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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by want2breal on November 27, 2006, at 16:44:47
Well, it is day 4, and now I want to know.....can I cut the darn thing in half, or even quarters???
Of course all of the directions say not to...is it because it is time released? Guess they would lose money too in the long run.This feels just like the Concerta felt to me after a few days, and eerily like those diet pills I took 15 years ago......which I finally quit both of them
Sure wish I could go the natural route, but oh well...
ANy advice, comments, putdowns...all is welcome!Do I just need to give it time? Duh.
Posted by Jost on November 27, 2006, at 18:35:03
In reply to Calling all EMSAM experts, posted by want2breal on November 27, 2006, at 16:44:47
Yeah, you do need to give it time.
You can cut it in half easily-- if you examine the individual packets, you'll see notches in all four sides-- they can help you fold the packet into equal sections--
I've done it-- at my pdoc's advice-- and he's very careful about things--
of course, Emsam hasn't been around that long-- so in some sense-- who knows? but on first instinct, it seems (according to an expert-- ie my pdoc) to be safe and reasonable.
But mainly, give it time-- and maybe don't be too quick to increase dose (not that you seem to be, though--) it has immediate effects and longer-fuse effects, I think.
Jost
Posted by stargazer on November 27, 2006, at 22:14:40
In reply to Calling all EMSAM experts, posted by want2breal on November 27, 2006, at 16:44:47
Sounds like it may be too stimulating for you since you already had insomnia before starting Emsam. But perhaps cutting it in half may be a good solution to see if it reduces your anxiety. It may just not be a good med for you. Some cause sedation and some cause anxiety and there's no sense feeling worse than you already do.
I don't have too many other recommendations for AD's, but the SSRI's were definately more sedating for me. I had good luck with Celexa and Paxil for awhile, Prozac was very good for anxiety. I took at night since they made me tired if i took during the day. I tried Cymbalta recently, but it made me feel more depressed, but it might help you since your depression has alot of anxiety.
Do not take Wellbutrin as it can also cause anxiety. I cna't remember what other meds you've tried.
Stargazer
Posted by Phillipa on November 27, 2006, at 23:21:01
In reply to Re: Calling all EMSAM experts, posted by stargazer on November 27, 2006, at 22:14:40
You can remove it at night too. And don't get the med on your hands if you cut them. But a smaller piece might be okay as my pdoc knows my high anxiety and said a quarter of a patch if and when I was ready. Love Phillipa
Posted by RN320 on November 28, 2006, at 18:11:05
In reply to Calling all EMSAM experts, posted by want2breal on November 27, 2006, at 16:44:47
As a person who's been on EMSAM since June, I'd leave things alone and give it some time. I've heard that it makes some people anxious in the early days of use. For me, it didn't do that, and actually has decreased my overall anxiety at the higher 12mg dose. I'd also not worry too much about the methamphetamine and amphetamine metabolites that this drug breaks down into. From the info that I have, just because something breaks down into metabolites doesn't mean that you're going to get some sort of reaction.
To answer your question, yes, even though they tell you in the patient info not to cut the patches- you can do this safely. The drug is applied on a grid and is supposed to be equally distributed on the patch. It has to be in order for them to monitor quality. I have this from a plastics engineer who has worked in the pharmaceutical industry with transdermal systems. Hope this helps.
About the insomnia.....I have it really bad and am unable to take Ambien because of sleepwalking and sleep binge eating, so I take Seroquel. If it turns out that you think that EMSAM is working for you, you may want to explore another med for sleep if you're still experiencing insomnia.
Good luck.
/m
Posted by want2breal on November 28, 2006, at 20:44:44
In reply to Re: Calling all EMSAM experts, posted by RN320 on November 28, 2006, at 18:11:05
THanks so much for your thoughtful reply. I do not feel well at all today (day 5) and will decide Monday, at my dr.s visit what to do. I do not feel any positive effects from it right now.
I am so glad that you are doing well on it.
The ambien worked last night...so we will see how it goes.
Blessings.
Posted by johnnyzero on November 29, 2006, at 8:21:59
In reply to Re: Calling all EMSAM experts, posted by want2breal on November 28, 2006, at 20:44:44
I've been using Emsam for about 6 months now with quite a bit of success, after suffering with crippling depression for about 25 years - for me it's been nothing short of miraculous. Perhaps my experience will be helpful to you & others.
Over the years I had tried literally EVERY known treatment under the sun: all classes of meds, alternative therapies, participated in a TMS clinical trial, importing unapproved meds from other countries, etc, etc, ad nauseum.
Last spring, while I was trying to get my insurance company to agree to coverage for a VNS implant, I heard about Emsam and thought it might be worth a try. Even more so because my only real success in the past had been with MAO Inhibitors - Nardil, Parnate, or Manerix. I was a bit dubious because I had even tried liquid Selegilene (active ingredient of Emsam) without any effect about 10 years ago.
