Monoamine Oxidase Inhibitors (MAOIs)

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Overview: Monoamine Oxidase Inhibitors (MAOIs) are a class of antidepressants that are sometimes used to help treat several mental health conditions. They were the very first antidepressants to have been created. They are rarely used in the contemporary age due to more modern and safer antidepressant classes like SSRIs and SNRIs being created. MAOIs are often a last line of medication-based treatment. They are permitted for use for Depression, Bipolar DisorderPersonality disorder‘s and Post-traumatic stress disorder.

 

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How do they work?: MAOIs prevent an enzyme called monoamine oxidase removing neurotransmitters norepinephrine, serotonin and dopamine from the brain. In doing so, the levels of these neurotransmitters rise – which is believed to improve mood and emotion. It is usually recommended to use MAOIs in conjunction with some form of psychotherapy.

 

How effective are they?: MAOIs were used hugely during the 1960s. They helped many people recover from depression. However, some MAOIs have since been withdrawn from the market. While certainly effective, anyone taking MAOIs need to avoid foods and beverages containing tyramine. This can include aged cheeses, some meat and alcohol among other substances. Those suffering from moderate and severe depression can benefit from MAOIs.

 

Treatment Course: MAOI Antidepressants generally come in tablet form. Once prescribed, a low dose will initially be set. A typical treatment course lasts six months, though it can often rise to around 18 months, or even indefinite use. Unfortunately, it takes at least two weeks for benefits to be felt. At first, your mood may start to increase again. The full benefits of antidepressants normally take up to six weeks to be felt. If after this point you haven’t witnessed an improvement, it is worth talking to your GP or mental health specialist. They may suggest switching antidepressants. Many people succeed on their second antidepressant. It is highly likely you will experience some mild side effects early in the treatment. It is crucial however to not stop taking the tablets, as these side effects will disappear quickly.

 

Types of MAOI Antidepressants: Very few MAOIs are prescribed in the contemporary age. However, if other classes of antidepressants have failed, they can be an option.

 

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Side Effects

We recommend consulting the individual page for each antidepressant for information on side effects – as they differ from tablet to tablet. Furthermore, the leaflet that comes with each pack of tablets contains enhanced information on side effects. Side effects generally are only present in the first few days of treatment, with the body needing time to get used to treatment. You will often see a GP during the first month of treatment to see how you are reacting.

 

MAOI’s need to be carefully managed. Most importantly, foods or beverages including tyramine need to be avoided. A high level of Tyramine can cause hypertensive crisis – which is usually fatal. Foods and drink that include tyramine include meat, fish, aged cheeses, sour cream, avocados, alcohol and more. Common side effects of MAOIs include dry mouth, dizziness, headaches, sedation, weight gain or loss, constipation, urinary retention, sexual dysfunction, and in extreme cases – psychosis.

 

Cautions

As with any medication, you must be careful when taking antidepressants. Your GP or mental health professional should make you aware of any types of medicine or foods that you should avoid. Some frequently used medications, even over-the-counter ones shouldn’t be used with antidepressants. It is worth looking at the individual page of each antidepressant to see cautions, but an overview is provided here.

 

Other Medicines: When taking an MAOI, there are several medicines to avoid. Other psychotropic medications like antidepressants, painkillers, stimulants and antipsychotics should be avoided. Tobacco-containing products too should be avoided. You should also avoid the herbal remedy St John’s Wort. To emphasise, you shouldn’t combine antidepressant classes.

 

Pregnancy and Breastfeeding: Antidepressants generally aren’t recommended for pregnant women. Taking antidepressants while breastfeeding also isn’t recommended.

 

Young People: People under the age of 18 are rarely prescribed antidepressants, instead being offered therapy. The exception to this is the SSRI Fluoxetine (Prozac). If therapy hasn’t worked, antidepressants can be prescribed. People under the age of 25 taking antidepressants have been shown to be vulnerable to suicidal thoughts – a serious side effect.

 

Illicit Drugs: The use of illegal or recreational drugs isn’t recommended, as they can react unpredictably with antidepressants. Cannabis, cocaine, heroin and ketamine have been known to particularly worsen symptoms.

 

As always, ensure you read the information leaflet.

 

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