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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 53 to 77 of 77. Go back in thread:
Posted by jealibeanz on June 20, 2006, at 13:14:16
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 20, 2006, at 13:00:14
I know there's nothing wrong with being an informed patient, but there are just so many sensitive and personal issues when dealing with anxiety and depression. It makes it so much harder to be assertive with symptoms and treatment.
I thought EMSAM doesn't have anything to do with SE at the doses currently available, only at very high amounts. I'm put off by serotonin because I suspect that it may have something to do with the weight gain side effect. I know that it has been reported on EMSAM, but it wasn't reported on Wellbutrin, which made me gain quite a bit. I am completely clueless as to how/why it actually occurs. Does it have something to due with the liver? stomach? brain? metabolism? I just don't get it!
Posted by Donna Louise on June 20, 2006, at 13:46:22
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 20, 2006, at 13:14:16
> I know there's nothing wrong with being an informed patient, but there are just so many sensitive and personal issues when dealing with anxiety and depression. It makes it so much harder to be assertive with symptoms and treatment.
>
> I thought EMSAM doesn't have anything to do with SE at the doses currently available, only at very high amounts. I'm put off by serotonin because I suspect that it may have something to do with the weight gain side effect. I know that it has been reported on EMSAM, but it wasn't reported on Wellbutrin, which made me gain quite a bit. I am completely clueless as to how/why it actually occurs. Does it have something to due with the liver? stomach? brain? metabolism? I just don't get it!
>
>I am rife with anxiety and depression. I know exactly how it feels. (Currently I am not as the EMSAM is working for me.) So I do understand it is hard to be assertive but you can do it.
It is confusing about the EMSAM dosage. It says 6mg but that is not the same as 6mg orally as the transdermal delivery system skips first pass metabolism, 20 mg worth (or there abouts) actually gets in the blood stream. Orally, it is metabolized much more in the liver and therefore you have lower levels of the parent compound (selegiline) and much higher levels of amphetamine metabolites. They have a diagram of it in the info sheet that comes with the rx, on line too.
So, the 6mg patch actually delivers an amount that is no longer MAO-B selective. It does catabolize MAO-A too which allows higher levels of seratonin. But I do not believe there is much of chance of weight gain on EMSAM although anything is possible. Someone reported an actual statistical weight loss.
Hope that is not just more confusing.donna
Posted by jealibeanz on June 20, 2006, at 17:16:28
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 20, 2006, at 13:46:22
Donna, what dose are you on? How long have you been on it? What else have you tried? Are you on anything else?
It's strange that something that is stimulating for some can control anxiety for others. I'd really like to find something longterm. I don't like the idea of continuous Xanax and I have always had recurrent depressions.
I thought that the 6 mg was supposed to be MAOI B selective, 9 mg was questionable, and 12 mg was both MAOI A and B. I can't remember where I read that. I could be wrong. The literature could be wrong to for that matter!
Posted by jealibeanz on June 20, 2006, at 17:20:21
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 20, 2006, at 13:14:16
Does anyone know the answer to this question?
Posted by Donna Louise on June 20, 2006, at 18:39:34
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 20, 2006, at 17:20:21
> Does anyone know the answer to this question?
I was hoping what I wrote earlier about the difference between oral and transdermal delivery and skipping first pass metabolism so that more of the parent drug (selegiline) enters the blood, would answer that question for you. What is 6mg orally is about 20mg transdermally. I don't know how else to say it. Anyone else able to explain it better? Help.
I take the 9mg patch which is equal to about 30mg of actual selegiline due to the bypass of metabolism in the liver the first time around. I took 6 mg for about 4 weeks and have been on 9 for about 4 weeks I think. I am much better on the 9mg. It is a stimulating drug due to the increased norepinephrine and dopamine levels and also in part by the amphetamine metabolites (although these are much less because there is less metabolism in the liver to create them. More parent compound, less metabolites with the transdermal system. The increase in serotonin helps the anxiety. But because I have ALOT of anxiety I also take klonopin .25 twice a day and either .25 or .5 at night before bed. I take 100mg provigil twice a day which is half the dose I took before the patch. I find it mood elevating and socially enhancing. I just added lamictal, I am only at 25 mg but it has from the get go made a huge difference in my irritability. That may be all the higher dose I need to take. That is all. I am feeling better than I have in a long time. I have taken all the sri's, wellbutrin, strattera, buspar, I can't remember what all. No TCA;s and this is my first MAOI. I will not go back to those others again.
