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Dr. Bob is Robert Hsiung, MD,
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Posted by RobertDavid on May 8, 2006, at 12:46:44
In reply to Re: dosage » tygereyes, posted by Donna Louise on May 8, 2006, at 6:36:16
A couple of points from some of the previous posts:
I too had terrible luck with Wellbutrin, more anxiety and more socially withdrawn. Not the case with EMSAM to this point though.
Though I had no redness initially, lately I have noticed a few red marks here and there that last about 2 days. Seems I get them on my chest and arms, but not my back. Certainly not a big issue for me. Today I put it on top of my shoulders towards my neck. Perhaps it's just in my mind, but lately I have noticed a slight increase in energy when I place the patch on my upper body compared to my stomach area. It's probably just in my head, but?
Lastly, my doctor mentioned that at the 30 & 40mg patch dose he didn't think there would be issues with diet restrictions, that the FDA just didn't get enough info to approve it that way. That if I needed to go to a higher dose to just "test" the worst food offenders. That most likely there won't be issues. Certainly the drug interactions are there for all doses.
Just my 2 cents worth. Still doing great on EMSAM. Rob
Posted by Jost on May 8, 2006, at 15:17:07
In reply to Re: dosage, posted by RobertDavid on May 8, 2006, at 12:46:44
I posted this on another thread, but maybe this is a better place to ask.
I'm interested in EMSAM, esp. whether it's a lot more effective than selegiline. My psych doctor originally was against selegiline, on the basis that it wasn't effective; now he's high on EMSAM.
I'm confused, because I could have taken high doses of selegiline, probably, because I was on v. high dose of Parnate without any hypertensive problems. My biggest problem with Parnate was that, rather unusually, it put me to sleep. That's why I needed the high dose--otherwise I was basically asleep all the time.
It wasn't in retrospect a very good idea, but nothing else so far has worked. Except for the cymbalta--which was okay, worth it, but not really great.
I'm just wondering, basically, if selegiline is a rather weak Maoi, why would Emsam be so great-- if the issue of dose is taken out of the picture. And how much of a difference does the larger dose make?
Jost.
Posted by tygereyes on May 8, 2006, at 17:41:33
In reply to Re: dosage » tygereyes, posted by strugglingsteve on May 8, 2006, at 0:05:40
> > << http://www.fdaadvisorycommittee.com/FDC/AdvisoryCommittee/Committees/Psychopharmacologic+Drugs/102605_emsam/102605_EmsamP.htm >>
> >
> > click on the link provided there
>
> That does not say much about 30 and 40. Is that what you are relying on? I am not that comfortable going to 30 and chancing it. Let me know when you get to 30. I will probably get there a week from this coming Wednesday when I see my doc unless the 20 mg patch starts to work for meYou obviously didn't see the studies (and the incredible graph) where they showed the pressor response to cheese in fluoxetine, tranylcypromine, and EMSAM at the three different doses. Tranylcypromine produced a pressor response after one bite of cheese.
AT 40 MGS OF EMSAM, THE SUBJECTS COULD NOT PRODUCE A PRESSOR RESPONSE; there was a slight increase in BP.
AND did you see the studies where it said that NONE of the subjects, REGARDLESS of dose, did NOT follow the MAOI diet and NO ONE had a hypertensive crisis?
Posted by tygereyes on May 8, 2006, at 17:43:28
In reply to Re: dosage » tygereyes, posted by Donna Louise on May 8, 2006, at 6:36:16
> > << http://www.fdaadvisorycommittee.com/FDC/AdvisoryCommittee/Committees/Psychopharmacologic+Drugs/102605_emsam/102605_EmsamP.htm >>
> >
> > click on the link provided there
>
> Thank you for providing this link, Tigereyes. I seriously doubt that there would be diet problems with this delivery system but just in the small small chance that you do would you please let us know? The only food that would be a remotely possible problem is soy and the occasional pizza, I can't have alot anyway or I would eat nohting else and get big as a house. I have no intention of going to 9mg yet, just can always use all info.
>
> thanks so much for your contibution,
>
> donnaDonna,
For most people, pizza is not a problem as long as it is not made with "exotic" cheeses. I ate MANY slices of pizza on 90 mgs Parnate and NEVER had a crisis occur. :)
Posted by spooly on May 8, 2006, at 18:27:18
In reply to Re: Emsam, ADD-Anxiety-Dysthemia » spooly, posted by Donna Louise on May 8, 2006, at 6:43:22
Lymom and DonnaLouise thank you both. Very, very, encouraging.
