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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by MARTY on April 1, 2006, at 4:37:23
Understand me, I'm not trying to bring down peoples hopes and expectancy.
I would just like to understand why there are so many people excited about trying the new EMSAM patch. Most of them, most of you, are veterans when it comes to meds and some are very knowledgeable in psychopharmacology and that is making me even more confuse and here's the very simple (too much simple?) thinking behind it, in 2 simple facts...
1. The EMSAM patch is just another 'way' of taking the drug SELEGELINE which is already available in pills forms since a long time.
Aside from change in the MAOI diet, there is not much changes we can expect in the effect of SELEGELINE delivered by the patch.2. SELEGELINE is having very limited success/efficacity as an MAOI for the depression/anxiety without the parkinson
disease. It is safe to say that it is no Nardil or Parnate and works much less often than Marplan and Manerix.
So now, why as many people want to try SELEGELINE now but weren't mostly uninterested before the patch, mainly because not much people were talking about the SELEGELINE pills because of 'fact #2'. I understand the need for some VERY-VERY-Treatment resistant few people to try everything new because they have nothing that works. But I also do understand that people like us, just like me, needs some hopes to be able to continue the fight...For my part I'm very thrilled by the fact that their is some scientific and economical interest/motivation in using modern science knowledges/capabilities to find ways to bring back the good old MAOIs. It could well be a solution for all the time, money and pain we've put in the last 25 years in the failure we call SSRIs. but plz don't use this thread to discuss with me if you disagree that the SSRIs are a failure, a massive lost of lives or a scientific controlled statistic lie; create a new thread to do so.. ;)
Marty
Posted by rod on April 1, 2006, at 5:30:02
In reply to EMSAM-YEAH. SELEGINE-NOT SO GOOD. uh!??, posted by MARTY on April 1, 2006, at 4:37:23
By using a patch you bypass first pass metabolism (the liver)... no metabolites means no nasty side effects because the metabolites are some amphetamines which very often cause anxiety and insomnia....
just my 2 cent
Posted by willyee on April 1, 2006, at 12:15:48
In reply to Re: EMSAM-YEAH. SELEGINE-NOT SO GOOD. uh!??, posted by rod on April 1, 2006, at 5:30:02
> By using a patch you bypass first pass metabolism (the liver)... no metabolites means no nasty side effects because the metabolites are some amphetamines which very often cause anxiety and insomnia....
>
> just my 2 cent
I agree,i have read tons of posts in newsgroups on this drug,and even the liquid form is considered worth anything,the tab form for whatever reason has gained no value.The liquid form however is very popular among smart drug users,users who seek drugs or nutrients to help slow down the natural degrading process of the brain.
Liquid deprenyl is one of the most popular ones.Also in any thing i read where deprenyl was used for depression it was the liquid form,the carrie in the liquid form is supperioir i believe i dont know much more in the technical aspect on that but im sure others here do.
I just know what i read,and i having known personaly people on tabs,and myself used liquid,in addition to the tons of stuff i read on actual users,have to say the liquid seems superior to the tab.
So with this logic,i can hold out hope that the patch might be the same,not only is the delivery different for the MAOI,but i believe this is the first anti depressant PERIOD comming in through the blood and poop out seems to be a problem with most of the meds,so maybe a new door will open with this drug,and it being a maoi first is just a process,and if successful well see the others or new ones via blood stream appear as well,lets keep our hopes high for now until we begin to have users appear here,then all the guessing will cease.
Posted by MARTY on April 1, 2006, at 12:46:08
In reply to Re: EMSAM-YEAH. SELEGINE-NOT SO GOOD. uh!??, posted by rod on April 1, 2006, at 5:30:02
> By using a patch you bypass first pass metabolism (the liver)... no metabolites means no nasty side effects because the metabolites are some amphetamines which very often cause anxiety and insomnia....
Bypassing First pass is a good thing indeed. But if SELEGILINE isn't worth much, what you got in the end is a 'poor antidepressant with less side-effects' and no MAOI diet ONLY on low dose. This would make the SELEGILINE patch an AD one step under Moclobemide.
