Larry Culpepper1, Lawrence J Kovalick. 1. Department of Family Medicine, Boston University Medical Center, Boston, Mass. ; and Bristol-Myers Squibb, Princeton, N.J.
Abstract
OBJECTIVE: To provide a narrative review of the properties of the selegiline transdermal system (STS) for the treatment of depression and its subtypes. BACKGROUND: Monoamine oxidase inhibitors (MAOIs) once represented the mainstay of therapy for the treatment of major depressive disorder (MDD). However, despite their efficacy, these agents fell from favor due to the risk of acute hypertensive reactions following ingestion of foods containing high concentrations of tyramine. Recent efforts to develop MAOIs that overcome these limitations have resulted in the introduction of the first transdermal formulation of the MAOI selegiline for the treatment of MDD. DATA SOURCES: A PubMed literature search was conducted in January 2007 using the keyword selegiline transdermal system. STUDY SELECTION: Articles retrieved were reviewed and selected for inclusion based on their being randomized, double-blind, placebo-controlled studies that appeared between the years 2000 and 2007 and examined efficacy, safety, and tolerability data from clinical trials of patients with MDD who were treated with the STS. Four articles, including 3 acute trials and 1 long-term prevention of relapse trial, were included in this review based on these criteria. CONCLUSIONS: The selegiline transdermal system provides several advantages compared to orally administered MAOIs, including minimal interaction with dietary tyramine and prolonged exposure to the parent compound, while offering a favorable side effect profile. As a result, treatment at the lowest effective dose of 6 mg/24 hours can be administered without the need for dietary modifications.
OBJECTIVE: To provide a narrative review of the properties of the selegiline transdermal system (STS) for the treatment of depression and its subtypes. BACKGROUND: Monoamine oxidase inhibitors (MAOIs) once represented the mainstay of therapy for the treatment of major depressive disorder (MDD). However, despite their efficacy, these agents fell from favor due to the risk of acute hypertensive reactions following ingestion of foods containing high concentrations of tyramine. Recent efforts to develop MAOIs that overcome these limitations have resulted in the introduction of the first transdermal formulation of the MAOI selegiline for the treatment of MDD. DATA SOURCES: A PubMed literature search was conducted in January 2007 using the keyword selegiline transdermal system. STUDY SELECTION: Articles retrieved were reviewed and selected for inclusion based on their being randomized, double-blind, placebo-controlled studies that appeared between the years 2000 and 2007 and examined efficacy, safety, and tolerability data from clinical trials of patients with MDD who were treated with the STS. Four articles, including 3 acute trials and 1 long-term prevention of relapse trial, were included in this review based on these criteria. CONCLUSIONS: The selegiline transdermal system provides several advantages compared to orally administered MAOIs, including minimal interaction with dietary tyramine and prolonged exposure to the parent compound, while offering a favorable side effect profile. As a result, treatment at the lowest effective dose of 6 mg/24 hours can be administered without the need for dietary modifications.
Authors: Madhukar H Trivedi; A John Rush; Stephen R Wisniewski; Andrew A Nierenberg; Diane Warden; Louise Ritz; Grayson Norquist; Robert H Howland; Barry Lebowitz; Patrick J McGrath; Kathy Shores-Wilson; Melanie M Biggs; G K Balasubramani; Maurizio Fava Journal: Am J Psychiatry Date: 2006-01 Impact factor: 18.112
Authors: M R Liebowitz; F M Quitkin; J W Stewart; P J McGrath; W Harrison; J Rabkin; E Tricamo; J S Markowitz; D F Klein Journal: Arch Gen Psychiatry Date: 1984-07