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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 47. This is the beginning of the thread.
Posted by UGottaHaveHope on March 9, 2007, at 12:20:07
I am on week nine of Emsam for generalized anxiety (along with 100mg of Seroquel and 3mg of Klonopin). The Emsam didn't do much for the first 6-7 weeks, perhaps even causing more anxiety. I was all prepared for a Nardil trial, and my pdoc gave me a prescription.
Here's the deal: In the last week, I have had about three days with zero anxiety. The other days, I had episodes where I had a couple of hours of midrange anxiety and then a few hours of high anxiety.
Right now, I have decided to stay on Emsam for at least another week to document everything. If anything, it can be backup if I take the Nardil and it does not work out.
So here is my question: With Ensam, I am like I am on second base. Would you take the Nardil to swing for the homerun? Or course, I could also strike out. But I will never know unless I try.
There are a couple of other factors: There is no washout period between Emsam and Nardil. And most importantly, my job is slowing up for the next few months, which would the best timing if I had a lot of highs and lows on Nardil.
What do you do? Stay on second or swing for the fence? Thanks in advance for your opinion. You guys have been in my shoes, therefore I highly value your opinion. Thanks, Michael
Posted by Phillipa on March 9, 2007, at 12:32:16
In reply to Need your ADVICE: What would you do? Emsam/Nardil, posted by UGottaHaveHope on March 9, 2007, at 12:20:07
Michael what about the ultram? I thought that was working great. I'm confused? Love Phillipa
Posted by Phillipa on March 9, 2007, at 12:35:03
In reply to Re: Need your ADVICE: What would you do? Emsam/Nardil » UGottaHaveHope, posted by Phillipa on March 9, 2007, at 12:32:16
Michael so sorry I mixed you up with blueberry who is doing well on ultram. I think if I were on second base I'd stick with that for a while as you've been able to tolerate the anxiety and you're working right? Love Phillipa
Posted by Crazy Horse on March 9, 2007, at 13:58:49
In reply to Need your ADVICE: What would you do? Emsam/Nardil, posted by UGottaHaveHope on March 9, 2007, at 12:20:07
> I am on week nine of Emsam for generalized anxiety (along with 100mg of Seroquel and 3mg of Klonopin). The Emsam didn't do much for the first 6-7 weeks, perhaps even causing more anxiety. I was all prepared for a Nardil trial, and my pdoc gave me a prescription.
>
> Here's the deal: In the last week, I have had about three days with zero anxiety. The other days, I had episodes where I had a couple of hours of midrange anxiety and then a few hours of high anxiety.
>
> Right now, I have decided to stay on Emsam for at least another week to document everything. If anything, it can be backup if I take the Nardil and it does not work out.
>
> So here is my question: With Ensam, I am like I am on second base. Would you take the Nardil to swing for the homerun? Or course, I could also strike out. But I will never know unless I try.
>
> There are a couple of other factors: There is no washout period between Emsam and Nardil. And most importantly, my job is slowing up for the next few months, which would the best timing if I had a lot of highs and lows on Nardil.
>
> What do you do? Stay on second or swing for the fence? Thanks in advance for your opinion. You guys have been in my shoes, therefore I highly value your opinion. Thanks, MichaelOnly you know how truly good or how much suffering you still have while on EMSAM. So if you are only 'half way there' (2nd base) i would try the Nardil, which has the ability to bring you past 2nd and all the way home. When it works, which is most of the time, it can truly be miraculous, if it doesn't you can always try Parnate or even go back on EMSAM. Good luck in making a choice.
-Monte
Posted by stargazer on March 9, 2007, at 15:18:52
In reply to Re: Need your ADVICE: What would you do? Emsam/Nardil » UGottaHaveHope, posted by Crazy Horse on March 9, 2007, at 13:58:49
Michael, I would go for the home run, I think (noncommittal).
Your anxiety is still up and down so it really isn't under good control yet, although it's bettr than it was, right?
It sounds like a good time to try Nardil so therefore why not do it to see if you can get a better response than Emsam. I'm all for the real thing if there is a possibility of getting a better response and Nardil would be the one to work.
