Table of ContentsView AllTable of ContentsWhat They AreTypesUsesFunctionSide EffectsBenefits
Table of ContentsView All
View All
Table of Contents
What They Are
Types
Uses
Function
Side Effects
Benefits
MAOI drugs can cause significant side effects like severe hypertension (high blood pressure) when taken with certain foods or drugs, so their use requires dietary and medication restrictions. This is one of the reasons why healthcare providers usually do not prescribe MAOIs unless other treatments are unsuccessful.
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Understanding MAOIs
MAOIs are the first type of antidepressant created. They were developed during the 1950s as a treatment for the lung disease tuberculosis. However, scientists found that they were effective at improving depressive symptoms as well.
MAOI drugs can have severe interactions with certain foods and drugs, resulting in significant side effects and even fatalities. Over the years, MAOIs have been replaced with newer antidepressants that are safer and have fewer adverse interactions.
Healthcare providers still prescribe MAOIs but generally only after other antidepressants or treatments have failed.
Which Drugs Are MAOIs?
Emsam is a transdermal patch worn on the skin. It may cause fewer side effects than the oral version of selegiline (Zelapar).
Additionally, Azilect (rasagiline) is another type of MAOI approved totreat Parkinson’s diseasein the United States.
Is Prozac an MAOI?Prozac is an SSRI (selective serotonin reuptake inhibitor), not an MAOI.
Is Prozac an MAOI?
Prozac is an SSRI (selective serotonin reuptake inhibitor), not an MAOI.
What Are MAOI Drugs Used For?
Although they are not a first-line treatment, healthcare providers use MAOIs to treatatypical depressionand other conditions.
A healthcare provider may prescribe MAOIs to treat depression that has not responded to other antidepressants.
Other conditions that MAOIs can treat include:
How They Work
The enzyme monoamine oxidase removes neurotransmitters like dopamine, serotonin, and norepinephrine from the brain. Low levels of those neurotransmitters are associated with depression.
Are MAOIs different from SSRIs?MAOIs and SSRIs are both antidepressants, but they work in different ways. MAOIs inhibit monoamine oxidase, while SSRIs block the reuptake of serotonin.
Are MAOIs different from SSRIs?
MAOIs and SSRIs are both antidepressants, but they work in different ways. MAOIs inhibit monoamine oxidase, while SSRIs block the reuptake of serotonin.
MAOI Side Effects and Restrictions
Below is information on the various side effects, risks, and dietary restrictions associated with MAOI use.
MAOIs and Blood Pressure
In addition to lowering levels of neurotransmitters, the enzyme monoamine oxidase has a vital role in removingtyramine. Tyramine is a chemical that is found in certain foods. High tyramine levels can cause sudden increases in blood pressure.
When you take MAOIs, monoamine oxidase can’t perform its usual function, which may result in abnormal levels of tyramine and, therefore, unmanaged blood pressure.
In some cases, if a person eatshigh-tyramine foods(like certain cheeses), they may get a “cheese reaction” or “tyramine pressor response.“This can cause ahypertensive crisis(dangerously high blood pressure), potentially leading to a cerebral hemorrhage and death in rare cases.
MAOIs can also causeorthostatic hypotension, a sudden drop in blood pressure when standing or sitting from lying down.
Other Side Effects
Beyond the potential for hypertensive crisis and serious medication interactions, MAOIs can also cause other side effects, including:
MAOI Dietary Restrictions
To avoid a blood pressure emergency, people taking MAOIs must follow dietary restrictions, which typically require removing high-tyramine foods.
Foods to be avoided or eaten with caution when taking MAOIs include:
Note that tyramine increases as food ages. Most of the above foods involve some process of aging or fermenting. If you are taking an MAOI, eating fresh foods like fresh fruits, vegetables, and newly cooked meat is better.
Drug Reactions
MAOIs can also dangerously interact with other medications and supplements. These include medications that increase serotonin such as certain other antidepressants, Sainti-John’s-wort, dextromethorphan (found in cough medicines), and medicines that can increase sympathetic nervous system activity, such as phenylephrine (decongestant) and certain anesthetics.
Other Safety Concerns
If you are pregnant or breastfeeding, talk to your healthcare provider before starting or stopping MAOIs or other antidepressants.
Rarely, and MAOI can cause a condition called serotonin syndrome, which occurs when you have dangerously high levels of serotonin in your body.This is more likely to occur if you are taking an MAOI with another drug or supplement that increases serotonin.
