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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 evenintherain on January 12, 2010, at 16:57:29
Hi,
I am about to start a new drug to try to help my MDD (unipolar) after failing to get much relief from many others (prozac, wellbutrin, nortriptyline, celexa, lamictal, remeron, cymbalta, maybe a few others i am forgetting at the moment.)
I've got anhedonia and chronic dysthymia and cry easily when thinking about all this stuff -- I guess it seems very overwhelming. I tend also to get obsessed with suicide when I am not on drugs, but luckily I am not obsessed with that at the moment (I do think about it daily, but not AS obsessed as I have frequently gotten, and I do not have any plans or anything). My main problem seems to be lack of motivation, trouble getting out of bed, etc. I am currently unemployed, which doesn't help matters.
Anyway, sorry, I don't mean to make this longer than it has to be, just thought some background might be helpful.
My pdoc suggested I try Parnate, but i have some time to think about this since i am withdrawing from Cymbalta now (on week 7 of taper, having a very very difficult time coming off this drug) and have to wait 2 weeks for the wash out.
It looks like a lot of people on here (and elsewhere) have found some relief with Parnate, and i definitely think this is a good option, but i have a few reservations. The most notable being the diet. I know it should be no big deal, and finding a drug that works is worth some sacrifice. But I am still a little bit reluctant. This is because the only foods I really enjoy eating, besides sugar, are cheese (stinkier = better) and tofu. I am a vegetarian and these are my main sources of protein. I have been taking note of what I eat at every meal and comparing that to the MAOI diet and am feeling very discouraged. I know it is possible to eat a vegetarian MAOI diet. It's just it has taken me a very long time to come up with the diet i have now, and to be enjoy eating food at all. Now pretty much the only pleasure i get is from food (this is strange for me to say, as i spent most of my life disliking food and wishing it could come in pill form). I guess I would just hope that I could experience other pleasures on Parnate?
This might be a good time to ask, how common are sexual side effects w/Parnate?
Has anyone on here had any lasting success with Emsam? I know you still have to watch your diet on the higher doses, but on the off chance a smaller dose works, do you think this would be worth trying first?
I have delayed sleep phase syndrome (this is like having constant jet-lag, i have a lot of trouble getting to sleep before morning). Parnate generally causes insomnia. Does Emsam as well?
I am very curious about stimulants. I don't know if my doctor would be willing to prescribe Dexedrine, (I suspect I would have to be very persuasive and I am not very good at being persuasive), but have a feeling it could really help me. Being able to get out of bed would be HUGE. I have also read it can be added to Parnate in some cases (or vice versa). I know there are many worries about dependence and abuse. I admit I have some trouble seeing the difference between dependence on this drug and any other AD, but that may be very naive of me to say. I suspect there is a possibility of mood swings (this definitely would NOT be helpful)?
On a final note, I am really scared of starting Parnate and it not working. Or of taking it for some time and having to stop because of the side effects and than if i started it again later there is no garuantee it would work the second time. I know it is not the ACTUAL last chance, but it seems it's getting close, and i find that very scary.
Anyway, any comments or advice you would be willing to share would be immensely appreciated.
Thanks!
Posted by desolationrower on January 13, 2010, at 10:35:42
In reply to Need advice - Parnate, Emsam, Dexedrine?, posted by evenintherain on January 12, 2010, at 16:57:29
i found tranylcypromine to help a lot with delayed phase sleep thingie, both because i'd wake up better, and being tired in the evening helped improve sleep hygine.
-d/r
Posted by evenintherain on January 14, 2010, at 10:50:39
In reply to Re: Need advice - Parnate, Emsam, Dexedrine?, posted by desolationrower on January 13, 2010, at 10:35:42
thanks, d/r.
i will look into it.
Posted by em_kath on January 19, 2010, at 10:52:49
In reply to Need advice - Parnate, Emsam, Dexedrine?, posted by evenintherain on January 12, 2010, at 16:57:29
I am in a similar situation where I'm considering Parnate and it is a difficult decision with the risks. I am leaning towards switching to it because, like you, I am starting to think of it as one of the few options left (I have tried many, many different medications with little to no success), and I have heard that it's pulled people out of deep depression after nothing else worked. I have been on Emsam for 6 or 7 weeks and I have not had success on the lowest 6mg dose or the dose that I am on now, the 9mg. But the transdermal delivery largely makes the diet a nonissue. I know to be on the safe side you are supposed to follow the diet on the higher doses, and while I started out following the diet on 9mg, I have gradually been eating more 'forbidden' foods and I am currently not following the diet very strictly at all (though I have been too scared to try aged cheese, I eat most cheeses without worry). I have heard from others that the dietary restrictions are only a precaution on Emsam and that there have been no reports of hypertensive crisis. However I am not on the higher 12mg dose, so I can't say if it becomes an issue then. One of the few positive things I have noticed on Emsam is that I sleep very well. Also, there don't seem to be any sexual side effects (FYI I am female). The only real side effect I have experienced (aside from a reduced tolerance to alcohol) is orthostatic hypotension, where if I stand up too quickly I lose vision for a few seconds and get lightheaded, and yesterday morning I lost my vision for a few minutes before it returned (and fainted for a moment). But this is not unique to Emsam, it can be a side effect with all MAOIs.
