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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by KellyJo on August 27, 2009, at 6:02:35
I've posted in a few other threads about my inability to sleep while on Emsam. I really need help with this and sexual dysfunction. I can find virtually no information about SD in women on Emsam. My pdoc is working with me on the sleep issues but says there may be no help for the sexual dysfunction. As of yesterday, my meds are-
6 mg Emsam patch
2 mg Klonopin at bedtime to help me sleep(I'll add that I also have PLMD)
12.5 Ambien CR at bedtime
.50 Klonopin for anxiety as needed
25-100 mg Vistaril for anxiety as needed
I only sleep about 4 hours a night. I take my meds and fall asleep right away but after 4 hours I toss and turn for 2 hours and then I'm awake for good. I'm starting to fall asleep at inapporpriate times (during the day). I'm so tired but can't sleep- it's so frustrating! I'd also like any information anyone has about female sexual dysfunction while on Emsam. This is so embarrassing but I can't find any inforomation anyhwere and my pdoc wasn't much help. Thanks for any help.Kelly Jo
Posted by Phillipa on August 27, 2009, at 11:42:04
In reply to Help with Emsam side effects-Can't sleep and SD!, posted by KellyJo on August 27, 2009, at 6:02:35
Kelly Jo I dont wish to sound insensitive but isn't the most important thing to get the depression and anxiety under control? What's PLMD? Then deal with sexual issues. To be ride of depression/anxiety I'd think would also help with those issues. Just my thoughts. Good luck Phillipa
Posted by Phillipa on August 27, 2009, at 12:01:26
In reply to Re: Help with Emsam side effects-Can't sleep and SD! » KellyJo, posted by Phillipa on August 27, 2009, at 11:42:04
I googled PLMD and it seems that parkinsons meds can help . I thought I'd post the link. Phillipa
http://www.talkaboutsleep.com/sleep-disorders/archives/rls_pmd_plmdintro1.htm
Posted by KellyJo on August 27, 2009, at 14:16:34
In reply to Re: Help with Emsam side effects-Can't sleep and SD! » KellyJo, posted by Phillipa on August 27, 2009, at 11:42:04
Thank you for the reply. I agree that treating the depression and anxiety are most important and that's why I've chosen to stay on Emsam because it's working (on the depression only). I was just hoping for information from others that have possibly had the same side effects. Sorry if I came accross as a whiner, depression is no joke. I finally have the will to live while on Emsam. I do however need to sleep and enjoy a normal sex life. The lack of those two things in themselves can cause depression. I don't want it creeping back in. I'm being treated for the PLMD by the doctor that conducted my sleep study and by my pdoc. The sleep doc put me on the Klonopin at night to treat the PLMD. My pdoc has since upped the dose several times because it is helping the anxiety but I'm still not sleeping. Selegiline is used to treat Parkinsons disease and PLMD and I was on Selegiline (oral) when I had he sleep study done and the diagnosis was made. I've since switched to Emsam. If either doctor suggests another Parkinsons med, I'll give it a try. In the meantime, I've been told that Klonopin is the most effective treatment for PLMD. I think the Emsam is keeping me awake now and not the PLMD but there's no way to know unless I have another sleep study. I only slept from 12:30- 4 last night. <sigh>
Posted by floatingbridge on August 27, 2009, at 15:28:20
In reply to Re: Help with Emsam side effects-Can't sleep and SD!, posted by KellyJo on August 27, 2009, at 14:16:34
Hi Kelly,
Until you reach your optimum sleep regime, there is sonata that will allow you to take it in the middle of the night when you wake up, so you can get back to sleep until morning. It works for me!
fb
Posted by desolationrower on August 27, 2009, at 22:09:47
In reply to Help with Emsam side effects-Can't sleep and SD!, posted by KellyJo on August 27, 2009, at 6:02:35
long-halflife benzo is not really an ideal sleep drug. if you could reduce that and maybe use a shorter benzo you'd probably be better off. gabapentin or IR quetiapine might be good too; i think gabapentin might help with the led movement.
the problems could be caused by various things, if you describe the sleep problem better it might help.
the sexual problem, thats odd with selegiline; does it affect libido, arousal, orgasm all or just one phase?
cyproheptadine might help both problems.
