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Old 07-19-2006, 04:14 PM   #16
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Re: Has anyone talked to their doctor about EMSAM?

i've been on it for two weeks with good results. not yet great, but good results. i am on a high dose. as for the dietary restrictions, with the lower therapeutic dose of the patch, none are required. additionally, the diet list was modified down several years ago for maoi's, and some have no problems with any of the foods. i am one of those. but the restrictions are not to be taken lightly until you have become familiar with whaat you can handle.

selegiline (0rally) has been around for years and used to treat parkinson's. years ago, when i first learned about the selegiline patch starting clinical trials for depression, i got my cutting-edge p-doc to prescribe the oral pills for me and for the first time in several years i was depression free and a new, active, confident person. after about 1 3/4 years, while under the stress of divorce, the meds stopped working. since then, (5 years ago) i have had severe depression. the new patch, after being off the oral pills for a while, appears to be helping again. for me, selegiline has been the best drug i've ever found. i hope i return again to comfortable mental functioning. i am optimistic. Note: the MAOI's work especially well on "ayptical depressions." check with your docs to see if it might good for you. good luck to us both.

please forgive typo's and errors. am using a new laptop and am not quite used to it's pecularities.>smile<

 
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Old 07-19-2006, 06:04 PM   #17
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Re: Has anyone talked to their doctor about EMSAM?

Good to hear... What dose are you taking? What have you tried in the past? Does you doctor have a favorable opinion about EMSAM? I'm wondering if it has any sort of reputation yet within the medical community, positive or negative. I hope my doctor has at least heard of it! I have, so he should too, right?

 
Old 07-20-2006, 05:28 AM   #18
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Re: Has anyone talked to their doctor about EMSAM?

i'm on 30 mg. patch per day. i've tried virtually all the newer ssri's and ssri-like clones as well as many of the old trycyclics. i've been fighting depression for two decades, before the ssri's came out. my best results have been with the maoi's. parnate worked for me for years but eventually fizzled out, altho i have remained on it because it still helps abit. the only way i know it helps is that i feel so much worse when i come off it; yet back on it i'm still depressed, but the subjective degree of the depression is clearly better. i am using both the emsam and the parnate (most doctors won't combine maoi's, but i've shown thru the years that i do well on the combo and i have no blood pressure problems (i check it regularly). as for emsam's reputation to date, i don't know...it's so new. in fact, that's why i came to the boards to see what others are saying about it. i suspect because it's an maoi a lot of people will choose to stay away from it, which is a shame because the maoi's have traditionally been considered the best antidepressant category in terms of efficacy, but the risks have scared both doctors and patients away. i suspect there will be a lot more interest in them now and more people will educate themselves about maoi's and a dialogue will begin with patients and doctors. selegiline (emsam) is what's called an maoi-b (parnate and the others used previously for depression are maoi-a's). the "b" variety does not carry the same risk factors as the "a's" when kept in the lower therapeutic ranges. i'm, too, interested in how well this drug is received and how successful it is. also, as stated before, the atypical depressions (which i have) have always responded best to maoi's.

i hope this thread keeps on keeping on and i can learn more about the success of this new depression drug with the novel delivery system.

thanks for the reply.

Last edited by PIEmotion; 07-20-2006 at 05:37 AM.

 
Old 07-20-2006, 08:28 AM   #19
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Re: Has anyone talked to their doctor about EMSAM?

When you say 30mg, what level patch is that? I know they come in 6, 9, and 12 mg. Did your doctor suggest EMSAM to you, or did you do research and present it to him?

Of course I can't expect doctors to have much of a solid opinion on the drug, since this formulation is so new. It takes years to uncover the true risks/benefits with patients. Would you think that doctors are aware of the fact that this drug has been released? They may not keep up with every new FDA approval, but this was covered by the news media, so it's a little more high profile than average I'd think.

I'd have no problem adhering to super-strict guidelines so I could try a medication, however, your right, the dietary restrictions are bad. I'm capable of monitoring my BP.

Have you noticed any problems sleeping or an increase in anxiety? Do you take anything else beside Parnate and EMSAM? Has Parnate caused weight gain for you?

Sorry about all the questions! I'd love to hear more success about the medication. I'd really like to bring it up with my doc, but am not quite that confident and don't want to sound like a know it all. Are TCA's the next line of treatment after SSRIs? I know I don't want a TCA.

