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Dr. Bob is Robert Hsiung, MD,
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Posted by Jost on September 22, 2006, at 3:35:00
In reply to Re: Emsam: constant dosing? » Jost, posted by WeeWilly on September 21, 2006, at 22:55:11
Hi. Do you use two 12 mg patches for 48 hours to achieve the same dose as 12 mg?
Why the 48 hours? The patch apparently is set up for 24-hour use. Although there's enough emsam for more than 6 mg (on the 6 mg patch), I'm not sure there's any claim by the company that you'd get any particular amount in the second 24 hours.
From what my pdoc said, if you use any size for 24 hours, there's real chance you're getting most of the drug absoption in the first hours, and then less for the latter part of the period. This could be even more so in a 48 hour period.
So if some of the effect is from the amphetamine, you'd be possibly getting much less of that after the first some hours-- leading to a shifting dose.
Did you and your pdoc come to the conclusion that a high emount for a few hours every 48 hours and lesser amounts for the rest was a better rhythm for you?
Jost
Posted by WeeWilly on September 22, 2006, at 15:05:03
In reply to Re: Emsam: constant dosing? » WeeWilly, posted by Jost on September 22, 2006, at 3:35:00
> Hi. Do you use two 12 mg patches for 48 hours to achieve the same dose as 12 mg?
>
> Why the 48 hours? The patch apparently is set up for 24-hour use. Although there's enough emsam for more than 6 mg (on the 6 mg patch), I'm not sure there's any claim by the company that you'd get any particular amount in the second 24 hours.
>
> From what my pdoc said, if you use any size for 24 hours, there's real chance you're getting most of the drug absoption in the first hours, and then less for the latter part of the period. This could be even more so in a 48 hour period.
>
> So if some of the effect is from the amphetamine, you'd be possibly getting much less of that after the first some hours-- leading to a shifting dose.
>
> Did you and your pdoc come to the conclusion that a high emount for a few hours every 48 hours and lesser amounts for the rest was a better rhythm for you?
>
> Jost
Hello Jost,I use 12mg patches. Each one stays on 48 hours. In the morning I take off the patch that has been on 48 hrs and put a new one on. So each morning I start with a new 12mg patch and the one that has been on for 24 hrs. Maybe the patch totally depletes in 24 hrs, I don't know.
Emsam on its own is not producing much of a response in me. If I add 15 or 20mg of Adderall, there is some response but not great. I would like to use Emsam alone for awhile to see its effecacy alone. But I need to accomplish some projects right now and for this past month on Emsam I have done so little.
I am sort of on my own in my treatment plan. I would have to travel 4 to 5 hrs to a large city to possibly find a Psychopharmacologist that would treat my condition out side the box like is needed. Finding a doc to prescribe treatments like stimulants with MAOI's or other legitimate aggressive coctails is very diffucult in this area of the country and probably most places. You read of people struggling to find a doc who will prescribe MAOI's alone. It's so ridiculous.
Are you doing quite well with the Emsam? I'm sure I have read how long and what dose you are currently on, but could you update me on this and what if anything you are adding to it. Thanks and best wishes.
Posted by Jost on September 22, 2006, at 19:16:14
In reply to Re: Emsam: constant dosing?, posted by WeeWilly on September 22, 2006, at 15:05:03
I'm doing really well-- at least until a recent problem-- but I'm planning to start again.
I must be lucky-- I have a pdoc who's really dedicated to finding what works. He'll do maois and other things --. He did that for me- He's extremely careful-- and keeps up with all the developments, but really cares about helping patients to find the best treatment available.
If he thinks the combo is potentially okay, but potentially not--and knows you'll be careful and keep him informed of any problems that arise-- he''ll go ahead-- and then pull back, very firmly, if any adverse reactions arise. I always check with him, if I have any doubt about what's happening-- I'm pretty careful myself if things don't feel right.
I was doing 12 mg of emsam, and taking it off at night, for 5-6 hours, and then putting it on and sleeping a few more hours. Seems to work really well- but I've had a good response to emsam. -- That amounted to about 9 mg (approximately).
I was using it with provigil (about 200 mg a day, sometimes more), and possibly ritalin-- although I'm not sure if the ritalin will work-- I had an adverse reaction--I'm sure to the Emsam, but don't know if the ritalin played a role. It remains to be seen when I start up again.