So my experience with Emsam has not been satisfactory, and I have decided to switch. Whether I switch to Parnate or something else will depend on the recommendations of my psychiatrist. I have not heard many positive things about Emsam, though I suppose it must be helping somebody or it wouldn't be on the market. I am not convinced that it is strong enough for severe depression, which I have, and you seem to have. If I could go back, I would not bother with Emsam, but of course you might react differently to it than I did, and since you are so concerned about the diet it might be worth a try. If it doesn't work, you could always upgrade to Parnate, but I think that requires another washout period that I am personally not looking forward to. It's always a tough decision with MAOIs. I hope things work out for you and you find something that helps!
Posted by evenintherain on January 19, 2010, at 16:11:45
In reply to Re: Need advice - Parnate, Emsam, Dexedrine? » evenintherain, posted by em_kath on January 19, 2010, at 10:52:49
Thanks a lot for your response. Sorry the Emsam hasn't worked for you. It's helpful to know that you wouldn't bother if you had to do this over.
After doing some research (mostly searching the archives here) it seems like Emsam takes forever to work (10 - 11 weeks?!) for some people. Who can afford to wait that long when there's no guarantee it'll even help? Especially after any washout period. That is very frustrating.i guess i'm going to try parnate. goodbye ethnic food :(
I don't understand why a Parnate patch hasn't been made yet.
Posted by em_kath on January 19, 2010, at 23:25:35
In reply to Re: Need advice - Parnate, Emsam, Dexedrine? » em_kath, posted by evenintherain on January 19, 2010, at 16:11:45
> Thanks a lot for your response. Sorry the Emsam hasn't worked for you. It's helpful to know that you wouldn't bother if you had to do this over.
> After doing some research (mostly searching the archives here) it seems like Emsam takes forever to work (10 - 11 weeks?!) for some people. Who can afford to wait that long when there's no guarantee it'll even help? Especially after any washout period. That is very frustrating.
>
> i guess i'm going to try parnate. goodbye ethnic food :(
> I don't understand why a Parnate patch hasn't been made yet.
>It really is SO frustrating to have to wait weeks to months for these medications to supposedly kick in, only to find they don't work and you have to start over. I've done that so many times and it's very discouraging. But what else can we do? We have to keep trying in hopes of getting some relief eventually. Good luck, I hope Parnate works for both of us!
Posted by MoonageDaydream on January 20, 2010, at 17:02:18
In reply to Need advice - Parnate, Emsam, Dexedrine?, posted by evenintherain on January 12, 2010, at 16:57:29
For what its worth, I also have delayed sleep phase syndrome, and Emsam 6mg/24hr didn't aggrevate this. Some people do get insomnia, anxiety, or agitation from it, though. Sexual side effects are uncommon at the 6mg dose, but they might be more frequent at higher doses where it increases serotonin more. I think it actually increased my libido. I didn't get a strong antidepressant effect, but the lack of side effects was great, and it didn't make me more apathetic and unmotivated like SSRIs. I'd still be taking it but it didn't help my ADD, and mixing MAOIs w/ stimulants is usually not something docs are willing to do.
Posted by aminated on January 22, 2010, at 17:47:13
In reply to Re: Need advice - Parnate, Emsam, Dexedrine?, posted by MoonageDaydream on January 20, 2010, at 17:02:18
DOES ANYBODY ON THIS BOARD understand that Emsam is selegeline (generic name), a drug that has been available even in the US for decades (brand name Eldepryl), and that the generic price of it in tablet form is about 60 cents a day--I just looked up Emsam's price online, and it's over $18.00/patch. Exact same drug, the patch just saves you from the ordeal of having to swallow a pill--and just once a day at that. Who on earth would pay almost $20.00 a day for that 'convenience'? I eat whole mouthfuls of food every day and it's never seemed an inconvenience to me. America's pharm companies know how ignorant their customers are, and how complacent their doctors are (not to mention stupid as well). Don't forget doctors' complacency in this ripoff. (Selegeline pills are actually pretty good antidepressants, certainly worth trying. Until Emsam was marketed selegeline was only used HERE as a treatment for Parkinson's.(It's a 'selective MAO inhibitor'--MAOI, just no dietary restrictions up to about 40 mg/day; antidepressant doses are much lower than that). This is such a stupid country, and psychiatry is an excellent example. Just go to www.deprenyl.net to learn more.
Posted by MoonageDaydream on January 23, 2010, at 15:25:42
In reply to EMSAM IS AN ASTOUNDING RIPOFF, posted by aminated on January 22, 2010, at 17:47:13
The Emsam patch has 74% bioavailability and keeps selegeline levels steady, whereas the pill has 4% bioavailability and peaks and troughs. What this means is you get WAY more selegeline in your system with Emsam. If you take the pill, much more is metabolized into l-methamphetamine, which basically just causes side effects. Emsam allows for selegeline levels that inhibit both MAO-B and MAO-A, and for a lot of people, MAO-A inhibition is necessary for any antidepressant response. By being a patch it avoids the necessity of dietary restrictions.
If I didn't have insurance, though, I'd almost certainly go for selegeline in the tablet form, because Emsam is ridiculously expensive.
This is the end of the thread.
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