Emsam Side Effects: What to Expect and When to Call Your Doctor

Emsam (selegiline transdermal system) is generally well-tolerated compared to oral MAOIs, but like all antidepressants, it does have side effects worth knowing about. Understanding what's normal — and what's a warning sign — can help you use Emsam safely and confidently.

This guide covers the most common side effects of Emsam, the serious reactions to watch for, and clear guidance on when to call your doctor or seek emergency care.

Common Side Effects of Emsam

In clinical trials, these side effects occurred in at least 5% of patients taking Emsam and at more than twice the rate of placebo:

Application site reactions (approximately 24%): Redness, itching, swelling, or rash at the patch location. This is the most common side effect. Minimize it by rotating application sites daily and ensuring skin is clean and completely dry before applying.

Insomnia (8–18%): Difficulty falling or staying asleep. Try applying the patch in the morning rather than the evening, and practice good sleep hygiene.

Headache: Usually mild and tends to improve over the first few weeks of treatment.

Dizziness: Especially when standing up quickly (orthostatic hypotension). Rise slowly from sitting or lying positions.

Dry mouth: Stay well-hydrated and consider sugar-free gum to stimulate saliva production.

Nervousness and abnormal dreams: May occur especially during the first weeks. Often improves as your body adjusts.

Diarrhea: Generally mild and transient.

Notably, unlike oral antidepressants and oral MAOIs, Emsam is associated with low rates of weight gain and sexual dysfunction — two side effects that often lead patients to discontinue other antidepressants.

How to Manage Application Site Reactions

Because skin reactions occur in about 1 in 4 patients, knowing how to minimize them is important:

Rotate application sites each day (upper torso, upper thigh, outer upper arm)

Wait at least 2 weeks before reusing the same site

Ensure the skin is completely dry before application — no lotions, oils, or powders

For persistent reactions: your doctor may recommend a topical corticosteroid or oral antihistamine

Serious or worsening skin reactions (blisters, spreading rash, severe pain) warrant a call to your doctor

Serious Side Effects: Know These Warning Signs

The following side effects are less common but require immediate medical attention:

Hypertensive crisis — A sudden, dangerous rise in blood pressure. This can occur when the 9 mg or 12 mg patches are combined with tyramine-rich foods (aged cheeses, cured meats, fermented products, draft beer) or certain medications. Symptoms include: severe, throbbing headache, chest pain, rapid heartbeat, stiff neck, nausea/vomiting, or sweating.

Call 911 immediately if you experience these symptoms. Important: No dietary restriction is required at the 6 mg/24hr dose.

Serotonin syndrome — Can occur if Emsam is combined with serotonergic drugs (SSRIs, SNRIs, TCAs, tramadol, St. John's Wort, etc.). Symptoms include: agitation, hallucinations, rapid heart rate, high fever, muscle rigidity or twitching, and loss of coordination. This is a medical emergency. Seek emergency care immediately.

Suicidal thoughts or behaviors (Black Box Warning) — Like all antidepressants, Emsam carries a black box warning for increased risk of suicidal thoughts in children, adolescents, and young adults, particularly in the first weeks of treatment or when doses change. Monitor closely for mood changes, agitation, or unusual behavior. Call your doctor or 988 (Suicide & Crisis Lifeline) immediately if you notice these.

Manic or hypomanic episodes — Patients with bipolar disorder may experience a manic switch. Tell your doctor if you notice racing thoughts, grandiosity, decreased need for sleep, or impulsive behavior.

Important Safety Rules While Using Emsam

At the 9 mg or 12 mg dose: avoid tyramine-rich foods (follow the low-tyramine diet) throughout treatment and for 2 weeks after stopping

Do not use SSRIs, SNRIs, TCAs, bupropion, mirtazapine, opioids (meperidine, tramadol), or other MAOIs with Emsam

Tell all healthcare providers (including dentists and ER doctors) that you use Emsam

If you need surgery, inform the surgeon and stop the patch at least 10 days before planned surgery

Dispose of used patches safely — fold them sticky-side in and place in a sealed container away from children and pets

When to Call Your Doctor vs. Go to the ER

Call your doctor if: Skin reaction is worsening, insomnia is severe, dizziness is causing falls, you notice mood changes or new behavioral symptoms.

Call 911 or go to the ER immediately if: You have a severe headache with stiff neck and high blood pressure, symptoms of serotonin syndrome, chest pain, difficulty breathing, or active suicidal ideation.

For a complete list of medications to avoid while on Emsam, read our guide: Emsam Drug Interactions: What to Avoid and What to Tell Your Doctor.