S2E78: Selegiline Patch for TRD: A PMHNP Prescribing Protocol

Hey! I'd love to hear your thoughts, send me a voice note.The selegiline patch (EMSAM) is the MAOI with no diet rules at 6 mg. A PMHNP protocol for candidates, washouts, dosing, tyramine, and monitoring in TRD. In this Deep Dive episode, two hosts walk through “Selegiline Patch for TRD: A PMHNP Prescribing Protocol” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • The selegiline transdermal system (EMSAM) is an FDA-approved MAOI for adult major depressive disorder, and at 6 mg/24 hours it needs no tyramine diet. • A 2025 real-world cohort of 117 patients with treatment-resistant depression found the patch was 0.81 CGI-S points better than tricyclics and better tolerated than oral MAOIs, with no hypertensive crises or serotonin syndrome. • The washout is the dangerous part: about 1 week off most antidepressants, at least 5 weeks off fluoxetine, and 2 weeks after stopping the patch before starting a contraindicated drug. • Start and stay at 6 mg when you can. Going to 9 or 12 mg brings back the tyramine diet, starting the first day at the higher dose. • Expect skin reactions (24% vs. 12% on placebo) and insomnia (12% vs. 7%). Check orthostatic blood pressure at every visit. • Contraindicated under age 12 and not recommended ages 12 to 17. For adults 65 and older the recommended dose is 6 mg. Read the full article: https://psychnpfellowship.com/selegiline-patch-emsam-treatment-resistant-depression-pmhnp-2026/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.