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Dr. Bob is Robert Hsiung, MD,
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Posted by Avenarius on November 9, 2011, at 22:21:00
In reply to Re: Emsam is neuroprotective. » avenarius, posted by floatingbridge on November 7, 2011, at 22:30:53
> I have not taken segiline orally, so I cannot compare. I am currently not experiencing anhedonia, though I think I am taking the equivalent of 30mg. (The 9mg patch)
>
> I cannot report any sx at the 9mg patch. I seem to have a full range of emotion. The patch at this dose feels transparent. Sleep has always been an issue so I have added gabapentin which seems to work, and if that fails I fall back on tenazepam.
>
> If you can afford the co-pay, I would suggest trying the patch and seeing how it is for you.
>
> The 12mg patch certainly had a more typical (from what I have heard) maoi reaction. Hypotension, the beginnings of food reactions, a sense of lethargy. For me that is.
>
> Don't know if this has been helpful. Maybe someone else will respond as well.
>
> Is the oral working for you (besides the insomnia)? I have been instructed to take my patch before sleep. Apparently my pdoc says this is becoming the new protocol for the patch. It seems to help.your post was very helpful actually.
yes, oral selegiline is working; i'm not at all depressed but i've still got anxiety. it's completely flattened my emotions though. i'm going to reduce the dose to 30mg and see how that goes.
so, if you take off the patch you can sleep without the help of any meds?
Posted by floatingbridge on November 9, 2011, at 22:32:29
In reply to Re: Emsam is neuroprotective. » floatingbridge, posted by Avenarius on November 9, 2011, at 22:21:00
I always need meds to sleep. 12 plus years of sleep aides. However, taking the patch off allows the sleep aides to work better, and I need less of them. Right now, just gabapentin and a few tenazepam throughout the week.
I can see that emsam might not take care of anxiety. I use gabapentin and that really reduces anxiety. I also take .5mg of Xanax XR, but right now, that is mainly because I am dependent. I think gabapentin alone would be enough. Not that I think it's a med for everyone.
It's odd that I do not feel flattened on this. I got off Pristiq and Cymbalta and years of snri's and personally felt so much better. Pristiq and Cymbalta really blocked me up emotionally. And made me cycle as well.
Are you doing or trying to do mono therapy with segiline? I'm curious what you would like to see you treatment look like.
Posted by Phillipa on November 10, 2011, at 18:36:23
In reply to Re: Emsam is neuroprotective. » Phillipa, posted by former poster on November 9, 2011, at 20:58:22
Friend of next door neighbor just here from Florida is on 60mg of cymbalta and xanax at bedtime says she now has no anxiety that the cymbalta did it maybe should have continued it longer than three months. It was new then and found this board seemed a lot of failures so I ditched it. Did work for back pain as when went off discovered I had it. Phillipa
Posted by Avenarius on November 10, 2011, at 21:32:18
In reply to Re: Emsam is neuroprotective. » Avenarius, posted by floatingbridge on November 9, 2011, at 22:32:29
Along with selegiline I take 0.5 to 1.0mg klonopin as needed, and ambien for sleep. (I also take synthroid for my hypothyroid condition.)
My diagnosis is textbook Atypical depression (though at least 10 doctors over 20 years failed
to recognize this).I have been on just about every antidepressant except remeron. Paxil helped somewhat for about 12 yrs, then I added Wellbutrin, and later switched to Effexor before having to give up ssri's and snri's altogether due to severe anticholinergic (mostly GI) side effects. I've been searching for a replacement for about 3 to 4 years. Selegiline is the first effective treatment in that time that hasn't given me severe pain and GI problems.
All of the AD's blunted my emotions but 50mg seleginine is the most severe in that regard. I think the dose was just too high. I'll see how it goes with 30mg and then perhaps try to augment if necessary with something dopaminergic like abilify.
If I give up on MAOIs I'll try remeron.
I was on a low dose of Cymbalta for a while and I thought it was pretty good relative to effexor or paxil, but that's not saying much. I don't know how anyone sticks it out long term on ssri's and snri's... just horrible side effects.
