Discussions that mention emsam

Depression board


I'm always surprised when some doctors are willing to keep trying to treat depression for years without major success, while others give up after a few failed trials. I've read so many mixed reviews about EMSAM, I don't know what to think, but I feel I'm a good candidate. I have treatment resisrent, atypical depression, along with anxiety.
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?
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.
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.
Quote from 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.
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.
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!
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.
Quote from 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.
BorkBork,

How has EMSAM been working out for you?
I am on Emsam 9 mg now, have been since June. I've had a severe complex depression for 3 years now, treated with numerous SSRI's (4 at the same time before I got the patch) I was nonfunctional, isolated, crying daily, no social activities. After 4 weeks on 9 mg i started feeling motivated, normal people feelings - it was exciting and wonderful. I had a setback in depression by a medical condition hospitalization and 4 week recovery, but slowly i have returned to my motivated state. Emsam has been a blessing. Sure there are lots of drug/food restrictions but i can manage those for the chance to live a productive life again. The unfortunate part of the Emsam for me is that I have a rather severe allergic reaction to the patch. There are 8 sites to place the patch, changing daily. However I am currently treating 12 sites with cortisone (placing the patch beside nearly healed sites) My allergic reaction is itching, redness, burning. The site of the patch for that day itches alot, site of the previous day is very red, burns, itches some. I have a long history of depression and treated very successfully with tricyclics and SSRI's over the years; but for the last 3 years nothing was successful. tricyclic before this 3 year drug resistent depression started worked for 14 years! However I gained 40 lbs. I started losing that 40 3 years ago with 10 lb first year, 10 lb 2nd year. With Emsam I 've had rapid weight loss - just no appetite. I've had problems with insomnia over the years with depression; but since Emsam I'm up most every night all night (it's 5:40 am now) despite 6 mg of lunesta. I do get 4 hours good sleep when I go to bed between 5:30 am and 7 am. I'm retired so fortuntely i don't have to try to hold down a job with this insomnia. To sum up, Emsam is working well for my depression; i can manage the 50+ food restrictions - can I manage this allergic reaction much longer? I don't know. My psychiatrist says there isn't anything else out now for me - I'm between a rock and a hard place. I see on some message boards depressed patients are using Emsam (selegiline) 5 mg oral but it's not available in the US yet; I don't know if US doctors might be prescribing and patients ordering from Canada, etc.) 5 mg is available in the US in a compaound for Parkinson's patients. also read about patients cutting the patches in two, using for 10-12 hours instead of 24. This might help me. My doctor knows nothing about this; and isn't interested in finding out. I don't want to discourage you from the patch if it would relieve your depression; and you might have no allergic problem with it. Good luck lulu
Wonderful that it's working for you!:)

I actually was thinking recently it would be a good option for me because the one thing I can think of that improves my mood is coffee, which contains large amounts of caffeine (like the amphetemines produced by selegiline) and causes Dopamine activation (like MAOI-B's). I also have mild inattentive ADHD, so this would improve my concentration as well, plus give some much needed energy for the 8-12 hours of classes (straight!) per day starting soon!

How much weight have you lost now? Did you ever gain on SSRI's? That's my biggest concern!

I had a physical last week. I told him about the insomnia, the Lunesta had stopped working and I've been sleeping 2-3 hours a night at school. I told him that I reluctantly experimented with stopping my Straterra for 5 days in efffort to help with insomnia. Since restarting, my depression has increased and I cry all the time.

He actually seemed a little stunned, since I act like a happy little ray of sunshine and enthusiasm when we speak:) I'm glad I brought it up. Right now I think he's sorta hoping it's attributed the odd med reactions and lack of sleep. I know this is untrue, but so proud of myself for having the guts to bring it up.

While he was "thinking outloud" after I told him all this, he said something about I wonder if we could try Celexa or something if, I wonder if it could be depression... Haha, seriously the guy thinks I'm too happy and successful to be depressed (even though I suffer from major anxiety, insomnia, ADHD, and have had depression in the past!). I was like umm yeah... but I've never liked any of the meds we've tried in the past (Wellbutrin, Paxil, Buspar, Effexor), so I'm not so sure. He agreed, not wanting to force an SSRI on me when I've always hated the side effects of all related meds.

