EMSAM, having a tough time.

Edit: I have MDD

I started the EMSAM patch in early September after a failed cocktail of Wellbutrin, Fetzima, and Buspirone destroyed my appetite and brain "signal" for hunger.

I did really well with this at first. I became more sociable and got into my hobbies again (art, music) and I was interested in TV shows and reading. This changed around Christmas, when I got severe insomnia. I spent all weekend over New Years abstaining from caffeine and doing anything I could think of to get to sleep: hot showers at night, lying there concentrating on relaxing each muscle in my body one by one - old trick I read in a social anxiety workbook many years ago - ear plugs, etc. etc. But nothing. My body was actively keeping me awake. I got my psychiatrist to lower the dose to 9mg and within a month my sleep got better.

Things have gotten worse since then. It is now almost June and I am in a total wasteland. I can't sleep again, my mood is really irritable and I'm starting to miss work more. My behavior is really concerning me - my mother is on her way to my town for a funeral and I had to tell her she couldn't stay with me because my place is an absolute wreck. I'm taking a lot of things people say as a personal slight and I know that's delusional. I am depressed & exhausted, every small task feels like a total chore, and I don't know if it's from the insomnia or if the med has just failed.

I see my pdoc this Wednesday and I am going to share with him my concerns on my behavior. I feel like I am hiding from everyone. At the least, I think I am going to have to switch from Xanax ER to the immediate release because it's not working, or some kind of sleeping pill. I don't like sleeping pills but I'm getting desperate here. I cannot stand walking around with heavy eyes everyday. I did get a blackout curtain and am able to get some sleep on the weekends so I take what I can get. Has anyone gone from EMSAM to another MAOI like Nardil?

Just trying to hang on...

I don't have any experience with the EMSAM patch or with MAOI's, but I just want to say that you sound really depressed, and I'm so sorry. It sounds like you're trying very hard to alleviate your MDD, but that the patch is maybe not working for you.

I hope someone else here can share their experience with an EMSAM patch.

Thank you. I have read a few posts on here, but they are few and far between because MAOIs are so rarely prescribed these days. It seems like others find EMSAM activating as well. I got a bit of a "kick in the *****" about my situation when I flew off the handle at my mom a few days ago after she made a mistake. The details aren't important, but my reaction really hurt her feelings and was uncalled for. I am not using the meds or depression to excuse it, but one or both is definitely the reason for this behavior and I need to rein it in.

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I am on Emsam 12mg. I started on 6mg 3/10 and had to keep increasing to the max. I slowly started to feel better after upping to the 12mg but the last two weeks the insomnia was getting worse and my dr thinks I am hypomanic. So he has been upping my Seroquel to try and get me to sleep. Last night I finally got a full night sleep in a long time. I hope things can start to turn around for you. I know how bad the insomnia can be and it just makes you more irritable.

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Thanks for replying. I'm not on anything except 9mg EMSAM and 0.5 Xanax ER. I'm glad to hear you got some sleep. I have to say the dietary restrictions really haven't affected me too much.

Does Seroquel cause weight gain? I have gained about 13 pounds since I started EMSAM and I think it's because my metabolism has shut down from the insomnia. No, I don't have great eating habits either but when you're depressed you just want sugar and carbs. We are having the first hot weekend of the year where I live and NONE of my summer clothes fit from last year, I feel awful about myself. I haven't been this heavy in 3 years.

Guess I'll just wait for that pdoc appointment on Wednesday...

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Yes Seroquel causes weight gain. I have gained 40 pounds in the last year. It is not all from Seroquel but I did gain 3 pounds in two weeks after I last upped the dose. I am wearing shorts for the first time this year and had to try on many to find one that fit. It was depressing. I already had to buy a bunch of new shirts for summer now I will have to get some shorts as well. Plus today I have been in bed a lot because I feel so worn out. I think I am coming down from my hypomania.

I use the Seroquel for depression and to help me sleep. Ambien and Lunesta don't work for me.

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i think it might be important to note that different people have a little different reactions to the different medications..
i didn't gain anyweight on the seroquel, but the zyprexa caused me to gain 60lbs :/

i was on 600mg seroquel for a little while... 400mg for about a year or so.. started at 300mg...

i've never used any maoi ..

i hate zyprexa :/ it didnt do anything but make me gain weight
but thats just my experience, it helps some people a lot
i was on 20mg for a year or 2 (its really hard for me to keep up with time..)

edit:
here is an interesting article about weight and APs.. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3998960/
its just an article though, i think basically any ap can cause weight gain.. just some have more reputation for it

I am a woman and I can't even get my shorts from last year buttoned - totally unwearable. Very depressing indeed. Thanks for the additional info on the meds.

