Introduced decades ago as the next step in antidepression pills, monoamine oxidase inhibitors (MAOIs) soon fell out of favor. Extremely effective in some people, they caused potentially lethal blood pressure spikes in others because of interactions with food in the gut. That and the subsequent rise of selective serotonin reuptake inhibitors (SSRIs) put them on a shelf. But a new skin patch has resurrected the drugs from obscurity.
The patch, Emsam, developed by Somerset Pharmaceuticals and marketed by Bristol-Myers Squibb, delivers an MAOI, selegiline, directly and continuously into the bloodstream, eliminating exposure to the gut and maximizing its effect in the brain. “This is big news for long-term patient benefit,” says Alexander Bodkin, chief of clinical psychopharmacology research at Harvard University’s McLean Hospital, who was part of the research team. “Now those who have been untreatable could be safely treated.”
That is about 30 percent of the 14 million Americans who have major depressive disorder, Bodkin says. These patients, suffering with entrenched symptoms such as oversleeping and overeating, typically are not helped with prevailing SSRIs such as Prozac or standard talk therapies. The transdermal dose significantly improved symptoms in studies in adults. The Food and Drug Administration recently approved the commercial version of the patch.
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Outside experts are still taking a wait-and-see attitude about widespread application of a class of drugs that was so dubious for so long. “It’s too early to tell,” says Michael Thase, professor of psychiatry at the University of Pittsburgh Medical Center, although he adds that the studies do suggest that the selegiline patch compares favorably with other modern antidepressants.