What you need to know about MAOIs (Monoamine Oxidase Inhibitors)

Has your doctor prescribed you a type of medication called an MAOI? Or have you heard about this medication somewhere and are curious to know exactly what it is? MAOIs are actually a type of medication that is given to treat mental health conditions like depression. However, doctors don't recommend them very often these days. There are several specific reasons for this. Let's talk about this from the beginning, very simply, in a way that you can understand.

What type of medication is an MAOI?

Simply put, MAOIs (Monoamine Oxidase Inhibitors) are the first class of drugs discovered to treat depression. However, you need to be very careful about what you eat when using them. Also, because of some side effects and problems with other medications, doctors often recommend them as a last resort, when other antidepressants don't work.

That means, if you've been given newer medications like SSRIs and your symptoms haven't improved, your doctor may consider an MAOI as the next step.

What are the main types of MAOIs used in the world?

There are several main types of MAOIs currently in use. Whether all of these are available in our country may vary, but it is good to be aware of these names.

• Isocarboxazid (Marplan®)
• Phenelzine (Nardil®)
• Selegiline (Emsam®)
• Tranylcypromine (Parnate®)

What conditions are MAOI medications prescribed for?

Although this medication is mainly prescribed for depression, it is also used for other mental health conditions.

Officially approved uses

These are cases where the relevant authorities have officially approved this medicine as suitable for these diseases.

• Major Depressive Disorder: Both Isocarboxazid and Tranylcypromine are approved for this condition.
• Treatment-resistant disorders: Phenelzine is used to treat depression, panic disorder, and social anxiety disorder that are not responsive to other treatments.
• Parkinson's Disease: Selegiline is a medication used to treat depression and is also used as an adjunct to other medications for Parkinson's disease.

"Off-label" uses

Sometimes, a doctor may prescribe this medication based on their medical knowledge and experience for a condition that is not officially approved. This is called "off-label" use. For example:

• A medication called tranylcypromine is sometimes prescribed for treatment-resistant social anxiety and panic disorder.
• There are times when the drug Selegiline is prescribed for attention deficit hyperactivity disorder (ADHD).

How does this medicine work inside the body?

This is very simple to understand. Imagine that our brains have chemicals that control things like our mood, happiness, and attention. We call these neurotransmitters . These are like little messengers that carry messages within the brain.

Now, our body has an enzyme called "Monoamine Oxidase." The job of this enzyme is to break down and remove those messengers (neurotransmitters) after they are used.

A person with depression may have low levels of these messengers in their brain. What an MAOI drug does is temporarily stop (inhibit) the action of that 'cleaning' enzyme. What happens then?

Several important neurotransmitters in the brain remain in the brain for longer without being broken down, which means their levels increase.

The main neurotransmitters increased by MAOIs are:

• Serotonin: Very important for mood, sleep, appetite, and social behavior.
• Norepinephrine: Important for alertness, focus, and activity.
• Dopamine: Related to pleasure, satisfaction, and attention.
• Tyramine: This is also a type of neurotransmitter. But its main function is to help control blood pressure. This is the main reason you need to be careful about what you eat when taking an MAOI. We'll talk about it in more detail in a bit.

What is the difference between MAOIs and SSRIs?

SSRIs (Selective Serotonin Reuptake Inhibitors) are another type of medication used to treat depression. You may have heard of names like Prozac and Sertraline. Although both are medications used to treat depression, they work differently.

• SSRI: These are like snipers. They only target the neurotransmitter serotonin . They only increase its levels.
• MAOIs: These are like a shotgun. They affect several neurotransmitters (serotonin, norepinephrine, dopamine) at once.

Because SSRI medications have relatively few side effects and there are no special rules regarding food and drink, doctors usually recommend SSRI medications first.

What are the common side effects of MAOIs?

Like all medications, this one can have side effects. But not everyone gets them. Some people may get one or two, and some may not experience any at all. If you have any new discomfort after starting this medication, talk to your doctor about it.

Serious risks associated with using MAOIs!

You should be especially aware of this part. MAOIs are a drug that should be used with great caution.

1. Increased suicidal thoughts

An increase in suicidal thoughts or behavior may occur, especially in young people under the age of 25, when this medication is first started or when the dosage is changed.

2. Serotonin Syndrome

This is a rare, but potentially life-threatening condition. It occurs when serotonin levels in the body become dangerously high. This risk is increased if you take an MAOI while taking other medications that increase serotonin levels (e.g., other antidepressants, some cough syrups, and painkillers).

Therefore, before you start taking an MAOI, you should tell your doctor about all medications you are currently taking (including vitamins and traditional medicines).

3. Antidepressant Discontinuation Syndrome

If you take an MAOI for more than 6 weeks and then stop it suddenly, you may experience withdrawal symptoms. This is not an addiction, but rather a way for the body to respond to the medication as it becomes accustomed to it.

Characteristics:

• Body aches, fatigue, and sweating, as if you have a fever
• Insomnia
• Nausea
• Dizziness
• Feeling like electricity is going through your body
• Anxiety, irritability

4. Dangerous reaction with food (Tyramine Reaction)

This is the most important and dangerous risk with MAOIs.

As we discussed earlier, MAOI medications block the enzyme that breaks down a chemical called tyramine. Tyramine is commonly found in some foods that we eat. In a person who is not taking the medication, the body easily breaks down and eliminates this tyramine.

But if someone taking an MAOI eats a food high in tyramine, the body cannot break it down. Then the level of tyramine in the blood rises dangerously, causing a sudden increase in blood pressure (Hypertensive Crisis) . This is very dangerous. In some rare cases, this can lead to a brain bleed and even death.

Foods to 'absolutely' avoid when taking MAOIs!

If you are taking an MAOI, you should completely avoid the foods on the list below. Talk to your doctor about this for more information.

Most importantly: Eat food as soon as it is cooked. Refrigerate leftovers and avoid reheating. As food ages, tyramine levels can increase.

How long does it take to feel the effects of the medicine?

It usually takes two to three weeks for the full effects of the medication to be felt. If you don't see any improvement in your symptoms during that time, talk to your doctor.

When should you call your doctor?

If you're taking an MAOI, you should see your doctor regularly to see if the medication is working and if you have any problems. In addition, be sure to talk to your doctor about these things:

• If the side effects bother you.
• If your symptoms do not improve or worsen.
• If you feel like you need to stop taking the medicine.