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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 55 to 79 of 83. Go back in thread:
Posted by SLS on September 26, 2006, at 1:21:25
In reply to Re: Can't Take it AnyMore ! Bad news - Good news » SLS, posted by Phillipa on September 25, 2006, at 20:09:08
> So you think paxil might work again?
Given your account of how it worked the first time and the circumstances of its discontinuation, I think returning to Paxil would not be unreasonable.
> And the reason EMSAM was so attractive to me was cause you can see it. And my thought was that if you had a side effect you could just rip it off and it would be gone.
Perhaps you could try looking at it from a nurse's perspective. How would you as a nurse advise a patient who was so hypervigilant regarding drug side effects, that they were refusing to take a newly-prescribed medication that could save their life? You know that the drug is relatively safe. You would not tacitly accept in a patient the decisions that you are making for yourself. You would try to persuade them to take the potentially life-saving medication.
> Now I hear that it takes 9 days for it the EMSAM to leave your body.
Technically, it takes 18-25 hours for the drug to leave the body, but probably 10 days or so for MAO activity to recover. I imagine most side effects would take a week or so to dissipate. The side effects are what - insomnia? site reactions? That's pretty much it.
"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)." - Drug Monograph
- Scott
Posted by Jost on September 26, 2006, at 10:35:40
In reply to Re: Can't Take it AnyMore ! Bad news - Good news » Phillipa, posted by SLS on September 26, 2006, at 1:21:25
Hi, Phillipa.
You said the your pdoc appointment was today.
Again, I wanted to add my voice to Scott's in his last post.
But if you don't feel ready for the Emsam, why don't you mostly talk to your pdoc about taking it?
Make another appointment with him for next week or two weeks, to talk about it again. Focus on the project of taking small steps over time toward Emsam. Maybe using paxil in the meantime, but with the idea that you have a goal and you'll work toward making it less frightening, and more doable.
Or go to a counselor. There must be someone you can afford on a once a week basis.
Are you depriving yourself of a life, perhaps for historical (your own history) reasons? Didn't you say your husband is a workaholic? Wouldn't he love to have you back again?
Wouldn't you love to have yourself back again?
As the sage says, If I'm not for myself, who will be? If I'm only for myself, who am I? If not now, when?
Try to think about the first and third questions.
Jost
Posted by SLS on September 26, 2006, at 11:26:41
In reply to Re: Can't Take it AnyMore ! Bad news - Good news, posted by Phillipa on September 25, 2006, at 20:13:39
I'm sorry, Phillipa.
I wasn't thinking.
Emsam has a 18-25 hour half-life. The rule-of-thumb (and I don't know whose rule this is) states that most of a drug clears your body after 5 half lives, which in this case would be 5 days.
It is hard to suggest to another person what they should do. The advice given is sometimes a projection of what is right for the advisor, but not for the recipient.
Let's see where your head is at.
What do you feel like doing right now? Really.
- Scott
Posted by SLS on September 26, 2006, at 12:16:11
In reply to If not now, when? ---Phillipa, posted by Jost on September 26, 2006, at 10:35:40
Jost is giving you a gentle nudge again.
I like his approach. You can continue to discuss with your doctor the merits of treatment with Emsam. There really is no rush. You are intelligent enough for this stuff. Start using that nurse brain of yours to consider Emsam and other treatments medically. Use your training to approach things with the medical knowledge and scientific logic you were so good at. You are a professional. Be stronger than your past and allow your professional achievements and survivalist spirit rise above your old and useless fears. Make decisions based on intellect; your motivation powered by a fierce drive to finally have a life filled with rich and rewarding experiences.
