Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment.

Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Some people may have a particularly high risk of having suicidal thoughts or actions. These include people who have (or have a family history of) bipolar illness (also called manic-depressive illness) or suicidal thoughts or actions.

Watch for and try to prevent suicidal thoughts and actions:

• Pay close attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings. This is very important when an antidepressant medicine is started or when the dose is changed.
• Call the healthcare provider right away to report new or sudden changes in mood, behavior, thoughts, or feelings.
• Keep all follow-up visits with the healthcare provider as scheduled. Call the healthcare provider between visits as needed, especially if you have concerns about symptoms.

Call a healthcare provider right away if you or your family member has any of the following symptoms, especially if they are new, worse, or worry you:

• thoughts about suicide or dying
• attempts to commit suicide
• new or worse depression
• new or worse anxiety
• feeling very agitated or restless
• panic attacks
• trouble sleeping (insomnia)
• new or worse irritability
• acting aggressive, being angry, or violent
• acting on dangerous impulses
• an extreme increase in activity and talking (mania)
• other unusual changes in behavior or mood

Never stop an antidepressant medicine without first talking to a healthcare provider. Stopping an antidepressant medicine suddenly can cause other symptoms.

Antidepressants are medicines used to treat depression and other illnesses. It is important to discuss all the risks of treating depression and also the risks of not treating it. Patients and their families or other caregivers should discuss all treatment choices with the healthcare provider, not just the use of antidepressants.

Antidepressant medicines have other side effects. Talk to the healthcare provider about the side effects of the medicine prescribed for you or your family member.

Antidepressant medicines can interact with other medicines. Know all of the medicines that you or your family member takes. Keep a list of all medicines to show the healthcare provider. Do not start new medicines without first checking with your healthcare provider.

Not all antidepressant medicines prescribed for children are FDA approved for use in children. Talk to your child’s healthcare provider for more information.

USING ANTIDEPRESSANTS IN CHILDREN AND TEENAGERS

Emsam at any dose should not be used in children under the age of 12 years even when administered with dietary modifications. Emsam is not approved for use in pediatric patients.

• Emsam (selegiline transdermal system) contains a medicine called a monoamine oxidase inhibitor, also called a MAOI. MAOI medicines, including Emsam, can cause a sudden, large increase in blood pressure (hypertensive crisis) if you eat foods and drinks that contain high amounts of tyramine. A hypertensive crisis can be a life-threatening condition. See "Side Effects" for signs and symptoms of a hypertensive crisis.
  • Emsam comes in three different doses and patch sizes:
    • a 6 mg/24 hours patch
    • a 9 mg/24 hours patch
    • a 12 mg/24 hours patch 
  • You must avoid (not eat or drink) certain foods and drinks while using Emsam 9 mg/24 hours and Emsam 12 mg/24 hours patches and for 2 weeks after stopping Emsam 9 mg/24 hours and Emsam 12 mg/24 hours patches.
  • You do not have to make any diet changes with the Emsam 6 mg/24 hours patch.

Tyramine-Rich Foods and Drinks to Avoid

• Air dried, aged and fermented meats, sausages and salamis
• Pickled herring
• Any spoiled or improperly stored meat, poultry, and fish.
• Spoiled or improperly stored animal livers
• Broad bean pods (fava bean pods)
• Aged cheeses
• All tap beers and other beers that have not been pasteurized
• Concentrated yeast extract (such as Marmite)
• Sauerkraut
• Most soybean products (including soy sauce and tofu)
• Over-the-counter supplements containing tyramine

Acceptable Foods and Drinks, Containing No or Little Tyramine

• Fresh meat, poultry, and fish, including fresh processed meats (such as lunch meats, hot dogs, breakfast sausage, and cooked sliced ham)
• Vegetables (other than broad bean pods)
• processed cheeses, mozzarella, ricotta cheese, cottage cheese, and yogurt
• As with other antidepressants, concomitant use of alcohol with Emsam is not recommended. (Bottled and canned beers and wines contain little or no tyramine.)
• Brewer's yeast, baker's yeast
• Soy milk
• Pizzas from commercial chain restaurants prepared with cheeses low in tyramine

All foods you eat must be fresh or properly frozen. 

Avoid foods when you do not know their storage conditions.

• Emsam can cause serious and potentially life-threatening reactions if used with certain other medicines. Do not take the following medicines while using Emsam, and for 2 weeks after stopping Emsam: 
       ▪ other medicines to treat depression (antidepressants) including other MAOI medicines
       ▪ medicine which contains selegiline (such as Eldepryl)
       ▪ St. John’s wort (a herbal supplement)
       ▪ Demerol (meperidine), or medicines that contain meperidine (a narcotic pain medicine) or the pain medicines tramadol, methadone, or propoxyphene
       ▪ Tegretol (carbamazepine), or other medicines that contain carbamazepine (a seizure medicine)
       ▪ Trileptal (oxcarbazepine), or other medicines that contain oxcarbazepine (a seizure medicine)
       ▪ Cold or cough preparations that contain dextromethorphan
       ▪ Flexeril or other medicines that contain cyclobenzaprine (a medicine used to treat muscle spasms)
       ▪ decongestant medicines, found in many products to treat cold symptoms
       ▪ over-the-counter diet pills or herbal weight-loss products
       ▪ any herbal or dietary supplement that contains tyramine
       ▪ medicines called amphetamines, also called stimulants or “uppers”
       ▪ BuSpar (buspirone HCl), an anxiety medicine

Some of these medicines will have to be stopped for at least a week before you can start using Emsam.

Do not use Emsam (selegiline transdermal system) if you are allergic to anything in Emsam. (See "Forms of Medication".)

• You must not eat foods or drink beverages that contain high amounts of tyramine while using Emsam 9 mg/24 hours and 12 mg/24 hours patches. You do not have to make any diet changes with the Emsam 6 mg/24 hours patch. 
• Do not take other medicines while using Emsam or for 2 weeks after you stop using it unless your doctor has told you it is okay. See “Drug Precautions".
• Do not drive or operate dangerous machinery until you know how Emsam affects you. Emsam may reduce your judgment, ability to think, or coordination.
• Drinking alcoholic beverages is not recommended while using Emsam.