That said I think the coming of EMSAM is a very good thing overall. Even with all I said I'm very excited by this medical advance and I'm looking forward to see many people on this forum telling us it is a godbless for them.Whatever I may think about EMSAM I wish I'll be prooved wrong in place and time.
Marty
Posted by gibber on April 1, 2006, at 13:39:13
In reply to Re: EMSAM-YEAH. SELEGINE-NOT SO GOOD. uh!??, posted by rod on April 1, 2006, at 5:30:02
I don't think the patch will avoid any side effects caused by the metabolites. The drug will still endup at the liver at some point to be metabolized. The advantage I think will come from not having the typical curve of drug concentration in the blood during the course of the day. It will be a steady stream of drug which may minimize the metabolite concentrations at any one time. I think insomnia was still a bit of problem for Adam while he was on the patch, but had a greater problem with it while taking the tabs. I don't think people who are on selegiline are really taking a high enough dose. I've read that 30-60mg is an antidepressant dose. I'm at 20mg of the tab and not seeing too much relief. There is no sense is saying that EMSAM is bad or good at this point. Its another case of what works for one doesn't for the other. Some people in the studies did really well on it and some did not. Studies don't reflect real life however. This is really a wait and see situation and of course that blows. Wouldn't it be nice to know a drug is coming out that is guaranteed to work...maybe in a hundred years.
Posted by ed_uk on April 1, 2006, at 14:01:38
In reply to EMSAM-YEAH. SELEGINE-NOT SO GOOD. uh!??, posted by MARTY on April 1, 2006, at 4:37:23
Hi Marty
My opinion of Emsam is that it will be effective for some people but will not be comparable in efficacy (as an AD) to Nardil or Parnate.
It is my hope that the introduction of Emsam will renew interest among psychiatrists in the classical MAOIs ie. Nardil and Parnate.
It is my belief that most psychiatrists have little knowledge of MAOIs. They do not understand their indications, nor do they understand the MAOI diet, their drug interactions or side effects. Basically, they don't know anything about them. They may believe that MAOIs are 'dangerous' but will not appreciate the relative safety of MAOIs in experienced hands.
MAOIs can be very effective treatments for severe depression and anxiety. It was once believed that MAOIs were less effective than the tricyclic ADs, this was the result of numerous trials which utilised very small (sub-therapeutic) doses of MAOIs. Unfortunately, many docs still believe this. Clearly, if MAOIs are to be effective, an adequate dose must be used. 45-90mg Nardil is commonly appropriate. The manufacturer of Parnate suggests 60mg as the maximum dose. In reality, some patients will require more - psychiatrists much realise this in order to gain the full potential of Parnate.
In summary.....
1. Nardil and Parnate are effective medications for many types of depression and anxiety.
2. An knowledgeable psychiatrist in necessary to use MAOIs safely. MAOIs can be remarkably safe in experienced hands. Things start to go wrong when MAOIs are prescribed to ill-informed patients. A lot of education may be required. It's not a case of just handing over the prescription. Time and effort is required on the part of the prescribing psychiatrist.
3. Doctors like meds which are 'easy to prescribe' eg. fixed dose, little patient education or monitoring required.
4. Some doctors try ECT for depression before prescribing MAOIs. This is extremely depressing in itself. I guess it's quicker and easier to give someone an electric shock to the head than it is to spend time with a patient explaining how to take their MAOI safely. In addition, most pdocs are more knowledgeable about ECT than they are about MAOIs. ECT tends to provide short-term relief of depression, there is, however, a very high relapse rate. MAOIs provide a more realistic long term treatment.
Ed
Posted by RobertDavid on April 1, 2006, at 14:20:23
In reply to Re: EMSAM-YEAH. SELEGINE-NOT SO GOOD. uh!?? » rod, posted by MARTY on April 1, 2006, at 12:46:08
I am one of those treatment resistant people, no luck with the SSRI's, SNRI's and about 20 other psycho tropic meds to treat my social anxiety/depression.
My doctor has been willing to put me on Nardil for years, but I chose to try other med's instead and have been holding out to take an MAOI as a last resort, my ace in the hole if you will. I probably should have taken Nardil when he first put it out there, but I didn't and am one that is excited/hopeful to be taking my first MAOI, EMSAM.