I had the same exact response to all forms of wellbutrin. The stuff was like LSD. The package insert should have had directions to the trip-out tent.
Posted by lymom3 on May 8, 2006, at 18:28:43
In reply to Re: dosage, posted by tygereyes on May 8, 2006, at 17:41:33
I don't understand why you have to be so hostile about it. Everyone is here looking for information. None of us are experts. Obviously we all have issues here or we wouldn't be looking for a medication to make us feel better. We aren't all suicidal either and people have a right to be cautious with their health without being talked down to like they are idiots. Please can't we be nice?
Posted by strugglingsteve on May 8, 2006, at 18:29:13
In reply to Re: dosage, posted by tygereyes on May 8, 2006, at 17:41:33
> > > << http://www.fdaadvisorycommittee.com/FDC/AdvisoryCommittee/Committees/Psychopharmacologic+Drugs/102605_emsam/102605_EmsamP.htm >>
> > >
> > > click on the link provided there
> >
> > That does not say much about 30 and 40. Is that what you are relying on? I am not that comfortable going to 30 and chancing it. Let me know when you get to 30. I will probably get there a week from this coming Wednesday when I see my doc unless the 20 mg patch starts to work for me
>
> You obviously didn't see the studies (and the incredible graph) where they showed the pressor response to cheese in fluoxetine, tranylcypromine, and EMSAM at the three different doses. Tranylcypromine produced a pressor response after one bite of cheese.
>
> AT 40 MGS OF EMSAM, THE SUBJECTS COULD NOT PRODUCE A PRESSOR RESPONSE; there was a slight increase in BP.
>
> AND did you see the studies where it said that NONE of the subjects, REGARDLESS of dose, did NOT follow the MAOI diet and NO ONE had a hypertensive crisis?I didnt see the studies, where are they? I have read plenty on emsam but not seen that yet. Yes I did read where no one followed the diet but I dont know what they ate. I suppose someone ate chinese didnt they? :)
Posted by spooly on May 8, 2006, at 18:43:51
In reply to Re: dosage, posted by Jost on May 8, 2006, at 15:17:07
He was originally against it before the pharmaceutical salesman offered him a free round at Pebble Beach where he confirmed, with several colleagues, over a complementary Martini, that it was indeed, effective :)
ahhh...I'm a cynic..sorry.
There were relatively few studies on selegilene til emsam (I know - I scoured the web)and my guess is that not many doctors wanted to open themselves up to litigation to prescribe an "anti-parkinsons" MAOI off-label. They also had little solid evidence.
> I posted this on another thread, but maybe this is a better place to ask.
>
> I'm interested in EMSAM, esp. whether it's a lot more effective than selegiline. My psych doctor originally was against selegiline, on the basis that it wasn't effective; now he's high on EMSAM.
>
> I'm confused, because I could have taken high doses of selegiline, probably, because I was on v. high dose of Parnate without any hypertensive problems. My biggest problem with Parnate was that, rather unusually, it put me to sleep. That's why I needed the high dose--otherwise I was basically asleep all the time.
>
> It wasn't in retrospect a very good idea, but nothing else so far has worked. Except for the cymbalta--which was okay, worth it, but not really great.
>
> I'm just wondering, basically, if selegiline is a rather weak Maoi, why would Emsam be so great-- if the issue of dose is taken out of the picture. And how much of a difference does the larger dose make?
>
> Jost.
Posted by Jost on May 8, 2006, at 20:50:33
In reply to Re: dosage, posted by spooly on May 8, 2006, at 18:43:51
> He was originally against it before the pharmaceutical salesman offered him a free round at Pebble Beach where he confirmed, with several colleagues, over a complementary Martini, that it was indeed, effective :)
>
> ahhh...I'm a cynic..sorry.
>
Thanks, Spooly. .I did some reading on it a while back--but it was mostly a person here or there recommending it. Maybe not a large enough sample.
So maybe he was just being cautious-- or hadn't met the right drug rep. ---
Although my doctor would never take one of those junkets to paradise. He's utterly beyond any breath of such doings.... I'm sure.....