 
Old 07-24-2006, 08:55 PM   #20
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Re: Has anyone talked to their doctor about EMSAM?

Quote:
Originally Posted by jealibeanz
When you say 30mg, what level patch is that? I know they come in 6, 9, and 12 mg. Did your doctor suggest EMSAM to you, or did you do research and present it to him?

i'm in the united states and it comes in a 30 mg. patch as well as lower dosages.

Of course I can't expect doctors to have much of a solid opinion on the drug, since this formulation is so new. It takes years to uncover the true risks/benefits with patients. Would you think that doctors are aware of the fact that this drug has been released? They may not keep up with every new FDA approval, but this was covered by the news media, so it's a little more high profile than average I'd think.

the infamous drug reps keep psychiatrists informed of ALL new psychotropic drugs in this country. also, this drug has been in clinical trials for years and psychiatrists (many) have known about it. i asked for it when i realized it had finally been approved and my doctor was already considering it for me since i had had good results from the oral form several years ago. it was given to me as an "off label" drug back then but it worked wonders.


I'd have no problem adhering to super-strict guidelines so I could try a medication, however, your right, the dietary restrictions are bad. I'm capable of monitoring my BP.

Have you noticed any problems sleeping or an increase in anxiety? Do you take anything else beside Parnate and EMSAM? Has Parnate caused weight gain for you?

parnate actually has some antianxiety effects, especially for social phobia. it does have to be taken early or it can cause some insomnia, at least that was my experience. it did cause slow weight gain and especially severe cravings for chocolate, but over time that diminished. since starting the high dose of emsam, my appetite has increased a little but when i first started the oral selegiline in lower doses it did not. my doctor thinks that the drug may not have "increased" my appetite so much as it has brought it back to normal. my husband agrees, since i had over the last few months had little appetite at all even on the parnate. i'm not so sure. either way, i don't like the increase but so far it's not severe. currently i take nothing else for depression, altho thru the years i have tried all the combinations suggested for treatment resistant depression with no success.

Sorry about all the questions! I'd love to hear more success about the medication. I'd really like to bring it up with my doc, but am not quite that confident and don't want to sound like a know it all. Are TCA's the next line of treatment after SSRIs? I know I don't want a TCA.
i think there are so many ssri's & ssri-like drugs now that usually the docs will try all those before going to the old tricyclics. tricyclics have a lot of side effects that make patients want to stop them, like sluggishness, excessive dry mouth, weight gain, etc. but, some of the tca's are good, they've just fallen out of popular use because of the lower side effect rates in the ssri's. still, many autorities still believe the best category of antidepressants is the maoi's. theyare just not popular. personally, i recommend them with appropriate patient education and caution.

i do believe in this day and age we have to be our own advocates and ask all the questions we want to understand. most psychiatrists would probably be glad to have an interested and informed patient. i have a full open dialogue with mine and am a participant in my treatment plans. i have, fortunately, a very avant guard doctor. since i have been treatment resistant for so long she appreciates any new ideas i discover thru reading up on current research. i have found some approaches before my doctors did because i am always searching.

hope this helps. good luck to you.

 
Old 07-25-2006, 01:47 AM   #21
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Re: Has anyone talked to their doctor about EMSAM?

Hi,

I have tried Emsam as a last resort type thing for treating my depression. I am told I have Atypical Depression. I sleep too much, I overeat, etc. MAOIs are supposed to be more effective for persons with Atypical Depression than other antidepressant types, and that was a major factor in my consideration when I asked to be prescribed this drug. Prior to trying this drug I had tried close to a dozen other antidepressants and none of them gave me any symptom relief. So seeing as how everything else was failing me, I thought I would give this a try. I had high hopes for it but unfortunately it too didn't do anything for me. I went from the smallest dose 6mg/24 hours all the way up to 12mg/24 hours over 2 months, with no benefit. You may find it hard to believe but my family doctor actually prescribed this drug for me. She is fairly young and had never used MAOIs in her practice before, and she told me that MAOIs were generally being prescribed very rarely when she was in medical school. The only reason I think she prescribed it was because we had tried so many other options over the years with no success and also that I appeared to her to be well-informed about psychiatric drugs and health issues in general (which I am). I would say that most family doctors would not prescribe this drug unless you held a gun to their head, so I guess I was fortunate. I doubt even many psychiatrists would be supportive of trying this drug at this point in time either.

