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climber47

Emsam/selegiline or other MAOI experiences?

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I just started Emsam 6mg, probably pretty much the last shot in a long line of meds (finally updated my sig, too!), and it's hard to find good info on MAOIs, are they really that archaic?? 

Mostly I'd love to know how quickly these tend to kick in? From some reviews sounds like people who saw a positive effect felt it in a few days! My pdoc didn't say I don't think. I assumed the usual 4-6 weeks, but I'd rather not wait that long to up the dose if needed.

really hoping with this one, maybe because my next step is probably ECT, and it's so hard to be hopeful after a failed round of TMS... I know ECT is more effective so that's good, just hard to upend your life for six weeks for nothing :( 

any other experiences with MAOIs or Emsam specifically are greatly appreciated!

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I have used emsam for about 6 years now.  I started on oral selegiline before I switched to the patch, but I was taking the equivalent of the 6mg patch and when I switched to the patch about 6 months in I switched to the 6mg.  I noticed a change after about 2 weeks.  I maintained on the 6mg patch until about 4 months ago, now I'm using the 9mg.  It works very well for me, I had run through just about everything else and had ect (which helped, very much) and I wanted to give an Maoi a try before having it again.  It's been a lifesaver for me.  Don't forget to rotate where you place the patch or your skin might start to get very irritated.  I hope it helps you as much as it did me.

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I took Emsam twice and it didn't really work that well for me. I took up to 9 mg both times, and the second time, I occasionally would split a 6 mg patch and tape the cut side on my skin to keep it from leaking out so I could get 12 mg, or put a 9 mg and 6 mg patch on for 15 mg and that would sometimes work okay, but wasn't sustainable (15 mg). I was also taking it with Adderall to potentiate it. The first time I was even taking nortriptyline and then protriptyline along with it. I eventually switched to Parnate recently, and am waiting for it to start working. I hope you have good luck with it though! 

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I've never done the MAOI route because of all the drug interactions possible. I did try Selegiline once  but it didn't do anything significant for me so I stopped.  Honestly, I'd go the ECT route if I could get to the place to do it early in the AM.  But if I could do that, it would mean I wasn't depressed!  Why doesn't somebody start an evening ECT clinic for us atypical depressives who can't get going in the AM? 

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On 1/14/2017 at 6:50 PM, climber47 said:

I just started Emsam 6mg, probably pretty much the last shot in a long line of meds (finally updated my sig, too!), and it's hard to find good info on MAOIs, are they really that archaic?? 

Mostly I'd love to know how quickly these tend to kick in? From some reviews sounds like people who saw a positive effect felt it in a few days! My pdoc didn't say I don't think. I assumed the usual 4-6 weeks, but I'd rather not wait that long to up the dose if needed.

really hoping with this one, maybe because my next step is probably ECT, and it's so hard to be hopeful after a failed round of TMS... I know ECT is more effective so that's good, just hard to upend your life for six weeks for nothing :( 

any other experiences with MAOIs or Emsam specifically are greatly appreciated!

I've heard the effect is very quick (like within 3-5 days of the target dose?) I'm starting to research MAOI's myself - as I'm in the same boat, treatment-resistant it seems. I'm surprised more people have not tried them. i guess because of the reported side effects/diet stuff. I think these things might be over-hyped though. Please keep us posted on this thread on how things are going for you and what effects you notice.

Is Emsam only in patch form? Is there a generic available (is it expensive?)

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I was on it for a week, 6mg, no noticeable effects at all.

 

but... also got a genetic test that said I metabolize Emsam very fast, so I need high doses. I think I'm just going to bag it and wait for ketamine at this point, I'll leave maois for a last resort, sounds complicated and I'm not at all excited about the diet or stressing about my bp.

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There is a pill form, it's selegiline, I'm not sure if it's generic, I know the patch is not and I think it's $500/mo out of pocket :(

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12 hours ago, climber47 said:

I was on it for a week, 6mg, no noticeable effects at all.

but... also got a genetic test that said I metabolize Emsam very fast, so I need high doses. I think I'm just going to bag it and wait for ketamine at this point, I'll leave maois for a last resort, sounds complicated and I'm not at all excited about the diet or stressing about my bp.

I think I might be a "high metaboliser" as well...Maybe before you throw in the towel, you could try higher doses? There are a few people (hopefully that can chime in) here that had to use high doses for an effect. There is also Parnate which could possibly be helpful...

Have you tried TCA's - I actually don't want to due to the high side effect profiles. I read they are quite dangerous/fatal at only 4-5x the daily dose.