Well, the Lunesta was increased, but it's not helping. I need to go back to see him about that. We stopped the Straterra altogether, hoping to ease the "mood swings", but I know better. It won't help. So, I must go back to ask for something different for the insomnia, and reiterate my feelings of depression. It'll be about 2-3 weeks from our last meeting, enough time to rule out adverse med reactions. I definitely want to mention that coffee helps, because I'm fairly certain he'll realize it's a dopamine problem, since stimulants cause a dopamine release. He may actually think of a stimulant, like Ritalin, esp. since I have some ADHD issues. This could help, but I'd really like to try EMSAM.
Lulu,

How are you doing with the EMSAM? Are you still taking it? If so, how's it helping with the depression?

If you're having problems with an allergic skin reaction, I'd suggest seeing a dermatologist, an allergist, or both. Success with an AD is worth making an extra effort to counter side effects.

I'd wonder what your actually allergic to. It wouldn't be Selegiline, most likely, but something involved in the patch formulation. Maybe you could have a cutstom made Selegiline patch through a compounding pharmacy.
Quote from BorkBork:
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.

I'm surprised a doctor would be so humble. Admitting to not knowing about a new drug and its indications takes some guts. Prescribing it on the spot does as well! This is partly why I'm hesitating to discuss EMSAM with my doctor. I fear that either he will be against an MAOI, or that I will catch him off guard and he won't know enough about the medication to be comfortable discussing or prescribing it.

I know they tend to like to give out medications they have samples of. I know they don't have samples of EMSAM. I wonder if the EMSAM reps have even started making rounds yet. If so, it would most likely be would pdocs, not family practices.
Hi, I started the Emsam patch in the last week. I must confess, being very leary about the side effects, I am currently cutting the patch into smaller but equal pieces as a precaution until I feel OK with this med. My doctor is giving me samples, so yes, it is available to Psych docs as samples. I am taking it for SA (Social Anxiety disorder) not for depression although many times my SA causes such dysfunction and stress in my life that I sometimes feel depressed. The one thing that stands out so far, in the few days I have been on such a small dosage( 1/4 of a 6 mg patch= 2 mg/day) is that I have insomnia. Even my valium, which I would sometimes take when woke up in the middle of the night, is not working on this stubborn insomnia. So I have been averaging about about 5 hours sleep now and I have been waking up a little later than usual. Fortunately I don't need to wake up early. I am now taking the patch off at about 6:30 pm and putting it back on in the morning. This seems to have helped- because at first I was awake almost the entire night, now at least I can sleep most of the night. I always felt I was more sensitive to meds side effects, which may or may not be true. But I tried many of the SSRIs in the past, mainly for my co-existing hoarding OCD disorder and I found that no matter how low a dosage I took, the SSRS's would cause me to sleep up to 16 hours a day! So they were just not a practical option for me. Since both the SA and OCD are about equally as debilitating in my life, I am very determined to find the correct mix of medication and therapy to help me. I will try share my experiences on Emsam over the next few weeks and would love to hear from others who are using it. The full 6 mg patch is supposed to bring results in 2 weeks.
RonneeGirl
Thanks for sharing! I have social/general anxiety too, so I know what you're going through, although I'm actually interested in EMSAM for its antidepressant properties. While my anxiety does cause me to be unhappy at times, I also am prone to major depressive episodes, unprovoked by SAD or GAD. I think that stimulants are good for people with SAD. It gives you the energy to be more social. I know I used to feel horribly drained of energy after social encounters and always felt the need to recouperate. So I'd say stick it out as long as possible. The valium will help calm you down, the EMSAM with give you the stamina you need to get out and stay out and interactive in this crazy world we live in!