A few months ago I was ready to just throw in the towel, not wait any longer, frustrated with the wait for EMSAM and just go to Nardil. I asked about trying oral selegiline. My doc told me the scoop was that EMSAM was most likely going to be appoved in Feb and suggested I wait just a few more months, keep taking klonopin for SP while I wait.
He told me in detail (and unfortunatly he is a scientist/reasercher and most of it flew over my head) why oral would not work as well as the patch, not just the reduced side effect profile/reduced food restrictions, but that it's benefits would be greater than oral (I wish I could explain it the way he did).
I discussed that I had heard/read that many say selegiline isn't good for anxiety disorters in oral form, but he say's there will be differeces in how they perform. So at this point I'm not going to try to analyze it anymore and just plan on taking it and seeing what happens. I'm a veteran at these drug trials so what's one more.
Since it will be out later this month and is supposed to start working quickly answers are just around the corner. That's when these EMSAM posts will get interesting and we can discuss actual results both good and bad. Those are the posts I'm looking forward to seeing!
Posted by TylerJ on April 1, 2006, at 14:49:56
In reply to Classical MAOIs, posted by ed_uk on April 1, 2006, at 14:01:38
> Hi Marty
>
> My opinion of Emsam is that it will be effective for some people but will not be comparable in efficacy (as an AD) to Nardil or Parnate.
>
> It is my hope that the introduction of Emsam will renew interest among psychiatrists in the classical MAOIs ie. Nardil and Parnate.
>
> It is my belief that most psychiatrists have little knowledge of MAOIs. They do not understand their indications, nor do they understand the MAOI diet, their drug interactions or side effects. Basically, they don't know anything about them. They may believe that MAOIs are 'dangerous' but will not appreciate the relative safety of MAOIs in experienced hands.
>
> MAOIs can be very effective treatments for severe depression and anxiety. It was once believed that MAOIs were less effective than the tricyclic ADs, this was the result of numerous trials which utilised very small (sub-therapeutic) doses of MAOIs. Unfortunately, many docs still believe this. Clearly, if MAOIs are to be effective, an adequate dose must be used. 45-90mg Nardil is commonly appropriate. The manufacturer of Parnate suggests 60mg as the maximum dose. In reality, some patients will require more - psychiatrists much realise this in order to gain the full potential of Parnate.
>
> In summary.....
>
> 1. Nardil and Parnate are effective medications for many types of depression and anxiety.
>
> 2. An knowledgeable psychiatrist in necessary to use MAOIs safely. MAOIs can be remarkably safe in experienced hands. Things start to go wrong when MAOIs are prescribed to ill-informed patients. A lot of education may be required. It's not a case of just handing over the prescription. Time and effort is required on the part of the prescribing psychiatrist.
>
> 3. Doctors like meds which are 'easy to prescribe' eg. fixed dose, little patient education or monitoring required.
>
> 4. Some doctors try ECT for depression before prescribing MAOIs. This is extremely depressing in itself. I guess it's quicker and easier to give someone an electric shock to the head than it is to spend time with a patient explaining how to take their MAOI safely. In addition, most pdocs are more knowledgeable about ECT than they are about MAOIs. ECT tends to provide short-term relief of depression, there is, however, a very high relapse rate. MAOIs provide a more realistic long term treatment.
>
> Ed
Good Job Ed. You definitely know your Psychopharmacology! What's best about you is that you have the ability to deliver your knowledge without a hint of arrogance. I for one can appreciate that. :}Tyler
Posted by ed_uk on April 1, 2006, at 14:53:59
In reply to Re: Classical MAOIs » ed_uk, posted by TylerJ on April 1, 2006, at 14:49:56
Thanks TJ :)
Ed
Posted by linkadge on April 1, 2006, at 15:19:45
In reply to Re: Classical MAOIs » TylerJ, posted by ed_uk on April 1, 2006, at 14:53:59
I would argue that in the tablet form it simply has not been tried on enough people to know for sure how good it is.
Perhaps with the approval of the patch, we might get a better idea of how it actually is as an antidepessant.
