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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on September 19, 2006, at 8:14:22
In reply to Re: discontonuimg Emsam » willyee, posted by Donna Louise on September 18, 2006, at 20:28:15
> Theoretically, these patches are non selective and should deanimate serotonin and norepinephrine as well as dopamine, as only dopamine is deanimated with the oral selegiline at the low mg. So I am suprised to find it still so activating,
Remember, the selegiline molecule itself might be acting as a stimulant. From what I have been able to find on Medline, and have previously posted about, it is.
I am sorry it is not doing the job for you as an antidepressant.
Have you tried any other MAOIs?
- Scott
Posted by Donna Louise on September 19, 2006, at 13:15:43
In reply to Re: discontonuimg Emsam » Donna Louise, posted by SLS on September 19, 2006, at 8:14:22
> > Theoretically, these patches are non selective and should deanimate serotonin and norepinephrine as well as dopamine, as only dopamine is deanimated with the oral selegiline at the low mg. So I am suprised to find it still so activating,
>
> Remember, the selegiline molecule itself might be acting as a stimulant. From what I have been able to find on Medline, and have previously posted about, it is.
>
> I am sorry it is not doing the job for you as an antidepressant.
>
> Have you tried any other MAOIs?
>
>
> - Scottyes, from what i have read, the selegiline molecule is of an activating nature. I really like the activation as everything else i have taken makes me sleep all the time and zero motivation, lots of apathy. I would hate to lose that aspect of this drug. And I do feel better now that I am just taking 6mg as opposed to 12mg. the 150 of lamictal may be getting a chance to help too but I would sure feel better about it if I didn't have that meltdown yesterday. Intense rage then a bunch of sobbing. Then within an hour after taking ,5mg klonopin, felt fine again. I have actually been able to take two walks, one with partially jogging even since i went down to 6mg. I have an emergency appt with the pdoc Thursday and then I will be out of town until Sunday so will be unable to update those of you who are interested (which I am on my knees grateful for).
After all that long windedness (which is what I had originally at 6mg, longwindedness..) to answer your question, no I have not been on other MAOI's. But from what is being suggested and what I am reading, it sounds like Parnate would be a good choice with the klonopin and lamictal. I am such a good sleeper I don't worry about insomnia. Has anyone heard of a bipolor II or any other bipolar type that is a good sleeper all the time?
Thanks Scott,Donna
Posted by jealibeanz on September 19, 2006, at 18:45:07
In reply to Re: discontonuimg Emsam » SLS, posted by Donna Louise on September 19, 2006, at 13:15:43
Donna, are you discontinuing the EMSAM? I have anxiety, as well as depression, and insomnia. Right now I am taking Provigil, 400 mg due to excessive daytime sleepiness. My anxiety increased when I began, so my doctor allowed my to increase my Xanax to 1mg t.i.d. I also take Lunesta. I'd like to ask my doc about giving EMSAM a try, but worry it may increase anxiety. However, I'm thinking that if I drop the Provigil, the Xanax may counter it.
Posted by Phillipa on September 19, 2006, at 20:48:18
In reply to Re: discontonuimg Emsam, posted by jealibeanz on September 19, 2006, at 18:45:07
Jelly you sound like me and you're asking the same questions with the same concerns. Another concern of mine is that when I get to l2.5mg of luvox my crying starts and then back to 25mg which seems to stop it. So how do you go through a two week wash out period without going insane?And is it true that even if you take off the patch the meds are in your body for 9 days? And then another two week wait to try something else? Love Phillipa
Posted by Donna Louise on September 28, 2006, at 5:42:05
In reply to discontonuimg Emsam, posted by Donna Louise on September 16, 2006, at 5:40:39
Well, I took the plunge and pulled the patch. Nice alliteration if I do say so myself...
I am on my 3rd day and so far no withdrawal unless these headaches are part of it. I doubt it, they started when I went up to 200mg lamictal. I am going to see if they don't go away, I have migraine medicine I take. And right now i feel better than I have for the past month. But I know that never lasts...unless this time I can get some mileage out of just the lamictal, klonopin and provigil. but even with the new understanding that i probably have bipolar II, I get such bad depression I can't imagine that I can get away with it and at some point will have to take yet another AD. I keep thinking that if I took a tiny dose of oral selegiline I could keep the energy and lose the mixed state..
Anyway, that is my update.donna
Posted by Jost on September 28, 2006, at 12:03:35
In reply to Re: discontonuimg Emsam, posted by Donna Louise on September 28, 2006, at 5:42:05
Not wanting to bring in anything from left field, but is it possible you were getting too high a dose of Emsam, and a low dose, or even a lower dose kept on only part of the time, would have worked for you.
There may be some aspects of the delivery of the drug that aren't yet known. For example, did you apply the patch to the same spot every day, or alternate spots? If you alternated, how many days in a row did you put it in the same place?