Were you already on the Klonopin and Seroquel or were they added to Ensam after you were on it. I'm asking because you don't really know what Emsam is doing by itself, do you?
I would recommend trying the Nardil and trying to get a better response. But only you can make that decision knowing your anxiety level and tolerance for meds. It's great that there is no wash out period from Emsam to Nardil. That is a positive.
Does your pdoc have an opinion?
Stargazer
Posted by bulldog2 on March 9, 2007, at 15:27:19
In reply to Need your ADVICE: What would you do? Emsam/Nardil, posted by UGottaHaveHope on March 9, 2007, at 12:20:07
My p-doc has a rule of thumb that on a scale of 1-10 your ad should at least give you an 8 or greater by six weeks or its time to change ads. If you factor in the placebo effect anything less than 8 is not really impressive. Since your already on an maoi I would go for the nardil or parnate. Also with you being on the seroquel and klonopin they could also be playing a role in reducing anxiety. If there's something out there that might make you happier why settle for less.
Posted by jealibeanz on March 9, 2007, at 16:48:58
In reply to Re: Need your ADVICE: What would you do? Emsam/Nardil, posted by bulldog2 on March 9, 2007, at 15:27:19
What dose of EMSAM are you on? I know some reported less anxiety with the 9mg and 12mg, since it then works as a MAOI A.
Posted by UGottaHaveHope on March 9, 2007, at 17:02:08
In reply to Re: Need your ADVICE: What would you do? Emsam/Nardil, posted by stargazer on March 9, 2007, at 15:18:52
SG: I always love your insights. Thanks so much for responding to my question. Yes, I have been on Seroquel and Klonopin for two years, and actually had a pretty good period for four months just on those two until some financial situation got me all jacked up with anxiety again. However, the pdoc did do one thing that helped a lot: Instead of me taking Klonopin as needed (usually 1mg day), I take 4mg per day. He's a huge believer in benzos, and yes that is likely playing a huge factor in me feeling better. Seroquel just helps with sleep like nothing else in this world.
My pdoc said I could 1) stay on current mix 2) take Ensam patch off every other day, 3) do Klonopin and Seroquel only or 4) try Nardil. He said he had no opinion, but when I asked him what he would do. He said "You have nothing to lose by trying Nardil."
Yes, my tolerance for Nardil is a concern, but you have eased my mind with your past posts about your own experiences with Nardil. I have saved all of them. They give me confidence.
Please do me a favor: Update me on you. Emsam still? Hows it working? Whats your plans? How are you feeling 1-10?
Posted by UGottaHaveHope on March 9, 2007, at 17:08:10
In reply to Re: Need your ADVICE: What would you do? Emsam/Nardil, posted by bulldog2 on March 9, 2007, at 15:27:19
If you're pdoc thinks you should be feeling like 8 after six weeks or its time to change meds, I would think that you have one of the better pdocs around. I like that. Until I went to my current pdoc, all the other ones were so passive on everything. You have someone willing to do whatever it takes to get you better and do it now (after a fair trail). You are blessed.
Klonopin: Yes after taking 1mg as needed for years, my current pdoc is a big believer in benzos and put me on 4mg per day. I think it has helped, probably a lot more than the Emsam I would speculate. Seroquel is great for sleep.
Bulldog, did you ever say that you tried Nardil or Parnate? What were or are your experiences? Side effects? How long did it take for you to feel something? And how specifically did it address anxiety (GAD)?
As always, thanks for responding. I always value your opinion, Michael
Posted by UGottaHaveHope on March 9, 2007, at 17:15:49
In reply to Re: Need your ADVICE: What would you do? Emsam/Nardil, posted by jealibeanz on March 9, 2007, at 16:48:58
Jealibeanz, that's a very interesting observation. I am on the 6mg patch and at first it appeared to be too energizing, which did not help my anxiety at all. I have not heard too much feedback on this board about others taking the 9 or 12. Have you? Or did you try the patch at either dosage?
