# Something interesting about EMSAM (MAOI)



## DistinctlyAmbiguous (Aug 23, 2009)

I have been on EMSAM 6mg/24hr transdermal patch for 12 days now and my depression is already lifting. I've been productive all week so far, and each day I just feel better.

Before starting EMSAM I was concerned about increased anxiety, which has been reported among some users. Well, it's true for me as well, I do have increased general anxiety... especially in anticipation of things. What I did not expect was DECREASED social anxiety. I'm beginning to feel "normal" amongst casual conversations!

Social phobia before ~7 Now: *4*
General anxiety before ~5 Now: *7*
Depression before ~9 Now: *5*

I think it's important to know if you can relieve one condition, sometimes the others come with it. I'm treating the general anxiety with Klonopin 6mg/day and it seems to be helping. I know that's a lot to some people, but I feel no therapeutic benefit at any dose below that right now.

Yay for EMSAM! Nay for its price.


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## Briisthebest (Apr 1, 2011)

In your case it sounds like lifting your depression might help you to become more social whcih depression can make you become quite anti-social. Any side effects with the Maoi because I am getting sick of these damn ssri's.


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## DistinctlyAmbiguous (Aug 23, 2009)

Briisthebest said:


> In your case it sounds like lifting your depression might help you to become more social whcih depression can make you become quite anti-social. Any side effects with the Maoi because I am getting sick of these damn ssri's.


First couple days I had slightly elevated blood pressure. (I've been monitoring it closely) Since then it's been pretty normal. I had more trouble sleeping at first until I added seroquel. Other than that, nothing!


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## JohnG (Sep 3, 2010)

Nice medication. Do you ever tried oral Selegiline? If yes, how do you compare the two?


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## upndownboi (Oct 7, 2010)

sounds like some really promising results so far! I would love to try the emsam patch as part of an augmentation with a ssri but its not available in the uk, and my pdoc was dismissive of oral selegiline as only licensed for parkinsons.

emsam seems quite revolutionary re. its method of drug delivery, I'm surprised it hasn't really taken off or perhaps it has I don't know.


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## Medline (Sep 23, 2008)

Carvedilol or Clonidine might help with the increased general anxiety caused by the selegiline.


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## jim_morrison (Aug 17, 2008)

Medline said:


> Carvedilol or Clonidine might help with the increased general anxiety caused by the selegiline.


Wouldn't the potent a1-adrenergic blocking properties from the Seroquel-XR that he's already on work in a similar manner?


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## Medline (Sep 23, 2008)

I overlooked that he takes Seroquel-XR.


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## DistinctlyAmbiguous (Aug 23, 2009)

JohnG said:


> Nice medication. Do you ever tried oral Selegiline? If yes, how do you compare the two?


Not yet. I still like the idea of not having dietary restrictions.. I'm hoping I can stay at the low dose.


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## DistinctlyAmbiguous (Aug 23, 2009)

upndownboi said:


> sounds like some really promising results so far! I would love to try the emsam patch as part of an augmentation with a ssri but its not available in the uk, and my pdoc was dismissive of oral selegiline as only licensed for parkinsons.
> 
> emsam seems quite revolutionary re. its method of drug delivery, I'm surprised it hasn't really taken off or perhaps it has I don't know.


Probably due to an extended drug patent making it impossible for people to afford. In generic form I bet it would be a huge hit.


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## Emile (Feb 3, 2010)

I wanted to try this but my doctor was an overcautious **** and wanted to stick to things he had experience with. Keep us updated.

It stumps me why they won't manufacture a transdermal version of nardil or parnate to bypass a heap of the tyramine. It could breathe new life into old discarded meds and bring MAOIs back to the forefront again.


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## DistinctlyAmbiguous (Aug 23, 2009)

Emile said:


> I wanted to try this but my doctor was an overcautious **** and wanted to stick to things he had experience with. Keep us updated.
> 
> It stumps me why they won't manufacture a transdermal version of nardil or parnate to bypass a heap of the tyramine. It could breathe new life into old discarded meds and bring MAOIs back to the forefront again.


Yeah, the market is definitely there for MAOI's. It's too bad most p-doc's run on auto-pilot...

*Typical scenario:*
*""*here's your SSRI's... oh, that doesn't work?... too many side effects?... here's your SSNI... same thing?... hmmm, here's your trycyclics and addictive benzos.... still not feeling better?... how about electroshock therapy? No way you say? Ok. You must be treatment resistant, yeah, but there's no way in hell I'm giving you a MAOI. Here's a nice place for CBT treatment.*""*

I'm still doing well on EMSAM. It's becoming a lot easier to cope with everyday life. I exercised today for the first time since I can remember.... It felt good.


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## upndownboi (Oct 7, 2010)

Emile said:


> It stumps me why they won't manufacture a transdermal version of nardil or parnate to bypass a heap of the tyramine. It could breathe new life into old discarded meds and bring MAOIs back to the forefront again.


think it might have something to do with how much of a drug you can fit onto a patch before it becomes unwieldy, so while there are fentanyl and selegline patches etc, and an lsd patch would theoretically work(!) effecitive doses of nardil are somewhat higher on a mg basis. Parnate could work tho... this is probably not the whole story tho.


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## RenegadeReloaded (Mar 12, 2011)

DistinctlyAmbiguous said:


> I have been on EMSAM 6mg/24hr transdermal patch for 12 days now and my depression is already lifting. I've been productive all week so far, and each day I just feel better.
> 
> Before starting EMSAM I was concerned about increased anxiety, which has been reported among some users. Well, it's true for me as well, I do have increased general anxiety... especially in anticipation of things. What I did not expect was DECREASED social anxiety. I'm beginning to feel "normal" amongst casual conversations!
> 
> ...


I try to convince my doctors for about a year now to give me maoi and they say NO. I envy u.

But glad you're doing good.


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## cybernut (Dec 13, 2011)

*Parnate and Nardil in patch form.....*

Hi all,

New to the form here. I realize this thread is old and hope everyone is still doing well. With regard to developing a Nardil or Parnate patch, I questioned the pdoc that was in charge of the EMSAM trials by email. Below is mine and his conversation about this topic:

> Dear Dr. Bodkin,
> 
> Hope this email finds you doing well. I have a curious question and probably one you have answered many times before so please accept my apologies in advance if so, but what would be the problem with using a non-selective MAOI such as phenelzine or tranylcypromine in the patch form like to EMSAM? I am "atypical"/MDD and have responded better to MAOI's than newer meds, but the options are so limited. Thanks in advance for your time in my curiosity.
> 
> Best Regards,
> Paul

You would not expect to avoid the tyrmamine interaction by giving a non-selective MAOI like parnate or nardil or maplan in a patch. For that selegiline is unique, as a type B MAOI at low concetrations and an incresing MAO A inhibiotor at higher concentrations. Parnate, for example inhibits MAO-A strongly at any blood concentrtion, and that's the interaction with food problem.

And its not obvious that MAOIs other than selegiline would have other advantages by patch, tho one doesnt know without trying; there is a very different metabolic pattern with transdermal drugs, which might be advantageoous or disadvantageous clinically.

Wish you luck.

Dr. B


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## Lacking Serotonin (Nov 18, 2012)

I'd like to know if Emsam's price has gone down much?


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## UltraShy (Nov 8, 2003)

Lacking Serotonin said:


> I'd like to know if Emsam's price has gone down much?


It's $1,053 per month according to GoodRX.com

I could get it for a $75 copay ($20 after discount offer Emsam has). If Parnate doesn't work out it's one of the drugs I'll have to consider trying. Though I'd try Nardil first.


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