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Dr. Bob is Robert Hsiung, MD,
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Posted by laima on July 27, 2006, at 17:07:10
In reply to Re: how to treat Low Blood Pressure caused by Emasam, posted by t2green01 on July 27, 2006, at 9:15:10
> that doesnt sound right at all
I asked my doctor about that (eat some cheese" option, too- but he was horrified at the thought- said it was not quite...I gathered there are other chemical processes going on than than merely raising blood pressure this way?
Posted by mayzee on July 27, 2006, at 19:12:09
In reply to new to emsa and SCARED!!!!, posted by hermansmom on July 27, 2006, at 14:29:53
Hermansmom,
I've been on Emsam 2+ months now; am on the 9mg patch now. I haven't experienced any weight gain. I've been trying to read all the posts here related to Emsam and I don't remember anyone saying they were gaining weight on it. So hope that helps. Good luck & please let us know how it goes.
Best wishes,
mayzee
Posted by Phillipa on July 27, 2006, at 20:54:24
In reply to Re: how to treat Low Blood Pressure caused by Emasam » Phillipa, posted by Donna Louise on July 27, 2006, at 6:54:52
What I don't understand is what your blood pressure has to do with eating? I can understand it lowering your blood sugar. And I'm glad you talked with your doc. So does he know a lot about EMSAM? Since it's so new? Love Phillipa
Posted by Phillipa on July 27, 2006, at 21:01:08
In reply to Re: how to treat Low Blood Pressure caused by Emasam » Phillipa, posted by Donna Louise on July 27, 2006, at 6:54:52
Donna I forgot to say if anything waiting a long time to eat and causing low blood sugar would probably if it even effected it lower your BP. Love Phillipa now maybe EMSAM has a mechanism that creates something abnormal like that. I don't know. Love Phillipa
Posted by mayzee on July 27, 2006, at 21:23:58
In reply to Re: how to treat Low Blood Pressure caused by Emasam » mayzee, posted by Donna Louise on July 26, 2006, at 14:47:51
When I was looking online for info about low blood pressure, I found this on the Wikipedia site for orthostatic hypotension, in the section titled "Lifestyle advice. Some suggestions for minimizing the effects [of orthostatic hypotension] include: ... As eating lowers blood pressure, eating multiple smaller meals rather than fewer larger meals." http://en.wikipedia.org/wiki/Orthostatic_hypotension
So there is that link between eating and bp.
Posted by laima on July 27, 2006, at 21:46:17
In reply to new to emsa and SCARED!!!!, posted by hermansmom on July 27, 2006, at 14:29:53
Dear hermansmom,
I had an awful experience with cymbalta, too: suicidal, immediately. I'm on EMSAM 9 now, after starting on the 6, and am delighted to report that on day 3, I scarcely dare say- I think it's starting to work! Unwanted weight gain is definately not a pleasant experience, and having experienced bewildering weight gain with some tricyclics and ssris, I wish to express empathy for what you are going through. Though it sounds promising what you already report about your recent weight loss! I don't think you are being vain. If, as it was for me, the weight is not what you want, that's how it is. I had always been so skinny when younger, my gain was an utter shock, and I confess, I wanted to fit into clothes a certain way and such. It did affect my self esteem. You might be encouraged to know my own weight gain went away, after I ended ssris and went through a stepped up excercise program for awhile (which also lifted my mood.) Of course, I pass no judgement on people who of course come in all sizes- but if the gain is unwanted, you need to buy new clothes but none fit, and especially if one is female, etc., -it might not be politically correct to admit- but sometimes one still in fact just ends up wanting to change size. A therapist I once had and greatly respected (before she retired) told me, "Well- you are not really fat and you are not too skinny-you are a teeny hefty-though not a lot-nothing wrong there-but if you want to lose some weight- go for it rather than wonder about it." I guess what I mean to say is, I think what I learned from her was that if you feel better about yourself and how you look and feel at a different weight than where you are-and your assessments and expectations are reasonable and not extreme, I don't think you are being vain. It also doesn't mean you are making any judgements about others. And I also think you have reported some encouraging developments towards where it sounds that you want to go. I really think we feel better when we feel have some control over our bodies and feel more attractive-whatever that means for an individual. Hope that makes sense and isn't misinterpretable.
