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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by TriedEveryMedication on January 19, 2016, at 14:45:58
currently on emsam 6mg patch. seems to help with depression ok, but I also suffer from ADD/low motivation.
desipramine has been the best drug for me for ADD, but my pdoc doesn't think it can be safely combined with emsam due to 5-HT action of the desipramine.
I've had mixed results with adderall - gets me motivated, but I end up just getting more distracted.
Any ideas for emsam augmentation?
I was considering trying a tiny sliver of a 10mg desipramine pill, but I'm kinda scared. Several years ago I had what I think was really minor serotinin syndrome on desipramine and paxil, and it was really terrible.
Posted by Christ_empowered on January 19, 2016, at 15:11:54
In reply to What can safely augment Emsam?, posted by TriedEveryMedication on January 19, 2016, at 14:45:58
maybe Vyvanse? Evekeo? There are a couple amphetamine preparations out there. Ritalin could be an option, too, I think...
Good luck!
Posted by linkadge on January 19, 2016, at 16:11:41
In reply to Re: What can safely augment Emsam?, posted by Christ_empowered on January 19, 2016, at 15:11:54
What about PEA with emsam? Have you heard of PEA?
Linkadge
Posted by SLS on January 19, 2016, at 16:55:11
In reply to What can safely augment Emsam?, posted by TriedEveryMedication on January 19, 2016, at 14:45:58
My vote is to add desipramine. Amphetamine, methylphenidate, bupropion, atomoxetine, or modafinil would be safe, too.
> desipramine has been the best drug for me for ADD, but my pdoc doesn't think it can be safely combined with emsam due to 5-HT action of the desipramine.
Desipramine is one of the most selective norepinephrine reuptake inhibitors (NRI) drugs available. It does not work directly on 5-HT at therapeutic dosages. For some people, it is the best ADD medication out there and is known to help increase motivation. I am dismayed that your doctor would say such a thing. Perhaps we expect too much from our doctors. There is a lot to know. Besides, using such combinations is something only the older psychiatrists would be familiar with. What can you do to change his mind about desipramine? I am currently taking Parnate with desipramine. Desipramine and nortriptyline are the two tricyclic antideperessants that combine well with MAOIs.
I guess you should use Google and Medline/PubMed to assemble a case for combining MAOIs with TCAs. Do not use imipramine or clomipramine. They are too serotonergic. I doubt you will find anything regarding Emsam specifically. It came along a little too late. No investigator would be motivated to study its use in combination with a TCA. Although I can't personally vouch for the Emsam + desipramine combination, I can't think of any reason why Emsam would be any less safe than Parnate, Nardil, or Marplan.
- Scott
This is the end of the thread.
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