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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by ExcellentCamper on January 10, 2008, at 6:03:34
So I've been on the patch for a month at 20/6 mg and then a week at 30/9 mg and now a day at 40/12 mg. Absolutely zero response so far except maybe more irritability and depressive thoughts (but that could be about not getting better). The patches are thoroughly annoying. I've had a couple of them fall off. Even tonight, with this 3M Blisterm tape I researched and my wife found, it was lifting off (you really have to pick your spots carefully, and this one on my upper back seems to get too much flexion when I move my shoulder). I have to take it off before a workout or the area gets red and irritated afterward, and it doesn't hold up well in a hot bath or shower. So I try to work out at the same time in the morning, removing it before I do and replacing it after I've cleaned up. But I don't know what success I would have in summer when I'm sweatier and active at various times in the day.Anyhow ... I'll try to stick with this for the full month on the 12 mg, but I'd like to have some ideas and get feedback on where to go from here.
I could try:
-- Switching to oral selegiline at a higher dose, 50 or 60 mg, if I don't get any response with this patch. Since I already have to modify my diet with this size patch, the only drawback would be the oral form would make my liver work harder (as I see it). Also, since they only see selegiline here in 5 mg doses, I'd be taking a whole lot of them! Anyone doing this with success?
-- Upping my Lamictal 150 mg. Has anyone with unipolar had a lift from doing this? My pdoc mentioned it, but I'm skeptical. Wouldn't that flatten my mood out?
-- Trying imipramine, "the gold standard." Most curious to try this.
-- Using higher-dose Remeron. Pdoc also said that at high doses, you can avoid the sedation and weight gain side effects. Not sure what my old dose was ...
I know that the SSRIs and other SNRIs are not for me, and Wellbutrin had no effect (although I don't think I got up to 450 mg), so those are not options.
Best to all of you in your search and recoveries.
Will
Posted by Justherself54 on January 10, 2008, at 8:02:49
In reply to Beyond Emsam, posted by ExcellentCamper on January 10, 2008, at 6:03:34
Have you thought of taking a MAOI? Parnate or Nardil? I've been on every SSRI, SNRI, except remeron, I've taken imiprimine and disiprimine..I can't tolerate the tri's as they knock me out..I've been on Nardil since September..best AD I've ever been on..
Posted by d0pamine on January 10, 2008, at 9:56:13
In reply to Beyond Emsam, posted by ExcellentCamper on January 10, 2008, at 6:03:34
It takes 6 to 8 weeks to have an effect. If you don't give it that long, then you've not tried it at all. An exception would be needing to quit due to negative reactions. If you react negativly (not to be confused with, not reacting at all, to start with, then it will likely only get worse.
As far as falling off goes... The best approach I've found to the patch is to put it on the shoulder. I've found it sticks MUCH better if I take a shower in the morning (throughly scrubbing the area removing all oil) and immediately upon leaving the shower, buff the patch application area of skin with a dry towel to remove all water and apply the patch while the skin is still warm/hot from the shower. When applied this way, I can hardly peal them off the next morning.
Posted by ericwagner on January 10, 2008, at 10:04:34
In reply to Re: Beyond Emsam, posted by Justherself54 on January 10, 2008, at 8:02:49
i understand your plight completely
i was on 6 mg. about 2 - 3 weeks
9 mgs. about 1 - 2 weeks
& 12 mgs. about 2 mos.
