Jump to content
CrazyBoards.org

Emsam experiences?


Guest Guest_johnnyzero_*
 Share

Recommended Posts

Guest Guest_johnnyzero_*

My doctor was just telling me about the introduction of "Emsam" (transdermal Selegilene patch) today. I hadn't heard anything about it until now - I usally try to stay on top of new things coming down the pipeline (boards, Internet searches, etc.), but I've been doing less of that lately since I'm currently waiting for insurance approval for VNS therapy.

I was wondering if anyone has any experiences to report about Emsam - good, bad, or ugly. I did a search and found a few brief posts - someone is even posting his "Emsam journal" - but any additional info will be much appreciated.

The only meds that have ever really worked for me are MAOI's - Nardil about 20 years ago, and to a lesser extent Manerix/Moclobomide (a reversible-MAOI which I had to import from Canada). Unfortunately, the Nardil "miracle" would tend to peter-out after a few months. I also tried liquid Selegeline about 10 years ago - drops under the tongue - which had little or no effect.

Anyway, I'm hoping that I might get a more sustained effect from an MAOI via a transdermal delivery system. Also, it may have less of a tendency to cause hypomania, which Nardil certainly did. I remember being able to actually feel the Nardil "kick-in" about an hour after taking it.

At the very least, maybe Emsam will be a good interim solution to at least help me feel better while I'm waiting for my stupid insurance company to rule on the VNS therapy coverage.

JohnB

Link to comment
Share on other sites

Have you tried Parnate? The profile is a little different than Nardil. I've found, for example, that Parnate is a much better "match" for me than Nardil was -- and it's had long term usefullness for me.

Thanks for your thoughtful reply, Fiona. Yes, I've tried Parnate at least a few times over the years. From what I can remember, it had neg side effects and/or wasn't effective. I believe I've also tried Marplan and maybe one other MAOI who's name I can't recall right now. As you can probably relate to, I've tried SO many meds over the last 25+ years that I sometimes have trouble remembering just what I tried when, and what the results where.

I seem to be one of those weird people with an atypical neuro-chemiistry that only responds to a very specific class of meds - in my case MAOI's. Over the years, the other 1st-line antidepressants (SSRI's, SNRI's, tricyclics, atypicals, mood stabilizers, etc) have had virtually NO effect on me - I might as well be eating M&M's. I guess I'm considered an oddball even among my fellow depressives ;) ...

I've always suspected that my use of inhalants/deliriants for a short time in my misspent youth had a devastating effect on my noggin, both structurally & chemically. I did some "huffing" back in the 70's before it was fashionable (not!). When you add this to the other factors involved (typical Western European genetic history of mood disorders & alcholism, abusive & traumatic childhood, past use of hallucinagens & other drugs), it's probably no wonder that my brain is unable to regulate/modulate mood in the "normal" fashion. Does this make sense?

Anywaaayz....enuf of my yakkin'. It looks like I'm gonna go ahead with a trial of Emsam and see how things go - at least as an interim solution until I can have the VNS procedure. Lord knows I've tried everything else.

Over the next few weeks, I'll try to post my Emsam experiences here for the benefit of others.

best,

JohnB

Link to comment
Share on other sites

I seem to be one of those weird people with an atypical neuro-chemiistry that only responds to a very specific class of meds - in my case MAOI's. Over the years, the other 1st-line antidepressants (SSRI's, SNRI's, tricyclics, atypicals, mood stabilizers, etc) have had virtually NO effect on me - I might as well be eating M&M's. I guess I'm considered an oddball even among my fellow depressives

Hey! I've found my meds twin ;) Only I can't blame my wacky neurochemistry on the use of recreational substances. I was just born wacky :) I've had the same problem with all the SSRIs and I've had horrible side-effects from ADs in other classes, mostly cardiac and anxiety-related--the cure being worse than the disease in my case. My pdoc is reluctant to prescribe another AD; I think I've scared the bejeezus out of her with my med horror stories. She just keeps upping my Lamictal. I was about to bring up the possibility of EmSam at my next appointment since I've yet to try anything in the MAOI class. It seems to me that the lowest EmSam dose would be the most innocuous way to go. I'm afraid of Nardil and Parnate, though I'd love to have their social anxiety-deflating effect. I wonder if the selegeline is similar in that respect.

