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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 23 to 47 of 57. Go back in thread:
Posted by SLS on May 25, 2011, at 6:42:15
In reply to Re: Help, please. Does EMSAM ever work for anxiety, posted by lepus on May 22, 2011, at 12:27:42
> My psychiatrist isn't overly imaginative so memantine would be impossible to get.
>
> I agree Nardil could be the answer. I think she is afraid of a reaction with the drug though and wants to start EMSAM because it doesn't require the dietary restrictions at low doses.
>
> I just want relief.My doctor has seen other patients beginning Emsam treatment that I saw in my own trial of this drug. It can have an anxiolytic effect, especially social anxiety. This occurs at low dosages (6 mg/24 hours). If your condition is one of comorbid SAD with MDD, you will probably need to use those dosages that effectively inhibit MAO-A. There's no free lunch with Emsam. To exert a robust antidepressant effect, which seems to happen infrequently, higher dosages of Emsam are usually necessary, requiring adherence to low- tyramine diet.
If it is your doctor's requirement that you choose to follow his directions with Emsam before moving on to Nardil, I would give it a shot. The worst thing to happen is that you react negatively to it, and just stop taking it. If it works, at least you won't gain too much weight.
Please continue posting of your progress.
- Scott
Posted by SLS on May 25, 2011, at 7:20:08
In reply to Lou's request-dhagreytdheepsp, posted by Lou Pilder on May 24, 2011, at 21:00:48
Lou.
Now, you can move on to this NIMH publication:
You will see that, despite the global warning of antidepressant-induced suicidality necessary to appear on every antidepressant package label, the actual rate of this altered state is low, even in children.
"In the FDA review, no completed suicides occurred among nearly 2,200 children treated with SSRI medications. However, about 4 percent of those taking SSRI medications experienced suicidal thinking or behavior, including actual suicide attemptstwice the rate of those taking placebo, or sugar pills."
It is my position that it is appropriate to place a global black box warning of the potential of suicidality and other negative effects on mood and anxiety. It is good operating procedure that both doctor and patient acknowledge the possible untoward effects that these drugs are capable of, including suicidal thinking.
So, Lou, what is the statistical risk of Emsam to cause one to think of suicide?
What about me? I am currently taking five different psychotropic drugs. Each one is capable of producing unwanted cognitive effects. I have been responding to these drugs with a degree of stable improvement that I have not known since 1987. Now, what would have happened to me should an alarmest convinced me to discontinue treatment due to concerns about suicidality?
If you are wanting to be a discussant in this thread, I request that you address your concerns about Emsam specifically, as this the subject of discussion. How does your discussing the phenomenology of osteoarthritis and other bone conditions serve to aid the person who urgently asked for help regarding his taking of Emsam.
I would just suggest to you that you extend to people participating in a thread the courtesy of staying on-topic. It would also be desirable that the subject line not be altered in a fashion that obfuscates the theme and issues being discussed in the thread. Hijacking a thread and changing the subject line is disrespectful to the forum, especially to the initiator of the thread.
To maintain a courtesy appropriate to an Internet forum such as this one, I request that you review the full articles containing the following quotes.
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http://en.wikipedia.org/wiki/Netiquette
"The points most strongly emphasized about USENET netiquette often include using simple electronic signatures, and avoiding multiposting, cross-posting, off-topic posting, hijacking a discussion thread, and other techniques used to minimize the effort required to read a post or a thread."
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http://forums.atozteacherstuff.com/faq.php?faq=vb_faq"FORUM ETIQUETTE: Thread Hijacking 101
It is polite to keep a thread on topic. If an idea is sparked by an existing thread, please go start a new one rather than hijacking the current topic. The original poster can end up confused or disrespected by the direction a thread takes."
