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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on July 19, 2006, at 6:08:31
In reply to Re: EMSAM - First Day, posted by mayzee on July 18, 2006, at 22:10:50
Don't let insomnia be the thing that stops you. There are too many ways to treat it.
It can take 3-4 weeks for an antidepressant to work from the time you start the right dosage, so the clock really started 9 days ago. Anything shorter than that is a gift.
Good luck.
- Scott
Posted by Donna Louise on July 19, 2006, at 7:20:31
In reply to Re: EMSAM - First Day » RobertDavid, posted by ette on July 18, 2006, at 18:03:13
> Hi. I just started the 9 mg patch three days ago. Previous to that, I was on the 6 mg patch. I've noticed that I'm having a hard time adapting to the 9 mg patch. I've nauseous, dizzy, and very tired. The first night, I had a very difficult time staying awake, and felt extremely dizzy and nauseous. I think I'm slowly adapating to the change in medication. Has anyone experienced these changes when going up in dosage? Thanks.
I have gone from 6 to 9 and now am on 12mg I guess for about a month, I loose track. Anyway, I have not had any of those side effects and have had none on dosage increase. the higher I go, the less irritable I am which is the only thing that is bothersome. And as Scott said about insomnia, that is no reason to stop it, there are too many ways to treat irritability, Lamicatl doin a good job of that for me. I am getting alot more benefits than the one side effect of irritablity. I hope that gives you some hope.
donna
Posted by mayzee on July 19, 2006, at 8:57:47
In reply to Re: EMSAM - First Day » RobertDavid, posted by ette on July 18, 2006, at 18:03:13
How long were you on the 6mg patch?
Did you have any side effects at 6mg?
Posted by ette on July 19, 2006, at 9:08:45
In reply to Re: EMSAM - First Day » ette, posted by mayzee on July 19, 2006, at 8:57:47
In response to the questions as to whether I had side effects at the 6 mg dose -- yes, in the beginning, I felt nauseous and dizzy, but the effects were less than when I started the 9 mg dose. I think I'm adapting to the 9 mg dose now. I'm still tired, a lot, now. However, I have Fibromyalgia, Diabetes, and a host of other conditions which contribute to tiredness, event though those conditions are under very good control. It's interesting -- since being on EMSAM, I have not had insomnia -- a condition that I suffered with when I took other antidepressants. Time will tell as I continue on in my journey with EMSAM.
Posted by mayzee on July 19, 2006, at 9:12:31
In reply to Re: EMSAM - First Day, posted by SLS on July 19, 2006, at 6:08:31
Since hypersomnia has always been my problem, this insomnia thing is totally new to me. I've never taken any kind of sleep aid.
What would be the first thing to try?
My problem is that I'm now waking up 4-6 times a night. Usually I can fall back to sleep, but my sleep is very restless. Also, I feel tired during the day, but then more alert/awake at bedtime so I end up staying up too late; not having enough sleep time. (When I first started on 6mg, and since I upped to 9mg, I've had more nights when I had a lot of trouble falling asleep or back to sleep, but I think that will wear off like it did after a few weeks on 6mg)
Posted by SFY on July 19, 2006, at 12:21:02
In reply to Re: EMSAM - First Day -- what to try for insomnia?, posted by mayzee on July 19, 2006, at 9:12:31
> Since hypersomnia has always been my problem, this insomnia thing is totally new to me. I've never taken any kind of sleep aid.
>
> What would be the first thing to try?
>
> My problem is that I'm now waking up 4-6 times a night. Usually I can fall back to sleep, but my sleep is very restless. Also, I feel tired during the day, but then more alert/awake at bedtime so I end up staying up too late; not having enough sleep time. (When I first started on 6mg, and since I upped to 9mg, I've had more nights when I had a lot of trouble falling asleep or back to sleep, but I think that will wear off like it did after a few weeks on 6mg)Some people have found relief from insomnia by taking the patch off at night. I've been taking generic Benadryl (diphenhydramine) for my early morning awakening issues. I believe others have found success with Seroquel.
Posted by Phillipa on July 19, 2006, at 19:57:12
In reply to Re: EMSAM - First Day -- what to try for insomnia? » mayzee, posted by SFY on July 19, 2006, at 12:21:02
Robert David uses two mg of klonopin for sleep. Love Phillipa
Posted by mayzee on July 20, 2006, at 12:24:59
In reply to Re: EMSAM - First Day -- what to try for insomnia? » mayzee, posted by SFY on July 19, 2006, at 12:21:02
SFY, Thanks for your reply.
