![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by BrightEyed+Blueberry on April 29, 2008, at 1:47:02
I feel the desire to put my story out there--especially if it will help another person "go for it" despite the scariness of trying the "stigmatized" maoi-class of drugs that EMSAM falls under. And my own self-oriented reaons- I don't want the pharma to stop making this patch before I have some "real time" under my belt--er, stuck to my skin under my belt/various straps, etc.! (Wouldn't hurt to drop the cost of this $450+ medication either--does it really cost that much to make? Hmmm) Anyway, maybe I should continue posting once/week or twice a month, as things change/stabilize/continue or stop working....It'd be nice, esp with newer drugs, to have a quarterly "follow-up"-- say, in the months of March/June/Sept/Dec.. Just thoughts. But back to my point: to post (share) and go to bed (sleep)!
I have been on EMSAM for 1 month now and it has helped me with my atypical depression. I'm no longer apathetic (as the last year of being on Effexor made me). I have motivation; I get things done. I'm not euphoric, but I feel "normal." I have energy that takes me from waking in the morning through going to bed at night. It has enabled me to exercise consistently, 3-4 days per week.
I'm not always hungry and looking forward to the next meal/snack. It's easier for me to discpline myself in terms of my diet.
I'm able to "get organized" again - trying and using new apps online to schedule my time, create to-do and project lists AND actually tick off COMPLETED tasks - I finish things now. I'm still in process of organizing my time and goals and becoming more efficient. It is a process that will take time and I'm fine with that, moving forward a little bit everyday. Nothing crazy fast, just-moderate. Which I like.
My social phobia has lessened; I make and commit to plans and go without thinking too much about it --without thinking "isolationistic." Again, no miracles here - I believe I'm coming out of my shell, slowly but surely. It might be slow but its substantial compared to say, 6 weeks ago.
This medication worked fast for me - I felt it with the first few days. It actually enhances my libido - and I'm a female talking here (I've read many reports re: libido + selegeline from older men, so I thought i'd report my finding. I'm in my mid 30's. Though, I speculate that perhaps after 10 years of various SSRIs, my libido is basically back to normal, and therefore only seems "enhanced".)
Cravings for recreational stimulants - insufflating cocaine (which I never really liked, but it's still addicting if it's around, and apathy/feelings of boredom really lend themselves to stimulant use-->abuse for me) or methamphetamine (drug of choice--interesting, what one's drug of choice might say about which medications might work for one, and what [and where in the..] brain "Stuff" is going on.) From what I know about selegiline metabolizing into amphetamine and methamphetamine....I wonder if it helps others as much as it helps me in just not thinking about even doing that stuff. Even if I force myself to think about it--incredibly, I just don't crave it. there's no spark of interest. (Often, in the past, if I felt even a little better on whatever anti-depressant I was on, the AD might push me into over-confidence and into using. Or, the opposite - theAD not really working [partial response-which is tantamount to 0 response--I'm a firm believer in deserving of 100% response/remission, damn the pdocs any less -- partial=acceptable from pdocs and myself is the kind of attitude that kept me on Effexor for so long] and I don't care about anything, and i'm depressed, so the thought of using was what could get me out of bed and out into the world-albeit into drug seeking behavior. But, after the first day, it would be downhill from there. 2 steps forward...3 steps back. The typical drill. Constant state of not getting anywhere in life--all aspects--mental, emotional, physical health--career, relationships. It's like it would be overkill. Though like I said, I'm not living in a state of euphoria; I feel "normal." Maybe it's suffice to say I'm "normalized"-- stabilized. I'd fallen back into using like that, weekends.
Back to EMSAM. I have some trouble falling asleep, and don't like to take meds to help me sleep, because historically they make me feel tired the next morning, and I like to wake up feeling...well-rested and awake--like Wellbutrin did for me. I do have xanax and neurontin to help with sleep if necessary. I can sleep 8 hours if the option is available to me.
It has been a month and the impatience that accompanied the first few weeks has subsided somewhat--being impatient and acting aggressive with people close to me was especially bad within the 1st 4 hours of affixing the patch.
Now I'm feeling tired in the afternoons. I wonder if its because of the <7 hours of sleep I've been averaging. 6 hours of sleep is not enough for me. 8 hours of uninterrupted sleep is my next goal I'm setting my mind to. It means going to bed by 11pm. Perhaps I'll buy an eye mask--now there's an idea thats cheap and not a systemic psychopharmalogical solution--I like it!
And I'll try to stop obsessing about perfection and being too focused on things like typing up emails or posts at 11pm! But, I will take time to add my eye mask to my to-do list! Cheaper than buying drapes/new curtains! Esp. cuz even with my insurance, EMSAM costs $150/month. Plus, I pay for my own insurance.