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- Scott
Posted by floatingbridge on May 25, 2011, at 12:33:08
In reply to Re: Does EMSAM ever work for anxiety, posted by lepus on May 24, 2011, at 13:02:00
Hi Lepus,
I wrote two responses and lost them :( My apologies for the delay. I hope the post-storm situation is o.k. for you
> Can you tell me more about what is causing you such massive panic attacks?I just get wound up. I had them before emsam.
>Is it fear of starting the new med, the change in how you feel...
Yes. Med trials provoke anxiety for me. The start up, someone referred to as a possible therapeutic response happened for me about 24-48 hours after the first half patch. It felt very different than a snri start up. I panicked, took lots of xanax, wrote a flurry of emails. Finally went to sleep :-/
>the actual med itself or the errors in dosing?Not the med, in my belief, but the errors I mentioned. I didn't understand that I had made an error, and the 'response' was delayed in my case about 24hrs. I had difficulty tracing the error to the response. My default is usually panic :-/
> How are you feeling about the medication now?Good. I think it's helping me. Insomnia is a bear, but seems to respond to 5mg of Valium nightly.
> Any tips on how to cut the patch?
Sharp scissors. It is like Scotch tape. Cut the patch perpendicular to the split in the non-adhesive backing. Then you'll be able to peel it easily w/o touching the sticky med part with your fingers.
Med didn't show up in me for about 24hrs or so. I did 1/2 patch for about 5 days (I think) before going on to the full 6mg.
I still don't understand why the effect of the med changes as dosage increases, like going from a b inhibitor to an a, or something like that.
Right now 6mg is good. If you start, esp with partial patches, it seems safe enough. Any anxiety you might feel--everyone is very different--should abate esp with an anti-anxiety med. And be in touch with your doc.
Will you let us know how it goes?
Super best to you,
fb
Posted by Lou Pilder on May 25, 2011, at 16:11:36
In reply to Scott's request of Lou - Emsam and Net etiquette » Lou Pilder, posted by SLS on May 25, 2011, at 7:20:08
Scott,
One of your questions to me concerning Emsam and suicide is about what is the statistical risk to those taking the drug to think of suicide.
In order to answer that, I need to have the reader understand that ;
A. A lot of the knowledge that I have concerning this involves organic chemistry that since I am prohibited from posting more than 3 consecutive posts, I do not think that I could explain such here with that rule.
Now I think that if I was allowed to post here more than 3 consecutive posts, that lives could be saved and the chances of people getting a life-ruining condition could be headed off.
B. I am prohibited from posting what could be part of an era of time that is related to psychiatry and nerve agents. Without my knowledge concerning that being posted here, I am restrained from including what I think could explain your question annd could also save lives
C. I am prohibited from posting what I believe that has been revealed to me (the foundation of Judaism) that I need to use in my answer your question. ( there are many processes in suicide thinking that I know)
D. Since there are quite a lot of outstanding requests from me to the admin here, I am not able to post in relation to content related to the outstanding requests since I am unsure as to what Mr. Hsiung is wanting to mean by what he has written here until there are answers to my requests.
E. I think that there is an indoctrination here unless my concerns are accommodated by Mr. Hsiung in relation to the requests from me that are outstanding which (redacted by respondent) which prohibits me from posting some things that I need to answer your question.
So let it be with the above. I come to save lives here, not to ruin them.
Now the chemical in Emsam is [selegiline]. The ancient sorcerers used plants and coal-tar and such to make drugs to alter the mind of the taker so that they could be controlled or killed or addicted. One of the drugs came from a plant in Asia that has amphetamine and has been synthesized now. Then there is (meth)amphetamine which come from what is known as the (phenethylamines) which also bupropion and the MDxx drugs and selegiline. So the chemical structure goes way back and the mind-altering effects are very well known.
But when you get into how these drugs can alter the mind to that the taker is compelled to kill themselves and/or others, involves cell biology that I have a base in as an undergraduate and have kept up to date on my own since there have been great advances in understanding. One of the aspects involves the mitochondria. When a chemical enters a mitochondria, it can short-out the chemical process that allows it to be life, and then death happens. I can not post here the historical development of the people that studied how to cause death and the use of nerve agents to kill.