Posted by floatingbridge on November 10, 2011, at 22:11:57
In reply to Re: Emsam is neuroprotective. » floatingbridge, posted by Avenarius on November 10, 2011, at 21:32:18
An anticolinergic effect is GI upset? I have never understood the term anticolinergic, but I have certainly felt the GI effect from snri's, most prominently from Cymbalta which was a shame because I deal with fibromyalgia, and it reduced my peripheral neuropathy greatly, but gave me debilitating gastritis.
Well, it has taken aboutt three months to stabilize on Emsam after trying three doses. I don't recall how long you have been taking the segiline. I hope you can give it time. I'd be
interested to know how it goes for you if you care to update. I wish you the best.
Posted by Chairman_MAO on November 11, 2011, at 8:01:36
In reply to Re: Emsam is neuroprotective., posted by avenarius on November 7, 2011, at 22:14:40
> MAOIs are the most effective treatment for me by far but I might give up on them due to the sleep issue... the anhedonia is a factor as well.Both problems are treatable. Which MAOIs have you tried?
Posted by former poster on November 17, 2011, at 15:00:23
In reply to Emsam is neuroprotective., posted by former poster on October 27, 2011, at 3:14:46
I found out yesterday that L-Theanine will interact with MAOI's, so now I have to give up green tea which was doing wonders for my prostate gland. I used to be on a lot of supplements before increasing Emsam to the 12mg dose. I don't know which supplements are safe now. My Dr. said take Melatonin to help sleep. Has anyone tried this? He says to not put the patch on at bedtime in case of hypertensive crisis when you are sleeping. So how do I sleep now? This is getting so complicated for me.
I had to give up Sam-e so I could take Emsam 12mg. Now I'm getting severe joint pain from stopping Sam-e.
My Dr. has increased from 12mg to 18mg of Emsam daily now? and said I have to be even more vigilant of hypertensive crisis at that dose.
Another complication: I often need to travel to Japan and Emsam was banned there. What are the legal ramifications of bringing a month supply of Emsam there?
Sorry if I sound like I'm whining. Maybe its time to just give up on Emsam?
My B.P. was 94/42 this morning. Probably due to the MAOI effect? I didn't feel any dizziness. But concerned about it being so low.
Any advice appreciated. Steve.
Posted by Phillipa on November 17, 2011, at 21:22:48
In reply to Re: Emsam is neuroprotective. » former poster, posted by former poster on November 17, 2011, at 15:00:23
Sounds like one big headache for you. Was the other med working for you? Phillipa
Posted by Avenarius on November 17, 2011, at 21:55:16
In reply to Re: Emsam is neuroprotective. » avenarius, posted by Chairman_MAO on November 11, 2011, at 8:01:36
I've only been on selegiline. At 30mg the anhedonia has subsided, but sleep is still impossible without Ambien, and I wake up consistently after 5.5 hrs feeling like I need a couple more hours. Anxiety remains a problem as well.
What specifically do you mean by "both problems are treatable"?
I would try Nardil if selegiline is problematic.
>
> > MAOIs are the most effective treatment for me by far but I might give up on them due to the sleep issue... the anhedonia is a factor as well.
>
> Both problems are treatable. Which MAOIs have you tried?
Posted by Chairman_MAO on November 18, 2011, at 4:55:41
In reply to Re: Emsam is neuroprotective. » Chairman_MAO, posted by Avenarius on November 17, 2011, at 21:55:16
> I've only been on selegiline. At 30mg the anhedonia has subsided, but sleep is still impossible without Ambien, and I wake up consistently after 5.5 hrs feeling like I need a couple more hours. Anxiety remains a problem as well.
>Are you using the immediate release or extended-release formulation of Ambien? What is the dose you take? Have you ever tried Lunesta? That can last longer. When I had bad insomnia from Nardil, I got the best results from 2mg of lorazepam at night.
I'd try Marplan or Parnate before Nardil first because there is less propensity for weight gain, but Nardil surely does work.
Posted by former poster on November 18, 2011, at 11:58:42
In reply to Re: Emsam is neuroprotective. » former poster, posted by Phillipa on November 17, 2011, at 21:22:48
Phillipa, I've been on quite a few combinations in the last 5 years. The most recent combination was Bupropion 450mg, Vyvanse 60mg, Sam-e 800mg, Emsam 6mg.
I gave Viibryd a 3 week trial a few months back and it made me feel a bit wierd, sort of dreamy feeling which scared me.
