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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 45. Go back in thread:
Posted by liliths on January 5, 2007, at 10:47:39
In reply to Re: EMSAM, posted by laima on January 5, 2007, at 7:52:34
hi,
I keep looking at EMSAM and everything I read says not to take it with stimulents or actually most of the other drugs I take - wellbutrin & buspar - though I'm considering going off those
have you had any problems taking it with Adderall?
is it possible that I could use EMSAM with a reduced dose of my focalin XR?
I have ADD in addition to depression & anxiety
thanks
namaste,
llilith>
> I started regular oral selegeline a year ago, and switched to Emsam as soon as it came out (April? May?) I think I felt better within 2 weeks of starting selegeline, but right now I am wondering if Emsam is enough or if I am setting my sights too high. All those people who say Emsam makes them nervous or gives insomnia? I don't get that- it lowers my blood pressure so much that I use adderall with it. I'd like to raise my dose, but last time I tried, I felt pretty faint due to low blood pressure. Today I visit my doctor and will find out if he thinks raising stimulant along with raising Emsam is a good idea or not.
> I hope you don't stay scared- I think Emsam, especially the "6"- is a very safe drug! And I'm not bothered by any side effects other than the lowered blood pressure.
>
>
> > Laima: How long have you been taking? How many days did it take for you to feel any effect? Please share your story. I am scared tonight, taking this new and powerful drug.
>
>
Posted by Crazy Horse on January 5, 2007, at 10:49:20
In reply to EMSAM (6mg) Day 1, posted by UGottaHaveHope on January 4, 2007, at 20:49:24
Good Luck Michael, i hope it works great for you! :)
-Monte
Posted by Crazy Horse on January 5, 2007, at 10:55:57
In reply to Re: Cant sleep. Any suggestions?, posted by UgottaHaveHope on January 5, 2007, at 7:04:16
>
> Anu suggestions on getting any sleep? Ive heard about taking Ambien (never tried, would it be stronger than Klonopin?), Trazadone (is stronger than Seroquel?), to taking off patch, to Benedryl (is that OK to take?).
>
>
Trazodone worked great for me. You can use Benedryl even in combination with trazodone. Ambien and Lunesta did not work for me, but they might be great for you. I never took the patch off at night. One thought, if you are getting insomnia already, it means you are a responder. MAOI's unfortunately are notorious for insomnia.-Monte
Posted by UgottaHaveHope on January 5, 2007, at 13:05:35
In reply to Re: Cant sleep. Any suggestions? » UgottaHaveHope, posted by Crazy Horse on January 5, 2007, at 10:55:57
Last night I went to bed with 200mg of Seroquel and 2mg of Klonopin. When I awakened three hours later, I took 25mg of Seroquel and 2mg of Klonopin. Didnt seem to do much. Then I took 50mg of Benadryl and it gave me three more hours of sleep.
Is it OK to take Benadryl? Can you take it indefinitely? Does it mess with EMSAM effects? Thanks, Michael
Posted by laima on January 5, 2007, at 13:23:59
In reply to Re: EMSAM » laima, posted by liliths on January 5, 2007, at 10:47:39
It's a rote no-no, but my doctor is a very respected one, and he says he prescribes stimulants along with MAOIs all the time and has never, ever had a problem. The key is to keep an eye on blood pressure by using a personal reader at home, daily, even several times a day- the danger is that the combo could raise it dangerously high. But MAOIs can LOWER blood pressure so low in some people, that they feel faint and lethargic. I'm one of them, and my natural blood pressure is very low to begin with. Even with adderall, at peak concentartion times, my highest readings hover around 110/70, with a pulse in the 70s. My adderall just got bumped up a touch. I'd guess that depending on your blood pressure, you might indeed be able to combine focalin and Emsam. I'd speculate you wouldn't need as much focalin though. Good luck!ps- By the way- I feel morally obligated to mention what might be common knowledge, just to be safe: the Emsam drug interaction warnings are no joke, especially since most of them- such as combing with wellbutrin or buspar, can cause seratonin syndrome.
> hi,
>
> I keep looking at EMSAM and everything I read says not to take it with stimulents or actually most of the other drugs I take - wellbutrin & buspar - though I'm considering going off those
>
> have you had any problems taking it with Adderall?
>
> is it possible that I could use EMSAM with a reduced dose of my focalin XR?
>
> I have ADD in addition to depression & anxiety
>
> thanks
> namaste,
> llilith
>
> >
> > I started regular oral selegeline a year ago, and switched to Emsam as soon as it came out (April? May?) I think I felt better within 2 weeks of starting selegeline, but right now I am wondering if Emsam is enough or if I am setting my sights too high. All those people who say Emsam makes them nervous or gives insomnia? I don't get that- it lowers my blood pressure so much that I use adderall with it. I'd like to raise my dose, but last time I tried, I felt pretty faint due to low blood pressure. Today I visit my doctor and will find out if he thinks raising stimulant along with raising Emsam is a good idea or not.
> > I hope you don't stay scared- I think Emsam, especially the "6"- is a very safe drug! And I'm not bothered by any side effects other than the lowered blood pressure.
