lunksmoo Posted May 18, 2009 Share Posted May 18, 2009 I will be seeing my doctor in a couple of weeks, and the last appointment I had he brought up the possibility of increasing my Emsam to 12 mg patches. Is there anybody out there on Emsam who has increased to 12 mg, and what benefits it may bring over the 9 mg dosage? Just curious. I have been doing pretty darn good on the 9 mg patches, except for a few issues such as sleep, which is numero uno on the side effect list for this med, hoarse voice and congestion, decreased libido, and a few moments of rage every week or so. Other than that, I have discussed before on previous posts what a damn miracle this drug has been for me over the last 6 months. I am up for a HUGE job promotion, my bosses have noticed a complete turnaround in my attitude and productivity at work, I am turning from a shut-in to a more outgoing individual socially (even drinking a couple of beers a week, which I used to love), and my house is clean and my laundry is done, and I shower every day, and I love to do home improvement projects and am learning new computer programming languages that I wouldn't have had the motivation or time to learn before. I will see what he has to say in this appointment. I am a good size guy (6'6", 280 lbs), so I am usually on the higher end when it comes to medication dosage. I think that if it helps with some side effects, I would say go up to 12, but right now I don't have complaints about the 9 mg, except for maybe the libido issue. Link to comment Share on other sites More sharing options...
Cappa Posted May 19, 2009 Share Posted May 19, 2009 EMSAM decreases your libido? That's very surprising, given how the drug works. It seems like it should do the opposite, if anything. Have you talked about this issue with your pdoc? I'm glad to hear that things are working out. Keep in mind that at higher doses, EMSAM will start to inhibit MAO-A as well as MAO-B, and dietary restrictions will become even more important. Theoretically, and I could be talking out of my ass here, but with higher doses, you may start to have a little less energy but also feel calmer and sleep better. I suppose it's possible that the MAO-A inhibition is responsible for the decreased libido, but that still seems unlikely. Is it lower compared to how it was when you were on a lower dose of EMSAM? Or is it lower compared to how it was before you started taking EMSAM altogether? I'm thinking of trying Selegiline/EMSAM to try to resolve or remediate some of the persistent issues that the SSRIs have left me with. Link to comment Share on other sites More sharing options...
lunksmoo Posted May 19, 2009 Author Share Posted May 19, 2009 EMSAM decreases your libido? That's very surprising, given how the drug works. It seems like it should do the opposite, if anything. Have you talked about this issue with your pdoc? I was just reading on a website called rxlist.com that as a side effect in women, Emsam had a 0% incidence rate for decreased libido in trial studies, but for men it had a 0.7% incidence rate of decreased libido, so even though extremely low, I guess Emsam can affect men and their libido. I will be talking with my doctor about this though next month. Link to comment Share on other sites More sharing options...
null0trooper Posted May 21, 2009 Share Posted May 21, 2009 EMSAM decreases your libido? That's very surprising, given how the drug works. It seems like it should do the opposite, if anything. Have you talked about this issue with your pdoc? It seems most psych meds have a risk of doing the opposite of what's expected. In this case, maybe something to do with prolactin levels in some folks? I'm glad to hear that things are working out. Keep in mind that at higher doses, EMSAM will start to inhibit MAO-A as well as MAO-B, and dietary restrictions will become even more important. Emsam is selegiline delivered via transdermal patch. The "cheese effect" risk with tyramine overload comes mostly from oral MAOIs inhibiting MAO-A in the gut (which is there for the purpose of preventing tyramine and various tryptamine chemicals from playing hell with blood pressure and mental state) I'm thinking of trying Selegiline/EMSAM to try to resolve or remediate some of the persistent issues that the SSRIs have left me with. For some reason, there have not been a lot of successes here with Emsam, even though it should help some people with depression. It's still worth trying. Link to comment Share on other sites More sharing options...
Cappa Posted May 25, 2009 Share Posted May 25, 2009 It seems most psych meds have a risk of doing the opposite of what's expected. In this case, maybe something to do with prolactin levels in some folks? The only explanation I can think of is MAO-A inhibition increasing prolactin through the activation of serotonergic receptors. Not sure though.. Emsam is selegiline delivered via transdermal patch. The "cheese effect" risk with tyramine overload comes mostly from oral MAOIs inhibiting MAO-A in the gut (which is there for the purpose of preventing tyramine and various tryptamine chemicals from playing hell with blood pressure and mental state) That's true. It would be less of an issue but I would still be cautious with higher dose patches (there should still be some exposure to the disgestive tract, even if this risk is minimized). Although, even with oral Selegiline, there have been no reported cases of any kind of hypertensive crises.. Link to comment Share on other sites More sharing options...
lunksmoo Posted August 24, 2009 Author Share Posted August 24, 2009 It has been 4 weeks since I increased to the 12 mg patch of Emsam, and I must say this week I have been feeling much better. A couple of weeks ago I couldn't say that, I had horrid anxiety attacks, the kind where you feel like you are going to die a horrible death, with stomach pains, headaches, extreme dizziness, and heart palpitations. Maybe the little kick into MAO-A territory was just what I needed in the past week. Who knows. I have lost a little weight the past few weeks, and haven't felt the down libido (oooh, ouch, don't use the word "felt" with libido), but I still don't feel like I did before with my libido. Maybe age has something to do with it (I'm not 18 anymore). Energy seems to be about the same, even exercising a little more recently. I have a blood pressure monitor, and my BP is alway around 115/75, even after I eat a few things on the MAO "Forbidden" list. On a bit of a side note, these 12 mg patches are HUGE!! I only use a couple of spots on my chest that are shaved (yes, I am male, don't have nightmares :}), and I can't use them on my arms being a big guy, my arms are kind of large, and I have big biceps and triceps, and the patches come off when I move my arms a little more than normal. Not big like Ah-nolds, just a little bit bigger than normal. Link to comment Share on other sites More sharing options...
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