I recommend giving EMSAM a try, especially for anyone with atypical depression (there's research there for sure, re: atypical depression + maois), recurrent treatment-resistant depression. BTW, only paxil worked for me really well -- and that was probably because it was "My FIRST" AD--and it petered out after 1-2 years, as it made its slpw ascent from 20mg...to 40, then 60. Made me kind of anorgasmic initially, which only "came back" 50%, if that makes sense. And kinda made me unafraid to engage in other "risk-taking" behavior--of various sorts. But hey, trying a belly-dancing class at the gym was "risk-taking" behavior for me at that point. I also traveled solo through asia and central america and did lots of great things. Paxil really helped with my social phobia at the time. I dont know, I attribute that to an "initial SSRI" kind of thing. And luck of the draw that my intial SSRI was the "right" one for me. Again, though, Ive done the SSRI-peter, with Paxil, Prozac, Lexapro, and Effexor, which I know is additionally an NRI. All eventually augmented with Wellbutrin SR or XL along the way (200-300mg/day), and Xanax in tow (PRN--> 1mg/day).
Hope this helps!
-6mg/day EMSAM patch
-1mg Xanax.Love/Light,
Bright
Posted by bulldog2 on April 29, 2008, at 8:24:47
In reply to EMSAM Success Story, posted by BrightEyed+Blueberry on April 29, 2008, at 1:47:02
Great to hear your story. I think having emsam around as a viable maoi choice is great. May not work for everyone but it does work for some. What's nice at the 6 mg size no need to follow the diet.
Please give us some followups on your progress.Are you planning on going up to the next size patch?
Posted by Phillipa on April 29, 2008, at 11:42:49
In reply to EMSAM Success Story, posted by BrightEyed+Blueberry on April 29, 2008, at 1:47:02
I see you're also new to babble I'd like to take the time to welcome you and thank-you so much for your wonderful success story may it continue. Love Phillipa
Posted by BrightEyed+Blueberry on May 5, 2008, at 10:27:49
In reply to Re: EMSAM Success Story » BrightEyed+Blueberry, posted by Phillipa on April 29, 2008, at 11:42:49
Thank you, Phillipa, I've lurked for a while, I've seen your posts, and I really appreciate your welcome.
It's been almost 6 weeks (where'd the time go?!) I report to my pdoc end of the week. I noticed in the week since I posted here initially, I've been able to fall asleep quite exhausted at the end of the night - anywhere from 10pm-midnight. No more staying up until 1! But, I'm tired in the morning :( . No morning "kick" like Wellbutrin always gave me--up and spritely, up and moving.
I don't drink coffee and I'll stay away (stomach aches, always)--I think this is "normal" wake-up. I still feel like I'm getting used to the EMSAM and changes are still taking place.
Will keep all posted!
-L/L,
Bright> I see you're also new to babble I'd like to take the time to welcome you and thank-you so much for your wonderful success story may it continue. Love Phillipa
Posted by RN320 on May 5, 2008, at 18:31:30
In reply to EMSAM Success Story, posted by BrightEyed+Blueberry on April 29, 2008, at 1:47:02
Hi Bright! Finally someone with a success story somewhat similar to mine! I started on EMSAM when it first came out and was available- about 2 years ago now. I've been at the max 12mg dose since September of 06, doing really well. 2007 was a horrible year for me from a med/surg perspective. I required brain surgery a year ago this week (and had major, lifethreatening complications that lasted for about 2 months after the surgery. My recovery is still not 100% and I've been told that it may never be), and then shortly after i fell at home and fractured (shattered) my left ankle, which required 2 surgeries (and complications of acute renal failure leading to heart failure and a stay in the ICU for CHF because I was given too many fluids to correct the acute renal failure). I tell you this because I would have NEVER been able to handle the stress of all that was going on around me and with me if it hadn't been for being stabilized on the EMSAM.
You mentioned the breakdown of EMSAM into amphetamine and methamphetamine. What I've been told by a psychopharmacologist and my psychiatrist is that the broken down components of EMSAM are just the metabolites of amphetamine alone (no meth). That's how it shows up in your urine drug screens and blood drug screens- amphetamine. Because they're just metabolites that are being excreted, they're not supposed to have any effect on the patient whatsoever. Some people say that they can "feel" it. I didn't, but just as you stated- life has improved, becoming more organized, pleasant, social, brighter and even during times of extreme stress at best I just drop out for a few days and sleep- it's the only way I can cope and my therapist and psychiatrist say that they feel that when the stress is that great that I (for some unknown reason other than the sheer amount of pressure/stress I feel myself under is just too much) "override" my meds. It simply means that I take them, but they don't work. Once I can calm myself down or get calmed down with the help of others, I'm ok and life again is copacetic.
I think that it's important to have reaslistic expectations of success of meds like EMSAM. Every time I've said to my psychiatrist or therapist that I think it's just a "miracle drug" they respond that they're really happy to see me doing so well, but that I need to understand that it's not a 100% cure all by itself. Compared to where I was 7+ years ago- I sure FEEL cured!