Now the question going on about those that take this drug... (continued)
Lou
Posted by SLS on May 25, 2011, at 18:43:52
In reply to Lou's reply-chmofdeth » SLS, posted by Lou Pilder on May 25, 2011, at 16:11:36
Perhaps you could initiate a new thread expressing your concerns regarding the safety of psychotopic drugs. Your concerns are off-topic here, and I am distressed that you continue to hijack threads by changing the subject line.
Do you think Emsam can ameliorate social anxiety?
- Scott
Posted by hyperfocus on May 25, 2011, at 23:38:00
In reply to Help, please. Does EMSAM ever work for anxiety, posted by Lepus on May 22, 2011, at 2:56:03
Hey could you describe your condition some more? What type of anxiety specifically did you have when it became noticeable - was it like social anxiety or one of the phobias or generalized? Have you had an official diagnosis? It's possible that you have some serious condition besides just the anxiety.
Anxiety stuff tends to get worse, unfortunately, if left untreated for a long time. Whatever your original condition was,its possibly morphed into something else that also needs proper treatment. Depression and dissociation can result from long-term anxiety conditions, plus a whole host of psychological maladies like BDD that you might need to spend time with a therapist repairing. But in my totally layman's assessment MAOIs are a good start for what you might have. You might find as your depression level goes down, the anxiety and everything else gets better. So I'd say stick with the EMSAM. It seems to work in the majority of cases for those who can tolerate it. If you can tolerate it and have even a partial response then you coud look with hope towards Nardil or Parnate. Atypical APs like Risperdal and Abilify and Zyprexa and Seroquel could also help a lot in the future. Benzos aren't a great long-term option but if you're in a lot of pain and non-functional they do have their role for short-term acute relief. Your doctor should know that anxiety sufferers cannot become emotionally dependent on benzos.
I'm in a sort of similar position where my mind seems uncontrollable and loves to build these gigantic black cathedrals of despair every day and all I can do is gaze at them when everything I want to do in life gets neglected. It can be scary and demoralizing, especially if it's gone on for a long time but there is hope. I'm in my thirties also but I believe I've started the long process of getting better, thanks to this site. I think that right now even with the ambiguous state of psychiatry there exists enough information and tools to help you. As long as you're willing to research you own treatment you will eventually find what you're looking for. That's what I believe anyway. I wish you the best.
Posted by SLS on May 26, 2011, at 5:26:46
In reply to Re: Help, please. Does EMSAM ever work for anxiety » Lepus, posted by hyperfocus on May 25, 2011, at 23:38:00
What a great post, Hyperfocus. You hit the target on everything.
"gigantic black cathedrals of despair"
Powerful verbiage.
- Scott
> Hey could you describe your condition some more? What type of anxiety specifically did you have when it became noticeable - was it like social anxiety or one of the phobias or generalized? Have you had an official diagnosis? It's possible that you have some serious condition besides just the anxiety.
>
> Anxiety stuff tends to get worse, unfortunately, if left untreated for a long time. Whatever your original condition was,its possibly morphed into something else that also needs proper treatment. Depression and dissociation can result from long-term anxiety conditions, plus a whole host of psychological maladies like BDD that you might need to spend time with a therapist repairing. But in my totally layman's assessment MAOIs are a good start for what you might have. You might find as your depression level goes down, the anxiety and everything else gets better. So I'd say stick with the EMSAM. It seems to work in the majority of cases for those who can tolerate it. If you can tolerate it and have even a partial response then you coud look with hope towards Nardil or Parnate. Atypical APs like Risperdal and Abilify and Zyprexa and Seroquel could also help a lot in the future. Benzos aren't a great long-term option but if you're in a lot of pain and non-functional they do have their role for short-term acute relief. Your doctor should know that anxiety sufferers cannot become emotionally dependent on benzos.