Is it OK to take Benadryl with EMSAM? For some reason I thought that was a no no.
I've read posts about Seroquel success, I just thought that might not be a good first choice; that there might be other less heavy duty (less scary to me) things to try first.
Thanks,
mayzee
>
> Some people have found relief from insomnia by taking the patch off at night. I've been taking generic Benadryl (diphenhydramine) for my early morning awakening issues. I believe others have found success with Seroquel.
>
Posted by mayzee on July 20, 2006, at 12:35:39
In reply to Re: EMSAM - First Day -- what to try for insomnia?, posted by Phillipa on July 19, 2006, at 19:57:12
Would that be a good first thing to try for help with sleep? I thought that Robert David used klonopin for anxiety, but I may be wrong.
I wondered if I'd be better off trying one of the drugs that are specifically targeted for sleep problems first (ambien? lunesta? I only know about them from the advertisements). I guess like everything, everyone has their own reaction and this would be another trial & error thing.
I am a scaredy cat re. taking drugs and I hate the idea of having to take a drug to treat a drug-induced side effect. But today is the 3rd day in a row that I'm feeling a little bit better (knock wood) so if EMSAM turns out to be the AD that actually works for me, I expect I'll be ready to take a sleep aid if necessary.
Thanks for your reply!
mayzee
> Robert David uses two mg of klonopin for sleep. Love Phillipa
Posted by RobertDavid on July 20, 2006, at 13:09:18
In reply to Re: EMSAM - First Day -- what to try for insomnia? » Phillipa, posted by mayzee on July 20, 2006, at 12:35:39
> Would that be a good first thing to try for help with sleep? I thought that Robert David used klonopin for anxiety, but I may be wrong.
>
I take klonopin for SAD, however I have no doubt it helps with sleep and probably some of the side effects others feel from EMSAM such as agitation.To sleep better at least until your body adjusts I'd recommend going with lunests, ambien, restoril, seroquel, benedryl, a benzo, whatever works best for you. It's trial and error.
In time you may find you can take less and less of the sleeping aids and perhaps get all the way off them. I no longer need any, though I take the patch off at night. Good luck everyone!
Posted by SFY on July 20, 2006, at 13:51:19
In reply to Re: EMSAM - First Day -- what to try for insomnia? » SFY, posted by mayzee on July 20, 2006, at 12:24:59
> SFY, Thanks for your reply.
>
> Is it OK to take Benadryl with EMSAM? For some reason I thought that was a no no.
>
> I've read posts about Seroquel success, I just thought that might not be a good first choice; that there might be other less heavy duty (less scary to me) things to try first.
>
> Thanks,
> mayzeeNo, Benadryl is fine with EMSAM. (In fact, topical Benadryl is one of the recommended treatments when EMSAM causes skin irritation.)
Posted by Phillipa on July 20, 2006, at 20:04:05
In reply to Re: EMSAM - First Day -- what to try for insomnia?, posted by RobertDavid on July 20, 2006, at 13:09:18
Rob Congratulations!!!!!! I know that was your goal. Love Phillipa When you get the time E-mail and update me okay?
Posted by ttee on July 21, 2006, at 0:11:54
In reply to Re: EMSAM - First Day -- what to try for insomnia? » RobertDavid, posted by Phillipa on July 20, 2006, at 20:04:05
Benadryl is contraindicated with Emsam. Benadryl effects serotonin. In fact, Benadryl derivatives were the predecessors of all the modern SSRI antidepressants. I would check with your doc and/or a pharmacist before mixing the two.
Posted by SLS on July 21, 2006, at 6:27:07
In reply to Re: EMSAM - First Day -- what to try for insomnia?, posted by ttee on July 21, 2006, at 0:11:54
> Benadryl is contraindicated with Emsam. Benadryl effects serotonin. In fact, Benadryl derivatives were the predecessors of all the modern SSRI antidepressants. I would check with your doc and/or a pharmacist before mixing the two.
Good catch!
I think this is precisely why Benadryl acts to mitigate the withdrawal symptoms from SRI antidepressants.