I sympathize with the insomnia as well. It's terrible to deal with, but you seem to be doing OK. If it doesn't subside, I woudn't hesistate to ask you pdoc for a sleeping med. Unfortunately, sometimes side effects do need to be treated with additional medications in order to keep the primary ones on board. Does your doctor have high hopes for EMSAM or any other patients on it? If it helps with your quality of life, keep trying for new and better medications that will help you be at your best!

Please update with your progression. I'd love to hear it!
Hi again,
I have been on the Emsam patch for a few more days since my first post. As I mentioned earlier, I am taking it for Social Anxiety Disorder.
I am quite certain now that the med is making me hyper. My insomnia remains, and I now have noticed that my appetite has decreased considerably. At this rate, I will be losing weight rapidly. I have very little appetite before dinner and then I don't eat much at dinner either, like I sometimes do. But I am still only on 1/4 of a 6 mg patch!

I took my dog for a walk today, and found that I had super energy and walked very fast. I could feel the muscles in my legs burning as I walked.
Right now this is OK because, before normally I have trouble losing even one pound, even though I am not really much overweight-just more out of shape.
It couldn't be more of an opposite reaction from what I had on the many SSRI's I tried previously for my OCD, which made me sleep endlessly and slowed down my metabolism! I wish I could find something in-between.

One thankful note: So far, I've had no problem with skin irritation at all using the patch.

But I do feel groggy right now- it is 6;30 pm Friday -yet I doubt that I could fall asleep even if I tried to take a nap. It's kind of a strange feeling -to be tired and wired at the same time. -An over-tired feeling.
As for diet, I found myself not heeding any dietary restrictions due to my self-regulated very low dosage of 1.5 Mg/day. I did feel some heart palpatations a couple of days ago after eating chinese food mixed with pepper steak- both were drowning in soy sauce. So I think I will avoid soy sauce in the future. I have been eating cheese, but not very aged. Just American, brie, and mozzarella (on pizza).
I'm really not worried about the high-blood pressure reaction because I normally have extra low blood pressure- although I haven't checked it since starting the EMSAM patch. I have not felt dizzy at all either, which is also a possible side effect.
My pdoc was ecstatic when the patch came out. He raised his fists in triumph, so apparently he thinks the medication is very worthwhile and is thrilled that the patch allows the med to bypass the GI tract therefore making it less dangerous than the pill form, (at least in the lower 6 mg patch dosage).
However, if the insomnia doesn't go away or at least lessen, I don't think I will be able to stay on EMSAM, since I don't think it is healthy to be awake half the night.
But I'll just continue to see how it goes for now, taking it one day at a time.