Jost
Posted by Donna Louise on May 8, 2006, at 21:21:08
In reply to Re: EMSAM: patch placement, posted by lymom3 on May 8, 2006, at 6:34:59
> I'm only on my 5th day of Emsam, but the first 4 days I put the patch on my breastbone area and the area breastbone area. The patches stuck great. Yesterday I put the patch on the outside part of my arm slightly down from my shoulder and it didn't come off, but it didn't stick as well there so I'm back to the chest area.
>
> No matter where I put it though, I end up with a red rash that lasts 2 days. It stings to remove the patch too, that's for sure, but I'm not giving it up. I've actually started using my treadmill again which is big for me...
I tried your idea of putting it on the breastbone and it is sticking just fine there. I take it off during a hot shower and kind of let the water push it off while I help just a little with the peeling. Maybe that would help your irritation.Donna
Posted by egas on May 9, 2006, at 23:12:09
In reply to Re: EMSAM: patch placement, posted by lymom3 on May 8, 2006, at 6:34:59
According to my doctor, you can use Benedryl cream over the patch while you wear it and
after removal if you still have the rash.best of luck!
> I'm only on my 5th day of Emsam, but the first 4 days I put the patch on my breastbone area and the area breastbone area. The patches stuck great. Yesterday I put the patch on the outside part of my arm slightly down from my shoulder and it didn't come off, but it didn't stick as well there so I'm back to the chest area.
>
> No matter where I put it though, I end up with a red rash that lasts 2 days. It stings to remove the patch too, that's for sure, but I'm not giving it up. I've actually started using my treadmill again which is big for me...
Posted by maggiedelena on May 10, 2006, at 19:55:20
In reply to Re: Emsam, ADD-Anxiety-Dysthemia » spooly, posted by Donna Louise on May 8, 2006, at 6:43:22
I fit the ADD-Anxiety-Dysthemia profile. Though I've also had hypomanias, so it's being called BPII. I also suspect my problems are dopamine-related (because I have restless leg syndrome, which is dopamine-related) and LOVE amphetamine-like drugs, like psuedoephedrine, which are basically dopamine-reuptake-inhibitors. In relatively low doses they make me calm and focused, motivated and happy. But not hypomanic happy. HOWEVER - I hated Wellbutrin. Made me agitated and miserable. (Zoloft -- the first thing I tried -- made me basically numb, tired all the time, and not much less depressed). Lamictal gave me mixed results, ultimately more bad than good, so I quit it. I'll be watching this EMSAM stuff closely...
Posted by jetcity10 on May 12, 2006, at 19:02:29
In reply to Re: EMSAM-Time for next refil » theo, posted by RobertDavid on May 2, 2006, at 18:24:55
I started my fourth week of EMSAM on Wednesday. I was having much more anxiety than normal for the first few weeks, but it has now decreased (to no more than normal levels and perhaps even lower - though I am a bit of a pessimist so maybe it is even better). I have started sleeping better too this past week after several weeks of very poor sleep. This seems to be fairly similar to other people's experiences so far, but I just wanted to share my experience so far. Overall I probably still feel better than I have felt in longer than I can remember. This is the best response I have ever had to any AD and I have been on way too many.
Posted by crazy777girl on May 13, 2006, at 13:07:48
In reply to Re: EMSAM-Time for next refil, posted by jetcity10 on May 12, 2006, at 19:02:29
Greetings. A search for EMSAM side effect info brought me to this board today, and much helpful insight. My diagnosis; treatment resistant depression (bipolar, a rapid cycler but in a major depressive state for quite some time) I have a knowledgable, well-regarded Dr, (psychopharmacologist) but because all we've tried so far has been only marginally successful, I've opted for a VNS implant. When insurance approval finalizes, I'll be implanted. It sounded like Sci-Fi in the beginning, but now sounds about as crazy as the pharmaceutical cocktail I swallow every day & its multitude of side effects, known & unknown. Which brings me back to my original point; I've developed serious leg cramps, more like lower body aching, hips down, actually, like I've run a marathon. Believe me, I haven't. I also had a mystery swelling in my neck that made breathing & swallowing difficult, just short of the need to take a trip to the ER but I did go to my PCP. He ordered an ultrasound, decided it was a cyst that burst. All coinciding w/ the start of my patch. I have no site irritation, other than it hurts like heck pulling them off. I switch off on the upper arm area. Showering is no issue, but if you pull one slightly off or touch it while applying, forget it - it won't stick. I've used surgical tape in that case, since they're so expensive I didn't want to toss it & start over w/ a new patch even though my insurance covers them, currently. I did read (just today) about the possibility of cysts & muscle "stiffness", but these don't seem to be common side effects, and my Dr. didn't expect me to experience any significant side effects. This is so new, however, how can we really know? I have high hopes for this, as my Dr has another pt with TRD who is also using a similar combination of meds, including EMSAM, and it seemed to be the magic bullet for him. Does anyone have more experience with EMSAM use, or its side effects?
