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Medicine for Depression: MAOIs

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

Examples

Generic Name

Brand Name

isocarboxazid

Marplan®

phenelzine

Nardil®

tranylcypromine

Parnate®

selegiline

Emsam®

How they work

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

Why they are used

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

  • Didn't get better with other antidepressants

  • Can't 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 they work

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 healthcare provider. He or she may be able to lower your dose or change your medicine. Don't suddenly stop taking your medicine unless your healthcare provider tells you to.

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

  • Trouble breathing

  • Hives

  • Swelling of your face, lips, tongue, or throat

Call your healthcare provider right away if you have:

  • Chest pains

  • Fast or slow heartbeat

  • Severe headache

  • Stiff neck

  • Nausea or vomiting

  • Thoughts of suicide

Common side effects of these medicines include:

  • Dizziness or lightheadedness

  • High or low blood pressure

  • Appetite changes or weight gain

  • Loss of sexual desire or ability

  • Muscle twitching

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, and beer and red wine. Eating these foods can cause severe high blood pressure and other health problems. Talk with your healthcare provider 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. You must also wait at least 14 days (longer for some medicines like fluoxetine) after stopping another antidepressant before starting an MAOI. 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.

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.

Taking medicine

Medicine is one of the many tools your healthcare provider has to treat a health problem. Taking medicine as your healthcare provider 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.

Advice for women

Taking medicines for depression during pregnancy may increase the risk of birth defects. Untreated depression can also have a negative impact on your baby's health, so medicines may need to be continued if your depression is severe. If you are pregnant, breastfeeding, or trying to get pregnant, talk with your healthcare provider. He or she can help weigh the risks of treatment against the risk of untreated or undertreated depression.

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 healthcare provider 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. 

Do You Have Thoughts About Suicide?

If you or a loved one has thoughts about death or suicide, call 911 or the Veterans Crisis Line at 800-273-TALK (800-273-8255) and press 1, or use other emergency services. Or you can chat with a trained counselor online at www.VeteransCrisisLine.net.

Author: StayWell Custom Communications
Last Annual Review Date: 7/1/2018
Copyright © The StayWell Company, LLC. except where otherwise noted.
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