Efficacy and safety of selegiline transdermal system (STS) for the atypical subtype of major depressive disorder: pooled analysis of 5 short-term, placebo-controlled trials

Pae, Chi‐Un; Patkar, Ashwin A.; Jang, Sae-Heon; Portland, Kimberly Blanchard; Jung, Sungwon; Nelson, J. Craig

doi:10.1017/s1092852913000655

Cited by 11 publications

(6 citation statements)

References 27 publications

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“… 11 In the GENDEP study, there was no indication that AD may respond better to SSRI than to tricyclic antidepressants as a similar efficacy of escitalopram and nortriptyline was observed. 37 Pae et al 76 in a post hoc analysis of five short-term trials with selegiline (selective MAOI type B) showed equal efficacy of this drug in patients with atypical and non-atypical subtype of depression.…”

Section: Treatmentmentioning

confidence: 99%

Atypical depression: current perspectives

Łojko¹,

Rybakowski²

2017

NDT

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The history and present status of the definition, prevalence, neurobiology, and treatment of atypical depression (AD) is presented. The concept of AD has evolved through the years, and currently, in Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, the specifier of depressive episode with atypical feature is present for both diagnostic groups, that is, depressive disorders and bipolar and related disorders. This specifier includes mood reactivity, hyperphagia, hypersomnia, leaden paralysis, and interpersonal rejection sensitivity. Prevalence rates of AD are variable, depending on the criteria, methodology, and settings. The results of epidemiological studies using DSM criteria suggest that 15%–29% of depressed patients have AD, and the results of clinical studies point to a prevalence of 18%–36%. A relationship of AD with bipolar depression, seasonal depression, and obesity has also been postulated. Pathogenic research has been mostly focused on distinguishing AD from melancholic depression. The differences have been found in biochemical studies in the areas of hypothalamic–pituitary–adrenal axis, inflammatory markers, and the leptin system, although the results obtained are frequently controversial. A number of findings concerning such differences have also been obtained using neuroimaging and neurophysiological and neuropsychological methods. An initial concept of AD as a preferentially monoamine oxidase inhibitor-responsive depression, although confirmed in some further studies, is of limited use nowadays. Currently, despite numerous drug trials, there are no comprehensive treatment guidelines for AD. We finalize the article by describing the future research perspectives for the definition, neurobiology, and treatment. A better specification of diagnostic criteria and description of clinical picture, a genome-wide association study of AD, and establishing updated treatment recommendations for this clinical phenomenon should be the priorities for the coming years.

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Section: Treatmentmentioning

confidence: 99%

Atypical depression: current perspectives

Łojko¹,

Rybakowski²

2017

NDT

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“…Reversible inhibitors such as moclobemide and toloxatone, on the other hand, represent safer and better-tolerated MAO-A inhibitors [14,15]. A transdermal delivery system of the MAO-B selective inhibitor, (R)-deprenyl (selegiline), has also been shown to be effective in the treatment of major depressive disorder in clinical trials [16]. Since this formulation does not lead to the inhibition of MAO-A in the gastrointestinal and hepatic systems, the risk of tyramine-induced hypertension is low.…”

Section: Introductionmentioning

confidence: 99%

“…Both reversible and irreversible inhibitors of MAO-B, on the other hand, do not cause tyramine-induced changes in blood pressure and these agents have good safety profiles[16]. To investigate the reversibility of MAO inhibition by the 1,4-benzoquinones, mixtures containing the MAO enzymes and test inhibitors were incubated for 15 min and subsequently dialysed for 24 h[39].…”

mentioning

confidence: 99%

The evaluation of 1,4-benzoquinones as inhibitors of human monoamine oxidase

Mostert

Petzer

2017

European Journal of Medicinal Chemistry

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“…EMSAM was equally efficacious in atypical and non-atypical depressives. 76 Whether EMSAM is more effective than non-MAOI antidepressants for atypical depression should be assessed. Nonetheless, these recent findings should provide clinicians at least a sense of confidence in administering EMSAM to patients with MDD since atypical depression did not have a negative influence on treatment response.…”

Section: Failure To Point Out Potential Advantages Of Emsam Over Othementioning

confidence: 99%

EMSAM (deprenyl patch): how a promising antidepressant was underutilized

Asnis

Henderson

2014

NDT

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The EMSAM patch is a unique monoamine oxidase inhibitor (MAOI) being the only antidepressant utilizing a transdermal delivery system. This was welcomed by clinicians who hoped that EMSAM would be better tolerated than oral MAOIs and non-MAOI antidepressants, as well as being effective for treatment in a wide spectrum of depressed patients including atypical depression, bipolar depression, and refractory depression. Unfortunately, the clinical use of EMSAM has been underutilized and its potential usefulness overlooked. This article suggests that fear of possible side effects, particularly the “cheese reaction” and serotonin syndrome, are some of the main contributors to underutilization by clinicians. These risks have been significantly exaggerated with the 6 mg/day dose not even requiring a special diet. Other contributing factors leading to underutilization are reviewed such as: the lack of studies addressing many important clinical questions; inadequate data analyses; not evaluating the effect of EMSAM on comorbid psychiatric conditions, particularly anxiety disorders; lack of antidepressant comparators versus EMSAM; no dose–response relationship examined; various depressive subtypes and conditions are unexplored, eg, bipolar depression and refractory depression; poor insurance coverage for an expensive medication; as well as minimal marketing efforts and postmarketing studies. On the other hand, many potential advantages of EMSAM are not highlighted enough in the literature and by pharmaceutical companies which might have increased clinical interest and utilization of the antidepressant. For example, the advantages of EMSAM include: avoidance of swallowing issues, as can be seen with oral antidepressants; minimal side effects, probably due to a favorable pharmacokinetic profile; minimal evidence of suicidal behavior, probably relating to the transdermal route of administration; low rates of inducing hypomanic/manic episodes; as well as significant efficacy in “anxious depression” and atypical depression. Recent efforts in conducting some post hoc analyses and presentations on EMSAM may yet stimulate further clinical interest and use of this antidepressant.

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Efficacy and safety of selegiline transdermal system (STS) for the atypical subtype of major depressive disorder: pooled analysis of 5 short-term, placebo-controlled trials

Abstract: STS appears to be comparably efficacious and tolerable in atypical and nonatypical subtypes of MDD. Adequately powered, controlled, clinical trials are necessary to confirm our findings.

Cited by 11 publications

References 27 publications

Atypical depression: current perspectives

Atypical depression: current perspectives

The evaluation of 1,4-benzoquinones as inhibitors of human monoamine oxidase

EMSAM (deprenyl patch): how a promising antidepressant was underutilized

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