Let me know if you decide to give it a try. It would be interesting to see how someone else with screwy brain chemistry reacts to it. Hope it works out for you if you go that route.

Link to comment
Share on other sites

hey, johnny

It's been about a month on the patch for me now - my mood has seemed to get better - but I want to make sure that it is just not me coming off the cymbalta. So far everything seems to be ok - a few days of being really depressed, but I am once again racking it up to coming off the cymbalta and not being on the patch for that long.

I would definitely try the patch before going to the VNS - which my pdoc has recommended to me also. I'll try to keep my journal updated more for ya (I am the worst when it comes to posting) ;)

Link to comment
Share on other sites

Hi Ella,

If you've had no real success with the common "first line" AD's, you may want to consider an MAOI. As I said in my post, Nardil was nothing short of a miracle for me - unfortunately it tended to peter-out after a short period of time in my case.

Just make sure that you're working with a competent doctor who's familiar with using MAOI's. The tyramine-free diet is bit of a down side, but I was able to enjoy plenty of cheese & other restricted foods with no real problems, even on a very high dose of Nardil. Life without pizza - now that would be depressing! ;)

Also, you mentioned Lamictal (a mood stabilizer) in your post. If you have any tendency toward bi-polar symptoms, you should be aware that MAOI's can cause/trigger hypomanic episodes. In my case this was dose-dependent and could be managed by lowering the dose.

Hey! I've found my meds twin :) Only I can't blame my wacky neurochemistry on the use of recreational substances. I was just born wacky :cussing:

I guess you could say that all people who suffer from a chronic mood disorder have a somewhat "wacky" neurochemistry, in that their brain's innate ability to modulate/regulate mood is somehow compromised. Know what I mean?

Over the years I've realized that my particular problem can be helped by boosting norepinephrine levels (and probably dopamine too); and probably has little or nothing to do with lack of available serotonin. This would explain why I've had some positive results with MAOI's; and to a lesser extent with Cymbalta, which is an SNRI. It also explains why SSRI's have had no positive effect for me.

With the discovery of SSRI's and the introduction of Prozac in the 1980's, the medical & pharmeceutical people were overly optimistic & assumed that simply boosting serotonin levels was going to be the "magic bullet" for most people with depressive disorders. Since that time, they've come to realize that, while important, serotonin is by no means the only neuorotransmitter involved in mood regulation. Besides norepinephrine and dopamine, researchers have continued to discover other chemicals important for mood regulation (Substance P, Substance D, etc).

I also think it's important to understand that neurochemistry is not the only factor involved. I firmly believe that mood disorders are intricately tied to brain structure & physiology - the nature and density of neural connections; the relative sizes of various brain structures, etc. I have a theory that perhaps mood disorders are primarily caused by these structural & neural factors, and that antidepressant medications work by compensating for these abnormalities in some way.

Ooops: it seems that I've hijacked my own post and turned this into a rant about my own personal views on the biology of mood disorders. Anyway, I invite any feedback or comments.

best,

JohnB

Link to comment
Share on other sites

Guest Guest

Hi Wakko,

Thanks for your reply & the feedback re: Emsam - I assume you're the "Emsam Journal" guy?

You're right: it certainly makes sense for me to try Emsam before doing the VNS therapy. I'm not exactly looking forward to having a gizmo implanted in my chest & wrapped around my carotid artery - but I guess if that's what it takes to get my life back, then that's what I'll do.

Please keep us appraised of how you're doing on Emsam & I'll try to do the same after I start my trial in a week or so. I'm also weaning-off of Cymbalta and doing a wash-out before starting Emsam, so I'm particularly curious to hear about your experiences.

best,

JohnB

Link to comment
Share on other sites

Over the years I've realized that my particular problem can be helped by boosting norepinephrine levels (and probably dopamine too); and probably has little or nothing to do with lack of available serotonin. This would explain why I've had some positive results with MAOI's; and to a lesser extent with Cymbalta, which is an SNRI. It also explains why SSRI's have had no positive effect for me.
As you point out in your post, it's probably more complicated than the three basic neurotransmitters. But, given your feeling that your issues are more norepinephrinergic, I'm assuming that you've tried the tricylcics. How have you fared on them?