> >
> >
> > > Laima: How long have you been taking? How many days did it take for you to feel any effect? Please share your story. I am scared tonight, taking this new and powerful drug.
> >
> >
>
>
Posted by laima on January 5, 2007, at 13:26:04
In reply to Re: Benadryl worked, hope it's OK to use, posted by UgottaHaveHope on January 5, 2007, at 13:05:35
Plain Benedry's fine! It's good to hear that it worked. If anything, I almost wonder if my best month wasn't August- a month that I was using a lot of Benedryl due to allergies. I think there are other people who might be better able to comment on using it long term.
> Last night I went to bed with 200mg of Seroquel and 2mg of Klonopin. When I awakened three hours later, I took 25mg of Seroquel and 2mg of Klonopin. Didnt seem to do much. Then I took 50mg of Benadryl and it gave me three more hours of sleep.
>
> Is it OK to take Benadryl? Can you take it indefinitely? Does it mess with EMSAM effects? Thanks, Michael
Posted by liliths on January 5, 2007, at 15:23:37
In reply to Re: EMSAM, posted by laima on January 5, 2007, at 13:23:59
thank you so much for the info.
Like you, I have low blood pressure. Many years ago, I tried both Nardil and Parnate. My blood pressure would drop so low that I had a tendency to pass out and twitch.
even on my focalin xr (I take 40mg, which I'm told is a fairly high dose) my pressure is about 110/70 as well
is there any problem with weight gain? I know the other ones had it but isn't EMSAM supposed to be different than the 'older' ones (I think it's called an MAOI B ?? )
thanks again for the heads up on the other meds.
I know one needs to take MAOI's seriously.Much appreciated
namaste
lilith>
> It's a rote no-no, but my doctor is a very respected one, and he says he prescribes stimulants along with MAOIs all the time and has never, ever had a problem. The key is to keep an eye on blood pressure by using a personal reader at home, daily, even several times a day- the danger is that the combo could raise it dangerously high. But MAOIs can LOWER blood pressure so low in some people, that they feel faint and lethargic. I'm one of them, and my natural blood pressure is very low to begin with. Even with adderall, at peak concentartion times, my highest readings hover around 110/70, with a pulse in the 70s. My adderall just got bumped up a touch. I'd guess that depending on your blood pressure, you might indeed be able to combine focalin and Emsam. I'd speculate you wouldn't need as much focalin though. Good luck!
>
> ps- By the way- I feel morally obligated to mention what might be common knowledge, just to be safe: the Emsam drug interaction warnings are no joke, especially since most of them- such as combing with wellbutrin or buspar, can cause seratonin syndrome.
>
>
> > hi,
> >
> > I keep looking at EMSAM and everything I read says not to take it with stimulents or actually most of the other drugs I take - wellbutrin & buspar - though I'm considering going off those
> >
> > have you had any problems taking it with Adderall?
> >
> > is it possible that I could use EMSAM with a reduced dose of my focalin XR?
> >
> > I have ADD in addition to depression & anxiety
> >
> > thanks
> > namaste,
> > llilith
> >
> > >
> > > I started regular oral selegeline a year ago, and switched to Emsam as soon as it came out (April? May?) I think I felt better within 2 weeks of starting selegeline, but right now I am wondering if Emsam is enough or if I am setting my sights too high. All those people who say Emsam makes them nervous or gives insomnia? I don't get that- it lowers my blood pressure so much that I use adderall with it. I'd like to raise my dose, but last time I tried, I felt pretty faint due to low blood pressure. Today I visit my doctor and will find out if he thinks raising stimulant along with raising Emsam is a good idea or not.
> > > I hope you don't stay scared- I think Emsam, especially the "6"- is a very safe drug! And I'm not bothered by any side effects other than the lowered blood pressure.
> > >
> > >
> > > > Laima: How long have you been taking? How many days did it take for you to feel any effect? Please share your story. I am scared tonight, taking this new and powerful drug.
> > >
> > >
> >
> >
>
>
Posted by laima on January 5, 2007, at 16:12:20
In reply to Re: EMSAM » laima, posted by liliths on January 5, 2007, at 15:23:37
Hi Liliths,
You sound like you may indeed be a good candidate for a stimulant-Emsam combo, like me! I hope your doctor is ok about it. Mine is, but he also teaches pharmacology at a major medical school, so he's comfortable with "unconventional". He did write me a note to take to the pharmacy the first time, saying it's ok, because he said they might balk. Now the pharmacy is used to me, and there's no questioning. I was using ritalin with Emsam for a long time, until I consulted with a super-expert (for second opinion), and he said that in his observation, many people tended to particularly respond to an Emsam/adderall combo. I was switched immediately after, and I think it's true, at least for me. I haven't had any weight gain at all from Emsam. Are you using it now, or looking to use it in the future?
I figured you'd know about mixing MAOIs and other meds as most people around here do, but with the dangers being what they are, and here I am blathering on about the wonders of an unconventional drug combo- I thought I'd bring it up just to be safe. Never know who's reading and what ideas pop into people's minds. Thanks for understanding :)
Anyway, good luck!