>
> I'm in a sort of similar position where my mind seems uncontrollable and loves to build these gigantic black cathedrals of despair every day and all I can do is gaze at them when everything I want to do in life gets neglected. It can be scary and demoralizing, especially if it's gone on for a long time but there is hope. I'm in my thirties also but I believe I've started the long process of getting better, thanks to this site. I think that right now even with the ambiguous state of psychiatry there exists enough information and tools to help you. As long as you're willing to research you own treatment you will eventually find what you're looking for. That's what I believe anyway. I wish you the best.
Posted by lepus on May 27, 2011, at 13:52:02
In reply to Re: Help, please. Does EMSAM ever work for anxiety » lepus, posted by SLS on May 25, 2011, at 6:42:15
Hi Scott,
My condition is MDD and severe panic attacks with agoraphobia. The panic attacks seem to be the worst symptom although depression is very bad right now. I'm just so frustrated and lost. For instance, I should really be hospitalized to get this mess straightened out but apparently unless you are suicidal or homicidal you will not be hospitalized.
What a crock.
Anyway, is there any evidence of low dose EMSAM working for panic disorder? I really don't see much evidence on the 'Net.
Posted by lepus on May 27, 2011, at 13:54:55
In reply to Re: Does EMSAM ever work for anxiety, posted by floatingbridge on May 25, 2011, at 12:33:08
Thanks for the information, FB. It's very helpful. I'm still talking to my pdoc about what to start or when. I'm thinking I might give Seroquel XR a trial first.
I just don't know. I know I can't tolerate anymore anxiety yet I'm so depressed I don't feel like I can do anything. I have no energy. Has that ever happened to anyone else? All you want to do is sleep all day and you feel so tired that you think you could slip into a coma?
Posted by lepus on May 27, 2011, at 14:02:05
In reply to Re: Help, please. Does EMSAM ever work for anxiety » Lepus, posted by hyperfocus on May 25, 2011, at 23:38:00
> Hey could you describe your condition some more? What type of anxiety specifically did you have when it became noticeable - was it like social anxiety or one of the phobias or generalized? Have you had an official diagnosis? It's possible that you have some serious condition besides just the anxiety.
I started having panic attacks at age 12. Just came out of nowhere. I believe it was related to puberty. I had panic attacks away from my home. Imipramine pulled me out of that terror and worked well for many years.
Right now I believe my last diagnosis was MDD and panic disorder with agoraphobia. I used to just have panic attacks away from the home but now I seem to be in a constant state of anxiety. As for any other medical conditions, I was in the beginning stages of being treated for psoriatic arthritis before the agoraphobia really kicked in and I could no longer make the trips to my doctor. I recently had my appendix removed also. But I've had bloodwork and been seen by many doctors and nothing physical comes up in the tests. If I have some other medical illness it is something rare and not easily detectable. Frankly, I keep thinking this is more than just anxiety because of how tired I am but no doctor has found anything.
I just want to be admitted to a hospital for a full work up and to get stabilized. Doesn't appear that will happen though.
Thank you for your thoughts and for taking the time to reply.
Posted by floatingbridge on May 27, 2011, at 17:14:01
In reply to Re: Help, please. Does EMSAM ever work for anxiety, posted by lepus on May 27, 2011, at 14:02:05
Lepus, I understand your hesitancy now to start a new med. Could you have a nurse visit you? Also, are there any university clinics in you area? Even if you needed to travel a bit to have confidence in someone overseeing what could be a delicate balancing act. I'm sorry you are facing such decisions.
I wanted to update you on my emsam experience. I'm tolerating it really well, which is surprising the jeepers out of my doctors. I feel more physical and mental energy. That's good. However....a big however, there is a core of anxiety it isn't addressing. My xanax usage has risen and I take Valium nightly for sleep. No one, including myself, is pleased with this part. Where this leads, I don't know.
