TL;DR- See bottom
I will probably come back and fill in the backstory at some point. But for now, I just want to get a record of my Emsam experience. I have high hopes for this drug, probably for the first time in my life. Don't want to put all my eggs in one basket, or say that I'm expecting a miracle, but I sort of am. After half a lifetime of depression, 2 years of failed treatments by clueless doctors, and 2 months of research, I think that Emsam (selegiline transdermal) should go a long way, if not all of the way, to fixing problems that have haunted me since I was very young.
So. Day 1. After all the work to obtain the prescription, actually getting my hands on it was a tad anticlimactic. I resisted the urge to thrust the package high above my head as though I were Link getting a piece of the Triforce. The patch was smaller than the internet peoples had made it out to be, probably 1 1/2" square. But its transparent and wafer thin and almost invisible to the casual observer, and not at all uncomfortable to wear.
Within an hour I thought I began to notice a difference. I really had no idea what to expect in terms of response time. I figured that significant MAO inhibition would take a while, maybe a few days, to really ramp up. When I started to feel the drug coming on (albeit very slowly, like watching bamboo grow), I was initially very nervous that I had overshot the dose, or that I still had some stimulants floating around in my system, and would be in for a nasty time.
But by T+2 hours, these concerns were gone as I was experiencing none of the CNS-stimulant/sympathetic response that I get from Adderall, like elevated heart rate/blood pressure, sweating, dry mouth, etc. At the same time, the pleasant feelings and higher levels of motivation were continuing to present.
By about T+4 hours, I seemed to reach a stable plateau emotionally, which I am still at now (T+11). It is similar to the dopaminergic effects of the Adderall, but perhaps a bit less. There is not the chomping at the bit urge to work fast, or talk a mile a minute, etc. I suppose if I had to write a 15 page paper by tomorrow, I might desire further stimulation, but for normal life, this is far preferable.
All of the normal positives seem to be here: Better self-image/self-confidence, improved energy, motivation, aches and pains are diminished, enjoying social interaction, food tastes better. I also feel considerably more emotional and was moved by Billy Joel's "Downeaster Alexa". I wonder if I will be able to cry again as well.
Summary: Day 1 has been extremely successful. The only downside, ironically, is that the rapid effects make me wonder if they are sustainable. Obviously this was the whole point of going with Emsam over Adderall, but the drug taking effect in 1-3 hours?
Ruminations: Could the MAO-B inhibition really happen so rapidly? Or is there other things at play here? (Reactivation of stimulant metabolites from day before? Action of selegiline's metabolite l-methamphetamine?) The other possibility is the increase in levels of phenethylamine (PEA). Supposedly MAO inhibition can increase PEA levels from as little as 3-fold to as high as 1000-fold. Thus even a partial MAO-B inhibition might rapidly increase PEA levels, which does.... something?
TL;DR: Day 1 has been everything I hoped for- the dopaminergic benefits of Adderall without the norepinephrine/sympathetic side effects. I feel wonderful- not high, and not MY normal state, but what I think should be normal. I am worried about how/why the drug worked so fast. I would probably break down and cry like when blind/deaf people are able to see/hear for the first time, but (1) I'm still a grouch, and (2) I do not know if this state is sustainable.
