Emsam...

I tried Emsam for a very short time in the past, and am desperate enough that I've been trying it again for the past week. I cut a patch in half and did 3 mg for 2 days, then have done 6 mg for 5 days.

I thought the first day I felt a little bit of positive effect from even the first patch. I'm thinking this was because I've just been depressed and so tired that any increase in energy feels good at first. I'm just really concerned about what it's doing, though, and I know I've gotta wait and see but I'm worried.

The first day I went out after starting the 6 mg, I felt so weird. My vision was off, in a way I can't even put my finger on. I just noticed when I was driving that something was different. I think it's almost like I can't see as much to the sides, and then even my vision straight ahead is a little off, too. I've also had this weird feeling which, even though I've really been struggling with derealization/depersonalization, I think is from the Emsam. It's not even the same as the DP/DR I've felt before, but it's like I just can't get a grap on what is real, or feel like I'm really where I am, if that makes sense. Time has been passing weird, too. The weirdness has continued and today I had to go home early from work partly because of it.

I think it's making my social anxiety worse, too. Everything's just been worse lately for me already and my memory's horrible so it's hard to tell, but I'm pretty sure I'm having more anxiety/paranoia about what other people think about me. I wouldn't expect this, especially so soon, and I'm desperate for it to work so kinda in denial, but I swear it's making me feel less motivation and more apathy. Generally I just feel pretty weird, and there's been some nausea, muscle aches, and bad headaches, too, but those don't worry me quite as much.

It's just one of those things I know I probably don't have much choice but to wait out, but I'm really worried for a few reasons. I started a new job a little over a month ago, and even just holding on and dragging through it this long has been a miracle with my recent mental health, I wouldn't normally be able to do that in the past while badly depressed and such. I'm pretty sure the Emsam has been giving me an extra kind of apathy that's kinda had me feeling like, "well, it's not that important. If I lose the job I won't be surprised," and it's been harder to get out of bed in the mornings. It's also making it even harder to think clearly, whether that's a direct side effect or from the increased anxiety, and it's so hard to function with any decrease in mental functioning right now.

Also, during the winter of 2014, I went from a horrible depression into a psychotic breakdown. I've never had psychosis any other time, and have chalked it up to possibly psychotic depression hugely amplified by meds. Long story short I'd been switching meds like crazy, back and forth quickly between Nardil, Parnate, Emsam, and possibly some others, under horrible psychiatric care. I've always believed it was mainly the Parnate, but I did spend a really short amount of time on Emsam in that spell, too, so I can't help but be nervous about it.

I guess I'm just wondering if anyone can share their experience with Emsam and starting on it. Has anyone had badly increased anxiety with Emsam that went away? Should I stick it out or is it not worth it? Hmmm.


Edit: Forgot to ask, if anyone knows, as far as dosing... I know 9 mg is where it switches from just MAO-B to MAO-B and MAO-A and have read that's also where it switches from just increasing dopamine to increasing serotonin and norepinephrine, too. I've assumed that that means a higher dose would be better because increasing all 3 would be less likely to just cause agitation and stuff and balance things out more. I've also read at least 1 or 2 people saying 9 mg actually caused them less anxiety and activation than 6, because of these reasons. So I've been trying to rush to 9 mg assuming that it'd be worth the rough start and decrease anxiety once I got there, and this wouldn't be a med that could be better at a lower dose for sensitive people. Is this right, or am I wrong? Could it end up being good and possibly useful to stay lower?

I've been on Emsam for 7 years. When I was first on it I had anxiety and needed extra meds to slow things down some because I was agitated. That lasted a few weeks and then I went to 9 mg and things settled. I never considered whether 9 was better because of the way the med works; I just assumed it was the dose I needed and didn't think about it. I never really had any of the distress you've been experiencing that I remember. I started it IP and I know the first few weeks back to work were hard but I remember that as lingering depression and anxiety.

I have been on lower doses at times when I have been manic and needed less stimulation and the lower doses did help calm me down.

