I’m Not Taking That!: Why You Shouldn’t Write Off MAOIs

Monoamine oxidase inhibitors (MAOIs) were among the first antidepressants created, along with Tricyclics (TCAs). Even though they are still regarded as highly effective, they are traditionally regarded as a “last resort” medications, as new “safer” antidepressants (namely SSRIs) have been on the market. MAOIs require careful dietary restrictions that require one to limit foods that contain high levels of tyramine, such as many cheeses, pickled foods, certain meats, beer and wine, as the interaction between MAOIs and these foods/drinks can cause a dangerous and even fatal spike in blood pressure known as a hypertensive crisis. Additionally, MAOIs can cause baneful peaks in serotonin levels, causing Serotonin syndrome. The hallmark signs of this include acute confusion, rapid or irregular heartbeat, dilated pupils, fever, and even unconsciousness. Immediate medical attention must be sought for those thought to be experiencing such. But out of all of the people using MAOIs, few fall victim to these risks, and many consider this type of medication to literally be a lifesaver.

MAOIs, often referred to as "the last resort" with regard to antidepressant medications may in fact be the one that helps save your life. (Though you must follow the dietary restrictions in order to remain safe!)

How Do MAOIs Work?

MAOIs ease symptoms of depression by affecting neurotransmitters used to communicate between cells in the brain. According to the Mayo Clinic, the enzyme monoamine oxidase is involved in removing the neurotransmitters norepinephrine ( influences sleep and alertness), serotonin (affects anxiety, mood, sleep, appetite and sexuality), and dopamine (influences body movement and is also believed to be involved in motivation, reward, reinforcement and addictive behaviors) from the brain [...] which MAOIs prevent from happening, thereby increasing the availability of these brain chemicals, and bolstering brain cell communication. The FDA has approved several MAOIs for use; the most commonly prescribed medications in this class are Emsam (Transdermal Selegiline), Marplan (Isocarboxazid), Nardil (Phenelzine), and Parnate (Tranylcypromine).

What Are The Most Common Side Effects?

  • Daytime drowsiness
  • Dizziness or lightheadedness
  • Low blood pressure (hypotension)
  • Dry mouth
  • Insomnia
  • Weight gain or weight loss (the latter is most typical of Parnate)
  • Difficultly urinating
  • Muscle aches

Despite the inherent risks, it is important to remember that all medications, antidepressants or not, carry potentially extremely side effects. These ADs are exceedingly effective at ameliorating depression, but must be used with care, as should any medication. A certain level of demystification is critical, as MAOIs have been given a bad name over the years when, in fact, many suffer worse side effects on SSRIs and SNRIs. But it’s true: one has to be very disciplined and careful. And then recovery may indeed be right around the corner.

If one truly needs picked herring that much, he or she is probably not depressed enough to be on an MAOI in the first place. This class of medication has saved countless lives, and does not deserve to be relegated to the shadows. If one requires it (and I speak from personal experience), it may be life changing in a demonstratively positive manner. Just be careful, as one would with anything. You may find an MAOI is exactly what you need to become well again!

Search for the positive and be patient as much as you can manage.

And don’t give up.