Posted by silvercoin on July 31, 2006, at 8:09:04
In reply to What would you do? EMSAM, posted by mayzee on July 30, 2006, at 15:11:26
> Well, I saw my pdoc yesterday and, as expected, she is unhappy about my problems with low blood pressure. She wants me to back down to the 6mg patch right away. (I only started having the low bp problems after a week or so at the 9mg level. I've had 20 days at the 9mg level, preceded by 7 weeks at 6mg)
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> The low bp problems are significant for me –lightheadedness, dimmed vision, headache, nausea, heart palpitations when I take a walk (I have to walk my dog twice a day), and extreme fatigue all the time. I have no energy to do anything. (oh, except sit at the computer and read Babble). I can’t live like this. Plus the pdoc said it’s bad for your heart; that low pb puts more of a strain on it.
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> Despite that I am hesitant to retreat on EMSAM. On days 9, 10, 11 at the 9mg level I felt good; better than I had in ages. (except for that one day –day 6—at 6mg where I felt good) That really got my hopes up that this was going to work. But the low bp stuff really got worse after those 3 days.
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> My pdoc said ok to me trying 1 more week at 9mg with drinking lots of water, eating salt, etc. to try to help my bp. But she really wants me to back down to 6mg, see if there’s any AD effect and, if not, wash out EMSAM and try a tricyclic. She doesn’t have any experience with MAOIs, and I haven’t ever tried a tricyclic yet.
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> I think I had such hopes for EMSAM since all the high-power pdocs I’d had consults with over the years had said that MAOIs are best for atypical depression. I’d dragged my feet getting around to trying one, so had my hopes very high. And I hate to give up on any med without going to the max so that I can say I gave it a full trial. (after previous experiences where docs said, oh but you didn’t really go high or long enough. It all takes such a long time!) But I do feel sick with this low bp.
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> What do you guys think? Does it sound like I gave EMSAM a full enough trial and that it’s time to back off and find something else?
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> *What would you do if you were me?*
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> --mayzee
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> P.S. she did give me klonopin to help with the ensam-induced sleep problems
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> P.P.S. other drugs I’ve taken without success: zoloft, effexor, prozac, paxil, wellbutrin, luvox, lexapro, cymbalta
I would stay on the 9 mg patch and add some other agent to raise BP. I take Marplan and have some of the same issues but have apparently strengthened my cardiovascular system enough through vigorous exercise to minimize them (I have a BP cuff and have discovered my problem has more to do with low heart rate than low BP). Stimulants can cautiously be used with MAOIs to raise BP and would also help with your fatigue symptoms--I would suggest trying Ritalin first rather than amphetamine for safety reasons. There are non-stimulants available that will also raise BP, but try to determine exactly what yours is first. If it's much below 100/60 and your heart rate is also below 60, I would cautiously add something to boost your cardiovascular system. It is worth pointing out that tricyclics can also lower BP, sometimes severely, but they do not usually lower heart rate as do MAOIs.Todd
poster:silvercoin
thread:672050
URL: http://www.dr-bob.org/babble/20060724/msgs/672238.html