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February 15th, 2011
10:11 AM ET

What is the antidepressant called Emsam?

Question asked by Samantha Gray of Oklahoma:

I am a 26-year-old female. I have a diagnosis of bipolar disorder, PTSD, and anxiety. The doctor gave me samples of a transdermal patch called Emsam. What can you tell me about the medicine and possible side effects?

Expert answer:

Dear Samantha,

I am glad you asked this question, not just because people don't know much about Emsam, but also because Emsam is a member of a larger class of antidepressants called monoamine oxidase inhibitors, or MAOIs, which aren't used much anymore, but can be lifesaving for people who have failed to respond to other types of antidepressants.

Older antidepressants tend to have more bothersome side effects than the newer ones, which is mostly why the new ones were developed in the first place. MAOIs were especially challenging for patients, because in addition to causing "regular" side effects like insomnia, nausea and dry mouth, they also interacted with certain foods and medications in ways that can be lethal.

Because Emsam is a patch that delivers the MAOI selegiline through the skin, it avoids the medication passing through the stomach - which was the danger area for problematic interactions with foods that contain a chemical called tyramine. This is Emsam's great advantage. At the lowest dose of 6 mg a day, people do not have to be careful about what they eat, which makes the drug much safer and easier to use. However, this is an important point: At higher doses of 9 or 12 mg a day, Emsam may interact dangerously with foods and so what one eats must be monitored.

Given all these troubles, it's reasonable to ask why anyone would bother using an MAOI nowadays, when there are so many newer and safer antidepressants available. Of course, the most straightforward reason is that some people don't respond to these newer medications and thus must turn to older antidepressants as the only available options. But anyone like me who has treated patients since the "old days" before Prozac could tell you plenty of stories of people who've had miraculous responses to an MAOI after failing with everything else. For this reason alone, a medication like Emsam is a welcome option.

MAOIs work especially well in people who have a lot of anxiety and who eat too much and sleep too much when they get depressed (as opposed to having insomnia and losing appetite). Given your combination of diagnoses, an MAOI is a very logical option for you.

A final point: Even though older medications like MAOIs and tricyclic antidepressants have more side effects than newer agents in general, people are really unique in their responses to these agents, for good or bad. I've treated plenty of patients who couldn't tolerate newer antidepressants but had no side effects whatsoever from one of the older antidepressants. This highlights how important it is not to give up on treating your depression, even when it comes time to reach for second-line options like MAOIs.


soundoff (28 Responses)
  1. Dawn

    i am frequently suicidial and my doctor wanted me to try that drug i told him point blank i would eat those food so i could die.
    so you can't be too depressed too take this

    February 15, 2011 at 10:52 | Report abuse | Reply
    • Carol

      What does "eat those food" mean?

      February 15, 2011 at 16:27 | Report abuse |
    • kake79

      Being severely depressed does not necessarily mean you are suicidal.

      February 15, 2011 at 16:52 | Report abuse |
  2. Dave Jensen

    Dawn, please remember that antidepressants are sometimes very dangerous. If you are exploring new antidepressants, I'd suggest you look at herbal antidepressants as well. There's an herb from Siberia, Rhodioa rosea, that my doctor prescribed which is sold in the USA by dozens of providers and it happens to work as good or better than the drugs. My life was improved dramatically by the herb. Good luck!

    February 15, 2011 at 11:43 | Report abuse | Reply
  3. jenfly

    Dawn: If you're still this depressed, time to see a new doctor. Ask her to check to make sure you are not bi-polar. I was treated for depression for a decade before they figured out I was. I feel normal now....

    February 15, 2011 at 15:11 | Report abuse | Reply
  4. newbieveryday

    Emsam has been fabulous for me. SSRI's were ineffective and had undesirable side effects. I read they're only effective in 40% of cases! My doc, whom I consider myself fortunate to have finally found after dealing with several who were typically SSRI-focused almost exclusively, if not just out-of-touch Rx writers, is not as concerned even with the 9mg dosage regarding tyramine interactions, but I avoid aged and fermented foods like those types of cheeses, meats, fresh beers, tofu, and a very few other things anyway. A small sacrifice for a very effective med with very little to no side effects, none of which I can't deal with... (the only on of issue is I've noticed that my resistance to going to sleep early enough is a bit stronger, but it's simply a matter of letting go of the day and distractions – keep your laptop out of your bedroom, and give positive reinforcement to sleep – which I love to do anyway, I just also like to put it off...).

    February 15, 2011 at 15:16 | Report abuse | Reply
  5. Tom Scherer

    I always love to hear all this nonsense on how old meds were found to be dangerous after being prescribed, but now, not the new ones. Give me a break. The drug industry pipeline has to keep making new drugs for stockholders so the generics do not cut in their profits.

    February 15, 2011 at 17:04 | Report abuse | Reply
  6. Bob

    There are other therapies besides drugs, maybe Drs should refer out to other qualified mental health providers who are more qualified dealing with Mental health...

    February 15, 2011 at 17:11 | Report abuse | Reply
  7. Clete

    This person should be asking her doctor about the drug...not Dear Abby.

    February 15, 2011 at 17:14 | Report abuse | Reply
    • Moodyme

      Snideness is childish and tiresome, Clete. The way the woman's question is worded, it is nothing more than an open request for information. When I get a new prescription, my doctor generally tells me very little about it. She'll suggest I try it and report back. So I go home and get online and read both the manufacturer's information and anything else I can find about the drug - pro and con. I look for discussion boards for patients on that prescription. I weigh the dangers and benefits and then - only then - I will get the prescription filled if it seems worthwhile. I learned this to do be this cautious by experience, after my neurologist prescribed a drug that caused horrendous side effects, and he didn't warn me about any of that ahead of time.

      February 15, 2011 at 19:50 | Report abuse |
  8. Dr. J

    Why not get your medical advice from the forum. Hey dont take 9mg take 27mg. Thats what i tell my patients. If one makes you feel good two will make you feel great. Double down on the dose. That is our motto.

    February 15, 2011 at 17:31 | Report abuse | Reply
  9. jen

    if i were a pyscharist the first i'd do is to tell my patients to try medical marijuana first - i have ultra ultra rapid cycle bipolar and have tried a bunch of different drugs - it wasn't until i took control of my own disease and started using MJ that I finally am able to live a good life. for people with bipolar, giving anti-depressants is just too dangerous - and my god, a drug that interacts with food? screw that! smoke MJ, eat a twinkie, relax and all will be well!

    February 15, 2011 at 18:58 | Report abuse | Reply
  10. Moodyme

    For a severely depressed person who is not responding to (or cannot tolerate) several drugs, and who eats and sleeps too much as a result, I would advise yoga or another slow-and-steady exercise discipline. I speak as a depressive myself. Changing my diet and taking on an exercise discipline (to say nothing of the spiritual aspect) did FAR more for me than any of the many drugs I tried.

    February 15, 2011 at 19:56 | Report abuse | Reply
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