Laima
Posted by Phillipa on January 5, 2007, at 18:04:42
In reply to Re: EMSAM » liliths, posted by laima on January 5, 2007, at 16:12:20
Michael how are you feeling now? Love Phillipa
Posted by UGottaHaveHope on January 5, 2007, at 20:57:05
In reply to Re: EMSAM, posted by Phillipa on January 5, 2007, at 18:04:42
It was hard to recover from a tough start to the day. I did not get a good night's sleep, and that bothered me. Always does. On my first night, I took 200mg Seroquel and 2mg Klonopin and slept only about three hours. I took 25mg of Seroquel and 2mg of Klonopin and when I awakened and it did not help. I took two Benadryl tablets and finally got three more hours.
Enough about that. In the early part of today, I was spooked. I have always read about MAOIs on this board but never knew I would take one myself. Seems like the people in the worst situation end up taking them. Therefore, by that logic, I must be in the group of people that are in the worst shape. I tried to counter that thought by telling myself that my doctor is one of the country's top researchers and he gave it to me because he has good idea it will have a positive effect. Oh what a battle of the mind.
I have to admit, though, that I am feeling better than yesterday on the patch. I know the doc said I would be unlikely to feel a difference until at least nine days, but my thoughts are more clear and my mood appears a little better. I don't think it has done anything with anxiety, but again it's early. I am hoping and praying God will give me the strength and courage to make it through 4-5 weeks on this med to give a shot.
Thanks everyone for your input. I live and sleep on this board, so any advice or insight is greatly appreciated. I need HOPE.
Posted by Phillipa on January 5, 2007, at 22:10:06
In reply to Re: EMSAM Day 2, posted by UGottaHaveHope on January 5, 2007, at 20:57:05
Michael well you know I'm attached at the hip to you so to speak. I hope it helps the anxiety as that is the main problem isn't it? You need sleep tonight so take what you need to take and take it easy this weekend. Love Jan
Posted by laima on January 5, 2007, at 23:30:08
In reply to Re: EMSAM Day 2, posted by UGottaHaveHope on January 5, 2007, at 20:57:05
Hey! I hope you don't worry too much about this- Emsam is really an MAOI for the masses. I am certain that they've traditionally been reserved for "the tough cases" because of the dietary and drug restrictions, and Emsam 6 cuts those worries into half. Really- why would anyone go for the restrictions and risks when something else works? That's just a neutral and practical thing. But meanwhile- lots of experts talk about how unique the MAOIs are, how they have much to offer that a lot of the newer meds don't. I've read in a number of places that a resurgence in the use of MAOIs in general is expected, largely thanks to Emsam. They are back on the table, so to speak. There already is a patch in development somewhere featuring another MAOI- but regretfully, I don't remember any details. It sounds like you are responding- that's great news! If your doctor is a researcher, I am especially certain he's reading a lot and knows what he's doing- doesn't sound like a random recommendation at all. My therapist is a researcher too, and she told me that it means she has to read all of the articles in her specialty every month in order to be current. I hope you give it the full go. Meanwhile, can you take anything to take the edge off your anxiety?
>Enough about that. In the early part of today, I was spooked. I have always read about MAOIs on this board but never knew I would take one myself. Seems like the people in the worst situation end up taking them. Therefore, by that logic, I must be in the group of people that are in the worst shape. I tried to counter that thought by telling myself that my doctor is one of the country's top researchers and he gave it to me because he has good idea it will have a positive effect. Oh what a battle of the mind.
>
> I have to admit, though, that I am feeling better than yesterday on the patch. I know the doc said I would be unlikely to feel a difference until at least nine days, but my thoughts are more clear and my mood appears a little better. I don't think it has done anything with anxiety, but again it's early. I am hoping and praying God will give me the strength and courage to make it through 4-5 weeks on this med to give a shot.
Posted by Crazy Horse on January 6, 2007, at 11:51:57
In reply to Re: Benadryl worked, hope it's OK to use, posted by UgottaHaveHope on January 5, 2007, at 13:05:35
>
> Is it OK to take Benadryl? Can you take it indefinitely? Does it mess with EMSAM effects? Thanks, MichaelYes it's okay to take Benadryl. You can take it indefinitely, however you will most likely develop tolerance to it eventually. I would say No, it doesn't mess with the effects of EMSAM.
-Monte
Posted by Karen44 on January 6, 2007, at 15:48:33
In reply to Re: EMSAM, posted by laima on January 5, 2007, at 13:23:59
Been on Emsam two weeks and two days and overall don't notice any difference. Two days ago I thought I was feeling better, but it was gone by yesterday and today; feel like I am sliding back down again. Is it worth it; the thought of going to work next week leaves me feeling overwhelmed. I have a meeting to run and four comprehensive evaluations to complete and write up. I think it is best not to think on it too much and just take one day at a time, I guess.
It also does not give me insomnia at the dose I am on--6 mg. patch.
Karen44
Posted by Honore on January 6, 2007, at 20:08:18
In reply to Re: EMSAM, posted by Karen44 on January 6, 2007, at 15:48:33
It can take three or more weeks for Emsam to have an effect--or really, even more--but you also might try 9 mg. A number of posts here have suggested that that's a more likely therapeutic dose than 6 mg (ie people report that their pdocs speculate to that effect).
