Experiencing Severe Orthostatic Hypotension After Excess Emsam Use
I’m a 39-year-old individual assigned female at birth, currently undergoing treatment for depression with 12 mg of Emsam. I recently began this medication and am currently on day 42 overall, with 16 days at the 12 mg dosage. Today is Sunday, August 10. Just this past Friday, while switching to a new patch, I completely forgot to remove the old one. Due to my ADHD-C, I often find myself easily distracted, which led to this oversight, and I only realized the mistake six hours later. Since Friday evening, I have been suffering from severe orthostatic hypotension. For some context, I also deal with high blood pressure; typically, my readings are between 160-180/90. I've been prescribed medication to manage my blood pressure, but I have avoided taking it because it tends to worsen my depressive symptoms significantly. Unfortunately, this weekend, my blood pressure unexpectedly dropped to as low as 80/54. I applied a new patch this morning, but after struggling to stand in the shower, I had to remove it after about an hour and a half of use. I’m hoping that by delaying reapplication until tomorrow morning, my Selegiline levels will decrease, leading to improved feelings. Interestingly, I’m experiencing more difficulty standing today than I did yesterday, as I could at least manage some walking then. Currently, standing for more than a few seconds seems impossible. However, I measured my blood pressure again and found it to be 127/87, which is an improvement compared to yesterday. I’m reaching out for any insight or recommendations regarding my situation, particularly how long these symptoms might persist. While orthostatic hypotension is a known side effect of Emsam, I have never experienced such severity before. Would reducing my dosage back to 9 mg for a few days be advisable, or should it be a long-term change? I hold concerns about possibly deteriorating my mood; it took five weeks for Emsam to show noticeable improvement, as I was at a very low point emotionally, crying daily and dealing with anxiety, and I certainly don’t wish to return to that state. Additionally, I have Vyvanse for managing my ADHD. Would it be prudent to consider taking it to help raise my blood pressure? I’ve refrained from using it as I work on stabilizing with Emsam. Thank you for taking the time to read my post; any advice would be greatly appreciated.
Answers (1)
8/10/2025, 3:01:43 PM
OpenHealth AI
Main Points:
You are experiencing severe orthostatic hypotension after using Emsam (Selegiline) incorrectly and have concerns about your blood pressure management. It's essential to address your symptoms while considering the effects on your mental health.
Explanation:
Orthostatic hypotension occurs when your blood pressure drops significantly upon standing up, which can cause dizziness, lightheadedness, or fainting. Given your history with Emsam, it's possible that the combination of the patch on your skin for too long and your existing blood pressure medications contributed to this drop. While an improvement in blood pressure is a positive sign, symptoms like severe difficulty standing suggest a need for careful management.
Next Steps:
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Postpone Reapplication of Emsam: Until your symptoms improve, you may want to hold off on applying another patch. Monitor your blood pressure regularly to see if it stabilizes further.
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Adjust Your Diet and Hydration: Increase your fluid intake to help manage blood pressure levels. Consider salty snacks like pickles or pretzels, as sodium can help raise blood pressure; however, keep your overall health in mind, especially due to your high blood pressure history.
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Assess Other Medications: Avoid taking Vyvanse without discussing it with a healthcare professional, as it may influence blood pressure differently in your case. However, if you believe it might help, ensure you have this conversation promptly with your doctor.
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Consider Dosage Adjustment: After discussing with your healthcare provider, consider temporarily lowering your Emsam dosage back to 9 mg if severe symptoms persist. Your doctor can help assess if this anatomical adjustment is right for you.
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Monitor Symptoms: Keep a diary of your symptoms, blood pressure readings, and how you feel overall. This can be crucial information for your healthcare provider in evaluating your treatment plan.
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Seek Support: Since managing both ADHD and depression can be challenging, consider reaching out to a therapist or counselor to support you during this period.
In this stressful time, focus on stability and improving your physical symptoms without rushing any changes that may impact your mental state. Let me know if you have any further questions or concerns.
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