emsam!
Saturday 30 September 2006 | I like a cookie
With new prescription in hand, or rather adhering to lower back, we’ve been crawling around crazymeds.org and the rest of Dear Internet questing for information on our Drug of the Month: EMSAM, which is a patch! and it really does come in all-caps, which we find impossible to pronounce without intoning roundly, grandly: EM-SAM!—see? (Or you could just call it selegiline, which isn’t nearly as impressive-sounding.)
Crazymeds doesn’t yet have a page specifically for the selegiline patch, which just came out in February, but there’s a mildly hoppin’ forum thread, 
and so far no one seems to have turned into a lizard or gone streaking through their doctor’s waiting room. Wiki also has a bizarre entry, thus I break my personal vow of never linking to them:
Selegiline [is] used for the treatment of early-stage Parkinson’s disease and senile dementia [and] off-label to treat narcolepsy and as a nootropic, as well as for its purported life-extending effects. It is also reported to positively affect libido, particularly in older males. Selegiline is also used (at extremely high dosages relative to humans) in veterinary medicine to treat so-called “cognitive dysfunction” in dogs. […] Possibly due to the structural similarity to illegal stimulants, selegiline has been classified as a controlled substance in Japan and thus can only be obtained with a prescription or special government license.
The most interesting thing to me about my new pharmaceutical chum is that it, get this, is actually meant for treatment resistant (”refractory”) atypical depression (jumps up and down, waves hand). It’s an MAOI, which I’ve never taken—traditionally the antidepressant of last resort, used to treat only refractory depression, mostly because up until EMSAM it’s had reasonably awful side-effects, including its infamous you’ll-die-if-you-have-a-beer dietary restrictions.
But EMSAM’s dosing and mechanism don’t require the same restrictions, and it’s worth a shot anyway before the Cool Psychiatrist and myself head, hand in hand with wandering steps and slow, toward the atypical antipsychotics like Risperdal (risperidone), Zyprexa (olanzapine), Abilify (aripiprazole), Geodon (ziprasidone), Seroquel (quetiapine) and Clozaril (clozapine). Wow, we be getting some good spam now.
The Bristol-Myers Squibb press release gives a little more MAOI info:
Although their mechanisms of action are not fully understood, MAOIs, including EMSAM, are presumed to work through potentiation of monoamine neurotransmitter activity in the brain by inhibiting the MAO enzyme. In an in vivo animal model, EMSAM exhibited antidepressant properties only at doses that inhibited both MAO-A and MAO-B in the brain. In the brain, MAO-A and MAO-B play important roles in the breakdown of neurotransmitter amines such as norepinephrine, dopamine and serotonin.
So it should work, the Psychiatrist says absently, rummaging in her massive, man-sized Arabian-Nights wicker basket of samples, on all three neurotransmitters, and have no discernable side effects. I sit in one of her hideous Bauhaus plastic chairs snivelling quietly to myself. “I’m sorry to be so hard to prescribe for…maybe I’m just, like, completely faking it, and I should just shut up and take Zoloft like everyone else.” She emerges from the basket momentarily to study my face. “No, I don’t think so,” is her cool reply, and then back into the basket she goes, coming out with two boxes of EMSAM and instructions for kicking Lamictal (just stop taking it, since I might as well have been swallowing Skittles anyway) and tapering my remnant of Wellbutrin. She gave me a box of Ambien to use if EMSAM keeps me awake at night; I can’t take Remeron as a sleeper anymore. And there may be some dietary “restrictions” if I increase my dose from 3 mg/24 hrs to 9 or 12 mg/24 hrs—as per the manufacturer’s helpful table.
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Class of Food and Beverage
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Tyramine-Rich Foods and Beverages to Avoid
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Acceptable Foods, Containing No or Little Tyramine
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Meat, Poultry and Fish
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Air dried, aged and fermented meats, sausages and salamis (including cacciatore, hard salami and mortadella); pickled herring; and any spoiled or improperly stored meat, poultry and fish (e.g., foods that have undergone changes in coloration, odor, or become moldy); spoiled or improperly stored animal livers
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Fresh meat, poultry and fish, including fresh processed meats (e.g., lunch meats, hot dogs, breakfast sausage, and cooked sliced ham)
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Vegetables
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Broad bean pods (fava bean pods)
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All other vegetables
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Dairy
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Aged cheeses
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Processed cheeses, mozzarella, ricotta cheese, cottage cheese and yogurt
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Beverages
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All varieties of tap beer, and beers that have not been pasteurized so as to allow for ongoing fermentation
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As with other antidepressants, concomitant use of alcohol with EMSAM is not recommended. (Bottled and canned beers and wines contain little or no tyramine)
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Miscellaneous
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Brewer’s yeast, baker’s yeast, soy milk, commercial chain-restaurant pizzas prepared with cheeses low in tyramine
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Um, how about everyone beware those moldy, spoiled or improperly stored animal livers, a’i'ght? Fortunately I loathe most of these food items (from pickled herring to Marmite) so no love lost. The Psychiatrist was very funny, eyeing me over her prescription pad: “Do you use? I can’t remember. Well, don’t slap this on and then go snort a noseful of coke, okay? And don’t drink too much.” I couldn’t help but laugh aloud. She looked at me quizzically. “I’m sorry, Barbara. It’s just that, you know, it’s a big day for me when I take a shower. I’m not really partying much lately.”
Crazymeds founder Jerod says:
If you think a regimen of St. John’s Wort and flax seed oil can keep bipolar disorder in check, it’s either not bipolar disorder or someone has a date with a 72-hour involuntary time-out from polite society in their future.
Slowly I may get it that I’m not to blame, that it’s not my fault, that I’m not weak or stupid or lazy, that taking B vitamins and going for a jog every day is not going to make this go away, although it may help; and maybe in the meanwhile this bloody patch will do something. Because after this, it’s on to a pretty strange round of meds that ultimately terminates in electroshock therapy and vagus nerve stimulation and stuff like that—compared to which even atypical options like something sporting the ludicrous name of EMSAM seem well worth a whirl.
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