MAOIs and other antidepressants have been associated with an increased risk of suicide, especially in children, teenagers, and young adults. If you have increased thoughts of suicide when taking MAOIs, talk to your healthcare provider right away.
Stopping MAOIs
Talk to your healthcare provider before you stop taking MAOIs. Stopping suddenly can cause discontinuation syndrome, which may lead to serious symptoms like confusion, convulsions, and psychosis.
Your healthcare provider will recommend gradually reducing your dose before stopping altogether. Some of the side effects that may occur while stopping treatment include:
You should not start taking a different antidepressant medication until you have been completely off your MAOI for at least two weeks.
A healthcare provider may recommend MAOIs to some people because the benefits of treating depression, Parkinson’s, or other conditions outweigh the risks of possible side effects.
A 2021 systematic review found that Nardil, a type of MAOI, was one of the most effective antidepressants in the clinical trials examined.
The study also found that all four FDA-approved MAOI types were comparable with other antidepressants, includingselective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), regarding their effectiveness and acceptability among people with depression.
As a result, the reviewers concluded that MAOIs are currently underutilized, despite their side effects and risks.
Summary
MAOIs are the original antidepressant. This class of antidepressants was developed in the 1950s and is still used. However, due to potential side effects, interactions, and dietary restrictions, MAOIs are not generally used unless other treatments have failed. There is some evidence suggesting that these potentially effective agents may be currently underutilized.
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.UptoDate.Monoamine oxidase inhibitors (MAIOs): Pharmacology, administration, safety, and side effects.American Association of Psychiatric Pharmacists.Monoamine oxidase inhibitors (MAOIs): Introduction.United States Food and Drug Administration.Drug approval package azilect (rasagiline mesylate) tablet.Prisco L, Sarwal A, Ganau M, Rubulotta F.Toxicology of psychoactive substances.Crit Care Clin. 2021;37(3):517-541. doi:10.1016/j.ccc.2021.03.013Ramsay RR, Albreht A.Kinetics, mechanism, and inhibition of monoamine oxidase.J Neural Transm. 2018;125(11).Calvi A, Fischetti I, Verzicco I, et al.Antidepressant drugs effects on blood pressure.Front Cardiovasc Med. 2021;8. doi: 10.3389/fcvm.2021.704281American Association of Psychiatric Pharmacists.Monoamine oxidase inhibitors (MAOIs): Significant drug-drug/drug-food interactions with MAOIs.American Association of Psychiatric Pharmacists.Monoamine oxidase inhibitors (MAOIs): Potential adverse effects: Prevention, monitoring, and management.Van den Eynde V, Abdelmoemin WR, Abraham MM, et al.The prescriber’s guide to classic MAO inhibitors (phenelzine, tranylcypromine, isocarboxazid) for treatment-resistant depression.CNS Spectr. 2022:1-14. doi:10.1017/S1092852922000906Keks N, Hope J, Keogh S.Switching and stopping antidepressants.Aust Prescr. 2016;39(3):76-83. doi:10.18773/austprescr.2016.039Suchting R, Tirumalaraju V, Gareeb R, Bockmann T, de Dios C.Revisiting monoamine oxidase inhibitors for the treatment of depressive disorders: A systematic review and network meta-analysis.J Affect Disord. 2021;282:1153-1160. doi:10.1016/j.jad.2021.01.021
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.UptoDate.Monoamine oxidase inhibitors (MAIOs): Pharmacology, administration, safety, and side effects.American Association of Psychiatric Pharmacists.Monoamine oxidase inhibitors (MAOIs): Introduction.United States Food and Drug Administration.Drug approval package azilect (rasagiline mesylate) tablet.Prisco L, Sarwal A, Ganau M, Rubulotta F.Toxicology of psychoactive substances.Crit Care Clin. 2021;37(3):517-541. doi:10.1016/j.ccc.2021.03.013Ramsay RR, Albreht A.Kinetics, mechanism, and inhibition of monoamine oxidase.J Neural Transm. 