-d/r
Posted by ihatedrugs on August 28, 2009, at 1:14:25
In reply to Help with Emsam side effects-Can't sleep and SD!, posted by KellyJo on August 27, 2009, at 6:02:35
Adding 25-50 mg of seroquel to the klonopin and Ambien knocked me out and I would sleep like a baby (while on the Emsam patch). I stopped it because just looking at Seroquel causes me to gain weight and I'm trying to lose previous ADs weight gain.
Posted by KellyJo on August 28, 2009, at 8:37:32
In reply to Re: Help with Emsam side effects-Can't sleep and SD!, posted by desolationrower on August 27, 2009, at 22:09:47
> long-halflife benzo is not really an ideal sleep drug. if you could reduce that and maybe use a shorter benzo you'd probably be better off. gabapentin or IR quetiapine might be good too; i think gabapentin might help with the led movement.
>
> the problems could be caused by various things, if you describe the sleep problem better it might help.
>
> the sexual problem, thats odd with selegiline; does it affect libido, arousal, orgasm all or just one phase?
>
> cyproheptadine might help both problems.
>
> -d/rThank you for all replies. All information/tips are appreciated.
I started out going to sleep just fine but would only sleep 4 hours then toss and turn. Now that I've been on Emsam about 7 weeks, I'm starting to have a hard time falling asleep then I sleep 3 to 4 hours then either wake up for good or wake up and toss and turn for an hour or two then get up for good. My Pdoc just upped the Klonopin to 2 mg and I slept great last night, only woke up twice but went right back to sleep and slept 9 hours! I'm dragging this morning but I'll drink some coffee to help with that. I'm afraid it isn't going to last because this is exactly what happened at .25 mg of Klonopin when I started out and it only last 5 days then back to no sleep again. I will ask about the Gaba, I have read about that for PLMD. Not sure what other short acting Benzos you are talking about. My Pdoc mentioned Trazadone but then looked it up and said I couldn't take it with Emsam. I know I'm pretty limited with the Emsam and other meds. I'm afraid to try Seroquel because of the weight gain, I just lost 60 pounds. I was also on Lithium but at 600 and 900 mg I had horrible hand tremors and my job requires fine motor skills. At 300 mg I still noticed weight gain (5 lbs in a week) I think from fluid retention. It wasn't helping anything so we discontinued it.
As far as the SD goes. My libido has increased (no complaints there!) but the orgasm is the problem. What used to take 2 minutes now takes 20-30 minutes and then it's jut blah, hardly worth the work.
I always get the odd side effects or the ones most people don't get. For instance, I was told that Emsam is supposed to help with anxiety, but it hasn't helped as a matter of fact it's much worse!
Thanks again for any help!
Posted by desolationrower on August 29, 2009, at 0:35:43
In reply to Re: Help with Emsam side effects-Can't sleep and SD!, posted by KellyJo on August 28, 2009, at 8:37:32
> > long-halflife benzo is not really an ideal sleep drug. if you could reduce that and maybe use a shorter benzo you'd probably be better off. gabapentin or IR quetiapine might be good too; i think gabapentin might help with the led movement.
> >
> > the problems could be caused by various things, if you describe the sleep problem better it might help.
> >
> > the sexual problem, thats odd with selegiline; does it affect libido, arousal, orgasm all or just one phase?
> >
> > cyproheptadine might help both problems.
> >
> > -d/r
>
> Thank you for all replies. All information/tips are appreciated.