My train of thought was this: If I was going to push Emsam past the non-food restriction level, then I might as well switch to Nardil, which has been around for 50+ years and has helped many with all forms of anxiety. Of course, I realize it could make me feel worse, too.
Have you had good experiences with MAOIs? Please tell. Thanks for your insight, Michael
Posted by jealibeanz on March 9, 2007, at 17:35:25
In reply to Re: The difference between 6, 9 and 12mg Emsam » jealibeanz, posted by UGottaHaveHope on March 9, 2007, at 17:15:49
No, I've never tried EMSAM. I don't go to a pdoc. My GP doesn't know about my depression. I act happy. Maybe I'll consider an AD in 10 years.
Posted by chiron on March 9, 2007, at 17:38:34
In reply to Need your ADVICE: What would you do? Emsam/Nardil, posted by UGottaHaveHope on March 9, 2007, at 12:20:07
Hello again UGottaHaveHope. So are you saying that Emsam took about 7 weeks before you noticed it having any effect? It seems like most people that have had a positive experience notice a difference even within the same week. I know the literature says it takes a while, but I am looking for some personal experiences to give me hope that it could still "kick in".
thanks
Posted by bulldog2 on March 9, 2007, at 17:59:03
In reply to Re: Wow, I need to go to your pdoc » bulldog2, posted by UGottaHaveHope on March 9, 2007, at 17:08:10
Tried emsam at 6 mg as was not impressed. Doc wants me to try parnate as that is his favorite. Told me he takes it himself and likes it.
Posted by Phillipa on March 9, 2007, at 19:28:20
In reply to Re: The difference between 6, 9 and 12mg Emsam » jealibeanz, posted by UGottaHaveHope on March 9, 2007, at 17:15:49
Don't forget to factor in the weight gain. I would think that would be of concern especially on seroquel with diabetes as a possible consequence. Not trying to be negative just throwing it all out. And does everyone gain weight on nardil? Love Phillipa
Posted by Phillipa on March 9, 2007, at 19:42:46
In reply to Question on how long Emsam took, posted by chiron on March 9, 2007, at 17:38:34
Chiron I e-mail with a nurse on the l2mg patch and providgil and loves it and it works wonderfully for her. Don't know how long it took to work though. Love Phillipa
Posted by stargazer on March 9, 2007, at 20:23:41
In reply to Re: I like homerun hitters like you SG » stargazer, posted by UGottaHaveHope on March 9, 2007, at 17:02:08
Hi Michael...still on Emsam 9 mg, still using 6 mg patches, 1 and 1/2 patches every day. I'm know it is doing something since after trying any medication I usually get worse before I get better. Most meds I've tried have never worked alone, except Nardil and Marplan. All the SSRI's have required the addition of other meds, which didn't always do very much.
Looking back over the years of med trials, with the exception of Nardil and Marplan, the only one that worked pretty well was Celexa with Wellbutrin and Adderall. That's in 20 years!
I just added Provigil the other day, too early to tell. This may be the last thing I try before my Nardil trial. My pdoc will do what ever I want at this point since I've had it with his suggestions.
We could be on Nardil together in a few weeks, you could pave the way since you're further along in your decision to try it.
I sill have another box of Emsam left (6 mg) so I can try it a little longer. If I was almost out of the patches I would try Nardil before getting more patches. I know how expensive they are and I feel I should use them up first. Well, maybe not the whole box.
I bet if you decreased the Klonopin, your anxiety would flare up again. It's probably doing most of the work especially when you went from 1 to 4 mg. That's a huge dose increase.
Is he going to keep you on the Klonopin while starting Nardil? If he does this, you should gradually wean slowly off the Klonopin as tolerated to see what Nardil is doing.
I made a mistake with my last Marplan trial. I was already on either Seroquel or Lamictal when I started Marplan and I never got off those to try Marplan alone. I regretted not trying Marplan by itself, since that is how I took it years ago when it worked.
Have I covered everything? I'm getting excited and eager for you to try it.