I might not need ritalin, though. I'll stick with the provigil, however. Ensam has given me a lot more energy, and a much better outlook-- I'm much less depressed, and easily thrown by situations, more confident, and less prone to negative ruminations.
At the beginning, after using 6 mg and feeling like I needed more than 6--but also having bad insomnia, I switched to 18 mg for 12 hours a day. After a while, I noticed was getting much more irritable, easily upset, and prone to constant agitation. It was extremely uncomfortable and oppressive, until I thought about the amount-- and went down to 12 mg, taken off at night for 6 hours or so. I felt much better pretty quickly--and also slept better, too.My sense is that you have to accommodate fairly slowly and make sure not to go up too quickly. Going up too quickly on the assumption that, as with most ADs, you'll reach a therapeutic dose, over time, by doing that-- might be a bad strategy with Emsam.
But then I'm not a pdoc-- and probably the data aren't in. I just worry that maybe some people are missing a good drug because taking too much, esp. too soon, is counterproductive-- ? I could be wrong, though.
Jost
Posted by WeeWilly on September 22, 2006, at 22:14:14
In reply to Re: Emsam: constant dosing? » WeeWilly, posted by Jost on September 22, 2006, at 19:16:14
> I'm doing really well-- at least until a recent problem-- but I'm planning to start again.
>
> I must be lucky-- I have a pdoc who's really dedicated to finding what works. He'll do maois and other things --. He did that for me- He's extremely careful-- and keeps up with all the developments, but really cares about helping patients to find the best treatment available.
>
> If he thinks the combo is potentially okay, but potentially not--and knows you'll be careful and keep him informed of any problems that arise-- he''ll go ahead-- and then pull back, very firmly, if any adverse reactions arise. I always check with him, if I have any doubt about what's happening-- I'm pretty careful myself if things don't feel right.
>
> I was doing 12 mg of emsam, and taking it off at night, for 5-6 hours, and then putting it on and sleeping a few more hours. Seems to work really well- but I've had a good response to emsam. -- That amounted to about 9 mg (approximately).
>
> I was using it with provigil (about 200 mg a day, sometimes more), and possibly ritalin-- although I'm not sure if the ritalin will work-- I had an adverse reaction--I'm sure to the Emsam, but don't know if the ritalin played a role. It remains to be seen when I start up again.
>
> I might not need ritalin, though. I'll stick with the provigil, however. Ensam has given me a lot more energy, and a much better outlook-- I'm much less depressed, and easily thrown by situations, more confident, and less prone to negative ruminations.
>
>
> At the beginning, after using 6 mg and feeling like I needed more than 6--but also having bad insomnia, I switched to 18 mg for 12 hours a day. After a while, I noticed was getting much more irritable, easily upset, and prone to constant agitation. It was extremely uncomfortable and oppressive, until I thought about the amount-- and went down to 12 mg, taken off at night for 6 hours or so. I felt much better pretty quickly--and also slept better, too.
>
> My sense is that you have to accommodate fairly slowly and make sure not to go up too quickly. Going up too quickly on the assumption that, as with most ADs, you'll reach a therapeutic dose, over time, by doing that-- might be a bad strategy with Emsam.
>
> But then I'm not a pdoc-- and probably the data aren't in. I just worry that maybe some people are missing a good drug because taking too much, esp. too soon, is counterproductive-- ? I could be wrong, though.
>
> Jost
>
>
>
>
>
Hey Jost,I envy your relationship with your Pdoc. From my experience with many docs and what I read of others it seems that the wellfare of the patient is way down on the priority list. Could you elaborate on the adverse reaction you had? Do you think Emsam has a chance to work as monotherapy for you without the Provigil? I am hopeing it will work well enough on its own for me. There are so many draw backs to polypharmacy. Anyway I sure wish you the best of fortune. Thanks for the update.
Posted by Jost on September 24, 2006, at 10:41:29
In reply to Re: Emsam: constant dosing? » Jost, posted by WeeWilly on September 22, 2006, at 22:14:14
I do think Emsam would work as monotherapy. I had used provigil for a long time because of insomnia, and insomnia was a problem when I first started the Emsam, and for quite a while. It has started to get better, and I have no more problem than before I started. It's really a good idea, if you have insomnia, to take the patch off for five or six hours (or even more) at night. It helped me stay with the Emsam, because the insomnia was quite bad. I often wake up anyway, and so I put it on toward the end of my sleep-- and can sleep a few more hours without much trouble.
