How effective is the selegiline transdermal system in treating depression at the 6 mg low dose?
Dr. Nemeroff: The selegiline transdermal system is available in 6 mg, 9 mg, and 12 mg. Most of my patients are prescribed the 6 mg dose, and the vast majority have stayed on that dose, whereas only ~25% of the patients have gone on to one of the higher doses. I tend to treat relatively refractory patients, so I probably have had an inordinate number of patients who have required 9 mg. I have had hardly any patients who required the 12 mg dose. Dr. Preskorn: Of the pivotal trials that led to the approval of selegiline transdermal patch, one was a positive placebo-controlled, fixed-dose study that only used the 6 mg/day dose, another was an ascending dose study starting all patients on 6 mg/day and allowing titration up to 12 mg/day, and finally the relapse-prevention study which also only used the 6 mg/day patch. Based on these studies, 6 mg/day is clearly an effective dose for many patients. Parenthetically, the package label warns against exceeding 6 mg without using the diet. Dr. DeV
