# MAOI Emsam Patch? Does it work?



## Bob Slydell (Oct 23, 2008)

I heard about this patch thats called the Emsam patch and its an MAOI that releases the drugs transdermally so you dont have to follow food and drug restrictions. 

Has anyone used this for treating SA? I would be willing to try an MAOI but then I read about this dangerous hypertensive crises and it scares me. 

Right now im weening off Klonopin cause it doesn't work anymore and I would like a new medication because all ive done for the past weeks is watch tv and internet. 

I have also tried Paxil, Lexapro, Zoloft, Wellbutrin, Seroquel, and Ativan with no success.


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## Foh_Teej (May 5, 2004)

I dont know of many if any SAS members that have used it. The studies indicate it works well for depression but not so much for SA. Side effects of EMSAM include heart attack and stroke once a patient is informed of the price tag.


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## Noca (Jun 24, 2005)

EMSAM patch works good for depression but sucks for SA from what I've read.


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## UltraShy (Nov 8, 2003)

Bob Slydell said:


> you dont have to follow food and *drug* restrictions.


I know it's supposed to let you eat anything you want and my psychiatrist said that with the few patients of his that have tried it they were able to eat anything.

Can anyone confirm that it avoids drug interactions though? I don't see how being transdermal would effect that problem.

Here's a rather long list of stuff not to take with it:



> DO NOT TAKE THIS MEDICINE if you are also currently taking amphetamine or amphetamine derivatives (such as methylphenidate or dexmethylphenidate), apraclonidine, atomoxetine, brimonidine certain medicine for seizures (such as carbamazepine or oxcarbazepine), certain weight loss medicines (such as phentermine, phendimetrazine, or sibutramine), cyclobenzaprine, nutritional supplements that contain tyramine, or sympathomimetics (such as ephedrine, phenylephrine, or pseudoephedrine). DO NOT TAKE THIS MEDICINE if you are currently taking, bupropion, buspirone, certain medicines for pain (such as meperidine, methadone, propoxyphene, or tramadol), dextromethorphan, certain herbal products (such as ma huang or St. John's wort), isometheptene, monoamine oxidase inhibitors (such as phenelzine or tranylcypromine), oral forms of selegiline, sibutramine, SNRI antidepressants (such as duloxetine and venlafaxine), SSRI antidepressants (such as citalopram), tetracyclic antidepressants (such as mirtazapine or maprotiline), or tricyclic antidepressants (such as amitriptyline, imipramine, or doxepin), or if you have taken any of these medicines within the past 7 days. DO NOT TAKE THIS MEDICINE if you are also taking fluoxetine or if you have taken fluoxetine within the past 5 weeks. ADDITIONAL MONITORING OF YOUR DOSE OR CONDITION may be needed if you are taking 5-HT3 agonists or "triptans" (such as sumatriptan or zolmitriptan), insulin, nefazodone, sulfonylureas (such as glimepiride or glyburide), other medicines for diabetes (such as nateglinide or repaglinide), or tryptophan.


And it costs around $530 a month, so that could give you a heart attack or give your insurance company one if they're paying for it.


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## dss (Oct 28, 2008)

If it's anything like Manerix (RIMA) then it's probably not very good.


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## gordonjohnson008 (Nov 2, 2008)

*No dawg*

No dawg. I tried EMSAM. It's very stimulating. It may be great for someone who is very depressed and lethargic, but it exacerbates social anxiety (makes it worse) IMHO. Your call, but this stuff is expensive.


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## gordonjohnson008 (Nov 2, 2008)

Ah, I just saw your comment about the hypertensive crises. Well, if you do decide to take an MAOI, it does require commitment. You have to buy a blood pressure monitor and you have to watch what you eat and drink, and medications you take. The list of contraindicated foods is outdated, but still proceed with caution... Try small amounts of the "Forbidden Foods", and if you get no headache/reaction, you can gradually try larger amounts. Generally stay away from aged cheese and meats and some other foods with high tyramine content. However, stuff like cheddar cheese and pizza is often fine... for most people.

MAOIs have significant side effects. Still, if SSRIs really don't help *at all*, then one is perhaps better off dealing with the side effects of MAOIs (such as daytime lethargy, nighttime insomnia, urinary difficulty, etc) than being depressed and agoraphobic.


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## daffy (May 25, 2010)

Bob Slydell said:


> I heard about this patch thats called the Emsam patch and its an MAOI that releases the drugs transdermally so you dont have to follow food and drug restrictions.
> 
> Has anyone used this for treating SA? I would be willing to try an MAOI but then I read about this dangerous hypertensive crises and it scares me.
> 
> ...


theoretically it should work, no special diet at lower dosage ..as long as you don't eat the patch


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## BearFan (Mar 22, 2008)

Emsam is still contraindicated with all of the other drugs MAOIs interact with. It just bypasses the gut so there is less risk of the food interactions. It's still in your bloodstream.


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## ambidexter (Jul 17, 2010)

My understanding is that EMSAM/selegiline is an MAO-B inhibitor at low/"normal" doses, but increasingly inhibits MAO-A at higher doses. At higher doses, they put you on the diet, although no one really knows if it's necessary with the patch. The advantage of the patch is supposed to be that it bypasses the gut, so there is much less chance of a food interaction. The medication restrictions are still in place even at low doses, though.

I was interested in trying EMSAM before Nardil (if only EMSAM were covered by my insurance), and seeing how it went at higher doses. Or who knows? Maybe a low dose could work, but most people with SA seem to need the MAO-A inhibition. I liked the idea of starting out with something more activating though, and slowly increasing the dose, plus reducing the risk of a hypertensive crisis.

Plus I think you can switch from EMSAM to Nardil or Parnate fairly easily, so I figure, why not try that first, if you can? But I haven't really experienced any MAOIs yet, so my take is purely theoretical.


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## elizabeth152 (Jul 22, 2010)

I tried Emsam when it first came on the market a couple of years ago and it really didn't seem to have any effect on me...No side effects, but it didn't really reduce anxiety to any extent either.

I was on Parnate for about a year after that... It definitely helped with depression, but I utimately found it a little too stimulating and it didn't really do very much to mitigate my anxiety.

I had two hypertensive incidents while I was on Parnate...once when I forgot the dietary restrictions and mistakenly ate cheddar cheese in a chef's salad, and another time when I took an over-the counter medication for an infection and didn't remember to check if it negatively interacted with m.a.o. inhibitors. But both incidents were totally preventable and only occurred because I was too lax in following the restrictions. (The restrictions are normally really easy to follow in my experience though)

During both occasions I experienced a really horrible headache. I didn't go to the doctor either time, I just waited it out and my blood pressure returned to normal and the headache went away. I should have probably taken it more seriously and gone to the hospital...that's the standard advice for a hypertensive incident because of the possibility of stroke.

I'm on a different m.a.o. inhibitor currently, Nardil, which I just started last week. According to all the research I've done about it, Nardil is supposed to be the gold standard for S.A. so I'm really hoping it works for me. However it's definitely way too soon to tell.

So that's my experience so far in the world of m.a.o.i.'s... Overall, if you follow the dietary restrictions the benefits seem to definitely outweigh the risks...Hope this helps

Elizabeth
improvingelizabeth.blogspot.com
twitter.com


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