My pdoc said he has eight patients on Emsam, who are doing well. I don't know if they're also had insomnia problems, but that's been mentioned here pretty frequently.
The energy I get from Emsam helps a lot, even on days without quite enough sleep, so I wouldnt necessarily need the provigil either. But on some days, it helps.
Provigil a pretty benign drug, from what I've seen and has some AD effects, too. Nothing like the stronger stimulants like adderall, or dexedrine.
My recent problem was from what seems to be an overdose, possibly from defective packets, and exercising in the heat. I don't think the dose I got would be a normal thing-- but be cautious about heat, such as baths, hottubs, saunas, heating pads. Heat seems to increae the dose quite a bit, especially if you absorb the drug easily. (The delivery system doesn't have a precise target amount, but rather a range of absorption.)
Maybe your pdoc would be more open to provigil. If not, I'd try the Emsam anyway. My advice (which might not be right for you, of course) would be not to go up too quickly on the dose for Emsam, esp. if you get irritability or the insomnia.
Good luck! I hope it works out for you.
Jost
Posted by WirelessWally on September 24, 2006, at 14:35:45
In reply to Re: Emsam: constant dosing? » WeeWilly, posted by Jost on September 24, 2006, at 10:41:29
> I do think Emsam would work as monotherapy. I had used provigil for a long time because of insomnia, and insomnia was a problem when I first started the Emsam, and for quite a while. It has started to get better, and I have no more problem than before I started. It's really a good idea, if you have insomnia, to take the patch off for five or six hours (or even more) at night. It helped me stay with the Emsam, because the insomnia was quite bad. I often wake up anyway, and so I put it on toward the end of my sleep-- and can sleep a few more hours without much trouble.
>
> My pdoc said he has eight patients on Emsam, who are doing well. I don't know if they're also had insomnia problems, but that's been mentioned here pretty frequently.
>
> The energy I get from Emsam helps a lot, even on days without quite enough sleep, so I wouldnt necessarily need the provigil either. But on some days, it helps.
>
> Provigil a pretty benign drug, from what I've seen and has some AD effects, too. Nothing like the stronger stimulants like adderall, or dexedrine.
>
> My recent problem was from what seems to be an overdose, possibly from defective packets, and exercising in the heat. I don't think the dose I got would be a normal thing-- but be cautious about heat, such as baths, hottubs, saunas, heating pads. Heat seems to increae the dose quite a bit, especially if you absorb the drug easily. (The delivery system doesn't have a precise target amount, but rather a range of absorption.)
>
> Maybe your pdoc would be more open to provigil. If not, I'd try the Emsam anyway. My advice (which might not be right for you, of course) would be not to go up too quickly on the dose for Emsam, esp. if you get irritability or the insomnia.
>
> Good luck! I hope it works out for you.
>
> JostJost, Just read your post. I have been on EMSAM for about 7wks. now. I am also on Risperdal (.5mg/day). I started the fist month at the 6mg dosage and at the third week found I had a ton of energy but lacked much joy in my life. At the 4mo. period the doc moved me up to the 9mg patch. At this dose I have been on for three weeks. I have lost much of my energy and seem more mellow. I do have joy in my life but miss the energy I had at the 6mg dosage. I have not heard of Provigil and wonder if that would help me gain some energy back. My blood pressure has dropped dramatically at this dose and no longer take any BP meds. It seems that I have also lost the laughter and joking around I used to do. I wonder if any of this will return the longer I stay at this dosage. No real insomnia but i do wake up early (6:00am) So far I like the way I emotionally feel but miss the energy. I feel like I have had a personality change of sorts because I used to always be joking and laughing even when depressed, it just felt forced or false. I have been thinking about going back to the 6mg dose but will wait it out if the energy and laughter would return in due time. I see the doc on the 6th of Oct and do not yet know what direction to take. The doc is open to my suggustions as long as they are within reason. Your Thoughts? Wally
Posted by teddi52 on October 3, 2006, at 8:00:57
In reply to Re: Emsam: constant dosing? » Jost, posted by WeeWilly on September 21, 2006, at 22:55:11
Has anyone experienced severe neck and upper back pain on EMSAM. I have cervical dystonia, and cannot continue EMSAM because of the pain I am experiencing. Any suggestions. I was on 6 mg for 2 weeks with minor pain, then 12 mg for two weeks with severe pain. Thanks
Posted by crimsonvik on November 1, 2006, at 15:09:04
In reply to Re: EMSAM - First Day -- what to try for insomnia?, posted by ttee on July 21, 2006, at 0:11:54
My Dr. says I CAN take Benadryl on the patch. Yaah!
