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Dr. Bob is Robert Hsiung, MD,
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Posted by linkadge on April 19, 2006, at 17:47:10
In reply to Re: EMSAM side effect info, posted by linkadge on April 19, 2006, at 17:39:46
I would not compare wellbutrin to emsam. For starters, Wellbutrin's effects on dopamine seem insufficiant to explain its antidepressant effects. Wellbutrin seems to work more with the noradrenergic system, it has only minimal effects on the dopamine transporter.
I would not equate a wellbutrin failure to an ensam failure, or anxiety on wellbutrin to anxiety on ensam.
Linkadge
Posted by Donna Louise on April 19, 2006, at 19:27:01
In reply to Re: EMSAM side effect info, posted by linkadge on April 19, 2006, at 17:47:10
Ok, my insurance will pay, I have the rx. Now the pdoc wants me to do a 2 week washout from the effexor. I have read that only one week is necessary. What do you guys think? I do not want to be in withdrawal hell one second longer than necessary. Also, before I have been able to avoid this in the past by switching to another seratonergic drug. Since the mechanism of effect is so different, do you think that once I am on the EMSAM the withdrawal will stop or will I have to endure withdrawals for god only knows how long??? I am down to 75mg from 225 and I can tell you I have had withdrawal with each dose reduction so this is going to be a nightmare. She wants me to do a week of 37.5 but I want to just get it over with because it is going to be awful anyway. Any body experience this yet or have an idea what I can expect once I start the EMSAM? Don't you think a week's washout is long enough?? Please, any and all feedback here would be ever so greatly much appreciated!!! I have been waiting years to start this drug.
Donna
Posted by strugglingsteve on April 19, 2006, at 20:01:16
In reply to Switching to EMSAM from Effexor, posted by Donna Louise on April 19, 2006, at 19:27:01
I did a one week washout from a tca and that was sufficient but no idea about the half life of effexor. If the half life is long then you best take a longer washout period. It also may help you in assessing where your side effects come from, coming off effexor or onto emsam. I didnt want to wait at all but glad I did. I have one side effect and I know its from emsam and its ok. Hope this helps.....
Posted by strugglingsteve on April 19, 2006, at 20:06:15
In reply to Re: EMSAM side effect info, posted by linkadge on April 19, 2006, at 17:47:10
I have no idea about wellbutrin but it stopped my insane anxiety and bad depression, just too many side effects for me. So I have no understanding of how the emsam will or will not help me. All I can do is hope that it works as well as wellbutrin did as I only have one side effect so far which is agitation and that is better than it was two days ago. My doc is very experienced with maoi's and he thinks emsam will help people with some forms of depression and anxiety, it is just a matter of if you are one of the ones it will help and the only way to find out is to try.
> I would not compare wellbutrin to emsam. For starters, Wellbutrin's effects on dopamine seem insufficiant to explain its antidepressant effects. Wellbutrin seems to work more with the noradrenergic system, it has only minimal effects on the dopamine transporter.
>
> I would not equate a wellbutrin failure to an ensam failure, or anxiety on wellbutrin to anxiety on ensam.
>
> Linkadge
Posted by Donna Louise on April 19, 2006, at 21:25:31
In reply to Re: Switching to EMSAM from Effexor, posted by strugglingsteve on April 19, 2006, at 20:01:16
> I did a one week washout from a tca and that was sufficient but no idea about the half life of effexor. If the half life is long then you best take a longer washout period. It also may help you in assessing where your side effects come from, coming off effexor or onto emsam. I didnt want to wait at all but glad I did. I have one side effect and I know its from emsam and its ok. Hope this helps.....
Yes, Steve,it does help, and you are right, I do not want withdrawals and start up side effects at the same time. My fear is that the withdrawals will last for months. I think effexor has a short half life, that is why I start getting sick the same day I do a dose reduction, and why it is so awful. But whatever it takes. I am so glad for all of you that this is helping, we have waited a long time.