total of just about/above 3 mos. trial
no real positive or side effects
i have read some people received a response around 2 - 3 mos. & not prior
others have reported feeling better almost instantly
my Dr. suggested staying on at least 3 mos. to give the med. a true chance to work
he said no study has been done that states quitting emsam & trying a different antidepressant prior to 2 - 3 month trial would be recommended
personally i would say express your concern to your Dr. & hopefully he'll suggest sticking it out for a complete trial
i've done what seems like hundreds of hours of research on the med both - medical reports & patient responses
it seems like it has really, really helped a lot of people
i just wasnt as lucky, but this is my response to every med i've tried (approx. 15)
good luck
Posted by Phillipa on January 10, 2008, at 10:49:00
In reply to Beyond Emsam, posted by ExcellentCamper on January 10, 2008, at 6:03:34
Sorry it isn't working out for you. I really still would love to try it but heard it is activating so not good for my anxiety according to my doctor. Good luck and maybe some other options will be suggested. Love Phillipa
Posted by bulldog2 on January 10, 2008, at 14:14:33
In reply to Beyond Emsam, posted by ExcellentCamper on January 10, 2008, at 6:03:34
>
> So I've been on the patch for a month at 20/6 mg and then a week at 30/9 mg and now a day at 40/12 mg. Absolutely zero response so far except maybe more irritability and depressive thoughts (but that could be about not getting better). The patches are thoroughly annoying. I've had a couple of them fall off. Even tonight, with this 3M Blisterm tape I researched and my wife found, it was lifting off (you really have to pick your spots carefully, and this one on my upper back seems to get too much flexion when I move my shoulder). I have to take it off before a workout or the area gets red and irritated afterward, and it doesn't hold up well in a hot bath or shower. So I try to work out at the same time in the morning, removing it before I do and replacing it after I've cleaned up. But I don't know what success I would have in summer when I'm sweatier and active at various times in the day.
>
> Anyhow ... I'll try to stick with this for the full month on the 12 mg, but I'd like to have some ideas and get feedback on where to go from here.
>
> I could try:
>
> -- Switching to oral selegiline at a higher dose, 50 or 60 mg, if I don't get any response with this patch. Since I already have to modify my diet with this size patch, the only drawback would be the oral form would make my liver work harder (as I see it). Also, since they only see selegiline here in 5 mg doses, I'd be taking a whole lot of them! Anyone doing this with success?
>
> -- Upping my Lamictal 150 mg. Has anyone with unipolar had a lift from doing this? My pdoc mentioned it, but I'm skeptical. Wouldn't that flatten my mood out?
>
> -- Trying imipramine, "the gold standard." Most curious to try this.
>
> -- Using higher-dose Remeron. Pdoc also said that at high doses, you can avoid the sedation and weight gain side effects. Not sure what my old dose was ...
>
> I know that the SSRIs and other SNRIs are not for me, and Wellbutrin had no effect (although I don't think I got up to 450 mg), so those are not options.
>
> Best to all of you in your search and recoveries.
>
> WillI also found the patches very irritating as I had red irritated spots for a couple days after I took off each patch. Was beginning to look spotted. You could also try gold standard maois such as nardil or parnate.
Posted by former trx resistant on January 10, 2008, at 17:37:50
In reply to Beyond Emsam, posted by ExcellentCamper on January 10, 2008, at 6:03:34
Remember the Bristol studies show most don't begin to feel response until 15 weeks to see if it's right for you. Yes, I do know how annoying this point is, as many out there can tell you it's taken years . . . me - 9.
As to the patch. I hated it at first. Called the company and they do give replacements. They admitted they were experiencing a batch of bad ones, sticking- wise. But now I'm lucky to get samples from pdoc and they stick perfectly. In fact, sometimes I have hard time peeling it off.
I find if I wipe skin with alcohol pad, the type used before injections (you buy box at drugstore or costco) it sticks through very long hot baths and showers. Once I put on and had wrinkle in patch so I pulled it of and repositioned and it stayed all day. Previously I couldn't get half of it to stick.
Placement - I alternate between upper back just above shoulder blade (I live alone and have limited flexibility) and upper thigh, just a bit inward from bone socket. One day early on when I didn't notice much difference from patch, my thigh had a red mark, so I asked friend to put on shoulder. that day, I had huge positive response to drug. Later that week I found some study that said for some unknown reason you get quicker better delivery if placed on upper back. Go figure?
Don't give up yet. Wait full 15-16 weeks before you stop. Call Bristol tell them about adhesive problem. By the way I'm allergic to those little ekg pads and all tapes unless silk or paper. No problem from patch, just pink after I take off for a couple of hours.
