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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 117 to 141 of 431. Go back in thread:
Posted by RobertDavid on April 15, 2006, at 15:09:34
In reply to Re: Day 9 Report - Robert David, posted by Last Chance on April 15, 2006, at 14:34:09
> Hi Rob - As you know I have been waiting a long time for the patch, and now that it is here I can't afford it. I am glad to hear you are doing so well, and wish I were along for the ride. Still trying to figure out a way, but not looking good. Continue to do well, and I know you will keep letting us know how it's going. Richard
Richard:
There is part of me that struggles when I post how well my "start" has been with EMSAM because I know that there are many out there who just can't afford it/don't have insurance to cover it.
That said, I know that BMS did send out samples with many of their drug reps and perhaps you could get enough samples from a doctor to see what kind of response you may get with it. I know that's not an ultimate solution, but might help you find out if it's worth searching for a finacial solution for or not. At least you'd have some idea.
I do think the cost really stinks though especially for deserving individuals like you. Perhaps the price will come down sooner than later. You might try to call BMS directly and ask if they have or will have a program to get EMSAM at a reduced cost to those that can't afford these horrific prices. I wish you the best...
Rob
Posted by strugglingsteve on April 15, 2006, at 15:17:54
In reply to Re: Day 9 Report » RobertDavid, posted by Crazy Horse on April 15, 2006, at 13:22:18
I was doing ok the first few days but now at day 5 agitation has hit in a big way. My doc does not like benzos and I want to stay away from them if I can but its a bad scene. I just couldnt calm down yesterday. Today is a little better so far but this reminds of starting wellbutrin. Eventually it got better when the med starting working. I am not as depressed as I was but not sure if emsam had anything to do with it. I am going to fight this one out because there are no other side effects which is a miracle for me. I may try asking my doc about lyrica again but he wasnt too keen on it before. I just am hoping that it calms down quickly. Congrats Robert on having such an easy time of it so far, count your blessings dude.....
Posted by pulse on April 15, 2006, at 17:51:41
In reply to Re: GI issue reply/pulse, posted by ravenstorm on April 15, 2006, at 11:51:10
ravenstorm,
good gracious, don't be sorry about anything. i well know what having multiple GI problems is like, although i must admit, it sounds like you've had an even rougher road to hoe than i. i never had to take a proton pump inhibitor until i had the misfortune of being seen by a doctor, during my first, of 4 stays in detox and/ or extended treatment centers (this 1st time in was only 4 days), for exactly FIVE minutes. this psychiatrist MISdiagnosed me as - get this - bipolar I w/ rapid cycling. yes, i know it's usually "the other way around."
i later found out that anyone who went to this doc at his private practice was automatically diagnosed as some variant of bipolar. he was later found to be a total crook, when he stole money in various ways - he was found out, had his license yanked, and was banished to florida. (i can easily see him down there now practicing w/out a license.)
my point is: only when they introduced the mood stabilizers, did my stomach get really bad. i was more serious about staying clean by then, so i was too petrified, and MUCH too compliant and accepting (a lifetime problem) to refuse taking them. it then took me 9 years to get my (correct) and original diagnosis from 1979 (Major Depressive Disorder) back on my chart. it also took a kind, young female psychiatrist to finally REALLY observe me, my moods and behavior, (not just see bipolar in my records), and also see that i could only take a very sub-theraputic dosage of any stabilzer, (i'd never had one single mini hypo mania, anyway).
unfortuntely, 6 months later, SHE moved....to florida!
the serotonin in so many of the ads has further done my digestive system in, in a very big way; to a lesser degree noradrenaline. wellbutrin is the only med a doc has pulled me off of on day one. oh, i could have got through the anxiety i'm sure, but i literally burped every waking minute i was on it. most pharmacists will tell you they've rarely heard of folks having stomach trouble on wellbutrin. i've instead heard the saying goes: for those who do well on wellbutrin, they really love it; for those who don't, they really HATE it.
i so wish i had never had to start the PPIs, because, imo, and my docs, it's next to impossible to ever get off them, and the price just keeps goin up, up , up.
my day has gone south again. so wish i was riding as smoothly as robert. i am trying to lower my klonopin dosage a quickly as i possibly can. i pretty much know that doing it this way, i will barely, if at all, sleep for the next month. (1 mg down each week) - that was my ECT doc's way of doing it, but i know from experiencing both ways, down 1/4 mg every 2 weeks is the way to go. i simply don't feel i have that kind of time, or i will blow my chance with ensam.