Donna
Posted by linkadge on April 20, 2006, at 8:05:00
In reply to Re: Switching to EMSAM from Effexor, posted by Donna Louise on April 19, 2006, at 21:25:31
Swiching from effexor to emsam might not be that easy. The ratio of effect on serotonin to catecholamines is likely much higher with effexor, so it is possible to be experiencing side effects related to serotonergic withdrawl for a little while.
To be honest, it might even take a few weeks for you to know what is emsam and what is effexor withdrawl.
Linkadge
Posted by jetcity10 on April 20, 2006, at 19:32:15
In reply to 11th day, posted by RobertDavid on April 17, 2006, at 15:08:56
I just started Emsam yesterday. I was curious as to whether you have found the best time of day to apply the patch? Also I have noticed a mild side effect of mild orthostatic hypotention.
Posted by Donna Louise on April 20, 2006, at 21:36:04
In reply to Re: Switching to EMSAM from Effexor » Donna Louise, posted by linkadge on April 20, 2006, at 8:05:00
> Swiching from effexor to emsam might not be that easy. The ratio of effect on serotonin to catecholamines is likely much higher with effexor, so it is possible to be experiencing side effects related to serotonergic withdrawl for a little while.
>
> To be honest, it might even take a few weeks for you to know what is emsam and what is effexor withdrawl.I am not sure what you are saying, Link, but it doesn't sound like fun. But it is good to know what to expect. Do you think the ratio thing of which you speak makes it dangerous to wait only a week before starting the patch? I can live with side effects and withdrawals but I can't live with dying....at least I still have a little sense of humor.
thanks for your talking to me.Donna
>
> Linkadge
>
Posted by RobertDavid on April 20, 2006, at 22:24:32
In reply to Re: 11th day, posted by jetcity10 on April 20, 2006, at 19:32:15
> I just started Emsam yesterday. I was curious as to whether you have found the best time of day to apply the patch? Also I have noticed a mild side effect of mild orthostatic hypotention.
I put it on every morning after I take a shower. Though they say to put it on at the same time each day I'm not exact about it, just put it on before noon each day.How noticable is your standing low blood pressure? Hopefully that will just be a side effect that goes away after your body adjusts. How else are you feeling? What are you taking it for? Are you taking any other meds?
Today is my 14th day. I just continually keep feeling better. I'm not having any side effect issues, just improved mood, energy, mental clarity. I'm also feeling more outgoing, less anxiety. I hope you have a similar response. Please post how you do and good luck! Rob
Posted by jetcity10 on April 21, 2006, at 0:07:45
In reply to Re: 11th day » jetcity10, posted by RobertDavid on April 20, 2006, at 22:24:32
> I put it on every morning after I take a shower. Though they say to put it on at the same time each day I'm not exact about it, just put it on before noon each day.
>
> How noticable is your standing low blood pressure? Hopefully that will just be a side effect that goes away after your body adjusts. How else are you feeling? What are you taking it for? Are you taking any other meds?
>
> Today is my 14th day. I just continually keep feeling better. I'm not having any side effect issues, just improved mood, energy, mental clarity. I'm also feeling more outgoing, less anxiety. I hope you have a similar response. Please post how you do and good luck! RobThanks for the info as well as your earlier posts. Your posts have been encouraging and have given me hope during this transitional process. There is very little info available on Emsam and both my doc and the pharmacist want me to tell them all I can.
I had been doing the morning thing but I was unsure if it would be better or worse to take it in the evenings depending on which side effects one might want to avoid. Though theoretically with the patch, that is probably moot.
I am also on Klonipin (1.5mg) in the evenings to help with sleep and two cardiac meds for "inappropriate sinus tachycardia". I am taking the psych meds primarily for "suicidal ideation". Due, it is felt, to moderate to major depression and fairly significant anxiety.
I have tried just about everything else through the years with little success and lots of side-effects. I am a little concerned that I may be developing some cardiac side effects but since I have a history of cardiac issues it is hard to tell if this is something new or just regular/irregular cardiac irregularity. Theoretically Emsam is not contraindicated with my cardiac meds and I would be really ticked to have to stop after forking over the $200 not covered by my insurance. But I am still willing to be patient and to wait and see. I have had orthostatic hypotension with mutiple meds in the past and it is something I can deal with (as long as I don't stand up to quickly and pass out in public). I will keep an eye on it- luckily I used to work in the emergency medical field in my younger years.
