Antidepressant Comparison Tool
Select your key concerns to see how Emsam compares to other antidepressant options.
Key Considerations
Emsam is most effective for those who have tried 2 or more antidepressants without success. It's especially helpful if you've experienced weight gain, sexual dysfunction, or emotional flatness with other medications.
If you're concerned about dietary restrictions, note that the 6 mg Emsam patch doesn't require special diet changes, but higher doses (9 mg and 12 mg) do.
Select a comparison criterion to see how Emsam compares to other antidepressants.
Depression doesn’t care how hard you try. If you’ve been on SSRIs like sertraline or fluoxetine for months and still feel stuck, you might be wondering: Emsam could be the next step. But is it right for you? And what are the real alternatives? This isn’t about guessing. It’s about understanding what actually works when standard treatments fail.
What Emsam (Selegiline) Really Does
Emsam is the brand name for selegiline, an MAOI - monoamine oxidase inhibitor. Unlike most antidepressants that boost serotonin or norepinephrine directly, Emsam blocks an enzyme called MAO-B that breaks down these mood chemicals. This means more of them stay active in your brain. What makes Emsam different? It’s the only MAOI you can use as a skin patch. That’s not just convenient - it reduces side effects like high blood pressure spikes that come from eating certain foods with oral MAOIs.
It’s approved for major depressive disorder in adults. The patch comes in three strengths: 6 mg/24 hours, 9 mg/24 hours, and 12 mg/24 hours. Most people start at 6 mg. If you don’t feel better after 6 weeks, your doctor might increase the dose. It usually takes 2-4 weeks before you notice any change. That’s slower than some pills, but the effects tend to last.
Why People Switch to Emsam
People don’t switch to Emsam because it’s trendy. They switch because other drugs didn’t work - or caused too many side effects. Weight gain? Sleepiness? Low sex drive? Those are common with SSRIs and SNRIs. Emsam doesn’t usually cause those. In fact, some users report more energy and better focus. That’s why it’s often chosen for people who feel emotionally flat, exhausted, or unmotivated - not just sad.
A 2023 study in the Journal of Clinical Psychiatry tracked 312 patients who switched from SSRIs to Emsam after failing two or more trials. About 47% saw a 50% or greater drop in depression symptoms. That’s higher than the typical 30-40% response rate for second-line antidepressants.
Top Alternatives to Emsam
There’s no single best antidepressant. What works for one person can fail another. Here are the most common alternatives - and how they stack up against Emsam.
1. SSRIs (Sertraline, Escitalopram, Fluoxetine)
These are the first-line treatments for a reason: they’re safe, widely studied, and easy to use. But they’re not magic. About 1 in 3 people don’t respond to SSRIs. And side effects like nausea, sexual dysfunction, and weight gain are common.
Compared to Emsam:
- SSRIs work faster - 1-2 weeks for some relief
- Emsam has fewer sexual side effects
- SSRIs don’t require dietary changes; Emsam at higher doses (9 mg and 12 mg) do
- SSRIs cost less - generic sertraline is under $5 a month
2. SNRIs (Venlafaxine, Duloxetine)
SNRIs boost both serotonin and norepinephrine. They’re often used for depression with physical pain or fatigue. Venlafaxine, in particular, can be very effective for treatment-resistant cases.
Compared to Emsam:
- SNRIs are pills - no patch needed
- They can raise blood pressure more than Emsam
- Emsam has less risk of withdrawal symptoms
- SNRIs may cause more sweating and dizziness
3. Bupropion (Wellbutrin)
Bupropion is the only antidepressant that doesn’t touch serotonin. It works on dopamine and norepinephrine. That’s why it’s popular for people who need energy, focus, or help quitting smoking.
Compared to Emsam:
- Bupropion is cheaper and available as a generic
- It doesn’t require dietary restrictions
- It has a higher risk of seizures (especially above 450 mg/day)
- Emsam may work better for severe, chronic depression
4. Mirtazapine (Remeron)
Mirtazapine is a sedating antidepressant. It helps with sleep and appetite - great for people who’ve lost weight or can’t sleep. But it often causes weight gain and daytime drowsiness.
Compared to Emsam:
- Mirtazapine works faster for sleep issues
- Emsam doesn’t cause weight gain
- Mirtazapine is easier to stop abruptly
- Emsam may be better for people who need mental clarity
5. Tranylcypromine (Parnate)
This is another MAOI - but it’s taken as a pill, not a patch. It’s older and more powerful than Emsam. It’s usually reserved for severe, treatment-resistant depression.