pulse
Posted by Phillipa on April 15, 2006, at 18:24:44
In reply to Agitation has arrived, posted by strugglingsteve on April 15, 2006, at 15:17:54
I thought if you had no insurance and no or very low income the drug companies would send it to your doc and you would get a 90 day supply free. At least Eli Lilly has this plan as I was given the form to fill out for cymbalta. But I couldn't tolerate the side effects and went off it. I have disability Medicaire. Who manufactures Ensam I must have missed that post. Love Phillipa
Posted by ttee on April 15, 2006, at 21:02:54
In reply to Re: Day 9 Report - Robert David » Last Chance, posted by RobertDavid on April 15, 2006, at 15:09:34
I don't know this as a fact or not for Emsam, but it is my understanding that the pharmaceutical companies do have programs for people that can not afford their meds. I have been told that often times, drugs that have a smaller target market like Emsam and the atypical antipsychotic, have inflated prices to help off set the known expense for the drug company to make their meds available to those without insurance. Generally the docs are aware of these programs or you can call BMS to see if you qualify. Usually your doc has to fill out the forms and the drug company will send your meds straight to your doc, NO CHARGE. It is certainly worth the time to make a few phone calls. The drug company benefits because it gets more exposure with their med and might help increase the number of prescriptions made and gets the docs comfortable in prescribing the med. A large percentage of the subsequent prescriptions will be a full price and/or covered by the patient's insurance. Sort of like Robin Hood. Ask your doc for help. The BMS reps will help your doc with the process. It is a hassle for your doc, but the better docs will go to bat for you if you are truly in dire straights. Good luck.
Posted by gardenergirl on April 15, 2006, at 21:04:46
In reply to Re: Love Jungle Jim's! » gardenergirl, posted by pulse on April 15, 2006, at 9:44:35
Yes, I'm in your general area and have been there.
Isn't spring putting on a great show right now?
gg
Posted by germanium on April 15, 2006, at 21:21:19
In reply to Re: EMSAM-Day 5-Too early??, posted by strugglingsteve on April 12, 2006, at 15:14:13
Don't be supprised with the early relief as selegiline can be very rapid indead. Many times less than a week. for me it's 2 to 3 days so don't discount it
Posted by germanium on April 15, 2006, at 21:56:49
In reply to Agitation has arrived, posted by strugglingsteve on April 15, 2006, at 15:17:54
selegiline boost's ones energy radicaly & for some may seem agitating but it does subside some with continued use. it however remains present & accounted for. For me It boosts my energy & I do feel only slightly but very tolerably agitated but calm at the same time. makes it easier to get up & get moving early in the morning. & my sleep is actually better. I feel rested when I wake up
I did find some qualitatively different charateristics this time restarting it than before as before it interfered with sleep for a time (2weeks) but not this time. My sleep actually improved this time. You should monitor you blood pressure though.I will also admit to taking it a little different to as I no longer swallow the pill but absorb it sublingually as this seems to avoid much of the generation of methamphetamine as a result of first pass metabolisation. It does make the tonge numb though for about 10 minutes taking it that way though but I take that as a sign of its rapid assimilation. The patch does essentially the same thing but spreads it out over 24 hours instead of 10 minutes.
I only take 2.5 mg compared to 6 mg from the patch though
& it is very effective for me. So much so that my dispatcher at work started asking about it for his wife as apperently she suffers from really bad depression like me.
Posted by pulse on April 16, 2006, at 3:10:31
In reply to Re: Love Jungle Jim's! » pulse, posted by gardenergirl on April 15, 2006, at 21:04:46
gardengirl,
well, then, hi there "neighbor."
nope, for me (i also have summer variety SAD), it's ALREADY too hot for me. said to be seeing a few cooler (in 60's) days, then right back up into the 70's or 80 (!), as it was 2 days ago. 70 is my cut-off limit for our humidity here, especially if we're also having bright sunlight. at least for me, the bright light works against my depression in this summer variety.
i'll have to go on an up all night/ sleep all day schedule soon - too soon - i fear. i was hoping for a longer true spring, like our indian summers in fall, but, as has been the case in the last couple of years, i doubt i'll get it. cooler temps would have given me some additional help - that i now seem to need.
pulse
Posted by pulse on April 16, 2006, at 3:41:51
In reply to Re: Love Jungle Jim's! » gardenergirl, posted by pulse on April 16, 2006, at 3:10:31
all,
i had posted earlier that i was going to immediately start lowering my klonopin by 1 mg. per week - hoping to finally get totally off it, as i was just last year at this same time - although for only one month. you may recall i'm on emsam much more for major depressive illness, than for any anxiety help.
even before my therapist called me back last night, i realized this was just not realistic. i also realized that i needed to:
1) stop comparing my emsam start-up with anyone's else's.