Best wishes to you on your journey!
/RN320
Posted by Phillipa on May 5, 2008, at 19:36:09
In reply to Re: EMSAM Success Story, posted by RN320 on May 5, 2008, at 18:31:30
Well my Dear Friend. Still doing great so glad. And she knows what she's talking about so listen up. Love Phillipa
Posted by KarenRB53 on May 7, 2008, at 9:18:42
In reply to EMSAM Success Story, posted by BrightEyed+Blueberry on April 29, 2008, at 1:47:02
Does anyone know if EMSAM raises blood pressure? My pdoc is so cautious because I have high blood pressure (which is being treated and its consistently great now.)
Posted by BrightEyed+Blueberry on May 7, 2008, at 11:53:15
In reply to Re: EMSAM Success Story, posted by RN320 on May 5, 2008, at 18:31:30
May I ask you some questions?
-How long did the 6mg work for you? Would you say "stabilizing" is like a 12 week affair--at least for you? I've read some people taking as long 12 weeks before even feeling anything.
-How did you decide to "move up the ladder" to 9mg and then 12mg? Didn't you "not want to" and wish to hold that off as necessary? Not only for the food restrictions but to "have in your back pocket" so to speak?
While I felt it worked right away, I'm wondering about this, "stabilizing" feeling....Like I said, I kind of feel "normal." I miss having or at least, noticing the more intense energy....I know it's not as intense anymore, but I also know I'm probably also just attenuated to the energy--meaning, it's more energy I had than when I was depressed, and I'm just used to that now. Still, I try to keep things in perspective and for once, note the POSITIVE things and not the negative--like I change it to, well, I'm still doing more things in a day than I did in a WEEK, so, the EMSAM must be working inside me. And it's giving me the opportunity to work on myself cognitively--i.e., positive thoughts instead of the "negative triad" thinking.
And that intense energy I initially felt - the first couple weeks (the first 4 hours after applying especially) also translated into severe impatience with people and events not going my way. So I don't miss that.
-Did you notice meds like xanax did not seem to effect you as much unless you took a little more - like I have to take 1.5 to feel a xanax instead of 1mg. At the same time, I wonder if I don't really need it for social anxiety, it's just a crutch I'm used to--that I'm not really afraid to meet new people and the EMSAM alone is fine. Does this make sense? I supposed my lithmus test would be participating in a classroom of people--any type of speaking in public--but I'm not taking courses at the moment!
Did you take off the patch at night to help sleep? It feels like sleeping and getting tired is normalizing....If I get 7 hours or less sleep a night, I feel a little tired in the day, and like a nap - I've taken some lengthy naps - 2 hours but i dont want the nap to interfere with my bed time, so I started "power napping" yesterday - 20 minutes!
I have more, but i have to get the me and the toddler off to swimming lessons this morning!
-Bright
Posted by undopaminergic on May 7, 2008, at 14:30:34
In reply to Re: EMSAM Success Story, posted by KarenRB53 on May 7, 2008, at 9:18:42
> Does anyone know if EMSAM raises blood pressure? My pdoc is so cautious because I have high blood pressure (which is being treated and its consistently great now.)
>On the contrary, MAOIs (such as EMSAM) usually lower blood pressure - sometimes excessively. On the other hand, they can interact with certain foods and drugs to produce hypertensive effects.
Posted by KarenRB53 on May 7, 2008, at 14:53:38
In reply to Re: EMSAM Success Story, posted by undopaminergic on May 7, 2008, at 14:30:34
> > Does anyone know if EMSAM raises blood pressure? My pdoc is so cautious because I have high blood pressure (which is being treated and its consistently great now.)
> >
>
> On the contrary, MAOIs (such as EMSAM) usually lower blood pressure - sometimes excessively. On the other hand, they can interact with certain foods and drugs to produce hypertensive effects.Thanks, great to know about the blood pressure. I've read that EMSAM (MAOIs) are good for atypical depression, do you agree?
Karen
Posted by BrightEyed+Blueberry on May 7, 2008, at 15:15:25
In reply to Re: EMSAM Success Story, posted by KarenRB53 on May 7, 2008, at 14:53:38
Yes I would agree EMSAM (and MAOIs in general, as goes the latest research) is good for atypical depression! As that is how I would explain me--I had "reversed" vegetative symptoms - I could sleep all night and *then* all day + a nap for good measure!--and I loved to eat. (Still like to eat!) And there is the distinction (from "melancholic" depression) of having mood reactivity I could always experience improved mood in response to happy occurrences.
