Aren't you happy? Are you tired of everything? We call this condition depression. So, there are different types of medications that are given to treat this mental condition called depression. Today we are going to talk about a group of medications that are a little older and that you need to be very careful with when using. These are called MAOIs, which stands for Monoamine Oxidase Inhibitors. Although this name may seem a little complicated, let's talk about it simply.
What exactly are these MAOIs?
Simply put, MAOIs are a type of medication that helps control symptoms of depression. These are the first antidepressants discovered in the world . However, doctors do not prescribe this medication easily these days. The reason for this is that you have to be very careful about what you eat and drink when taking these medications, and you also have to pay close attention to certain side effects and safety.
Usually, doctors only prescribe MAOIs as a last resort when other newer antidepressants (such as SSRIs) have failed to improve symptoms.
What medicines belong to this category?
Here are some of the types of MAOIs used in the world:
- Isocarboxazid (Marplan®)
- Phenelzine (Nardil®)
- Selegiline (Emsam®)
- Tranylcypromine (Parnate®)
These names may be unfamiliar to you, as they are not commonly used in our country. But it's good to know.
What conditions are treated with MAOIs?
These medications have been approved for various diseases.
| Type of medicine | Mainly used medical conditions |
|---|---|
| Isocarboxazid and Tranylcypromine | Major Depressive Disorder |
| Phenelzine | Treatment-resistant depression, panic disorder, and social anxiety disorder |
| Selegiline | As an adjunctive treatment for major depressive disorder and Parkinson's disease. |
What is "off-label" use?
Sometimes, doctors use a drug for a condition for which it is not officially approved. This is called "off-label" use. It is only done if the doctor's experience and knowledge suggest that it will benefit the patient. For example, Selegiline is sometimes prescribed for ADHD, and Tranylcypromine is sometimes prescribed for social anxiety.
How does this medicine work?
This is very easy to understand. Imagine that there are little messengers inside our brains. We call them neurotransmitters . Serotonin, Norepinephrine, and Dopamine are the main messengers that control things like happiness, sleep, and memory in our minds.
Now, there's another enzyme in our brain called monoamine oxidase . The job of this enzyme is to "clean up" those messengers. That is, to break them down and reduce their levels.
What an MAOI does is it stops the enzyme that cleans up (Monoamine Oxidase) from working. What happens then? Those happy messengers (like serotonin and dopamine) accumulate in the brain instead of being broken down. Their levels increase. Then our mood improves and the symptoms of depression decrease.
Meanwhile, there is also a chemical called Tyramine . It helps control blood pressure in our body. MAOI drugs also stop the breakdown of this Tyramine. This is the biggest risk that comes with these drugs . We will talk about it later.
What are the side effects and risks of MAOIs?
There are several possible side effects and serious risks associated with using these medications. Therefore, it is very dangerous to use them without medical advice .
Common side effects
- Dizziness or lightheadedness (due to low blood pressure)
- Dry mouth (xerostomia)
- Nausea
- Bloating or constipation
- Drowsiness
- Insomnia
Serious risks and complications
1. Serotonin Syndrome
This is the most serious and potentially life-threatening condition. It occurs when serotonin levels in the body become too high. This risk is even greater if you take MAOIs with other medications that increase serotonin levels (e.g., SSRIs, some painkillers). That's why it's important to tell your doctor about all the medications you're taking, even vitamins.
| Symptoms of serotonin syndrome | |
|---|---|
| General characteristics | Restlessness, nausea, vomiting, stomach upset, eye twitching , sweating , tremors, muscle twitching. |
| Severe symptoms (requiring immediate hospitalization) | Confusion, tachycardia, high blood pressure, fever, seizures, loss of consciousness. |
If you experience any of these severe symptoms, go to the nearest hospital's Emergency Department (ETU) immediately . Delaying treatment can be life-threatening.
2. Problems with food (Tyramine interaction)
This is the biggest practical problem with MAOIs. As we mentioned earlier, MAOIs stop the breakdown of a chemical called tyramine, which is naturally found in some foods.
If you eat foods high in tyramine while taking an MAOI, the level of tyramine in your blood can become dangerously high. This can cause a sudden and severe increase in blood pressure . This is called a "Tyramine Pressor Response." In rare cases, this high blood pressure can cause bleeding in the brain (cerebral hemorrhage) and even death.
What foods should you avoid when taking MAOIs?
Below is a list of foods that should definitely be avoided by someone taking this medication, due to their high levels of tyramine.
| Food type | Description and examples |
|---|---|
| Aged Cheese | Cheeses like Cheddar, Swiss, and Parmesan (newer cheeses like Cottage cheese and Mozzarella are less risky). |
| Soy Sauce | All products made from soy. |
| Fermented or preserved meat/fish | Sausages, salami, dried fish, and other items. |
| Liver | Although new liver does not contain tyramine, tyramine levels may increase because it deteriorates quickly. |
| Very ripe fruit | When fruits like bananas, avocados, and figs are fully ripe. |
| Fermented beer | Especially tap beer. |
The most important thing: As food ages, its tyramine levels increase. Therefore, a person taking this medication should always avoid eating leftovers and eat freshly cooked food .
3. Antidepressant Discontinuation Syndrome
This condition can occur if you stop taking this medicine suddenly after taking it for more than 6 weeks. Symptoms such as fever, body aches, headache, dizziness, insomnia, and restlessness may occur. Therefore, never stop taking this medicine without consulting your doctor . If you stop taking the medicine, you should do so gradually over a period of several weeks and only under the supervision of your doctor.
4. Suicidal thoughts
There is a small risk of increased suicidal thoughts when young people under 25 years of age first start taking this medicine. If you or your child have these thoughts, talk to the doctor who prescribed the medicine right away.
When should you see a doctor?
If you are taking an MAOI, you should see your doctor regularly to check if the medication is working and if there are any problems. In addition, talk to your doctor about these things as well.
- If you experience side effects that you cannot tolerate.
- If your symptoms do not improve, or if they worsen.
- If you feel like you need to stop taking the medicine.
Take-Home Message
- MAOIs are a very powerful and dangerous old class of antidepressants that are not commonly used today.
- If you are taking this medication, diet control is mandatory . Foods high in tyramine should be completely avoided.
- It is very important to inform your doctor about any other medications you are taking, otherwise you may develop dangerous serotonin syndrome.
- Do not start or stop taking this medication without medical advice for any reason.
- If you develop severe symptoms of serotonin syndrome or suicidal thoughts, go to a hospital emergency room (ETU) immediately.
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