Let me say it's working better, even the benzo use factored in, so far than my snri cocktail. Just being able to get out of bed is stress relief of sorts.
So, it's not a magic bullet for stress :(
It's not harming me :)
It has an actual AD effect :)
You might tolerate it well enough to be able to prove to both yourself and your doctor that you might tolerate Nardil.
Super good luck with this.
fb
Posted by lepus on May 27, 2011, at 18:46:37
In reply to Re: Help, please. Does EMSAM ever work for anxiety » lepus, posted by floatingbridge on May 27, 2011, at 17:14:01
Is your anxiety the same since starting EMSAM or worse? You said you're using more benzos which seems like it is worse but I just want to clarify.
I could really use more physical and mental energy right now. I am so tired I can't even do my homework. I just can't think. I think I might have to drop out of school this semester.
Posted by Phillipa on May 27, 2011, at 21:20:18
In reply to Re: Help, please. Does EMSAM ever work for anxiety, posted by lepus on May 27, 2011, at 14:02:05
My Mother had that and it's an autoimmune disease and sometimes they cluster possible you have another. I'd suggest seeing a Rheumatologist for a work up. So many autoimmune disorders manifest as phychological. Phillipa
Posted by floatingbridge on May 27, 2011, at 21:29:46
In reply to Re: Help, please. Does EMSAM ever work for anxiety, posted by lepus on May 27, 2011, at 18:46:37
Gosh. Let's see. It's better. And I need to take more xanax to achieve the same effect. I am having less anxiety or panic attacks. But when I do, I need twice the benzo. Sorry I can't give you a straight answer :(
I don't know how this will ultimately shake out for me. But hey, I cleaned my son's room, prepared a very easy meal, went to a parent teacher conference, actually purchased groceries (I hadn't been able to go to the market in months.)
When I write this out, it sounds like progress.
Oh, I need to take something to sleep every single night. Right now Valium works. I can get 5-7 hours of sleep. Working on getting 8-9.
Hope this helps.
fb
Posted by Phillipa on May 27, 2011, at 21:38:11
In reply to Re: Help, please. Does EMSAM ever work for anxiety » lepus, posted by floatingbridge on May 27, 2011, at 21:29:46
FB geez that is serious progress. Keep up the great work!!!! Phillipa
Posted by floatingbridge on May 27, 2011, at 22:20:14
In reply to Re: Help, please. Does EMSAM ever work for anxiety » floatingbridge, posted by Phillipa on May 27, 2011, at 21:38:11
Thanks Phillipa. It is improvement:) It could mean that tomorrow might be crummy. That's fibro. Buy I have always had good days/weeks and bad days/weeks before fibro. Today was a good day. Maybe tomorrow won't be too bad. Now that would be real progress :)
I am exhausted now. Hopefully sleep soon and long :)
fb
Posted by Phillipa on May 28, 2011, at 0:02:13
In reply to Re: Help, please. Does EMSAM ever work for anxiety » Phillipa, posted by floatingbridge on May 27, 2011, at 22:20:14
I do wonder if taking 3 200mg tabs of motrin for 24 hours and then the next day if you will have a great day like I did the time the dentist had me do this for immflammation? Phillipa
Posted by lepus on May 28, 2011, at 15:00:25
In reply to Re: Help, please. Does EMSAM ever work for anxiety » lepus, posted by Phillipa on May 27, 2011, at 21:20:18
I suppose that is always a possibility. My bloodwork always comes back negative for everything though. Even psoriatic arthritis doesn't show up in bloodwork that often. I lucked out because she was the first doctor to really examine me. She noticed the psoriasis on my hands, the pitted nails, etc. I wish I could beat this agoraphobia and get back to see her. She'll probably be retired by then...