By the way, my pdoc has used MAOIs for years, even though many other pdocs haven't. He prescribed both adderall and ritalin with both parnate and emsam. While it depends on individual response (he wanted me to be careful at the beginning with both), it's certainly possible to use them.
As far as taking the emsam patch off at night-- I do it, and it really helps me. I don't know the pharmacological explanation of the change in effect. It may be because there are some amphetamine-like breakdown products that are reduced when the patch is off--- Mainly, though, I believe in it-- because it works. I do also take a little seroquel and some ambien to get to sleep-- but I've always had insomnia, and I find that I'm sleeping as well or better than I ever have, with that combination.
Honore
Posted by liliths on January 8, 2007, at 7:52:26
In reply to Re: EMSAM » liliths, posted by laima on January 5, 2007, at 16:12:20
Hi Liama,
would you know the dose that one can take EMSAM on without having the dietary restrictions and in your opinion, would this dose be efficacious? I remember the restrictions of old being absolute and difficult in that I am a vegetarian.
what are the benefits of the EMSAM patch over oral selegeline?
If I may ask, what is your current combination and dosages of each?
I am looking to make a major change in my meds. It has been initated by forces outside me and and I'm probably going to being forced off the only one that still works. But I haven't felt the wellbutrin or buspar were doing much for me these days, though when I went to my pdoc about making changes, he told me it wasn't the meds, I just needed more exercise and structure in my life. Oh Duh! If I could've been doing those things, I wouldn't have been asking him to change meds to begin with. But I ended up agreeing it was ALL my fault and not his laziness!
indeed! so I am most likely going to need a new pdoc anyway. I'd honestly like to go off as many meds as possible but I think I also need to be realistic
the only other question I have is whether there's weight gain associated with EMSAM? I had a real backlash weight problem after a number of successful months on nardil, which caused me to have to stop the drug. But I also did have a lot of unpleasant side effects. Passing out from low blood pressure as well as an inability to urinate... ended up on medication to help the side effect and that's not something I'd be willing to do again
But the nardil really did help, if only for a while... if EMSAM doesn't carry weight gain and I could eat most of my food, it seems to be a pretty good candidate along with my focalin XR and klonopin.
And I could also consider going back on Concerta, which I used for years. I only changed when my insurance threatened to stop covering it. Then I guess when they realized people were just switching to focalin (which was more expensive LOL), it appeared back on my formulary. I'm thinking Concerta might be more gentle with the EMSAM... but what do I know?
sorry for posing so many questions. You seem to be the one person on a combo that 'might' work for me as well.
thanks for your help.
namaste,
lilith> Hi Liliths,
>
> You sound like you may indeed be a good candidate for a stimulant-Emsam combo, like me! I hope your doctor is ok about it. Mine is, but he also teaches pharmacology at a major medical school, so he's comfortable with "unconventional". He did write me a note to take to the pharmacy the first time, saying it's ok, because he said they might balk. Now the pharmacy is used to me, and there's no questioning. I was using ritalin with Emsam for a long time, until I consulted with a super-expert (for second opinion), and he said that in his observation, many people tended to particularly respond to an Emsam/adderall combo. I was switched immediately after, and I think it's true, at least for me. I haven't had any weight gain at all from Emsam. Are you using it now, or looking to use it in the future?
>
> I figured you'd know about mixing MAOIs and other meds as most people around here do, but with the dangers being what they are, and here I am blathering on about the wonders of an unconventional drug combo- I thought I'd bring it up just to be safe. Never know who's reading and what ideas pop into people's minds. Thanks for understanding :)
>
> Anyway, good luck!
>
> Laima
Posted by laima on January 8, 2007, at 9:40:24
In reply to Re: EMSAM Q? » laima, posted by liliths on January 8, 2007, at 7:52:26
Hi Liliths,
The # 6 doesn't have any dietary restrictions, and I get a little sloppy sometimes following the restrictions with the 9, and everything's been fine. (Technically, dietary restrictions haven't been officially studied with the 9 or 12-so they have to warn people, and caution is prudent.) It's only the MAOI drug warnings which are in full and undisputed effect for all three. I'd say that dietary freedom and relaxation is the # 1 benefit of Emsam over oral selelgeline. My doctor also seems to believe that the selegeline is somehow absorbed by the body differently or more efficiently from Emsam, but I didn't quite catch the details of why he believes that. I've not associated any weight gain or increased appetite with any strength Emsam. I'm personally not so sure about the efficacy of the 6, however. My doctor even said that he went to an Emsam conference where there was talk between the doctors that most people started responding when the dose was at least # 9--though the 6 has helped a fair number of people. I'm using the 9 right now with 15 mg adderall (it went up!). With the adderall increase especially, it's working out alright. Winter has always been really tough for me, and the weather has been very dark lately... I think I could be much, much better, but I'm back to believing my doctor when he keeps emphasizing therapy and lifestyle adjustments. His mantra could be, "Medication while it works gives you a window of opportunity..." (Working on that!) I blew off those urgings in the past, but this time I am heading as best as I humanly can. It's so interesting, he's a psychpharmacology expert who doesn't believe antidepressents work indefinately, but that's a whole other thread and story. So I completely believe you when you say wellbutrin and buspar aren't doing much for you these days. I've been on Emsam or selegeline for a year, and my doctor told me it was indeed entirely possible that it's not as helpful for me now as it used to be- but that there should still be some mileage left. And finally- the low blood pressure has been the only side effect I've associated with Emsam- but adderall keeps that under control, so it's not a problem. On days that I take a break from a stimulant, I remain a weak feeling slug, even after the stimulant's washed out. That's how I was when I started the Emsam by itself, too. I don't recall the low blood pressure being this big of an effect with the oral version- there's something about the oral version being more stimulating. But yes, I've been instructed to be super cautious with adderall, and before, with the ritalin. Especially with adderall- for the first couple weeks I was instructed to check my blood pressure both lying down and standing up in the morning, then about three hours after taking the adderall (because that's when it supposedly is at highest level in the body), and then at the end of the day. I had to show off my numbers so he'd feel ok that I wasn't in danger. I'm so sick of that blood pressure reader I could throw it out the window!
