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Really worried about Emsam

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Pdoc is starting me out on the 6mg dose and I know that you don't have to follow the MAOI diet on that dose, but he says the goal is to get to 12mg and from the information I've gathered you DO need to follow the diet with that level. But pdoc says that I don't have to worry about it at any level. He has assured me that a lot of things are OK on Emsam that the PI sheet says are not. I know that at some point I need to trust pdoc, but I'm not sure that this is the point. I really need someone to pat my head and say that every thing will be OK and I guess he's doing that but I'm sort of not comforted by him. I don't know why either. He doesn't seem like a Lying McLierson. I've always been afraid of MAOIs. They are the tiger hiding in my closet. I don't have the discipline to follow the MAOI required diet. No chocolate or caffeine? There is this little meal called breakfast what am I supposed to do for that? Anyone else on a higher dose of Emsam? What were you told about the diet restrictions? Should I just trust pdoc?

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Everything WILL be ok. The manufacturer wants to cover its ass by recommending that you follow a diet at the higher doses. But the truth is that there is not one case of a problem due to diet at any dose. Your pdoc is right. He is prescribing and advising based on actual evidence, and not on some theoretical concern of the manufacturer. I'd listen to my pdoc if I were you.

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Hey, check out this information on the modern MAOI diet:


. . . which you can view as a critique of the 1996 MAOI diet - with many references to back up the points made.

The web site, psychotropical, is also interesting (he has some good things to say about MAOIs).

Now, here is some information on the 1996 diet that was developed:


You can check out some other forums on MAOI diet:


. . . especially scroll down to the notes from Ivan Goldberg, who has a table on "suggest / my experience"; I think has has some useful "in the field" experience (and somewhat funny caution regarding American vs. European chocolate).

Reading all of the above, the diet doesn't seem that difficult to understand or follow, and the risk of dietary interactions with MAOIs seems overhyped. Although the interactions of MAOIs with other drugs seems underhyped, and shouldn't -- these are very dangerous.

Emsam, also, has an additional safety feature - the transdermal delivery. This avoids your GI tract, where tyramine is deactivated from your diet.

I started Emsam (6 mg/day) a week ago - so far, so good. At least, not dead yet.

Get a medical ID that states you are taking a MAOI. You can get these from many places - medic alert, oneida medical jewelry, american medical id. Important because of the drug interactions - if you can't speak for yourself in an emergency, you don't want them giving you certain drugs that will create a hypertensive reaction with Emsam/Selegiline/MAOI. Also put an entry in your cell phone "contacts" list called ICE (In Case of Emergency) that not only contains phone numbers of people to contact, but also a note about your MAOI use and other meds you're taking (and dosages).

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