, Volume 67, Issue 2, pp 257–265

Selegiline Transdermal System In the Treatment of Major Depressive Disorder

Adis Drug Profile


  • ▴ The monamine oxidase (MAO) inhibitor selegiline is selective for MAO-B at the low oral dosages used in the treatment of Parkinson’s disease. However, MAO-A is also inhibited at the high oral dosages needed to effectively treat depression (not an approved indication), necessitating a tyramine-restricted diet. The selegiline transdermal system was designed to deliver antidepressant drug concentrations to the CNS, without substantially impairing small intestine MAO-A activity. At the target dose of 6 mg/24 hours, tyramine dietary restrictions are not needed.

  • ▴ Short-term treatment with fixed (6 mg/24 hours) or flexible (6, 9 or 12 mg/24 hours) doses of selegiline transdermal system was superior to placebo on most measures of antidepressant activity in 6- or 8-week, randomised, double-blind, multicentre studies in adult outpatients with major depressive disorder (MDD).

  • ▴ Likewise, long-term treatment with a fixed dose of selegiline transdermal system 6 mg/24 hours was superior to placebo as maintenance therapy in a 52-week, randomised, double-blind, multicentre, relapse-prevention trial in patients with MDD.

  • ▴ Selegiline transdermal system therapy was generally well tolerated in placebo-controlled studies; application site reactions, mostly of mild to moderate severity, were the most commonly reported adverse events. The incidence of sexual adverse effects and weight gain was low and similar to that with placebo.


  1. 1.
    Holtzheimer PE 3rd, Nemeroff CB. Advances in the treatment of depression. NeuroRx 2006 Jan; 3 (1): 42–56PubMedCrossRefGoogle Scholar
  2. 2.
    Kessler RC, Berglund P, Dernier O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 2003 Jun 18; 289 (23): 3095–105PubMedCrossRefGoogle Scholar
  3. 3.
    Ustun TB, Ayuso-Mateos JL, Chatterji S, et al. Global burden of depressive disorders in the year 2000. Br J Psychiatry 2004 May; 184: 386–92PubMedCrossRefGoogle Scholar
  4. 4.
    Mann JJ. The medical management of depression. N Engl J Med 2005 Oct 27; 353 (17): 1819–34PubMedCrossRefGoogle Scholar
  5. 5.
    Patkar AA, Pae C-U, Masand PS. Transdermal selegiline: the new generation of monoamine oxidase inhibitors. CNS Spectr 2006; 11 (5): 363–75PubMedGoogle Scholar
  6. 6.
    Robinson DS. Monoamine oxidase inhibitors: a new generation. Psychopharmacol Bull 2002 Summer; 36 (3): 124–38PubMedGoogle Scholar
  7. 7.
    Anderson IM, Nutt DJ, Deakin JFW, et al. Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 1993 British Association for Psychopharmacology guidelines. J Psychopharmacol 2000; 14 (1): 3–20PubMedCrossRefGoogle Scholar
  8. 8.
    American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder (revision). Am J Psychiatry 2000 Apr; 157 (4 Suppl.): 1–45Google Scholar
  9. 9.
    Thase ME. Novel transdermal delivery formulation of the monoamine oxidase inhibitor selegiline nearing release for treatment of depression. J Clin Psychiatry 2006 Apr; 67 (4): 671–2PubMedCrossRefGoogle Scholar
  10. 10.
    Mahmood I. Selegiline transdermal system Somerset. Curr Opin Investig Drugs 2002 Aug; 3 (8): 1230–3PubMedGoogle Scholar
  11. 11.
    Preskorn SH. Why the transdermal delivery of selegiline (6 mg/ 24 hr) obviates the need for a dietary restriction of tyramine. J Psychiatric Practice 2006 May; 12 (3): 168–72CrossRefGoogle Scholar
  12. 12.
    EMSAM® (selegiline transdermal system) continuous delivery for once-daily application. Prescribing information. Somerset Pharmaceuticals Inc., Tampa (FL). 2006 AprGoogle Scholar
  13. 13.
    Gordon MN, Muller CD, Sherman KA, et al. Oral versus transdermal selegiline: antidepressant-like activity in rats. Pharmacol Biochem Behav 1999 Jul; 63: 501–6PubMedCrossRefGoogle Scholar
  14. 14.
    Mawhinney M, Cole D, Azzaro AJ. Daily transdermal administration of selegiline to guinea-pigs preferentially inhibits monoamine oxidase activity in brain when compared with intestinal and hepatic tissues. J Pharm Pharmacol 2003 Jan; 55 (1): 27–34PubMedCrossRefGoogle Scholar
  15. 15.
    Ziemniak JA, Kemper EM, Goodhead M, et al. Pharmacokinetics of selegiline administered via transdermal patch, single oral dose, or intravenous infusion [poster]. New Clinical Drug Evaluation Unit (NCDEU) Annual Meeting; 2001 May 29; Phoenix (AZ)Google Scholar
  16. 16.
    Rohatagi S, Barrett JS, DeWitt KE, et al. Multiple dose pharmacokinetics and dose proportionality of selegiline and metabolites in healthy males following transdermal administration [abstract no. PPDM 8441]. Pharm Res 1996 Sep; 13 (Suppl.): S–503Google Scholar
  17. 17.
    Rohatagi S, Barrett JS, McDonald LJ, et al. Selegiline percutaneous absorption in various species and metabolism by human skin. Pharm Res 1997 Jan; 14 (1): 50–5PubMedCrossRefGoogle Scholar
  18. 18.
    Azzaro AJ, VanDenBerg CM, Blob LF, et al. Tyramine pressor sensitivity during treatment with the selegiline transdermal system 6 mg/24 h in healthy subjects. J Clin Pharmacol 2006; 46: 933–44PubMedCrossRefGoogle Scholar
  19. 19.
    Bodkin JA, Amsterdam JD. Transdermal selegiline in major depression: a double-blind, placebo-controlled, parallel-group study in outpatients. Am J Psychiatry 2002 Nov; 159: 1869–75PubMedCrossRefGoogle Scholar
  20. 20.
    Amsterdam JD. A double-blind, placebo-controlled trial of the safety and efficacy of selegiline transdermal system without dietary restrictions in patients with major depressive disorder. J Clin Psychiatry 2003 Feb; 64: 208–14PubMedCrossRefGoogle Scholar
  21. 21.
    Feiger AD, Rickels K, Rynn M, et al. Selegiline transdermal system for the treatment of major depressive disorder: an 8-week, double-blind, placebo-controlled, flexible-dose titration trial. J Clin Psychiatry 2006 Sep; 67 (9): 1354–61PubMedCrossRefGoogle Scholar
  22. 22.
    Amsterdam JD, Bodkin JA. Selegiline transdermal system (STS) in the prevention of relapse of major depressive disorder: a 52-week, double-blind, placebo-substitution, parallelgroup clinical trial. J Clin Psychopharmacol 2006; 26: 1–8CrossRefGoogle Scholar
  23. 23.
    FDA approves Emsam (selegiline) as first drug patch for depression [online]. Available from URL: http://www.fda.gov[Accessed 2006 Mar 1]

Copyright information

© Adis Data Information BV 2007

Authors and Affiliations

  1. 1.Wolters Kluwer Health / AdisMairangi Bay, AucklandNew Zealand
  2. 2.Wolters Kluwer HealthConshohockenUSA

Personalised recommendations