By the way, I was reading up about use of stimulants as antidepressents, and it seems that dexedrine is most associated with an anti-depressent effect (but it's hard to get a prescription). I am completely convinced that adderall is really giving me a mood boost in addition to its other benefits. Dexedrine is a component of adderall. The second expert, a researcher I consulted with per my doctor's suggestion, says he's observed that Emsam and Adderall appear to work synergistically. A clinical observation and hunch- not a study. (But that's why I was switched over from ritalin.) Neither doctor thought tolerance would be much of an issue with adderall or other short-acting stimulant if dose was kept as low as possible, and if not taken late in the day. The theory is it then gets a chance to wash out on a daily basis, and the brain gets lots of recovery time at night.
I hope I answered everything you were wondering. Good luck, Liliths!
Laima
> Hi Liama,
>
> would you know the dose that one can take EMSAM on without having the dietary restrictions and in your opinion, would this dose be efficacious? I remember the restrictions of old being absolute and difficult in that I am a vegetarian.
>
> what are the benefits of the EMSAM patch over oral selegeline?
>
> If I may ask, what is your current combination and dosages of each?
>
> I am looking to make a major change in my meds. It has been initated by forces outside me and and I'm probably going to being forced off the only one that still works. But I haven't felt the wellbutrin or buspar were doing much for me these days, though when I went to my pdoc about making changes, he told me it wasn't the meds, I just needed more exercise and structure in my life. Oh Duh! If I could've been doing those things, I wouldn't have been asking him to change meds to begin with. But I ended up agreeing it was ALL my fault and not his laziness!
>
> indeed! so I am most likely going to need a new pdoc anyway. I'd honestly like to go off as many meds as possible but I think I also need to be realistic
>
> the only other question I have is whether there's weight gain associated with EMSAM? I had a real backlash weight problem after a number of successful months on nardil, which caused me to have to stop the drug. But I also did have a lot of unpleasant side effects. Passing out from low blood pressure as well as an inability to urinate... ended up on medication to help the side effect and that's not something I'd be willing to do again
>
> But the nardil really did help, if only for a while... if EMSAM doesn't carry weight gain and I could eat most of my food, it seems to be a pretty good candidate along with my focalin XR and klonopin.
>
> And I could also consider going back on Concerta, which I used for years. I only changed when my insurance threatened to stop covering it. Then I guess when they realized people were just switching to focalin (which was more expensive LOL), it appeared back on my formulary. I'm thinking Concerta might be more gentle with the EMSAM... but what do I know?
>
> sorry for posing so many questions. You seem to be the one person on a combo that 'might' work for me as well.
>
> thanks for your help.
>
> namaste,
> lilith
>
> > Hi Liliths,
> >
> > You sound like you may indeed be a good candidate for a stimulant-Emsam combo, like me! I hope your doctor is ok about it. Mine is, but he also teaches pharmacology at a major medical school, so he's comfortable with "unconventional". He did write me a note to take to the pharmacy the first time, saying it's ok, because he said they might balk. Now the pharmacy is used to me, and there's no questioning. I was using ritalin with Emsam for a long time, until I consulted with a super-expert (for second opinion), and he said that in his observation, many people tended to particularly respond to an Emsam/adderall combo. I was switched immediately after, and I think it's true, at least for me. I haven't had any weight gain at all from Emsam. Are you using it now, or looking to use it in the future?
> >
> > I figured you'd know about mixing MAOIs and other meds as most people around here do, but with the dangers being what they are, and here I am blathering on about the wonders of an unconventional drug combo- I thought I'd bring it up just to be safe. Never know who's reading and what ideas pop into people's minds. Thanks for understanding :)
> >
> > Anyway, good luck!
> >
> > Laima
>
>
Posted by liliths on January 8, 2007, at 11:28:27
In reply to Re: EMSAM Q? » liliths, posted by laima on January 8, 2007, at 9:40:24
hi Liama,
I'm guessing that not having to be digested gastrointestinally probably has a lot to do with the patch not necessarily having dietary restrictions. Gee, I actually thought about it LOL
Thank you SO much for your info.