Very sincere best wishes,
Laima
> I have recently gone off of cymbalta and have experienced helliosh withdrawal symptoms. I, like many of you have been on virtually every SSRI and have been treatment resistant. I have an anxiety disorder, major depression, and agoraphobia. I saw my pdoc yesterday, and he gave me emsam samples (6mg) and wants me to try it for 2 weeks. I also take clonazepam (klonipin) and Rozarem (sp?) a sleep RX. I gained a gang of weigth on Cymbalta about 60 pounds in 7-8 mos. Since going off it 22 days ago, i have lost 7 lbs (still look like a fat beast, but going down is better than up!) The weight gain has worsened my depression, and social anxiety-frankly, I just feel fat and disgusting and at my wits end!!!I have been off work for 2 years and pdoc has suggested ECT, but I'm scared of that, now, too. The Cymbalta experience (increased suicidal ideation, including hospitalization for suicide attempt, and withdrwal symptoms from hell) has made me reluctant to try yet another guinea pig drug. I am curious about potential psych side effects,as well as weight gain, I already have low BP, and wonder if there are withdrawal effect from this as with Cymbalta. If you google cymbalta withdrwal you'll get an idea of what I mean. I am so scared and so desperate! I know the weight gain thing may just sound like a vanity thing, but it really has put a huge dent in my self image and increased my dpression. I already feel gross and worthless enough.
Posted by laima on July 27, 2006, at 22:02:16
In reply to Emsam, et. al, posted by Kirkster on July 10, 2006, at 12:19:02
Dear Kirkster-
EMSAM not nearly as scary or dangerous as the other MAOIS. Hence the huge news buzz around it, heralding it as a major breakthrough development.
I hear that even on a higher dose, if you slip up with food, you are most likely still absolutely safe. And I can only speak for myself, but I've experienced scads of side effects with most drugs, but nothing remarkable at all with EMSAM.Best wishes,
Laima
> Confused about EmSam -
> I was diagnosed as Bipolar Depression (cycle from norm. to depressed) and put on Lithium and Lamictal and doing great until Lithium toxicity (lots of fun!). I went down a bit on Lithium and so did my mood - big time. Now back up halfway on Lithium and not doing too well. Now my doc wants to try Emsam, but the idea of a MAOI is scary to me - been on every SSRI known to man, but not sure about trying Emsam. Is it worth a try or are the side effects so bad I should run away from it.
>
> Kirkster
Posted by laima on July 27, 2006, at 22:05:43
In reply to Re: how to treat Low Blood Pressure caused by Emasam » Donna Louise, posted by Phillipa on July 27, 2006, at 20:54:24
>So does he know a lot about EMSAM? Since it's so new? Love Phillipa
I noticed and speculate ...some doctors are really into research and have ties to drug trials and follow them avidly, whereas others are more patient focused instead of research focused??
Posted by Donna Louise on July 28, 2006, at 6:39:12
In reply to Re: how to treat Low Blood Pressure caused by Emasam » Donna Louise, posted by Phillipa on July 27, 2006, at 20:54:24
> What I don't understand is what your blood pressure has to do with eating? I can understand it lowering your blood sugar. And I'm glad you talked with your doc. So does he know a lot about EMSAM? Since it's so new? Love Phillipa
That is what I don't understand either. That is the question I am asking. Does anyone know about this? It is not about the EMSAM.
Posted by Donna Louise on July 28, 2006, at 6:42:20
In reply to Re: how to treat Low Blood Pressure caused by Emasam, posted by mayzee on July 27, 2006, at 21:23:58
> When I was looking online for info about low blood pressure, I found this on the Wikipedia site for orthostatic hypotension, in the section titled "Lifestyle advice. Some suggestions for minimizing the effects [of orthostatic hypotension] include: ... As eating lowers blood pressure, eating multiple smaller meals rather than fewer larger meals." http://en.wikipedia.org/wiki/Orthostatic_hypotension
> So there is that link between eating and bp.