Posted by RobertDavid on May 13, 2006, at 13:45:37
In reply to Re: EMSAM-3rd Week Side Effects, posted by crazy777girl on May 13, 2006, at 13:07:48
It's been the majic bullet for me. No side effect issues. I'm going into my 6th week and have never felt better. Though everyone is different, no side effects for me other than improved mood, more energy, not depressed.
Though I suppose it's possible for you to get the side effects you're having from EMSAM, I'd think it's unlikely, most likely unrealated. Even if it is listed as a possible side effect it may have been just something someone experience in the trial that was unrelated to the drug. They have to list every side effect people get whether or not it's related to the medication, the drug companies want to cover their butts.
I hope it works for you! Rob
Posted by Donna Louise on May 13, 2006, at 22:00:19
In reply to Re: EMSAM-3rd Week Side Effects, posted by crazy777girl on May 13, 2006, at 13:07:48
> Greetings. A search for EMSAM side effect info brought me to this board today, and much helpful insight. My diagnosis; treatment resistant depression (bipolar, a rapid cycler but in a major depressive state for quite some time) I have a knowledgable, well-regarded Dr, (psychopharmacologist) but because all we've tried so far has been only marginally successful, I've opted for a VNS implant. When insurance approval finalizes, I'll be implanted. It sounded like Sci-Fi in the beginning, but now sounds about as crazy as the pharmaceutical cocktail I swallow every day & its multitude of side effects, known & unknown. Which brings me back to my original point; I've developed serious leg cramps, more like lower body aching, hips down, actually, like I've run a marathon. Believe me, I haven't. I also had a mystery swelling in my neck that made breathing & swallowing difficult, just short of the need to take a trip to the ER but I did go to my PCP. He ordered an ultrasound, decided it was a cyst that burst. All coinciding w/ the start of my patch. I have no site irritation, other than it hurts like heck pulling them off. I switch off on the upper arm area. Showering is no issue, but if you pull one slightly off or touch it while applying, forget it - it won't stick. I've used surgical tape in that case, since they're so expensive I didn't want to toss it & start over w/ a new patch even though my insurance covers them, currently. I did read (just today) about the possibility of cysts & muscle "stiffness", but these don't seem to be common side effects, and my Dr. didn't expect me to experience any significant side effects. This is so new, however, how can we really know? I have high hopes for this, as my Dr has another pt with TRD who is also using a similar combination of meds, including EMSAM, and it seemed to be the magic bullet for him. Does anyone have more experience with EMSAM use, or its side effects?
The only side effect I can say that I have had is a slightly higher pulse. My BP dropped to normal because it was too high from other meds. I have had no orthostatic hypertension or anything like that. I have had none of the other side effects I have gotten from all the sri's and such. nothing. Not even a site irritation. As Robert said, more than likely what you are having is coincidence but ya just never know about these things I guess anything is possible.
Donna
Posted by spooly on May 14, 2006, at 2:16:15
In reply to Re: Emsam, ADD-Anxiety-Dysthemia, posted by maggiedelena on May 10, 2006, at 19:55:20
That describes me pretty much exactly. I'm not going anywhere near bipolar meds though.
> I fit the ADD-Anxiety-Dysthemia profile. Though I've also had hypomanias, so it's being called BPII. I also suspect my problems are dopamine-related (because I have restless leg syndrome, which is dopamine-related) and LOVE amphetamine-like drugs, like psuedoephedrine, which are basically dopamine-reuptake-inhibitors. In relatively low doses they make me calm and focused, motivated and happy. But not hypomanic happy. HOWEVER - I hated Wellbutrin. Made me agitated and miserable. (Zoloft -- the first thing I tried -- made me basically numb, tired all the time, and not much less depressed). Lamictal gave me mixed results, ultimately more bad than good, so I quit it. I'll be watching this EMSAM stuff closely...
Posted by spooly on May 14, 2006, at 2:24:12
In reply to Re: EMSAM-3rd Week Side Effects » crazy777girl, posted by Donna Louise on May 13, 2006, at 22:00:19
oh yeah that raises a good question. Anyone on EMSAM have high blood pressure? I take a relatively low dose of Avalide for blood pressure (160/100 before medication). It's normalized now but I'm curious if anyones had increased blood pressure as a direct result of EMSAM.