I seems to me that the blood pressure effects of the stims would be a 'good' thing, considering how low the MAOI's make it - I'm actually surprised to hear of the caution.
when I was on the nardil - I had to constantly take readings because my bp went so low, so I understand how what starts out interesting ends up annoying!
the few times I've missed my morning meds (accidently) I'd realize it only because I'd spend the day like a slug as well, only also crying a LOT and eating for 'comfort'
I'm pretty athletic - weight gain is a BAD thing LOL
Though my pdoc was among the first to tell me I'd have to be on meds the rest of my life (I'd always thought of them more as that 'window of opportunity' thing), he also told me that someone like me couldn't be helped by any pill unless I worked out regularly.
But the stupid pills do have to at least relieve some of the symptoms or else why take them? It doesn't help to 'know' working out will make me feel better if I can't go out of the house and do it!! That's what pissed me off about his unwillingness to realize the meds weren't working anymore.
I definitely agree that we have to change our lifestyles, habits, and behavior since depression as a lifestyle itself can become pretty addicting - no matter how miserable you are - it's the misery you know
Interesting information about the adderall - I'd definitely be willing to try it with the EMSAM and my klonopin if I can find a pdoc willing to do it.
what's the exchange for adderall? Is it like focalin, which is half what one would take on ritalin or concerta?
you've been great
thanks again
namaste,
lilith> Hi Liliths,
>
> The # 6 doesn't have any dietary restrictions, and I get a little sloppy sometimes following the restrictions with the 9, and everything's been fine. (Technically, dietary restrictions haven't been officially studied with the 9 or 12-so they have to warn people, and caution is prudent.) It's only the MAOI drug warnings which are in full and undisputed effect for all three. I'd say that dietary freedom and relaxation is the # 1 benefit of Emsam over oral selelgeline. My doctor also seems to believe that the selegeline is somehow absorbed by the body differently or more efficiently from Emsam, but I didn't quite catch the details of why he believes that. I've not associated any weight gain or increased appetite with any strength Emsam. I'm personally not so sure about the efficacy of the 6, however. My doctor even said that he went to an Emsam conference where there was talk between the doctors that most people started responding when the dose was at least # 9--though the 6 has helped a fair number of people. I'm using the 9 right now with 15 mg adderall (it went up!). With the adderall increase especially, it's working out alright. Winter has always been really tough for me, and the weather has been very dark lately... I think I could be much, much better, but I'm back to believing my doctor when he keeps emphasizing therapy and lifestyle adjustments. His mantra could be, "Medication while it works gives you a window of opportunity..." (Working on that!) I blew off those urgings in the past, but this time I am heading as best as I humanly can. It's so interesting, he's a psychpharmacology expert who doesn't believe antidepressents work indefinately, but that's a whole other thread and story. So I completely believe you when you say wellbutrin and buspar aren't doing much for you these days. I've been on Emsam or selegeline for a year, and my doctor told me it was indeed entirely possible that it's not as helpful for me now as it used to be- but that there should still be some mileage left. And finally- the low blood pressure has been the only side effect I've associated with Emsam- but adderall keeps that under control, so it's not a problem. On days that I take a break from a stimulant, I remain a weak feeling slug, even after the stimulant's washed out. That's how I was when I started the Emsam by itself, too. I don't recall the low blood pressure being this big of an effect with the oral version- there's something about the oral version being more stimulating. But yes, I've been instructed to be super cautious with adderall, and before, with the ritalin. Especially with adderall- for the first couple weeks I was instructed to check my blood pressure both lying down and standing up in the morning, then about three hours after taking the adderall (because that's when it supposedly is at highest level in the body), and then at the end of the day. I had to show off my numbers so he'd feel ok that I wasn't in danger. I'm so sick of that blood pressure reader I could throw it out the window!
>
> By the way, I was reading up about use of stimulants as antidepressents, and it seems that dexedrine is most associated with an anti-depressent effect (but it's hard to get a prescription). I am completely convinced that adderall is really giving me a mood boost in addition to its other benefits. Dexedrine is a component of adderall. The second expert, a researcher I consulted with per my doctor's suggestion, says he's observed that Emsam and Adderall appear to work synergistically. A clinical observation and hunch- not a study. (But that's why I was switched over from ritalin.) Neither doctor thought tolerance would be much of an issue with adderall or other short-acting stimulant if dose was kept as low as possible, and if not taken late in the day. The theory is it then gets a chance to wash out on a daily basis, and the brain gets lots of recovery time at night.
>
> I hope I answered everything you were wondering. Good luck, Liliths!
>
> Laima
>
>
>
>
> > Hi Liama,
> >
> > would you know the dose that one can take EMSAM on without having the dietary restrictions and in your opinion, would this dose be efficacious? I remember the restrictions of old being absolute and difficult in that I am a vegetarian.
> >
> > what are the benefits of the EMSAM patch over oral selegeline?
> >
> > If I may ask, what is your current combination and dosages of each?
> >
> > I am looking to make a major change in my meds. It has been initated by forces outside me and and I'm probably going to being forced off the only one that still works. But I haven't felt the wellbutrin or buspar were doing much for me these days, though when I went to my pdoc about making changes, he told me it wasn't the meds, I just needed more exercise and structure in my life. Oh Duh! If I could've been doing those things, I wouldn't have been asking him to change meds to begin with. But I ended up agreeing it was ALL my fault and not his laziness!