Patch much better delivery mechanism than oral. You can't regulate your gut and absorption which varies by food, drink, enzymes, other meds, etc. Patch is smooth, easy and constant into blood.
I'm hopin we'll soon hear from you about the
miracle you found!
Posted by former trx resistant on January 10, 2008, at 22:24:15
In reply to Re: Beyond Emsam, posted by bulldog2 on January 10, 2008, at 14:14:33
Oops! I reread the posts. I forgot to tell you also that somewoman in an old EMSAM archive mentioned she would give the patch a bit of a blast with blow dryer and the warmth really kept it on. I tried it with a couple and it worked.
Also I had worst experience of my life on Lamictal. I quite literally experienced such profound rage, then mood swing, but one phone call away from hospitalization because I could not stand the "pain in my brain" from that stuff. New bad pdoc thought it was worth a try for atypical depression and seizure protection. I could not swallow my own saliva, nor eat. I lost 20 lbs in 6 weeks. I wanted to die. I put up with this because I was told it might help for 2 months. Then I decided it would be better to die than to live on this stuff. I only got to the lowest starting dose but it did not agree with me. But it taught me profound understanding to those of you who have mood swings. I've only experienced down, never rage.
Posted by ExcellentCamper on January 11, 2008, at 12:40:18
In reply to Re: Beyond Emsam, posted by former trx resistant on January 10, 2008, at 22:24:15
Thank you all for your many generous and insightfully posts. I had a rough night last night and felt woefully depressed. (I have been functioning pretty well up to now for the last couple of years on Lamictal 150 mg ... great for rumination, obsession, and a baseline level of support but hasn't provided the mental clarity, motivation, brightness that I've been looking for for much of the last 15 years.)
Anyhow, last night for the first time in a long time, suicial ideation entered the picture; I started fantasizing about heaven as a relief from all my psychological struggling. I was also very irritable (a work deadline may have had something to do with it, but my level of anger and agitation was definitely greater than normal). I decided to rip off the patch and felt immediately better. (Know that was just in my head, but ...)
These are great tips on making the patches stick, but some part of using them makes me feel like a science project. I think I'd rather take a med and forget about it, even if it makes my liver work harder. My doctor called me back this morning and told me to start weaning off and go back to 9 mg. I see him Wednesday. He'd also like me to increase Lamictal to 175 to see if that helps. After 14 days off Emsam, I can also try the imipramine, which I'm very curious about. The other MAOIs are options, too, but I love my tofu and miso soup!
Hate to throw in the towel early on a drug I had high hopes for and researched, but how I felt last night scared me and seemed to warrant a retreat.
My best to all of you,
Will
Posted by ericwagner on January 11, 2008, at 12:50:04
In reply to Re: Beyond Emsam, posted by ExcellentCamper on January 11, 2008, at 12:40:18
defenitely keep you dr informed of your described thoughts/feelings
if it gets bad/persists - u may want 2 go 2 a hospital
just to be safe/sure
some people have a dangerous response to some meds
theres plenty of medical options out there & if emsam is not 4 u - there's still hope
emsam did nothing 4 me over 3 mos. - but if i had a serious reaction like you described (not that i've never had it), i would possibly tell my dr i want to end trial
good luck & hang in there
hope something i said is reassuring/helps
i dont post like this 4 me, but 2 try 2 help people if i can - so just so u know people care & can relate entirely
Posted by former trx resistant on January 11, 2008, at 13:16:15
In reply to Re: Beyond Emsam, posted by ExcellentCamper on January 11, 2008, at 12:40:18
Will,
Obviously you and you dr. know best but my experience on Lamictil sounds a bit like yours in terms of irratibility, suicide ideation, etc. Be cautious that the Lamictal isn't contributing to the fallout. I was on Lamictal at the beginning of my EMSAM trial and wonder if that's what prevented an earlier response. When I stopped (you must taper Lamictal), immediate turn around with Emsam.
