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Dr. Bob is Robert Hsiung, MD,
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Posted by jealibeanz on June 26, 2006, at 10:31:34
In reply to Re: Who's Still Going Strong with EMSAM?, posted by Jost on June 25, 2006, at 22:20:55
How long have you been taking it? What kind of doc prescribes it?
Posted by nickguy on June 26, 2006, at 22:07:53
In reply to Re: Who's Still Going Strong with EMSAM?, posted by jealibeanz on June 26, 2006, at 10:31:34
I don't understand why people want emsam (selegiline) when there are already proven effective maoi's out there. The whole point was that it would avoid food interactions, but that's only on the lowest dosage. Theres very little info out there about the effectiveness and saftey of emsam.
Posted by cecilia on June 27, 2006, at 0:51:23
In reply to Re: Who's Still Going Strong with EMSAM?, posted by nickguy on June 26, 2006, at 22:07:53
Unfortunately some of us here have already tried every AD there is, including all the MAOI's, with lack of benefits and/or intolerable side effects. You're right about the lack of knowledge about Emsam side effects and safety though. I had intolerable eye pain (worsened by extreme insomnia). The Emsam info lists eye pain as "infrequent" but I'm the 2nd person on Babble to get it. Emsam (or any new drug) should definitely not be the 1st thing someone tries(though at the price they charge, it's not likely to be). Cecilia
Posted by jealibeanz on June 27, 2006, at 7:00:08
In reply to Re: Who's Still Going Strong with EMSAM?, posted by nickguy on June 26, 2006, at 22:07:53
I just think docs may be more likely to to prescribe it, since it seems safer, especially to GP's.
Posted by ZeitGuest on June 27, 2006, at 15:08:45
In reply to Re: Who's Still Going Strong with EMSAM?, posted by nickguy on June 26, 2006, at 22:07:53
> I don't understand why people want emsam (selegiline) when there are already proven effective maoi's out there. The whole point was that it would avoid food interactions, but that's only on the lowest dosage. Theres very little info out there about the effectiveness and saftey of emsam.
Emsam is appealing to AD seekers because, for most people, it has a very low side effects profile (much lower than the other MAOIs, much lower than SSRIs). This partly due selegiline's selective boosting of dopamine, and partly due to the patch delivery system. The patch zaps the drug directly into your bloodstream, bypassing the gut and therefore reducing the infamous hypertensive "cheese effect" that plagues oral-delivery MAOI users.
I've been on Emsam for nearly 8 weeks and although I've never tried any other MAOIs, I can attest to the fact that for me, Emsam has fewer side effects than the all the SSRIs I've tried. No sexual dysfunction; no weight gain; no drowsiness or "drugged feeling." The only side effect that I have experienced on Emsam is increased irritabiltiy/anxiety. Boosting my dosage from the 6mg patch to the 9mg patch did help reduce the irritability somewhat (perhaps because higher doses of selegiline boost serotonin levels), but not completely.
Whether Emsam works as well (for me) as SSRIs is another question. So far I haven't gotten the great antidepressant, anti-social anxiety effect from Emsam that I got from Prozac (before it pooped out on me). So for me, Emsam hasn't been the magic bullet/holy grail that I've been seeking. I'll probably continue using the patch until I hit the 10-week mark, just to give it a completely fair trial. Barring some miraculous eleventh-hour "kick in" effect, I'll then switch back to Prozac and hope that it works like it did the first time I tried it.
At this point, I don't think I want to deal with the more extreme side effects/diet-and-drug restrictions of oral MAOIs like Nardil and Parnate.
Posted by cecilia on June 27, 2006, at 17:11:19
In reply to Re: Who's Still Going Strong with EMSAM?, posted by ZeitGuest on June 27, 2006, at 15:08:45
I guess there are advantages to everything. Since I've never had a med work for me I've never had to experience it pooping out. That must be worse than not having it work in the 1st place. Cecilia
Posted by jealibeanz on June 27, 2006, at 17:30:16
In reply to Re: Who's Still Going Strong with EMSAM?, posted by ZeitGuest on June 27, 2006, at 15:08:45
Nickguy, you say it's not as great as Prozac for you, but are you getting any antidepressant effect?