Then there is that stuff about rejection sensitivity--check that box for me (who isn't a little rejection-sensitive?--but is that an esteem issue or co-dependent issue...for me anyways....I now can try to "not care better"--remain functional by cognitively deciding not to behave/ reacting / dwelling on rejection, and then feelings wax and wane as it is so...but I digress)--but not sure if that characteristic is still technically on the table.
Why it's called "atypical" when it's pretty common--especially in women, for some reason, I don't know.
I've read a bunch of research by a doctor named...last name is Thase...I may have the articles and can post some pointers to them or email them or whatever the protocol is here if anyone's interested....
Posted by KarenRB53 on May 7, 2008, at 15:36:20
In reply to Re: EMSAM Success Story » KarenRB53, posted by BrightEyed+Blueberry on May 7, 2008, at 15:15:25
> Yes I would agree EMSAM (and MAOIs in general, as goes the latest research) is good for atypical depression! As that is how I would explain me--I had "reversed" vegetative symptoms - I could sleep all night and *then* all day + a nap for good measure!--and I loved to eat. (Still like to eat!) And there is the distinction (from "melancholic" depression) of having mood reactivity I could always experience improved mood in response to happy occurrences.
>
> Then there is that stuff about rejection sensitivity--check that box for me (who isn't a little rejection-sensitive?--but is that an esteem issue or co-dependent issue...for me anyways....I now can try to "not care better"--remain functional by cognitively deciding not to behave/ reacting / dwelling on rejection, and then feelings wax and wane as it is so...but I digress)--but not sure if that characteristic is still technically on the table.
>
> Why it's called "atypical" when it's pretty common--especially in women, for some reason, I don't know.
>
> I've read a bunch of research by a doctor named...last name is Thase...I may have the articles and can post some pointers to them or email them or whatever the protocol is here if anyone's interested....Thanks for the information and I'd appreciate any info you have by Dr. Thase if you have it. I'll check the internet also.
Karen
Posted by undopaminergic on May 7, 2008, at 18:58:10
In reply to Re: EMSAM Success Story, posted by KarenRB53 on May 7, 2008, at 14:53:38
>
> Thanks, great to know about the blood pressure. I've read that EMSAM (MAOIs) are good for atypical depression, do you agree?
>
> KarenYes - indeed, some definitions of atypical depression is based on the fact that it responds better to MAOIs than tricyclics (or SSRIs, probably).
Posted by BrightEyed+Blueberry on May 7, 2008, at 21:20:47
In reply to Re: EMSAM Success Story, posted by KarenRB53 on May 7, 2008, at 15:36:20
Here's the TOC, a link, and summation:
VOLUME 68 2007 SUPPLEMENT 3
Atypical Depression:
Management Challenges and
New Treatment Advances
***************************TOC:
-Introduction: New Directions in the Treatment of Atypical Depression.
-A History of the Concept of Atypical Depression.
-Atypical Depression: A Valid Subtype?
-Treating Depression With Atypical Features.
-Translating the Evidence on Atypical Depression Into Clinical Practice.
***************************LINK:
Go here and login - you can register for a free account.http://www.psychiatrist.com/elerts/cme022007/cme022007.htm
If you have any trouble, I have the PDFs....very informative stuff dates February 2007....
***************************SUMMARY:
2.20.07 From the desk of Sebastian . . .
Atypical Depression: Management Challenges and New Treatment Advances Michael E. Thase, MD (Chair)
Atypical depression is common and occurs in almost all clinical settings; at least one seventh of patients, and sometimes as many as one third, have been shown to have atypical depression according to DSM-IV criteria. Read this new Supplement to learn about the evolution and the validity of the concept of atypical depression, as well as pharmacologic interventions to effectively treat your patients with this disorder. This CME activity is free.Supplements are compilations of evidence-based articles that fully explore topics of clinical significance to help you improve care for your patients.
> Yes I would agree EMSAM (and MAOIs in general, as goes the latest research) is good for atypical depression! As that is how I would explain me--I had "reversed" vegetative symptoms - I could sleep all night and *then* all day + a nap for good measure!--and I loved to eat. (Still like to eat!) And there is the distinction (from "melancholic" depression) of having mood reactivity I could always experience improved mood in response to happy occurrences.
> >
> > Then there is that stuff about rejection sensitivity--check that box for me (who isn't a little rejection-sensitive?--but is that an esteem issue or co-dependent issue...for me anyways....I now can try to "not care better"--remain functional by cognitively deciding not to behave/ reacting / dwelling on rejection, and then feelings wax and wane as it is so...but I digress)--but not sure if that characteristic is still technically on the table.
> >
> > Why it's called "atypical" when it's pretty common--especially in women, for some reason, I don't know.
> >
> > I've read a bunch of research by a doctor named...last name is Thase...I may have the articles and can post some pointers to them or email them or whatever the protocol is here if anyone's interested....
>
> Thanks for the information and I'd appreciate any info you have by Dr. Thase if you have it. I'll check the internet also.
