Emsam is an MAOI AD that is a patch. This makes it easier to handle than traditonal MAOIs because it isn't affected by food going through the stomach. The lowest dose has no restrictions and the higher two have restrictions that are less strict than traditonal MAOIs. My pdoc even allows me to eat cheese in moderation on the middle dose.

I've been on it for 10 years and it hasn't ever lost effectiveness. We move the dose up and down as needed, sometimes cutting patches to get the right dose for a given episode. I usually am on the middle dose.

It doesn't really have side effects. The first months I was on it my appetite was decreased and I lost some weight, not a bad thing. It is stimulating and I had to have my Seroquel dose adjusted up to combat that. For a long time on it I slept from 11PM-4AM every night. It wasn't enough sleep but it's all I could do until we got the Seroquel right.

The only other side effect is sometimes I get red marks where patch was but those go away quickly.

It's good stuff. If you've failed ADs in all categories it is worth asking about. Some pdocs won't prescribe any MAOIs but plenty do.