Whats an mao inhibitor

MAOIs for Bipolar Disorder: Types, Uses, Side Effects

Written by WebMD Editorial Contributors

What Are Monoamine Oxidase Inhibitors?

Monoamine oxidase inhibitors (MAOIs) are an extremely strong class of antidepressants that treat depression by preventing the breakdown of the brain chemicals serotonin, dopamine, and norepinephrine. This helps them do their work of regulating your mood.

These medications aren’t used often because there’s a risk they’ll change the way other drugs you’re taking work. This could lead to blood pressure issues and other problems. Also, an overdose of these drugs can be especially dangerous.

MAOIs approved by the FDA to treat bipolar depression include:

Isocarboxazid (Marplan)
Phenelzine (Nardil)
Selegiline (Emsam)
Tranylcypromine (Parnate)

Like other classes of antidepressants, MAOIs take several weeks to begin working. Your doctor may also prescribe a sedative to help relieve anxiety, agitation, or sleep problems while the antidepressant begins to work. You will also need to monitor what foods you eat to avoid side effects.

Selegiline (Emsam ), a newer MAOI, works by blocking monoamine oxidase B (MAOI-B). It gets into your body through a patch that you wear on your skin.

How MAOIs Work

Monoamine oxidase inhibitors (MAOIs) change the levels of the brain chemicals norepinephrine, serotonin and dopamine called neurotransmitters. Known as neurotransmitters, their job is to keep your mood stable. An enzyme called monoamine oxidase helps to remove them from your brain. MAOIs stop that enzyme from being able to work as it usually does, which leaves higher levels of neurotransmitters in your brain where they can work on cells that are affected by depression.

MAOI Side Effects

Common side effects of MAOIs may include:

Sleepiness, or trouble getting to sleep
Dizziness, lightheadedness, and fainting
Dry mouth, blurred vision, and appetite changes
High or low blood pressure
Changes in heart rate and rhythm
Muscle twitching or cramps, feelings of restlessness, or a pins-and-needles feeling in your skin
Weight gain
Stomach issues such as nausea, diarrhea or constipation
Skin irritation where patches are used
Loss of sex drive or ability, or having a hard time reaching orgasm
Headaches

MAOI Safety Concerns

These medications can cause other problems such as:

Food interactions. Eating certain smoked, fermented, or pickled foods or drinking certain beverages can cause severe, sudden high blood pressure in combination with MAOIs. People taking these antidepressants must follow a special diet that includes limiting certain cheeses, meats, and alcohol. In addition, some experts think that MAOIs may be especially likely to cause mood switches from depression to mania in people with bipolar disorder, and therefore, mood changes must be monitored closely.

Drug interactions. As with eating certain foods, taking certain medications can also cause dangerous and sudden high blood pressure when they are taken at the same time as MAOIs. This includes other antidepressants, pain medications, and cold and allergy medications. It’s important to tell your doctor or pharmacist about any medications you are taking, including herbal supplements, if you are prescribed an MAOI.
Serotonin syndrome. A rare side effect of MAOIs is having a dangerously high level of the neurotransmitter serotonin. This can happen when you take two medications that raise your serotonin levels at the same time (like other antidepressants, some pain medications, migraine treatments, or St. John’s wort). It’s rare, but it can be life-threatening. Seek immediate medical help if you experience symptoms of serotonin syndrome, like:
- Feeling agitated or restless
- A fast heartbeat or high blood pressure
- Diarrhea, nausea or vomiting
- Hallucinations (seeing things that are not real)
- Fever or a higher body temperature
- Loss of muscle control or coordination
- Abnormal eye movements
- Sweating
- Overactive reflexes
Suicide risk. The FDA requires all antidepressants, including MAOIs, to carry a warning that there’s a small risk they could make you more likely to attempt suicide. This risk is highest when you’ve just started taking MAOIs or the doctor recently changed your dosage.

The longer you’ve been taking an MAOI, the more likely you are to have these symptoms.

If you are pregnant

There’s little information on the safety of MAOIs during pregnancy. Talk to your doctor if you get pregnant while taking an MAOI or if you plan to become pregnant. Don’t stop taking any prescribed medication without letting your doctor know.

Stopping treatment

It’s important that you talk to your doctor before you decide to stop taking an MAOI. Stopping suddenly can cause withdrawal symptoms, which can be dangerous to your health, including:

Flu-like symptoms (sweating, chills, nausea)
Trouble sleeping
Agitation

Confusion
Psychosis

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Types, Side Effects, and More

Understanding MAO Inhibitors: Types, Side Effects, and More

Medically reviewed by Alan Carter, Pharm. D. — By Brian Krans — Updated on September 29, 2018

What are MAOIs?