How many separate spots did you use?
I'm curious because of a question about how long the emsam from the patch can remain unabsorbed, but capable of absorption, after the patch is removed.
Thanks, Jost
Posted by SLS on September 28, 2006, at 15:13:43
In reply to Re: discontonuimg Emsam, posted by Donna Louise on September 28, 2006, at 5:42:05
Hi Donna.
> Well, I took the plunge and pulled the patch. Nice alliteration if I do say so myself...
Show off.
> And right now i feel better than I have for the past month.
Discontinuation rebound improvement. I get that from Nardil.
> But I know that never lasts...
Me too.
> unless this time I can get some mileage out of just the lamictal, klonopin and provigil.
Hey, it just might be.
> but even with the new understanding that i probably have bipolar II, I get such bad depression I can't imagine that I can get away with it and at some point will have to take yet another AD.
Probably.
> I keep thinking that if I took a tiny dose of oral selegiline I could keep the energy and lose the mixed state..
Ever try Wellbutrin or Parnate? Are you a partial responder to either?
> Anyway, that is my update.
:-)
- Scott
Posted by Phillipa on September 28, 2006, at 18:52:04
In reply to Re: discontonuimg Emsam » Donna Louise, posted by SLS on September 28, 2006, at 15:13:43
Donna please answer Jost's question as it's very important. As my pdoc if I'd tried it said only use 1/4 of a patch. And are you the one who could only use the area above her breasts to apply. Thanks Phillipa
Posted by Donna Louise on September 29, 2006, at 5:32:20
In reply to Re: discontonuimg Emsam » Donna Louise, posted by Jost on September 28, 2006, at 12:03:35
> Not wanting to bring in anything from left field, but is it possible you were getting too high a dose of Emsam, and a low dose, or even a lower dose kept on only part of the time, would have worked for you.
>
> There may be some aspects of the delivery of the drug that aren't yet known. For example, did you apply the patch to the same spot every day, or alternate spots? If you alternated, how many days in a row did you put it in the same place?
>
> How many separate spots did you use?
>
> I'm curious because of a question about how long the emsam from the patch can remain unabsorbed, but capable of absorption, after the patch is removed.
>
>
> Thanks, JostI don't know, I tried all the different dose sizes, at the end I was using half a nine. Too little and I was rageful, more and I was depressed. It took awhile for all this to show up, at least the depression took a while, I was easily aggravated and enraged early on. I was enjoying the energy so much I thought that this was it. It is really disappointing. I had been trying to find the right dose since April.
I was alternating hips, a little different spot on each hip every other day. Anywhere else I put it would either come off with sweat or something would knock it off, like a tree limb. That sounds odd doesn't it. No, I have not regressed and climbing trees, I run through narrow trails on horses and had more than one hanging from a branch. They always stayed on my hip.
My pdoc and i tried everything we could think of and finally I had to throw in the towel. sighdonna
Posted by Donna Louise on September 29, 2006, at 5:41:04
In reply to Re: discontonuimg Emsam » Donna Louise, posted by SLS on September 28, 2006, at 15:13:43
> Hi Donna.
>
> > Well, I took the plunge and pulled the patch. Nice alliteration if I do say so myself...
>
> Show off.
>
> > And right now i feel better than I have for the past month.
>
> Discontinuation rebound improvement. I get that from Nardil.
>
> > But I know that never lasts...
>
> Me too.
>
> > unless this time I can get some mileage out of just the lamictal, klonopin and provigil.
>
> Hey, it just might be.
>
> > but even with the new understanding that i probably have bipolar II, I get such bad depression I can't imagine that I can get away with it and at some point will have to take yet another AD.
>
> Probably.
>
> > I keep thinking that if I took a tiny dose of oral selegiline I could keep the energy and lose the mixed state..
>
> Ever try Wellbutrin or Parnate? Are you a partial responder to either?
>
> > Anyway, that is my update.
>
> :-)
>
>
> - ScottI wish I knew how or had a Mac or something so I could respond line by line like you and some others do. it is like having a conversation. I would tell you that I can't help but be poetic, I am just so artistic that way... not.
I get psychotic on wellbutrin, hiding from cars when I was jogging (gotta get back to that, jogging I mean, not hiding from cars). And the social phobia was like paranoia. yick and yuck.
I have not tried Parnate, I was considering it after some of you suggested it. My pdoc thinks I will get the awful mixed state again. Maybe all the anxiety is just not going to let me do well on a stimulating med. I really did well on paxil a million years ago before i became mummifed in front of the tv.