Posted by ZeitGuest on June 28, 2006, at 1:12:15
In reply to Re: Who's Still Going Strong with EMSAM?, posted by jealibeanz on June 27, 2006, at 17:30:16
> Nickguy, you say it's not as great as Prozac for you, but are you getting any antidepressant effect?
jealibeanz,
I think you meant to address the above message to me. At any rate, I'll assume so, and start flapping my virtual yap.
Yes, I am getting an antidepressant effect from the Emsam -- just not a lot. (I was getting none at all until I upped my dose from the 6mg patch to the 9mg patch.) My yardstick is, of course, Prozac, which worked very well for me for about a year and a half, and then began to slowly peter out. AD-wise, Emsam for me is like Prozac during my fourth year on it: Better than nothing, but not great. Even at its "pooped-outest, " Prozac helped alleviate my social anxiety/shyness much more than Emsam.
Posted by jealibeanz on June 28, 2006, at 4:00:10
In reply to Re: Who's Still Going Strong with EMSAM?, posted by ZeitGuest on June 28, 2006, at 1:12:15
yay good. maybe you could go up to 12 mg?
i need to work up the courage to discuss this recurrent depression with my doc at my physical. How do you just drop that out of nowhere? Then hope he presribes more than SSRIs? And hope his next thought would be EMSAM? not likely...
Posted by jealibeanz on June 28, 2006, at 10:27:08
In reply to Re: Who's Still Going Strong with EMSAM?, posted by ZeitGuest on June 28, 2006, at 1:12:15
Zeitguest, what's your main concern? The social anxiety or the depression? How much did Prozac help you? A great deal?
My concerns flip flop between the anxiety and depression. When one is controlled or not evasive the other is. I think they shield one another. Right now I'm going to say my main concern is depression. However, quite often it is social/general anxiety.
I don't usually have too much depression, just dysthymia throughout the year. I almost always have SAD, maaaajorly (can an MAOI help with that?). The is rare that major depression is occuring at this time of the year, but with my history doesn't surprise me.
Posted by SFY on June 28, 2006, at 15:36:33
In reply to Re: Who's Still Going Strong with EMSAM?, posted by jealibeanz on June 28, 2006, at 10:27:08
> Zeitguest, what's your main concern? The social anxiety or the depression? How much did Prozac help you? A great deal?
>
> My concerns flip flop between the anxiety and depression. When one is controlled or not evasive the other is. I think they shield one another. Right now I'm going to say my main concern is depression. However, quite often it is social/general anxiety.
>
> I don't usually have too much depression, just dysthymia throughout the year. I almost always have SAD, maaaajorly (can an MAOI help with that?). The is rare that major depression is occuring at this time of the year, but with my history doesn't surprise me.Yes, MAOI's (esp. Nardil) have proven effective for treatin Social Anxiety Disorder.
Posted by SFY on June 28, 2006, at 15:38:26
In reply to Re: Who's Still Going Strong with EMSAM?, posted by jealibeanz on June 28, 2006, at 10:27:08
I'm on Day 8 of 6mg. of Emsam with 75 mg. of Nortriptyline. So far, I'm not seeing much, if any, noticeable effects. But except for some possible sleep disturbance, I'm not having any side effects either.
Posted by jealibeanz on June 28, 2006, at 16:53:37
In reply to Re: Who's Still Going Strong with EMSAM?, posted by SFY on June 28, 2006, at 15:38:26
Oops...by SAD I meant seasonal affective disorder ("winter depression"). Does it help with this? However, I do have social anxiety as well.