I am a pretty unusual case though according to my psychologist, and I've heard good things about Emsam from other people, so just because it didn't work for me doesn't mean it won't work for others. From what I've researched the drug tends to begin working very quickly, usually with in the first few days or by the end of the first week of treatment. Many report experiencing results the very first day they used the patch.

I was not so fortunate though. I am hoping to get a CES (cranial electrotherapy stimulation) device as my next choice of treatment, since I had some positive results using a similar device (TENS unit) which I jury-rigged to behave in a similar fashion to a real CES unit, which requires a prescription. TENS units are very similar to CES units, and in fact there exist combination units that function as both TENS and CES units all in one. My understanding is that the only real differences are the freqency ranges and waveform characteristics. So I modified the TENS unit to settings which correspond to CES device specifications. However, I do not recommend people try what I did though because it could be potentially dangerous. I did it out of desperation, nevertheless I believe it gave me some positive results and no negative ones that I could tell, and the results lasted long after I used the device (as much as 48 hours later). In fact, in all the years of trying different treatments, i'd say it's the only thing I've tried that has shown any promise. Now I have an uphill battle to try and convince my psychiatrist to give me a prescription for the device.

Right now I'm taking Provigil which is supposed to help me with my hypersomnia problem but as with everything else I've tried so far, it has not helped, and it is supposed to start working quickly.

Having said all this I think that Emsam could be good for many people and may one day become a treatment of choice for depression. Right now the cost is extremely high. I had to pay $479 for a 30day supply of the smallest dose of the drug, I had no insurance coverage at the time, though, and once I got back on my insurance plan, the cost came down to only $40 for me.

Good luck to those who do try it. Don't be discouraged because it didn't work for me because no antidepressant I have ever taken has ever had any affect on me.

 
Old 07-25-2006, 09:29 AM   #22
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Re: Has anyone talked to their doctor about EMSAM?

So had your family doctor been aware of EMSAM or did you bring up the idea, forcing her to research it? I'm surprised you think even pdocs will be reluctant to prescribe. I am very intelligent and well informed about health matters (in school right now, start rotations in a year). My doctor knows I'm perfectly capable of looking after myself, regarding adverse reactions. It sounds like such a good idea for me to try. I haven't tried all the SSRI's/SNRI's but I've had bad reactions with the ones I have taken, and do not wish to try again. I just don't wanna ask him!

 
Old 07-26-2006, 11:17 AM   #23
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Re: Has anyone talked to their doctor about EMSAM?

i need to make a correction about my dosage, which you were wise enough to question but which i missed. you are right about the 30 mg. dosage being suspect. the medication box says "30 mg." but right under that it says "(9mg/24hr)". in looking at the insert i see that the dosages are listed as: 6 mg/24hours; 9 mg/24 hours; and 12 mg/24 hours. i see nothing in the insert about the meaning of the "30 mg." that's shown on the box. i'm sure it correlates to something that i'm missing; what it is, i have no clue. will ask my doc tomorrow just for my own clarification.

one thing to remember about selegiline (eldepryl) is that doctors have been using it for years with parkinson's patients. the lower dosage does not pose any threat in terms of diet. i think it's worth asking your doctor about. however, like the poster just prior to your last one, the emsam is not working as quickly with me this time. when i took the oral selegiline, it worked almost immediately. i am a little disappointed with emsam to date but will continue with it for a bit longer. thanks for making me re-question my dosage. don'[t want to be giving out erroneous info when i can avoid it.

my next plan is to try to get into the research program in toronto for the "brain pace-maker" that's been in the news a lot lately. very good results with that; just hope i can find a way to get into it since i live several hundred miles away from toronto. the logistics are not appealing but at this point i am ready for brain surgery, given the very good results reported thus far, altho the patient numbers are low. only 12 to date according to my latest reading. success rate is about 70%, with patients reporting "immediate" changes in perception of their moods as soon as the apparatus is turned on! anyone else have any impressions of this study. dr. helen mayberg is one of the primary investigators and every time i pick up a mental health journal or even much of the popular press, her study is being praised. my doctor is in contact with her colleagues in canada (she's moved to emory in atlanta but has not started up any research protocols yet) and we are trying to get some paperwork started. if i get there, i'll keep the board informed. while it's a very promising procedure with none of the negative effects of the vagus nerve implant, there still are not a lot of people signing up for "brain surgery." i'm hoping i can be accepted even tho i'm not close by because of the hesitancy of many to go under the knife. at my age, it's not so much a big deal to me now. if i were younger, i might want to wait for other treatment prospects.

again, sorry for the mis-statement about a 30 mg. dosage for emsam.

