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Monoamine Oxidase Inhibitors (MAOIs) for Depression

Examples

Generic Name Brand Name
isocarboxazid Marplan
phenelzine sulfate Nardil
tranylcypromine sulfate Parnate
selegiline Emsam

Monoamine oxidase inhibitors (MAOIs) are older antidepressants (first-generation). They generally have more side effects than newer (second-generation) antidepressants such as serotonin reuptake inhibitors (SSRIs) and other second-generation antidepressants such as bupropion (Wellbutrin, Wellbutrin SR) and duloxetine (Cymbalta).

How It Works

These medicines balance certain brain chemicals called neurotransmitters by reducing the amount of monoamine oxidase, the substance that breaks down the neurotransmitters. This helps make the symptoms of depression better.

Why It Is Used

Monoamine oxidase inhibitors (MAOIs) are usually given to people who have depression and who:

  • Did not get better with other antidepressants.
  • Cannot tolerate the side effects of other antidepressants.
  • Have a family or personal history of successful treatment with MAOIs.
  • Have unusual symptoms of depression, such as weight gain and sleeping more.

MAOIs usually are not the first medicines given for depression, because they have serious side effects when combined with certain foods and/or medicines.

MAOIs are not recommended for children or teens.

How Well It Works

Current research suggests that MAOIs may work as well as other antidepressants in treating severe depression. They may work better than other antidepressants in those who have depression with uncommon symptoms, such as sleeping and eating too much and being overly sensitive to rejection.

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor right away if you have:

  • Hives.
  • Chest pains.
  • Fast or slow heartbeat.
  • Severe headache.
  • Stiff neck.
  • Nausea or vomiting.

Common side effects of this medicine include:

  • Dizziness or lightheadedness.
  • High blood pressure.
  • Appetite changes or weight gain.
  • Loss of sexual desire or ability.
  • Muscle twitching during sleep.

Serious reactions—or even death—can result when MAOIs are combined with some foods and medicines. While taking MAOIs, you must avoid eating certain foods, such as some cheeses, broad beans such as fava beans, pickled foods such as sauerkraut, beer, and red wine. Eating these foods can cause severe high blood pressure and other health problems. Talk with your doctor about diet and medicine restrictions you need to follow if you are planning to take an MAOI.

You must wait at least 14 days after you stop taking MAOIs before taking another antidepressant. Common nonprescription medicines, particularly certain cold remedies and diet pills, can also be dangerous when taken with an MAOI.

MAOIs can cause death if they are taken in overdose.

The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. Talk with your doctor about these possible side effects and the warning signs of suicide.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

Taking medicines for depression during pregnancy may increase the risk of birth defects. If you are pregnant, breast-feeding, or trying to get pregnant, talk to your doctor. Medicines may need to be continued if your depression is severe. Your doctor can help weigh the risks of treatment against the risk of harm to your pregnancy.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Credits

By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Lisa S. Weinstock, MD - Psychiatry
Last Revised January 11, 2013

Last Revised: January 11, 2013

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