If not now, when? You don't have to rush to decide to take a drug. If not now, when? Make now the time that you begin to live the rest of your life. Make now the time you decide to fight to regain control of the inner Jan. Jan is there. Be Jan right now. Leave your fears somewhere else. They are not part of Jan. Let Jan start to make the decisions. Crap. I'm beginning to sound like an evangalist or a psychologist. Really, though. Do it. Do it now. Not later. Not after you read more posts. Do it right now as you are reading and then re-reading this one. There is a forever-young, vital, strong, angry, determined, and adult Jan inside ready and capable of dealing with old and useless fears and putting them in their place. For now, they belong compartmentalized. There are real reasons why they exist, but they do not belong in the present. They belong in a box where you can deal with them at a time of your choosing. Now is not that time. Now is the time to allow the adult Jan to begin to work on the logical consideration of Emsam along with other drugs as treatments for Major Depressive Disorder and possibly Generalized Anxiety Disorder. Take control right now.
Now you can go back to the top and start over.
:-)
- Scott
-------------------------------------------------
> Hi, Phillipa.
>
> You said the your pdoc appointment was today.
>
> Again, I wanted to add my voice to Scott's in his last post.
>
> But if you don't feel ready for the Emsam, why don't you mostly talk to your pdoc about taking it?
>
> Make another appointment with him for next week or two weeks, to talk about it again. Focus on the project of taking small steps over time toward Emsam. Maybe using paxil in the meantime, but with the idea that you have a goal and you'll work toward making it less frightening, and more doable.
>
> Or go to a counselor. There must be someone you can afford on a once a week basis.
>
> Are you depriving yourself of a life, perhaps for historical (your own history) reasons? Didn't you say your husband is a workaholic? Wouldn't he love to have you back again?
>
> Wouldn't you love to have yourself back again?
>
> As the sage says, If I'm not for myself, who will be? If I'm only for myself, who am I? If not now, when?
>
> Try to think about the first and third questions.
>
> Jost
>
>
>
>
Posted by exquilter on September 26, 2006, at 14:33:51
In reply to Re: If not now, when? ---Phillipa » Phillipa, posted by SLS on September 26, 2006, at 12:16:11
What a wonderful post Scott! Good advice for all of us I think.
Exquilter
Posted by ed_uk on September 26, 2006, at 14:34:56
In reply to Can't Take it AnyMore !!!!!!!!!!!!!!!!!!!!!!Help!!, posted by Phillipa on September 23, 2006, at 21:33:16
Dear PJ
I don't believe that Emsam would be a suitable drug for you. I think it would make you agitated. I do think Nardil would help, but you would have to study the dietary restrictions first. I'm sorry you're having such an awful time lately.
(((((PJ)))))
Love
Ed xxx
Posted by SLS on September 26, 2006, at 16:29:51
In reply to Re: Can't Take it AnyMore !!!!!!!!!!!!!!!!!!!!!!Help!! » Phillipa, posted by ed_uk on September 26, 2006, at 14:34:56
> I don't believe that Emsam would be a suitable drug for you. I think it would make you agitated.
What makes you say this?
From the reports here and by my doctor, this drug seems to have anxiolytic properties, even though it is energizing in the beginning. People have even been able to reduce their dosages of Klonopin.
Having said that, I value your knowledge, opinions, and instincts.
I personally think that Nardil is well suited for Phillipa. It would probably be a good idea for her to start at 7.5mg, though, if it is possible to cut the new Nardil pills in half. I haven't seen them yet. Starting low and going slow with Nardil will help avoid any intitial sedation and hypotension.
For the times that I was on Nardil for extended periods of time, I didn't even know I was on the drug except that I had to take the pills every day. No side effects. The diet was no big dea. For the few months that it worked for me, it was a wonderful remission. The response waned and I then entered a mixed state hypomania. I remained in this state quite stable at 30mg for a few months. Things got very ugly after that. I actually entered a psychotic mania once I *discontinued* the Nardil.
Anyway, I don't know what I would do in Phillipa's position. Emsam is attractive for its lack of side effects, except for site reaction and insomnia. I would still follow the diet, though, because I would anticipate needing to go up to 9mg/24hr. I am still dubious of the safety at that dosage and higher.