>Thanks so much, I will go to the link now. I had read that fasting lowers bp, and I am having the opposite, which I have never heard of. I have searched and been unable to find anything so thanks!
donna
Posted by jkshrews on July 28, 2006, at 10:46:39
In reply to Re: how to treat Low Blood Pressure caused by Emasam, posted by naughtypuppy on July 27, 2006, at 9:02:21
I think eating some tyramine sounds like a pretty dangerous approach to raising your blood pressure while on Nardil. (Unless, of course, you ae suicidal!) How would you know how much you are getting? Or the status of your digestive MAO on that particular day?
Here are some things to remember.
1) These drugs have been around for decades. Selegiline is an old drug--EMSAM is merely a new method of delivering it.
2) Low blood pressure has always been a troublesome side-effect for MAOIs. One MAOI, Eutonyl (pargyline) is actually sold to treat hypertension.
3) Since the 1970's, there have been two cures for the hypotension side-effect. One is salt pills, which is very safe, you can do it yourself, and it is usually very effective. The other is a metal-corticoid hormone, and I think you will have trouble finding a doctor in the U.S. that will try it.4) Having hypotention can be hard to get treated, because doctors in the U.S. usually do not consider it a pathology. I have heard that in Europe doctors regard it as a disease and in med school are taught about two dozen treatements for hypotension. I would like to know what they do over there for MAOI-induced hypotension.
> My pdoc recomended eating a little bit of aged cheese several times a day with Nardil to bring my base bp of 90/50! up to a higher level. Increases Tyramine level. I was hitting the floor several times a day going into convulsions. Still get dizzy, but it seems to help, and I like the cure. Better than another taking another pill!
Posted by Phillipa on July 28, 2006, at 20:27:07
In reply to Re: how to treat Low Blood Pressure caused by Emasam » Phillipa, posted by Donna Louise on July 28, 2006, at 6:39:12
Donna maybe try the health board? I'm at a loss. Love Phillipa
Posted by Donna Louise on July 29, 2006, at 7:23:10
In reply to Re: how to treat Low Blood Pressure caused by Emasam » Donna Louise, posted by Phillipa on July 28, 2006, at 20:27:07
> Donna maybe try the health board? I'm at a loss. Love Phillipa
I now understand why the eating brings the bp down. It is a parasympathetic response to induce digestion which concurrently relaxes blood vessels, ect. What I now need to know is why it is shooting up in the first place and why that seems correlated to not eating. I take my pressure obsessively all day long and as long as I don't wait any longer than 5 hours to eat, it stays within a normal range. It is like 95/65 when I first wake up and that is when I have gone the longest without eating. I know bp is lowest in the morning but that period of not eating while I am asleep seems to discount the theory tha not eating is causing the bp to get too high.
Oh well, I at least know the solution if not the cause. Just don't wait for longer than 5 hours to eat. I do appreciate your concern and attempts to help me. Thanks.donna
Posted by jealibeanz on July 29, 2006, at 10:22:11
In reply to new to emsa and SCARED!!!!, posted by hermansmom on July 27, 2006, at 14:29:53
You sounds a bit like me, except my last AD was Effexor, not Cymbalta. It also caused rapid weight gain, so I D/C'd. I'm now skeptical about this aspect with any AD. I too have an anxiety disorder and insomnia. I take Xanax and Lunesta, which is no longer helping much with sleep. How do you like the Rozerem? What type of med is that? Did you doc have any concerns about EMSAM worsening insomnia and anxiety? Let me know how you're doing. Thanks:)
Posted by t2green01 on July 29, 2006, at 14:00:23
In reply to Who's Still Going Strong with EMSAM?, posted by jealibeanz on June 24, 2006, at 21:48:28
did anybody else have extreme insomnia with emsam and did it improve or did you have to medicate the insomnia. im so tired but i dont want to take more pills.
Posted by mayzee on July 29, 2006, at 17:26:52
In reply to Emsam (insomnia), posted by t2green01 on July 29, 2006, at 14:00:23
I had insomnia when starting Emsam 6mg, and again when going up to 9mg. For me, the insomnia went away but not the waking up many times during the night, daytime fatigue. I just got a script for klonopin today to address that.
