The Pharmaceutical Journal
Vol 269 No 7223 p668
9 November 2002

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American Journal of Psychiatry (ajp.psychiatryonline.org)

Transdermal selegiline effective treatment for major depression

Transdermal selegiline is an effective and well-tolerated treatment for adults with major depression, a new study shows.

The drug, a monoamine-oxidase-B (MAO-B) inhibitor, is licensed in the United Kingdom for use in patients with Parkinson's disease at a dose of 10mg daily. This dose requires no dietary restriction of tyramine.

However, when oral selegiline is used at higher doses, such as those required to treat major depression effectively, its selectivity for MAO-B diminishes resulting in increased inhibition of MAO-A. This in turn means there may be a need to restrict dietary tyramine because of the risk of severe hypertensive reactions.

In the current study, the researchers point out that transdermal selegiline was developed to deliver sustained blood concentrations of the drug without extensive inhibition of liver MAO-A. The transdermal formulation induces no greater sensitivity to tyramine than the 10mg daily dose for Parkinson's disease, they say.

They randomly assigned 177 patients with major depression to receive either transdermal selegiline 20mg daily or placebo for six weeks. Improvements in the symptoms of depression were greater in patients treated with transdermal selegiline than in those treated with placebo.

Although the risk of hypertension after ingestion of tyramine could not be assessed (because patients followed a tyramine-restricted diet) no differences with respect to hypertension were observed between the two groups.

Additional trials to investigate more fully the characteristics of this new antidepressant treatment are warranted, the researchers say (American Journal of Psychiatry 2002;159:1)