> Karen
Posted by Nadezda on May 8, 2008, at 13:40:45
In reply to Re: EMSAM Success Story, posted by KarenRB53 on May 7, 2008, at 15:36:20
Although Maois lower blood pressure, Emsam raises mine after I take it-- although it goes down after a little while.
That's probably not a typical response-- but I've observed it, more at some times than others.
So it's something you should at least check for at first, if you do start Emsam.
Maois are thought to begood for atypical depression-- that's why my pdoc prescribed them for me.
Nadezda
Posted by BrightEyed+Blueberry on May 8, 2008, at 14:02:52
In reply to Re: EMSAM Success Story » KarenRB53, posted by Nadezda on May 8, 2008, at 13:40:45
Nadezda,
When do you measure your blood pressure = how soon after you patch the EMSAM do you note the rise in blood pressure? And, when does it go down--and does it go down to your normal level or lower?
I haven't bothered to measure mine, but maybe it's a good idea to? Or would I *know* -- feel it if my blood pressure were rising? Could that be what the initial 4 hours of feeling really impatient and kinda tense in that amphetamine-way have been about, the first couple weeks I was on EMSAM?
I should probably check only because I was reading pretensive (?) on blood pressure but that was last fall when my weight was up and since then I've lost at least 10 pounds and been exercising fairly regularly (3x/week, not hardcore-no stamina for more than 20 min on treadmills, while on my blackberry/listening to books on my iPod, and then another 20 minutes on strength machines and situps. Then stretching - love stretching - feels good - you're done with the exercise, on the floor, practically nap-ready--best part of exercising!)
-Bright
***> Although Maois lower blood pressure, Emsam raises mine after I take it-- although it goes down after a little while.
>
> That's probably not a typical response-- but I've observed it, more at some times than others.
>
> So it's something you should at least check for at first, if you do start Emsam.
>
> Maois are thought to begood for atypical depression-- that's why my pdoc prescribed them for me.
>
> Nadezda
Posted by KarenRB53 on May 8, 2008, at 14:45:08
In reply to Re: EMSAM Success Story » KarenRB53, posted by Nadezda on May 8, 2008, at 13:40:45
> Although Maois lower blood pressure, Emsam raises mine after I take it-- although it goes down after a little while.
>
> That's probably not a typical response-- but I've observed it, more at some times than others.
>
> So it's something you should at least check for at first, if you do start Emsam.
>
> Maois are thought to begood for atypical depression-- that's why my pdoc prescribed them for me.
>
> NadezdaSorry to jump in,but I was wondering how the MAOIs are working for you atypical depression?
Thanks,Karen
Posted by undopaminergic on May 9, 2008, at 10:43:32
In reply to Re: EMSAM Success Story » Nadezda, posted by BrightEyed+Blueberry on May 8, 2008, at 14:02:52
>
> I haven't bothered to measure mine, but maybe it's a good idea to?
>Yes, because if it's consistently high, it's a good idea to do something about it.
> Or would I *know* -- feel it if my blood pressure were rising?
>Severe elevation - hypertensive crisis - can be felt as headache, affecting the back of the head in particular; this needs to be treated promptly. Moderate increases need not be readily noticeable, but tachycardia with palpitations is a hint, and so is reduced heart rate with coldness of peripheral body parts such as fingers, toes and nose.
Posted by BrightEyed+Blueberry on May 11, 2008, at 23:48:01
In reply to Re: EMSAM Success Story, posted by undopaminergic on May 9, 2008, at 10:43:32
Here's where I'm at, via an old post by Sharzi (wonder how she's doing?):
*stars are mine*
***
- posted by Sharzi on July 19, 2006, at 20:21:13MAOIs are notorious for causing *midafternoon drowsiness* during the *ramp-up phase,* though typically they produce *nighttime insomnia at the same time*. In any case, for most people, this *diminishes over time*. I hardly slept the first month I was on Parnate, except for the hour to hour and a half of sleep that seemed unavoidable in the middle of the afternoon. Then one night suddenly everything was *back to normal and I both slept well at night and stayed awake all day*.
***
I'm holding onto that "ramping up phase" bit, the "diminishes over time," and her sudden return to normal. Maybe my blood pressure is low, because now I'm experiencing daytime fatigue AND almost a return of...apathy? or..dare I say it...depression? What I mean is, since Wednesday - probably the anniversary of my 6 weeks on 6mg EMSAM, well, that was the last day I exercised. I've had no desire to exercise for 5 days and I've been totally fatigued mid-day, taking restless nap (disturbed by toddler, what can i do?- spending time at grandmas so i can get help with sleep and fatigue and care of toddler-lucky for that)It's like a return to .... my atypical depression for the last few days. So, now I still have the trouble getting to bed, staying asleep (waking up early and sleeping restlessly next couple hours). I wake up tired and not wanting to be up (almost wishing for sbility to take small dose of Wellbutrin XL for its past "wake-up- bright" ability, no naps or decline in energy, just very steady, tho no anti-dep effects)
Could be the xanax and neurontin I've been varying to help with the sleep (Even though I've cut the doses way down) are amplifying the morning/ daytime hangover they always caused in past. i prefer them prn for anxiety/social anxiety situations, NOT sleep. xanax is so short lasting its no wonder more chance I'd wake up middle of night - 4 hours later, like 4am-5am.... so no more that.
