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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by d0pamine on October 27, 2007, at 14:31:26
Why does there need to be a washout between EMSAM and bupropion? Is it because of the possibility of excessive norepinephrine levels resulting in hypertension, or is there something that I've missed? Also, does anyone have any thoughts on what the minimum washout between stopping EMSAM and starting bupropion is? I know the official number is 14 days, but I'll never manage that. I'm shooting for a week, but really it would be better if I didn't have to wait that long as I'm in a position that has very little tolerance degraded performance. I don't understand why the washout needs to be very long at all given the mere 9.5 hour half-life.
Posted by Racer on October 27, 2007, at 16:28:27
In reply to Washout between EMSAM and Bupropion, posted by d0pamine on October 27, 2007, at 14:31:26
> Why does there need to be a washout between EMSAM and bupropion? I don't understand why the washout needs to be very long at all given the mere 9.5 hour half-life.
It's because EMSAM is an irreversible MAO inhibitor, and you have to wait for new MAO to be synthesized before you can take any of the other sorts of antidepressants out there. Half-life in the body isn't the issue -- presence of MAO is the issue.
As for the minimum, that would be -- about 14 days, because that's about how long it takes to synthesis adequate MAO.
Talk to your doctor. There has been a fair amount of information coming out lately about ways to handle the washout period for patients who are, as they say, "brittle." I don't know all that they say, but maybe your doctor can find something to help you transition.
Good luck.
Posted by d0pamine on October 27, 2007, at 16:49:31
In reply to Re: Washout between EMSAM and Bupropion » d0pamine, posted by Racer on October 27, 2007, at 16:28:27
Thanks. BTW My Dr can't spell MAO.
Posted by Phillipa on October 27, 2007, at 20:19:14
In reply to Re: Washout between EMSAM and Bupropion, posted by d0pamine on October 27, 2007, at 16:49:31
Dopamine looks like you got a smart one!!!!! Phillipa.
Posted by War-Face on October 28, 2007, at 13:20:28
In reply to Re: Washout between EMSAM and Bupropion » d0pamine, posted by Phillipa on October 27, 2007, at 20:19:14
My pdoc said no washout was required when moving from Wellbutrin to Emsam, but the reverse switch might require a washout.The transition from Wellbutrin to Emsam has not been easy in the past week.
Why are you quitting Emsam?
Posted by War-Face on October 28, 2007, at 13:28:46
In reply to Re: Washout between EMSAM and Bupropion, posted by War-Face on October 28, 2007, at 13:20:28
I read the post above about why you are quitting EMSAM.
I hope this EMSAM thing works out for me... so far, mine has been a little rough. I hope it improves. I am fatigued, irritable, and having difficulty concentrating.
Posted by d0pamine on October 28, 2007, at 14:35:50
In reply to Re: Washout between EMSAM and Bupropion, posted by War-Face on October 28, 2007, at 13:28:46
Remember that I've had a very positive experience with EMSAM in spite of my issues now. If I had it to do over, I would have removed the patch for 8 to 12 hours / day (during sleeping hours) once I achieved remission. I'm not aware of any natural pattern that mimics the strait path of EMSAM. All natural rhythms follow a sine wave and EMSAM (at least for me at the 12mg dose) eventually flattens out the bottom part of that wave effectively disrupting all parasympathetic activity, but I suspect there is a way it could be used effectively without such disruptions. I'm starting to think there is a definite flaw in the 24h constant delivery mentality. Needless to say, I'll not be trying the XL form of bupropion for the same reason.
Posted by Phillipa on October 28, 2007, at 21:17:52
In reply to Re: Washout between EMSAM and Bupropion, posted by d0pamine on October 28, 2007, at 14:35:50
Dopamine misread your thread above and thought the opposite of the doc's spelling of MAO. Sorry as my reply sounds sarcastic to me wasn't meant to be. But couldn't you remove the patch at night as others have done? What happened so you are changing meds? Phillipa
Posted by d0pamine on October 29, 2007, at 15:58:17
In reply to Re: Washout between EMSAM and Bupropion » d0pamine, posted by Phillipa on October 28, 2007, at 21:17:52
I suppose I could try taking it off at night, and may well end up coming back in a few weeks and doing just that, but during my trial of it, bupropion seemed to be considerably more effective for me and I have an idea for attempting to prevent the tinnitus that caused me to abandon it after my last 2 week trial. If it works, I'll share the details for the benefit of anyone else who may have experienced the same issue.
This is the end of the thread.
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