAM 6. Now that I'm switching to 9, and still using the small amount of ritalin, I was told to keep an eye on where it is going. Apparently the higher dose could make it dip even lower. I got a blood pressure reader at Walgreens drug store for less than 50$.-not cheap, but not as bad as I expected.
I hope you have better luck with your doctor on your next appointment, and that he or she is open to exploring this possibility. The stimulant/maoi is a classic "no-no" (because maoi plus stimulant can cause blood-pressure crisis)- but my doctor reports that in reality, it can be absolutely fine, with restraint of course, for many, many patients-particularly if they keep an eye on what their blood pressure is doing, at least until they understand it.
I wish very good luck to you- I hope you find relief from the problem you describe, despite the unfair obstacles you face, in terms of insurance, I mean.
Best wishes,
Laima
> Laima,
>
> I haven't been able to take a reading on my blood pressure yet. I have been experiencing dizziness, lightheadedness, headache, blurred or dimmed vision at various times. Originally it was only when changing position (e.g. bending over then standing up) but lately it happens just when walking up a slight incline. I do tend to have low bp, so should get it checked out. I tried to see the pdoc today but she was out sick. I don't have medical insurance at the moment so am very limited in my doctor visits :(
>
> Thank you for your suggestion. I'll try to follow up on it.
>
> I have been hoping that this side effect will go away. Maybe the low blood pressure side effect doesn't though? I'm in my 15th day at 9mg. Didn't have this at 6mg.
>
> Best,
> mayzee
>
Posted by theo on July 25, 2006, at 17:11:53
In reply to Re: Everyone PLEASE share your EMSAM updates » laima, posted by RobertDavid on July 22, 2006, at 11:39:23
Are you still taking 1/2 of a 9mg patch? Are you leaving on full time or just putting on in the morning and taking off at night? Also, have you found locations for the placement of the patch working better than others?
Thanks
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