Lo and behold, Emsam helped me function & feel much better almost immediately. I did, however, experience the jittery feeling you describe - bordering on hypomania - and that's at the lowest dose, 6mg/patch. I knew from past experiences that I could experience hypomanic symptoms from MAOI's, although it usually occured only at very high doses. Perhaps my brain chemistry is just particularly sensitive to Selegilene.
In any case, my solution was to just use a 6mg patch EVERY OTHER DAY to cut the effective dose in half, without having to go thru the hassle of cutting the actual patch in half or whatever. Even though the lit says it's designed to deliver it over a 24-hour period, this seems to work fine for me - I'm able to go 2 days and the patch seems to be able to do its thing over the 48 hours without any "withdrawal effects" like shocks in extremities, mood nosedive, etc. Even over the 2-day time frame, the Selegilene seems to be delivered very evenly - as compared to Nardil that I could literally feel "kick-in" with a rush about 45 min after taking it.
One word of caution: I wouldn't recommend going any longer than 2 days. On those few occasions where I forgot to change my patch, I started to get some withdrawal effects some time into the 3rd day - mostly the "shocky" sensations in the extremities that you can get when weaning off any MAOI. Not life threatening, but rather uncomfortable.
To be honest, I've gotten to the point where I can self-regulate my Emsam dose as needed. Occasionally if I start to feel a little "down" (oe even in anticipation of an upcoming stressful event, like an impending visit from my mother-in-law ;-), I will switch to 1 patch/day for a few days. That seems to boost my mood & energize me a little. Contrary to what you would think, this doesn't seem to cause any type of "rollercoaster" effect, at least for me.
I hope my experiences will be helpful to you.
best to all,
JohnB
Posted by stargazer on November 29, 2006, at 9:44:51
In reply to Re: Calling all EMSAM experts, posted by johnnyzero on November 29, 2006, at 8:21:59
JZ (hope you don't mind informality of initials),
What an inspiring post. I'm so happy for your success w Emsam. Your experience with depression sounds similar to mine...on MAO's with success years ago, none since. Lots of failures, mostly marginal responses to other AD's, alive, but dead inside.
I started Emsam about 2 weeks ago, holding steady, no big, fireworks type response but steady increase in energy and motivation, which suit me just fine. I will wait to see how this goes over the next few weeks/months and hopefully my response will be like yours.
That is great to go every two days with 1 patch. For those of us who might have to pay out of pocket (currently on samples from pdoc), that is a good way to stretch the value, since the cost is prohibitive w/o insurance coverage.
Keep in touch as you can.
Stargazer (SG)
Posted by johnnyzero on November 29, 2006, at 14:01:54
In reply to Re: Calling all EMSAM experts/JohnnyZero, posted by stargazer on November 29, 2006, at 9:44:51
SG,
Yes, I forgot to mention that going 2 days/patch is also a great way to stretch a 30-day refill for 2 months - cutting them into pieces has the same advantage.
I'm lucky enuf to have RX coverage thru my wife's insurance, but even the $50 co-pay for a months supply (+ $50/month for Lunesta) sometimes stretches it for us. I guess I should consider myself very fortunate: the "regular" price for (30) 6mg Emsam patches is $580+ - or about $18 PER PATCH - insane!
You can't tell me that the drug company needs to charge that much in order to recoup their R&D costs & make a little profit:
1) It's not like they had to custom-design an entirely new molecule or anything like they now do with a lot of modern drugs. Selegilene has been around for many years as an effective treatment for Parkinson's Disease. In fact, it may even have been around long enuf for the patent to have expired.
2) The technology for manufacturing transdermal drug delivery systems was perfected years ago with the introduction of nicotine patches & scores of other drugs.
So it's not like they've introduced anything really novel here - they've simply created a product that uses existing technology for a new application. I bet their stock is doing very well, tho.
Anyway, enuf of my griping. Good luck w/ Emsam and keep us "posted".
best,
JohnB
Posted by Phillipa on November 29, 2006, at 18:33:16
In reply to Re: Calling all EMSAM experts/JohnnyZero, posted by johnnyzero on November 29, 2006, at 14:01:54
I like your approach. As it kind of gives you a day off. Love Phillipa
Posted by Shyster on December 11, 2006, at 15:48:50
Thanks for a post w/a little hope. Sounds like you've been through even more "fixes" than I have. Never taken this type of medication before though I've been on every typical anti depressant for 25 years. I also have anxiety/panic disorder and take 3 mg. of xaanax/day. Have done the traditional therapys, most recently six months of serious cognitive therapy w/a very qualifed psychologist w/no luck.
I lost my son and only child in a car accident on 1/1/04 and this is the worse time of the year for me. Told the shrink today that things are worse than they've ever been--zero motivation, self worth, hope and he suggested Emsam. Gave me 25 6 mg. patches.
Has anyone had problems w/the restrictions? I have very bad sinus problems and go through the OTC meds heavily, but if this can make me want to live I can find a way around that. I was a practicing alcoholic for more than 20 years (16 years sober now). If I can quit that I can quit anything.