2) be much more patient.
3) not go one bit lower on the klonopin for now.
4) give the ensam ample time, longer than the "up to 2 weeks to work," (cited on my pharmacy read-out).
(*i do still believe it's going to give me full remission of my MDD.)
therefore, i may well be more scarce around here for awhile.
many thanks to everyone who has helped me on this thread with their excellent info, and good luck to all on emsam.
pulse
Posted by Sarah T. on April 16, 2006, at 5:56:36
In reply to my/ therpist's new strategy, posted by pulse on April 16, 2006, at 3:41:51
Are those of you who are starting on Emsam on the 20mg patches?
Posted by Last Chance on April 16, 2006, at 12:24:04
In reply to Re: Emsam - The Anxiety Community, posted by Last Chance on April 14, 2006, at 22:25:54
I emailed The Anxiety Community yesterday suggesting they list Emsam - so now, amazingly one day later, there is a forum on Emsam - no posters yet. www.anxietyhelp.org - hit treatment, then medications list, then Emsam. Richard
Posted by SFY on April 16, 2006, at 15:34:36
In reply to Re: Agitation has arrived » strugglingsteve, posted by Phillipa on April 15, 2006, at 18:24:44
Emsam is made by Somerset Pharmaceuticals (which itself is a joint venture of Mylan Laboratories and Watson Pharmaceuticals) but is being marketed by Bristol-Myers Squibb (BMS).
There is a BMS Patient Assistance Foundation to provide meds to people without prescription drug coverage who cannot otherwise afford them. Its website is http://www.bmspaf.org/
Posted by rvanson on April 16, 2006, at 18:00:30
In reply to Emsam Price, posted by cecilia on April 11, 2006, at 18:10:24
> I called my local pharmacy to find out the cost of Emsam-$552.79 for a box of 30 patches (i.e.$18.42/day)!!!!!!! And you apparently can't buy it in quantities of less than 30; so no way to try it and see if you tolerate it. And of course, I'll pay, even though the chance of my being able to tolerate it (I don't do well with stimulating meds), let alone it working are probably one in a million. I certainly would never put down that kind of money at a roulette table, but these greedy drug companies know that depression hurts so bad, we'll pay anything for the remote possibility of help. I'm not sure how they're really any different ethically than a heroin dealer....Not that I have a clue how much heroin or any other illegal drug costs, and $552 is nothing compared to all the money I wasted on useless therapy. but it still seems outrageous...Cecilia<
Useless talk therapy for a chemical genetic defect, yes, you bet.
IME, most Pdocs charge the insurance companies 110 to 170 USD per visit and only the initial visit is longer then 15 or 20 minutes.
Emsam will be a decent bargain when it comes down to 300 dollars or less per month.
Lots of "poor" folks spend that much a month on booze or smokes.
Posted by rvanson on April 16, 2006, at 18:09:07
In reply to Re: amphetamine/selegeline, posted by ravenstorm on April 10, 2006, at 11:01:53
> Found an article that indirectly states that it does metabolize into amphetamine:
>
> "Unlike selegiline, the novel irreversible selective MAO-B-inhibitor rasagiline (Agilect, Azilect) is not metabolised to methamphetamine or amphetamine."
>
> Concerned about this.You should be.
If you are tested for drugs and you are using Emsam your urine will show a false positive for Methampethamines, and you will have to disclose your medical condition and a prescription for the medication or you will probably lose your job.
You may lose it anyway if you didnt disclose your condition/meds on your employment papers.
If this does happen, get to an employment attorney fast, else your career could be in jepordy.
Posted by Donna Louise on April 17, 2006, at 9:45:06
In reply to Re: Emsam Price/ Pulse » Last Chance, posted by pulse on April 14, 2006, at 12:20:31
Well, I am freaking out, after waiting all these years, it is here, my insurance company never heard of it...someone posted a help # to call and I can't find it. I feel like I am in an alternate sick joke world.
thanks for helping,Donna
Posted by RobertDavid on April 17, 2006, at 15:08:56
In reply to Re: Emsam Price help #, posted by Donna Louise on April 17, 2006, at 9:45:06
I'm continuing to feel better particularly with mental clarity, memory and mood. It seems I go a few days feeling the same (which is good), then on occation, like today, notice a surge, a change for the better. I'm sleeping better than I did before starting EMSAM, something that has improved from my first week. Perhaps that's do to depression lifting.