:wave:
I've never taken a prescription stimulant before. I do know from history that caffeine wires me up. I couldn't take Midol years ago, since it would drive me up a wall(I think it has caffeine in it). Antihistamines in cold meds did the same.
I honestly didn't even know that the Emsam was a stimulant. My pdoc just knew that I couldn't handle the SSRIs, and told me the patch helps with Social Anxiety Disorder. I was (and still am) worried about warnings not to take it if there is history of Mania. I have at least three generations of family members who are Bipolar and my sister needs to take anti-psychotics. - so the genetic predisposition is there, and apparently the EMSAM can trigger it. But my pdoc told me to trust him, since I have no personal history of it myself.
I'm seeing my pdoc tomorrow, and I'll let him know about my hyper state.
I have never been diagnosed as depressed, although I know I have definitely been depressed at times.
The thing is -I can't really tell if my depressed phases were due to situational issues-like relationship breakups or whether my hyper state right now has to do with some very severe social/financial problems that have cropped up recently, which are totally consuming me right now.
My inability to sleep might also have a lot to do with the stressful situations I am now experiencing. I was pacing in my driveway for 2 hours this morning, thinking about some jerk who is intentionally trying to piss me off at work-and he's obviously succeeding.
People have told me at times in the past that I've seemed depressed.
As for sleep aids- I've taken Ambien in the past for insomnia, but it only worked for a few days and then I would become totally dependent on it. (When I would try to get off it after 3 days of it working great, I'd find I couldn't sleep one wink without it.) I do think Ambien is a wonderful sleep aid for the occasional need to get a full night's sleep before some important day but not for on a regular basis. I never woke up groggy from it.
I asked the pdoc for Ambien when I was trying the SSRIs, but he said that I don't need Ambien if I am taking the Valium.
And I don't want to go without the Valium since I feel it helps me. It works immediately (within 10 minutes) for my anxiety. I also take the beta-blocker Inderol on occasion when I need it - an hour before situational anxiety, like when I know I have be assertive with someone who is intimidating, or when I might need to speak in front of a group, or to an authority figure.
I do have a strong feeling the EMSAM patch could help people with depression. I don't feel at all depressed-I actually feel like I'm ready to "take on the world" right now, with all the energy I have now on the patch-but I still have anxiety.
it's lulu yes, i am still on Emsam patch - i really don't know what my alternative is at this point but to use it it has greatly relieved my depression for which i am most grateful i continue with the allergic rash and insomnia but still with 6 mg lunesta at 10 pm i'm sleeping from 3-4 a.m. instead of 6-7 a.m. your idea about custom compound to possibly avoid allergic reaction never occurred to me - i'll look into it thanks for the idea i continue looking for the 5 mg oral selegiline and found someone who gets it out of country - i'm not courageous enough to self prescribe i'm trying to find FDA status on approving 5 mg oral for depression
Do you suspect that it would help with seasonal depression as well, as major/atypical/depression and dysthymia? I worsen in the winter. I know first line treatment would be light therapy then SSRI's, then SNRI's, but they haven't worked well for me. I think the EMSAM may help during my other periods of depression, so maybe seasonal too. Who knows... it's all a crap-shoot with meds and reactions. I didn't end up getting EMSAM or any AD at my appointment, however, got Provigil, which I greatly needed so I somewhat pleased at the moment. I think my doc didn't want to make more than one change at a time. My next appointment is in 6 weeks. I know my seasonal depression will be starting up then (he doesn't know I have it, I forget to mention things). I'll probably have to address it, even if I ask about Celexa or something that I don't really want, just to bring up the matter. Then may throw in EMSAM. My insomnia is not so bad right now. Tne idea is to use the Provigil to stop me from sleeping 18 horus a day, which I've been doing lately, and get more active. This should help me be tired enough to sleep.

