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I was talking to my pysch doctor about possibly going on Nardil, weighing all the pros and cons and she mentioned a new drug similar to Nardil (an MAOI) thats a patch and supposedly doesn't have the same dietary restrictions.

Anybody heard of it? I don't remember what it's called but I believe it started like: En - something. Not sure.
 

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I've been on the emsam patch for about 2 months now, but it really hasn't helped my anxiety at all. It has helped a bit for depression though.
 

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"a bit"... Really??? Are you on a low-dose?

Kinda seems worthless if it's only "a bit"...
 

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Is this Emsam for SA?
It's marketed as an antidepressant. It's selegeline, a MAO-B inhibitor used to treat Parkinson's disease. It's been around in pill form for a couple decades.

This patch received much hype a number of years ago when it first hit the market, being hailed as some great breakthrough; an MAOI without the pain in the a** dietary restrictions that turn off so many doctors & patients to MAOIs. (To be fair, there are MAOI fans who will tell you the dietary restrictions aren't all the restrictive and not really a big issue with Nardil & Parnate.)

I can't recall ever hearing anybody say it worked for their SA so far and I've certainly read about meds quite a bit on this forum for years now. I have no personal experience with it, largely because I don't care to part with $530 a month. Emsam is anything but cheap for those of us who lack insurance to cover the obscene cost.

If it works well for SA one has to wonder why we haven't seen it in use for SA for a long time. This patch is just a new way to absorb an old drug.
 

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If you can get a script for selegiline, you could just ask for a generic pill form at the pharmacy (or order it online).

In my experience it does not help anxiety, but can be useful if combined with anxiolytics (as long as interactions are kept in mind).
 

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If you can get a script for selegiline, you could just ask for a generic pill form at the pharmacy (or order it online).

In my experience it does not help anxiety, but can be useful if combined with anxiolytics (as long as interactions are kept in mind).
I just looked up the price differential between patch & generic capsule form out of curiosity.

9 mg patch x 30 = $529

5 mg capsule x 60 = $29

That's a $6,000 a year difference, an amount most people would consider quite significant if coming out of their pocket.

What interactions would have to be kept in mind? Were you thinking of some specific drug(s) that it would not work with? I'm not familiar with this particular MAOI, but it seems like the Nardil & Parnate the drugs that you don't want to mix with them basically are any stimulant, while benzos are fine. And in 2009 an anxyolitic really means a benzo. Unless one actually thinks other ADs (that shouldn't be mixed with MAOIs) have some anxyolitic effect -- a claim that I've never been able to substantiate with personal experience.
 

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In my experience it does not help anxiety, but can be useful if combined with anxiolytics (as long as interactions are kept in mind).
How would you rate it as far as antidepressant effect?

And do you think that taking it via patch vs orally would in any way change how effective or ineffective it is on depression?

In my price comparison above I did 2 x 5 mg capsules a day vs a 9 mg a day patch. I used that comparison since 5 mg is the only size the oral form comes in and is roughly the same amount as the 9 mg patch. I'm not sure if the potency would equal though due to different means of administration. Any thoughts? Just like morphine shot into a vein has a higher potency than an equal mg amount taken as a pill.
 

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"a bit"... Really??? Are you on a low-dose?

Kinda seems worthless if it's only "a bit"...
I'm on the lowest dose, the dose without any diet restrictions... I guess I mean that it has helped my overall depression a good deal, but it has not helped at all with depression caused by social anxiety, which is my main issue... if that makes sense.
 

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What interactions would have to be kept in mind? Were you thinking of some specific drug(s) that it would not work with? I'm not familiar with this particular MAOI, but it seems like the Nardil & Parnate the drugs that you don't want to mix with them basically are any stimulant, while benzos are fine. And in 2009 an anxyolitic really means a benzo. Unless one actually thinks other ADs (that shouldn't be mixed with MAOIs) have some anxyolitic effect -- a claim that I've never been able to substantiate with personal experience.
Selegiline has these actions in the body (at selective doses):

  • Increased dopamine
  • Increased levels of MAO-B substrates (including PEA; even higher levels when you eat chocolate)
  • Increased release of noradrenaline/adrenaline/dopamine (dopamine to a lesser extent)

Even at "selective" doses it may have slight effects on MAO-A substrates (serotonin, adrenaline, noradrenaline, dopamine, octopamine, tryptamines, etc.), so a bit of potentiation can be expected.

So in terms of drug interactions, it's really any drug that affects dopamine or noradrenaline (I think adrenaline as well), but primarily dopamine. It should be fine to take with SNRIs, SSRIs, NRIs and benzos, but not any other MAOIs or stimulants (without a big dose change). I'm not entirely sure on all this, especially any drug with an NRI component, as it's currently just a guess that NRIs cancel out the effects of noradrenaline-releasers.

All rewarding substances should get a boost from selegiline, including cigarettes, benzos, cannabis, alcohol, GHB, L-dopa, etc. Too much dopamine can result in vomiting, psychosis, and presumably death from overheating/hypotension/etc..

Selegiline did make my anxiety a lot worse, but I'd say 1-2mg clonazepam/alprazolam would be enough to balance it (on no tolerance). It may also be wise to keep the dopamine/acetylcholine balance regulated with huperzine A, but I have no experience there.

How would you rate it as far as antidepressant effect?

And do you think that taking it via patch vs orally would in any way change how effective or ineffective it is on depression?

In my price comparison above I did 2 x 5 mg capsules a day vs a 9 mg a day patch. I used that comparison since 5 mg is the only size the oral form comes in and is roughly the same amount as the 9 mg patch. I'm not sure if the potency would equal though due to different means of administration. Any thoughts? Just like morphine shot into a vein has a higher potency than an equal mg amount taken as a pill.
For depression, selegiline is very effective, but not really as a single treatment (at least for us) as it increases stress and anxiety to unbearable levels. I doubt it would help melancholic depressive sadness, but will be of use to those with low energy and anhedonia. If you have panic attacks, without a moderate/high benzo dose this would be unwise.

The patch may bypass some of the metabolism to L-meth/L-amphetamine, but I don't think there would be a significant difference between the two. You can always just sublingual the pill.
 
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