I know I;m not making sense...kind of too tired to. Exercise helped me feel better - amplified my mood if you will, kept me from getting daytime-tired.
I feel like locking my sleeping meds in my safe deposit box 15 miles away (hey - price of gas here $4/gallon its practically $10 to get it!), just shrugging on some ugly dark drapes over my windows for tonight, forcing myself to sleep early, turning computer off (doc says light emanating from tv/computer is stimulating, vs. reading a book (better to read book) - i think she's right, never mind interactivity of internet.).... remembering to take off the patch, and do this every night and just wait this it out....
I've read others have had this side effect with daytime fatigue and that it passes - especially if it takes perhaps a couple months to stabilize. I expect to go through all kinds of changes. (what makes people decide to go up to 9mg? not ready for that yet, unless this is where im stuck)....I just hope that THIS (insomnia/daytime fatigue/no energy to exercise or care/ feeling cranky-irritable) goes away. And without adding meds to the mix.
Though, I'm adding food to the mix--cookies and chocolate and brownies and milk--cuz I'm bummed out you know? nice combo with the exercise lack. And i was doing so well, 6 week stride of normalcy, not hypomanic, just normal!
Totally back to the atypical depression exacerbated by nighttime insomnia! Don't take away my night time sleep, is what I ask of any meds I take - I'm a firm believer in getting enough sleep, and in its place - for me, that's night. I'd be a depressed MONSTER if it wasnt for sleep all these years!
This post - maybe nonsensical, but i don't care. Maybe good nights sleep and over next few days can get things to stabilize.
That's where I'm at.
off for milk and cookies (last week, I would've walked the 3 miles to the store and back to "compensate" for sweets.)
L/L
-Bright (?!)> >
> > I haven't bothered to measure mine, but maybe it's a good idea to?
> >
>
> Yes, because if it's consistently high, it's a good idea to do something about it.
>
> > Or would I *know* -- feel it if my blood pressure were rising?
> >
>
> Severe elevation - hypertensive crisis - can be felt as headache, affecting the back of the head in particular; this needs to be treated promptly. Moderate increases need not be readily noticeable, but tachycardia with palpitations is a hint, and so is reduced heart rate with coldness of peripheral body parts such as fingers, toes and nose.
Posted by BrightEyed+Blueberry on June 5, 2008, at 3:10:15
In reply to Re: EMSAM Success Story » undopaminergic, posted by BrightEyed+Blueberry on May 11, 2008, at 23:48:01
Its Bright again posting to my May 11th self....I wonder if what I was experiencing --the sudden onset of my atypical depression after 6 weeks of pretty excellent EMSAM response --was really just...PMS. So now the men aren't interested but could the interplay of hormones have THAT much of an effect on my EMSAM response? I am 35 and really never experienced PMS the way most women Iknew did...not that I was AWARE of anyway (What with being depressed a lot all the time, or being on half hearted SSRI medications, etc.) Obviously if I've always had some symptoms of PMS, they were too light to notice any regularity of occurrence. I was never in pain lying on the couch with my "special" bag of chocolates.... That probably because I was always eating sweets, so who'd know if I was PMSing (boyfriends?!).
But, it fits - the sudden onset of: daytime fatigue, a 3-day binge (voracious and uncontrollable) on bakery fresh and chewy chocolate chip cookies, Straight-up feelings of depression-lack of interest in things-isolating from friends behavior. Very similar to my atypical depression - except this time I'm not actually able to really sleep (in that, ahhh, escape, comfortably under the covers and lose myself from the world way) during my daytime fatigue, and nights still difficult.
So, jury is out for -- wow time flies-- only another couple of days. I should note/calendar if the same things happen again, to note a possible relationship to PMS. But it doesn't make sense to me why an anti-depressant such as EMSAM, an MAOI, would not HELP PMS symptoms, not allow them to break through! They even prescribe that serafim (same ingredients as prozac I believe) for women who suffer PMS, to take only that 1 week of the month, and I guess it works?
We'll see if hormones are somehow wreaking havoc, or if my sudden fall into depression just coincided with an oft-described EMSAM "ramp down" phase that some people have experienced after their initial 6 weeks on it (as described by me and a former poster from 2006, below)
If anyone has any thoughts on this, I'd be curious. Hormones are similar to neurotransmitters, right? But more...systemic? I've forgotten my psychobiology.....