Thanks again.
Posted by RobertDavid on April 21, 2006, at 1:13:03
In reply to Re: 11th day, posted by jetcity10 on April 21, 2006, at 0:07:45
> I had been doing the morning thing but I was unsure if it would be better or worse to take it in the evenings depending on which side effects one might want to avoid. Though theoretically with the patch, that is probably moot.
>
> I am also on Klonipin (1.5mg) in the evenings to help with sleep and two cardiac meds for "inappropriate sinus tachycardia". I am taking the psych meds primarily for "suicidal ideation". Due, it is felt, to moderate to major depression and fairly significant anxiety.
>
> I have tried just about everything else through the years with little success and lots of side-effects. I am a little concerned that I may be developing some cardiac side effects but since I have a history of cardiac issues it is hard to tell if this is something new or just regular/irregular cardiac irregularity. Theoretically Emsam is not contraindicated with my cardiac meds and I would be really ticked to have to stop after forking over the $200 not covered by my insurance. But I am still willing to be patient and to wait and see. I have had orthostatic hypotension with mutiple meds in the past and it is something I can deal with (as long as I don't stand up to quickly and pass out in public). I will keep an eye on it- luckily I used to work in the emergency medical field in my younger years.
>
> Thanks again.
Thanks for the info. Sounds like the standing low blood pressure issue is not out of the ordinary for you. And if there aren't drug interactions which appears to be the case it would seem you may get past that or hopefully at worst it will be a minor issue.As far as when is best to put it on, like you said, I'm not sure it matters as it's supposed to trickle steadily for 24 hours, I just like putting it on in the morning. It's just part of my routine now, I think nothing of it.
There are a few people I know personally that are not here on psycho babble that have started taking it without side effect issues, though no conclusions can be made after just a few days. But for me, 2 weeks out, I'm getting more and more convinced it's my answer. I've never felt so good, motivated, happy.
I'm very intersested in hearing how you're doing and am hopeful that you'll start to feel better. Please keep posting how you're doing, many here need feedback from you and others.
I wish you the best of luck! Rob
Posted by Crazy Horse on April 21, 2006, at 8:39:33
In reply to Re: 11th day » jetcity10, posted by RobertDavid on April 21, 2006, at 1:13:03
> > I had been doing the morning thing but I was unsure if it would be better or worse to take it in the evenings depending on which side effects one might want to avoid. Though theoretically with the patch, that is probably moot.
> >
> > I am also on Klonipin (1.5mg) in the evenings to help with sleep and two cardiac meds for "inappropriate sinus tachycardia". I am taking the psych meds primarily for "suicidal ideation". Due, it is felt, to moderate to major depression and fairly significant anxiety.
> >
> > I have tried just about everything else through the years with little success and lots of side-effects. I am a little concerned that I may be developing some cardiac side effects but since I have a history of cardiac issues it is hard to tell if this is something new or just regular/irregular cardiac irregularity. Theoretically Emsam is not contraindicated with my cardiac meds and I would be really ticked to have to stop after forking over the $200 not covered by my insurance. But I am still willing to be patient and to wait and see. I have had orthostatic hypotension with mutiple meds in the past and it is something I can deal with (as long as I don't stand up to quickly and pass out in public). I will keep an eye on it- luckily I used to work in the emergency medical field in my younger years.
> >
> > Thanks again.
>
>
> Thanks for the info. Sounds like the standing low blood pressure issue is not out of the ordinary for you. And if there aren't drug interactions which appears to be the case it would seem you may get past that or hopefully at worst it will be a minor issue.
>
> As far as when is best to put it on, like you said, I'm not sure it matters as it's supposed to trickle steadily for 24 hours, I just like putting it on in the morning. It's just part of my routine now, I think nothing of it.