Posted by Jeffy on November 26, 2006, at 18:03:08
In reply to Re: Emsam Price, posted by SFY on September 6, 2006, at 12:56:29
Hi.
Do you REALLY have to be off SSRI's BEFORE you take Selegiline or Tianeptine?
Grateful for any insight, thanks!
- Jeffy.
Posted by Phillipa on November 26, 2006, at 19:27:11
In reply to SSRI waiting time?, posted by Jeffy on November 26, 2006, at 18:03:08
Someone who just started EMSAM said one week on the leaflet in the box after stopping an SSRI. But my pdoc said two weeks. Google the site to be safe Love Phillipa
Posted by Jeffy on November 26, 2006, at 20:35:55
In reply to Re: SSRI waiting time? » Jeffy, posted by Phillipa on November 26, 2006, at 19:27:11
Thanks, P - anyone else? - Jeff.
> Someone who just started EMSAM said one week on the leaflet in the box after stopping an SSRI. But my pdoc said two weeks. Google the site to be safe Love Phillipa
Posted by stargazer on November 27, 2006, at 12:16:53
In reply to Re: SSRI waiting time? » Phillipa, posted by Jeffy on November 26, 2006, at 20:35:55
According to EMSAM package insert, a time period equal to 4-5 half lives (approx 1 week) of treatment with SSRI's, SNRI's, TCA's, MAOI's, meperidine and other analgesics (listed in package insert) should elapse before starting Emsam.
The exception is for prozac where you should wait 5 weeks due to it's long half life. Buspar requires 2 week washout. Those are the only two exceptions to the 1 week rule.
Stargazer (Ensam day 10+)
Posted by Jeffy on November 27, 2006, at 12:23:55
In reply to Re: SSRI waiting time?, posted by stargazer on November 27, 2006, at 12:16:53
Thanks Stargazer and best of luck with the patch. Anyone else on waiting time? - Jeffy.
Posted by Jeffy on November 27, 2006, at 12:24:23
In reply to Re: SSRI waiting time?, posted by stargazer on November 27, 2006, at 12:16:53
Thanks Stargazer and best of luck with the patch. Anyone else on waiting time? - Jeffy.
Posted by ryanz on January 2, 2007, at 16:43:16
In reply to Re: EMSAM - First Day -- what to try for insomnia? » mayzee, posted by SFY on July 20, 2006, at 13:51:19
According to what I've read, benadryl is technically not supposed to be used with MAOI's, nor is Tylenol according to at least one source.
(Benadryl is the active ingredient in over-the-counter sleep aids as well, for those who weren't aware of this).It seems like it would go doubly so for Benadryl, because it also acts as an SSRI, although most people do not know this. And SSRI's are also contraindicated while taking MAO inhibitors.
But, has anyone taken benadryl as a sleep aid or for allergies with EMSAM, and did you have any problems? Thanks.
Posted by CrimsonVik on January 2, 2007, at 16:51:54
In reply to Re: EMSAM: taking it with benadryl/diphenhydramine, posted by ryanz on January 2, 2007, at 16:43:16
Benadryl is about the only medication of that type we can use. I use it all the time when I don't have Ambien.
If you're concerned, check Benadryl's label. There is no MAOI warning on it.
My Dr. told me all this initially.
Vik> According to what I've read, benadryl is technically not supposed to be used with MAOI's, nor is Tylenol according to at least one source.
> (Benadryl is the active ingredient in over-the-counter sleep aids as well, for those who weren't aware of this).
>
> It seems like it would go doubly so for Benadryl, because it also acts as an SSRI, although most people do not know this. And SSRI's are also contraindicated while taking MAO inhibitors.
>
> But, has anyone taken benadryl as a sleep aid or for allergies with EMSAM, and did you have any problems? Thanks.
Posted by ryanz on January 2, 2007, at 17:33:19
In reply to Re: EMSAM: taking it with benadryl/diphenhydramine » ryanz, posted by CrimsonVik on January 2, 2007, at 16:51:54
> Benadryl is about the only medication of that >type we can use. I use it all the time when I >don't have Ambien.
> If you're concerned, check Benadryl's label. >There is no MAOI warning on it.
