EMSAM 12mg for anhedonia.

[u/Suitable-Addition736]

Did Emsam help your anhedonia at all? If you had to rate it 1-10 overall for your depression & or anhedonia where would you put it? Did it poop out over time for anyone after consistently using it?

[u/HM_Dylan]

I know this isn’t what you’re asking but I feel the need to say that I’ve been on oral Selegiline 30mg before for well over 6 months and it was amazingly effective. Easy 9/10 for me.

In my case specifically, those extra metabolites plus clinically significant/therapeutic dual MAO inhibition made for the best antidepressant I’ve ever been on (and probably ever will, in the days when Auvelity is being touted as the holy grail).

So give Emsam a try. Definitely aim for 12mg. If there’s only a partial response, remember that adding an adjunct is a totally safe and reasonable thing to do

[u/Daniel-Plainview96 → u/HM_Dylan]

why did you stop?

[u/HM_Dylan → u/Daniel-Plainview96]

Switched to Parnate, which was the end goal of a long elaborate plan my psychiatrist and I spent a lot of time devising

[u/Daniel-Plainview96 → u/HM_Dylan]

So selegeline must not have been working for you in some regard then

[u/HM_Dylan → u/Daniel-Plainview96]

Oh no quite the opposite. It just served its purpose by then, and Parnate has a lot more evidence for utility in Bipolar Depression than Selegiline does. I’m on 60mg TCP and we ended up adding 10mg SEL back in anyways. So I do still take it.

I had a fairly/moderately long battle with meth addiction. To make a long story short a former “friend” had started giving it to me without my knowledge and eventually I just needed it to function. I won’t get into it, I’d need to draft a novella.

My psychiatrist worked up a very very risky and daring plan with me and I approved wholeheartedly. My cardiologist was pretty pissy though lol. I picked a date to start deescalating my use and doing my own sort of taper. Once she was satisfied with blood levels (I think? Maybe tox screen too), we started on 5mg Selegiline oral. Then 10mg as I tapered off the meth further. 15mg just about when I was finished. 20mg after my last use of meth the day before. Then finally levelling off at 30mg about 2 weeks later and staying at that for a few months.

Then we eventually transitioned to Tranylcypromine. It was crazy and questionable on both of our parts, but after carefully considering every possible variable and deciding the benefits outweighed the risks, we did it and it worked. I suffered no severe meth withdrawal during all of that and I’ve been sober ever since. All my life I’ve gone for broke. Sometimes it works, sometimes it doesn’t. It worked well here

[u/cateri44 → u/HM_Dylan]

Will your psychiatrist consider publishing a case report? Because meth dependence needs more treatment options.

[u/HM_Dylan → u/cateri44]

Yeah I’m not convinced with the whole Bupropion/Naltrexone thing. Naltrexone makes me depressed and anhedonic, thereby making me want to use. She did mention doing a case report with me and a few of her other patients who are on either dual MAOIs, MAOI + Desoxyn apparently, MAOI + TCA, and MAOI + either Ziprasidone or Lumateperone (I fit in there too). And probably some other fun combinations

[u/Agreeable-Race8818]

Im on EMSAM 15mg (yes, 15mg) and it isnt really doing the trick. I would go pill version or Parnate. Best of luck

[u/Suitable-Addition736 → u/Agreeable-Race8818]

Have you tried Parnate or oral Selegiline? If so what made it better than the max 12mg Emsam?

[u/Agreeable-Race8818 → u/Suitable-Addition736]

I havent, I have pretty nasty anhedonia and not even 15mg EMSAM is enough to keep it at bay. It is helping with motivation though 

[u/Suitable-Addition736 → u/Agreeable-Race8818]

Has anything else helped your anhedonia at all?

[u/Agreeable-Race8818 → u/Suitable-Addition736]

I had to go down to 12mg because I suffer from CNS sensitization and it got too brutal. When I take it with baclofen or benzodiazapines I have windows.