Thanks for the update girls!!
That is very interesting, Jealibeanz. My pdoc wanted to put me on an anti-narcoleptic/stimulant med to counteract the 16 hour/day I slept on SSRIs. I wonder if he had Provigil in mind. At the time, I thought it was a crazy idea and I refused to take a med for a condition I would not normally have if I wasn't on those SSRIs. But now I find myself taking the stimulant, EMSAM patch, and continue to have the severe insomnia. I saw my pdoc yesterday and he did acknowledge that EMSAM can cause insomnia, but he believes there is something I can take to counteract it. He's going to get back to me in 2 weeks. For the time being, he advised I take the Valium at bedtime. I took more than 5mg Val. last night and slept for a few hours, but then I was up again half the night and gave up trying to sleep by 5 am. Tonight I will take the full 10 mg.
I have also suffered from seasonal depression. Have you ever tried the light therapy for it? Is it covered by medical insurance? I think I will take a vacation this winter-even if it means for a just weekend somewhere down South.
I also told the pdoc about my hyper state from the EMSAM and he acknowleged that the EMSAM can cause Mania.
We agreed that I should stay on the meds for the time being since it might help my SAD. (Social anxiety disorder). But either way, having to take SSRIs and a stimulant, or taking EMSAM and a sleep enhancer, -both seem unacceptable to me in the long run.
There has to be a better solution!!
Yeah, it's so very hard to get it right with the meds. As for your sleeping too much-It's definitely not a good thing to be in bed all day. I think I'd rather have my insomnia and anxiety, although that's been really super tough, too. I've taken Xanax in the past and found it didn't do enough for me;hence, now I take the Valium. The Valium had helped me enormously to get thru some very bad times and I couldn't care less what some people think about taking sedatives. Let them walk one mile in my shoes and they'll think differently about it. The diazapam (Val) has a longer half life, so it stays in the system longer, which is fine with me. I also know people who take Klonopin for anxiety and are satisfied with it. It comes in a wafer form, and I believe a bite of it can be taken as-needed....Although, I'm sure you are familiar with a lot of this info already. I just rented several DVDs tonight, One is "I'm Dancing As Fast As I Can". It's a true-life story about a woman who becomes hopelessly dependent on tranquilizers. Not that I'm at all dependent on the Valium, but I just thought it would be interesting to watch.
I finally fell asleep this evening, I was so tired from not sleeping well for a few weeks now. Of course now that means I will not be able to fall asleep again until very late tonight, but I FINALLY feel rested.
My level of functioning has been at a low for a long time now. also.
I can empathize with your hesitation to be fully open with your doctor. I am struggling with the same difficulty. Maybe it's my Social Anxiety, although your GAD (Generalized Anxiety) must be even harder to deal with than just the SAD. I know someone on BuSpar for panic attacks, but you said you tried Buspar and Effexor, and had to stop SSRIs due to side effects. I read up a little on the Strattera you are currently on- it is a NON-Stimulant for ADHD. But If you are so very depressed and sleeping so much you might really want to talk again to your doc about getting on an stimulant anti-depressant, like EMSAM, and even possibly discuss an alternative to the Xanax, if upping the dosage is not an alternative. If you have the reaction that I've had so far on the EMSAM, you might lose weight instead of gaining like with the SSRIs. I hear the patch is very expensive but as long as I get the free samples I can continue to try it out. I don't have prescription coverage with my med insurance plan. The Diazapam (Valium) is no problem- its super cheap, about 5dollars for one month supply. Thankfully, my pdoc has no hesitation prescribing it for me, like other general docs would.