Posted by pulse on June 29, 2006, at 0:58:31
In reply to Who's Still Going Strong with EMSAM?, posted by jealibeanz on June 24, 2006, at 21:48:28
my final trial of emsam resulted in 'remission.' remission of: ONLY the numerous side-effects i'd had on every other trial.
(you can search to find my 3-4 shorter trials & the unbearable SEs, lack of efficacy, and not even close to acceptable results.)this last & FINAL trial i made - tada - less than 2 wks. i'd been cutting patch into quarters and eigths, apllying more often 3/8. (cutting only into 1/2s, i still had every one of the SEs. to just as high a degree). oddly, the only SE i never had once was the #1- orthostatic hypotension. i've low bp naturally, so this is a mystery to me.
when light bulb went off that remission of SEs was all that was going on i was devastated once again. i'm the type of depressive for whom being very sick daily w/ GI, then add in insomnia, well, there is no way i can overcome this. any possible gains in mdd help are then obliterated for me, ie depression back or even worse from being so phyically ill.
cecilia is right about emsam building up in your system. i'm only posting so that others know that this can happen (unlike cecilia on 9 mg patch), ALSO at ultra low doses; ultra low time kept on.
however, i do still believe that IF you are one who has little to no GI or insomnia problems, (or can take sleep meds for the latter) cutting the patch into less that the 1/2 that dr. bdokin FINALLY owned up to, could possibly get you full remisssion. however, i'm still of the belief it will end up doing more for sa (i don't have) than for mdd. YYMV and good luck to all troopers and/or guinea pigs, depending on your perspective.
no ads remain for me now & both my ect docs have retired. it's a scary position to be in, especially now i'm having my annual summer sad also, but until/ if rtms is approved, this is where i'll 'be.'
pulse
Posted by ZeitGuest on June 29, 2006, at 1:10:24
In reply to Re: Who's Still Going Strong with EMSAM?, posted by jealibeanz on June 28, 2006, at 4:00:10
> yay good. maybe you could go up to 12 mg?
>
Yes, I might consider going to the 12mg patch. however, I'm a bit reluctant to do so because I'd rather not increase the hypertensive reaction risk factor.Also, I'm beginning to suspect that my brain doesn't respond well to increased levels dopamine. Wellbutrin made be agitated and angry, and simultaneously left me feeling more introverted/emotionally isolated from other people. That latter sensation was subtle, and is hard to describe. It was certainly not a "drugged" feeling. It's just that I felt as though I was not fully engaged in conversations. My verbal fluency also seemed to take a hit when I was on Wellbutrin, and this was probably one of the reasons why I felt disconnected when dealing with others. I just couldnt keep up.
Emsam at the lowest dose had a similar -- though not quite as pronounced -- effect on me. Increasing the dose helped alleviate some of the agitation and that feeling emotional isolation. Selegiline at higher doses increases inhibition MAO-A, which in turn boosts serotonin levels. I wonder if the extra serotonin is what helped smooth over some of the dopamine-driven agitiation and mental fog.
>
> i need to work up the courage to discuss this recurrent >depression with my doc at my physical. How do you just drop >that out of nowhere? Then hope he presribes more than SSRIs? And hope his next thought would be EMSAM? not likely...If I were you, I wouldn't waste my time and energy trying to persuade a GP to prescribe Emsam. I would find a good pdoc, who is more likely to be receptive to prescribing Emsam. And a good pdoc might be able to suggest a number of other options, based on his/her assessment of your particular situation.
Posted by pulse on June 29, 2006, at 9:52:46
In reply to Re: Who's Still Going Strong with EMSAM?, posted by ZeitGuest on June 29, 2006, at 1:10:24
according to substance abuse 'expert's and pdocs supposedly well versed in - who all suggest wellbutrin - ha!, it makes no sense re: my fairly long past history of cocaine use, BUT i'm now 100% SURE that dopamine in maois & i are done.
in tcas, *if i could still tolerate,* dopamine's GOT to be much more balanced w/ serotonin & norepinephrine (other than desipramine).
