MAOIs How They Work
Millions of people suffer from depression every year. As one of the leading causes of disability in the world, depression is a common clinical illness. Although it is a devastating and lifelong disease, depression is highly treatable. Many different approaches can help people find relief from distressing, painful depression symptoms, the most popular of these being the use of antidepressant drugs. One of the oldest types of antidepressant drugs is called MAOIs. Although these drugs have fallen out of favor for SSRIs and SNRIs, the drugs are still used sparingly today to treat stubborn cases of depression. The following article will explore MAOIs in more depth.
What is an MAOI?
MAOI stands for monoamine oxidase inhibitor, and these drugs were the first type of antidepressant ever developed and used to treat clinical depression in the 1950s. The drug was incredibly effective at alleviating the symptoms of depression, but they came with several, severe side effects and also diet restrictions. The drugs fell out of favor once SSRIs were developed, which come with fewer side effects. But, MAOIs are still used today when SSRIs and SNRIs fail.
How do MAOIs work?
Depression is a complex disorder, and the symptoms of depression can vary significantly from one person to the next. In some cases, depression symptoms are contradictory. Some people may experience severe mood swings, while others may feel emotionless, or empty. Scientists continue to study how the illness manifests, works, and how best to treat the disorder. Although there is no singular, definitive cause of depression, there are a number of factors known to trigger the disease or make it worse.
One of these factors is the role of important brain chemicals that work to regulate mood and feelings of calm, well-being, and alertness. The chemicals dopamine, serotonin, and norepinephrine play crucial roles in how depression starts and also how it is alleviated. One of these critical brain chemicals is called monoamine oxidase. MAOI drugs work by changing the way this chemical operates in tandem with other vital neurotransmitters involved in the development and treatment of depression.
Naturally-occurring monoamine oxidase works by removing the neurotransmitters norepinephrine, serotonin, and dopamine from the brain. When these chemicals are lacking in the brain, the person will experience depression symptoms, such as lethargy, fatigue, unexplained sadness, guilt, and other physical symptoms. For people with depression, they are unable to produce enough of these chemicals naturally. The research on why this happens isn’t 100% clear yet. But what scientist do know is that it is crucial to keep these chemicals circulating in the brain for longer to alleviate depression symptoms. MAOIs prevent the brain from reabsorbing serotonin, dopamine, and norepinephrine, keeping them in the brain for more extended periods until new compounds are produced in the body and circulated in the brain. Besides depression, MAOIs have also been found to be useful for alleviating the symptoms of other conditions, such as Parkinson’s disease.
What MAOI drugs has the FDA approved for current use?
There are several MAOI drugs on the market today:
- Phenelzine, or Nardil
- Selegiline, or Emsam
- Isocarboxazid, or Marplan
- Tranylcypromine, or Parnate
All of these MAOIs except for Selegiline are taken as an oral tablet. Selegiline comes in a patch form, and typically has fewer side effects than MAOIs taken orally. People who use the lowest-dose of Selegiline may not have to deal with diet restrictions commonly found with MAOI use.
What are the restrictions and side effects of MAOIs?
Because of severe side effects, several notable safety concerns, and diet restrictions, many doctors opt to treat patients with safer SSRIs and SNRIs before trying an MAOI drug. The most common side effects found with MAOIs include the following:
- Cottonmouth
- Headaches
- Insomnia
- Drowsiness
- Digestive issues
- Dizziness
- Skin irritation if taken as a patch
Although these are not dangerous side effects, they can lower a person’s quality of life. However, there are a few dangerous and potentially severe side effects associated with MAOIs:
- Muscle spasms
- Reduced libido and inability to reach orgasm
- Low blood pressure
- Trouble urinating
- Muscle cramps
- Paresthesia
Also, MAOIs can react dangerously with certain foods. MAOIs interact poorly with a compound called tyramine, which is found in some wines, fermented foods, aged cheeses, cured meats, draft beers, and soy products. It can cause dangerously high and potentially fatal blood pressure.
MAOIs are also not safe for pregnancy and can interact poorly with allergy and cold medications. Some people may also have an adverse reaction to MAOIs called Serotonin Syndrome, where patients experience anxiety, agitation, and rapid heart rate.