>
> I started out going to sleep just fine but would only sleep 4 hours then toss and turn. Now that I've been on Emsam about 7 weeks, I'm starting to have a hard time falling asleep then I sleep 3 to 4 hours then either wake up for good or wake up and toss and turn for an hour or two then get up for good. My Pdoc just upped the Klonopin to 2 mg and I slept great last night, only woke up twice but went right back to sleep and slept 9 hours! I'm dragging this morning but I'll drink some coffee to help with that. I'm afraid it isn't going to last because this is exactly what happened at .25 mg of Klonopin when I started out and it only last 5 days then back to no sleep again. I will ask about the Gaba, I have read about that for PLMD. Not sure what other short acting Benzos you are talking about. My Pdoc mentioned Trazadone but then looked it up and said I couldn't take it with Emsam. I know I'm pretty limited with the Emsam and other meds. I'm afraid to try Seroquel because of the weight gain, I just lost 60 pounds. I was also on Lithium but at 600 and 900 mg I had horrible hand tremors and my job requires fine motor skills. At 300 mg I still noticed weight gain (5 lbs in a week) I think from fluid retention. It wasn't helping anything so we discontinued it.
>
> As far as the SD goes. My libido has increased (no complaints there!) but the orgasm is the problem. What used to take 2 minutes now takes 20-30 minutes and then it's jut blah, hardly worth the work.
>
> I always get the odd side effects or the ones most people don't get. For instance, I was told that Emsam is supposed to help with anxiety, but it hasn't helped as a matter of fact it's much worse!
>
> Thanks again for any help!hm. female sexual function isn't as well understood as male, but i think 5ht2 might be involved. and blx can improve sleep too. but antagonists often tend to cause weight gain. have you had similar problems with ssris? i might try a pde5 inhibitor first, if only because they have a good side effect profile.
even my pdoc let me have trazodone with an maoi, although it isn't uniquely useful. cyproheptadine i like because its a short half life, so even if it makes you hungry, its gone by morning, unlike most antihistamines or 5ht2 antagonists. i think geodon is weight neutral, but that not apply here and it can cause anxiety too.
gabapentin is good afa weight gain goes. clonidine also helps with muscle spasms, and i think alpha1 antagonists might be especially good for maoi insomnia, like trazadone which also is an alpha1 antagonist (but it might interfer with sexual function, so take after sex.) also, have you tried baclofen for the movement problem? although it sounds like thats not the main problem.
thats a lot of ideas. i might approach it as:
first, switch to a shorter halflife benzo, like triazolam, with .75 or however much klonopin you need to control anxiety during the next day. that should reduce daytime fatigue and 'save' your gaba receptors so the benzo will help more at night.
then, see if gabapentin/pregabalin can be used instead. this should improve sleep quality.
you can try those pretty quickly, so i might do that first, maybe while also trying a pde5i, since those don't have overlapping effects. not using a benzo might be a goal, since they are the worst for sleep quality.
if either problem isn't solved, i would also try cyproheptadine, maybe up to 12mg, that might help both problems, although it wouldn't the the sole hypnotic/antispastic.
if still having sd (espcially if cypro helped at all but caused any weight gain - antihistamine action probably could contribute there), maybe .5mg of risperdone as the 5ht2 antagonist.
clonidine if still having some sleep problems. with some of the shorter halflife drugs, just doing 4h of sleep, waking up and taking another pill with a glass of water, and then doing another 4h of sleep would probably work ok. waking up isn't necessarily problematic.
hopefully thats enough options you can find something your pdoc will ok
-d/r
Posted by KellyJo on September 1, 2009, at 5:40:40
In reply to Re: Help with Emsam side effects-Can't sleep and SD!, posted by desolationrower on August 29, 2009, at 0:35:43
> > > long-halflife benzo is not really an ideal sleep drug. if you could reduce that and maybe use a shorter benzo you'd probably be better off. gabapentin or IR quetiapine might be good too; i think gabapentin might help with the led movement.
> > >
> > > the problems could be caused by various things, if you describe the sleep problem better it might help.
