Emsam
® (
selegiline transdermal patch) is a prescription medication that is used to treat
depression (also known as major depression or clinical depression). It is currently the only skin patch that is approved to treat this condition.
Emsam is made by Bristol-Myers Squibb.
Emsam belongs to a class of medications called monoamine oxidase inhibitors (MAOIs).
To better understand how these medications work, it is important to understand how brain cells communicate with each other. Monoamines are special chemicals that carry messages from one brain cell to another. These messages can include information about many things, including your emotions. Some examples of the monoamines that help transmit these messages include:
- Dopamine
- Norepinephrine
- Epinephrine
- Serotonin
- Melatonin
- Histamine.
When a message (electrical impulse) reaches the end of one brain cell, monoamines are released into the gap between the cells. Here, they quickly travel across the gap until they reach a receptor on the next cell, settling in like a key in a lock. This triggers the electrical impulse to continue through the next cell and on to its final destination.
Once the message has been transmitted, the monoamines in the gap are either reabsorbed by the first cell or broken down by an enzyme called monoamine oxidase (MAO). There are two types of monoamine oxidase enzymes: MAO-A and MAO-B.
If a person has low levels of monoamines in the brain, it can reduce the amount of communication between the brain cells and cause the person to feel depressed.
MAOI medications improve the communication between brain cells by blocking the action of monoamine oxidase. This increases the amount of monoamines in the brain and thus improves a person's depression. While most monoamine oxidase inhibitors work equally on both MAO-A and MAO-B enzymes, Emsam works more on MAO-B than on MAO-A.
There are also monoamine oxidase enzymes (particularly MAO-A) in the digestive tract, and these enzymes are responsible for breaking down tyramine, a naturally occurring chemical (found in many foods and beverages) that affects
blood pressure. MAOI medications stop the body's ability to break down tyramine and can cause a person's tyramine levels to become too high, which can be extremely dangerous.
While most MAOIs block the action of monoamine oxidase in the digestive tract, because they are taken by mouth, Emsam (when used at the lowest dose) has little effect on digestive monoamine oxidase, since it is absorbed into the skin through a patch. However, higher doses may be more likely to interact with tyramine-rich foods. Because tyramine is found in many foods and beverages, people taking higher doses of Emsam must follow a strict diet
(see Emsam Food Interactions for more information).
Studies have shown Emsam to be effective for
depression treatment in adults. In these studies, people who took the drug showed more improvement in
depression symptoms than people who were not taking it. Also, long-term studies have shown that fewer people taking Emsam have a depression relapse, compared with people not taking it.
Some considerations for when and how to take Emsam include the following:
- Emsam comes as a skin patch. It is applied once a day.
- It is important to place the patch on clean, dry skin on the upper torso (below the neck and above the waist), upper thigh, or outer arm. Make sure to rotate where you place the patch. Do not use the same place each day.
- You should apply your patch at the same time each day to maintain an even level of the medication in your blood. Do not forget to take the old patch off when you put on the new one.
- For Emsam to work properly, you have to use it as prescribed. The medication will not work if you stop using it.
The dose of Emsam your healthcare provider recommends will vary, depending on a number of factors, including:
- Other medical conditions you may have
- Other medications you may be taking.
As with any medication, do not adjust your dose unless your healthcare provider specifically instructs you to do so.
As with any medicine, side effects are possible with Emsam. However, not everyone who takes the drug will experience side effects. In fact, most people tolerate it well. If side effects do occur, they are often minor and either require no treatment or can easily be treated by you or your healthcare provider. Serious side effects are less common.
Some of the side effects seen with this drug include:
(Click Emsam Side Effects to learn more, including potentially serious side effects you should report to your healthcare provider.)
You can also read about specific side effects in the following eMedTV articles:
Food and Drug Interactions
What Should I Tell My Healthcare Provider?
You should talk with your healthcare provider prior to taking Emsam if you have:
Also, let your healthcare provider know if you:
It is extremely important to tell your healthcare provider about all of the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Never take any medication (including non-prescription medications) without first checking with your healthcare provider.
Depression, even in its most severe form, is highly treatable. As with many illnesses, getting
depression treatment early is more effective and reduces the chance of recurrence.
The most common forms of treatment for depression are medication (
antidepressants) and psychotherapy ("talk therapy"). In cases of severe depression, some healthcare providers may recommend electroconvulsive therapy (ECT). Some people may also try complementary or alternative treatments for depression
(see Natural Remedies for Depression).
While most monoamine oxidase inhibitors are usually used as a last resort when other antidepressants have failed, Emsam is an option that may be considered much earlier. Because this drug (when used at the lowest dose) is less likely to interact with foods, it can be much easier to take, compared with other MAOIs. However, side effects may occur or the medicine may not work as well as needed. In these cases, your healthcare provider may recommend an alternative. Some examples of substitute depression medications include:
What If I Take an Overdose?
People who take too much Emsam may have overdose symptoms that could include:
If you happen to take too much, seek immediate medical attention.
How Should Emsam Be Stored?
Emsam should be stored at room temperature, away from moisture and heat. Do not remove the patch from its pouch until you are ready to use it. After removing a patch, fold it in half so that the sticky part sticks to itself and throw it away.
Keep Emsam (including used patches) and all other medications out of the reach of children.
What Should I Do If I Miss a Dose?
If you forget to change your patch as scheduled, simply change your patch as soon as you remember, and continue with your regular schedule. If a patch falls off, replace it with a new patch, and continue with your regular schedule.
Emsam patches are available in three strengths:
- Emsam 6 mg
- Emsam 9 mg
- Emsam 12 mg.
Currently, no generic versions of Emsam are licensed for sale
(see Generic Emsam for more information).