emsam somehow hits dopamine hard from outset. for only a VERY small minority of those posting here, you can easily see this by the side-effects they encountered, and that most are still struggling with at 4- 6 wks. or longer.
emsam (even moreso parnate) for me = speed, plain & simple. unlike perhaps (???) the majority of street-drug stimulant users, i hated speed - 2 times 30 yrs ago + ritalin trial of 2 mos., 3 yrs. ago, that i (not pdoc) stopped.
dopamine in maois - for me - case closed.
if all i want is a blast of speed, i'll just whip out a patch & put on for 1/2 hr. TOPS. would that be considered a relapse? kidding...or maybe...not.
pulse
Posted by cecilia on June 29, 2006, at 18:03:30
In reply to Re: Who's Still Going Strong with EMSAM?, posted by pulse on June 29, 2006, at 0:58:31
Pulse, sorry this didn't work out for you even at the low doses. All the MAOI's definitely build up gradually in your system, that definitely was my experience with Nardil, no side effects whatsoever for 38 days (28 at 45 mg, 10 at 60) then boom hit like a ton of bricks and not with anything good. But I think the patch may actually make this building up problem even worse, obviously a lot more research needs to be done. My eye problems are finally starting to improve, my eye doctor (not the idiot who wanted to do surgery for dry eyes, another one) said I had a dermatitis on my eyelids, he said it could well be a reaction to the Emsam, though the idiot doctor who was ready to operate, sight unseen, said that Selegiline didn't cause dry eyes, should actually help them! For any one else who gets the same problem, TobraDex ointment on the eyelids (and/or getting the poisonous Emsam out of my system), was what finally helped, my eyes are still sore and itchy but improved. This sounds trivial but it was EXTREMELY painful, and of course the Emsam insomnia didn't exactly help the situation. Cecilia
Posted by Last Chance on June 29, 2006, at 19:03:36
In reply to Re: Who's Still Going Strong with EMSAM? Pulse, posted by cecilia on June 29, 2006, at 18:03:30
One month total now on Emsam - 8 days on 9mg 24/7. Yesterday my depression, and still today, is as bad as before I started. Agitated depression. I don't really know what to do - sleeping ok, not great. Definitely have no more of that energy that I was getting for awhile. Even having extra trouble thinking and making this post. I know I need to try this higher dose for a longer time, but am having thoughts of quitting. I don't get it - any thoughts out there about this? Thanx, Richard
Posted by SFY on June 29, 2006, at 23:10:08
In reply to Re: Who's Still Going Strong with EMSAM?, posted by jealibeanz on June 28, 2006, at 16:53:37
> Oops...by SAD I meant seasonal affective disorder ("winter depression"). Does it help with this? However, I do have social anxiety as well.
Sorry, I actually thought that for a second - ever since they changed Social Phobia to Social Anxiety Disorder it's been a source of confusion.
I haven't looked into it so I can't say whether MAOI's have been studied for treating SAD - though I don't know that that's a class of meds you want to start up for a few months out of the year.
Posted by pulse on June 30, 2006, at 1:18:50
In reply to Re: Who's Still Going Strong with EMSAM? Pulse, posted by cecilia on June 29, 2006, at 18:03:30
thanks so very much for your empathy, cecilia.
< But I think the patch may actually make this building up problem even worse, obviously a lot more research needs to be done. >
you could very well also be right re: all your above. what do any of us REALLY know about emsam?
one would (like to) think that the 18-20 yrs. of research already done on it, would surely be enough, but in my view, as yours, it most definitely is NOT!
i can easily believe your eye problem was dermatological in nature. all times i was on emsam, i noticed that all my skin had become FAR dryer than from any ad, ever before (my skin is normally still on the slightly oily side.) my wrists to elbows became reddish; itchiness was starting. i had only a slight problem at the application sites, though.
woo - glad for you that no operation was performed!
pulse
Posted by pulse on June 30, 2006, at 1:31:31
In reply to Re: Who's Still Going Strong with EMSAM? Pulse, posted by Last Chance on June 29, 2006, at 19:03:36
hi Richard,
my only input is that emsam (to say the least) is a highly unpredictable drug. only you can make the choice, but - me - i would not go further at the higher dosge. i would quit.
i also had that extra trouble thinking, much less posting. people had no idea how much time i had to spend to edit, then re-edit - ad nauseum...every single post.
best of luck with whatever YOU decide.
pulse
p.s i must be honest: i think we'll find that, for vast majority, emsam - as a last hope - won't materialize. there's something quite amiss (or missing) with it.
