Anna Posted October 26, 2011 Share Posted October 26, 2011 Kinda stressing on this one..... definitely decided to try emsam as my best (worst) alternative. I'm totally TANKING. Okay, a few questions/thoughts? I've just read so much conflicting shit on this crap now, and I really don't know what to think. I am effectively convinced that it is the least likely to touch my serotonin, at low doses, and send me into a flagrant mania. Kinda worried about the insomnia and overactivity part. MOST worried about the blood pressure part. I know some people who get low BP on emsam can do just fine on low dose amphetamine, and that it's done, which isn't even what I'm taking anyway, BUT I do take provigil 200 m.g. a day and that's for ADHD sx, not wakefulness, and seriously, I don't know what I'd do without it. Seriously, just how overhyped is this risk? I'm not starting the damn stuff until after I leave and come back from CA, I've decided, though my doc is giving me a scrip now over the phone. I really do not want to end up in the hospital out of state.... thinking of a washout period of down to 100 m.g., of provigil while there (oh so fun) asking for some bp lowering medication to tote around just in case I get a fun "episode", and starting at 3 m.g. (if you can cut the patch) to be on the safe side, plus checking BP everyday or something, just to see what it does (just in terms of both sending me into the stratosphere, which is obviously a risk for me with ANY FUCKING AD not just SSRIs, not to mention all the rest of it) would probably be a fine idea to reduce my coffee intake just a bit which I swill like water anyway, right? IDK. Just looking for thoughts/experiences/ideas.... has anyone taken this combo, and what did it do/did not do? Pharmakonetically, just how big of a risk are we talking here? I mean, it isn't even a REAL stim, right? Just really not into DYING right now (except theoretically) in the middle of my custody madness.... any feedback? Also, BP peeps who have tried this (the very very BP I) any feedback, generally? Keep in mind MANIA is a real possibility.... sigh. I just can't imagine a freaking crash, man..... TCAs are out of the question, they are the most likely to flip you into mania. So it's emsam or fucking nothing unfortunately. I just don't think I could DO my job w/o some type of stim like thing atm, though doesn't emsam like do shit to your dopamine majorly anyway.... how effective might we be talking here? Lowering provigil potentially possible anyway? Emsam just seems to have a bunch of flagrant warning shit crap on it anyway for no reason, I am just wondering...? Anna Link to comment Share on other sites More sharing options...
helloheartbreak Posted October 26, 2011 Share Posted October 26, 2011 Nothing but my own experience here, but I take the oral form of Emsam (selegiline) and Provigil and I have not had any problems. My blood pressure hasn't varied from baseline at all, though like you I was nervous and checked it frequently for the first month. I do remember my pdoc saying that the selegiline could increase the effects of the Provigil, so maybe you'll end up needing less? I added the Provigil to the selegiline instead f the other way around so I don't know. Good luck! Link to comment Share on other sites More sharing options...
Velvet Elvis Posted October 26, 2011 Share Posted October 26, 2011 I've read that mixing stimulants and old school MAO-Is like Parnate and Nardil can be safe but requires close monitoring. Since Emsam is a bit different from classical MAO-Is and Provigil is a bit different from classical stimulants I can't really say. It should be safe but buying yourself a blood pressure cuff wouldn't be an unreasonable thing to do. Increasing your AP dose (I forget which one you're on) might help reduce the risk of mania from the Emsam as well as help with the depression. Link to comment Share on other sites More sharing options...
Cetkat Posted October 26, 2011 Share Posted October 26, 2011 I can't find any hard evidence on the level of noradrenaline in provigil vs adderall, but I have to believe it's less. I'm thinking that the provigil would be weaker but longer-acting. I do know that adding emsam to a med is better than a med to emsam, and that a lower amount of a stim would be needed to get the same effect when taken with emsam. I believe the 100mg to 3mg ratio would be sound, and you may be able to stay at the 100mg while modifying the emsam dose to where you need it to be.. with the option of lowering the provigil further (if that's possible rx-wise - I don't know if the pills are split-able). I would definitely try to get the emsam where you want it prior to considering a more normal dose of provigil.. if it turns out you tolerate it well. As for a blood pressure med for emergency measures.. I came up with laberalol for me. So I'd look into that one in particular. Link to comment Share on other sites More sharing options...
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