I hope you can get a med or combo of meds that works for you.donna
Posted by jealibeanz on June 20, 2006, at 21:41:37
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 20, 2006, at 18:39:34
It really does seem worthy of a trial for me. I was worried that it would be negated since I've taken, actually still take, Straterra, which is a NE and DA reuptake inhibitor. This does help with my concentration, but not so much with the depression. It probably does with the motivation to a small degree. I keep trucking myself through life (a very challeging one , academically and socially, at that!)when I'd love to sleep all day, avoid people, and never work a day in my life. I'm miserable, but try to hid it to further myself.
Did you ever have problems with insomnia previously to EMSAM or with EMSAM? I've dealt with it for the past year and take Lunesta. I had a 2 week period when starting Straterra where I couldn't sleep. How did the SSRI's, SNRI's affect you (depression/anxity relief, weight, apathy, motivation, nausea)? Do you have any noticeable side affects with EMSAM? Is this the best you've ever felt?
Posted by Donna Louise on June 20, 2006, at 22:17:59
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 20, 2006, at 21:41:37
> It really does seem worthy of a trial for me. I was worried that it would be negated since I've taken, actually still take, Straterra, which is a NE and DA reuptake inhibitor. This does help with my concentration, but not so much with the depression. It probably does with the motivation to a small degree. I keep trucking myself through life (a very challeging one , academically and socially, at that!)when I'd love to sleep all day, avoid people, and never work a day in my life. I'm miserable, but try to hid it to further myself.
>
> Did you ever have problems with insomnia previously to EMSAM or with EMSAM? I've dealt with it for the past year and take Lunesta. I had a 2 week period when starting Straterra where I couldn't sleep. How did the SSRI's, SNRI's affect you (depression/anxity relief, weight, apathy, motivation, nausea)? Do you have any noticeable side affects with EMSAM? Is this the best you've ever felt?Let's see if I can answer all the questions without forgetting one. First thing I want to say is that you can't take an MAOI with Strattera. You would have to do a week's washout before starting the patch.
I have always slept alot, never had problems there. I have not with EMSAM but I am the only one on the board that I know of that has not had problems with it. At first, I did not sleep as well as usual but now I do so I think it is something that you adjust to after awhile if you do get insomnia, and you hang in there, I think it may pass. I do take klonopin at night and that probably helps but I do sleep like a log. I feel like you do when I am depressed. Just want to sleep and avoid people and not work, can't work. When I first started taking ssri's in 1990, prozac worked great for me and later so did paxil. But when I quit paxil for sexual side effects and tried wellbutrin, I got almost psychotically paranoid. And when I tried going back to paxil it didn't work anymore. Before, I really had no side effects other than the sexual one. After the wellbutrin experiment, I had wait gain, apathy and anhedonia, very zombie like. Some weight gain but not that much. No nausea, I have a cast iron stomach. Stomach and sleep are my assets. I just felt depressed in a different way than before. Effexor was a little stimulating at first and then back to wanting to sleep all day and all night.
The only noticable side effect with I had with EMSAM was irritability but that has is not an issue any longer either because I went to 9mg and hence more serotonin effects for anxiety or because of the lamictal. Or both. Yes, this is the best I have felt maybe in my whole life. since I have always had anxiety and then later depression too.donna
Posted by Phillipa on June 20, 2006, at 23:15:46
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 20, 2006, at 22:17:59
I talked to Robert David tonight via E-mail. He is still doing great on the EMSAM. Still taking klonopin. And you you have problems remove the patch for sleep or cut it in pieces. It's working for him it can work for you too. Love Phillipa
Posted by ZeitGuest on June 20, 2006, at 23:30:08
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 20, 2006, at 22:17:59
> I have always slept alot, never had problems there. I have not with EMSAM but I am the only one on the board that I know of that has not had problems with it.
>I haven't had any insomnia problems on Emsam, either. I've been "patching it" for six and half weeks now. Since going from the 6mg patch to the 9mg patch last week, my irritability (the worst side effect) seems to be on the wane -- probably because of the 9mg patch's increased inhibition of MAO-A, which boosts serotonin levels. I do feel a bit less depressed than I did a week and a half ago, but I can't say the drug's effect has been dramatic. I tried a bit of Klonapin (.25mg a day) a few times last week. Taking it before bed did nothing for me the next day. And taking it in the morning just made me drowsy for most of the day. So I stopped taking it. I seem to be better off without it for now.
Posted by jealibeanz on June 21, 2006, at 3:56:19
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 20, 2006, at 22:17:59
Donna what week is this for you now? Are you certain that I need a week washout from the Straterra, since there is no Serotonin syndrome risk involved? I thought that was the reasoning behand the washout period.