I've heard about Ketamine, but is it available for docs to prescribe - can you can get right now? I've heard it's more of a tranquilizer & sedating/hypnotic, so not sure how effective it is for depression, but certainly worth a try if you can get it.

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59 minutes ago, cloudmonger said:

I think I might be a "high metaboliser" as well...Maybe before you throw in the towel, you could try higher doses? There are a few people (hopefully that can chime in) here that had to use high doses for an effect.

Me too ... in general I am on high doses of some meds because they seem to go through me fast.  I'm not sure what is actually happening, but I do need higher doses of things, as well as the doses spread out to cover me all day.

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I just googled the EMSAM patch because I was interested in it ...  and foundthis article helpful to understand that talks more about it:

---------------

There are also no dietary restrictions for EMSAM ... but just for the patch:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730099/

Abstract:

Quote

Although monoamine oxidase inhibitors (MAOIs) at one time represented the mainstay of therapy for major depressive disorder (MDD), the risk of acute hypertensive reactions following the ingestion of tyramine-rich foods and the consequent need to restrict dietary tyramine represent a barrier to their use. In this article, we present an overview of the efficacy and safety of a transdermal formulation of the MAOI selegiline for the treatment of MDD. Transdermal delivery of selegiline at the effective dose of 6 mg every 24 hours eliminates the need for a tyramine-restricted diet. Our emphasis on potential drug–drug interactions and contraindications should be useful to prescribers who counsel patients with MDD.

(STS is used a lot in the article so I am just saying what it is ahead of time ... I had a hard time finding what it meant):

Quote

Transdermal selegiline (Emsam, Somerset/Bristol-Myers Squibb) is the first therapeutic option of its kind to be approved by the Food and Drug Administration (FDA) for the treatment of MDD. Given the primary role of pharmacists and physicians in advising patients on the use of concomitant medications, we outline the efficacy, safety, potential interactions, and contraindications of the selegiline transdermal system (STS).

The STS has a unique delivery system that was designed to overcome the limitations associated with oral MAOIs, particularly those relating to dietary constraints.

Conclusion:

Quote

The clinical data regarding the Emsam patch demonstrate both its short-term and long-term safety and efficacy in patients with MDD. In particular, the STS provides several advantages to orally administered MAOIs, including freedom from dietary tyramine modifications at a dose of 6 mg/24 hours and a favorable side-effect profile.

Given their positions in the pathway of care, pharmacists and physicians play a major role in counseling patients about the potential for drug interactions and alternative treatments. Accordingly, awareness of potential interactions that may be encountered with the STS will optimize the use of this MAOI as an alternative for patients with MDD.

 

I hope this is helpful!

Edited by melissaw72

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http://www.fda.gov/downloads/drugs/drugsafety/ucm088589.pdf

Quote

You do not have to make any diet changes with the EMSAM 6 mg/24 hours patch.

^^ Wanted to emphasize this ... you will need to make dietary changes with a dose higher than this.  But with the 6 mg/24 hours patch you don't need the restrictions.

I was looking at other articles saying how you do need to make dietary changes, but NOT with the 6 mg/24 hours.

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Well, even at 6mg I have to be careful because I also take adderall... however my genetic test says I'm an ultra rapid metabolizer of Emsam, so I need high doses... I'm not sure I'll be able to do that with adderall...

i made another post, but I think I'm gonna leave maois for a last resort... even the new pdoc I talked to said the protocol now is to try ketamine before maois and ECT; I doubt most docs would say that but she's pretty progressive and out-of-the-box. I've got an appointment to try the ketamine nasal spray at the end of February!

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I haven't taken EMSAM, but I was on Parnate for around a year and a half at a dose of up to 40mg 2x/day. I also took Ritalin while on Parnate. Parnate is the antidepressant I had the best response to, for all that it was insufficient. As you can see from my signature, I have tried all major classes of antidepressants (SSRIs, SNRIs, MAOI and tricyclics).

I found the diet surprisingly easy/undisruptive to follow, even when also following a vegetarian diet (I was not exclusively vegetarian but I did not find the MAOI diet overly limiting). I found this pdf handout helpful and provided it to people who were routinely cooking or grocery shopping for me, and kept a copy posted on my fridge for reference. 

I generally saw response to a dose change within about 3-4 weeks. 

The most annoying thing was medication interactions. I don't like Ritalin as much as I like Vyvanse. I don't find it as effective and I dislike the fall-off and length of time it is effective, however it is the only ADHD stimulant my pdoc is willing to prescribe in combination with an MAOI.