I think my decision would pivot upon the pervasiveness and magnitude of the anxiety. I don't see Emsam as being a drug capable of treating Axis I anxiety disorders. I could be wrong, of course (I hope I am). Nardil, on the other hand, has been demonstrated for years to be a potent treatment for these disorders. As Phillipa describes her sometimes paralyzing anxiety, I am drawn to the conclusion that the anxiety should be treated as aggressively as the depression. This leaves Nardil.
Phillipa, if you are more comfortable trying Emsam first, then do that. You won't be sacraficing epochs of your life by doing so. If these patches deliver sufficient MAOI, you might end up with a very nice response, including a reduction in anxiety. If Ed is correct, as he often is, and you react to Emsam badly, you should know pretty quick. I am guessing it is the parent compound that would be doing the dirty work directly, not the consequences of MAO inhibition. Like you said, if it happens, you just rip the patch off, and that's that. It will clear up in a couple of days. Then move on to Nardil (or something else or nothing, whichever Jan thinks is right for her).
Remember Phillipa, these are powerful drugs. They are not sugar pills. They do have side effects, and you might feel some weird stuff in the beginning. You MUST expect that these things might occur. You MUST take things one day at a time. Jan, you must be in control here if this thing is going to work. Come here to report your progress and express your concerns. Call your doctor if necessary.
- Scott
Posted by Declan on September 26, 2006, at 17:44:08
In reply to Re: Can't Take it AnyMore !!!!!!!! » Phillipa » ed_uk, posted by SLS on September 26, 2006, at 16:29:51
PJ, I don't think you'd sleep with Emsam. You could take something for that but then you have another drug layer, because I couldn't imagine benzos cutting it for you. Apart than that, and maybe some increased anxiety, it might be OK
Posted by Jost on September 26, 2006, at 19:26:44
In reply to Re: Can't Take it AnyMore !!!!!!!!, posted by Declan on September 26, 2006, at 17:44:08
Insomnia is a problem with Emsam, no question.
First, there's accommodation over time-- perhaps not total, but substantial in reducing insomnia.
Even more, taking the patch off for some part of the night may be a crucal element of successful use for some people (myself included).
I'd also like to emphasize that Scott is, IMO, correct about adherence to the dietary restrictions on higher emsam doses, esp. if the patch isn't removed at night. If absorption stays within expected levels, the dietary restrctions may not be necessary even on stronger patches.
So far, however, the effect of non-standard conditions. such as heat, even during transportation, or individual differences in absorption have not been studied adequately. Therefore, some danger of reaching a level where tyramine could be problematic remains--esp. since it's not tyramine at one meal, but over days, that can be implicated.
Until these issues are further investigated some degree of dietary caution should be practiced.
Jost
Posted by Phillipa on September 26, 2006, at 22:17:46
In reply to Re: Emsam insomnia, posted by Jost on September 26, 2006, at 19:26:44
Scott that was a wonderful post. Thanks. And my Ed thanks for standing by an opinion you've e-mailed me many times and jost too. Well I do therphy with the pdoc too 50minute sessions. She said no to EMSAM now just now. Wants me to go up on luvox from the 25mg to 300mg at my own pace since it agrees with me. And continue with valium and xanax as needed hardly take. And then maybe if the 300mg doesn't do it add something like providgil. She is amazed that I've stuck this long at 25mg. And continued to semi-function. But she wants me to set my own goals form of CBT. Even going to the bank(always afraid of the) I did yesterday that goes on the positive side. and keep adding slowly. And see how it goes. I see her again in a month she's five hours each way. Well by then more will be out on emsam. Oh we discussed lyrica. She only wants to change one thing at a time. So that's the story for now. Love Jan. To some very special people in my life. I love you all dearly.
Posted by SLS on September 27, 2006, at 1:46:19
In reply to Re: Emsam insomnia, posted by Phillipa on September 26, 2006, at 22:17:46
Now, that sounds like a plan!
I am very impressed with your going to the bank. That was a true achievement.