We seem very similar is our medication trials and reactions. I actually have never tried Prozac. I'd rather not at this point. What kind of reaction did you have to Straterra?
So you don't believe you're experiencing weight gain with EMSAM? With me, it was always immediate, constant, and very noticeable. Do you have more or less energy? I can't afford a decrease. I'm afraid dropping the Straterra will drop my energy. What am I saying. I don't have this drug. I prbably never will. I'll never get up the guts to bring up the depression with my super positive doc, let along suggest a medication that he would have no experience with and most likely say flot out no to.
Posted by Donna Louise on June 21, 2006, at 7:27:13
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 21, 2006, at 3:56:19
> Donna what week is this for you now? Are you certain that I need a week washout from the Straterra, since there is no Serotonin syndrome risk involved? I thought that was the reasoning behand the washout period.
>
> We seem very similar is our medication trials and reactions. I actually have never tried Prozac. I'd rather not at this point. What kind of reaction did you have to Straterra?
>
> So you don't believe you're experiencing weight gain with EMSAM? With me, it was always immediate, constant, and very noticeable. Do you have more or less energy? I can't afford a decrease. I'm afraid dropping the Straterra will drop my energy. What am I saying. I don't have this drug. I prbably never will. I'll never get up the guts to bring up the depression with my super positive doc, let along suggest a medication that he would have no experience with and most likely say flot out no to.No, I am not certain you would need a washout. You are right, it would not be a serotonin issue but a norepinephrine one. Could be problems with hypertension. But I am not certain, I just wouldn't take a chance. And it is not even an issue of your dropping it if you don'thave an rx for EMSAM in your hand.
I think this is week 9. LIke ZeitGuest, I feel better on 9mg probably due to increased MAOI. I have had no weight gain. Yes, I have a ton more energy, I am not sleepy all day.
I did not especially like strattera. It did improve focus and energy somewhat, but I became impatient with others and more introverted. I have a few friends who weren't real pleased with me during that time. I took in conjunction with some sri or other.
I wish I could ask your dr. for you. What is the worst that could happen? Do you think he would shame you? Is it possible your fear has to do with your illness and is not truly reflective of the situation? Don't say Never! You can do it.donna
Posted by Donna Louise on June 21, 2006, at 7:58:55
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 20, 2006, at 21:41:37
Click here: Strattera Overdose, Contraindications and Information - Atomoxetine HCl - RxList Monographs
I cannot figure out how to put something in here you can just click on to go to. I am computer stupid. Anyway, this says you can get neuroleptic malignant syndrome combining strattera with an MAOI. You can google "Strattera and MAOI combination" and a bunch of stuff will appear.
donna
Posted by Porky on June 21, 2006, at 12:22:22
In reply to Are Family Doctors prescribing EMSAM?, posted by jealibeanz on May 24, 2006, at 6:33:46
> Has anyone been prescribed or told of EMSAM from a general practitioner? I know a lot of people on here see pdocs. I'd like to give it a try, but only see my GP.
Yes, my family doctor prescribed EMSAM for me. I doubt she would have even considered it but for the fact that she recognizes that I'm someone who is pretty well educated on Psychiatric drugs and such. When I came into her office that day to ask for the prescription, she had never even heard of the drug. She also has never prescribed an MAOI before. She is only in her early-to-mid 30s I think so MAOIs were not popularly used after she got out of med school, according to her.
I also brought along a printout of the full prescribing information for EMSAM which I obtained from the BMS website for her perusal.
If it weren't for the fact that I was educated on the matter and the fact that I brought the prescribing information, I highly doubt she would have prescribed it. But yes, at least in my case, Family Doctors DO prescribe EMSAM.
Posted by jealibeanz on June 21, 2006, at 21:35:58
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Porky on June 21, 2006, at 12:22:22
Oh I know they have the authority. I'm just wondering whether or not they are considering it to be risky or not. I'm actually surprised some may not know about it. I'm sure I'd be my doc's first on it if I were to get EMSAM in August. That makes me feel doubtful. I want him to suggest it, not me! I also want him to have confidence in it, not me to convince him! I'm the distressed patient! God... It'll be a wonder if I make it through this school alive and well. I can't believe there aren't frequent med school student suicides. It's so tough academically, socially, physically, mentally. Then, just thinking about the future of your practice and dealing with lives jeeeeeeez! I'm a nut to begin with. Haha, I think most of the students are too.