The anxiety at first did go away and I got off the meds I needed for anxiety the first few weeks. I was feeling pretty good on it by a month on 9 mg (2 months total).

I like it. It really has no side effects for me unless I'm manic and then we just cut the dose. It works well and has been the only AD that has done this for me.

If I can answer anything else let me know. I'm not sure I answered what you were asking very well.

Thank you, BeyondtheRainbow.
It's hard to find tons of personal experiences with it, so hearing yours is very helpful.

I've been at 9 mg for a bit now and have been feeling weird. Still some stimulation, but at times mixed with an almost slight sedation feeling. Trouble thinking, literally have problems even reading things and understanding them sometimes. I had a few moments of thinking I could be feeling improvement, then the past 2 days have just not been doing well. Ho hum, we'll see.

Yes, finding people who've had experience with Emsam is tricky. Last fall I did a search on here when I was trying to figure something out and discovered that back when I went on it that I had a user name and had asked some questions on this board that I had no memory of posting. I thought the board was entirely new to me in spring of 2015.

I didn't go through what you are. Once I got acclimated to the stimulation I was fine on it. I slept a lot less (5 hours per night and I woke up at 4 AM daily no matter when my patch was applied but I was rested and fine; eventually my meds were adjusted and that stopped). And it took a while to eat normally again because for about 9 months it really limited my appetite but that was it once I was calm on it.

I hope it gets easier for you.

I had hopes for Emsam when my pdoc started to try me on it; however, it caused my blood pressure to have sudden severe drops and I kept passing out and finding myself on the floor so pdoc took me off of it after just a few weeks. Hope it goes better for you.

Yeah, the low blood pressure at first cost me ankle reconstruction surgery from a fall, but it did go away. My BP is still very low but I've learned to live with it.

wow 7 years is it working for your GAD?

I honestly don't know. I'm on so many other meds that are more effective for anxiety. I did have less anxiety in the early months on it but I also was on double the Seroquel and more anxiety meds than I had been on before so again, too hard to tell.

Sorry for the lack of answer.

I mean, EMSAM is pretty cool. It doesn't require the dietary constrictions and comes in a patch. I personally found no issues with my diet, and the patch became annoying, but it's still a useful medication.

It did make me anxious. But the absolute worst part was the crippling insomnia.

No doubt though selegiline can do some really good things for the brain, and may be a nootropic. Just didn't work for me.

BeyondTheRainbow - Woah, that's crazy. Glad it ended up working out for you at least, after going through all that.

Hemmingway - Why did it ultimately not work for you? Was the insomnia the deal breaker, or was the anxiety bad enough to just not be worth it?

I haven't taken the Emsam in about a week, I'm a little mad at myself because I'm still so indecisive. I'd planned on probably quitting for a day or 2 to see if I felt better because it was just getting too much and then probably continuing a bit more, but I ended up just letting it go and staying off.

Now after a few days of that I'm remembering, oh yeah, I still don't feel great off of it, need a med, and don't have many options left. I'm trying to decide whether I should go back on and try it a little longer or not. I think I feel a little better in some ways, and some of the weirdness I've been feeling I can't tell if it's from withdrawal or just something coming back that the Emsam may've been slightly helping with. I can't decide whether more time on it is bearable, and again Emsam just really worries me because it seems to be an odd med for me and I don't want it to make me deteriorate. I've seen small signs of it possibly making me feel less connected to reality, and maybe even pushing me toward (dysphoric) hypomania (because that's a possibility, uncertain whether I could have bipolar 2), but then again I've been hypervigilant and over-analyzing everything. Those are just the scary things I wouldn't wanna mess with and take the risk.

I wish I could just see into the future after a few more weeks on it and see if it'd be totally different and I'd be glad I stuck through the anxiety and everything, because that could be possible. I just kinda wonder if the anxiety ever really would go away enough or if it'd just end up making my anxiety too bad to be worth it. I can't really see that many side effects and weird feelings just going away, but I don't know.

