Seeing a psychotherapist and taking antidepressants in the form of pills are no longer the only options for depression treatment. Back in 2006, the Food and Drug Administration approved an antidepressant patch — Emsam.
Emsam is a selegiline transdermal patch used to treat major depressive disorder in adults. It is applied to the skin and helps deliver more sustained drug levels to the brain, restoring the balance of particular brain chemicals. This drug is a good alternative for individuals who cannot tolerate or don’t want oral antidepressants.
Being an MAOI medication (Monoamine oxidase inhibitor), Emsam has specific side effects. And since no low-cost generics for the selegiline patch exist, it is the only brand name and is quite expensive. Still, you may be prescribed this medicine if the doctor decides it is the best option, so read on to know more about its mechanism of action, interactions, and other facts.
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How Does an Emsam Antidepressant Patch Work?
Selegiline is an irreversible MAOI used to treat multiple disorders. For those struggling with depression, the drug can be administered as a transdermal patch.
Emsam inhibits the enzyme monoamine oxidase (MAO), which usually breaks down brain chemicals like norepinephrine, serotonin, dopamine, and phenylethylamine. MAO enzyme has two subtypes known as MAO-A and MAO-B. The two have varying levels in body systems. When administered transdermally, selegiline blocks the activity of the brain MAOs without substantially impairing the MAO-A activity in the gut. As such, dietary restriction of tyramine intake might not be needed when using the patch in low doses.
Although the activity of the selegiline MAOI patch in depression is not fully understood, it’s believed that the antidepressant patch Emsam restores the balance of brain chemicals and improves mood through its MAO inhibition.
Emsam Dosage
The typical starting dose for the Emsam patch is 6 mg applied daily. If the desired effect is not achieved, the dose can be increased by 3 mg in a two-week interval. The maximum recommended dosage per day is 12 mg. The drug is available in 30 patches of 6 mg, 9 mg, and 12 mg that should be applied once in 24 hours.
What are the Emsam Patch Side Effects?
Like other medications, Emsam for depression has benefits but also produces some undesired side effects. While Emsam side effects can vary from person to person, the most common ones include the following:
- Skin irritation around the patch
- Sleep disturbance (problem falling and staying asleep)
- Headache
- Diarrhea and stomach upset
- Dry mouth
- Skin rash
- Pain and swelling in the throat
Typically, these side effects resolve as your body gets used to the patch. However, if they persist or worsen, promptly inform your doctor. Although rare, other side effects like sexual dysfunction, weight changes, and blood pressure fluctuations might occur.
Warnings
If you or anyone using the Emsam patch for depression experiences the following symptoms, contact the doctor immediately:
- Suicidal ideations and behavior, including thoughts of dying or self-harm, aggression, irritability, acting on dangerous impulses, and attempting suicide.
- Serotonin syndrome. Increased serotonergic activity leads to elevated body temperature, muscle jerks, blood pressure alterations, tremors, seizures, and agitation. Serotonin syndrome can lead to coma.
- Blood pressure spike. Sudden-onset severe headaches, fast heart rates, and chest pain might indicate blood pressure elevation. Other symptoms include sweating, sore neck, vomiting, and widened pupils with light sensitivity.
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Emsam (Selegiline) Drug Interactions and Contraindications
Interaction with other drugs changes how Emsam works or increases the risk and severity of side effects. This selegiline MAOI interacts with many medications, including over-the-counter and prescription medications and herbal products. Keeping a list of your current medications and sharing it with the doctor is vital in preventing adverse outcomes.
Some drugs that interact with the selegiline patch include:
- Other MAO inhibitors like linezolid, isocarboxazid, and methylene blue
- ADHD medications such as methylphenidate and amphetamine
- Nasal decongestants such as phenylephrine and phenylpropanolamine
- Other antidepressants like bupropion, mirtazapine, and maprotiline
- Triptans for migraine headaches, including rizatriptan, zolmitriptan, and sumatriptan
- Supplements like tyramine
- Street drugs, including LSD and mescaline
The Emsam patch is contraindicated for individuals using the following classes of drugs to prevent hypertensive crisis and serotonin syndrome:
- SSRIs and dual SNRIs
- Tricyclic antidepressants
- Certain analgesics, vasoconstrictors, anticonvulsants and antitussive agents
After discontinuing any of these drugs, at least four to five half-lives, equivalent to two weeks, should elapse before starting the transdermal Emsam patch.
Emsam for Depression: FAQs
What foods should you avoid when using Emsam (selegiline) patch?
At the typical dose of 6mg per day, no selegiline dietary instructions are necessary as the drug does not impair the activity of the MAO-A enzyme in the gut. However, higher daily doses of 9 mg and 12 mg require tyramine and beverage intake restrictions. Even after stopping Emsam or switching to a lower dose, you should not take tyramine-rich foods and beverages for two weeks. The foods rich in tyramine include tropical fruits, red wine, and smoked, pickled, fermented, or cured foods. Ask your doctor or pharmacist about other foods that might interfere with Emsam.
Does the Emsam patch treat anxiety?
While the selegiline patch improves mood and emotions associated with depression, the drug is not approved for anxiety. If you’re experiencing anxiety symptoms, consult your doctor to prescribe the appropriate medication.
What should you do if you can’t tolerate Emsam?
The lowest recommended dose for Emsam is 6 mg daily. If you can’t tolerate such a dosage, talk to your provider for alternative medication. However, the dose can be decreased in case you’re experiencing severe side effects with higher doses.
Conclusion
Emsam patch is an MAOI that treats depression in adults by modulating the level of particular brain chemicals. The medication should only be used after getting a prescription. Notably, the selegiline patch can interact with many drugs, including prescribed, over-the-counter, and herbal medicines, leading to toxicity or ineffectiveness. Before using this antidepressant patch, disclose to your doctor any current medications you could be taking. To get the most effective treatment and get a medication chosen based on your symptoms and health history, contact EZCare Clinic today.
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