> >
> > indeed! so I am most likely going to need a new pdoc anyway. I'd honestly like to go off as many meds as possible but I think I also need to be realistic
> >
> > the only other question I have is whether there's weight gain associated with EMSAM? I had a real backlash weight problem after a number of successful months on nardil, which caused me to have to stop the drug. But I also did have a lot of unpleasant side effects. Passing out from low blood pressure as well as an inability to urinate... ended up on medication to help the side effect and that's not something I'd be willing to do again
> >
> > But the nardil really did help, if only for a while... if EMSAM doesn't carry weight gain and I could eat most of my food, it seems to be a pretty good candidate along with my focalin XR and klonopin.
> >
> > And I could also consider going back on Concerta, which I used for years. I only changed when my insurance threatened to stop covering it. Then I guess when they realized people were just switching to focalin (which was more expensive LOL), it appeared back on my formulary. I'm thinking Concerta might be more gentle with the EMSAM... but what do I know?
> >
> > sorry for posing so many questions. You seem to be the one person on a combo that 'might' work for me as well.
> >
> > thanks for your help.
> >
> > namaste,
> > lilith
> >
> > > Hi Liliths,
> > >
> > > You sound like you may indeed be a good candidate for a stimulant-Emsam combo, like me! I hope your doctor is ok about it. Mine is, but he also teaches pharmacology at a major medical school, so he's comfortable with "unconventional". He did write me a note to take to the pharmacy the first time, saying it's ok, because he said they might balk. Now the pharmacy is used to me, and there's no questioning. I was using ritalin with Emsam for a long time, until I consulted with a super-expert (for second opinion), and he said that in his observation, many people tended to particularly respond to an Emsam/adderall combo. I was switched immediately after, and I think it's true, at least for me. I haven't had any weight gain at all from Emsam. Are you using it now, or looking to use it in the future?
> > >
> > > I figured you'd know about mixing MAOIs and other meds as most people around here do, but with the dangers being what they are, and here I am blathering on about the wonders of an unconventional drug combo- I thought I'd bring it up just to be safe. Never know who's reading and what ideas pop into people's minds. Thanks for understanding :)
> > >
> > > Anyway, good luck!
> > >
> > > Laima
> >
> >
>
>
Posted by laima on January 8, 2007, at 18:08:43
In reply to Re: EMSAM Q? THANK YOU » laima, posted by liliths on January 8, 2007, at 11:28:27
Hi Liliths,I'm with you- the blood pressure increase from the stims is a good thing. But we do have lower blood pressure than a lot of people. Like you, I guess I would also be considered athletic, because I do a lot of active stuff. I think that it would be an entirely different story for a sedentary person with high blood pressure and resting pulse. I'm sure there's plenty of reason for a warning.
What does your doctor think about your low blood pressure anyway? He/she should be sympathetic, one would think. How is one supposed to feel better when faint and weak? I understand that the two choices are either a hormone (don't recall what it's called) or a stimulant, small dose. And viola- the stimulant just so happens to also help ADD stuff. Getting THAT under control helps loads!
I asked if there was any stimulant comparison chart, something like what there is for comparing benzos, but no. My doctor wasn't keen on making any specific comparisons like that either, just said adderall is much stronger than ritalin. Hard to get straight answers sometimes!
Good luck, very eager to hear what happens for you.
Laima
Posted by stargazer on January 8, 2007, at 22:38:13
In reply to Re: EMSAM Q? THANK YOU » liliths, posted by laima on January 8, 2007, at 18:08:43
I think the drug to increase BP might be Florinef. My father was put on this when he developed hypotension with his parkinson's meds. It is used to prevent dehyration and therefore keeps BP from becoming too low when your body excretes more fluid than it needs to maintain a normal BP.
SG
Posted by laima on January 9, 2007, at 10:08:30
In reply to Re: EMSAM Q? THANK YOU/Laima, posted by stargazer on January 8, 2007, at 22:38:13
Florinef- Yes, I think that's the one.
Posted by liliths on January 10, 2007, at 14:51:28
In reply to Re: EMSAM Q? THANK YOU » liliths, posted by laima on January 8, 2007, at 18:08:43
Hi Liama,
my bp's been low all my life. Since I'm on the focalin, it 'appears' so normal LOL so no one cares. It was really only a problem those many years ago when I was trying MAOI's. What a trip that was! I was fainting everywhere. Even ended up with a mild concussion from one fall... of course, no one ever treated the low bp - just told me to be very careful and check it often
I'm not likely to be making any changes soon. I'm going to have to find a new pdoc as a result of the current nightmare I'm enduring with the state. My hearing is next week and I won't be doing anything until that is over
in case you haven't a clue what I'm talking about, there are long threads on both "work" and "alternative" about the fact that in applying to the state for a license, my being on medication kicked me into a kafkaesque nightmare, which basically left me suicidal and totally dysfunctional. Whether you want to bother reading them is totally up to you, but I will warn you that they're upsetting...
my current pdoc reacted so poorly to it that I've totally lost faith and respect for him and so I now have to find someone else. And I will say, the stress of that is totally overwhelming, though I'm hoping my primary will write my scripts in the interim.