Getting back to depression- I read today that many people suffer from end-of-Summer blues which provokes depression and anxiety. Apparently it's a very common occurance. Also read there is a 13-part series called "Healthy Minds" that's airing Sunday, 11:30 pm on WLIW/21. I believe this is a local TV station, but it must also be airing on other channels. Mike Wallace from "60 minutes" will talk in depth about his personal bouts of depression and attemped suicide.
Well I stopped the Straterra. I'm on Provigil now for the sleepiness and no longer experiencing the constant sleepiness. Do you find Valium to be more sedating that Xanax? It's supposed to be. Hence, its use for minor surgeries.

The EMSAM would be a good idea for stimulation. I don't think I need anymore, but maybe could lower the Provigil if I add EMSAM. I doubt I'd get EMSAM anytime soon. My doc seems to only make one change at a time. Smart, but hard when I want to better NOW! :)

Probably, he'd suggest either raising the Xanax or lowering the Provigil. We didn't discess depression at the last visit, even though it had been an issue at the one two weeks before. Kinda strange. I'd definitely have to be very specific about it. Even then, I don't think he'd make too many changes. So addressing depression at the next visit would have to push the other concerns further down the list.
Sorry about that, Jealibeanz. I knew you were now on Provigil, I must have been still exhausted when I last posted. I'm glad it is working for your sleepiness. It seems that people with mental illnesses -like with the anxiety disorders/depression/etc -they usually have co-existing conditions. I have hoarding OCD, possibly OCPD, SAD (Social Anxiety), occasional depression, as well as some other related OCD/anxiety conditions. Fortunately, my pdoc is well aware of such comorbidity, and we discuss them at each sesssion. Even though my pdoc has a file on me, he is seeing so many patients so I like to remind him to ensure he best treat me for my particular mix of disorders. It is genuinely hard for me to talk to him, which is partly due to my SAD, which causes me to have a fear of speaking to authority figures, such as doctors.
I can completely understand your fear of not wanting your doctor to think you are telling him which conditions you have and which meds you think might help you. Many doctors have super, super egos. Fortunately my pdoc has so far been very open to my imput into my disorders and the available meds, as well as which meds we have tried and did not work for me due to disabling side effects or whatever.
I definitely found the Valium to be more effective (calming) than Xanax for treating my anxieties, which are very debilitating at times. I still only take it on an as-needed basis, since I have concerns about possible dependency. My pdoc has recommended I now take it at bedtime due to my insomnia. Last night I was so tired from not sleeping well for over a week that I fell asleep without it.
The EMSAM patch supposedly works for both depression and social anxiety. I dont' know if it helpful for GAD.
Quote from lulu0810:
I am on Emsam 9 mg now, have been since June. I've had a severe complex depression for 3 years now, treated with numerous SSRI's (4 at the same time before I got the patch) I was nonfunctional, isolated, crying daily, no social activities. After 4 weeks on 9 mg i started feeling motivated, normal people feelings - it was exciting and wonderful. I had a setback in depression by a medical condition hospitalization and 4 week recovery, but slowly i have returned to my motivated state. Emsam has been a blessing. Sure there are lots of drug/food restrictions but i can manage those for the chance to live a productive life again. The unfortunate part of the Emsam for me is that I have a rather severe allergic reaction to the patch. There are 8 sites to place the patch, changing daily. However I am currently treating 12 sites with cortisone (placing the patch beside nearly healed sites) My allergic reaction is itching, redness, burning. The site of the patch for that day itches alot, site of the previous day is very red, burns, itches some. I have a long history of depression and treated very successfully with tricyclics and SSRI's over the years; but for the last 3 years nothing was successful. tricyclic before this 3 year drug resistent depression started worked for 14 years! However I gained 40 lbs. I started losing that 40 3 years ago with 10 lb first year, 10 lb 2nd year. With Emsam I 've had rapid weight loss - just no appetite. I've had problems with insomnia over the years with depression; but since Emsam I'm up most every night all night (it's 5:40 am now) despite 6 mg of lunesta. I do get 4 hours good sleep when I go to bed between 5:30 am and 7 am. I'm retired so fortuntely i don't have to try to hold down a job with this insomnia. To sum up, Emsam is working well for my depression; i can manage the 50+ food restrictions - can I manage this allergic reaction much longer? I don't know. My psychiatrist says there isn't anything else out now for me - I'm between a rock and a hard place. I see on some message boards depressed patients are using Emsam (selegiline) 5 mg oral but it's not available in the US yet; I don't know if US doctors might be prescribing and patients ordering from Canada, etc.) 5 mg is available in the US in a compaound for Parkinson's patients. also read about patients cutting the patches in two, using for 10-12 hours instead of 24. This might help me. My doctor knows nothing about this; and isn't interested in finding out. I don't want to discourage you from the patch if it would relieve your depression; and you might have no allergic problem with it. Good luck lulu


emsam IS available in the US, it's just not called emsam. selegiline, the generic name for eldepryl, has been available for many years in oral form. it is the same drug, not a change in compound. if you use oral selegiline for derpession, which i did with great success 7 years ago, it's simply called "off brand" treatment, meaning it's not FDA approved for the use of depression, but any doctor who wants to use it for depression is able to do so. many drugs are used "off brand."
Definitely. I don't hold a grudge. I'm glad that you have found something that helps. I'll continue to look into EMSAM and appreciate your input.
It's been about 3 weeks now since I started Emsam. 4 or 5 days now with the 12 mg patch. A little inconsistant response. I started augmenting with Adderall 30 mg today. Not much difference. It would be preferable to not augment, but its not likely to work in my case. It really is shooting in the dark with these psychoactive meds is'nt it. The only meds that I have had short remissions(3 months) are Parnate, Nardil, and Librium. Parnate was the superior treatment. If Emsam with some augmentation is'nt effective I will likely try Parnate again with different augmentations than I have tried in the past. I am thinking possibly Lamictal.
I am certain within 2 years a treatment to normalize dysregulated HPG axi's will be discovered. This is the key to my disorder. I must keep trying these crude psych meds for now.
Transdermal delivery of medications seems like a good method. Hopefully Emsam will help many sufferers.
HPG... any new updates on EMSAM? Have you ever considered seeing an endocrinologist for testing and monitoring?

How are our members doing with their EMSAM?