I agree with your doctor that it is a comment on your strength of character that you have been able to function at 25mg of Luvox. You were really functioning without an antidepressant/anti-GAD.
It is true that Lyrica is approved for GAD in Europe, but it was rejected in the US. The drug company says that it will continue to apply.
Congratulations on devising a plan. Good luck on implementing it.
- Scott
Posted by Jost on September 27, 2006, at 10:18:23
In reply to Re: Emsam insomnia, posted by Phillipa on September 26, 2006, at 22:17:46
Phillipa, that's great news.
Now you have a plan and can know where you're heading. Not without hesitations, and uncertainties, and moments when you think it may go wrong--but coping with those, using the friends you have, and your own intelligence and knowledge -- so that that won't keep you from going forward.
You and your pdoc talked about your anxieties about using medications, made a plan--and you went to the bank--both are such important accomplishments. They may seem small, but they aren't, they can be solid beginnings.
This can be the beginning of a better future.
Jost
Posted by ed_uk on September 27, 2006, at 16:05:34
In reply to Re: Can't Take it AnyMore !!!!!!!! » Phillipa » ed_uk, posted by SLS on September 26, 2006, at 16:29:51
Hi Scott
I had an image of Phillipa being up all night, unable to sleep, with many anxious thoughts. Insomnia is bad news for people suffering from anxiety.
Ed
Posted by SLS on September 27, 2006, at 16:51:30
In reply to Re: Can't Take it AnyMore !!!!!!!! » SLS, posted by ed_uk on September 27, 2006, at 16:05:34
> Hi Scott
>
> I had an image of Phillipa being up all night, unable to sleep, with many anxious thoughts. Insomnia is bad news for people suffering from anxiety.Okaleedokalee.
:-)
I'm afraid that might be a problem with Nardil too.
- Scott
Posted by Crazy Horse on September 27, 2006, at 17:29:24
In reply to Can't Take it AnyMore !!!!!!!!!!!!!!!!!!!!!!Help!!, posted by Phillipa on September 23, 2006, at 21:33:16
> I can't take it anymore. All the people trying to feel normal. Used to be that people thought meds would make them well. Now everyone or a lot of posters are regretting every taking meds. They feel worse than they ever did. Is there no hope? I'm losing mine very fast. So what if you are gone in 20 years or 50years it's all the same. I'm so confused. Where do I go from here? Love Phillipa the biggest pain that ever lived!!!!!
Jan,
The problem is quite simple sweetheart, you spend too much time here reading all the negative things about medications..and then you are afraid to try any medications yourself. YOU, have to try a particular medicine YOURSELF to find out how it is going to effect YOU. Just because "John" was on prozac and experienced severe migraines, does not mean that if you took prozac you too would have migraines. It's that simple Jan, you spend way, way too much time at P.B. reading all this negative bull sh*t! Bottom line is that there are many excellent meds out there that could help you..but YOU have to try them to find out if they work for YOU!
Love, Monte
Posted by Phillipa on September 27, 2006, at 19:54:57
In reply to Re: Good work! » Phillipa, posted by SLS on September 27, 2006, at 1:46:19
Scott what do you mean by 25mg/antiGad? Scott and Jost you really think going to the bank is an acomplishment? It only took a second. I should be able to go to mall, restaurants, all over the place by myself and not be afraid. I could before. One positive thing that happened today. My across the street neighbors got their Daughter and brought her to live with them. Their one Son committed suicide, she had tried once and lost her kids , and now her boyfriend had dumped her and was thinking the same thing again. Has been hospitalized many times. But she told me they said she was bipolar and anger was her mania.Also was addicted to pain meds. Crying very hard. She was off her prozac for nine months and felt she was doing fine. I walked up to her and before you knew it we were hugging. She told me her story I told her mine. So in a way I felt like I helped someone today. She said how thank-ful she felt to have someone to trust that understood. So is this my CBT accomplishment for the day? I did take 50mg of luvox last night. And also doubled by valium. Realized I would run out but Greg got up and I wake-up whenever he leaves. When he got back in bed his body was so cold it scared me so I took extra valium. Now how do I stop myself from doing this? I had my chart yesterday and read my dx. Axis I MDD with anxiety. Axis ll deferred(what does that mean deferred?) Axis lll multiple medical conditions. lV and V nothing written. Love Jan. ps this is to Jost, Ed everyone on this thread.