Also the patch issue - you are not a guinea pig, hundreds of thousands (millions if we include Europe and Canada) of people now take medication for pain relief, hormones for women, Nicoderm for smokers via same mechanism because it's the only method to get small constant absorption into your body. Maybe you are not aware that EMSAM patch has been successful in Europe for 10-15 years! But whatever you do, I really send you all good, positive thoughts so you are able to get peace back in your life. I'm always here for you.
Posted by former trx resistant on January 11, 2008, at 13:33:03
In reply to Re: Beyond Emsam, posted by ericwagner on January 11, 2008, at 12:50:04
Trust me I have no relationship with Bristol but I am passionate about EMSAM because it quite literally saved my life. I know what it's like to be inside and checked out of life and totally without desire to live for months, sometimes reading boards (this is the BEST, DR. Bob!)looking for help because at the end of the day the pdoc doesn't have to go home and face your problems or try to live life 24 hours a day like you do.
I know the "cocktails" are the current trend but it never made sense to me and it's quite frightening how pdocs give a pinch of this and a pinch of that for each symptom with so many unpredictable drug interactions and they are the first to tell you they don't know how this stuff works or what the effects will be on your brain and/or liver 10-20 years down the road.
But it is a bit disheartening to hear so many of you giving up at 3 month mark (of course if you have bad reaction that's understandable)when the research shows you should give it minimum 15-16 weeks, maybe a little longer since you should be titrating up. As I said for me, 4 weeks @ 6mg and nothing, so I went to 9mg and couldn't stand it after 3 days . . .went off for a week, then started with 1/2 of 6mg for 24 hours, still too much, so kept decreasing until I found 1/2 patch of 6mg for 12-14 hours.
Posted by ExcellentCamper on January 14, 2008, at 10:59:00
In reply to Re: Beyond Emsam, posted by former trx resistant on January 11, 2008, at 13:33:03
Trx,I'm glad that the Emsam is working out for you and that there is a place for it in the market. One person's sustenance is another person's poison (as in our varying reactions to Emsam and Lamictal).
If you are taking 1/2 of a 6 mg (20 mg) patch for half of the day, I guess that would be roughly equivalent to 5 mg of oral selegiline. I had tried the oral before, going as high as 15, with no results. Even added DLPA based on some suggestions here on the board.
I just think it's not the drug for me, as I hadn't felt that level of morbidity in years and have felt a LOT better since being off it. I've also gone up to 175 mg on the Lamictal and may go higher. Also have to say that, unless someone has failed many a medication, a drug (or patch) is not appealing if you have to wait 15 weeks for its full effect. So many other meds give a more immediate response, and when you have to keep pace in a job or are severely depressed, you're not likely to stick with it. We Americans (myself included) are damn impatient people!
Thanks again for your feedback,
Will
Posted by former trx resistant on January 15, 2008, at 0:20:52
In reply to Re: Beyond Emsam, posted by ExcellentCamper on January 14, 2008, at 10:59:00
Will:
So sorry you did not find it helpful. I am an American so am just as impatient as the next MDD/atypical but I failed with everything. But after 9 years of trial and worsening condition then about 2 weeks on EMSAM, my first experience with MAOI I felt better than I felt since college and that was 1974! In Fall I was off cymbalta and on Lamictal. I really was inches away from throwing myself into the traffic @ 5:00 PM in major city on major hwy!
When I said EMSAM could take up to 15 weeks to reach full effect (that's what Bristol told me), I didn't mean I didn't feel anything. It took 4 weeks @ 6mg and slight change BUT improvement. Then 3 days @ 9mg and way too activating, scared me. Went off for week, then tried 3mg for 24 hrs, then 3mg for 12 hour. Perfecto! I'm still a skeptic, waiting for some proverbial other shoe to drop, but WOW. I've stopped Ambien in last few days and will get off 1mg Xanax XR as soon as I see neuro.
I wish you all the best and quick resolution, most of all just to get back to normal for you.
This is the end of the thread.
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