Compared to Emsam:
- Parnate works faster - sometimes in 1-2 weeks
- It has stricter food restrictions (all tyramine-rich foods)
- Emsam’s patch form reduces side effects
- Parnate has more reported cases of hypertensive crisis
When Emsam Might Not Be Right
Emsam isn’t for everyone. You should avoid it if:
- You’re taking other antidepressants, opioids, or stimulants - interactions can be dangerous
- You have uncontrolled high blood pressure
- You’re pregnant or breastfeeding - data is limited
- You’re over 65 and have heart issues - older adults are more sensitive to MAOIs
Also, if you’re eating a lot of aged cheese, cured meats, soy sauce, or tap beer, you need to be careful. At the 6 mg dose, dietary changes aren’t required. But once you go to 9 mg or 12 mg, you must avoid tyramine-rich foods. A single mistake - like a slice of blue cheese or a glass of red wine - can spike your blood pressure to dangerous levels.
Cost, Access, and Insurance
Emsam is expensive. A 30-day supply of the 6 mg patch can cost $500-$700 without insurance. Even with coverage, copays can be $100 or more. Generic selegiline patches aren’t widely available yet. That’s why many people try cheaper options first.
Some manufacturers offer patient assistance programs. Ask your doctor for a coupon or check the Emsam website for savings cards. Insurance often requires you to fail two other antidepressants before approving Emsam.
Real-Life Scenarios
Here’s how this plays out in practice:
- Sarah, 38: Took fluoxetine for 8 months. Still felt numb. Switched to Emsam. After 6 weeks, she slept better, stopped crying at work, and started running again. No weight gain. No sex drive issues. She’s now on the 9 mg patch and avoids blue cheese.
- Mark, 52: Had depression after a heart attack. Tried venlafaxine - his BP went too high. Switched to bupropion - it made him jittery. Emsam was the first thing that stabilized his mood without affecting his heart. He uses the 6 mg patch and eats normally.
- James, 45: Tried everything. SSRIs, SNRIs, even therapy. Nothing worked. His doctor suggested Parnate. He was scared of the diet. Emsam was the compromise - same class, easier to manage. He’s been on it for 14 months with no relapse.
What to Do Next
If you’re considering Emsam or another alternative:
- Track your symptoms for 2-4 weeks. Use a mood app or journal.
- Write down what didn’t work with past meds - side effects, timing, energy levels.
- Ask your doctor: "Has my depression been resistant to at least two other drugs?" If yes, Emsam or another MAOI might be appropriate.
- Ask about cost and insurance rules. Some plans require prior authorization.
- Don’t rush. Give any new treatment at least 6 weeks. If it’s not helping, you can try something else.
There’s no perfect antidepressant. But there is one that works for you. Emsam isn’t the first choice - but for many, it’s the only one that finally brings back the person they used to be.
Is Emsam better than SSRIs for depression?
Emsam isn’t necessarily "better" - it’s different. SSRIs are easier to start and have fewer dietary restrictions. But if you’ve tried 2-3 SSRIs and still feel depressed, Emsam has a higher chance of working. Studies show about 47% of people who fail SSRIs respond to Emsam. It’s also less likely to cause weight gain or sexual side effects.
Can I drink alcohol while using Emsam?
At the lowest dose (6 mg), moderate alcohol is usually okay. But at 9 mg and 12 mg, alcohol can raise your blood pressure and increase the risk of dangerous reactions. It’s safest to avoid it completely. Even one glass of wine could cause a spike if you’re on a higher dose.
How long does it take for Emsam to work?
Most people start noticing changes in 2-4 weeks, but full effects can take 6-8 weeks. That’s slower than some pills, but the results tend to be more stable. Don’t stop if you don’t feel better right away. Give it time - and talk to your doctor if there’s no change after 8 weeks.
What foods should I avoid with Emsam?
At the 6 mg patch dose, no dietary changes are needed. At 9 mg and 12 mg, avoid aged cheeses, cured meats (like salami), soy sauce, tap beer, red wine, fermented foods, and overripe fruits. These contain tyramine, which can cause dangerous blood pressure spikes when MAO is blocked.
Can I stop Emsam suddenly?
Unlike many antidepressants, Emsam doesn’t usually cause withdrawal symptoms. You can stop the patch without tapering. But that doesn’t mean you should. Stopping abruptly might bring back depression. Always talk to your doctor before making changes.
Is Emsam safe for older adults?
Emsam can be used in older adults, but with caution. People over 65 are more sensitive to MAOIs and have a higher risk of high blood pressure and falls. Doctors often start with the lowest dose (6 mg) and monitor closely. If heart problems or uncontrolled hypertension are present, Emsam may not be recommended.