I just can't make up my mind, and I know going back and forth is bad for me. When I'm on it I really wanna just take the patch off, thinking I'll feel better, then when I'm off it I feel like maybe I should try it and see.

I'm back on it, cut a 9 mg patch in half today, not really sure why I'm doing this to myself... haha.

I wish I could find reports of someone having this bad of anxiety on Emsam and having it go away and eventually doing well. I feel like I'm gonna lose it, I'm worried about ending up in a mixed state or something, or just depressed worse, and it's so hard to just suffer through this.

I don't know what other options I have, I've thought about Savella but know it'd probably just be like other SNRIs for me.

Do you have plenty of anxiety meds? It's been a while but as I recall at first I was alternating klonopin and hydroxyzine and taking valium as well. I think that lasted maybe 3 weeks and I was able to taper back down to my usual klonopin only. I do know it took a lot more meds for a little bit and if I was using valium and working then it was needed badly because valium generally leaves me pretty groggy.

I hope it works for you this time.

Well, maybe this will give you hope.....I wrote this when I had been on it a few weeks.

I'm bipolar with treatment resistance and med sensitivities. I ran into my last antidepressant choice a few weeks ago and am really suffering.

I've been on Emsam for about 2 1/2 weeks now. I had to be hospitalized to start because the taper off my old AD (imipramine) was dreadful. That was expected, although I did wind up in the hospital 2 weeks sooner than anticipated.

I am in a weird place because my psychiatrist is on medical leave and because of various issues with allergies and med sensitivities seeing another doctor isn't in my best interest. So my family doctor is handling this the best he can.

I'm on 9 mg/24 hours now. Today is the first day I've felt even remotely better and it's not exactly a huge difference. I'm dealing with very severe, constant anxiety that is barely touched by meds (and I'm taking a lot. 600 mg of Seroquel, up to 300 mg Vistaril, 2 mg Klonopin and ativan, plus lithium if that helps anxiety).

I know Emsam takes time. I'm getting tired of hearing that, in fact. But what I'm needing to know is is this slowness normal? Is the anxiety normal? In the hospital I got hypomanic and they had me skip a couple days, which did end that, but I'm reluctant to go back to that since I'm not hypomanic anymore.

If you had the horrible anxiety, how was it treated?

(Along with all the meds I'm seeing my psychologist twice a week, following carefully with my family doctor, and will see my psychiatrist as soon as she's back to work in a couple weeks).


So I guess it wasn't so easy back then. But it did get better.

BeyondtheRainbow, thank you so much. That is really helpful to hear.

I do have some ativan, though I'm running low and should probably call my psych. I typically don't like using benzos when I'll be in public (because my reaction is too inconsistent, worried about getting sleepy/acting weird/derealization and stuff) so I avoided taking it while working, and I've been guilting myself into not using them much generally, but the few times I do remember taking the ativan in the evening a few weeks ago I think it kinda just felt like it didn't even touch the anxiety (like you said in your old post).

A weird symptom I forgot it had been giving me was feeling like crying really easily. So weird, I don't think I've ever had that from meds.
I've taken the patch off for the night, and am going to see how I feel about things tomorrow.

Thank you again, I really appreciate it!

FYI - I was told by my psychiatrist to never cut or alter the patch because it messes with the distribution of the medication.

That being said, I have been on this for a year and it is not working anymore. It may as well be a nicotine patch at this point. It worked great and I felt awesome for about 3 months and then everything came crashing down 9 months ago due to the insomnia side effect that set in. I asked for my dose to be lowered back to 9 mg from 12, which my pdoc did, but the insomnia persisted and my depression got worse. As I write this, I am 15 pounds heavier than I was a year ago because my metabolism is destroyed due to the lack of sleep. I am constantly angry, I get into misunderstandings with people, I can't stop having panic attacks or acute physical anxiety (especially in my chest area), and I don't venture very far away outside a certain mile radius because of my fatigue. Lack of sleep will literally make you bonkers. I sound like a real treat to be around, don't I.