For instance, I know a bunch of people who prefer smoking to SSRI's. Their doctors unsucessfully gave them SSRI's to try and quit smoking.
It might have utility in these cases
(You could wear the selegeline patch on one arm, and a nicotine patch on the other.)
It might also be usefull in geriatric depression. Older people sometimes respond better to energizing types of antidepressants. Adhering to a patch might be easier than tablets too.
I think its too early to say how the drug will perform.
Another thing to consider is that there are number of people who give up on conventional antidepressants due to cognitive, sexual and other side effects.
Ensam may have a more favorable side effect profile for certain patients.Linkadge
Posted by ed_uk on April 1, 2006, at 16:00:12
In reply to Re: Classical MAOIs » ed_uk, posted by linkadge on April 1, 2006, at 15:19:45
Excellent points Link
Ed
Posted by Phillipa on April 1, 2006, at 21:12:02
In reply to Re: EMSAM-YEAH. SELEGINE-NOT SO GOOD. uh!??, posted by rod on April 1, 2006, at 5:30:02
So does this mean that if anxiety is your number l problem that the patch may work for you? see the way I is see it like this. I couldn't tolerate the progestone in oral HRT but I could tolerate it in the cream form and then could wash it off. Pchologically it worked for me no side effects. now with the patch would it mean that if you remove it you also remove the med from system or does it stay there for a certain amt of time. i really have been thinking about this a lot and it is important to me. Love Phillipa
Posted by Sarah T. on April 2, 2006, at 0:55:11
In reply to EMSAM-YEAH. SELEGINE-NOT SO GOOD. uh!??, posted by MARTY on April 1, 2006, at 4:37:23
Hi Marty.
I tend to agree with you except that a couple of years ago, there were a few posters here on PB who had participated in clinical trials for the patch. They were pleased with the results. When the clinical trial ended, they were unable to obtain the patch so they switched to oral Selegiline and were quite disappointed. Also, about a year ago, I asked my psychopharmacologist about Selegiline. He said that I should wait until the patch comes out. I will ask him for more details the next time I see him, but I got the impression that as far as antidepressant efficacy, the patch seemed to be superior to the oral form.
I'm annoyed that the patch is only available in fairly high doses. I'm extremely sensitive to most meds, and I'd like to start at a low dose, but, if I'm not mistaken, the lowest dose of the patch is 20mg. That's seems too high.
Posted by rod on April 2, 2006, at 5:35:46
In reply to Re: EMSAM-YEAH. SELEGINE-NOT SO GOOD. uh!?? » rod, posted by MARTY on April 1, 2006, at 12:46:08
>
> > By using a patch you bypass first pass metabolism (the liver)... no metabolites means no nasty side effects because the metabolites are some amphetamines which very often cause anxiety and insomnia....
>
>
> Bypassing First pass is a good thing indeed. But if SELEGILINE isn't worth much, what you got in the end is a 'poor antidepressant with less side-effects' and no MAOI diet ONLY on low dose. This would make the SELEGILINE patch an AD one step under Moclobemide.Well, i am neither a pdoc nor a psychopharmacologist but in my opinione the amphetamine metabolites totally cancel out the therapheutic effect of Selegiline. Good and restfull sleep is crucial in depression I think.
Anyway. Oral selegiline sucked, but the sublingual is great.... The Patch isnt available where I am..
over and out.
Roland
>
>
> That said I think the coming of EMSAM is a very good thing overall. Even with all I said I'm very excited by this medical advance and I'm looking forward to see many people on this forum telling us it is a godbless for them.
>
> Whatever I may think about EMSAM I wish I'll be prooved wrong in place and time.
>
> Marty
Posted by rod on April 2, 2006, at 5:44:42
In reply to Re: EMSAM-YEAH. SELEGINE-NOT SO GOOD. uh!??, posted by gibber on April 1, 2006, at 13:39:13
> I don't think the patch will avoid any side effects caused by the metabolites. The drug will still endup at the liver at some point to be metabolized. The advantage I think will come from not having the typical curve of drug concentration in the blood during the course of the day. It will be a steady stream of drug which may minimize the metabolite concentrations at any one time. I think insomnia was still a bit of problem for Adam while he was on the patch, but had a greater problem with it while taking the tabs. I don't think people who are on selegiline are really taking a high enough dose. I've read that 30-60mg is an antidepressant dose. I'm at 20mg of the tab and not seeing too much relief. There is no sense is saying that EMSAM is bad or good at this point. Its another case of what works for one doesn't for the other. Some people in the studies did really well on it and some did not. Studies don't reflect real life however. This is really a wait and see situation and of course that blows. Wouldn't it be nice to know a drug is coming out that is guaranteed to work...maybe in a hundred years.