>
> There are a few people I know personally that are not here on psycho babble that have started taking it without side effect issues, though no conclusions can be made after just a few days. But for me, 2 weeks out, I'm getting more and more convinced it's my answer. I've never felt so good, motivated, happy.
>
> I'm very intersested in hearing how you're doing and am hopeful that you'll start to feel better. Please keep posting how you're doing, many here need feedback from you and others.
>
> I wish you the best of luck! RobHi Rob,
I just wanted to tell you that i am very happy for you. :) Your story is similar to mine with Parnate. It's a breath of fresh air to see someone like you doing so well on EMSAM...I think, like me, and many others here, you have suffered way too much, and way too long! Isn't it nice to finally feel GOOD!? You have been an inspiration to so many hopeless people here..I particular like what you wrote to Phillipa yesterday. Anyway, CONGRATULATIONS, keep up the good work, and may God continue to bless the "New Rob" on EMSAM! :)Monte
Posted by pederspd on April 21, 2006, at 9:05:20
In reply to Re: EMSAM-Day 5-Too early?? » RobertDavid, posted by Sarah T. on April 15, 2006, at 3:59:41
I am glad to see that people are doing well on Emsam. I was in a clinical trial for it almost 6 years ago and have been waiting for it to finally become available. During the 1st week of the trial I felt normal for the first time in my life. My only side effect was heartburn. All other anti-depressants had never worked and gave me horrible side effects. I received my prescription yesterday and am looking to have it filled in the Chicago area. CVS told me that they may have it in 3 or 4 months! My local Costco doesn't have it yet. I appreciate the name and number of the pharmacy in CA. I will order from there if I have to. Has anyone found a place to fill it in this area?
Posted by Donna Louise on April 21, 2006, at 9:41:54
In reply to Re: EMSAM-Day 5-Too early??, posted by pederspd on April 21, 2006, at 9:05:20
> I am glad to see that people are doing well on Emsam. I was in a clinical trial for it almost 6 years ago and have been waiting for it to finally become available. During the 1st week of the trial I felt normal for the first time in my life. My only side effect was heartburn. All other anti-depressants had never worked and gave me horrible side effects. I received my prescription yesterday and am looking to have it filled in the Chicago area. CVS told me that they may have it in 3 or 4 months! My local Costco doesn't have it yet. I appreciate the name and number of the pharmacy in CA. I will order from there if I have to. Has anyone found a place to fill it in this area?
I am in Fla. and they have it in Walgreens. I don't know if Chicago has a Walgreens or not. I thought for an afternoon that I had the rx in my hand finally but had nowhere to go with it. My pdoc says they have not been to her with samples yet either. But they ordered it for me at Walgreens and had it ready the next day. Now I have to finsh this washout...
Posted by RobertDavid on April 21, 2006, at 13:38:21
In reply to Re: EMSAM-Day 5-Too early??, posted by pederspd on April 21, 2006, at 9:05:20
> I am glad to see that people are doing well on Emsam. I was in a clinical trial for it almost 6 years ago and have been waiting for it to finally become available. During the 1st week of the trial I felt normal for the first time in my life. My only side effect was heartburn. All other anti-depressants had never worked and gave me horrible side effects. I received my prescription yesterday and am looking to have it filled in the Chicago area. CVS told me that they may have it in 3 or 4 months! My local Costco doesn't have it yet. I appreciate the name and number of the pharmacy in CA. I will order from there if I have to. Has anyone found a place to fill it in this area?
I filled my perscription at Spencers Pharmacy in Riverside CA. The pharmacist said he'd mail perscriptions to people outside the area. I paid $440 and I think some of the bigger pharmacies are charging a little less, maybe he is now too. Anyway, If you want to order it thier number is 951-686-7373.I'd love to hear about your experience with EMSAM during the clinical trial. How long were you on it, what dose, how did you do, side effects, benefits? How did others do in the trial? Please elaborate. I'm assuming you want a perscription because you did well. Did you try other meds such as oral selegiline after the trial? It would be great to hear you're impute!