One thing I'm noticing is that I'm not so critical about myself, my mental issues or any issue for that matter. I can even tolerat my ex-wife (no offense ladies). I'm less anxious and am more accepting of myself. I'm not beating myself up on a daily basis (which is the norm). For lack of better words it feels like I've taken a "chill pill" or I guess I should say "chill patch."
Yesterday I went to a hot springs where I spent the day relaxing in the sun. I was concerned about being in the water especially hot water. I swam and soaked up the hot water for 5 hours and didn't have issues with it the patch coming off or feeling any different.
My driving anxieties are becoming less noticable. Socially I'm feeling more outgoing. For those just starting who may be feeling some slight increase in anxiety/engery or perhaps some difficulty sleeping I suspect it will ease with time, hang in there and see what happens.
For me, I've never taken a drug without feeling negative side effects. I think I had an irrational concern that EMSAM wasn't going to work, be strong enough because I didn't feel the negative side effects I typically expect when trying a new medicine. Like, how can a drug have be working if you don't feel something weird happening? For the first time in a long time I can read a book and actually remember what I just read. I'm getting to tasks I ordinarily just don't feel like doing.
I've mentioned before I've taken klonopin for 12 years (2mgs) and continue to do so per my doctors advise. Perhaps that's helped with EMSAM side effects though I've had terrible side effects while blending SSRI's, SNRI's and other meds with same dose of klonopin.
The reason I went to EMSAM was that though klonopin really has improved my social anxiety, I've had a lack of zest for life, low energy, poor mood and I still needed some improvement with SAD and GAD. I've done so many med trials, taking weeks, months out of my I was begining to lose hope, that I had only one or two med trials left in me. I just pray this continues, that there's no poop out.
Though my doctor wanted me to stay on klonopin for several months while I adjust to EMSAM, I now feel like starting a slow klonopin taper (.25 at a time) and see if I can get by with a lower dose or get off it. I've tried before, but couldn't, perhaps with EMSAM I can. As this is my first try with an MAOI I'm optimistic as I know how well Parnate and Nardil work for so many of you.
Anyway, sorry for the long post, but I continue to do really well. I know everyone is different, but I believe EMSAM will be the answer many have been looking for. Hopefully EMSAM will also re-open MAOI's in general to all the doctors who don't use them in their arsenal of drug treatments.
Rob
Posted by Last Chance on April 17, 2006, at 15:33:54
In reply to Re: Emsam Price, posted by rvanson on April 16, 2006, at 18:00:30
Costco price - $393.00 - still too much for me. Richard
Posted by Phillipa on April 17, 2006, at 15:39:23
In reply to 11th day, posted by RobertDavid on April 17, 2006, at 15:08:56
Great news
Great news!!!!!!!!I'd say I will E-mail you later but am getting a cast on my arm I won't be able to type if they put it over my fingers and hand. This sure gives me hope. Love Jan
Posted by strugglingsteve on April 17, 2006, at 18:10:48
In reply to 11th day, posted by RobertDavid on April 17, 2006, at 15:08:56
I wish my trial with emsam was going as well as yours is Robert. I have one side effect and its killing me. I have extreme anxiety and agitation and nothing seems to calm it down. I am hoping this is the it gets worse before it gets better routine but I am getting pretty scared right now. I am hoping it eases off soon. My doc wont let me take benzos so I am really stuck. I am going to ask him about lyrica tonight but he doesnt like that either. Good luck to you.
Posted by ravenstorm on April 17, 2006, at 20:13:27
In reply to Re: 11th day-envy you, posted by strugglingsteve on April 17, 2006, at 18:10:48
I am so sorry things are not going well for you. I suspect that emsam is going to be way too agitating for me as well.
However, you did state in an earlier post (I believe) that you felt agitated at first on WB and then adjusted to it. Could that be the case this time?
Unfortunately for me, I had the opposite reaction to WB. At the beginning of the trial it made me very tired and sick, then I felt good for a very brief time and then the extreme, crawling out of my skin agitation began and NOTHING the pdoc threw at it could stop it. I had to stop taking the WB and it took a month or two to regroup (no withdrawal syndrome, though, which was nice for once!)
I will keep my fingers crossed for you!