> > >
> > > the sexual problem, thats odd with selegiline; does it affect libido, arousal, orgasm all or just one phase?
> > >
> > > cyproheptadine might help both problems.
> > >
> > > -d/r
> >
> > Thank you for all replies. All information/tips are appreciated.
> >
> > I started out going to sleep just fine but would only sleep 4 hours then toss and turn. Now that I've been on Emsam about 7 weeks, I'm starting to have a hard time falling asleep then I sleep 3 to 4 hours then either wake up for good or wake up and toss and turn for an hour or two then get up for good. My Pdoc just upped the Klonopin to 2 mg and I slept great last night, only woke up twice but went right back to sleep and slept 9 hours! I'm dragging this morning but I'll drink some coffee to help with that. I'm afraid it isn't going to last because this is exactly what happened at .25 mg of Klonopin when I started out and it only last 5 days then back to no sleep again. I will ask about the Gaba, I have read about that for PLMD. Not sure what other short acting Benzos you are talking about. My Pdoc mentioned Trazadone but then looked it up and said I couldn't take it with Emsam. I know I'm pretty limited with the Emsam and other meds. I'm afraid to try Seroquel because of the weight gain, I just lost 60 pounds. I was also on Lithium but at 600 and 900 mg I had horrible hand tremors and my job requires fine motor skills. At 300 mg I still noticed weight gain (5 lbs in a week) I think from fluid retention. It wasn't helping anything so we discontinued it.
> >
> > As far as the SD goes. My libido has increased (no complaints there!) but the orgasm is the problem. What used to take 2 minutes now takes 20-30 minutes and then it's jut blah, hardly worth the work.
> >
> > I always get the odd side effects or the ones most people don't get. For instance, I was told that Emsam is supposed to help with anxiety, but it hasn't helped as a matter of fact it's much worse!
> >
> > Thanks again for any help!
>
> hm. female sexual function isn't as well understood as male, but i think 5ht2 might be involved. and blx can improve sleep too. but antagonists often tend to cause weight gain. have you had similar problems with ssris? i might try a pde5 inhibitor first, if only because they have a good side effect profile.
>
> even my pdoc let me have trazodone with an maoi, although it isn't uniquely useful. cyproheptadine i like because its a short half life, so even if it makes you hungry, its gone by morning, unlike most antihistamines or 5ht2 antagonists. i think geodon is weight neutral, but that not apply here and it can cause anxiety too.
>
> gabapentin is good afa weight gain goes. clonidine also helps with muscle spasms, and i think alpha1 antagonists might be especially good for maoi insomnia, like trazadone which also is an alpha1 antagonist (but it might interfer with sexual function, so take after sex.) also, have you tried baclofen for the movement problem? although it sounds like thats not the main problem.
>
> thats a lot of ideas. i might approach it as:
>
> first, switch to a shorter halflife benzo, like triazolam, with .75 or however much klonopin you need to control anxiety during the next day. that should reduce daytime fatigue and 'save' your gaba receptors so the benzo will help more at night.
>
> then, see if gabapentin/pregabalin can be used instead. this should improve sleep quality.
>
> you can try those pretty quickly, so i might do that first, maybe while also trying a pde5i, since those don't have overlapping effects. not using a benzo might be a goal, since they are the worst for sleep quality.
>
> if either problem isn't solved, i would also try cyproheptadine, maybe up to 12mg, that might help both problems, although it wouldn't the the sole hypnotic/antispastic.
>
> if still having sd (espcially if cypro helped at all but caused any weight gain - antihistamine action probably could contribute there), maybe .5mg of risperdone as the 5ht2 antagonist.
>
> clonidine if still having some sleep problems. with some of the shorter halflife drugs, just doing 4h of sleep, waking up and taking another pill with a glass of water, and then doing another 4h of sleep would probably work ok. waking up isn't necessarily problematic.
