Discussions that mention emsam

Depression board


This may be long, but I assue it's an easy read! :) I'd like to share my story with you:

I have been diagnosed with GAD, insomnia, ADHD, and depression over the past 4 years.

1. Insomnia:

I've only had this disorder for a year! I began having problems getting to sleep and staying asleep when returning from a summer in England. After a few months of struggling I went to my Dr.'s office and his PA gave me Lunesta ,2mg. It worked wonderfully for about 6 months. When it wasn't helping I switched to Ambien CR. After a few unpleasant nights with that medication, I returned to Lunesta and it worked even better than it had in the past.


I started graduate school this May (a PA program!). Since then, I haven't been able to sleep more than 2-3 hours per night. :eek: I went to my doctor for a physical last week and told him about this problem. He increased the Lunesta to 3 mg, since the reps are claiming that there's not much success with the 2mg.

Obviously insomnia is a symptom of depression, but he's never brought that idea up. I'm just too smiley and friendly in his office because he's such a great guy. I don't come off as depressed. And I certainly and successful, accomplished, and driven, so I doesn't looook like I lack motivation and am unhappy.

It's working a little better. I end up sleeping about 4-5 hours at night at the most, but it's not continuous. I never sleep for more than 1 or 2 hours at a time. I'd really like to be able to get through the majority of the night.

2. Anxiety:

I've always battled anxiety and my doctor knows that. It's basically my major, underlying issue. I've been taking .5mg Xanax t.i.d. since May. Not completely controlled, but this is due to my struggles with the other disorders. No real complaints here regarding treatment.

3. ADHD:

I'm intelligent and having always just managed to get through school with good grades. However, I really don't focus well, and always forgetting things and multitasking, I don't pay attention to oral presentations, and never can manage to sit down and read and study. I started Straterra last March. It's helped, but we just stopped it from my treatment line. I decided to take a few days break a month ago to see if it would help the insomnia. It didn't. I then restarted and noticed an increase in depression and crying, ect. My ADHD, is mild, but probably needs to be treated if I want to be in such an academic field, career-wise.

4. Depression:

I've battled depression on and off since I was 15. I almost always have seasonal depression, which can last a good 6 months with the weather in my area! I'm also dysthymic and prone to depressive episodes at other times too.

I've been on AD's in the past, but I don't remember if I was ever dianosed with depression. I don't believe so. I started Paxil for anxiety 4 years ago, my Sophomore year in college. After a couple of weeks it was causing a lot of rapid weight gain, so I switched to Buspar, which did the same. My doctor then put me on Wellbutrin, since it's not known to cause weight gain. However, it did, 20 lbs in 4 months (I was an extreeeeemly active athlete and ate very well.). Soo, I stopped that b/c that side effect certainly didn't help with things!:rolleyes:

I'm not sure I was ever officially diagnosed with depression until last fall! My PA had given my Klonopin and Adderall for anxiety, since my doc had prescribed it in the past. It induced a huuge major spiral into a depressive episode and crying spell, which is abnormal for me. I'm not normally a crier.

Anyway, I came back and told me PA, how horrrrible I suddently felt and had stopped the meds. He reassured me that was definitely the right thing to do, and we discussed the idea of antidepressants. I explained my reluctance since I'd tried them in the past, just basically was unhappy with the weight gain issue (early 20ish woman here... this is a valid concern!). He agreed that is a side effect for some.

He suggested I try an SNRI, Cymbalta or Effexor, since I never had before. He said he'd never had to pull anyone off either for weight concerns, but he couldn't garauntee anything. So, since I was in such a horrible state at that point, I agreed to try something, and he suggested Effexor since Cymbalta is newer and has less of a track record.

Well, it did bring me out of the rock bottom period I'd fallen into. However, I was verrry apathetic and cared about nothing. Eventually, after 7 weeks, I decided I would rather feel terrible then feel nothing at all, so I stopped. Alllso, I was desperately trying to ignore side effects and give it a chance, but... It caused serious nausea, I could barely eat. Despite this fact, and the fact that I worked out heavily daily, I'd put on 20 lbs in those 7 weeks! Yuck!!! I'm now against anything that involves serotonin reuptake (Wellbutrin XR has some) or involved with histamine (Buspar). I haaate the weight issues!!!!:mad: (especially since the meds weren't amazing enough, mood wise, to deal with side effects)

I can't really say that I went into remission, although I told my PA this. Mainly because I didn't want another SSRI/SNRI to try, and that I was feeling much better than from the onset of the episode. He wasn't pushing another med on me anyway, since I'd never had great experiences.

Soo, I'd say that basically been depressed for a year, with some ups and downs. The Effexor trial was one small period of remission. Since then, it's built in severity. The worst started in April, when I just walked around in near tears all day, every day, I experienced crying spells (again, not really normal for me). This hasn't gotten better, actually it gets worse since it's untreated.

I've seen my doctor a few times for rechecks on the Lunesta, Straterra and Xanax, but never wanted to bring up the depression b/c I'm afraid of meds. Well, last week was the first time I mentioned it. He seemed shocked since I work sooo hard at portraying a happy, energetic, enthusiastic young person in public!:p

I told him that it had worsened since my experiments w/ Straterra. I didn't tell him it had basically been going on for a year. He was startled and told me to stop the Straterra. I also added that the lack of sleep wasn't helping and he agreed.