SG
Posted by Phillipa on March 9, 2007, at 20:53:40
In reply to Re: I like homerun hitters like you SG, posted by stargazer on March 9, 2007, at 20:23:41
Stargazer I'm excited for you with the addition of providgil as this nurse I e-mail with has a lot physical problems you don't and she seriously feels great. I hope I hear the same from You. Love Phillipa
Posted by UGottaHaveHope on March 10, 2007, at 0:47:29
In reply to Question on how long Emsam took, posted by chiron on March 9, 2007, at 17:38:34
Every med affects everybody differently. I felt an energizing impact almost immediately after putting the patch on me on the first day, which did my anxiety no good. It's week 9, and I would say all of sudden I started to feel a little better out of nowhere in my general outlook on life in week 7 and even more this week. Thats why I will probably give it 12 weeks before making a final decision. I highly recommend keeping a diary to note how you feel each day. If I dont, when I feel bad, I forget I ever felt good. Good luck and e me if you have any more questions.
Posted by UGottaHaveHope on March 10, 2007, at 0:51:54
In reply to Re: Wow, I need to go to your pdoc, posted by bulldog2 on March 9, 2007, at 17:59:03
Your doc told you he is taking Parnate, it is working for him, and recommended that you try it? First of all, bravo for the doc, for dropping his ego and shield to admit he is like the rest of us (Ive never had any pdoc admit they take anything). Secondly, if you choose to take Parnate, he will be a wonderful source to walk you through it. Man you are lucky. You going to do it?
Posted by Declan on March 10, 2007, at 0:54:09
In reply to Need your ADVICE: What would you do? Emsam/Nardil, posted by UGottaHaveHope on March 9, 2007, at 12:20:07
I haven't read the thread so someone might have said it. But Scott used to quote some doctor (Francis Quitkin?) who said that Nardil helped 90% of patients but 75% of them gave it up because of the side effects....or something like that.
So, because Emsam is helping you (isn't it?), I think you should stick with it.
Posted by UGottaHaveHope on March 10, 2007, at 0:59:26
In reply to Re: Need your ADVICE: What would you do? Emsam/Nar, posted by Declan on March 10, 2007, at 0:54:09
That's what I have heard, or at least what my pdoc said, but every med affects everyone differently. However, it does seem like people get more side effects from Nardil when they take a dosage of 60mg or higher. Did you?
Thanks for the quote.
Emsam? I feel like I'm on second base with the Emsam, which is good I guess. But I want to swing for the fence with Nardil, and I know I could strike out. But I could knock it out of the park. I know I'll never know if I don't try.
How about your experiences with MAOIs?
Posted by UGottaHaveHope on March 10, 2007, at 1:08:11
In reply to Re: I like homerun hitters like you SG, posted by stargazer on March 9, 2007, at 20:23:41
You remind me of my mom by using up your Emsam patches before considering switching meds. My mom hates it when any food or money is wasted, which is a credit to her.
I'm interested to hear what the effect of Provigil is on you?
The pdoc has instructed me to stay on the same dose of Klonopin (4mg) and Seroquel (100mg) when and if I begin taking Nardil, which didnt arrive in the mail today but should be here tomorrow or Monday. I'm sure if Nardil has a sedative effect on me and also squashes my anxiety, I would get to the point of eliminating the other two. But I'm not going to rush to any changes, because doing that has always messed up any progress in the past. I dont always listen to pdocs, this time I am.
Let me know when you are finished with Emsam and we can walk this walk together.
Posted by jealibeanz on March 10, 2007, at 5:46:03
In reply to Re: Wow, your doc said he was taking Parnate » bulldog2, posted by UGottaHaveHope on March 10, 2007, at 0:51:54
> Your doc told you he is taking Parnate, it is working for him, and recommended that you try it? First of all, bravo for the doc, for dropping his ego and shield to admit he is like the rest of us (Ive never had any pdoc admit they take anything). Secondly, if you choose to take Parnate, he will be a wonderful source to walk you through it. Man you are lucky. You going to do it?
Wow... as a med student, I've wondered how I'd approach this situation myself. It's tricky!As a provider, you're taught not to get too close to the patient. If they start to think of you as a friend, their treatment could suffer for many reasons.