Last edited by PIEmotion; 07-26-2006 at 11:28 AM.

 
Old 07-26-2006, 11:43 AM   #24
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Re: Has anyone talked to their doctor about EMSAM?

I do think I should ask my doctor, but I'm scared!!! Haha. Is asking for an MAOI thaaat out of line with current practice? I feel like I haven't truely explored anti-depressants, since I've only used Paxil, Buspar, Wellbutrin, and Effexor.

I can't even say that I'm treatment resistent, I just wasn't happy with side effects. I didn't stay on Paxil or Buspar long enough to ellicit a response. I honestly don't remember how much Wellbutrin effected me emotionally, except that when I quit it (cold turkey without telling my doc who never scheduled a recheck!) I remember thinking that I had felt more real, indicating I'd been experiencing apathy, a common, yet almost welcome response from SSRI's (ish drugs). The apathy with Effexor was extreme, as was the weight gain with all of them!

So, there may be a chemical imbalance worth trying to correct, I just don't wish to experience the side effects my body has from the mechanisms of reuptake inhibitors.

 
Old 07-26-2006, 06:43 PM   #25
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Re: Has anyone talked to their doctor about EMSAM?

Quote:
Originally Posted by jealibeanz
So had your family doctor been aware of EMSAM or did you bring up the idea, forcing her to research it? I'm surprised you think even pdocs will be reluctant to prescribe. I am very intelligent and well informed about health matters (in school right now, start rotations in a year). My doctor knows I'm perfectly capable of looking after myself, regarding adverse reactions. It sounds like such a good idea for me to try. I haven't tried all the SSRI's/SNRI's but I've had bad reactions with the ones I have taken, and do not wish to try again. I just don't wanna ask him!
She hadn't heard of the drug before, and no, I didn't force her into anything, I brought her the prescribing information, which I obtained from the manufacturer's website and told her up front that my intention was not to put her on the spot, and told her that if she wanted to take some more time to learn about the drug and not prescribe it right away, I was happy to let her do so. She said she didn't think she would have any problem with it but nevertheless wanted to go to her office for a moment to briefly read over the materials I gave her as well as check her own information, presumably the bible for MDs, and when she came back she said she would prescribe it for me. I was surprised that she prescribed it to be honest.

 
Old 07-26-2006, 07:55 PM   #26
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Re: Has anyone talked to their doctor about EMSAM?

When was this? Right after it's release?

 
Old 07-26-2006, 08:01 PM   #27
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Re: Has anyone talked to their doctor about EMSAM?

The drug only received FDA approval in February, and I got my prescription in May. So it's still very new by drug standards. The pharmacists didn't even know what it was when I delivered the prescription.

 
Old 07-27-2006, 09:20 AM   #28
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Re: Has anyone talked to their doctor about EMSAM?

Really? I would have thought that after a few months the pharmacists should have known about it. They, along with doctors, must do continuing education. Strange and a little disappointing/sad.

 
Old 08-02-2006, 12:38 PM   #29
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Re: Has anyone talked to their doctor about EMSAM?

BorkBork,

How has EMSAM been working out for you?

 
Old 08-06-2006, 09:00 AM   #30
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Re: Has anyone talked to their doctor about EMSAM?

My psychopharmacologist told me about the patch last year, and I was keeping my fingers crossed that it would get FDA approval. But life has gotten in the way since it was approved in February and we have put off switching me over to it. Maybe next month. I have been on Parnate for 3+ years and have mixed feelings about it. Although it has probably helped keep my treatment-resistent depression more or less in check, I hate the food restrictions. And it caused me to put on a lot of weight when I first started on it. (I also take Lamictal and lithium, which may also have contributed to the weight gain.) My biggest concern about the patch is that the elimination of the food restrictions only applies to the lowest dosage, and I think my doc wants to put me on a higher dose. That kind of defeats the purpose for me, but he seems to be less concerned about the tyramine problems even at the higher doses.

I'm not sure I understand why you are so afraid to talk to your doctor about this, Jealibeanz. What's the big deal? I'm sorry if I am being dense.

Thanks for this thread -- it has been very interesting.

 
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