I also tried TMS (I couldn't complete a series of treatments, I found it quite painful) and started ECT while taking Parnate. ECT helped some but not enough. I'm currently hoping to get involved in a local ketamine trial but if that doesn't work out I intend to ask my pdoc to put me back on an MAOI, either return to Parnate or possibly try Nardil. Being old, generic meds they are cheap and as I said before, Parnate was, for me, more effective than anything else I've done.

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5 hours ago, climber47 said:

Well, even at 6mg I have to be careful because I also take adderall... however my genetic test says I'm an ultra rapid metabolizer of Emsam, so I need high doses... I'm not sure I'll be able to do that with adderall...

i made another post, but I think I'm gonna leave maois for a last resort... even the new pdoc I talked to said the protocol now is to try ketamine before maois and ECT; I doubt most docs would say that but she's pretty progressive and out-of-the-box. I've got an appointment to try the ketamine nasal spray at the end of February!

That is great!  I really hope it works for you!

 

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EMSAM is a gift from god. I've tried absolutely every known antidepressant on earth, nothing worked. Been on EMSAM for 3 years now. Magic. Taking the highest dose 12 mg. 

NO interractions with food whatsoever!! My fave food is sushi and I consume loads of soy sauce. Nothing. I eat absolutely everything. Alcohol too. The only thing I get drunk much faster now - 3 drinks. But maybe that's a good thing, ha. But might be due to abilify too. 

I did take adderal on it, was fine, but still won't risk it. My doc prescribes me Provigil and Nuvigil (Modafinil/Armodafinil) for alertness. These have no i terrractions with MAOIs. I take abilify which makes me super tired. 

I think I have a decent experience with EMSAM by now, combining, and other drugs. Happy to answer questions. Good luck!

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I started EMSAM 11 days ago at 6mg/day and am mostly dealing with the side effects right now. However, there seemed to be a slight boost almost immediately, within 2-3 days, but it was not especially significant. Slightly more energy and motivation (MAO-B) but no appreciable mood lift (MAO-A). My doctor wants me to hold on for at least four weeks to see how things settle in; I'm game. 

The good: Less suicidal ideation. Improved ability to get out of the house and do social things.

The bad: Insomnia, sexual dysfunction, dry mouth, headache, dizziness. I wish I was having @Jules_Jules luck.

 

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Given that Emsam is a patch, can the insomnia be controlled by removing the patch at night? Maybe that's a dumb question as I've never worn a patch before and don't know if its worn 24/7 or if it comes off at a certain point before a new one is applied.  

Edited by Allieb

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16 minutes ago, Allieb said:

Given that Emsam is a patch, can the insomnia be controlled by removing the patch at night? Maybe that's a dumb question as I've never worn a patch before and don't know if its worn 24/7 or if it comes off at a certain point before a new one is applied.  

It's supposed to be worn 24/7, but I suppose some pdocs might tell their patients to take it off at a certain point in the day to avoid insomnia. My pdoc used trazodone or doxepin or something else to help with insomnia. Hey, it's not a dumb question, no need to belittle yourself. :) When I was on it, I always would take the old one off in the morning, take a shower, and put a fresh one on each morning on clean skin so it would stick better and I guess distribute better through the skin. I did have mild skin allergies with it, but not as bad as with the Neupro patch (totally different class of meds -- dopamine agonist).

Edited by mikl_pls

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On 9/6/2017 at 3:12 PM, Jules_Jules said:

 

EMSAM is a gift from god. I've tried absolutely every known antidepressant on earth, nothing worked. Been on EMSAM for 3 years now. Magic. Taking the highest dose 12 mg. 

NO interractions with food whatsoever!! My fave food is sushi and I consume loads of soy sauce. Nothing. I eat absolutely everything. Alcohol too. The only thing I get drunk much faster now - 3 drinks. But maybe that's a good thing, ha. But might be due to abilify too. 

I did take adderal on it, was fine, but still won't risk it. My doc prescribes me Provigil and Nuvigil (Modafinil/Armodafinil) for alertness. These have no i terrractions with MAOIs. I take abilify which makes me super tired. 

I think I have a decent experience with EMSAM by now, combining, and other drugs. Happy to answer questions. Good luck!

 

I’m going to me starting Nardil either this weekend (tomorrow) or next week. I’m really nervous for the side effects of insomnia (which I already have chronic treatment resistant insomnia) severe GAD, panic, “pure o” OCD and depression. I also get racy and irritable at times, but docs do not think it’s bipolar, but  combination of the anxiety, OCD and sleep deprivation. 

I’m concerned that I’m the state I’m in Nardil will be too stimulating for me? But I’ve also read that it can calm you down. 

I have tried many many medications from all the classes except MAOI’s. 

Would love to chat♥️

Edited by Britton777

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