But at the same time, if you want to really be a good practitioner, you want to have some sort of relationship. Smalltalk about both the doctor's and patient's lives helps.
I was thinking about this the other day actually. If someone came to me, embarrassed and scared to admit to being depressed, and told me there's no way I could understand, what would I say? I've been there before? I've been depressed and taken several medications? I know what it's like to be frustrated when you have to endure side effects or find a medication to stick with? I know that weird little feeling you get, physically and emotionally, inside your head on days 4-5 on a Effexor XR trial?
Or would I just want to stick with the... "I've seen this many times. It's much more common than you think, don't be ashamed. It's OK to talk about. There's many medications to try and all my patients have different reactions and preferences" line?
I think most doctors tend not to share any medical experiences whatsoever. Haha, I remember last year I was complaining about my allergies and the bad allergy season, my doctor was like... yeah, I noticed my eyes have been really itchy lately. I was sitting there thinking to myself... whoa! oh my god! you're not supposed to tell me that! You're my doctor, not a real person. Doctors don't have medical problems! They can't admit them to patients!
Haha, yes, that is what I thought. About a small allergy comment. Not even about medications. And this is a doctor who I have a pretty close relationship with. But I was just floored by the first time that a practitioner ever gave any information about their own health.
I think this really depends on the situation. A well established doctor can do this much easier than a young one. You need your credibility built up first. You'd also need to judge your relationship with the patient, and the emotional capacities of the patient. If you know and trust your patient, and have earned his/her trust, revealing something after years may be OK, although I'd have to say... telling someone you're on Parnate is risky!
OK, I'll stop now with my random thoughts on life and medical practice.
Posted by UgottaHaveHope on March 10, 2007, at 10:44:28
In reply to Re: Wow, your doc said he was taking Parnate, posted by jealibeanz on March 10, 2007, at 5:46:03
You bring up a lot of excellent issues. I have had pdocs say they experienced anxiety and depression themselves all the time, as to relate to me, but they never revealed any drug history.
I am surprised this pdoc admitted he was on Parnate. But perhaps he is very well-established and confident in himself or herself. You know, Parnate is a MOAI, and just the pure mention of MAOIs (only because the diet and medicine restrictions) scares the heck out some people, including ME. Perhaps the pdoc said it to give his or her patient the confidence to take it. I know if my pdoc said that, my confidence level would shoot through the roof.
There is also another view: If there is a medicine that radically changes your life in a positive way (like Parnate has done with some of this board), you tend to want to share that glorious news with the world. For the pdoc, it would be taking a little hit on his ego or appearance of perfection for the betterment of humankind.
Finally, and this is most important, I think far and away the No. 1 thing that helps anyone out there challenged by emotional issues is TO KNOW OTHER PEOPLE ARE STRUGGLING, TOO. When it first started with me, I thought I was the only one who had those challenges because no one else ever talked about it openly. Only when I found out I was in the boat with many, many others did I come to terms with what I was facing.
Cheers to that pdoc! And I hope you find the same compassion and selflessness in your med field. Michael
Posted by stargazer on March 10, 2007, at 11:36:06
In reply to Higher calling: Your pdoc said he taking Parnate » jealibeanz, posted by UgottaHaveHope on March 10, 2007, at 10:44:28
My pdoc hasn't said he takes meds but he has alluded to having personal experience with depression. I think I may have even asked him if he has depression.
My belief is that many people who are in the psych profession have had experience with it themselves. It is my imagination or are there many people here who work in psychiarty?
Or all we all psychiatrists due to the research and conversations we have so often?I think it makes sense for a doctor to reveal this only in the right situation, either when asked directly or when it seems appropriate like, when someone has no faith in meds, it can provide a personal connection that may be the difference between life and death.
It's different than a doc saying I have allergies or something that tivial. I would find that more annoying than helpful.
It is a judgement call, but in this instance where your doc revealed that, I find it really a statement of strength, not one of weakness.
It probably depends alot on the patient, as well. You wouldn't want to reveal this to just any patient. Some might find this too equalizing, where the doctor is supposed to be the one without any problems (fat chance of this).
Stargazer
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