Posted by lepus on May 28, 2011, at 15:03:29
In reply to Re: Help, please. Does EMSAM ever work for anxiety » lepus, posted by floatingbridge on May 27, 2011, at 21:29:46
So you are having fewer panic attacks but the attacks you have are more severe? Or the benzos just don't work as well on them? I wonder if the EMSAM works on some neurotransmitter that makes the benzos less effective.
Yes, FB, your post definitely sounds like progress! I have my fingers crossed you will continue to feel well!
Thanks for answering my questions.
Posted by Phillipa on May 28, 2011, at 21:28:28
In reply to Re: Help, please. Does EMSAM ever work for anxiety, posted by lepus on May 28, 2011, at 15:00:25
Yes those are signs of psoriasis pitting nail I also have been also test negative for rheumatoid arthritis no skin plaques. Aren't the two arthriti's basically the same? I must google if a rheumatoic factory is the method of diagnosis. Do you have joint swelling and pain? Phillipa
Posted by floatingbridge on May 28, 2011, at 21:55:32
In reply to Re: Help, please. Does EMSAM ever work for anxiety, posted by lepus on May 28, 2011, at 15:03:29
Your welcome Lepus, anytime.
When might you give it a go?
You caught me reading about other maoi's. I am only 3 weeks in; yesterday was good. Today, bedrest all day :( .
When I read, I don't quite get it. Nardil with my anxiety seems the real ticket.
Maybe emsam will change if the dosage goes up, But it isn't really helping anxiety if it's causing rapid tolerance for xanax.
You got me at a low point :( I still feel emsam is a logically safe starting place. Maybe it will be all you need. I can hope. And if you see improvements, maybe Your doc Will release Nardil. I think it:s a safe try.
My apologies for the down tone. A day in bed is not fun unless I was Yoko Ono with John Lennon.
Good luck. I'll answer any question from you :-)
Posted by floatingbridge on May 30, 2011, at 2:14:28
In reply to Re: Help, please. Does EMSAM ever work for anxiety, posted by lepus on May 28, 2011, at 15:03:29
I wanted to give you an update. A major portion of My anxiety may have been due to major hyperthyroidism. I just got the numbers tonight. A tsh of .05. I have hashimoto's and thought armour would be better than levoxyl. Well, nope.
I'll let you know of benzos regain efficacy, and insomnia lets go abit.
What are you doing these days? Have you started anything?
fb
Posted by lepus on May 30, 2011, at 19:16:10
In reply to lepus » lepus, posted by floatingbridge on May 30, 2011, at 2:14:28
Oh wow. Yes. That would make a lot of sense. Benzos aren't going to work very well on an overactive thyroid. Glad you found out you have that issue so you can correct it.
I haven't taken anything yet. At this point I think I've lost my mind. I'm so med-phobic. I'm terrified to try anything yet I'm sleeping all day and feel incredibly depressed. If I'm not spending my days fighting back horrible anxiety then I'm massively depressed. I know I need something but every drug scares me so much. I'm just tired and out of the strength to deal with this #@&* anymore.
Posted by lepus on May 30, 2011, at 19:19:22
In reply to Re: Help, please. Does EMSAM ever work for anxiety » lepus, posted by Phillipa on May 28, 2011, at 21:28:28
RA and PA are similar but not the same. I think RA tends to be more severe. I do have joint swelling and pain. However, my symptoms are much better since I was diagnosed and treated for a Vitamin D deficiency. Who would have thought an agoraphobic would not be getting enough sunlight! :rolls eyes: My number was about a 5 when low normal is 30. Ridiculous.
Posted by lepus on May 30, 2011, at 19:21:04
In reply to Re: Help, please. Does EMSAM ever work for anxiety » lepus, posted by floatingbridge on May 28, 2011, at 21:55:32
I'm sorry you had a down day, FB. I hope getting your thyroid corrected will help you immensely.
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Dr. Bob is Robert Hsiung, MD,
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