Posted by Donna Louise on June 22, 2006, at 4:57:30
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 21, 2006, at 21:35:58
> Oh I know they have the authority. I'm just wondering whether or not they are considering it to be risky or not. I'm actually surprised some may not know about it. I'm sure I'd be my doc's first on it if I were to get EMSAM in August. That makes me feel doubtful. I want him to suggest it, not me! I also want him to have confidence in it, not me to convince him! I'm the distressed patient! God... It'll be a wonder if I make it through this school alive and well. I can't believe there aren't frequent med school student suicides. It's so tough academically, socially, physically, mentally. Then, just thinking about the future of your practice and dealing with lives jeeeeeeez! I'm a nut to begin with. Haha, I think most of the students are too.
You know, this very experience you are having will make you a good, caring and sensitive dr. One of those things that in hindsight will serve you well.
donna
Posted by jealibeanz on June 22, 2006, at 5:45:30
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 22, 2006, at 4:57:30
I don't think I'm gonna get that far without some more help. Asking is tough. Asking several times after failure is even tougher. You think you are weak and crazy. Some doctors do too. They'll hand out SSRI's like candy. If those are perfect, then you just must be a feak.
I'm not sure how to present myself to my doc. What to say...
Posted by Donna Louise on June 22, 2006, at 5:50:29
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 22, 2006, at 5:45:30
> I don't think I'm gonna get that far without some more help. Asking is tough. Asking several times after failure is even tougher. You think you are weak and crazy. Some doctors do too. They'll hand out SSRI's like candy. If those are perfect, then you just must be a feak.
>
> I'm not sure how to present myself to my doc. What to say...It sounds to me like your angst with this is a presentation of your condition. Hopefully, a dr. would notice this.
What has helped me in the past is to write down what I want to say. Maybe many times until I get it right. You could then take it with you and read it to him. At least it would help you sort out what you are feeling and wanting to say.donna
Posted by jealibeanz on June 22, 2006, at 16:22:50
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 22, 2006, at 5:50:29
Haha... well he won't notice if he doesn't know it's what I'm thinking! I'm not quite sure what a full physical entails, since I haven't had one in years, normally just for sports. You'd hope that whenever you have a patient with anxiety, you would ask about depression, especially since I had a major episode last fall, but he didn't when I was there a couple of weeks ago. At this point I'm just trying to learn the material to pass the exams (this doesn't mean that I don't know much, passing standards are verrrry high!). I have no desire to work or treat patients. This bothers me. I am overwhelmed by the material, but am smart enough to learn it. I'm just lacking confidence, desire, and plagued by constant worry or unhappy thoughts about the whole experience. I try to put on the happy face, but it's fading quickly and becoming noticeable. I know I have the right personality to do this, just need to be in the right place emotionally.
Posted by Donna Louise on June 22, 2006, at 16:38:17
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 22, 2006, at 16:22:50
> Haha... well he won't notice if he doesn't know it's what I'm thinking! I'm not quite sure what a full physical entails, since I haven't had one in years, normally just for sports. You'd hope that whenever you have a patient with anxiety, you would ask about depression, especially since I had a major episode last fall, but he didn't when I was there a couple of weeks ago. At this point I'm just trying to learn the material to pass the exams (this doesn't mean that I don't know much, passing standards are verrrry high!). I have no desire to work or treat patients. This bothers me. I am overwhelmed by the material, but am smart enough to learn it. I'm just lacking confidence, desire, and plagued by constant worry or unhappy thoughts about the whole experience. I try to put on the happy face, but it's fading quickly and becoming noticeable. I know I have the right personality to do this, just need to be in the right place emotionally.
You sound like I do when I am not in remission. I bet you anything if you were treated appropriately you would feel so much better about the whole experience. And if you still didn't want to treat patients, there is always teaching and research. That's what I would want to do, research. Not so many pesky people to interact with that way.
donna
Posted by jealibeanz on June 22, 2006, at 18:31:22
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 22, 2006, at 16:38:17
Actually, I'm better, depression wise, when I am forced to interact with people. I have social anxiety, yet being able to do it gives me some confidence, so hiding from patient interaction would make me feel terrible.
Posted by Donna Louise on June 22, 2006, at 21:33:44
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 22, 2006, at 18:31:22
> Actually, I'm better, depression wise, when I am forced to interact with people. I have social anxiety, yet being able to do it gives me some confidence, so hiding from patient interaction would make me feel terrible.
Yes, isolation makes me worse too. I definately feel better it I can get out and interact with others, which has been impossible at times.
donna
Posted by jealibeanz on June 22, 2006, at 22:16:56
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 22, 2006, at 21:33:44
I actually like going to class right now b/c I'm around happy people. Dropping out will be the death of me... :(
Posted by jealibeanz on June 24, 2006, at 21:45:19
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Porky on June 21, 2006, at 12:22:22
What's the biggest risk for the patient? High blood pressure? I've seen members citing side effects of insomnia and some other odd effects. I am unsure as to whether I am sensive to to medications.