Serotonin syndrome is more likely to occur when people combine MAOI drugs with other antidepressants, such as SSRIs. For this reason, it is important to wait two weeks before starting an MAOI after you discontinue the use of another antidepressant medication to allow the old medication to clear from your system, so it does not interact with the MAOI.
Serotonin syndrome is potentially fatal and can involve the following serious symptoms:
- Fever
- Confusion
- Extreme Sweating
- Seizures
- Liver and Kidney Problems
- Rigid Muscles
Given the potential side effects of MAOIs, users must exercise caution with these medications and communicate with their doctors about any side effects and any other medications they are taking.
While it is not common for high tyramine levels to cause severe side effects, a tyramine buildup can lead to high blood pressure levels in rare cases. In rare instances, a person may experience a fatal cerebral hemorrhage. Given the potentially dangerous side effects of MAOI drugs, people who take these medications for depression must follow restrictive diets. For instance, as experts caution, tyramine levels increase as foods age, so even leftovers can become problematic when taking an MAOI prescription. When fruits like bananas or avocados become too ripe, they can also become dangerous. Some people may find these dietary restrictions associated with MAOIs challenging to manage.
Why would someone take an MAOI?
If a person is careful and prudent about their MAOI use, MAOIs are safe and incredibly effective at treating stubborn depression. Up to 30% of people with depression will have what’s called “treatment-resistant depression.” A doctor will diagnose someone with this condition if the patient has not responded favorably to at least two different SSRIs or SNRIs after at least six weeks of being on the medication. Usually, a doctor will try an alternative treatment method for this type of depression, including MAOIs. Failing to treat depression adequately is linked to poorer life satisfaction, poorer physical, and mental health outcomes, and also increases the risk of the patient attempting suicide or engaging in other self-harming behaviors.
However, some patients and their doctors may not find MAOIs or SNRIs suitable treatment methods for depression. MAOIs do come with severe side effects and can significantly restrict someone’s diet. Depending on the patient’s lifestyle and medical needs, they may opt for alternative methods for treating stubborn depression. These methods include a variety of deep brain stimulation techniques, including vagus nerve stimulation, electroconvulsive therapy, or transcranial magnetic stimulation. Of these three, transcranial magnetic stimulation is the least invasive ad the most effective for treating depression.
Effectiveness of MAOIs
MAOIs may come with side effects, but they can be highly effective for people who have a case of depression that does not respond to other treatment methods. Scientists have conducted extensive research with MAOIs to determine their effectiveness in treating depression. For example, in a 2019 study in the Journal of Affective Disorders, researchers compared MAOIs with another type of drug, called a tricyclic antidepressant. They found that among patients who had been unsuccessful with at least one prior depressant treatment attempt, MAOI drugs were more effective than tricyclic antidepressants were.
According to experts, MAOI drugs can effectively treat unique presentations of depression, such as depression with atypical features, like oversleeping and overeating. These drugs are also useful in cases of panic disorder and social phobia.
Transcranial Magnetic Stimulation as an Alternative to MAOIs
While MAOI drugs can be effective for treating cases of depression that do not respond to other medications, the reality is that they can come with side effects so that some people may prefer alternative treatments. As mentioned above, Transcranial Magnetic Stimulation (TMS) is the top alternative treatment for depression.
According to research, TMS for depression is safe and well-tolerated, whereas electroconvulsive therapy is effective but has negative effects on cognitive functioning. Other treatments, such as vagal nerve stimulation and deep brain stimulation, are surgical and, therefore more invasive. Fortunately, a growing body of more recent research shows that TMS is beneficial for resistant cases of depression.
Suppose your depression symptoms just aren’t improving, and you decide to explore TMS as a treatment option. In that case, our psychiatrist will perform an initial consultation to determine the best treatment plan for you and then schedule you for daily 18-minute treatment sessions at times that accommodate your needs. You may receive behavioral therapy alongside TMS treatment, and after you complete TMS, our staff may recommend lifestyle changes, such as practicing meditation and healthy sleep habits.
If you or someone you love is suffering from depression, it might be time to explore treatment methods. Please talk to your doctor or call Pulse TMS about exploring deep brain stimulation techniques such as transcranial magnetic stimulation for relief from treatment-resistant depression.