I've been on 12mg Emsam for about a month now and I have fleeting moments of calmness and a moments of being a bit more assertive, So I decided to give it a couple more weeks try at the 18mg dose.
Maybe Emsam's effects are inverse- the higher the dose the less stimulation? I actually seem to sleep better at 12mg but only 5 hrs a night. (same as all the other posters). It seems impossible to break the 5hr sleep barrier.
I was on Nardil from 1996 to 2008. I remember the same sleep sleep problem..
Posted by former poster on November 18, 2011, at 12:14:54
In reply to Re: Emsam is neuroprotective. » former poster, posted by Phillipa on November 17, 2011, at 21:22:48
Looks like I didn't quite answer your question Phillipa. Yes the other meds were working. I have never had a med that I didn't benefit from except for one, Celexa.
My previous combo, Bupropion, Vyvanse, Sam-e, Klonopin worked adequately until I had a relationship crisis 6 months ago. Since then I have been slowly sinking.Thanks for keeping my post going! Can always count on you when everyone else can't find any comment!
Posted by floatingbridge on November 18, 2011, at 16:12:56
In reply to Re: Emsam is neuroprotective. » Phillipa, posted by former poster on November 18, 2011, at 11:58:42
I was told to take the patch off not for hypertensive crisis but to allow myself sleep-- that is to stop more med from entering my system. If i remeber, i take it off a couple of hours before bed. That was at 12mg, but I didn't feel right so went back to 9mg. My sleep has fallen apart lately anyways. (I take the 9mg off for sleep anyways.) It was good for a while. Sorry. No help from me today. But I do wish you the best with everything. It is sounding complicated.
Posted by Phillipa on November 18, 2011, at 18:52:40
In reply to Re: Emsam is neuroprotective. » Phillipa, posted by former poster on November 18, 2011, at 12:14:54
I guess the RN training open ended questions Thanks Phillipa
Posted by maggiemae on November 22, 2011, at 16:57:40
In reply to Re: Emsam is neuroprotective. » Phillipa, posted by former poster on November 18, 2011, at 11:58:42
I started EMSAM 6mg almost 3 weeks ago. So far, nothing much happening. Yet nothing too bad (side effects wise) either. Plan was to give it 6 weeks and then consider upping the dose if still not effective. Does it really take so long to notice anything? If I can get it to work for me at low dose, it would be easier to tolerate, right? So I should be patient? Or should I call Dr. and speed up going to the higher dose?
Posted by floatingbridge on November 22, 2011, at 19:51:22
In reply to Re: Emsam is neuroprotective., posted by maggiemae on November 22, 2011, at 16:57:40
Idk. I found for myself it took longer that I thought. At least six weeks for my system to settle in. I went up too quickly then decided to go down. No harm done in that in my case. I am currently at 9mg. I often wonder if 6mg would have done just as well. I had gone to 12mg. Everyone and every situation is different.
I wish you the best.
Hopefully others will share their experience.
Posted by former poster on November 22, 2011, at 22:38:33
In reply to Re: Emsam is neuroprotective., posted by maggiemae on November 22, 2011, at 16:57:40
It's week 5 at 12mg for me. Starting tomorrow I might be on 18mg. It's strange that I don't feel it working. Sometimes I think its not, but when I take inventory of my thoughts and behaviours I see a change. Memory seems to be improved. Funny how this med with all of its amphetamine metabolites makes me lethargic. I really have to force myself to get off my *rs*, then I actually seem to get things accomplished.
If I could only get 7hrs sleep every night instead of 3 or 4!This could be very popular among truck drivers!
Posted by former poster on November 22, 2011, at 23:29:31
In reply to Re: Emsam is neuroprotective., posted by maggiemae on November 22, 2011, at 16:57:40
Maggiemae.. I can say with my long experience with Maoi's that they take longer to kick in than SSRI's and TCA's. I'm sure you felt the amphetamine pep on your first 6mg patch. It's by no means the full effect. When I first tried Nardil in 1982 I took it for 2 months in good faith of my Dr. At the 2 month mark it started working like a switch was turned on.
If possible I would give it a 2 month trial before increasing unless your depression is severe, start at the top and work your way down. Only problem is the side effects might be overwhelming at the high dose.
Back in 1982 my Pdoc started me at 90mg Nardil the very first day. Actually higher than the maximum dose at the time. Hang in there!