I felt nothing but apathy and had weight gain from SSRI's. I had an inital increase in motivation and energy and nausea, followed by extreme apathy and weight gain. Wellbutrin... a little apathy and a lot of weight gain. Straterra... slight nausea and increased energy. So, I'm not sure what to think. It's obviously a very different type of medication.
What's the biggest risk in a doc prescribing it? A fear of lawsuit or their tendency to stick to "safe" drugs, those commonly used by their own practice, espcially in the sample closet? I already have an open-ended script for daily Xanax, and the oppotunity to increase the dose, which is considered taboo by many general practitioners. I'm completely certain he does not do this for many patients (he couldn't, the DEA would be after him). But he does see the need to treat me with something "outside the box" because he wants to give me that tiny bit of relief from the hell I live in.
I know it's true. We have very fun and light hearted conversations. But he knows me and my family and that I've stuggled terribly with anxiety and depression despite leading a normal typical existance and being a high acheiver.
I almost think he'd be willing to try EMSAM if I ask (say, I'm basically suicidal here, gonna drop out of school, cycle though depressions constantly, I need this last ditch effort to help me further my life). But I'm not sure if it's considered soo dangerous that he wouldn't, especially if great success is not being had by many.
Posted by Donna Louise on June 25, 2006, at 6:00:51
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 24, 2006, at 21:45:19
> What's the biggest risk for the patient? High blood pressure? I've seen members citing side effects of insomnia and some other odd effects. I am unsure as to whether I am sensive to to medications.
>
> I felt nothing but apathy and had weight gain from SSRI's. I had an inital increase in motivation and energy and nausea, followed by extreme apathy and weight gain. Wellbutrin... a little apathy and a lot of weight gain. Straterra... slight nausea and increased energy. So, I'm not sure what to think. It's obviously a very different type of medication.
>
> What's the biggest risk in a doc prescribing it? A fear of lawsuit or their tendency to stick to "safe" drugs, those commonly used by their own practice, espcially in the sample closet? I already have an open-ended script for daily Xanax, and the oppotunity to increase the dose, which is considered taboo by many general practitioners. I'm completely certain he does not do this for many patients (he couldn't, the DEA would be after him). But he does see the need to treat me with something "outside the box" because he wants to give me that tiny bit of relief from the hell I live in.
>
> I know it's true. We have very fun and light hearted conversations. But he knows me and my family and that I've stuggled terribly with anxiety and depression despite leading a normal typical existance and being a high acheiver.
>
> I almost think he'd be willing to try EMSAM if I ask (say, I'm basically suicidal here, gonna drop out of school, cycle though depressions constantly, I need this last ditch effort to help me further my life). But I'm not sure if it's considered soo dangerous that he wouldn't, especially if great success is not being had by many.
Actually the most commonly reported adverse side effect during the trials is skin irritation from the patch. What is showing up on the board as the biggest problem is insomnia and agitation. These can be rememdied with other drugs, in my case it is klonopin and lamictal. I have never felt better with less side effects on any AD and I have tried many. I am on the 9mg patch. Most dr's greatest concern is drug interactions which have been fatal in the past and still can be theoretically. I am ordering a med ID bracelet just in case I am unconscious in the ER and they want to give me demerol or something. Most ER and OR docs know what not give as long as they know you are on an MAOI. My pdoc gave me a little credit card size card to carry that lists drug and food interactions although you don't have to worry about the food interactions on the patch. (I have had some tofu on the 9mg patch which is supposed to be a no-no).
I made it my business to educate myself about which drugs are not safe to take with an MAOI because I think I need to be my own advocate in all my affairs. So, at any rate, what harm to ask and try it if you get yourself informed.donna
Posted by jealibeanz on June 25, 2006, at 15:15:26
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 25, 2006, at 6:00:51
Hopefully, this is one of those cases where you say, the people you hear from are those with problems. The patients doing well aren't all over the message boards complaining of horrible side effects. If I had a great medication. I'd take it and go one with life. (I don't log on to Lunesta or Flonase boards telling people how much I like them.) I think I could deal with insomnia and agitation by increasing Lunesta and Xanax. So, drug interactions are the biggest problem with MAOI's? If there's a lethal possibility, I'd guess I'd have little chance of obtaining a prescription in such a safe office. I wonder if you can get statistics on how much EMSAM has been prescribed so far and by what type of doc, probably not at this point, but I'd be curious.
This is the end of the thread.
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