- Scott
Posted by pulse on July 24, 2006, at 8:27:39
In reply to Re: EMSAM - First Day -- what to try for insomnia?, posted by ttee on July 21, 2006, at 0:11:54
on the contrary, i yesterday asked my doc and 2 pharmacists re: benadryl OR any antihistime, such a zyrtec regular - NOT zyrtec-d - and emsam. their firm conclusion: benadryl and the like are NOT contra-indicated for emsam.
it is ONLY the decongestants - or combo decongestants and antihistimes - which, of course , will still contain psuedephedrine - OR - any of the newer non-psuedephedrine other drugs termed 'non drowsy' - with which emsam should NEVER be taken.
it's not serotonin or serotonin sydrome that's the worry (re: the former).
it IS raised bp, possibly to probably, very extreme, that IS. (re: the latter).
i'm no longer on emsam, but like to find out all i can...'just in case'... even though i'm in full mdd remsision now w/no ad.
this is because my real hope is that someday w/in my lifetime there will be the options, if needed ever again for me, of one to many ads , that will come in the patch form. for me, that would be one/s that are NOT maois.
Posted by mayzee on July 24, 2006, at 10:28:00
In reply to Re: EMSAM - First Day -- what to try for insomnia?, posted by pulse on July 24, 2006, at 8:27:39
>
> - OR - any of the newer non-psuedephedrine other drugs termed 'non drowsy' - with which emsam should NEVER be taken.
>Hi pulse,
Can you please give some examples of the newer other drugs you mention?
thanks!
mayzee (still on emsam)
Posted by WirelessWally on August 21, 2006, at 18:38:07
In reply to EMSAM - First Day, posted by RobertDavid on April 8, 2006, at 11:15:36
I am on my 21st day with EMSAM. I find that I am doing much more activity wise but still feel a lack of joy in my life. Also I am still not very patiant or tolerant of things/others. Will this improve as I gain more time on ENSAM? I also take clonazepam .5mg 4 times a day which seems to help with my agitation. Wally
Posted by WirelessWally on August 27, 2006, at 12:34:59
In reply to Re: EMSAM - 30 days and beyond, posted by WirelessWally on August 21, 2006, at 18:38:07
I am on my 21st day with EMSAM. I find that I am doing much more activity wise but still feel a lack of joy in my life. Also I am still not very patiant or tolerant of things/others. Will this improve as I gain more time on ENSAM? I also take clonazepam .5mg 4 times a day which seems to help with my agitation. BTW I just checked the response box. Wally
Posted by Mimi321 on September 4, 2006, at 23:44:10
In reply to Re: Emsam Price, posted by Iansf on April 13, 2006, at 16:39:26
Why is everyone using (or wanting to use) Emsam when you can get selegeline in a topical cream from a compounding pharmacist for 50-100 dollars a month depending on how much you shop around. It works the same as a patch, but you rub it on your skin once a day. You get the same options of dosage. Just need a prescription and go to a compounding pharmacist. YOu can find a list of them in your area - just google and poke around.
Here's another option: you can order liquid selegeline on the web with no prescription - its sold as a supplement under the names denepryl, selepril, ceprenyl (spelling may be off). it costs 57-65$ for 300ml which translates into about a months supply (a drop contains one mg, so 6 drops a day is one lowest dose.) YOu can put it under the tongue or rub on skin or use intra-vaginal (good absorption). you just google 'deprenyl' and you'll see it. its not a controlled substance, so its my understanding that its legal to sell in the u.s. Good luck all - I just started the liquid selegeline and will see how it goes.
Posted by Phillipa on September 5, 2006, at 19:43:31
In reply to Re: Emsam Price, posted by Mimi321 on September 4, 2006, at 23:44:10
How come no one has told us of this? The Patch was the big breakthrough. That's how I used hormones from a compounding pharmacy in a cream. Anyone else know of this? Love Phillipa
Posted by SFY on September 6, 2006, at 12:56:29
In reply to Re: Emsam Price, posted by Mimi321 on September 4, 2006, at 23:44:10
The price of Emsam luckily isn't an issue for me since my insurance covers it.