I have been thinking about revisiting strattera. I got alot done when I was on it before and lord knows i could use some focus. I don't know why I quit taking it. It is a good thing my pdoc takes copious notes.donna
Posted by Donna Louise on September 29, 2006, at 5:46:33
In reply to Re: discontonuimg Emsam, posted by Phillipa on September 28, 2006, at 18:52:04
> Donna please answer Jost's question as it's very important. As my pdoc if I'd tried it said only use 1/4 of a patch. And are you the one who could only use the area above her breasts to apply. Thanks Phillipa
Nope, not me, I am not the breast lady. I think I may have tried that spot once but it sweated off. I am very active outside in the summer, even if I am in a coma, as I am on my way to being again without the patch.donna
Posted by SLS on September 29, 2006, at 6:09:48
In reply to Re: discontonuimg Emsam » SLS, posted by Donna Louise on September 29, 2006, at 5:41:04
Then Nardil?
- Scott
Posted by jealibeanz on September 29, 2006, at 10:28:33
In reply to Re: discontonuimg Emsam, posted by Donna Louise on September 29, 2006, at 5:46:33
So have you officially been diagnosed with Bipolar?
Posted by Donna Louise on September 29, 2006, at 13:09:12
In reply to Re: discontonuimg Emsam » Donna Louise, posted by SLS on September 29, 2006, at 6:09:48
> Then Nardil?
>
>
> - ScottI apologize for the exteme vanity, but I am terrified I would gain weight. I don't think any positive effects would offset the agony of weight gain out of my control.
BTW, the patch put on about 5lbs that I could live with..barely...and it is magically coming off since I quit. I didn't think a drug with so amphetamine metabolites, albeit, not nearly as with the transdermal absorbtion but there you go, you just never know. What is with the poetry??? A new aspect of rebound?
Posted by Donna Louise on September 29, 2006, at 13:14:52
In reply to Re: discontonuimg Emsam, posted by jealibeanz on September 29, 2006, at 10:28:33
> So have you officially been diagnosed with Bipolar?
i am not sure what would qualify as official since there are no PET scans or anything that can scientifically prove any of these afflictions. My pdoc thinks so if that can be considered official. I considered myself to have many manifestations of soft bipolar for many years and it may be that the patient, if they can still think, may be the best one to know. My pdoc didn't think so until I responded so well to the lamictal because I sleep like a log for many hours. Insomnia is a major hallmark of bipolar and I just don't have that, never had. I slept like a rock as a baby.
Posted by Phillipa on September 29, 2006, at 13:24:08
In reply to Re: discontonuimg Emsam » jealibeanz, posted by Donna Louise on September 29, 2006, at 13:14:52
Insomnia is a hallmark of bipolar? Never heard that before. All types of things to my knowledge(limited) like excessive stress can cause insomnia to my knowledge. Love Phillipa
Posted by SLS on September 29, 2006, at 14:53:28
In reply to Re: discontonuimg Emsam » jealibeanz, posted by Donna Louise on September 29, 2006, at 13:14:52
> Insomnia is a major hallmark of bipolar
This is true in the manic phase of the illness or during a mixed-state - and then not always.
> and I just don't have that, never had. I slept like a rock as a baby.
Me too, in my depressed state. Mania is another story. The few times I had it, I could exist on 3-4 hour of sleep without really missing it.
Phillipa is right about insomnia being a component of some forms of unipolar depression. In fact, it was part of the original diagnosis.
In other words, you can sleep or oversleep and still be bipolar.
- Scott
Posted by jealibeanz on September 29, 2006, at 15:43:58
In reply to Re: discontonuimg Emsam » SLS, posted by Donna Louise on September 29, 2006, at 13:09:12
> > Then Nardil?
> >
> >
> > - Scott
>
> I apologize for the exteme vanity, but I am terrified I would gain weight. I don't think any positive effects would offset the agony of weight gain out of my control.
> BTW, the patch put on about 5lbs that I could live with..barely...and it is magically coming off since I quit. I didn't think a drug with so amphetamine metabolites, albeit, not nearly as with the transdermal absorbtion but there you go, you just never know. What is with the poetry??? A new aspect of rebound?
>
>You did gain weight? Ughhh... that saddens me. I feel the same way you do. Was it when you increased the dose that you noticed it? I was thinking of asking my doc about EMSAM when I see him in 2 weeks. I no longer think I'll be doing that. I majorly gained on my AD's in the past for no reason other than medication. I just happen to be very susceptible. That just makes me feel worse in the end. Not worth it. :(
Posted by Donna Louise on September 30, 2006, at 21:15:09
In reply to Re: discontonuimg Emsam, posted by jealibeanz on September 29, 2006, at 15:43:58
> > > Then Nardil?
> > >
> > >
> > > - Scott
> >
> > I apologize for the exteme vanity, but I am terrified I would gain weight. I don't think any positive effects would offset the agony of weight gain out of my control.
> > BTW, the patch put on about 5lbs that I could live with..barely...and it is magically coming off since I quit. I didn't think a drug with so amphetamine metabolites, albeit, not nearly as with the transdermal absorbtion but there you go, you just never know. What is with the poetry??? A new aspect of rebound?