While thinking outload he said something about wondering about trying something like Celexa and bewilderedly mentioned that he wondered if it were depression. (seriously, he seemed shocked due to my cheery demeanor, but really shouldn't be, I'm a patient w/ extreme anxiety and insomnia... they all go together!). I mentioned that I wasn't too sure I wanted to, since I wasn't happy with the others I'd tried. So, the plan was to just see how things work out with the other med changes.

Since then, I've gone into the depressive state where I need to sleep constantly and alllways feel terribly fatigued. Sometimes I can barely manage get out of bed during the day. I want to sleep constantly and feel like there's a huge, overwhelming, weight on my body, forcing me to take multiple naps a day. I can sleep 15-18 hours in total each day. (big change!)

This has happened before. Five years ago, I basically slept my way through me freshman year of college due to depression (although I wasn't aware of this cause and never sought treatment). It was the same thing, about 3 naps a day, 15-18 hours of sleep, and jut never feeling remotely rested. I'm normally very active and energetic.

Soo, I want to go back to my doc to try to find a sleep med that will help me sleep longer and through the night. My body's just too used to Lunesta right now to react correctly. But I'm afraid of telling him about the fatigue and constant sleeping sooo much. I believe I need a better sleep med. I also believe I need some sort of stimulant (ADHD and for the depression fatigue) and a stimulating antidepressant.

However, I'm afraid that if I tell him about fatigue he'll take away my Xanax. (which does cause a little drowsiness, but nothing compared to what I'm feeling right now). I'm afraid that I express my need for something stimulating he'll worry about it affecting my sleep. (valid, but I need both issues treated!) I'm afraid he'll just dismiss the idea of depression altogether (cited its occurance due to the other problems), or just give me the option of an SSRI. (YUCK!) I actually want to try the new MAOI EMSAM, but don't know if he'd think of it or be willing, since it has side effects. (it's stimulating (dopamine), and usually good for those who don't respond to SSRI's, also no signs of weight gain yet).

I also fear reported emotional symptoms since I'm in PA school. I don't like looking like I'm "messed up" and incapable of being a professional, especially in my doctor's eyes. Also, I don't want it on my record that I'm taking meds, it might affect certification and employment. But if I don't get these things properly treated I won't make it that far!

Help!!!! Suggestions??!!?! Do you think that he'll understand my symptoms, even though some of them almost contradict one another? (insomnia, but sleeping constantly, just not continuously; need for stimulants, but also sleep).
The Ashton Manual... it's sooo biased and against the use of benzodiazepines! They do help people! Many people. And there are many who are struggling with trying to control their anxiety through counseling or SSRI's, while they'd truely benefit from a low dose benzo. Doctors now have a fear instilled in their brains about these medications, largely in put to the publications of Ms. Ashton.

Same type of fear about the MAOI's too! It's almost as if they're aren't really taught why to hate benzo's and MAOI's, just that they should, and should denounce their use at every opportunity.

Ha, funny that the meds do (benzo's) and may (MAOI) help me the most, are the ones doctors are against, without much reason. There are many dangerous, highly addictive, highly lethal drugs in this world. These aren't in that category!

This being said, I think I'm still going to try for my EMSAM prescription from my doctor when I go back. I'm just praying that:

1. He's open minded about "alternative" (re: not SSRI) antidepressants

and

2. He know's what EMSAM is and hooopefully has at least read an article or two about it.

I haven't heard of many who have been prescribed EMSAM by anyone other than a psychiatrist. But who knows, maybe I'll get lucky and my doc will go for my suggestion. He did with the Xanax script, which is unusual for a GP. God knows family practitioners are terribly busy and overwhelmed!
Quote from jealibeanz:
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I'll have to go back and see what suggestions he has, as well as give him mine.[/QUOTE]

THIS is the smartest thing i've heard you say since i started reading your posts. If you are too timid/anxious/afraid of all the what-if's to be totally honest with your doctors about your symptoms (ALL symptoms), how can you expect a doctor to devine what to treat you with. it's like having appendicitis and not telling your doctor your side hurts. you've got to find a strong back-bone and talk openly with him. he will respect you for it alot more than learning piece-meal over time what it is that's making you dysfunctional. print out an artical on emsam and show it to him if you're afraid to speak the words. drs are not as dumb and uninformed as some seem to think they are. it's time to take responsibility for yourself and your health issues. learn to be your own best advocate.

didn't mean to lecture, but you seem to be a little less mature than some 21 year old's and if you have ADHD that's one of the symptoms. it's not your fault. statistically, adhd kids usually "catch up" in terms of maturity at about age 28. still, you are doing yourself NO GOOD by picking and choosing the symptoms you're telling your doctor about. and also, get a psychiatrist! family docs and gp's are kind, learned people, but when you have a specialized illness, you need a specialist. that's why medical schools produce them.

now, go to it! you've got a long road ahead of you. get "on track" now.

my sincerest best to you. be good to yourself!

PIE