From previous posts it seems that most people taking Emsam are also taking some kind of sleep aid. Also seems many were taking those aids prior to starting Emsam.
Good luck!
mayzee
Posted by jkshrews on July 29, 2006, at 22:53:23
In reply to Emsam (insomnia), posted by t2green01 on July 29, 2006, at 14:00:23
Well, I didn't go to sleep until 6 AM last night. It was a real killer, esp since I needed to work today. And since I started Emsam, I have been taking a lot more Klonopin than I used to.
I suspect there are two factors at work:
1) Bipolars are subject to disturbance of Circadian rhythm, much more so than are other people. I have a friend at work who says I "go nocturnal" when I start sleeping days and staying up nights. A lot of people taking Emsam are probably bipolar (whether they know it or not) and are more easily goofed up by the drug because of the fragility of their Circadian sleep/wake cycle.
2) Lots of MAOIs are chemically related to amphetamines and are therefore stimulants. In the case of Selegeline (Emsam), I have read it breaks down into d-amphetamine and methamphetamine. I was hoping for some good things due to this, as these compounds are strong antidepressants in their own rights, apart from the MAO inhibition. Also, I was hoping for some appetite suppression and weight loss, but it hasn't happened. However the negative upshot of amphetamines is, they disturb your sleep--much worse caffeine does--and that definitely has happened to me with Emsam.
Tomorrow I move up to the the *big patch* -- 12 mg. I think I will start taking 1 mg clonazapam (Klonapin) every night, like a preemptive strike!
Another thing I am going to try is putting on the patch as early as possible in the morning. I know nothing about how the thing works, but I strongly suspect more of the the drug comes out at the beginning.
Another thing I might try is using the big patch, but if it causes too much trouble, take it off sometime in the evening. Maybe I can still get as much of the drug into me as with the 6 or 9mg patch, but w/o having it percolating into my body while I'm trying to sleep.
Who knows what might work? There are lots of things to try.
> did anybody else have extreme insomnia with emsam and did it improve or did you have to medicate the insomnia. im so tired but i dont want to take more pills.
Posted by Jost on July 30, 2006, at 20:37:50
In reply to Re: Emsam (insomnia), posted by jkshrews on July 29, 2006, at 22:53:23
Insomnia's been a problem for me, too.
The last three days, I've used the 9 mg patch, and gone to sleep, and then when I wake up at some point in the night, like 5 am or so, I take it off for four or five hours. Then I put it back on at 9 or 10 am, depending on when I wake up.
This has helped my sleep in the later part of the night a lot, for some reason. Think I'm sleeping much better, and also more hours. Both. Guess the amphetamine effect wears off enough for me to sleep better.
My energy has been much much better the last three days, and I've been less agitated.
Even if I'm getting slightly less medication overall, the effect is better than more emsam and no sleep.
I'm taking lots of things to get to sleep initially. You could experiment with taking it off earlier, if you can't sleep at all, and then putting it back on at some point in the night, or right after you wake. You could use a little extra during the day, if you pdoc okays it, to make up for the amount you didn't get if you sleep through the night.
Mine did, although so far I haven't needed it. I might try it, though, if necessary, later.
More might require some accommodation while awake, but that could well happen.
Jost
Posted by laima on July 30, 2006, at 21:13:07
In reply to Re: Emsam (insomnia), posted by Jost on July 30, 2006, at 20:37:50
May I ask, are you saying that you are finding that if you take off the patch at a certain time of the night, you immediately feel able to get back to sleep? I might try that...I haven't been able to figure out when exactly that amphetamine effect occurs, or if it is always going on, or if there is a delay phase- you know?
> Insomnia's been a problem for me, too.
>
> The last three days, I've used the 9 mg patch, and gone to sleep, and then when I wake up at some point in the night, like 5 am or so, I take it off for four or five hours. Then I put it back on at 9 or 10 am, depending on when I wake up.