~cache-monkey

Link to comment
Share on other sites

As you point out in your post, it's probably more complicated than the three basic neurotransmitters. But, given your feeling that your issues are more norepinephrinergic, I'm assuming that you've tried the tricylcics. How have you fared on them?

Thanks for the thoughtful input, cache-monkey. You bring up a really good point: of all the classes of AD's, I really haven't tried too many tricyclics over the years. From what I can recall, I have tried maybe 2 or 3 different tricyclics at one time or another. Since they really had no effect, I had pretty much ruled out the entire class of drugs.

When I first sought medical intervention for my depression in the 1980's, the doctor somehow decided that Nardil would be the best med to try first, probably based on my particular "atypical" symptomology. As I've posted previosly, Nardil turned out to be nothing short of a miracle, but it would crap-out after a few months time.

I then spent the next year or two trying to get Nardil to "work" for me by adjusting the dose; we also tried Parnate at that time. By then it was 1987 and the medical world was abuzz about Prozac and the SSRI "miracle". Consequently, the tricyclics were seen as yesterday's news.

I have tried a number of other noradrenergic meds over the years with little or no success; but these are technically not tricyclics - I believe they are classified as "atypical antidepressants": Remeron, Edronax, Wellbutrin, Effexor, etc.

In any case, you've given me some food for thought. Perhaps I'll talk to my doctor about taking another look at tricyclics if Emsam doesn't work for me.

best,

JohnB

Link to comment
Share on other sites

Life without pizza - now that would be depressing! ;)

Dear god! My spirits are flagging at the mere thought.

I guess you could say that all people who suffer from a chronic mood disorder have a somewhat "wacky" neurochemistry, in that their brain's innate ability to modulate/regulate mood is somehow compromised. Know what I mean?

Oh, sure. I look at it as a chicken-and-egg conundrum, though. Did a neurochemical glitch cause the mood disorder, or did frequent or chronic bouts with anxiety/depression mess with the wiring? If the latter is the case, then medication is merely a stop-gap measure and therapy is what actually rewires the circuitry.

With the discovery of SSRI's and the introduction of Prozac in the 1980's, the medical & pharmeceutical people were overly optimistic & assumed that simply boosting serotonin levels was going to be the "magic bullet" for most people with depressive disorders. Since that time, they've come to realize that, while important, serotonin is by no means the only neuorotransmitter involved in mood regulation. Besides norepinephrine and dopamine, researchers have continued to discover other chemicals important for mood regulation (Substance P, Substance D, etc).

I'd be interested in knowing what the other chemicals are. I was only aware of those three. I do think SSRIs are overprescribed. There are probably a lot of people out there working their way through them with little to no success who would fare better with a different type of AD.

Link to comment
Share on other sites

In any case, you've given me some food for thought. Perhaps I'll talk to my doctor about taking another look at tricyclics if Emsam doesn't work for me.
Another thought: have you explored adding a low-dose mood stabilizer like lithium to your ADs? That's often a strategy used in treatment-resistant depression. It also speaks to a growing, albeit controversial, belief that poop-out/recurrent depression is indicative of something within the bipolar spectrum.

I don't know if you are still looking for experiences with EMSAM, but there are some folks over at http://www.dr-bob.org/babble who are posting about their trials. Some successful, others not. (As usual this is a highly skewed sample. People with negative experiences are more likely to post than those with positive ones...)

In any case, best of luck. It seems like EMSAM could be a very good fit for you, based on your reaction to other MAOIs.

Regards,

cache-monkey

Link to comment
Share on other sites

Guest Guest

Hi Ella,

Thanks again for your feedback & input.