Thanks Rob
Posted by RobertDavid on April 21, 2006, at 14:00:59
In reply to Re: EMSAM-Day 5-Too early?? » pederspd, posted by RobertDavid on April 21, 2006, at 13:38:21
I'm probably sounding like a broken record here, just wanted to report that I continue to do well and am not experiencing side effects. I can tell/feel that my energy has increased, my mood is better, I feel like doing more things (going to disnyland tomorrow), just overall more upbeat. I sleep good and my anxiety is fine. I've never really had a positive response before to an anti depressant so this is all new for me. I'm looking forward to hearing others experience with it...
Rob
Posted by crabwalk on April 21, 2006, at 14:18:00
In reply to Re: EMSAM-Day 15, posted by RobertDavid on April 21, 2006, at 14:00:59
Rob, have you (or anyone else) noticed any affect on libido? I'm very much hoping for a positive one myself. Probably starting the patch tomorrow.
Posted by RobertDavid on April 21, 2006, at 14:42:31
In reply to Re: EMSAM-Day 15, posted by crabwalk on April 21, 2006, at 14:18:00
> Rob, have you (or anyone else) noticed any affect on libido? I'm very much hoping for a positive one myself. Probably starting the patch tomorrow.
It's better than before. I have more interest in it and for lack of better words I'm "performing better" with an increase in daily activity. I'm not sure how much has to do with my mood improving/feeling better or how much has to do with med side effect, either way, I've noticed a change for the better. Rob
Posted by germanium on April 21, 2006, at 20:14:53
In reply to Re: EMSAM-Day 15 » crabwalk, posted by RobertDavid on April 21, 2006, at 14:42:31
I'm taking Selegiline the active ingredient of Emsam & it does indeed improve your labido. Animal tests have also born this out with more frequent copulation from low performing animals to even old past thier prime animals that had stopped having sex start up again.
Posted by theo on April 22, 2006, at 14:32:54
In reply to Re: EMSAM-Day 15, posted by RobertDavid on April 21, 2006, at 14:00:59
Just curious, where are you placing your patch, upper or lower body? Does it work better in certain areas?
Posted by pederspd on April 22, 2006, at 14:59:56
In reply to Re: EMSAM-Day 5-Too early?? » pederspd, posted by RobertDavid on April 21, 2006, at 13:38:21
> > I am glad to see that people are doing well on Emsam. I was in a clinical trial for it almost 6 years ago and have been waiting for it to finally become available. During the 1st week of the trial I felt normal for the first time in my life. My only side effect was heartburn. All other anti-depressants had never worked and gave me horrible side effects. I received my prescription yesterday and am looking to have it filled in the Chicago area. CVS told me that they may have it in 3 or 4 months! My local Costco doesn't have it yet. I appreciate the name and number of the pharmacy in CA. I will order from there if I have to. Has anyone found a place to fill it in this area?
>
>
> I filled my perscription at Spencers Pharmacy in Riverside CA. The pharmacist said he'd mail perscriptions to people outside the area. I paid $440 and I think some of the bigger pharmacies are charging a little less, maybe he is now too. Anyway, If you want to order it thier number is 951-686-7373.
>
> I'd love to hear about your experience with EMSAM during the clinical trial. How long were you on it, what dose, how did you do, side effects, benefits? How did others do in the trial? Please elaborate. I'm assuming you want a perscription because you did well. Did you try other meds such as oral selegiline after the trial? It would be great to hear you're impute!
>
> Thanks Rob
>
>
>Rob-
I was in the trial where everyone was given the patch for the first 10 weeks then switched into the blind study part where you either continued on the drug or received placebo, but you didn't know which.Within 4 or 5 days on the patch I felt normal. No other medication had ever helped me before (or since). It was so wonderful. I was able to think clearly, get out of bed, enjoy life. My only side effect was heartburn. But that was easy to control with tums or rolaids. No other problems. We were only allowed to put the patch on the upper torso so I never tried it on my legs. I noticed no difference, tho, whether it was on my back, arm or chest.
When the change came, I knew within a week that I was on the placebo. I hit bottom sooooo quick. I was very suicidal. I recovered in about another week and returned to my previous state of depression. After that I went on the pill form of selegiline but it never worked. I think because there wasn't the continuous release.
