What Are MAO Inhibitors?
Monoamine oxidase (MAO) inhibitors are a class of antidepressants medications. MAO inhibitors are highly effective prescription medications for atypical and treatment-resistant depression and anxiety. They are considered first-line medications for these conditions and outperform other antidepressants in comparison clinical trials. Read more their effectiveness here. For more information on the basics of MAO inhibitors see our MAO inhibitor guide here.
FDA-Approved MAO Inhibitors
Generic: Tranylcypromine / Brand: Parnate (tablet)
Generic: Phenelzine / Brand: Nardil (tablet)
Generic: Isocarboxazid / Brand: Marplan (tablet)
Generic: Selegiline / Brands: Eldepryl (tablet) and Emsam (skin patch)
Why Haven’t I Heard of MAO Inhibitors?
Despite being among the most effective antidepressants and the gold standard/first-line treatment for treatment-resistant depression and anxiety, few psychiatrists give out MAO inhibitor prescriptions often due to a lack of experience with them and fears of tyramine-induced hypertension and serotonin syndrome. We talk about this issue in greater detail here.
What is Tyramine-Induced Hypertension?
Tyramine is an amino acid that helps regulate blood pressure, it’s mostly naturally occurring in your body but can be found in certain foods like aged cheeses, cured, smoked or processed meats, pickled or fermented foods, and alcohol.
Is this a concern?
The fear stems from consuming too many foods containing tyramine while taking MAO inhibitors as this would increase your blood pressure. This concern sounds was truer in the 1960s when tyramine-dense foods were more prevalent. Though still found in foods today, the amounts are extremely low because of modern FDA standards.
What is Serotonin Syndrome?
Serotonin syndrome is a potentially life-threatening condition that can occur by taking two serotonergic drugs concurrently.
Is this a concern?
Since the 1960s experts found many serotonergic drugs can be safely combined with MAO inhibitors. Serotonin syndrome also occurs in a gradient, thus the signs of serotonin syndrome maybe recognized before becoming troublesome if doses of a second serotonergic medication are slowly increased.
There are four FDA-approved MAO inhibitors, Parnate, Nardil, Marplan, and Selegiline, and two subtypes of the MAO enzyme, MAO-A and MAO-B. Parnate, Nardil, and Marplan are non-selective MAO inhibitors, which means that they will bind with either MAO-A or MAO-B enzymes. Whereas at a low dose, Selegiline will bind specifically to MAO-B enzymes and only becomes non-selective at higher doses.
We support our patients’ choices for which MAO inhibitor they want when it is reasonable and safe, we recommend that you review our breakdown and comparison of the four FDA approved medications before making this choice or recommendation to a doctor.
What are the most common side effects with MAO inhibitors?
The most common side effects are insomnia and orthostatic hypotension (dizziness with standing). Parnate and Selegiline may cause weight loss while Nardil may cause weight gain. Marplan has been associated with weight loss and weight gain. You can view a more comprehensive description of the side effects of MAO inhibitor prescriptions and how to manage them here.
Serious Risks When Taking MAO Inhibitors
- Hypertensive Crisis
- Serotonin Syndrome
If you’re concerned about these risks or are currently taking MAO inhibitors and experiencing any unusual symptoms, read more about these issues and how to manage them here.
Our doctors prescribe Parnate, Nardil, Marplan, and Selegiline to patients via telemedicine. If you’re interested in MAO inhibitors and want to consult a doctor to see if any of these medications are right for you, click on our Get Started tab and fill out our patient intake form. No payment information is required.