Monoamine oxidase inhibitors (MAOIs) are a class of medication used to treat depression. They were introduced in the 1950s as the first drugs for depression. Today, they’re less popular than other depression medications, but some people benefit from their use.

Read on to learn more about MAOIs, including how they work, who they might help, and what foods to avoid while taking them.

MAOIs work with the chemicals in your brain called neurotransmitters that allow brain cells to communicate with each other. Depression is thought to be caused by low levels of the neurotransmitters dopamine, serotonin, and norepinephrine, which collectively are called monoamines. A chemical found naturally in the body, monoamine oxidase, removes these neurotransmitters.

By inhibiting monoamine oxidase, MAOIs allow more of these neurotransmitters to remain in the brain, thus elevating mood through improved brain cell communication.

Monoamine oxidase is a type of enzyme that helps neurons fire throughout your body. It’s formed in your liver and cleans up neurotransmitters in your brain once they’ve done their jobs.

Besides neurotransmitters, monoamine oxidase cleans out tyramine, a chemical that helps regulate blood pressure. Because MAOIs inhibit monoamine oxidase from doing its job, they adversely affect blood pressure in addition to keeping neurotransmitters at optimal levels. People taking MAOIs have to pay special attention to their blood pressure, including avoiding certain foods.

One downside to MAOIs is that they come with dietary restrictions because of the elevated tyramine levels in the blood.

When this class of drug first entered the market, no one knew about the concerns over tyramine and blood pressure. This caused a wave of deaths that prompted further research. Now we know that certain foods contain excess tyramine, and these should be avoided when taking MAOIs.

The more food ages, the more concentrated the levels of tyramine become. This is true for aged meats, cheeses, and even leftovers in your fridge. Foods with dangerously high levels of tyramine include:

soy sauce and other fermented soy products
sauerkraut
salami and other aged or cured meats

Other foods that contain high levels of tyramine are:

aged cheeses, such as Brie, cheddar, Gouda, Parmesan, Swiss, and blue cheese
alcohol, especially chianti, vermouth, and beers
fava beans
raisins, dates, and other dried fruits
tofu
all nuts

Get more information about tyramine-free diets.

Besides blood pressure problems, people taking MAOIs should also beware of a condition called serotonin syndrome. Symptoms can include:

confusion
fever
irregular or rapid heartbeat
dilated pupils
occasional unconsciousness

The condition can manifest if a person on MAOIs takes other antidepressants or the herbal supplement St. John’s wort.

To avoid serotonin syndrome, people taking MAOIs shouldn’t take anything for two weeks when ending MAOI treatment and starting another.

These days, MAOIs are rarely the first choice of prescription medication to treat depression. However, the U.S. Food and Drug Administration (FDA) — the regulating agency of all prescription medication — has approved the following MAOIs:

isocarboxazid (Marplan): can take three to six weeks to fully take effect
phenelzine (Nardil): can take up to four weeks to fully work
tranylcypromine (Parnate): can take up to 3 weeks to achieve its desired effects

Selegiline

Selegiline (Emsam, Atapryl, Carbex, Eldepryl, Zelapar) is a newer type of MAOI. It works by selectively blocking monoamine oxidase B (MAO-B). This reduces the breakdown of dopamine and phenethylamine and means there are no dietary restrictions. It’s available in patch form. Learn about other medications used to treat depression.

Aside from depression, selegiline is also prescribed for early onset Parkinson’s disease and dementia.

MAOIs carry more side effects than other antidepressants, which is why they’re often the last drug prescribed to treat depression. Some side effects of MAOIs include:

fatigue
muscle aches
nervousness
insomnia
reduced libido
erectile dysfunction (ED)
dizziness
lightheadedness
diarrhea
dry mouth
high blood pressure
tingling of the skin
difficulty urinating
weight gain

The FDA requires a warning on antidepressants that they may increase the risk of suicide in children and young adults. While MAOIs are rarely prescribed for children, all people beginning any kind of antidepressant therapy should be watched for changes in mood, mindset, or attitude. Successful antidepressant treatments should lower suicide risk by increasing mood.

However, you should consult your doctor before you stop taking MAOIs or any other prescribed medication.

MAOIs are only one type of medication used to treat depression. Like most antidepressants, they may not be right for everyone and take weeks of use to reach their full effect. However, when used in combination with other therapies and lifestyle changes, they can be highly effective at combating depression symptoms. Talk to your doctor for more information to see if MAOI therapy suits your lifestyle.