Posted by jealibeanz on June 30, 2006, at 4:38:12
In reply to Re: Who's Still Going Strong with EMSAM? Pulse » Last Chance, posted by pulse on June 30, 2006, at 1:31:31
You think so? I wonder how the drug companies can be thaaaat far off with a medication that's already in use. Maybe the majority of people using aren't expriencing these effects, but it's the people here who are reporting them. Just a thought/hope.
Posted by pulse on June 30, 2006, at 12:12:23
In reply to Re: Who's Still Going Strong with EMSAM? Pulse, posted by jealibeanz on June 30, 2006, at 4:38:12
no, i KNOW they're thaaaat far off and for far too many reasons to take up space here, but here is one: i talked 3 times to one of somerset's head emsam researchers....& was outright lied to.
i know your dream is emsam, as was mine. i mentally and physically exhausted myself far more than should be required of ANYONE, JUST to tolerate this drug.
your posts are often not clear: as in, < a medication that's already in use. >
i will now mind-read & (be forced to) assume that you must mean oral selegiline, as emsam's only been in use for a very few people before april 15, 2006; then only by 2 - 4 days before. btw, i was one of these very few. for all others, as of today, that then would = approx. 2 months + 2 weeks.
re: oral selegiline, i have no personal experience, but from reading here and elsewhere, seems there are few for whom it works well. has many horrid SEs, and often requires very high dosing. of course, there are folks who are exceptions to this.
you're correct that - usually - those doing well would not be posting as much, here or anywhere; maybe not posting at all (pity!), but re: emsam all here have REALLY gone to the mat, and, again - the vast majority have still had little to no success, or are even getting worse.
i realize you're suffering, and looking for answers, but from the sheer number of your posts, i would suggest that therapy may well be your best bet. i know you have some privacy concerns, re: stigma, but if your records were even able to be accessed, therapy would be far less 'stigmatizing' than psych med/s. (not that any stigma should exist anywhere in 2006!, no matter what field anyone hopes to be in or is in.)
pulse
Posted by helpme on June 30, 2006, at 12:48:48
In reply to Re: Who's Still Going Strong with EMSAM? Pulse » jealibeanz, posted by pulse on June 30, 2006, at 12:12:23
I've been on EMSAM since the week it came out, and my conclusion is that it is $475. glorified scotch tape. I often can't even get it to stick on properly- we are supposed to exercise to relieve depression, right? The patch usually partially sweats or wrinkles off, even off my thigh. For me, it has been a major let down, and I'm crushed because I had such high hopes. Nothing has been working for me, except exessive doses of stimulants (ie 60- 80mg ritalin)- which doctor is reluctant to prescribe at amounts adqeuate for me to perceive and pharmacists make me feel like a drug addict. Is it possible I have a weird drug metabolism?
Posted by jealibeanz on June 30, 2006, at 12:54:24
In reply to Re: Who's Still Going Strong with EMSAM? Pulse » jealibeanz, posted by pulse on June 30, 2006, at 12:12:23
Yes, I meant oral selegiline. I suppose I was just fixated on EMSAM since it's new and different from anything I've tried. I don't think EMSAM or any other medication from another class is a horrible idea, it's worth a shot. I've been trying to get as many reviews about this particular medication so I can be informed. I'm not unrealistic and I also don't think there will ever be a miracle pill I'll take, but something to give me a slightly better quality of life.
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