Emsam (Selegiline) for Major Depressive Disorder

Emsam (selegiline) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) for treating adults with major depressive disorder.

How Emsam Works and How It's Taken

Emsam works by blocking an enzyme called monoamine oxidase, or MAO. This enzyme normally breaks down certain brain chemicals called neurotransmitters. When MAO is blocked, the levels of these chemicals increase in the brain and spinal cord. The exact way Emsam helps depression is not fully known, but these changes are thought to play a role in treating major depressive disorder.

Doctors prescribe Emsam for adults with major depressive disorder. Emsam is a skin patch that is applied once every 24 hours to dry, unbroken skin on the upper torso (below the neck and above the waist), upper thigh, or outer upper arm. The patch needs to be changed every 24 hours, and to avoid irritation, rotate where the patch is placed on the application site.

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Emsam Side Effects

The most common side effects of Emsam include:

Skin reaction where the patch is placed (such as irritation or redness)
Headache
Insomnia (trouble sleeping)
Diarrhea
Dry mouth
Dyspepsia (indigestion)
Rash
Pharyngitis (sore throat)
Sinusitis (sinus infection)

In clinical trials of adults with major depressive disorder, the most common side effects of Emsam occurred in about 3 percent to 24 percent of people.

Serious Side Effects and Warnings

Emsam can cause serious side effects that require immediate medical attention. These include:

Suicidal thoughts and behaviors (risk is increased in adolescents and young adults taking antidepressants)
Serotonin syndrome (a potentially life-threatening reaction that can cause confusion, agitation, fever, sweating, fast heart rate, muscle stiffness or twitching, seizures, and diarrhea)
Hypertensive crisis, or severely high blood pressure (a sudden, dangerous rise in blood pressure that can cause severe headache, chest pain, nausea or vomiting, sweating, neck stiffness, and vision changes, and can lead to stroke)
Mania or hypomania (a “manic episode,” with unusually high energy, racing thoughts, risky behavior, or needing much less sleep)

Get medical help right away if you think you are having a serious reaction.

How To Save on Emsam

Viatris, the manufacturer of Emsam, offers the EMSAM Savings Card. Eligible people with commercial insurance may pay as little as $20 for each monthly fill of Emsam.

To learn more, visit the EMSAM Savings Card page or call 800-657-7613.

What To Know Before Taking Emsam

Before starting Emsam, your doctor will check for a personal or family history of bipolar disorder, mania, or hypomania.

Tell your doctor if you have any allergies to selegiline or any ingredients in Emsam.

Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, and supplements.

Do not take Emsam if you are less than 12 years of age or have pheochromocytoma (a tumor of the adrenal gland) because of an increased risk of severe increases in blood pressure.

Do not take Emsam if you take certain medicines, including SSRIs (fluoxetine, sertraline, or paroxetine), SNRIs (venlafaxine or duloxetine), tricyclic antidepressants (clomipramine or imipramine), opiate analgesics (meperidine, tramadol, methadone, pentazocine, or propoxyphene), dextromethorphan, and carbamazepine.

If you are pregnant, planning to become pregnant, or breastfeeding while taking Emsam, talk with your doctor about the risks and benefits. Breastfeeding is not recommended during treatment with Emsam and for five days after the final dose.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Emsam?
In two short-term studies in adults with major depressive disorder, people taking Emsam showed greater improvement on a depression rating scale than those taking placebo over six to eight weeks. In a longer relapse-prevention study, people who stayed on Emsam had a longer time before their depression came back compared with those who switched to placebo.

How long does Emsam take to work for depression?
Emsam does not work right away. The full effect of antidepressants may take several weeks to see improvement. In clinical studies of major depressive disorder, improvement was seen over six to eight weeks.

What side effects can Emsam cause when used for depression?
Common side effects reported include skin reactions where the patch is placed, headache, trouble sleeping, diarrhea, dry mouth, indigestion, rash, sore throat, and sinus infection. Skin reactions at the patch site are the most common. They were reported in about 24 percent of people using Emsam compared with 12 percent using placebo. Most of these reactions were mild or moderate. About 2 percent of people stopped treatment because of these skin reactions.

Can Emsam for depression be used with other medicines?
Emsam should not be used with some other medicines, such as certain antidepressants, opioid pain medicines, and cough medicines with dextromethorphan, because serious reactions can occur. Your doctor will decide which medicines are safe to use together.