>
> hopefully thats enough options you can find something your pdoc will ok
>
> -d/rThank you for the information! I have a lot of research to do and will definitely discuss these options with my pdoc.
Posted by KellyJo on September 8, 2009, at 21:16:16
In reply to Re: Help with Emsam side effects-Can't sleep and SD!, posted by KellyJo on September 1, 2009, at 5:40:40
Small update. Klonopin stopped working like I thought it would and now they've added the Gabapentin. She dosed me at 600 mg but said to work up to that. I'm a little scared- 3 sleep meds at once? I start tonight. PLEASE let it work!
Posted by floatingbridge on September 8, 2009, at 22:33:23
In reply to Re: Help with Emsam side effects-Can't sleep and SD!, posted by KellyJo on September 8, 2009, at 21:16:16
> Small update. Klonopin stopped working like I thought it would and now they've added the Gabapentin. She dosed me at 600 mg but said to work up to that. I'm a little scared- 3 sleep meds at once? I start tonight. PLEASE let it work!
Hi Kelly Jo--so your sleep drugs are ambien, klonopin, and gabapentin? Good luck tonight. They really aren't all the same--don't worry too much. You have to deal with the insomnia. Gabapentin made my MIL sleep like a (good) baby. Though she did complain of being groggy the next day--maybe that will help with your daytime anxiety? I hope so!
I still am peddling the same advice--try peeling the patch off at night, unless it's against doc's advice. Try lunesta rather than ambien (longer, better sleep for me) or sonata (short acting sleep aide for mid-night awakenings.)
Best to you and your new good sleep regime!
fb
Posted by KellyJo on September 9, 2009, at 5:56:34
In reply to Re: Help with Emsam side effects-Can't sleep and S » KellyJo, posted by floatingbridge on September 8, 2009, at 22:33:23
Thanks for the words of encouragement! I did sleep like baby on only 1/4 of gaba pill last night (plus the Ambien CR and 2 mg klonopin) nd I didn't wake up at my usual 2:00. I just hope it lasts longer than the usual 5 days! I tried sleeping without the patch and it didn't help. As a matter of fact, if I don't change it every 24 hours exactly my mood drops (all in my head??). I tried Lunesta, I could have taken nothing and had the same effect- in other words, it didn't work at all. I mentioned to the pdoc about Trazadone and she said I couldn't take it with Emsam. After reading your post I mentioned that others have done it. She's worried about Serotonin Syndrome and I pointed out that I take Frova which can cause SS but doesn't. If the Gaba doesn't work she said we'll try Trazadone. Thanks again for all the help! Now if I could only find some relief for the SD!
Posted by floatingbridge on September 9, 2009, at 11:10:10
In reply to Re: Help with Emsam side effects-Can't sleep and S, posted by KellyJo on September 9, 2009, at 5:56:34
Kelly Jo--Hooray!!!!!!
The gaba shouldn't poop-out. ( I haven't heard of it from my MIL) IMHO, sounds like you've got a good thing going.
Great news! Isn't good sleep wonderful? This emsam seems to be working for you--you are finding ways to deal w/ side-effects. And your doc sounds great. Now, on to SD. Good Luck! and continuing success!
fb
BTW--I don't think I mentioned tradzedone--I found it rather like being hit on the head the next morning--though some here say that feeling goes away--but I don't think you have to worry now :)
Posted by KellyJo on September 10, 2009, at 19:16:49
In reply to Re: Help with Emsam side effects-Can't sleep and S » KellyJo, posted by floatingbridge on September 9, 2009, at 11:10:10
Oh my gosh, I can't win for losing. What's worse- only sleeping a few hours a night or sleeping all night and wanting to sleep all day too? I'm draggin' and I only took 1/4 of a dose the last two nights. I took a nap today and I'm still so tired. How am I going to work like this? Also, I feel very agitated and grumpy. I'll give it some more time but I don't know........
This is the end of the thread.
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