> My Dr. told me all this initially.
> Vik
>You're probably right, but to be fair:
I checked for a drug interaction between parnate and benadryl at drugs.com and it shows a moderate drug interaction (basic warning about taking Benadryl and other antihistamines with MAOI's).
Also, Benadryl does reportedly potently block the reuptake of serotonin, although most psychiatrists and pharmacists probably don't even know this.
Posted by CrimsonVik on January 2, 2007, at 20:19:24
In reply to Re: EMSAM: taking it with benadryl/diphenhydramine, posted by ryanz on January 2, 2007, at 17:33:19
If you're worried about it then of course don't take it.
I also take the same ingredient in the PM meds like Tylenol PM. It's what's in Benadryl. I prefer not to take Tylenol too much though because it's bad on the liver.Vik
Posted by laima on January 3, 2007, at 8:21:53
In reply to Re: EMSAM: taking it with benadryl/diphenhydramine » ryanz, posted by CrimsonVik on January 2, 2007, at 20:19:24
I've never had any problem taking Benedryl with Emsam either- my doctor and pharmacist both said it was fine.
Posted by ramsea on January 3, 2007, at 8:36:10
In reply to Re: EMSAM: taking it with benadryl/diphenhydramine » ryanz, posted by CrimsonVik on January 2, 2007, at 20:19:24
how much tylenol is bad on the liver? i use it everyday, 2-3 tablets. thanx
Posted by CrimsonVik on January 3, 2007, at 9:59:07
In reply to tylenol and liver » CrimsonVik, posted by ramsea on January 3, 2007, at 8:36:10
I thought it was only drinkers who shouldn't take too much, but it's not. I don't know the exact amount but I wouldn't go over the 3 a day. Ask your Dr. though.
My husband saw a TV show the other day on Discovery about it on Dr. G, Medical Examiner.
Vicki> how much tylenol is bad on the liver? i use it everyday, 2-3 tablets. thanx
Posted by laima on January 4, 2007, at 9:48:17
In reply to Re: tylenol and liver » ramsea, posted by CrimsonVik on January 3, 2007, at 9:59:07
If you google tylenol and liver, you'll get a lot of specifics. They say that some people can have liver trouble even when using it according to package instructions. Trouble can occur with advil and other NSAIDS, too.
Posted by jenro on February 25, 2007, at 14:17:52
In reply to Re: EMSAM - 30+ day questions, posted by WirelessWally on August 27, 2006, at 12:34:59
I've been on emsam 6mg for 5 weeks now. Like some others here I feel more active but don't feel better, i.e. more hopeful, etc. I started with lamital about 10 days ago, still pretty anhedonic. I've also tried the DL-phenylaline with it. Still, up at at things but with my mood is still not much improved. (In the past had real mood boost with lexipro and geodon but both pooped out eventually.) Though, now I'm thinking of getting off the emsam and getting back on those. The psychpharm says it's still too early to tell re the emsam. Have people had really good responses to emsam suddenly on their 6th week? Seems unlikely to me. I don't want to go up on the emsam because of the irritability effect which I'm experiencing quite a bit of on this dose. I guess my ? is: What combinations have worked for people w/ emsam? any ideas out there for treating anhedonia and irritation?
Posted by laima on February 26, 2007, at 7:36:42
In reply to Re: EMSAM - HAVE PEOPLE STAYED ON IT W/SUCCESS?, posted by jenro on February 25, 2007, at 14:17:52
It's been working out for me- selegeline/Emsam for about a year now, or longer. I didn't get much out of the "6" though- perhaps that dose is too low for some people? The "9" has worked much better. I tried the "12", but Emsam significantly lowers my blood pressure, and the highest patch really made me feel disfunctionaly faint, dizzy when I stood up, etc. Maybe try to up your dose? Why not up the dose before giving up on it? It can be a good med, and with such a beneign side efect profile compared to so many others. Mine worked alright for most of the time, then started fading, but after a few different augmentation strategies, the one that became the magic combo (for me) turned out to be Emsam/brand name Adderall. (I ultimately did not get good result from generic amphetamine, Barr brand.)
Posted by laima on February 26, 2007, at 7:41:21
In reply to Re: EMSAM - HAVE PEOPLE STAYED ON IT W/SUCCESS?, posted by jenro on February 25, 2007, at 14:17:52
By the way, yes, both Emsam and oral selegeline seem to take a while to "kick in".
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