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I saw my tdoc today, and of course, the subject of meds came up and how I think that mine aren't working. The tdoc said that perhaps I should ask my pdoc about Emsam. I know that it's a "mild" MAOI, but that's about all I know about it. We also talked about the possibility of a good old fashioned MAOI.

Does anyone here have any experience with Emsam?

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Emsam is prohibitively expensive - $600 for 30 patches. This is crazy. The active ingredient - selegiline - has been around for quite a while. I don't know if it is worth asking about selegiline or maybe just going straight to Parnate.

Why are psych meds so expensive?

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I have not tried emsam but it's next on my list of things should I hit a rough patch. I'd rather do the expensive patch and see if it helps low dose and not have to deal with all the annoying dietary restrictions than go straight to traditional MAOIs, really. Of course, my insurance would pay for it, so there is that.

MAOIs are good, but dirty, drugs. In fact, many people seem to feel they are MORE effective than SSRIs for the seriously depressed (doctor wise, that I've met) but they hesitate to use them as a) they SSRI lobby is firmly down our throats and b) they come with unpleasant side effects, indeed, and c) their lethality is fairly well known, so it's a balancing act. That seems to be the skinny from most docs I talk to about them

That said, I read an article lit review that concluded they are the ADs LEAST likeely to send the BP into the stratosphere, so if things go to shit here, shortly, I am damn well leaving my doc's office with a nice prescription for emsam or... bad things will happen. Heh, i jest. I think my doc would do it with enough convincing....

Anna

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Good to hear that you are considering Emsam, Anna. I guess the dietary restrictions don't really bother me all that much. I don't eat a lot of aged cheese and I don't like Chinese food. Those are the big ones. Oh, and I don't drink a lot of beer. So I think I'm good to go.

Unfortunately, I read a discouraging study about Parnate (an old MAOI considered more effective than Emsam by many):

link to study

This study compared to Remeron + Effexor to Parnate in treatment resistant patients. The fact that it found the combo slightly better than Parnate is beside the point. Look at how many experienced remission. The range is 7% - 16%! To me this is unbelievable, and I'm not sure it's even worth trying an MAOI. This doesn't make my future look bright.

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Depression likely has a lot of different causes. People with chronic depression might all present the same, but they likely have a wide range of different things going on under the hood. The bottom line is that the people who respond well to the remeron + effexor combo (california rocket fuel) are not the same people who respond well to some other treatments. Just because treatment A is 70% effective and treatment B is 70% effective, there's no reason to think that the 70% is comprised of the same people.

IIRC low dose oral selegiline is safer than other MAO-Is in terms of dietary restrictions. Emsam, on the other hand, does have dietary restrictions at higher doses.

I'm skeptical that the new patch delivery method makes that big a difference.

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