Examples

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

How It Works

These medicines balance certain brain chemicals (neurotransmitters). When these brain chemicals are in proper balance, the symptoms of anxiety are reduced. Monoamine oxidase inhibitors do this by reducing the amount of monoamine oxidase, the substance that breaks down the neurotransmitters.

Why It Is Used

Monoamine oxidase inhibitors (MAOIs) usually are not the first medicines given for anxiety, because they have serious side effects when combined with certain foods and/or medicines. They are usually given to people who have anxiety 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 depression or anxiety symptoms.

When these drugs are not recommended

MAOIs are not recommended for children or teens.

How Well It Works

MAOIs may not be the first medicines given for anxiety, because the side effects can be severe. But MAOIs are the treatment of choice in cases of anxiety or depression with unusual features, such as a heavy feeling in the arms and legs, sensitivity to rejection, and a reactive mood. MAOIs are often used as an alternative treatment for anxiety or depression that has not responded to other medicines.

Side Effects

Side effects of MAOIs include:

• Difficulty getting to sleep.
• Dizziness, lightheadedness, and fainting.
• Dry mouth, blurred vision, and appetite changes.
• High blood pressure and 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

People who are taking MAOIs need to avoid eating certain foods, such as some cheeses, broad beans like fava beans, pickled foods like sauerkraut, and red wine. Eating these foods can cause dangerously high blood pressure.

People who take MAOIs also need to avoid some nonprescription medicines, particularly certain cold remedies and diet pills.

People who stop taking MAOIs need to wait at least 14 days before taking another antidepressant.

MAOIs can cause death if they are combined with certain foods, taken with certain medicines, or taken as an overdose. Talk with your doctor about diet and medicine restrictions you need to follow if you are planning to take an MAOI.

MAOIs are not recommended for children or teens.

Taking medicines for social anxiety disorder during pregnancy may increase the risk of birth defects. If you are pregnant or thinking of becoming pregnant, talk to your doctor. You may need to take medicine if your social anxiety disorder is severe. Your doctor can help you weigh the risks of treatment against the risk of harm to your pregnancy.

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