State of Mind

Sam Bankman-Fried Confirmed He Wears an Emsam Patch. What’s an Emsam Patch?

His supposed use of the depression medication had kicked up some rumors.

Sam Bankman-Fried, pictured in a suit, next to an Emsam package.
Photo illustration by Slate. Photos by Tom Williams/CQ-Roll Call, Inc. via Getty Images and Amazon.

It was a big week for 30-year-old disgraced crypto king and productivity influencer Sam Bankman-Fried. On Tuesday he was scheduled to testify to lawmakers about why FTX, his $32 billion crypto exchange, collapsed into bankruptcy, leaving investors unable to withdraw anything. But on Monday evening, authorities in the Bahamas arrested him on behalf of prosecutors for the Southern District of New York and charged him with wire fraud and money laundering, among other things. The Securities and Exchange Commission and the Commodity Futures Trading Commission tacked on charges of their own.

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As many dissected the federal complaints’ effect on various congressional hearings and the future of crypto, a smaller group of people were more focused on another area of Bankman-Fried revelations: his admission of wearing something called an Emsam patch.

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“I have a prescription for Emsam, and have for roughly a decade,” Bankman-Fried planned to tell a House committee, according to a prepared version of his remarks published by Forbes on Tuesday. He added, “It is not generally the case that people are expected to talk about their private medical conditions, but enough paparazzi have snapped photos of my belongings and theorized about it online that I guess I have no choice.”

Indeed, as SBF rose to prominence over the past few years, fans and critics developed theories about what precisely was fueling him. He fanned these flames by tweeting about stimulants and sleeping pills and his views on maximizing focus, without naming specific drugs. In November, Autism Capital, a crypto-focused Twitter account, seemed to offer an answer: zooming in on something blurry on SBF’s desk and tweeting that it was Emsam.

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Because so few people had ever heard of Emsam before, this was wildly intriguing and became a decent way to prove whatever you wanted to prove about SBF. A quick internet search showed that the drug had been created to treat Parkinson’s. But the man didn’t have Parkinson’s! That demonstrated … something.

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“I use it, daily, for its only on-label use as an antidepressant,” SBF said in a portion of his prepared testimony dedicated to debunking claims.

All of this has prompted the reactions you’d expect, like jokes wishing SBF luck finding Emsam in prison. But none of these have helped explain what on earth Emsam is.

As it turns out, the Emsam patch has quite a bit in common with Bankman-Fried: Once hyped for its groundbreaking potential, it has been a flop. And though no one is accusing Emsam’s creators of fraud, when consumed with gorgonzola the drug is potentially lethal.

Truly. Let’s go there.

The Emsam patch contains something called Selegiline, which was originally used primarily to treat Parkinson’s. Eventually researchers figured out that it could also effectively treat depression, according to Dr. Dan Iosifescu, a psychiatry professor at NYU Grossman School of Medicine. The trouble with Selegiline is that it can also cause significant problems if the person taking it consumes certain foods or drugs. There is a perpetual risk of a “cheese reaction,” in which tyramine, a chemical present within moldy cheese and other fermented foods and beverages, interacts with the drug in a way that could potentially kill someone.

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“It’s real,” Iosifescu said of the cheese reaction, adding, “Those people can still eat fresh cheese or cottage cheese.” Some relieving news: If you deliver Selegiline through a patch you attach to your skin instead of a pill you swallow, you reduce the likelihood of the cheese reaction, he said.

Still another potential reason for excitement around the patch system, according to one journal paper in 2014, was that many depressed patients don’t take their pills. Perhaps some of them would prefer a patch. The paper said that it was “bewildering” that more doctors did not prescribe the patch or other similarly effective antidepressants in its particular drug category.

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Cost is another possible reason the patch has not become more common since its introduction in 2008. It’s expensive, said Dr. Sean Ziegler, a psychiatrist based in Washington state who comes up when you go searching for psychiatrists who accept Bitcoin. (Despite advertising this, no one has ever tried to pay him with cryptocurrency, Ziegler said.) It’s typically prescribed only after patients with certain types of depression have tried several safer, less expensive treatments for depression that have failed, he said.

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As to whether the Emsam was the juice fueling the growth of the FTX empire, it depends how you look at it. Many have suggested that patch was the magical stimulant that SBF alluded to in interviews and tweets. It’s not.

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“It has some energizing and antidepressant effects, but it’s not really giving people the immediate effect they would get with stimulants,” said Iosifescu.

For an additional assist, Bankman-Fried still relied on Adderall every four hours. At least, that’s what the New York Times reported that SBF’s lawyer said his client required for his attention deficit disorder in a hearing in the Bahamas on Tuesday. (Bail was denied.)

As to whether SBF could have gotten it together to build and destroy FTX without the patch, it’s impossible to say. Depression impedes many people’s ability to get stuff done. Others do fine. And regardless, it’s not clear how well the patch was working for him.

As SBF stated in one of the more poetic lines of his prepared testimony: “I am, and for most of my adult life have been, sad.”

State of Mind is a partnership of Slate and Arizona State University that offers a practical look at our mental health system—and how to make it better.

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