Posted by strugglingsteve on April 17, 2006, at 20:32:28
In reply to Re: 11th day-envy you struggling steve, posted by ravenstorm on April 17, 2006, at 20:13:27
> I am so sorry things are not going well for you. I suspect that emsam is going to be way too agitating for me as well.
>
> However, you did state in an earlier post (I believe) that you felt agitated at first on WB and then adjusted to it. Could that be the case this time?
>
> Unfortunately for me, I had the opposite reaction to WB. At the beginning of the trial it made me very tired and sick, then I felt good for a very brief time and then the extreme, crawling out of my skin agitation began and NOTHING the pdoc threw at it could stop it. I had to stop taking the WB and it took a month or two to regroup (no withdrawal syndrome, though, which was nice for once!)
>
> I will keep my fingers crossed for you!I just talked to my doc and he said to hang in there. He said if I am bipolar then it wont get better but if its just depression and anxiety, then give it a couple weeks and it may get better. He has a lot of experience with MAOI's so I best wait it out and see. I asked him about lyrica but he didnt want to mix two new drugs together so I have to grin and bear it. My close friend thinks I will get better in that time frame and to just hang on. Who knows, I could be a trail blazer for some who come after me, so I guess I have to try to survive one day and one hour at a time. I am self employed and managed to do some work today so that was a good thing.
Posted by ravenstorm on April 18, 2006, at 8:18:29
In reply to Re: 11th day-envy you struggling steve, posted by strugglingsteve on April 17, 2006, at 20:32:28
Wait, are you saying your doctor is going to assume you are bipolar if you have anxiety and agitation from an antidepresant that is known to be on the activating side??!
My doctor didn't say I was bipolar because I couldn't take the agitation/anxiety from Wellbutrin.
Is your doctor aware that the patch is more activating than the other MAOI's because it affects more MAOI B than MAOI A?
Posted by ravenstorm on April 18, 2006, at 9:26:36
In reply to Re: 11th day-envy you struggling steve, posted by ravenstorm on April 18, 2006, at 8:18:29
Found this on another site. Discouraging for those of us who also couldn't tolerat WB. :(
Attempt Ends in Failure
My Emsam Attempt Ends in Failure
15. Apr 2006 at 03:48 I was just prescribed the Emsam patch for treatment-resistant atypical depression and anxiety. I may be avoidant personality disorder or borderline-- it is a matter of some debate.
In any case, my recent attempt to use Emsam ended in failure.
About 12 hours after applying Emsam, I noticed increasted energy, a pleaseant physical agitation, wanting to move-- all very different and much improved from depression.
About 18 hours, I started getting very scared, very agitated; crying spells, feelings of hopelessness, abandonment, confused thinking. Waves of anger (which is unusual for me).
Doping myself with variations of Klonopin, Seroquel and Ambien allowed me to endure the symptoms for another day or two.
At 72 hours, I had a phone consultation and a decision was made to discontinue.
------------
I probably should have anticipated thse problems. These symptoms very closely paralleled my experience with Wellbutrin-- I had drug-induced psychosis when I was on it. Apparently my brain doesn't like increasing dopamine.
-----
Posted by RobertDavid on April 18, 2006, at 16:07:31
In reply to Re: agitation post from another board, posted by ravenstorm on April 18, 2006, at 9:26:36
Here is some info regarding side effects from one of the pre-approval trials.
Among 817 depressed patients who received EMSAM at doses of either 3mg/24hours (151 patients), 6mg/24hours (550 patients) or 6mg/24hours, 9mg/24hours, and 12mg/24hours (116 patients) in placebo-controlled trials of up to 8 weeks in duration, 7.1% discontinued treatment due to an adverse event as compared with 3.6% of 668 patients receiving placebo. The only adverse event associated with discontinuation, in at least 1% of EMSAM -treated patients at a rate at least twice that of placebo, was application site reaction (2% EMSAM vs. 0% placebo).
I think it's notable that only 3.5% more people stopped taking EMSAM than those taking a placebo. Also, application site reaction was the only side effect where the drop out rate was twice that of placebo. Hopefully those that experience some side effects will not be significant enough to have to stop taking EMSAM before being able to determine if it will work for them.Everyone is so different. I have had such terrible side effects from other anti depressants like Wellbutrin, SSRI's, SNRI's and tricyclics, yet others do fine with them. As I've been posting, so far EMSAM is all benefit with no negative side effects. Just shows you that there's no making sence of which meds will or won't work for you. It's pretty much trial and error.
Rob
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Dr. Bob is Robert Hsiung, MD,
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