-B+B
> Here's where I'm at, via an old post by Sharzi (wonder how she's doing?):
>
> *stars are mine*
>
> ***
> - posted by Sharzi on July 19, 2006, at 20:21:13
>
> MAOIs are notorious for causing *midafternoon drowsiness* during the *ramp-up phase,* though typically they produce *nighttime insomnia at the same time*. In any case, for most people, this *diminishes over time*. I hardly slept the first month I was on Parnate, except for the hour to hour and a half of sleep that seemed unavoidable in the middle of the afternoon. Then one night suddenly everything was *back to normal and I both slept well at night and stayed awake all day*.
>
> ***
>
>
> I'm holding onto that "ramping up phase" bit, the "diminishes over time," and her sudden return to normal. Maybe my blood pressure is low, because now I'm experiencing daytime fatigue AND almost a return of...apathy? or..dare I say it...depression? What I mean is, since Wednesday - probably the anniversary of my 6 weeks on 6mg EMSAM, well, that was the last day I exercised. I've had no desire to exercise for 5 days and I've been totally fatigued mid-day, taking restless nap (disturbed by toddler, what can i do?- spending time at grandmas so i can get help with sleep and fatigue and care of toddler-lucky for that)
>
> It's like a return to .... my atypical depression for the last few days. So, now I still have the trouble getting to bed, staying asleep (waking up early and sleeping restlessly next couple hours). I wake up tired and not wanting to be up (almost wishing for sbility to take small dose of Wellbutrin XL for its past "wake-up- bright" ability, no naps or decline in energy, just very steady, tho no anti-dep effects)
>
> Could be the xanax and neurontin I've been varying to help with the sleep (Even though I've cut the doses way down) are amplifying the morning/ daytime hangover they always caused in past. i prefer them prn for anxiety/social anxiety situations, NOT sleep. xanax is so short lasting its no wonder more chance I'd wake up middle of night - 4 hours later, like 4am-5am.... so no more that.
>
> I know I;m not making sense...kind of too tired to. Exercise helped me feel better - amplified my mood if you will, kept me from getting daytime-tired.
>
> I feel like locking my sleeping meds in my safe deposit box 15 miles away (hey - price of gas here $4/gallon its practically $10 to get it!), just shrugging on some ugly dark drapes over my windows for tonight, forcing myself to sleep early, turning computer off (doc says light emanating from tv/computer is stimulating, vs. reading a book (better to read book) - i think she's right, never mind interactivity of internet.).... remembering to take off the patch, and do this every night and just wait this it out....
>
> I've read others have had this side effect with daytime fatigue and that it passes - especially if it takes perhaps a couple months to stabilize. I expect to go through all kinds of changes. (what makes people decide to go up to 9mg? not ready for that yet, unless this is where im stuck)....I just hope that THIS (insomnia/daytime fatigue/no energy to exercise or care/ feeling cranky-irritable) goes away. And without adding meds to the mix.
>
> Though, I'm adding food to the mix--cookies and chocolate and brownies and milk--cuz I'm bummed out you know? nice combo with the exercise lack. And i was doing so well, 6 week stride of normalcy, not hypomanic, just normal!
>
> Totally back to the atypical depression exacerbated by nighttime insomnia! Don't take away my night time sleep, is what I ask of any meds I take - I'm a firm believer in getting enough sleep, and in its place - for me, that's night. I'd be a depressed MONSTER if it wasnt for sleep all these years!
>
> This post - maybe nonsensical, but i don't care. Maybe good nights sleep and over next few days can get things to stabilize.
>
> That's where I'm at.
>
> off for milk and cookies (last week, I would've walked the 3 miles to the store and back to "compensate" for sweets.)
>
> L/L
> -Bright (?!)
>
>
>
> > >
> > > I haven't bothered to measure mine, but maybe it's a good idea to?
> > >
> >
> > Yes, because if it's consistently high, it's a good idea to do something about it.
> >
> > > Or would I *know* -- feel it if my blood pressure were rising?
> > >
> >
> > Severe elevation - hypertensive crisis - can be felt as headache, affecting the back of the head in particular; this needs to be treated promptly. Moderate increases need not be readily noticeable, but tachycardia with palpitations is a hint, and so is reduced heart rate with coldness of peripheral body parts such as fingers, toes and nose.
>
>
Posted by atmlady on July 17, 2008, at 16:37:13
In reply to Re: EMSAM Success Story » BrightEyed+Blueberry, posted by BrightEyed+Blueberry on June 5, 2008, at 3:10:15
Bright, how are you doing with your EMSAM? Did the magic of the first 6 weeks ever return? Still on 6mg? You may have posted elsewhere and I missed it .....
