EMSAM (transdermal) Tapering Guide
selegiline
Boxed Warning
Suicidality risk in children, adolescents, and young adults under 25 during initial antidepressant treatment.
Overview
Selegiline is a selective MAO-B inhibitor at low oral doses (used in Parkinson disease) but loses selectivity at antidepressant doses. The transdermal patch (EMSAM) bypasses gut MAO-A, allowing the 6mg/24h dose to be used WITHOUT dietary restrictions; the 9 and 12mg/24h doses still require the tyramine-restricted diet.
EMSAM patches: 6mg/24h, 9mg/24h, 12mg/24h
Transdermal patch: 6mg/24h, 9mg/24h, 12mg/24h; Oral tablets/capsules: 5mg (used in Parkinson)
Category C
Mechanism of Action
At low doses, selective MAO-B inhibition (preserves dietary tyramine breakdown). At higher doses, also inhibits MAO-A. Active metabolites include amphetamine and methamphetamine.
Taper Notes
Step down by patch strength (12 → 9 → 6 → off) typically 1-2 weeks per step. Watch for amphetamine-like withdrawal at higher doses.
Hyperbolic Tapering Guidance
Patch makes MAOI use much more practical, but withdrawal is still meaningful and washout periods before serotonergic agents are still required.
Summary written by TaperCommunity, informed by the Maudsley Deprescribing Guidelines (Horowitz & Taylor) and related literature — see Sources & References below. Not affiliated with or endorsed by the Maudsley.
Withdrawal Timeline
1-5 days after stopping
1-2 weeks
3-6 weeks
Anhedonia and low motivation can persist 1-2 months because of metabolite effects
Common Withdrawal Symptoms
Interactions & Safety
Drug Interactions
- SSRIs, SNRIs, TCAs, triptans, tramadol, meperidine, dextromethorphan — contraindicated
- Sympathomimetics — hypertensive crisis
- Other MAOIs — contraindicated
Contraindications
- Same as other irreversible MAOIs
- Skin sensitivity at patch site is a relative contraindication
Toxicity
Hypertensive crisis at higher doses with tyramine. Serotonin syndrome with serotonergic drugs.
Pharmacokinetics
ADME Profile
Hepatic via CYP2B6, CYP2C9, CYP3A4 to L-amphetamine and L-methamphetamine.
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Other Drug Profiles
Sources & References
EMSAM (transdermal) (selegiline) information on this page is sourced from peer-reviewed research, regulatory bodies, clinical guidelines, and patient-advocacy organizations.
Encyclopedic & chemical databases
Neutral, high-authority entity references.
Regulatory sources
Official prescribing information and safety notices.
Peer-reviewed research
Primary literature cited in this taper guide.
- Horowitz MA, Taylor D 2019 — Tapering of SSRI treatment to mitigate withdrawal symptoms (hyperbolic taper) (The Lancet Psychiatry)
- Davies J, Read J 2019 — A systematic review into the incidence, severity and duration of antidepressant withdrawal effects (Addictive Behaviors)
- Framer A 2021 — The patient voice: an exploration of the experience of withdrawal from antidepressants (Therapeutic Advances in Psychopharmacology)
Clinical guidelines
Evidence-based deprescribing and prescribing standards.
Deprescribing-specific resources
Clinician-facing references on tapering protocols.
- Deprescribing.org — Evidence-based deprescribing algorithms from the Bruyère Research Institute
- Royal College of Psychiatrists — Stopping antidepressants — UK clinical guidance on safely discontinuing antidepressants
Patient-advocacy & lived-experience
Long-running communities documenting withdrawal experience.
- Surviving Antidepressants — tapering forum — Long-running community archive of antidepressant taper experiences
- Inner Compass Initiative — Withdrawal Project — Peer-led resources for psychiatric drug withdrawal
- Mad in America — antidepressant withdrawal archive — Journalism and personal narratives on SSRI/SNRI discontinuation
- RxISK — adverse drug reaction reporting — Independent database of patient-reported adverse effects
TaperCommunity does not provide medical advice. Always consult a qualified prescriber before adjusting psychiatric medication.