Last medically reviewed on September 5, 2017

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Depression: FDA-approved medications may help. (2017).
fda.gov/ForConsumers/ConsumerUpdates/ucm095980.htm
Drug approval package: Marplan/isocarboxazid 10 mg tablets. (2005).
accessdata.fda.gov/drugsatfda_docs/nda/98/11961-s017.cfm
Safety concerns with MAOIs. (2016).
mayoclinic.org/diseases-conditions/depression/in-depth/maois/art-20043992?pg=2

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Medically reviewed by Alan Carter, Pharm.D. — By Brian Krans — Updated on September 29, 2018

Monoamine oxidase inhibitors

A special group are drugs for the treatment of depression, the therapeutic effect of which is associated with inhibition of the activity of the mitochondrial enzyme monoamine oxidase, accompanied by a decrease in the breakdown of catecholamines, as well as indole amines. Most monoamine oxidase inhibitors (MAOIs) act indiscriminately and therefore increase the level of not only catecholamines and serotonin, but also dopamine.

Monoamine oxidase inhibitors (iproniazid), as well as tricyclic antidepressants, appeared in the 1950s, in the process of finding drugs needed to treat tuberculosis.

There are conflicting opinions about the effectiveness of these antidepressants. In some cases, they are effective in depressions resistant to other antidepressants, with increased appetite, drowsiness, and an atypical course of depression.

The effect of MAOIs on arterial arterial pressure is unpredictable, since these drugs increase the level of norepinephrine and adrenaline in the blood, then blood pressure numbers increase. At the same time, MAOIs inhibit vasomotor centers and thereby reduce sympathetic activity (Anthony P., et al., 2002). The first signs of an increase in blood pressure may be pain in the occipital region, heaviness in the region of the heart, a tense pulse, and fainting.

In order to prevent a sharp increase in blood pressure while taking these drugs, certain medications (desensitizing agents, anesthetics and painkillers), as well as foods containing tyramine (cheese, pizza, sour cream, smoked beef, sauerkraut) should be excluded , legumes, avocados, yeast products, soy sauce, etc.), drinks (champagne, beer, whiskey, coffee, chocolate). Normally, tyramine is destroyed by MAOI even before absorption, while under conditions of inhibition of monoamine oxidase activity, tyramine contained in food is absorbed. In the future, it is captured by adrenergic neurons, participates in synthetic processes and turns into a "false mediator" - octopamine, which in turn leads to a massive release of norepinephrine and can cause a hypertensive crisis (Anthony P. , et al., 2002). MAOI preparations are metabolized in the liver and, if this organ is diseased, can cause its toxic damage.

According to L. Elkin et al. (1989), non-selective MAO inhibitors are secondary in the treatment of depression and are used only for simple and mild depression and when other, safer methods of treatment do not help. These are old, currently rarely used inhibitors - phenelzine (Nardil), isocarboxazid (Marplan), tranylcypromine (Parnate).

Combining MAO inhibitors with TCAs has been shown to be effective in depression refractory to the latter drugs (Pande A., et al., 1991). Non-selective MAO inhibitors can also be effective in atypical depressions (hyperphagia, hypersomnia, anxiety and phobias) (Puzhinskiy S., 2000). It is believed that MAOIs are more effective than TCAs in the treatment of atypical depression.

The half-life of MAOIs is approximately 2.5 hours, the maximum binding of MAOIs (maximum effectiveness) is observed 14 hours after the absorption of MAOIs, however, the antidepressant effect of these drugs does not appear until 4 weeks after the start of therapy.

Modern selective monoamine oxidase inhibitors that inhibit the activity of an isolated isoenzyme A or B include: selective monoamine oxidase inhibitors of type A - pyrazidol, moclobemide, selective monoamine oxidase inhibitors of type B - selegiline (used in the early stages of Parkinson's disease).

Pyrazidol

Pyrazidol is a domestic antidepressant of balanced action, it selectively inhibits type A MAO (short-term and completely reversible). The thymoanaleptic effect is manifested in the relief of depressive symptoms, primarily vital anguish, mental anesthesia and psychomotor retardation.

This drug normalizes the metabolism of monoamine neurotransmitters, blocks the deamination of serotonin, to a lesser extent - norepinephrine, and to a small extent - tyramine, partially inhibits the reuptake of monoamines. It exhibits nootropic properties and improves cognitive functions. It should be borne in mind that pyrazidol is mainly used for mild depression or its moderate forms, including neurotic and masked depressions, and may be ineffective in severe depression accompanied by manifestations of agitation (up to 50% of patients with deep depressions of the melancholic type give a positive response to therapy). pyrazidol). The drug is also used for Alzheimer's disease, "organic" depression, alcohol withdrawal syndrome. Pyrazidol is also used in the treatment of psychosomatic disorders, with astheno-depressive symptoms that have developed against the background of myocardial infarction and cerebral atherosclerosis (the drug goes well with other medicines). The drug has a normalizing effect on the lungs with manifestations of hypoxia.

The therapeutic effect after taking pyrazidol appears after 3-5 days after the start of therapy. The optimal daily dose of the drug is 15-300 mg. (begin treatment with 50-75 mg in two divided doses). With a dosage of the drug over 200 mg. its sedative effect begins to dominate, and more than 400 mg. the drug may have an effect on severe endogenous depression.