But even if it were, I don't think that a cream would be an adequate substitute for Emsam. While it would have the benefit of delivering selegiline transdermally, the dosage would likely not be delivered in a continuous, constant timed-release fashion over 24 hours. It would probably cause a dosage spike right after the time of application and might require more than one daily application to smooth out the selegiline delivered.
Posted by mimi321 on September 6, 2006, at 13:43:06
In reply to Re: Emsam Price » Mimi321, posted by Phillipa on September 5, 2006, at 19:43:31
> How come no one has told us of this? The Patch was the big breakthrough. That's how I used hormones from a compounding pharmacy in a cream. Anyone else know of this? Love Phillipa
I dunno - I thought of the compounding issue myself and then comtacted compounding pharmacists, and I found out about denepryl (liquid selegeline - the active ingred in emsam) by poking around on the web. Like I say - just google 'denepryl' or liquid selegeline or ceprenil or selephyl (spelling on last 2 might be off) and you will find it for sale by the 300 ml bottle. pass it around - i think emsam is outrageous unless you have insurance that covers. do others a favor - if you are on the other boards (anxiety, etc) feel free to copy the info from my post and put it up so others can see. it breaks my heart to hear that others are spending 400 that they cant afford on monthly meds, or worse - going without.
Posted by dbc on September 8, 2006, at 0:43:16
In reply to Re: Emsam Price, posted by Mimi321 on September 4, 2006, at 23:44:10
I havent seen anyone having much luck with any oral solution. Belive me i really considered it when i saw the insane price of emsam. Redosing is an issue also as the oral solutions only have a half life of 3 to 4 hours and most only come available in very small doses (1mg droppers) that are intended for the nootropic market.
Posted by Jost on September 21, 2006, at 21:28:07
In reply to Re: Emsam Price, posted by SFY on September 6, 2006, at 12:56:29
My pdoc just told me that the company making Emsam doesn't promise constant, time-release absorption of the drug from the patch.
More likely, absorption varies considerably. First of all, it varies from person to person. But also, it varies within 24 hours.
The most the company claims is that you'll get about 6 mg (actually probably between 4-6 mg) from the 6 mg patch every twenty-four hours. But there's a good chance, for example that the highest absorption could be at the beginning right after application of the patch.
I'm not sure this matter so much, under good conditions, as long as you replace the patch every 24 hours.
Jost
Posted by WeeWilly on September 21, 2006, at 22:55:11
In reply to Re: Emsam: constant dosing?, posted by Jost on September 21, 2006, at 21:28:07
> My pdoc just told me that the company making Emsam doesn't promise constant, time-release absorption of the drug from the patch.
>
> More likely, absorption varies considerably. First of all, it varies from person to person. But also, it varies within 24 hours.
>
> The most the company claims is that you'll get about 6 mg (actually probably between 4-6 mg) from the 6 mg patch every twenty-four hours. But there's a good chance, for example that the highest absorption could be at the beginning right after application of the patch.
>
> I'm not sure this matter so much, under good conditions, as long as you replace the patch every 24 hours.
>
> JostInteresting. I have been on Emsam for about 1 month. 2 weeks or so on 12mg. I have been leaving each patch on for 48 hrs. I wear 2 patches. So far my response has been disapointing. Seeing my Pdoc 9/26 tues and I am leaning toward discontinuing Emsam and maybe trying Marplan. Many years ago when I first tried Parnate my response was complete within a 1/2 hour it remained great for 3 months then abruptly quit. Increased the dose to 100 mg's with no luck. Every year since then I have returned to Parnate for 3 months per year. Usually the response is quick and last 3 months. Last spring it was not quite so good, likely because of my being on Nardil a few months before the parnate. Nardil was not as effecatious as Parnate. It also lost its effectiveness after 3 months. I sure thought I would stumble onto a treatment long ago but providence has'nt provided that. At one time I responded great to sleep deprivation, but not anymore. If you knew my existence you would not believe how strange it is. Oh well, thems the cards I have been dealt. I often wonder if I am playing them the best possible way. I think so. Of course if I did'nt have the disableing symptoms of this disorder I could be more organized in recording factors in my condition and analyzing the best course of action then do it. I would like to hook up with an influential research scientist at NIMH or similar place. I think I have unique information that I have accumulated that would illuminate disorders such as mine. I'm running on here so I'll just wish you all the best fortune. Thanks for listening.
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Dr. Bob is Robert Hsiung, MD,
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