I felt like Charlie did in Flowers for Algernon. I finally had experienced normal life and had it ripped away from me. So, I have been anxiously waiting for the release of emsam so that I can feel good again.
Posted by jetcity10 on April 22, 2006, at 15:32:14
In reply to Re: EMSAM-Day 15 » RobertDavid, posted by theo on April 22, 2006, at 14:32:54
> Just curious, where are you placing your patch, upper or lower body? Does it work better in certain areas?
I am only on day four (and have tried four different places) but, so far the best seemed to be the upper chest in that it seemed the least disturbed by movement during the day and at 24 hours looked almost new. Thigh was ready to fall off and lower back was hard to place for me. As to whether there is greater potential effectiveness with one area or another I have no clue, but as long as the patch stays intact and in place it doesn't "seem" like it should matter (for what that is worth...)
Posted by RobertDavid on April 22, 2006, at 23:27:58
In reply to Re: EMSAM-Day 15 » RobertDavid, posted by theo on April 22, 2006, at 14:32:54
> Just curious, where are you placing your patch, upper or lower body? Does it work better in certain areas?
I have been moving it to a different location each day. Today is the first day I have put it on my lower body (right side of stomach) and noticed no difference. Otherwise it's been on my upper chest, back or arm (both sides).
The instructions give you muliple options both upper and lower and I really don't think it matters. After 16 days I have yet to notice any difference that I can attribute to patch location. It's just working for me regarless of where I put it. Good luck! Rob
Posted by RobertDavid on April 22, 2006, at 23:49:23
In reply to Re: EMSAM-Day 15, posted by jetcity10 on April 22, 2006, at 15:32:14
I will say when I go to the gym I put it on an area that I'm not working so it will be less likely to fall off. I've not had it come of at all yet, but haven't tried the legs.
I have wondered though if it will not stick as well to my legs do to leg hair. I agree and think as long as you get it to stick tight, it probably doesn't matter where you put it.
Rob
Posted by RobertDavid on April 23, 2006, at 0:21:11
In reply to Re: EMSAM-Day 5-Too early??, posted by pederspd on April 22, 2006, at 14:59:56
Rob-
> I was in the trial where everyone was given the patch for the first 10 weeks then switched into the blind study part where you either continued on the drug or received placebo, but you didn't know which.
>
> Within 4 or 5 days on the patch I felt normal. No other medication had ever helped me before (or since). It was so wonderful. I was able to think clearly, get out of bed, enjoy life. My only side effect was heartburn. But that was easy to control with tums or rolaids. No other problems. We were only allowed to put the patch on the upper torso so I never tried it on my legs. I noticed no difference, tho, whether it was on my back, arm or chest.
>
> When the change came, I knew within a week that I was on the placebo. I hit bottom sooooo quick. I was very suicidal. I recovered in about another week and returned to my previous state of depression. After that I went on the pill form of selegiline but it never worked. I think because there wasn't the continuous release.
>
> I felt like Charlie did in Flowers for Algernon. I finally had experienced normal life and had it ripped away from me. So, I have been anxiously waiting for the release of emsam so that I can feel good again.
It is very encouraging to hear how well you did in the trial. Your response in the study seems just like mine this point. I've never had a positive response to any anti depressant before. I'm so encouraged!I find it very interesting that the patch worked significantly better than oral selegiline for you. That has been the topic of much debate and concern, that EMSAM just may not be that good because of how others have responded to taking it orally.
Many have been concerned that anxiety will be an issue with EMSAM because it seems to be an issue with oral selegiline. Would you mind expanding on the difference you felt between the two?
May I also ask if you know if your experience was similar to others in the study? The study showed that only 3.5% more people dropped out taking EMSAM vs placebo. That would suggest very few had enough side effects to quit. Do you have any insight regarding that?It must have been very difficult to have had such good luck, to have felt well for the first time and then have to wait all this time. I can only imagine how you felt!
Thanks so much for your insight. Rob
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