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Patients with MDD frequently exhibit suicidal behaviorA prior survey by our group found that over 25of depressed outpatients had made prior suicide attemptswith over half having made multiple attempts in their lifetime while another 25had suicidal ideation62 Most of these suicide attempts were impulsive and involved overdoses with antidepressants and other medicationsAlthough EMSAM has been FDA-approved since 2006there have been a minimal number of reported cases of suicide attempts or completed suicides with this drug in the literatureIn the premarketing clinical trial data set of 2,064 patientsthere were no completed suicidesThe package insert states that 0.5n=11of EMSAM group versus 0.4n=3of the placebo group had a suicidal eventviolent behavioror attempted overdose63 RecentlyPae et al201237 presented a summary of postmarketing data on 29,141 patients that have been prescribed EMSAMThis updated report found that four cases had completed suicide and four more made suicide attemptsOf the completed suicidesall cases used multiple drugsparticularly those that were contraindicated with EMSAM usagesuch as crystal methamphetamine and bupropiontaken in overdose quantitiesOne case did make an overdose with 28 EMSAM patches applied to him concomitantly with numerous doses of amphetaminebut survived37 It would appear that the use of transdermal patches makes it more difficult to successfully overdose andthereforemay protect someone from such impulsive attemptsTheoreticallyit would be possible to administer enough EMSAM patches to successfully commit suicide although the lethal amount of patches necessary is unclearAlthough clearly rare eventsa few isolated reports in the literature cite suicidal behavior with other transdermal patchesWiesbrock et al and LoVecchio and Ramos each reported a successful suicide with fentanylan opioidtransdermal patcheswith one patient applying 20 patches and the other eleven patchesrespectively6465 Raber et al reported an unsuccessful suicide attempt with a patient ingesting a clonidine transdermal patch65 Lastlynine cases unsuccessfully tried to commit suicide with nicotine patchestwo to 20 patches66 Thusthe literature suggests that suicidal behavior rarely occurs with the use of transdermal patchesThereforeEMSAM might be a preferred treatment in depressed patients who have a history of previous suicidal behavior or who are currently suicidalNonethelesssince there are no comparative studies comparing EMSAM to other antidepressantsthis possible advantage for EMSAM awaits validation.

This drug may rarely cause an attack of extremely high blood pressurehypertensive crisiswhich may be fatalMany drug and food interactions can increase this riskSee also Drug Interaction sectionStop using selegiline and get medical help right away if any of these very serious side effects occurfrequent/severe headachefast/slow/irregular/pounding heartbeatchest painneck stiffness/sorenesssevere nausea/vomitingsweating/clammy skinsometimes with feverwidened pupilssudden sensitivity to lightphotophobia

Before using selegilinetell your doctor or pharmacist if you are allergic to itor if you have any other allergiesThis product may contain inactive ingredientswhich can cause allergic reactions or other problemsTalk to your pharmacist for more details.

Tell your doctor or pharmacist if you are using any of these medications beforeduringor within 2 weeks after treatment with selegilineTell your doctor or pharmacist if you have taken fluoxetine during at least 5 weeks before starting selegilineDiscuss with your doctor how much time to wait between starting or stopping any of these drugs and taking selegiline.

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ThusMAOIs appear to be an alternative antidepressant treatmentand may be particularly effective in refractory depressionatypical depressionmelancholiaand possibly bipolar depressionUnfortunatelyside effects and dietary issues may limit its general usefulnessRecentlyselegilinea MAOI-Bwas developed as a transdermal patchEMSAMin an attempt to develop a more user-friendly MAOIThe availability of a new MAOIEMSAMthat is an easily applied transdermal antidepressant preparation should provide an antidepressant that is easier to administer and more tolerable than oral MAOI preparationsThis is clinically relevant since the use of oral MAOIs is clearly limited by their potential side effectsas seen in the STAR*D projectoral MAOIs are not well-tolerated by a significant subgroupleading to limitation of dosage and/or early discontinuation20.

To minimize dizziness and the risk of faintingget up slowly when rising from a sitting or lying position.

Do not use EMSAM if youtake certain medicines includingselective serotonin reuptake inhibitorsSSRIssuch as fluoxetinesertralineor paroxetineserotonin and norepinephrine reuptake inhibitorsSNRIsuch as venlafaxine or duloxetineclomipramine or imipraminetricyclic antidepressantsmeperidinetramadolmethadonepentazocinepropoxypheneopioid medicinesdextromethorphanor carbamazepine are less than 12 years of age have a tumor on your adrenal gland called a pheochromocytoma Ask your health care professional or pharmacist if you are not sure if you take these medicines.

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