working with Emsam patch

[Igor4sugry]

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Anyone using or trialed Emsam patch? Have someone that did all types of your usual augmentations (TMS, SSRIs, SNRIs, atypical, stimulants, Li, Deplin, Cytomel, but not TCAs). Trialing Emsam patch to at least give an MAOI a try. Seems that 6mg may not be sufficient. Anyone augment it with atypicals? I know I know, should have trialed TCA, but pt was off anti-depressants before seeing me, so wanted to trial MAOI since I didn't have to wait for wash-out period.

 

[splik]

MAOIs should be augmented with Lithium or T3 because that is what the evidence supports. Conversely SSRIs should be augmented with atypicals rather than Li or T3. In general the recommendation is if you're starting someone on a TCA or MAOI you might as well add Li or T3 right off the bat since antidepressant monotherapy is unlikely to be enough in someone with that many treatment failures. for the more cautious adding a stimulant to an MAOI can also be effective though patients will often need sedatives to get them to sleep. why dont you try one of the real MAOIs (i.e. nardil?)