Posted by BrightEyed+Blueberry on July 19, 2008, at 11:25:18
In reply to Re: EMSAM Success Story » BrightEyed+Blueberry, posted by atmlady on July 17, 2008, at 16:37:13
At 6 weeks or so, magic seemed to wear off at the 6mg level. Not sure if it was coincidence (I don't know if I've heard of 6 week poop out; mostly seems to be that it starts working right away, at 2-3 weeks, or at 6 weeks, or "give it 3 months" to start working- that's what I can recall, I think....what have you heard? And poop out seems to take a ...i dont know, year+?
It coincided, pardon me, with PMS/"period" week....though why that would effect it and not return to feeling ok perhaps after the week of excess/crazy hormones doesn't make sense to me. And, why wouldn't being on the EMSAM help me have a less distressing/depressed period - they prescribe fluoxetine (under the name S....? instead of "Prozac") for PMS, to be taken only just before or during that week of symptoms - so that anti-depressant , if that helps some women, makes me think the PMS is soothed by something serotonin-related (that doesn't require the 4-6 weeks of being on an SSRI continuously to work, like a total rebalancing of the neurotransmitters).
EMSAM at 6mg, being an MAO-b inhibitor, is only hitting dopamine among others, and doesn't hit MAO-a inhibitory effects--serotonin/norep--until the dosage is raised to at least 9mg--is my understanding. So, dopamine didnt help my period in any case!
Maybe it only felt like a really depressing PMS (cuz I never got PMS symptoms previously - noticeable to ME, anyhow--though wouldn't be surprised if I was irritable towards others but didn't notice myself!--because I was doing quite all right, and then had farther to fall--so I really noticed.
Plus, I stopped exercising (its a commonly used excuse I notice I use to take a break from exercising in general--pain is, physical). Worse yet it seemed I began to eat sweets like crazy, bags of cookies and gallons of milk like I couldn't stop! Whereas, the first 6 weeks of EMSAM my willpower kept me going with exercising and monitoring and being disciplined with food, eating salads, drinking water, taking vitamins, being consistent with good habits in general. --so after 6 weeks of positive behavior, I felt really bad and couldn't get back on that horse....
I'm not overweight; though I would like to shed 15+ pounds-I'm 5'6" and 140 lbs. Which is also depressing though, to me, because pre-pregnancy I was 115-120.
EMSAM - is it making me voracious for sugar or fats possibly? I've noticed others being hungry on EMSAM, and noticed others the exact opposite. I'm noticed excess energy, and then noontime naps. I've seemed to experience both....
So, perhaps at around 6 weeks the EMSAM was finally really "settling in" - and its working so effectively, so quickly, initially for those 6 weeks - could that have been more of a side-effect? And then hitting the wall at 6 weeks--maybe that an indication I need a higher therapeutic dosage?
Anyway, I'm supposed to go up to 9mg but I've kind of lagged on that. However, as things haven't changed, (I started "coping" by over-relying on my xanax) - relying on meds depresses me further! Xanax doesn't depress me like klonopin, but I have less energy, and using it regularly instead of sporadically prn seems to lessen its therapeutic benefits for me - I become avoidant)--Im working up to starting 9mg in a week.
I'm kind of scared to go to 9mg - I feel like I'll be into a more dangerous med situation - like Nardil, Parnate - "real" MAOIs. The kind when you first start out on the AD treadmill, and you read overviews about the meds, and you're like, <shudder> geez, I'm never gonna get to THAT class of meds...and you settle in for the SSRIs to do the trick, as even getting to that point, for some of us, was quite a ... an acceptance. Back then, it was, everyone else was on Prozac, it could never be me. now its like, i hope it works for you and you don't have to continue down the road and your depression clears up with good habits and CBT and you can get off the pills in 6 months and lead a normal life again.
So...9mg next, and I don't know if I've gotten much of a response to what to expect in terms of sexual dysfunction at the higher dosage. I dont want that.
Thanks for asking. You thinking about it/have experience with EMSAM/the other MAOIs?
-Bright
> Bright, how are you doing with your EMSAM? Did the magic of the first 6 weeks ever return? Still on 6mg? You may have posted elsewhere and I missed it .....
Posted by SLS on July 19, 2008, at 13:33:11
In reply to Re: EMSAM Success Story » atmlady, posted by BrightEyed+Blueberry on July 19, 2008, at 11:25:18
I'm not 100% sure, but I believe that at 6mg/24hr, MAO-A is inhibited in the brain, even if not in the GI tract. The package insert says that Emsam inhibits both isoforms at antidepressant dosages. I think this is an important statement when trying to hypothesize what mechanism one is responding to.
"MAO exists as two isoenzymes, referred to as MAO-A and MAO-B. Selegiline has a greater affinity for MAO-B, compared to MAO-A. However, at antidepressant doses, selegiline inhibits both isoenzymes (see below)."
http://www.rxlist.com/cgi/generic/emsam_cp.htm
- Scott
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