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True, however you might be the first person I've read about who has not had a Seroquel weight gain though. I have read dozens of posts about Seroquel (too many to count, and on many forums) and they've all said the same thing - they ballooned.

I was on Paxil for a dozen years and I gained a ton of weight on that, ugh, I was hungry all the time...

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Add me to the list of people who have gained a lot of weight on Seroquel. It made me feel SO hungry that if I didn't eat I literally felt unwell. Never mind that I ate only healthy foods...I still put on weight.

Seroquel sure helps with insomnia, though.

So much for that. Pdoc doesn't get it either. He wants me to take the thyroid booster that he wanted me to start 2 months ago and I didn't like some of the side effects I read about it in the information sheet that came with the prescription. He said if I started experiencing an unpleasant side effect I could quit taking it. That's all well and good, but I still can't ****ing sleep. I guess I wasn't forceful enough in asking for help with this, or he is of the opinion it's mostly external stressors. He did offer me sleeping pills 5 months ago and I said no because when I was on them they wouldn't wear off in time for me to go to work. So maybe he was just assuming my aversion to them and he didn't offer it. He did give me a very limited supply of immediate release Xanax for a legitimate problem I'm having with dental anxiety, but I'm hesitant to use those for something else. Oh well.

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It's very odd your doctor hasn't taken you off this med after sleep that poor for that long time. You're where sleep deprivation is starting to become dangerous. Contrary to what some docs think, people need sleep.

Don't I know it.

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Have you tried alternating patch days? I've done that when the Emsam was too activating I'm bipolar so it can cause mania if not cautious). I've also cut patches to get a custom dose. When I was really manic last year we did 3 mg every other day (I wore the same patch 2 days I think; can't remember for sure) and that was cut down from 9 mg patches. Then I cut them diagonally to get 4.5 mg patches for another long time. When I got depressed I went up to 12 and since I get my patches through patient assistance and can't change the dose easily I was cutting a patch and making 12 mg. That worked until I was IP and they had to use the 9 mg patches (my hospital doesn't stock Emsam so I provide my own).

Despite some struggles with sleep (I take 1200 mg of gabapentin and 350 mg of clozaril plus 2 mg of klonopin at bedtime but that's more my bipolar then Emsam) I've been on it nearly 7 years and love it. It's been one of the few ADs that ever did anything for me. It just takes some creative dosing.

Did you try another MAOI?

I was told to never cut them. I am not bipolar so your method may not work for me at all. All I know is this series of events: I was feeling good in December at 12mg, I got horrible insomnia 2 weeks later, got depressed all over again, and went back down to 9 the week after New Years because not sleeping was worse than anything else. Now it's mid June and I still have almost no interest in anything and I can't sleep most nights. My pdoc is filing an aggressive and detailed appeal against my insurance company with assistance from his colleagues at the American Psychiatric Association because they won't cover TMS.

The worst part of all of this? The depression is making me forget everything so I can't remember to do basic tasks that may help me, like remembering to take Vitamin D or scheduling bloodwork to check those levels. My pdoc did put me on a thyroid booster (liothyronine) but I don't feel any differently after 2 1/2 weeks.

Update: I finally went down to the 6 mg patch 4 days ago. I told my pdoc enough was enough. He also increased my Xanax at bedtime which does a good job of knocking me out so far. Since I last posted in this thread, I got even worse and the anxiety kicked up to levels I haven't experienced in 4 years. Fear of having to interact with people in the parking lot outside my place, fear of having to drive in heavy traffic, I even have to give myself pep talks before going into crowded stores. Monday and Tuesday were some of the worst days I've had ever at work - 8 hour long performance, heart beating out of my chest, trouble breathing, coupled with the back pain. I broke an appointment with the GYN yesterday because I didn't feel like I could hold myself together well enough, total panic attack as I was getting ready to walk out the door. I have very poor concentration and memory recall overall, but that is the depression & insomnia and not the benzos because I had memory/cognitive issues with depressive episodes before when I was not taking any anxiety meds at all.