Oh, sure. I look at it as a chicken-and-egg conundrum, though. Did a neurochemical glitch cause the mood disorder, or did frequent or chronic bouts with anxiety/depression mess with the wiring? If the latter is the case, then medication is merely a stop-gap measure and therapy is what actually rewires the circuitry.

I guess I'm not the only one who wonders about the chicken-n-egg thing too, although I have a slightly different take on it. I've always suspected that mood disorders are related to some type of trauma that occured earlier in life, most likely during the first 20 years when the brain is still forming lots of new neural connections & pathways. It's no coincidence that if you talk to adults w/ mood disorders, they will almost invariably mention some type of significant childhood trauma - emotional, physical, or both.

Of course, it's not quite that simple since almost all people have experienced some type of painful stuff in early life, and the vast majority don't develop a mood disorder later on. As we all know, a mood disorder also requires some type of biological/genetic pre-disposition which probably causes certain individuals to react to the trauma in such a way that it really screws up their wiring. Know what I mean?

I certainly agree with you that repeated episodes of depression & anxiety cause further damage - chemically, structurally, and with neural connections. This is the well-known "biological scar" effect. But I would bet that, in most cases, the really serious damage was done early on - probably before they even experienced their first depressive episode.

If the latter is the case, then medication is merely a stop-gap measure and therapy is what actually rewires the circuitry.
I guess I'm a little more optimistic than you when it comes to meds. I wasn't necessarily using "compensate" in a negative sense - just like insulin can allow someone to function by "compensating" for the fact that their pancreas isn't working right. I believe that the right medication can be more than a stop-gap measure for many people, and it can actually help to undo some of the damage and re-wire things to a certain extent. Unfortunately, with old folks like me (46 ;) ) I think the brain is much less malleable and prone to re-wiring as compared to, say, a 22-year-old kid.

Certainly, well-directed therapy (and indeed any type of positive experience) can also help greatly in this regard.

I'd be interested in knowing what the other chemicals are. I was only aware of those three. I do think SSRIs are overprescribed. There are probably a lot of people out there working their way through them with little to no success who would fare better with a different type of AD.

I sure agree with you on that. SSRI's are way over-hyped and over-prescribed, especially by GP's who really don't know a lot about the other alternatives out there. You need to work with someone who really knows his/her stuff when it comes to AD medications, especially if you haven't had any success with SSRI's.

best,

JohnB

Link to comment
Share on other sites

Another thought: have you explored adding a low-dose mood stabilizer like lithium to your ADs? That's often a strategy used in treatment-resistant depression. It also speaks to a growing, albeit controversial, belief that poop-out/recurrent depression is indicative of something within the bipolar spectrum.

Thanks, cache. Once again, you're right on the money.

I've tried a bunch of mood stabo's over the years without much success. Some of my docs tried them as an adjunct to "kick start" various AD's; and others have prescribed mood stablilizers because they suspect that I may have some type of atypical bi-polar variant - masked, rapid-cycling, Type2, Type3, or whatever.

Given my symptoms, there definitely are a lot of bi-polar features. I also think it's no coincidence that I've experienced hypomanic episodes with Nardil. Unfortunately, I've never been able to get a straight answer as to whether that could be a diagnostic indicator that I'm indeed bi-polar; or whether hypomania is merely a side effect that anyone would experience on such a high dose of Nardil. The answer I've always gotten is "We just don't know".

Thanks for the Emsam links too. To quote the Faber College motto from "Animal House":

"Knowledge Is Good"

best,

JohnB

Link to comment
Share on other sites

  • 10 years later...

I started this as a new topic elsewhere, but figured people might find it here.   Forgive me moderator if this is wrong.

 

I'd like to share my positive experience with EMSAM.   I'm not affiliated with the manufacturer in any way.    This is a PATCH VERSION of Selegine MAOI.

This is the ONLY antidepressant that worked for my Bipolar 2 depression in twenty years.   The SSRIs and SNRIs would work halfway, then stop working or cause anxiety (Prozac, Wellbutrin, etc).   Lexapro, Effexor, Cymbalta- all had bad side effects or were ineffective.