Posted by Phillipa on September 27, 2006, at 21:16:15
In reply to Re: Can't Take it AnyMore !!!!!!!! » SLS, posted by ed_uk on September 27, 2006, at 16:05:34
Ed I fall asleep for 2-3hours at a time. Wake up take5mg of valium and try to go back to sleep. Average about 6 hours of sleep total as I can't sleep when Greg leaves. Just stay in bed as the pup and poodle are still asleep as I too wish I could be. I've always needed about l0 hours of sleep a night. Way back when even in high school I went to be a 9pm and up at 7;30. Took each Wed off to sleep in. Love PJ O
Posted by ed_uk on September 28, 2006, at 14:47:23
In reply to Re: Can't Take it AnyMore !!!!!!!! » ed_uk, posted by SLS on September 27, 2006, at 16:51:30
>I'm afraid that might be a problem with Nardil too.
True, but Nardil is probably more anxiolytic, so the insomnia might not be so distressing!
ED
Posted by SLS on September 28, 2006, at 16:03:10
In reply to Re: Can't Take it AnyMore !!!!!!!! » SLS, posted by ed_uk on September 28, 2006, at 14:47:23
> >I'm afraid that might be a problem with Nardil too.
>
> True, but Nardil is probably more anxiolytic, so the insomnia might not be so distressing!I guess there is no way to predict who will get insomnia with Nardil. When it strikes, it can be very stubbon. With either drug, it might become an issue that will have to be treated aggressively.
How do you feel about combining Ambien with Valium?
Emsam seems to have a reduced side effect burden compared to Nardil. That makes it attractive as a first choice of a MAOI. With Nardil, one must be prepared for things like hypotension, sedation, urinary hesitency or retension, edema, weight gain, constipation, insomnia, and anorgasmia. The problem with Emsam, though, is that it probably doesn't work to get as many people well as Nardil.
If I were in Phillipa's situation, I would choose Nardil. I would take the plunge. The side effects I listed are usually not too problematic and often disappear with continued treatment. After being on Nardil for 2-3 months, I could not even tell I was taking a drug. There were no side effects. In addition, I think she may have a comorbid anxiety disorder - perhaps GAD. Of the two drugs, Nardil is the one that is more apt to treat it.
- Scott
Posted by Crazy Horse on September 28, 2006, at 17:42:04
In reply to Re: Can't Take it AnyMore !!!!!!!!, posted by SLS on September 28, 2006, at 16:03:10
> > >I'm afraid that might be a problem with Nardil too.
> >
> > True, but Nardil is probably more anxiolytic, so the insomnia might not be so distressing!
>
> I guess there is no way to predict who will get insomnia with Nardil. When it strikes, it can be very stubbon. With either drug, it might become an issue that will have to be treated aggressively.
>
> How do you feel about combining Ambien with Valium?
>
> Emsam seems to have a reduced side effect burden compared to Nardil. That makes it attractive as a first choice of a MAOI. With Nardil, one must be prepared for things like hypotension, sedation, urinary hesitency or retension, edema, weight gain, constipation, insomnia, and anorgasmia. The problem with Emsam, though, is that it probably doesn't work to get as many people well as Nardil.
>
> If I were in Phillipa's situation, I would choose Nardil. I would take the plunge. The side effects I listed are usually not too problematic and often disappear with continued treatment. After being on Nardil for 2-3 months, I could not even tell I was taking a drug. There were no side effects. In addition, I think she may have a comorbid anxiety disorder - perhaps GAD. Of the two drugs, Nardil is the one that is more apt to treat it.
