TaperCommunityselegiline
Boxed Warning
Suicidality risk in children, adolescents, and young adults under 25 during initial antidepressant treatment.
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
At low doses, selective MAO-B inhibition (preserves dietary tyramine breakdown). At higher doses, also inhibits MAO-A. Active metabolites include amphetamine and methamphetamine.
Step down by patch strength (12 → 9 → 6 → off) typically 1-2 weeks per step. Watch for amphetamine-like withdrawal at higher doses.
Patch makes MAOI use much more practical, but withdrawal is still meaningful and washout periods before serotonergic agents are still required.
1-5 days after stopping
1-2 weeks
3-6 weeks
Anhedonia and low motivation can persist 1-2 months because of metabolite effects
Toxicity
Hypertensive crisis at higher doses with tyramine. Serotonin syndrome with serotonergic drugs.
Pharmacokinetics
Hepatic via CYP2B6, CYP2C9, CYP3A4 to L-amphetamine and L-methamphetamine.
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