Posted by ronaldo on December 11, 2006, at 16:36:19
In reply to Emsam, posted by Shyster on December 11, 2006, at 15:48:50
Shyster I am so sorry for your loss. It must be very difficult to remember your son in a time of festive cheer. I have no advice to offer on the subject of Emsam just a bit of sympathy. Scroll down to the bottom of the board and you will see a google search window. Stick Emsam in the window and you will come up with loads of threads and many posts on the subject of Emsam. I don't use it myself. I'm on Lithium and Zyprexa. Trying hard and for the third time to come off the Zyprexa.
Good luck
....ronaldo
Posted by Shyster on December 11, 2006, at 18:27:28
In reply to Re: Emsam » Shyster, posted by ronaldo on December 11, 2006, at 16:36:19
Thanks Ronaldo. I could go on for a long time about what a great kid he was. 21 and a senior honors student in chemical engineering, but that's not what this thread is about.
Which brings me to: Where's the rest of this thread? I can only see my post and you're reply. Thought I was resonding on a contining Emsam thread.
I'm not a stranger to message board but guess I haven't figured my way around here yet.
Posted by Phillipa on December 11, 2006, at 18:42:25
In reply to Re: Emsam, posted by Shyster on December 11, 2006, at 18:27:28
I too am extremely sorry for your loss of your Son. I think you will need the Dr. Bob google search for the EMSAM thread. There is a poster now stargazer doing well on it. My pdoc said it would be too stimulating for me. That's what a lot of others found that after a few days it's stimulating. Good luck. Phillipa
Posted by stargazer on December 11, 2006, at 19:17:31
In reply to Re: Calling all EMSAM experts/JohnnyZero » johnnyzero, posted by Phillipa on November 29, 2006, at 18:33:16
Hi Shyster,
I am by no means an expert on Emsam but I have been on it now for a few weeks with good results. Since there are no dietary restrictions on the 6 mg dose, it makes it much easier to take than the older MAO's.
I'm not sure of all the drug restrictions though, so you should either consult you doc or read the package insert. I think you can find out on EMSAM.com if you're interested.
There doesn't appear to be that many experts but occasionally there is a response or two to Emsam posts.
I did not have any side effects when I started it other than a bit of insomnia and I take a small dose of Seroquel most nights, although I have been able to skip occasionally.
It seems to be a good AD in my opinion, and I have had alot of SE's on other AD's for one reason or another. I did have good results to the older MAO's years ago and I'm grateful this has seemed to be giving me some stability.
Time will tell as it does with all AD's. Good luck and I'm so sorry to hear of your loss. No AD can make that kind of grief go away but hopefully it can help soften it.
Stargazer
Posted by Honore on December 11, 2006, at 21:19:54
In reply to Re: Emsam » Shyster, posted by Phillipa on December 11, 2006, at 18:42:25
Hi Shyster.
I'm sorry about your loss. It's very sad to hear.
I wanted to suggest Claritin, which you can take with MAOIs, although you can't take sudafed, etc.
Also, instead of regular sprays, you can take Flonase, or Nasacort. These are steroidal, but the doses are not absorbed, and remain only topical. I've used both and find the Flonase more effective, although perhaps a little harsher (in theory, at least).
The restrictions really aren't that bad, especially on Emsam, so I think you'll find that aspect of it pretty tolerable. You mostly have to worry about drug interactions, not food interactions.
If sleep is a problem, there are lots of threads. I personally often take Emsam off for a few hours at night to get to sleep. Also you can use Ambien, or even Seroquel (low dose).
Let us know how it goes.
Honore
Posted by RN320 on December 12, 2006, at 19:27:20
In reply to Emsam, posted by Shyster on December 11, 2006, at 15:48:50
Hi Shyster-
I agree with Honore....I've been on EMSAM since early June 2006 and it's worked really well for me. I've had chronic sinusitis for years and regularly used Flonase for about 10 years. When I get a cold, I would have (off of EMSAM) taken Sudafed- (lots of it!!!) and was really concerned about what would happen. I've had one really bad cold since June, and what I did in addition to the Flonase was to use benadryl to try to dry up secretions and it seemed to work really well for me. I'm currently on the 12mg dose of EMSAM. I used seroquel for sleep for almost a year and it became less effective recently. I now take 300mg of Trazadone and I'm able to sleep again. Good luck to you...I hope that EMSAM helps you as much as it helped me.
/m
Posted by Shyster on December 12, 2006, at 21:02:40
In reply to Re: Emsam, posted by RN320 on December 12, 2006, at 19:27:20
Thanks. Small price to pay if Emsam helps but I'm not gettting my hopes up.
Had a little more trouble sleeping than usuall last night (I've been on the Xanax so long it's not a lot of help. I do cook up some "herbal" brownies and eat a half about an hour before I go to bed. That helps <grin> but of course the chronic prostate infection gets me back up 5 times a night anyway).
This is the end of the thread.
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