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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Darkness At Noon on July 22, 2007, at 9:09:08
I am now entering my 7th week on EMSAM. I went up 9 mg a few days ago.
Benefits: none to date.
Side effects: still more difficulty sleeping. Increased Klonopin to 3 mg at bedtime.
Mild, but tolerable constipation seems unchanged by dose increase.
Loss of libido continues, may be worse. But how to tell if the loss is greater when loss means you didn't have have it to begin with? (Loss of libido is side effect of drug, not symptom of depression.)
For several days after increasing dose, I notice a few hours of heightened activation after putting on patch, followed by a few hours of fatigue. Then just a more activated state (that is, couldn't sleep without sleep meds). The few hours of fatigue seem more intense after going up to 9 mg, but were less so yesterday.
Again no problems at application site.
Still marking time, still darkness at noon. In my world, noon is 24/7.
Posted by yznhymer on July 23, 2007, at 1:45:46
In reply to EMSAM At 6 Weeks, posted by Darkness At Noon on July 22, 2007, at 9:09:08
I'm at EMSAM 4 weeks, 6 mg. Overall, I think this has been the smoothest adjustment I've made to an antidepressant. Remarkably, I've had no adverse sexual side effects and no weight gain. However, I have experienced some agitation/anxiety... its hard to describe exactly, sort of a tightness in my chest especially in the evening. I also experienced some difficulty settling down in order to sleep. Both of these effects have eased up over time, though not completely.
Still, I have no problem falling asleep within a couple of minutes with the help of some Ambien. I have Klonopin on hand but haven't felt so anxious that I've been using it, though I have a bad habit of not using Klonopin even when it probably would be helpful to do so. I'm not getting enough sleep each night though, and this has been going on for years. My best sleep recently was after stopping Wellbutrin and before starting EMSAM. I do get sleepy some days in the afternoon, and will take a nap, and I have to tell you they are exquisitely wonderful - I'm really reluctant to wake up and leave the state I'm in. So at this point, I'd say my sleep issues still need to be resolved.
In terms of benefits from EMSAM, I am feeling somewhat better. I have more energy and more motivation, and its pretty consistent. After the first 2 weeks, I went through a few days where I was feeling pretty low again but then rebounded. I should say that I am seeing a new therapist who is excellent, and I think that has been key also. He has been pivotal in getting me back to the gym and increasing my exercise routine. I'm sure this has helped. Two indicators that things are substantially better: my apartment looks great and I've got an active To Do List with 43 items on it.
I am wondering if moving up to 9mg would add some benefit. In fact, trying to find information about optimal dosage of EMSAM is what got me snooping around tonight. I got the impression from my pdoc that he's reluctant to move to a dose that requires dietary restrictions, though I don't see that as a big issue. I was hoping for a more robust impact on my social anxiety similar to my experience on Nardil many years ago, but I haven't seen that. While I still experience anticipatory anxiety about social situation, I do find myself more talkative than I am usually, and somewhat less withdrawn as well.
Posted by Darkness At Noon on July 23, 2007, at 9:18:59
In reply to Re: EMSAM At 6 Weeks, posted by yznhymer on July 23, 2007, at 1:45:46
> I am wondering if moving up to 9mg would add some benefit.
From what my pdoc said, and what I read on this board, people are reporting best results at 12 mg, and then often after 4-6 weeks at that dose.
Posted by yznhymer on July 23, 2007, at 11:27:37
In reply to Re: EMSAM At 6 Weeks, posted by Darkness At Noon on July 23, 2007, at 9:18:59
I haven't read that many posts yet. I suppose its still a little early in the game to make a decision about trying a higher dose yet... perhaps at 6 weeks. I'm willing to bet if the dietary restrictions were lifted at higher doses my pdoc would be more willing to try it out. I'd like to find some current information about the record at higher doses and if there are any plans to lift the dietary restrictions.
There is really no way to know if I'd get a better response without increased agitation and sexual dysfunction kicking in without a trial. I'm still amazed this stuff hasn't zapped me below the waist - almost everything else does. In the meantime, I remain pleased so far and actually much prefer using a patch and not taking another pill. Now if I can only figure out the sleep issue.
Posted by tendency on July 24, 2007, at 1:28:35
In reply to EMSAM At 6 Weeks, posted by Darkness At Noon on July 22, 2007, at 9:09:08
It seems only obvious to ask: what symptoms are you trying to ameliorate?
Posted by Darkness At Noon on July 24, 2007, at 3:18:32
In reply to Re: EMSAM At 6 Weeks » Darkness At Noon, posted by tendency on July 24, 2007, at 1:28:35
> It seems only obvious to ask: what symptoms are you trying to ameliorate?
Depression. Deep, recurring, debilitating depression. As the pdocs like to say, treatment-resistant depression; as I find more accurate, treatment-guessing pdocs.
Posted by Sigismund on July 24, 2007, at 19:13:09
In reply to Re: EMSAM At 6 Weeks, posted by Darkness At Noon on July 24, 2007, at 3:18:32
Hello
If I had to describe what depression means for me I would say that
a. I get trapped in words and can't think.
b. I get trapped in situations and can't get out.
c. Too much disappointment, bitterness and anger.
d. I certainly used to feel like people took me over.What I am wondering is what we mean by depression. I understand there is suffering, and not much else.
Maybe for me it was just depersonalisation, until I'd had so much it made me depressed as well as anxious?
I realise this is tangential to your post, but it seems important to have words that have clearly understood meaning that we can share.
Posted by Darkness At Noon on July 25, 2007, at 5:40:31
In reply to The meaning of depression » Darkness At Noon, posted by Sigismund on July 24, 2007, at 19:13:09
> If I had to describe what depression means for me I would say that
> a. I get trapped in words and can't think.
> b. I get trapped in situations and can't get out.
> c. Too much disappointment, bitterness and anger.
> d. I certainly used to feel like people took me over.Your description of depression is accurate, but I wonder what's the cart and what's the horse. For me:
1. I lose the motivation/interest/energy to do things which are important to me, and which at one time I enjoyed.
2. I cannot tolerate being around people. My social network atrophies.
3. Survival (like getting groceries) becomes a struggle, not a nuisance.
4. Life is painful. There is too much one day at a time, one hour at a time, one minute at a time. Only to pass to the next day which gets marked one day at a time.
To me, the continued 1-2-3-4 resulted in the a-b-c-d. Then, of course, the a-b-c-d becomes another part of the depression.
I've learned techniques to break out of the a) circular word thoughts, although they can be easily triggered again (and broken out of again).
d) People take me over to the extent that I don't have the will to make decisions or take action.
But continued depression definitely b) traps us in situations which cannot be escape while depressed. Indeed, even if the depression stops, we are still stuck with the results of lost or botched opportunities.
c) Disappointment, bitterness and anger naturally flow from the hand that life has dealt us. Not to mention often ineffectual and questionable treatments from the mental health profession. I have learned ways to temporarily dissolve these feelings, but their underlying causes remain, so they return.
But if I had to describe depression in just one word: blackness.
Posted by Sigismund on July 25, 2007, at 16:33:40
In reply to Re: The meaning of depression, posted by Darkness At Noon on July 25, 2007, at 5:40:31
Thank you.
I appreciate that.
This is the end of the thread.
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