Monoamine oxidase inhibitors (MAOIs) for depression


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 with depression 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

Side effects of monoamine oxidase inhibitors include:

  • Difficulty getting to sleep.
  • Dizziness, lightheadedness, and fainting.
  • Dry mouth.
  • Blurred vision.
  • Appetite changes.
  • High blood pressure.
  • Changes in heart rate and rhythm.
  • Muscle twitching and feelings of restlessness.
  • Loss of sexual desire or ability.
  • Weight gain.
  • Negative interactions with other medicines and some foods.

FDA Advisory. The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.

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

What To Think About

Antidepressant medicines work in different ways. No antidepressant works better than another, but different ones work better or worse for different people. The side effects of antidepressant medicines are different and may lead you to chose one instead of another. Tell your doctor about side effects.

You may have to try different medicines or take more than one to help your symptoms. Most people find a medicine that works within a few tries. Other people take longer to find the right one and may need to take the antidepressant and another type of medicine.

Take your antidepressant as your doctor says. Don't quit taking your medicines without talking to your doctor. If you quit suddenly, it can cause dizziness, anxiety, fatigue, and headache. If you and your doctor decide you can quit using medicine, gradually reduce the dose over several weeks.

You must avoid eating certain foods while taking these drugs. Foods to avoid include some cheeses, broad beans like fava beans, pickled foods like sauerkraut, and beer and red wine. These foods and drinks can cause severe high blood pressure or death when combined with MAOIs.

There are some drugs that you must not use along with MAOIs because serious, sometimes fatal, reactions can occur. You will need to wait several weeks after you stop MAOI treatment before you can begin taking certain other drugs. Talk to your doctor about these drugs.

You must avoid some nonprescription medicines, particularly certain cold remedies and diet pills.

You must wait at least 14 days after you stop taking MAOIs before taking another antidepressant.

Talk with your doctor about foods and medicines you should avoid if you are planning to take an MAOI.

Taking medicines for depression during pregnancy may make birth defects more likely. If you are pregnant or thinking of becoming 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.

These medicines must be used very carefully in those with bipolar disorder because they may trigger a manic episode. If you have bipolar disorder, your doctor may prescribe them, along with a mood stabilizer.

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Last Updated: March 13, 2009

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