The balance of action of pyrazidol is characterized by a combination of an antidepressant effect with an activating effect in adynamia and apathy and a sedative effect in an agitated state. As a result of the foregoing, the drug is effective in mixed, atypical depressions.

In the process of treatment, such comorbid depression symptoms as: manifestations of senesto-hypochondria, obsessive-compulsive states, signs of depersonalization also disappear.

Side effects of pyrazidol are mild and limited to dry mouth, sweating, weakness, tachycardia. More rarely, allergic reactions and dizziness occur. Unlike TCAs, the drug does not have an anticholinergic effect. Contraindications to the appointment of the drug are acute hepatitis and blood diseases.

Moclobemide

The psychotropic profile of a reversible selective MAO inhibitor type A (MAO-A selectively destroys serotonin, norepinephrine and dopamine) - moclobemide approaches the TCAs that have a disinhibitory effect (imipramine, desipramine). Indications for the use of moclobemide are depressive states with a predominance of apathy, lethargy, anergy (Fitton A., et al. 1992).

Moclobemide is given at a dose of 300-450 mg. inside once a day after meals. If there is no effect, increase the dosage by 150 mg. per day, at intervals of 2-3 weeks (maximum daily dose - 600 mg twice a day).

Despite the fact that moclobemide inhibits MAO-A, within therapeutic doses, its interaction with sympathomimetics and tyramine-containing products is unlikely, since the main pathway of tyramine metabolism is via monoamine oxidase type B (MAO-B). After the abolition of this antidepressant, MAO-A activity is relatively quickly restored (24-48 hours).

Placebo-controlled studies have shown that moclobemide has a therapeutic effect in major depression and dysthymia. J. Angst, M. Stabl (1992) and J. Angst, F. Jhonson (1994) indicate that moclobemide can be used to treat severe depression.

Due to its low toxicity and good tolerance, moclobemide is the drug of choice in the clinic of depression in the elderly. Moclobemide does not interact with alcohol.

Numerous researchers point to the good tolerability of moclobemide, due in particular to the absence of peripheral and central anticholinergic effects (Fitton A. , et al., 1992; Baldwin D., Rudge S., 1994; Pujynski S., Rybakowski J., 1995).

The most common side effects of moclobemide include: dry mucous membranes (especially the oral cavity), dizziness, headaches, drowsiness, nausea, insomnia. Less common are constipation, discomfort in the stomach. Very rarely there are muscle twitches, visual impairment. With a bipolar course of the disease, a change from a depressive phase to a manic phase is possible (Mashkovsky M.D., 1997).

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What you should know about MAO inhibitors - Psychotherapy Articles - Articles

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04/13/12

MAO inhibitors are used to treat depression, some anxiety disorders, and other illnesses.

Precautions

Tell your doctor if you are allergic to any drugs, if you are pregnant, intending to become pregnant or if you are breastfeeding before taking these medicines.

While taking MAO inhibitors, it is generally best for you to check with your doctor before taking any other medicine, whether or not prescribed by other doctors. Make sure all your doctors, including dentists, know about all the medicines you take.

Possible side effects

Many patients do not experience any side effects while taking MAO inhibitors. In some cases, patients experience mild and transient side effects. Usually these include dizziness, feeling of lightheadedness, especially when getting up from a lying or sitting position (you should get up slowly), drowsiness, gastrointestinal disturbances, decreased appetite, muscle twitching, sexual dysfunction. Tell your doctor if side effects become bothersome. Your dosage or treatment regimen may be changed to reduce side effects.

You should also tell your doctor about side effects such as dark urine, diarrhea, severe dizziness, skin rash, swelling of the feet, legs, unusual nervousness, jaundice of the eyes or skin.

Stop taking this medicine and seek emergency care immediately if you experience any of the following side effects: severe chest pain, dilated pupils, severe headache, increased eye sensitivity to light, nausea and vomiting, stiffness or tenderness in the neck, unusually rapid or slow heartbeat, drastically increased sweating.

Be patient if the remedy doesn't work right away. In some cases, at least four weeks must pass before a drug from the group of MAO inhibitors will give an effect. Carefully follow the instructions of your doctor, do not stop taking medication without his advice. Your patience may be rewarded with improved well-being.

Foods, drinks and drugs to avoid while taking MAO inhibitors.

The following foods, drinks, and drugs are not recommended while taking MAO inhibitors and for two weeks after stopping them.

Drinks

Beer, red wine, other alcoholic drinks

Miscellaneous

soy sauce
Excessive amount of chocolate or caffeine
non -impedial or long -stored fisheries (meat, milk, milk, milk, milk, milk, milk, milk.
Learn more
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