Emsam is a brand name of the drug selegiline. Selegiline is a selective, irreversible MAO inhibitor that’s used to treat Parkinson’s disease (PD) and some forms of depression. Selegiline was discovered in the early 1960s when doctors noticed that tuberculosis patients taking the drug iproniazid experienced an elevated mood. They could track these effects back to the drug’s MAO-inhibiting effects.
Emsam increases the expression the neurotransmitters dopamine and norepinephrine. Selegiline is different from older generation MAO inhibitors in that it targets MAO-B pathways while neglecting MAO-A pathways. This results in fewer complications and milder side effects. However, like first-generation MAO inhibitors, Emsam’s effects are irreversible. This means that even after the patient stops taking Emsam, the brain will continue to inhibit the breakdown of certain neurotransmitters in the brain. In high doses, selegiline loses its MAO-B specificity and begins to target both MAO-A and MAO-B pathways.
Emsam is taken orally when used as a treatment for Parkinson’s disease. Selegiline is often used in conjunction with L-DOPA, a protein that functions as a precursor to the neurotransmitter dopamine. Treating Parkinson’s patients with both L-DOPA and Emsam allows doctors to reduce the necessary dose of L-DOPA.
Researchers have created a transdermal patch form of the drug for treatment of depression. The majority of the side effects of selegiline are due to dopamine levels becoming too high. Side effects of the pill form of Emsam may include confusion, depression, nausea, insomnia, hallucinations, poor balance, involuntary muscle movements, slow or irregular heart rate, delusions, chest pain, and syncope (fainting). Common side effects of the patch include insomnia, sore throat, diarrhea, and agitation of the skin at the patch site.
Emsam, like all MAO inhibitors, should not be mixed with foods or alcohol that contain the nutrient tyramine. When selegiline combines with high levels of tyramine, it can lead to a hypertensive crisis. Individuals on a low dose of the patch are able to continue consuming tyramine-containing foods. Patients taking higher doses are advised to eat a low-tyramine diet.
MAO inhibitors like selegiline aren’t considered to be psychologically addictive by either the medical community or the federal government. Cessation of selegiline treatment does not result in drug cravings, as is the case with addictive substances like benzodiazepines and opioids. Emsam has low rates of withdrawal symptoms compared to other MAO inhibitors. Some MAO inhibitors can cause amphetamine-like mania during discontinuation of the drug. Discontinuing use of selegiline comes with no such side effects, but can lead to increased feelings of depression.
MAO inhibitors like selegiline can take two to three weeks before the body’s metabolic processes have adjusted to no longer processing the drug. During this time, patients may experience an increase in depression. This adjustment period can last longer for some. Patients who had been taking Emsam for over a year are more likely to experience an increase in depressive symptoms upon cessation of treatment.
Withdrawal symptoms like increased depression tend to be worse in patients who abruptly discontinue use of selegiline. Speak with your doctor if feelings of depression begin to return or if side effects begin to get worse. It’s never advisable to miss doses of selegiline without first consulting your doctor. Your doctor will attempt to minimize the negative effects of discontinuation syndrome by gradually reducing the doses over time.
For patients that have been taking Emsam for a long time, discontinuing treatment can take anywhere from a couple of months to over a year. During this time, doses will be decreased at small intervals every few weeks until doses are stopped entirely. Your doctor may choose to increase doses of the protein L-DOPA during the discontinuation phase to offset the inevitable decrease in dopamine expression that comes with stopping selegiline treatment.
Emsam Signs, Symptoms and Side Effects
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