> >
> >
>
> You did gain weight? Ughhh... that saddens me. I feel the same way you do. Was it when you increased the dose that you noticed it? I was thinking of asking my doc about EMSAM when I see him in 2 weeks. I no longer think I'll be doing that. I majorly gained on my AD's in the past for no reason other than medication. I just happen to be very susceptible. That just makes me feel worse in the end. Not worth it. :(I personally don't mind 5lbs, it would be well worth it if the drug had worked well. 5 lbs is insignifant to me. That is all I gained. And I can't swear it was the patch. other things going could have done it too. So don't not try it just because of something I said. I am just one person and not even sure if that is what caused me to gain a few measely lbs. It is the 10+ lbs I would find unacceptable. And I have not gained weight on meds that others have and vice versa. What I said about it just isn't applicable to another person's situation.
donna
Posted by Donna Louise on September 30, 2006, at 21:18:05
In reply to Re: discontonuimg Emsam » Donna Louise, posted by Phillipa on September 29, 2006, at 13:24:08
> Insomnia is a hallmark of bipolar? Never heard that before. All types of things to my knowledge(limited) like excessive stress can cause insomnia to my knowledge. Love Phillipa
You misunderstand. I am not saying that bipolar is the only thing that causes insomnia, just that it does for most people. Of course there are a myriad of other etiological possibilies for insomnia. Too many to count probably.
donna
Posted by Phillipa on September 30, 2006, at 21:18:44
In reply to Re: discontonuimg Emsam » jealibeanz, posted by Donna Louise on September 30, 2006, at 21:15:09
Donna do you think you may have eatten more? Feeling better and all? If it's transdermal and bypasses the gut and liver how could it add pounds? Love Phillipa
Posted by Donna Louise on September 30, 2006, at 21:25:38
In reply to Re: discontonuimg Emsam » Donna Louise, posted by SLS on September 29, 2006, at 14:53:28
> > Insomnia is a major hallmark of bipolar
>
> This is true in the manic phase of the illness or during a mixed-state - and then not always.
>
> > and I just don't have that, never had. I slept like a rock as a baby.
>
> Me too, in my depressed state. Mania is another story. The few times I had it, I could exist on 3-4 hour of sleep without really missing it.
>
> Phillipa is right about insomnia being a component of some forms of unipolar depression. In fact, it was part of the original diagnosis.
>
> In other words, you can sleep or oversleep and still be bipolar.
>
>
> - ScottI have never had the classice bipolar I mania so I don't know how that would effect my sleep. I imagine I would be up painting the garage or some other productive activity...I have just had this major agitation, irritablity, panic and rage one minute, then fine the next and then towards the end of my run with the patch I fell into a pretty serious depression. We raised my lamictal to 200mg a few days before I quit the patch and I don't know which to credit for the cessation of my bipolar type symptoms. Either it was drug induced or the lamictal is working really really well for me. Or reboudn as we talked about before. Whatever, I am going to run with it as long as it lasts. BTW, I had much more subtle symptoms of soft bipolar before I started the patch, the patch just seemed to bring it to the surface. Probably any type of peripherally active stimulant would do the same thing. I won't be finding out, not going there, no siree.
donna
>
Posted by jealibeanz on September 30, 2006, at 21:30:08
In reply to Re: discontonuimg Emsam » jealibeanz, posted by Donna Louise on September 30, 2006, at 21:15:09
Yeah, you're right. It's just that I've been so susceptible in the past, I don't want to go down that road again.
Posted by Donna Louise on September 30, 2006, at 21:30:53
In reply to Re: discontonuimg Emsam » Donna Louise, posted by Phillipa on September 30, 2006, at 21:18:44
> Donna do you think you may have eatten more? Feeling better and all? If it's transdermal and bypasses the gut and liver how could it add pounds? Love Phillipa
No, if anything I ate less, I eat more when I don't feel good. Don't ask me how it could happen.Who know what any of these drugs are going to do or how they actually do it to any one given individual. I guess there is vague general idea how they work but that is just scratching the surface. It is not a matter of first pass metabolism that would make the difference though.
I am surely not the one to ask, that is all I really know.donna
Posted by Donna Louise on September 30, 2006, at 21:34:25
In reply to Re: discontonuimg Emsam, posted by jealibeanz on September 30, 2006, at 21:30:08
> Yeah, you're right. It's just that I've been so susceptible in the past, I don't want to go down that road again.
I can surely understand that. You can always try it and then pull it if you don't like what happens. Trying these things is not some kind of binding contract. That is the way I think of it, otherwise I doubt I would try anything. No, that is not true. When I am in the middle of a bad depression I would drink lye if I thought it would help. Well, that is an exaggeration....donn
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