Not doing well socially or at home either. I flew off the handle at a few more people and I think I may have lost a friend of almost 20 years because I took something she said the wrong way and now I absolutely can't stand her. I have tried to work this out in therapy and my feelings haven't changed towards my friend and I don't want to speak to her. My mom immediately goes into orbit if I don't answer her phone calls even once - she automatically thinks I've hurt myself or something, and then I get angry at her for overreacting. My home is an absolute disaster area and I am so overwhelmed I don't even know where to start to get my housekeeping under control.

Unfortunately this med change, which i think I should embrace as a positive thing, could not have come at a worse time. I developed sudden and intense back pain that hit me like a freight train when I woke up this past Monday morning. I have about 4 or 5 different theories as to what may have caused this, but I think overall my body is telling me "no more" to lying down for excessive amounts of time every weekend this year. So my back has just gone into a sort of atrophy, if you will. I have to sleep "in shifts" because sleeping in one position for too long wakes me up. I have a call into a physical therapist for this one.

Insomnia is truly crazy-making. what a mess.

Omgoodness that sounds horrible. I'm sorry you are going through this. I hope you are feeling better very soon

I, too, am so sorry you're having such a difficult time of it.

Thanks to both of you.

Hiya, Just saw this post. I have started taking Moclobemide - MAOI. Been on it a whole two weeks so I guess I haven't even reached the "therapeutic level" yet. I do not like the side affects this is having on me.

Any medication that a P'doc prescribes, whether it be and MAOI, SSRI, SNRI, Antipsychotic etc has to eventually have more benefits than not.

You are having a very hard time. The side affects that you mention should have eased up considering that you have been on this med since June. Panic attacks and back spasms and insomnia are deal breakers. If it were me I would ask for a change. If it hasn't worked by now it isn't a good sign.

Hope your p'doc listens. Maybe your T can have a chat with your P'doc?

I'm sorry you're going through all this. I'm on another EMSAM attempt (I think we talked in a thread I made), so I somewhat know how crazy the stuff can be. And from my time on Nardil, you're right about how amazingly bad insomnia can be. Is there any chance at all the back pain is from the EMSAM, or do you think it's something else?

Sorry if this comes across as rude, but I don't think you read this entire thread. I have been on EMSAM for 13 months, not since June. I made that post in June where I said I started EMSAM last September. I started getting insomnia in Dec '15/Jan '16 when my dose was up to 12mg. I just said in the recent post about the back pain that I did make a change, I went down to the lowest dose which is where I started and my sleep is better already. Also, I said that my pdoc and his colleague at the American Psychiatric Association (an attorney) are waiting on a decision from my insurance company for TMS approval after filing a series of aggressive appeals. Btw, the back pain is not from the EMSAM at all. It is my mattress and muscular strain/atrophy caused from lying on said mattress every weekend and weeknight because depressive people tend to like to stay in bed a lot.

I'm sorry you're having a hard time with side effects while starting your new med. When I first started EMSAM it knocked me out and I could never get enough sleep. I think pdocs downplay the magnitude of side effects overall, but that's just my personal opinion from being a patient for so long.

Hi, thanks. No, the back pain is not from the EMSAM, but it is an injury indirectly caused by the insomnia. My theory is that the insomnia actually made the depression come back, which led to me staying in bed all weekend and many weeknights, all the while not noticing that my mattress was getting worse and worse. I saw a physical therapist on Tuesday and for lack of a better term, she manhandled me (LOL) but I didn't mind because I wanted to find out exactly where I was having trouble. Well, she pressed in on multiple points in my neck, shoulders, in between my shoulder blades, and even my breastbone (sternum) and I felt quite significant pain in all of those places. She said the body does not like inactivity and she said all of my theories were probably correct, and that anxiety and depression can enhance levels of pain. She's going to work with me over the next 5 weeks and she thinks this can all be corrected because I've responded well to PT in the past for an unrelated matter. I have to walk for at least 30 minutes a day and do 3 easy exercises every day to start off.

I stayed over at a relative's house last night and immediately noticed a difference in my pain levels once getting into bed and when I woke up in the morning. I tried the "quick fixes" for my own bed (like a mattress topper) which failed. I'm going to need to buy a new mattress ASAP.

It doesn't come across as rude.

I am sorry. I didn't read it properly. I do wish you well and hope that are able to find wellness and the help that you need and deserve.