>
> This has helped my sleep in the later part of the night a lot, for some reason. Think I'm sleeping much better, and also more hours. Both. Guess the amphetamine effect wears off enough for me to sleep better.
>
> My energy has been much much better the last three days, and I've been less agitated.
>
> Even if I'm getting slightly less medication overall, the effect is better than more emsam and no sleep.
>
> I'm taking lots of things to get to sleep initially. You could experiment with taking it off earlier, if you can't sleep at all, and then putting it back on at some point in the night, or right after you wake. You could use a little extra during the day, if you pdoc okays it, to make up for the amount you didn't get if you sleep through the night.
>
> Mine did, although so far I haven't needed it. I might try it, though, if necessary, later.
>
> More might require some accommodation while awake, but that could well happen.
>
> Jost
>
>
Posted by Jost on July 31, 2006, at 19:30:38
In reply to Re: Emsam (insomnia) » Jost, posted by laima on July 30, 2006, at 21:13:07
Hi laima.
I don't fall right to sleep, but that's always true for me. My sleep has been considerably worse on emsam, though.--waking up many times, and only being half-asleep for periods of night.
.
In theory, after waking up, I'd be ready for the energy, and it could help rather than being at odds with my rhythm. In the middle of the night, the amphetamine effect (if that's what it is) seemed more likely to be disruptive.Of course, if I hadn't been able to sleep in the earlier night, I would have tried it the other way.
But I do take half an ambien, or a sonata when I wake up and take it off. Even normally, if I wake up in the middle of the night, I do that--
Jost
Posted by hermansmom on August 6, 2006, at 21:10:06
In reply to Re: new to emsa and SCARED!!!!, posted by jealibeanz on July 29, 2006, at 10:22:11
> You sounds a bit like me, except my last AD was Effexor, not Cymbalta. It also caused rapid weight gain, so I D/C'd. I'm now skeptical about this aspect with any AD. I too have an anxiety disorder and insomnia. I take Xanax and Lunesta, which is no longer helping much with sleep. How do you like the Rozerem? What type of med is that? Did you doc have any concerns about EMSAM worsening insomnia and anxiety? Let me know how you're doing. Thanks:)
Before the Emsam, the Rozarem helped alot. I have noticed the last couple of nights being up at 2 & 3 AM. Had previously tried ambien & lunesta without any effect, so this one I think is better. I am feeling like my anxiety has heightened with the emsam, and consequently am taking a higher dose of klonipin. I'm so sick of this! I am really afraid of where this is going to end. I am tired of this and really don't want to live like this. I had inquired about any good long term psych hospitals, and my doc suggested austen riggs in Mass., or the menninger clinic in houston for long term therapy. So, now it is a battle between MD recommendation and the insurance company. I am desperate, and can't keep going like this. I live in CA, so if anyone knows of any good hospitals that do more than zap you full of drugs & put you in the parking lot after a 3 day stay (they call that stabilization)PLEASE let me know. In CA it seems like the only centers that do longer term therapy (inpatient) are for detox, and that is the ONE problem I don't have!!!!
Posted by jealibeanz on August 6, 2006, at 23:08:03
In reply to Re: new to emsa and SCARED!!!!, posted by hermansmom on August 6, 2006, at 21:10:06
Well do you think EMSAM is helping the depression at all? It's OK, that you have to take more Klonopin. That's what you have it for, to relieve anxiety. Maybe that anxiety will lessen once you get used to the medication.
It's always tough when you're through that weird out of body feeling of titration on to a new prescription. That might be the cause of your anxiety rather than what you typically feel. People will anxiety disorders tend to have hightened awareness of their bodies and sesitivities to changes, discomfort, and pain.
You might just need to stick it out a little longer. How long have you been on it know and at what dose? Ideally, there would be no side effects, but if there are and you need to counter them with other medications, so be it. Whatever gives you any bit of relief is worth trying.
