Posted by bleauberry on November 24, 2009, at 5:05:07
In reply to Re: Add anything to help with the EMSAM wait...., posted by Monica L on November 23, 2009, at 19:23:35
Monica,
If you are going to do a washout, I believe one week would be sufficient. I am not a doctor or rocket scientist, just common sense. I think it would also be important to start Parnate, if you do, at a very low dose for the first week...5mg, half of a 10mg pill, as an introduction. Then week two begin ramping up. I was suprised even a mere 5mg once every other day helped me quite a bit, contrary to the posts of so many people who say they felt nothing at much larger doses. Sometimes I wonder if less is more, as I've seen so often in various topics of life. In any case, as ensam washes out, introduce parnate lowly.
Your symptoms sound more like anhedonia, which is a syndrome that is usually a component of depression, but which can also be a stand-alone syndrome without depression, usually be confused as depression. That might be possible with you?
My primary symptom has always been the same as yours. When ADs worked, I was still lifeless and joyless. No depression when the meds worked, but no life and no joy either.
Some things I found helpful:
Either Adrafinil, Provigil, or Ritalin added to a very low dose of your favorite SSRI.
Low dose Milnacipran, with possible Ritalin addition.
10mg prozac (enough to ease depression but not enough to worsen the AD emotional numbness thing), 300mg Adrafinil, and 25mg Amisulpride, was a decent combo.
The best single agent I've ever tried, Amisulpride 25mg once every other day. Begins working on day 2 or 3.
Amisulpride and Adrafinil are both international meds available mailorder. Adrafinil is a quasi-stimulant, Amisulpride is an antipsychotic at doses higher than 50mg, but an anti-anhedonia antidepressant at lower doses.
And my very short trial of Parnate at tiny doses was positive. I have Lyme complications of low blood pressure, cold body temperature, and easily provoked numbness/tingling of extremeties, all of which got much worse on Parnate. Too bad.
In the natural arena, people who have stuck with it and experimented to find their exact dosing have had great success with combinations of 5htp (usually lower doses than suggested on the bottle) combined with Tyrosine.
You have lots of options, so if there is no other reason to smile today, hold on to hope! :-)
Anhedonia requires a different approach than the generic term depression. While we assume anhedonia is dopamine, it really involves at complex interaction of all the neurotransmitters, but dopamine and/or norepinephrine are the biggest players.
On paper it is often suggested to take dopamine agonists for anhedonia. I don't like that option. Very troublesome side effects, and longterm outcomes are poor or worse than baseline.
If I were meeting with a friend who was trying to make a list of things for his/her anhedonia, the list of ingredients for mono agents or combos would be:
Low dose prozac. (not more than 10mg)
Low dose Milnacipran (Savella) (12.5mg bid)
Ritalin. As needed.
Adrafinil. 300mg - 600mg per day.
Amisulpride. 25 mg once every two days.
Parnate 5mg - 80mg.
Tyrosine.
5htp.Anything not on that list, waste of time. Of course I realize we are all different. The list is not just my own, but a gathering from various people at various forums of various diseases where anhedonia happened to be the issue.
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> Thanks for taking the time to respond to my post. I dont' know if I feel worse because I expected so much from Emsam or what. I expected for it to work fairly quickly for me, everything I have tried in the past has kicked in that way. And as far as what I have tried, I have tried it ALL, over a period of almost 5 years. I have been hosp. once and all they did was put me on about 5 different meds. I wouldn't say I was depressed, more of just lacking interested in anything, no motivation or drive and little energy. I know all those things sound like depression, but I'm not really SAD. I'm actually more talkative and outgoing and laugh more since I've been off all meds., but still no motivation, drive or energy, no dopamine. Then I start thinking about how the Emsam is not working and get very discouraged, things shouldnt be this hard to do, I used to do things without thinking whenever meds were working for me. I looked forward to things and felt like I had a purpose.
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> So I called the doc today and of course he didnt get back with me, I'm sure they were busy though being monday and all. The guy that takes the msg will I'm sure get back with me tomorrow. I'm thinking of just telling him to tell my doc that I'm going to stop the Emsam so I can start Parnate. Do you know how long the washout would be? I hate when they bring up the diet as if they think you wouldnt try the drug because of it. If they understood what this feels like, they would know I'd be willing to sacrifice not eating certain foods, anything to not feel this way and feel normal again. I'm tired of waiting, I'm trying to hang in there, nothing matters more to me than my mental health, I wish the docs could understand that.
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> Sorry I wrote so much..
>
> Monica
poster:bleauberry
thread:926582
URL: http://www.dr-bob.org/babble/20091117/msgs/926781.html