Posted by maggiemae on November 23, 2011, at 8:58:19
In reply to Re: Emsam is neuroprotective. » maggiemae, posted by former poster on November 22, 2011, at 23:29:31
> I'm sure you felt the amphetamine pep on your first 6mg patch. >
Honestly, no. I have felt no "pep" at all. The only discernable side effect has been an exacerbation of my IC symptoms. And perhaps a clearer head/more awake in the morning (and morning comes very early!) I can't sleep without xanax, and have no appetite, but that was the same before (I had been using remeron - loved it and miss it).
> If possible I would give it a 2 month trial before increasing unless your depression is severe, start at the top and work your way down. Only problem is the side effects might be overwhelming at the high dose.
>I will try to give it a chance. The past few days have had a bit of the weird heart racing anxiety -similar to what I experienced the first few days on Lexapro. Could this be a sign it is "kicking in?"
I really am hoping for some positive effect on my chronic pain and headaches, and for that it could be the higher dose is going to be required anyway. But I do want to give the 6mg a chance. Even if I can just get some improvement in energy and motivation I may be better able to deal with the pain...
Posted by former poster on November 24, 2011, at 4:28:23
In reply to Re: Emsam is neuroprotective., posted by maggiemae on November 23, 2011, at 8:58:19
The good thing is that the racing anxiety didin't seem to get worse with the increase in dose for me.
I too have chronic pain.
I'm noticing improved long term memory. Lethargy still seems to be there but I can overcome it. I also noticed less social inhibition.
Dr. gave me Trazodone for sleep. I'll let you know how it works out.
Hang in there!
Posted by Christia on November 27, 2011, at 11:10:16
In reply to Re: Emsam is neuroprotective. » maggiemae, posted by former poster on November 24, 2011, at 4:28:23
hi all. starting emsam tomorrow. Scared of hypertensive crises and the diet (which my doc told me I had to follow even at 6 mgs or less). I've been lurking, searching for emsam related posts, etc. but any 'new user' tips would be appreciated.
I took parnate for years before it pooped out, but I was younger then.
Posted by former poster on November 27, 2011, at 16:05:39
In reply to Re: Emsam is neuroprotective., posted by Christia on November 27, 2011, at 11:10:16
Hypertensive crisis at 6mg?
My 2 Drs. told me I can take any med. and eat any food at 6mg! They make Emsam 6mg patch sound safe as a band-aid. I have been taking antihistamines to help with my sleep, eating cheese, drinking wine.... I recently heard that green tea will interact. I kept on drinking it long after I increased my dose to 12mg. but I of course did stop when I found out.
Don't worry about hypertensive crisis. I think it is less likely to occur with Emsam. Parnate is the one that,(in my opinion) is the most likely to cause hypertensive crisis.
I get a lot of headaches at the higher dose. Now working my way up to 18mg. I was worried and checked my B.P. and it was 94/42. I check it several times a day and its always low. Amazingly, I'm not getting any dizziness upon standing.
Good luck, and relax.. Nothing to be afraid of with Emsam, except insomnia.
Posted by Phillipa on November 27, 2011, at 18:42:17
In reply to Re: Emsam is neuroprotective. » Christia, posted by former poster on November 27, 2011, at 16:05:39
6mg no dietary restrictions. A friend takes 9mg and none with that either. Phillipa
Posted by Christia on November 27, 2011, at 21:25:15
In reply to Re: Emsam is neuroprotective., posted by Phillipa on November 27, 2011, at 18:42:17
Thanks both of you. I thought there was no restrictions. It could be a cya. I had a few incidents on parnate that felt awful. I took nifedipine, which I now hear is not good. The funny thing is that my normal bp is around 90/60, and I got the searing, mind-bending headaches at just over 120/80.
Not that I plan on taking cold medicine, but does anyone know if that would actually cause a reaction? Ditto for epinephrine if one was in an accident or something?
Again, thanks!
Posted by former poster on November 28, 2011, at 18:22:16
In reply to Re: Emsam is neuroprotective., posted by Christia on November 27, 2011, at 21:25:15
At the 6mg. patch dose, I took every kind of cold medicine, every kind of herbal supplement you could think of and I never had a problem.
This is the end of the thread.
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