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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Racer on January 18, 2008, at 17:58:12
I just finished a failed trial of EMSAM, lasting about two and a half months. It was a complete failure, with side effects and no benefits, and I started feeling better within days of stopping it.
My question is this: similarities and differences of MAOIs being what they are, would this suggest that other MAOIs would also fail to be helpful for me? Or might a conventional MAOI be totally different?
By the way, this is a purely theoretical question. My therapist and my psychopharmacologist are both in agreement that MAOIs are contraindicated in my case, and won't be prescribed. I tend to agree with them, because their reasons for this decision seem valid to me. I'm just curious about this, not planning to try to change their minds.
Thanks for any answers offered.
Posted by bleauberry on January 18, 2008, at 19:01:24
In reply to Question about EMSAM versus other MAOIs, posted by Racer on January 18, 2008, at 17:58:12
I'm sorry Racer. You put so much into it over the last couple months. You deserve better.
I don't know if failed ensam means failure on all maois. My hunch is they are not comparable. While we tend to view these drugs in a narrow spectrum of how they work on serotonin, dopamine, and norepinephrine, they do a whole lot more than that. They affect a multitude of genes, enzymes, and all kinds of stuff I see in research but I don't understand it all. Regardless if I don't understand it, it is apparent to me that each drug molecule does a lot of different stuff biochemically above and beyond what it does to serotonin. Heck, I often wonder if the therapeutic effects actually come from a conglomerate of all those other things and don't have much to do with serotonin at all.
Anyway, I was curious...why are maois viewed as contraindicated in your case?
Posted by Racer on January 18, 2008, at 22:45:26
In reply to Re: Question about EMSAM versus other MAOIs » Racer, posted by bleauberry on January 18, 2008, at 19:01:24
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> Anyway, I was curious...why are maois viewed as contraindicated in your case?There are a variety of reasons for that. The biggest one, the one that really can't be mitigated by other medications, is that I am also being treated for anorexia. As my therapist points out every time this comes up, the whole idea is to get me to *stop* restricting foods, so any medication which requires me to watch my diet and restrict certain foods is unacceptable. My pdoc agrees, and I kinda agree, too -- particularly since so many things on the list are staples in my diet.
The other reasons involve side effects and suicidal ideation: first, when MAOIs came up at one point, I admitted that it was kinda tempting to say yes, and then try to trigger a crisis -- suicide, without it being obvious. I'm pretty sure she passed that information on to my pdoc. And my blood pressure runs very low to begin with -- it's not uncommon in anorexia. In the past, all the TCAs I've tried, except nortriptyline, lowered my blood pressure a lot. EMSAM lowered it a bit, too -- I was averaging about 80/55 -- so it's obviously something I'm sensitive to. MAOIs are known for lowering blood pressure, so that's a probable problem for me. And -- gee, what a surprise -- weight gain is an issue for me. It's a huge issue for me. It's happened on nearly every drug I've taken, and it's not acceptable. Sedation/insomnia are also problems I've had on a lot of medications, particularly those that affect serotonin. EMSAM left me very isolated, since I had no motivation to speak -- about once a week, I'd make an effort to be around people, but even then I felt isolated and stupid.
I agree with you that the big three neurotransmitters discussed so often are not the whole picture. What I've learned over twenty some years of meds, is that noradrenergic medications are usually more effective for me than any of the serotinergic meds. Otherwise, I've learned that there are some side effects I can't deal with.
I'm just babbling now, so I'll stop...
Posted by Phillipa on January 18, 2008, at 23:34:41
In reply to Re: Question about EMSAM versus other MAOIs » bleauberry, posted by Racer on January 18, 2008, at 22:45:26
Racer a long journey and a lot of extenuating circumstances. I'm truly sorry about the EMSAM. But I know you will continue to find an answer. Any thought to Deplin with what you try next. Just asking. Phillipa. Truly a strong lady.
Posted by stargazer2 on January 19, 2008, at 18:56:57
In reply to Re: Question about EMSAM versus other MAOIs » Racer, posted by Phillipa on January 18, 2008, at 23:34:41
I failed Emsam (Nov 2006 - May 2007) and Nardil has worked for me twice in my life, in 1987 (original formula at 30 mg, no side effects) and in 2007 (60 mg, more side effects, but affective vs. depression.) I too have extremely low BP, as low as 80/40 on Nardil with a pulse 40, worse than on Emsam. On Emsam I had dizziness but with a normal BP.
What I found with Nardil and Emsam is that when I started I was on Abilify too. I think perhaps Abilify complicated the Nardil and Emsam effect. Also I was on Nardil and Nortriptylline and Nardil and Wellbutrin and all 3 add-on meds, that my MD pushed for, caused severe dizziness.
Since going only on Nardil alone, my dizziness has resolved and I haven't checked my BP in a long time since I don't feel lightheaded anymore.
Nardil took from March to November of 2008 to get straightened out and this may be too long for many people to stick with. All I knew is that my mood was better despite the physical SE's and now most of them have resolved, but I had cut back on some meds my pdoc had wanted me to continue with Nardil such as Nortriptyline.Overall, Nardil has been the first med in a very long time I can say has more mood benefits than every other med I've tried in many years.
The only other meds that worked longer than a year was Marplan in 1993 (until Roche discontinued it) and Celexa, Wellbutrin and Adderall from 2000 to 2003. So my track record is not not terrific in the 20+ years I have sought treatment for depression.
Nardil is a Godsend. I hope it can continue to keep my depression at bay. It has not been a full year yet. No one knows anything about long term treatment of depression, especially chronic relapsing and remitting depression. It is just like any other chronic disease that requires long term management. I am not fooled anymore by expecting a permanent cure for it. I have had it too long with frequent reoccurrences to think like that anymore, but I am still hopeful for that remote possibility.
Stargazer
Posted by trx resistant on January 27, 2008, at 2:28:29
In reply to EMSAM versus Nardil and Marplan, posted by stargazer2 on January 19, 2008, at 18:56:57
Stargazer:
You have been through the ringer and your are still ticking! Better than a Timex. I began my EMSAM journey after 9 years of failure on all SSRIS. MDD late in life according to statistics, job induced. My initial response was good with slow titration of Wellbutrin up to 450mg over 9 months, then pdoc added Dexidrine up to 30 mg, slowly. Great after 2 months, 2 weeks short of returning to work after 1 year off, then, WHAM, 11 seizures in 5 hours. I can never have any "activating" type stuff until EMSAM. Searching my best recollection of what I was like exactly 9 years ago with Wellbutrin and Dex, EMSAM is so much better!!!! Now I really am getting my life back. And I at the same time I started EMSAM I began taking night classes on, "Mindful Living" a unique (though ancient) form of easy meditation, very nonjudgmental. Google it, started in Boston about 20 years ago, then Canada, just came to West coast of USA about 5 years ago. In Canada most hospitals offer 8 week classes and in US, most universities. You can download the meditations free or read some books. try it, I think it made a difference this time.
Thank God and Bristol.
This is the end of the thread.
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