Posted by Dave954 on April 28, 2006, at 22:32:54
My name is David and I have been on psych meds since 1999. As of late, I am on a combination of lexapro, seroquel and neurontin. The lexapro is taken in the morning for depression, and the seroquel and neurontin are both taken at bedtime for insomnia (and are a god-send for that purpose, I might add). As of the past month, I've spoken with my psychiatrist about switching from lexapro to EMSAM - but not because the lexapro isn't working (it is working quite well), but because EMSAM has reportedly less sexual side effects, if any (comparable to placebo in clinical trials), and does not cause lethargy, lack of motivation, and clouded concentration as lexapro (and other SSRIs) do. I do have some concerns, however. Primarily, I am worried that EMSAM may cause me extreme agitation/anxiety as wellbutrin did. Let me add that the last two times that I even had a single cup of coffee or anything that had caffeine in it, I ended up in the emergency room with a sustained heart rate of 160 bpm (for HOURS) for which they had to keep me overnight for observation and give me beta blockers and benzos. I am understandably apprehensive and hope that EMSAM won't be the equivalent of caffeine or wellbutrin. I will say that in the past I have been on Strattera without a problem (though that is a norepinepherine reuptake inhibitor and doesn't affect dopamine). Ever since the seroquel was added to the lexapro and neurontin I have felt less agitated and sleep a lot better. My fear of going on EMSAM became ignited the moment that I read other postings from people saying that they experienced extreme anxiety and insomnia without any antidepressant effect (one poster even mentioned that her experience paralleled that of wellbutrin and that she tried throwing klonopin, seroquel and ambien at it and still the anxiety didn't lessen and she eventually had to discontinue treatment). I desperately want an antidepressant without sexual side effects and thought this might be the answer since it is an MAOI that doesn't have the typical side effect profile of traditional antidepressants. However, I am now starting to get the idea that the reason why is because this is an MAOI that is more partial to inhibiting MAO-B (dopamine, etc) than MAO-A (serotonin, etc). Typically, antidepressants with good serotonergic activity tend to be the most effective, but also tend to cause the most sexual side effects (the exact opposite seems to apply to antidepressants that work primarily on norepinerpherine and dopamine - in that they seem to be less effective for depression but allow better sexual functioning). And I may add that I have been on almost every medication so far *except* the MAOIs and most have helped my depression - its just the sexual side effects that have been so frustrating. The exceptions being serzone, remeron and wellbutrin - they didn't cause sexual side effects, but also weren't particularly effective antidepressants either. I am willing to give EMSAM an honest try, but only if I feel confident that it won't send me to the emergency room. I hope my doctor will allow me to stay on the neurontin and seroquel (as I don't believe there would be any sigificant interactions with EMSAM - but anyone tell me if I'm wrong). I told him my history of emergency room admissions from caffeine - but he seemed to down-play it. Any replies or opinions would be appreciated. Thank you.
poster:Dave954
thread:637995
URL: http://www.dr-bob.org/babble/20060423/msgs/637995.html