EMSAM is the first drug I've taken that has me absolutely depression free. I've been on it for 6 months.   It took me a while to find the right dosage (6, 9, or 12mg patches).   You leave them on for 24 hrs. 

I have also been taking Lamictal (Lamotragine) for 12 years. 

I can't believe this isn't used more widely for people who have failed using other medicines.

Side effect #1:  I can get a bad rash at the patch site that leaves me looking like a red and white checkerboard.   The squares fade after a couple of weeks.

BUT, I figured out if I do two things, I can minimize the rash.  First, spray the area with fluctonase (Flonase).   Second, open the patch and let it air out for 10 minutes; this seems to allow some of the glue/solvent to dissipate and the patch still sticks fine.

Side effect #2:   Sleep disturbance.   Sometimes I find myself not sleeping well.   If it is bad, I take off  the patch (though you are supposed to leave it on) and then after an hour I can sleep.   My pdoc said this is ok.

Side effect #3:  Activating.   I've rarely had hypomania, just a few times over the last 20 years.   The lamictal keeps that in check.   Too much Emsam would give me a bit of that manic activation- feeling too good, too much energy.

PM me if you have questions.

50 y.o. male, Bipolar 2 mostly with depression and anxiety.   Father was Bipolar 1.

Link to comment
Share on other sites

23 hours ago, Zounds said:

I started this as a new topic elsewhere, but figured people might find it here.   Forgive me moderator if this is wrong.

 

I'd like to share my positive experience with EMSAM.   I'm not affiliated with the manufacturer in any way.    This is a PATCH VERSION of Selegine MAOI.

This is the ONLY antidepressant that worked for my Bipolar 2 depression in twenty years.   The SSRIs and SNRIs would work halfway, then stop working or cause anxiety (Prozac, Wellbutrin, etc).   Lexapro, Effexor, Cymbalta- all had bad side effects or were ineffective.

EMSAM is the first drug I've taken that has me absolutely depression free. I've been on it for 6 months.   It took me a while to find the right dosage (6, 9, or 12mg patches).   You leave them on for 24 hrs. 

I have also been taking Lamictal (Lamotragine) for 12 years. 

I can't believe this isn't used more widely for people who have failed using other medicines.

Side effect #1:  I can get a bad rash at the patch site that leaves me looking like a red and white checkerboard.   The squares fade after a couple of weeks.

BUT, I figured out if I do two things, I can minimize the rash.  First, spray the area with fluctonase (Flonase).   Second, open the patch and let it air out for 10 minutes; this seems to allow some of the glue/solvent to dissipate and the patch still sticks fine.

Side effect #2:   Sleep disturbance.   Sometimes I find myself not sleeping well.   If it is bad, I take off  the patch (though you are supposed to leave it on) and then after an hour I can sleep.   My pdoc said this is ok.

Side effect #3:  Activating.   I've rarely had hypomania, just a few times over the last 20 years.   The lamictal keeps that in check.   Too much Emsam would give me a bit of that manic activation- feeling too good, too much energy.

PM me if you have questions.

50 y.o. male, Bipolar 2 mostly with depression and anxiety.   Father was Bipolar 1.

Thank you for posting! As someone who's depression is treatment-resistant, I really appreciate people's testimonials here on newer stuff. I assume it is not generic yet.

Questions: Do you always leave the patch on the same spot? Do you ever have a problem with it coming off in shower? (I was on birth control patch years ago and it was a bit of a pain to always move around my waist area, and it would start to lose it's stickiness in shower.) Do you have to avoid all of the MAOI-foods interactions? (like cheese, soy, etc?)

Link to comment
Share on other sites

Here's a bit of info about the MAOI problem with EMSAM:
"at higher doses of EMSAM (ie, 9 mg/24 hours or more), dietary restriction of tyramine intake is recommended"

Also about putting it on the same spot:
"Due to application site reactions, patients should be advised to rotate the application sites to avoid re-application to the same site on consecutive days. "

Hope that helps

-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656289/

Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

 Share

×
×
  • Create New...