>
>
> - ScottI totally concur with Scott, Jan. You must take the "Plunge." Nardil is an excellent medication. Only by trying it will you know if it's right for you.
Love, Monte
Posted by Phillipa on September 28, 2006, at 21:12:45
In reply to Re: Can't Take it AnyMore !!!!!!!! » SLS, posted by ed_uk on September 28, 2006, at 14:47:23
Hey guys it's me you're talking about. My pdoc prescribed upping my luvox dose at my pace to 300mg not nardil or EMSAM right now. So I'm now on 50mg of luvox goal of 300mg. Or should I listen to a blog sent to me where they say excercise has a higher remission rate than ad's. Maybe that's why I look forward to my 7.5bike rides daily at least now while the weather is still warm enough and light enough in the evening. Love Jan
Posted by ed_uk on September 29, 2006, at 15:11:56
In reply to Re: Can't Take it AnyMore !!!!!!!!, posted by SLS on September 28, 2006, at 16:03:10
Hi Scott
>How do you feel about combining Ambien with Valium?
In Phillipa's case? I think it might help, but I expect she might have a high tolerance to Ambien.
Regards
Ed
Posted by Jost on September 29, 2006, at 22:27:40
In reply to Re: Can't Take it AnyMore !!!!!!!! » SLS, posted by ed_uk on September 29, 2006, at 15:11:56
It's probably best for Phillipa to follow the plan she and her pdoc mapped out. I don't see any reason to change course, until that option has been explored. It it works, that'll be great.
Even going through the process of making and carrying through a decision could help her-- I mean, you, regain another bit of confidence-- in your ability to make a good decision (even if it doesn't work out, it will have been a good decision)-- and carry it out. It's part of finding that you can go forward, without pulling back. Ex ante, there's no 'right" answer-- there's not enough information to make more then rational guesses. Even if there are other rational options, this one is also a rational way to go. Esp. because Phillipa and her Pdoc came to that conclusion, after Phillipa had really given it thought.
So let's give Plan A a chance. And why not just let Plan B be Plan B-- the one you don't try, before Plan A works or doesn't work.
If luvox isn't right, then it's not the end of the world-- but you'll know that it's not the one for you, for sure-- and not wonder forever.
Then maybe Nardil, because it's been around a long time, and there's a body of knowledge and experience to call on. You don't have to be on new terrain--and a few months later, if you need it, the management of Emsam will be clearer. There's plenty of time to get to that bridge, before deciding how to cross it.
--And yes, going to the bank is an accomplishment. Any time you manage something you're reluctant to do and often draw back from-- it's a very positive step It's important to recognize small accomplishments! And not get so far ahead of yourself, with a barrage of other things that you "can't" do-- yet. One step at a time.
So, I do thing it's great that you did go.
By the way, did you and your Pdoc work out a schedule for raising the luvox?
Jost
Posted by Phillipa on September 29, 2006, at 22:31:54
In reply to Re: Can't Take it AnyMore !!!!!!!! Phillipa, posted by Jost on September 29, 2006, at 22:27:40
Thanks Jost for supporting me. She said to do what's comfortable for me. As she knows all the other stresses going on in my life and my grown Kids family's now. Number two would be EMSAM though. I already have sample patches. And as I've said before somehow it feels safer to see the med and be able to have the control of ripping it off. And thanks baby steps for now. Love Phillipa
Posted by SSJW on September 30, 2006, at 6:30:23
In reply to Re: Can't Take it AnyMore !!!!!!!! Phillipa » Jost, posted by Phillipa on September 29, 2006, at 22:31:54
Hi, I'm sorry your having such a rough time.I'm wondering if your Lyme infection was throughly treated?
It can produce many neuropsychiatric sypmtoms.
http://www.columbia-lyme.org/flatp/lymeoverview.htmlThe spirochete are very difficult to eradicate and co-infections are also common.
-Steve
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Dr. Bob is Robert Hsiung, MD,
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Script revised: February 4, 2008
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