MAOI (transdermal patch); at the lowest dose, MAO-B selective with reduced dietary restrictions

Emsam (selegiline (transdermal)) Withdrawal

Emsam (transdermal selegiline) has a milder discontinuation pattern than oral MAOIs at low doses because of its MAO-B selectivity. At higher doses the pattern resembles other MAOIs. Most patients tapering Emsam describe sleep changes and return of depression as the dominant experiences.

By Dr. Ben Soffer, DO — board-certified physician, at-home ketamine therapy in Florida and New Jersey.

Half-life

~18-25 hours for the patch system.

Withdrawal timeline

Onset— 3-7 days after removing the last patch

Onset is gradual.

Peak— Week 2-3

Returning depression typically peaks in the second or third week.

Resolution— 4-6 weeks

Most patients return to baseline within a month or two.

Common symptoms

  • Sleep disturbance
  • Fatigue
  • Return of depression
  • Mood changes

Less common

  • Headache
  • Mild anxiety

Tapering guidance

  • A typical taper involves stepping down through the available patch strengths (6, 9, 12 mg) every 1-2 weeks.
  • The 14-day washout consideration before starting most other antidepressants applies after the higher-dose patches because dietary restrictions are required.
  • Coordinate the taper with the prescribing physician.

Where ketamine therapy fits

Emsam at the lowest dose (6 mg) has minimal dietary restrictions and a milder profile. Combination with ketamine still warrants careful clinical oversight as with other MAOIs. Discuss with both prescribing physicians before starting.

Check ketamine therapy eligibilityMedication safety with ketamine

Frequently asked questions

How long does Emsam withdrawal last?

Most patients return to baseline within 4-6 weeks. The pattern is similar to oral MAOIs but generally milder at the lowest patch dose.

Can I do ketamine therapy on Emsam?

MAOIs including transdermal selegiline require additional caution with ketamine. Discuss with both your prescribing physician and a ketamine-prescribing physician before starting.

Important: This page is informational and does not constitute medical advice or a recommendation to start, stop, or change any medication. Tapering psychiatric medications should always be coordinated with the prescribing physician. Compounded ketamine for anxiety, depression, PTSD, and chronic pain is not FDA approved.

Browse all medication withdrawal guides.