Any hypertensives out there on EMSAM?
Posted by jetcity10 on May 14, 2006, at 10:43:07
In reply to Re: EMSAM-3rd Week Side Effects, posted by crazy777girl on May 13, 2006, at 13:07:48
I am on my fourth week and I have noticed a little muscle "achiness" near the patch placement, but that is it. If I put the patch on my upper arm some times it kind of feels as if I had a flu shot or something. If I put the patch on my lower back I get some lower back pain. I don't notice it when it is on the chest area, so I tend to favor that placement. It is not a big enough deal to cause me to change me mind about EMSAM but at times it is a bit annoying...
Posted by darcan on May 22, 2006, at 19:28:40
In reply to Re: EMSAM-3rd Week Side Effects, posted by spooly on May 14, 2006, at 2:24:12
> oh yeah that raises a good question. Anyone on EMSAM have high blood pressure? I take a relatively low dose of Avalide for blood pressure (160/100 before medication). It's normalized now but I'm curious if anyones had increased blood pressure as a direct result of EMSAM.
>
> Any hypertensives out there on EMSAM?I'm on Toprol and Lisinipril. No change in BP since starting EMSAM 9 days ago, but no improvement in my depression either.
Posted by pederspd on May 23, 2006, at 10:13:20
In reply to Re: EMSAM-3rd Week Side Effects, posted by darcan on May 22, 2006, at 19:28:40
Spoke with my doc the other day about the itching/rash type side effects and using benadryl cream. She said the pharm. reps say no because of the whole thing about not taking cold and decongestions. The recommendation is cortisone or hydrocortisone cream.
I'm not having that as a problem but I am getting bruises, like hickies, a day or two after removing the patches. Is it the way that I'm removing them? Anyone else have that problem? Pat
Posted by SFY on May 23, 2006, at 15:40:29
In reply to Side Effects, posted by pederspd on May 23, 2006, at 10:13:20
> Spoke with my doc the other day about the itching/rash type side effects and using benadryl cream. She said the pharm. reps say no because of the whole thing about not taking cold and decongestions. The recommendation is cortisone or hydrocortisone cream.
There isn't a blanket prohibition on taking cold medications.
From the EMSAM insert: "As with other MAOI’s, EMSAM is contraindicated for use with sympathomimetic amines, including
amphetamines as well as cold products and weight-reducing preparations that contain vasoconstrictors (e.g., pseudoephedrine, phenylephrine, phenylpropanolamine, and ephedrine)."In addition the cough suppressant dextromethorphan, which is found in many cold medications, is also contraindicated.
However, there is no prohibition or adverse reaction listed for diphenhydramine the active ingredient in Benadryl. This is especially true when it is a locally applied topical cream that has little chance of getting into your bloodstream.
Posted by stabb on June 9, 2006, at 22:23:49
In reply to EMSAM - First Day, posted by RobertDavid on April 8, 2006, at 11:15:36
new to board...just wondering how those who recently started with the patch are doing. there hasn't been many posts of late. all the best to everyone!
Posted by stabb on June 10, 2006, at 1:13:57
In reply to Re: EMSAM - First Day, posted by stabb on June 9, 2006, at 22:23:49
sorry everyone...just read all recent posts
Posted by Donna Louise on June 10, 2006, at 6:42:22
In reply to Re: EMSAM - First Day, posted by stabb on June 9, 2006, at 22:23:49
> new to board...just wondering how those who recently started with the patch are doing. there hasn't been many posts of late. all the best to everyone!
Welcome to the board, Stabb. I hope you are well.
I am not as good as I had hoped to be by now. I have increased the dose to 9mg for about two weeks now. I do have energy which is a great change from fighting or being asleep all the time. I have gotten alot done. But I am still somewhat depressed. The anxiety is better too but not as good as I had hoped. I see the pdoc Wed. and see what she advises. Something more needs to be done I am afraid. It could be I am just in a down type cycle and I will be better any moment. The most upsetting thing to me is I get angry so easily. I big explosion and then it is over. That is what I am like if I am not on medicine and I am afraid tht is what I will be like if the medicine doesn't numb me out. I like that the patch doesn't do that but I am left with these rage attacks and residual depression. sigh.Donna
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