Posted by jkshrews on August 7, 2006, at 11:01:20
In reply to Re: new to emsa and SCARED!!!!, posted by hermansmom on August 6, 2006, at 21:10:06
Hermansmom,
There are in-patient facilities in almost every hospital, but will one really do you any good? To get your insurance to approve it, you have to be suicidal. I think in their minds, it's nothing but a matter of liabilities, i.e., in every case they can say "No" and refuse in-patient treatment to every person, but if someone kills himself, then they know they are in trouble. So to get in, you have to tell the intake counselor that you are making plans to off yourself (which may be true). It's a lousy way to do business.
jkshrews
> > You sounds a bit like me, except my last AD was Effexor, not Cymbalta. It also caused rapid weight gain, so I D/C'd. I'm now skeptical about this aspect with any AD. I too have an anxiety disorder and insomnia. I take Xanax and Lunesta, which is no longer helping much with sleep. How do you like the Rozerem? What type of med is that? Did you doc have any concerns about EMSAM worsening insomnia and anxiety? Let me know how you're doing. Thanks:)
>
> Before the Emsam, the Rozarem helped alot. I have noticed the last couple of nights being up at 2 & 3 AM. Had previously tried ambien & lunesta without any effect, so this one I think is better. I am feeling like my anxiety has heightened with the emsam, and consequently am taking a higher dose of klonipin. I'm so sick of this! I am really afraid of where this is going to end. I am tired of this and really don't want to live like this. I had inquired about any good long term psych hospitals, and my doc suggested austen riggs in Mass., or the menninger clinic in houston for long term therapy. So, now it is a battle between MD recommendation and the insurance company. I am desperate, and can't keep going like this. I live in CA, so if anyone knows of any good hospitals that do more than zap you full of drugs & put you in the parking lot after a 3 day stay (they call that stabilization)PLEASE let me know. In CA it seems like the only centers that do longer term therapy (inpatient) are for detox, and that is the ONE problem I don't have!!!!
>
Posted by hermansmom on August 8, 2006, at 22:22:53
In reply to Re: new to emsa and SCARED!!!!, posted by jealibeanz on August 6, 2006, at 23:08:03
> Well do you think EMSAM is helping the depression at all? It's OK, that you have to take more Klonopin. That's what you have it for, to relieve anxiety. Maybe that anxiety will lessen once you get used to the medication.
>
> It's always tough when you're through that weird out of body feeling of titration on to a new prescription. That might be the cause of your anxiety rather than what you typically feel. People will anxiety disorders tend to have hightened awareness of their bodies and sesitivities to changes, discomfort, and pain.
>
> You might just need to stick it out a little longer. How long have you been on it know and at what dose? Ideally, there would be no side effects, but if there are and you need to counter them with other medications, so be it. Whatever gives you any bit of relief is worth trying.To be honest with you, I haven't noticed any relief of depression with the emsam. I am only 1 week into it, and am using the 6mg. patch. My pdoc wanted to give it at least a 2 week trial before coming to any real conclusion. I just polished off a wicked 34 day ride with cymbalta withdrawal, so just being through that is a relief! I think the emsam is perhaps making me a little more edgy, but the klonipin is helping there. Just trying to hang in there while I battle w/insurance company for a longer term solution. I have so had it with the drugs! Right now I feel like a legal football getting kicked back & forth so the insurance company doesn't have to put out any more $ regardless of my quality of life!
Posted by SFY on August 9, 2006, at 11:36:58
In reply to Re: new to emsa and SCARED!!!!, posted by hermansmom on August 8, 2006, at 22:22:53
> To be honest with you, I haven't noticed any relief of depression with the emsam. I am only 1 week into it, and am using the 6mg. patch. My pdoc wanted to give it at least a 2 week trial before coming to any real conclusion. I just polished off a wicked 34 day ride with cymbalta withdrawal, so just being through that is a relief! I think the emsam is perhaps making me a little more edgy, but the klonipin is helping there. Just trying to hang in there while I battle w/insurance company for a longer term solution. I have so had it with the drugs! Right now I feel like a legal football getting kicked back & forth so the insurance company doesn't have to put out any more $ regardless of my quality of life!
Two weeks is definitely not enough time to see if Emsam is effective - six weeks is considered the minimum because it can take that long for it to kick in.
This is the end of the thread.
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