What you need to know about MAOI medications for depression (Monoamine Oxidase Inhibitors)

If you or someone close to you suffers from depression, or as we all know it, depression, you have probably heard about the medications that are prescribed for it. Today we are going to talk about one such, somewhat old, but very powerful class of drugs called Monoamine Oxidase Inhibitors , or MAOIs for short. Although these drugs are not commonly used anymore, doctors still recommend them in some special cases. So it is very important to know exactly what they are.

Simply put, what is this MAOI?

MAOIs are a class of drugs used to treat depression. There are special chemical messengers in the brain that control our mood, that is, keep us happy and relaxed. We call these neurotransmitters. You may have heard of names like serotonin, dopamine, and norepinephrine . These are those messengers.

Now, in our brains, we have an enzyme called Monoamine Oxidase. It's like a brain cleaner, this enzyme removes those messengers. In someone with depression, the levels of these messengers in the brain can be low.

So what MAOI drugs do is they stop the work of that cleaning enzyme. Then those happy messengers ( neurotransmitters ) stay in the brain longer and do their job properly. This is what gradually reduces the symptoms of depression.

Some other medications that belong to this category are:

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

Like other antidepressants , this MAOI medication takes a few weeks to work. During that time, your doctor may prescribe other medications to help control your anxiety and insomnia.

What are the common side effects of MAOIs?

Like any medicine, these can have some side effects. But not everyone gets all of them. Some people may get one or two, and some may not get anything at all. So don't be afraid to see these. Talk to your doctor about this.

Things to be aware of when using MAOIs

This is the most important part. Some things can cause dangerous side effects when combined with this medication. So it's very important for you and your family to be aware of this.

1. Problems with food (Food Interactions)

If you eat certain foods while taking an MAOI, your blood pressure can suddenly and dangerously increase. This is called a 'Hypertensive Crisis'. This is a medical emergency. Therefore, a person taking this medication must follow a special diet .

Foods that should not be eaten:

• Aged cheeses: Aged, fermented cheeses like cheddar, blue cheese, and mozzarella.
• Fermented meats: things like salami, sausage, ham.
• Smoked or dried: Smoked fish, salmon, dried fish, sardines.
• Some alcohol: red wine, some beers.
• Soy products: soy sauce, tofu.
• Ripe fruits like bananas and avocados (when fully ripe).

This list is not complete. When you are prescribed this medication, your doctor and nutritionist will give you a complete list of foods to avoid . Follow it exactly.

2. Problems with other medications (Drug Interactions)

Just like food, some medications can be dangerous when taken with MAOIs. This can cause a sudden increase in blood pressure.

In particular, other antidepressants, painkillers, and allergy medications can interact with this.

3. Serotonin Syndrome

This is a rare but serious, potentially life-threatening condition. It occurs when serotonin levels in the brain become dangerously high. This risk increases if you take an MAOI with another drug that increases serotonin levels (another antidepressant, a migraine medicine, or some painkillers).

Symptoms of serotonin syndrome:

• Feeling very restless and anxious
• Increased heart rate, increased blood pressure
• Diarrhea, nausea, vomiting
• Seeing or hearing things that are not there (Hallucinations)
• Fever, excessive sweating
• Inability to control appetite, body tremors

If you experience any of these symptoms, go to a hospital's Emergency Treatment Unit (ETU) immediately. If necessary, you can also call the National Poisons Information Centre at the Colombo National Hospital for advice.

4. Suicidal thoughts

The FDA has issued a warning for all antidepressants. That is, there is a very small risk of suicidal thoughts when you first start taking these medications or when the dosage is changed. This risk is especially high among young people. If you or someone you love has such thoughts, tell your doctor without delay.

Stopping medication and pregnancy

Stopping treatment

Stopping MAOI medication suddenly is very dangerous. Doing so can cause withdrawal symptoms.

• Symptoms of a cold or flu, such as fever, body aches, and sweating
• Insomnia
• Restlessness
• Confusion
• Psychosis

Therefore, if you feel like you need to stop taking the medication, talk to your doctor first. He or she will be able to advise you on a method for gradually reducing the dosage and discontinuing the medication without harming your health.

During pregnancy

There is very little information about the safety of MAOIs during pregnancy. If you become pregnant while taking this medication, or if you are planning to become pregnant, tell your doctor right away. Never stop taking the medication without first talking to your doctor.

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