But I don't want to ask her to write something like EMSAM, when she's clearly not knowledgeable. I know she'd be extremely uncomfortable writing anything I'm not already on.
But if I survive the next few weeks and actually manage to find a GOOD pdoc willing to take a chance... I promise to keep you informed
btw, I've read some of your other posts and I've noticed you've expressed some concerns that the EMSAM isn't really doing much... how ARE you doing on the combo? Do you think it's more the adderall that's helping? Are you at all satisfied with the EMSAM or are you thinking about trying something else?
I hope it all works out for you!
thanks for your help
namaste,
lilith>
> Hi Liliths,
>
> I'm with you- the blood pressure increase from the stims is a good thing. But we do have lower blood pressure than a lot of people. Like you, I guess I would also be considered athletic, because I do a lot of active stuff. I think that it would be an entirely different story for a sedentary person with high blood pressure and resting pulse. I'm sure there's plenty of reason for a warning.
>
> What does your doctor think about your low blood pressure anyway? He/she should be sympathetic, one would think. How is one supposed to feel better when faint and weak? I understand that the two choices are either a hormone (don't recall what it's called) or a stimulant, small dose. And viola- the stimulant just so happens to also help ADD stuff. Getting THAT under control helps loads!
>
> I asked if there was any stimulant comparison chart, something like what there is for comparing benzos, but no. My doctor wasn't keen on making any specific comparisons like that either, just said adderall is much stronger than ritalin. Hard to get straight answers sometimes!
>
> Good luck, very eager to hear what happens for you.
>
> Laima
>
>
Posted by RN320 on January 12, 2007, at 13:54:09
In reply to Re: EMSAM Q? » laima, posted by liliths on January 8, 2007, at 7:52:26
Hi- For what it's worth, I'm on EMSAM (12mg) and I take florinef to keep my BP up. It's worked really well. I still have some moderate orthostatic problems but they are more manageable and my baseline BP has gone from 86/48 to 110/70......works for me, and gives me an incredible boost in energy! Also, at the 12mg dose I found my anxiety to decrease greatly, and the first couple of weeks I had a sudden weight loss of 11 pounds. (I became the size of the Hindenburg on Seroquel, so I was really worried about it and am pleased that weight gan is not something you need to worry about on EMSAM. My understanding of the reason that oral selegeline is not supposed to be an option is that the "Safe dose" is for treatment of Parkinson's and that much higher doses are required to treat depression (because it absorbs better from the skin than the gut). My pdoc will not use selegeline for depression because he says that the required doses to really treat depression are at a dangerous/toxic level. Anyway, that's what I was told.
Regards.
/m
Posted by liliths on January 12, 2007, at 14:43:16
In reply to Re: EMSAM Q?, posted by RN320 on January 12, 2007, at 13:54:09
thank you for posting... you're probably one of the first people to post such an extremely positive response to the drug.
At 12mg do you have any dietary restrictions? Do you leave the patch on all the time? How long have you been using it and do you augment with anything else?
sorry for all the questions
I'm hoping to be able to combine it with my ADD meds so the low bp shouldn't be a problem.
thanks again
namaste,
lilith> Hi- For what it's worth, I'm on EMSAM (12mg) and I take florinef to keep my BP up. It's worked really well. I still have some moderate orthostatic problems but they are more manageable and my baseline BP has gone from 86/48 to 110/70......works for me, and gives me an incredible boost in energy! Also, at the 12mg dose I found my anxiety to decrease greatly, and the first couple of weeks I had a sudden weight loss of 11 pounds. (I became the size of the Hindenburg on Seroquel, so I was really worried about it and am pleased that weight gan is not something you need to worry about on EMSAM. My understanding of the reason that oral selegeline is not supposed to be an option is that the "Safe dose" is for treatment of Parkinson's and that much higher doses are required to treat depression (because it absorbs better from the skin than the gut). My pdoc will not use selegeline for depression because he says that the required doses to really treat depression are at a dangerous/toxic level. Anyway, that's what I was told.
> Regards.
> /m
Posted by RN320 on January 12, 2007, at 15:15:19
In reply to Re: EMSAM Q? » RN320, posted by liliths on January 12, 2007, at 14:43:16
Hi Lillith-
At 12mg you do have dietary restrictions, but they're not as bad as with the oral MAOIs.
I recently had a tyramine reaction (hypertensive crisis) which was scary but managed ok. Still don't know the source of it, but it came from a Thai restaurant (where I was promised that there was no soy, MSG or fermented products in what I ordered.) My pdoc is in the process of following up with a "Medical Letter" to BMS and to the FDA.I have had several serious obstacles that have popped up in the course of getting regulated on EMSAM, but they've all been able to be handled successfully.
I will be starting provigil next week as an adjunct. My pdoc has told me that the only really safe atimulant is Provigil. I told him that people take adderall and ritalin and he said that they were "expressly contraindicated" in use with EMSAM.
Good luck to you. Feel free to write anytime, if you think that I could be of help.
/m
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