2018;125(11).Calvi A, Fischetti I, Verzicco I, et al.Antidepressant drugs effects on blood pressure.Front Cardiovasc Med. 2021;8. doi: 10.3389/fcvm.2021.704281American Association of Psychiatric Pharmacists.Monoamine oxidase inhibitors (MAOIs): Significant drug-drug/drug-food interactions with MAOIs.American Association of Psychiatric Pharmacists.Monoamine oxidase inhibitors (MAOIs): Potential adverse effects: Prevention, monitoring, and management.Van den Eynde V, Abdelmoemin WR, Abraham MM, et al.The prescriber’s guide to classic MAO inhibitors (phenelzine, tranylcypromine, isocarboxazid) for treatment-resistant depression.CNS Spectr. 2022:1-14. doi:10.1017/S1092852922000906Keks N, Hope J, Keogh S.Switching and stopping antidepressants.Aust Prescr. 2016;39(3):76-83. doi:10.18773/austprescr.2016.039Suchting R, Tirumalaraju V, Gareeb R, Bockmann T, de Dios C.Revisiting monoamine oxidase inhibitors for the treatment of depressive disorders: A systematic review and network meta-analysis.J Affect Disord. 2021;282:1153-1160. doi:10.1016/j.jad.2021.01.021
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
UptoDate.Monoamine oxidase inhibitors (MAIOs): Pharmacology, administration, safety, and side effects.American Association of Psychiatric Pharmacists.Monoamine oxidase inhibitors (MAOIs): Introduction.United States Food and Drug Administration.Drug approval package azilect (rasagiline mesylate) tablet.Prisco L, Sarwal A, Ganau M, Rubulotta F.Toxicology of psychoactive substances.Crit Care Clin. 2021;37(3):517-541. doi:10.1016/j.ccc.2021.03.013Ramsay RR, Albreht A.Kinetics, mechanism, and inhibition of monoamine oxidase.J Neural Transm. 2018;125(11).Calvi A, Fischetti I, Verzicco I, et al.Antidepressant drugs effects on blood pressure.Front Cardiovasc Med. 2021;8. doi: 10.3389/fcvm.2021.704281American Association of Psychiatric Pharmacists.Monoamine oxidase inhibitors (MAOIs): Significant drug-drug/drug-food interactions with MAOIs.American Association of Psychiatric Pharmacists.Monoamine oxidase inhibitors (MAOIs): Potential adverse effects: Prevention, monitoring, and management.Van den Eynde V, Abdelmoemin WR, Abraham MM, et al.The prescriber’s guide to classic MAO inhibitors (phenelzine, tranylcypromine, isocarboxazid) for treatment-resistant depression.CNS Spectr. 2022:1-14. doi:10.1017/S1092852922000906Keks N, Hope J, Keogh S.Switching and stopping antidepressants.Aust Prescr. 2016;39(3):76-83. doi:10.18773/austprescr.2016.039Suchting R, Tirumalaraju V, Gareeb R, Bockmann T, de Dios C.Revisiting monoamine oxidase inhibitors for the treatment of depressive disorders: A systematic review and network meta-analysis.J Affect Disord. 2021;282:1153-1160. doi:10.1016/j.jad.2021.01.021
UptoDate.Monoamine oxidase inhibitors (MAIOs): Pharmacology, administration, safety, and side effects.
American Association of Psychiatric Pharmacists.Monoamine oxidase inhibitors (MAOIs): Introduction.
United States Food and Drug Administration.Drug approval package azilect (rasagiline mesylate) tablet.
Prisco L, Sarwal A, Ganau M, Rubulotta F.Toxicology of psychoactive substances.Crit Care Clin. 2021;37(3):517-541. doi:10.1016/j.ccc.2021.03.013
Ramsay RR, Albreht A.Kinetics, mechanism, and inhibition of monoamine oxidase.J Neural Transm. 2018;125(11).
Calvi A, Fischetti I, Verzicco I, et al.Antidepressant drugs effects on blood pressure.Front Cardiovasc Med. 2021;8. doi: 10.3389/fcvm.2021.704281
American Association of Psychiatric Pharmacists.Monoamine oxidase inhibitors (MAOIs): Significant drug-drug/drug-food interactions with MAOIs.
American Association of Psychiatric Pharmacists.Monoamine oxidase inhibitors (MAOIs): Potential adverse effects: Prevention, monitoring, and management.
Van den Eynde V, Abdelmoemin WR, Abraham MM, et al.The prescriber’s guide to classic MAO inhibitors (phenelzine, tranylcypromine, isocarboxazid) for treatment-resistant depression.CNS Spectr. 2022:1-14. doi:10.1017/S1092852922000906
Keks N, Hope J, Keogh S.Switching and stopping antidepressants.Aust Prescr. 2016;39(3):76-83. doi:10.18773/austprescr.2016.039
Suchting R, Tirumalaraju V, Gareeb R, Bockmann T, de Dios C.Revisiting monoamine oxidase inhibitors for the treatment of depressive disorders: A systematic review and network meta-analysis.J Affect Disord. 2021;282:1153-1160. doi:10.1016/j.jad.2021.01.021
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