Well I think you certainly do.
It will end up in the liver, but beause the dose it much much lower you get virtually no metabolites. Search the archives of a post of me about Xilopar (sublingula Selegiline. (I think the plain liquid form would do the same.. (?)))
If you take 10mg Selegiline, the liver transforms 7/8 (8,75mg) into metabolites and ONLY 1,25 mg actually reach your blood and your brain.
You only need 1,25mg sublingually or otherwise administered which instantly reaches your bloodstream to achieve the SAME BLOOD CONCENTRATION as you would get by swallowing 10mg Selegiline.....Anyway. tried both and love the sublingual one. No patch here, but I could take 2 x 1,25mg to achieve MAO unselective (A+B) inhibition.....
bye
Roland
Posted by rod on April 2, 2006, at 5:53:09
In reply to Re: EMSAM-YEAH. SELEGINE-NOT SO GOOD. uh!?? » rod, posted by Phillipa on April 1, 2006, at 21:12:02
> So does this mean that if anxiety is your number l problem that the patch may work for you? see the way I is see it like this. I couldn't tolerate the progestone in oral HRT but I could tolerate it in the cream form and then could wash it off. Pchologically it worked for me no side effects. now with the patch would it mean that if you remove it you also remove the med from system or does it stay there for a certain amt of time. i really have been thinking about this a lot and it is important to me. Love Phillipa
Hi Jan :-)
I do not know. But the patch sure has less anxiety as a side effect. Regular selegiline makes me totally jittery and anxious. the "patch" actually is anxiolytic to me.
About the Progesterone... hmm no idea. I guess (!) you just got a lower dosage in the end and thats the reason you could tolerate it. And as soon as you "wash it off" (or remove a patch) your blood levels just will begin to sink. How fast this is, depends on you and the drug. So yes, it still is in your blood for a while and the ammount of the drug in your blood starts sinking.
bye
Roland
Posted by linkadge on April 2, 2006, at 9:35:41
In reply to Re: EMSAM-YEAH. SELEGINE-NOT SO GOOD. uh!??, posted by Sarah T. on April 2, 2006, at 0:55:11
Can a patch be exacto-knifed in half, for a lower dose ?
Linkadge
Posted by linkadge on April 2, 2006, at 9:36:57
In reply to Re: EMSAM-YEAH. SELEGINE-NOT SO GOOD. uh!?? » MARTY, posted by rod on April 2, 2006, at 5:35:46
Yeah, it is slow here in Canada too. I don't even think we have lexapro.
Linkadge
Posted by Phillipa on April 2, 2006, at 19:16:42
In reply to Re: EMSAM-YEAH. SELEGINE-NOT SO GOOD. uh!??, posted by linkadge on April 2, 2006, at 9:35:41
Good question Link. That might give a lot of people more confidence in trying it especially if it stays in the blood stream like pill. Love Phillipa
Posted by tmapj on April 11, 2006, at 14:38:25
In reply to Re: EMSAM-YEAH. SELEGINE-NOT SO GOOD. uh!?? » linkadge, posted by Phillipa on April 2, 2006, at 19:16:42
Hello everyone. I've been doing some research on this drug because I have both ADD and major depression (psychotic depression). Apparently this drug can help with both of these diseases, besides increasing cognative ablity (spatial learning and effortful concentration), increasing motivation, redusing neural and DNA degeneration and even increasing life span (20%). (All Reportedly)
To answer Sara's question: The smallest dose is very small, and I'm guessing very safe at 6 mg (transdermal patch).
The question I have now, after reading this topic, is, will it be effective at such a small dose??
This is the end of the thread.
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