I think when I see my psychiatrist on Tuesday I am going to ask to go off this damn thing completely. I can't get much worse anyway, I'm pretty depressed.

My pdoc is currently fighting my insurance company along with an attorney from the APA to get approval for TMS.

Sorry I don't have a more positive story for you.

Cutting the patch has never seemed to be a problem for me. I've done it a number of times over the last 7 years when it was making me manic. Obviously listen to your own pdoc but mine has given me permission to cut them and I've never had problems. My pdoc got a lot more relaxed about Emsam after she met the man who developed it. That's when she started letting me cut patches and she also decreased the dietary restrictions on 9 mg somewhat based on what he told her. I've been on anywhere from 3 mg to 12 mg at different times and have also alternated doses by the day.

Glad it's worked out for you

I ended up taking a break from that trial and have now been on emsam again (I know, I know) for about 11 or 12 days now, having jumped up to 9 mg from the beginning this time.

Feeling weird and unsure. I'm doing worse in life/outwardly (have now had a few lying on the couch unmotivated type of days) but somehow almost feel like there's some sort of improvement I can't put my finger on? Life circumstances taking my mood really up and down make it hard to consistently measure how meds are really affecting my mood, too, (i.e. not working now and that having me down in a rut and not consistently functioning, niece visiting from out of town which made me have to get up and out for a bit and positively affected my mood, stuff like that). It's pretty up and down.

I've noticed I'm pretty sure it has me feeling a little better about myself in some ways, yet anxious and to where I can't go do things anyway.

It's the weirdest thing, I swear it's like it's taking some depression symptoms away and adding new ones. I've been in a sorta dysthymic (but maybe a little worse) kinda unmotivated, feel like I've lost myself, not happy but not particularly painful depression. With emsam, (I think) I've felt a tiny bit more positive about some things in general and want to do things a bit more, but only in my mind... in reality, I'm kinda doing less. This stuff seems like (so far) it's giving me more symptoms of what feels like my old major depressions. I feel sad and tearful sometimes, definite mood swings.
Anxiety-wise it almost helps in some tiny way, but has definitely increased anxiety a lot in other ways. I've got a constant internal anxiousness and having been having a lot of increased overthinking.

I'm trying to figure out whether some of the effects are caused by the med or are just kinda more "indirect" effects than the med itself causing things. For example, if I feel an increase in sadness and anxiousness about life...is the med itself making me feel sad about things, or could it be that like... coming from a depressive spell not doing much, I'm now actually wanting more from life and I want to do more but can't yet, so that makes me feel sad, but doesn't actually mean the med should be stopped.


Last night I'm pretty sure I was having some kind of visual hallucinations. I've had basically constant pretty bad floaters for months from lamictal, and I'm trying to decide whether this could just be some kind of vision thing added onto that, or actual hallucinations, but the way it was last night I think it went into actual hallucination territory. For a few days I've been having just sort of peripheral hallucinations where things just look weird out of the corner of my eye. But last night it was like things in my field of vision were moving. When I'd look at anything with a weird texture, it'd do weird things to my eyes. Also, when I looked around my mind kept mistaking objects for other things just for a split second.

I know I should probably be pretty worried about that, but for some reason I can't even explain I'm not. This was one of the meds I was on the winter that I became psychotic, but I was doing a lot worse then already and the doctors and I believed that was probably caused by actually switching the meds too fast rather than by 1 med itself. Also, I always placed more blame on parnate for it all. I feel like common sense should tell me to get off the med ASAP, and part of me really wants to, but part of me has just finally settled on pushing myself through sticking on it and I almost think I could be feeling some improvement under all the junk. I also can't 100% rule out that I'm somehow having symptoms of psychotic depression on my own and it's not the med. I've never been psychotic other than the one complete psychotic break I had 2 years ago, but what if I'm prone to psychotic depression and it's just happening? In that case I'd be scared to death to quit, because if it's just my depression naturally getting that bad I'd want to get help from a med ASAP and cross my fingers for emsam.

Sorry for my overthinking and babbling, getting it out and complaining kinda helps.

