Antidepressants: The Need-to-Know Series (Part 2)

Your physician has recommended an antidepressant. Well that’s just great. Unfortunately, you know nothing about them. All you know is you’re miserable. What to do? chipur can help!

We began a series yesterday on antidepressants, opening with a bit of history. We moved-on to discuss the tricyclic and tetracyclic antidepressants. Here’s a link to yesterdays piece.

Today we’re going to review the monoamine oxidase inhibitors (MAOIs). And we just might learn a few more things along the way.

Monoamine Oxidase Inhibitors (MAOIs)

The MAOIs are an older class of antidepressants. Some of the better known MAOIs are isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), moclobemide (Aurorix), and selegiline (Emsam).

What the Heck is a Monoamine Oxidase?

First the monoamine part. In yesterday’s piece we established that neurotransmitters facilitate the jump of electricity from one neuron (nerve cell) to another – allowing them to communicate. Well, neurotransmitters are categorized. And the neurotransmitters serotonin, dopamine, norepinephrine, and epinephrine are known as monoamines.

Monoamine oxidases (MAOs) are a family of enzymes that induce the oxidation of monoamines (well that makes sense). And any sort of monoamine oxidase imbalance can cause emotional and/or mental issues.

How Do MAOIs Work?

The monoamine oxidase inhibitors, indeed, inhibit monoamine oxidase. This prevents the breakdown of the monoamine neurotransmitters, increasing their availability. Does that make sense?

Now, it’s vitally important to understand that the MAOIs have significant dietary restrictions. In fact, ignoring these restrictions can be fatal.

When foods with tyramine are ingested, a hypertensive crisis may result. When foods containing tryptophan are consumed, something known as hyperserotonemia (excessive serotonin levels) may occur.

More on this, as well as drug interaction issues, downstairs.

Why Would I Take an MAOI?

The primary reason one would take an MAOI would be to address treatment resistant depression. MAOIs are typically used as a last resort because of the dietary restrictions and drug interaction issues we just discussed.

That said, there’s a fairly new MAOI administered via skin patch,  selegiline (Emsam), that decreases the dangers of dietary interactions. That’s accomplished by the drug being absorbed through the skin; thereby sidestepping the gastrointestinal system.

Moclobemide (Aurorix) is also considered to be safer than the earlier MAOIs; however, it may not work as well.

MAOIs are also used to treat the anxiety disorders, Parkinson’s Disease, and migraine headache.

Any Side Effects?

MAOI side effects include – daytime sleepiness, low blood pressure, dry mouth, diarrhea, edginess, weight gain, reduced sexual desire or difficulty reaching orgasm, and erectile dysfunction.

Any Other Concerns?

Let’s reference the dietary restrictions we discussed earlier. Common foods containing high amounts of tyramine include cheeses, alcoholic beverages, herbal extracts, eggplant, figs, grapes, oranges, pineapples, plums, prunes, raisins, aged meats, fish, poultry, and soy products.

Common foods high in tryptophan include – chocolate, oats, dried dates, milk, yogurt, cottage cheese, red meat, eggs, fish, poultry, sunflower seeds, and peanuts.

Finally, there’s the matter of interaction issues with prescription, over-the-counter, and recreational drugs; as well as supplements. The list is longer than both of my arms, so how ’bout we leave it at this. If you’re using a MAOI, touch-base with your physician before taking any drug or supplement.

Oh, as with any antidepressant, sudden cessation isn’t such a hot idea. Believe me, you won’t like the outcome. Here’s a link to an article I wrote on antidepressant discontinuation syndrome.

Alrighty, then – that’s a wrap on Part 2 of the series. Come on back tomorrow and we’ll tie a bow on the series, as we discuss the selective serotonin reuptake inhibitors (SSRIs), the selective serotonin norepinephrine reuptake inhibitors (SSNRIs), and a few more.

Here’s a link to the FDAs Information for Consumers website. You may find it helpful.

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