You're not babbling, I get what you're saying.

The first thing that jumped out at me in your post are the visual hallucinations. I don't want to sound like one of those "you should do this..." people, but seriously consider telling your pdoc that. Mine has asked me if I've had any and he's framed the question like this: "sometimes when people get severely depressed they see or hear things that aren't there. Do you ever experience those things?" I had a brief concerning experience this weekend. I have long hair and a strand happened to fall down over my face. I was walking from my kitchen into my living room and for a split second that strand of hair scared me - I thought it was something hanging down from the doorway like a cobweb or something. I immediately realized it wasn't that but it startled me because all of a sudden this "thing" just flew in my face.

I have been on the lowest dose of EMSAM for 2 weeks. My sleep immediately improved. But I'm still depressed and I had a really, really bad weekend and stayed home from work yesterday. I know all of the visible signs and behaviors I exhibit when I get into that state.

This medication crap is so frustrating to figure out - I thought it was the insomnia caused by the EMSAM that brought back the depression. Or maybe it's too early to tell since I'm trying to pick up the pieces from 9 months' worth of sleep deprivation.

Please take care of yourself.

Thanks, with or without you! Yes, that's exactly the type of thing that's been happening to me. Do you think it was the depression for you, or just a random thing?

I've noticed it seems like it's been happening at night. Back right before/during the really bad episode I had, it seemed like I got really bad paranoia and out-of-it feelings at night, but then I've also had less severe similar things at other times with depression. It still worries me, though. It makes me think the possibilities are: EMSAM itself caused some of it back then and is now; it was from depression back then and is now; it's some sort of anxiety thing, because my anxiety was extremely high then and it's been high now with EMSAM revving it up through the roof. There's also the whole slight possibility of something bipolar involved, since I have possible bipolar.

I noticed EMSAM increasing my depression each time I started it, and I know when I went off after the first time last month I felt really depressed... I assumed it was just my depression worsening as time went on, but now how do I know EMSAM isn't just pushing my depression into psychotic depression levels? What if before that bad spell, the EMSAM and withdrawal just worsened my depression that much? BUT if it's just the depression independent of EMSAM causing these things, I'd need to stay on EMSAM and see if it helped since I'd need to keep trying to improve asap. Aaah, I feel trapped.

I will tell my pdoc, but I know he'll literally just tell me to stop the med and look for no further explanation nor give any help with what to do next. I expressed concern about this, with the timing of taking EMSAM before my past episode and everything, a couple appointments ago. I asked him to get my records from that time from another doc just to check how close my EMSAM trial was to when things really got bad, and he waved it off.

(sorry again, still, for the just kinda babbling. :P)

I'm sorry to hear you've been going through all that. I know from when I was on Nardil, and a short time on Parnate, the built up insomnia really can mess with you. It really is frustrating, and I remember you said you'd been dealing with the back pain on top of it, too. Hopefully more time catching up on sleep will help improve things at least some.

Hi, I think my confusion/slight hallucinations are definitely from depression and being isolated. I am not bipolar. I thought I was for a long time because I read that some things can be masked, but my pdoc said that my "ups" don't last long enough to constitute mania. I now see my ups as a state of mind where I know the depression is going to come back, so let's cram in as much enjoyment as I can until it all goes off the rails again.

All I know is that in my case, my depression got better and better after each increase in EMSAM, but when I couldn't sleep anymore I started nosediving hard. Real tailspin. It's like I'm so fragile that one little thing ruins everything. Someone will say something I don't like and it feels like my world is ending. I don't know if EMSAM can actually cause depression. What I know is that it is activating as hell. Yes, I am now having back pain but that is definitely not medication related. It is from spending most of my free time this year lying in bed (but not sleeping, obviously), playing on my phone/computer with bad posture, probably moving into bad positions in my sleep...all the while not noticing that my mattress was deteriorating.

I'm not encouraged to read that other MAOIs have this insomnia side effect too. (The only MAOI I've ever taken is this one.)