Monoamine oxidase inhibitors (MAOIs)

A class of older antidepressants known as monoamine oxidase inhibitors (MAOIs) has a restricted but specific application in the treatment of depression. These drugs have been replaced with safer, more recent ones like bupropion and selective serotonin reuptake inhibitors (SSRIs), Depression medications (mirtazapine) and (venlafaxine) are prescribed. Among the MAOIs are (selegiline), (tranylcypromine), (phenelzine), and (isocarboxazid) therapy for Parkinson’s disease as opposed to depression.
The method by which brain cells, or neurons, interact with one another is called neurotransmission. A neurotransmitter, such as dopamine, serotonin, or norepinephrine, is released from the neuron into the space between it and the next neuron as a result of an electrical impulse that travels down the nerve cell.  

This allows the electrical stimulus to continue into the neighboring neuron. The way that neurotransmitter’s function is principally brought to an end by two processes first, the reuptake of neurotransmitters into neurons, then the breakdown of neurotransmitters by enzymes before reuptake. The complex enzyme system known as monoamine oxidase (MAO), which is extensively distributed throughout the body, is one kind of enzyme that breaks down neurotransmitters and discovered in the brain. SSRIs and other antidepressants don’t function the same way as MAOIs. They prevent MAO from degrading neurotransmitters, which raises the concentration of neurotransmitters in the distance between two neurons.

 Older MAOIs like Parnate, Marplan, and Nardil block MAO enzymes permanently and non-selectively, whereas Eldepryl is comparatively more selective for a particular kind of MAO enzyme. When the patient quits taking the medicine, its inhibition ends more quickly. 

Certain neurotransmitters in the brain may be unusually low, which may lead to depression and other mental illnesses. Affected brain regions may undergo alterations as a consequence of this anomaly, giving rise to psychological symptoms like anxiety or sadness. The antidepressant may reduce or eliminate the symptoms of the disease by restoring normal functioning to the damaged brain regions via changes in neurotransmission. 

The use of MAOIs has been restricted to the treatment of severe and resistant types of depression due to the abundance of safe and efficient antidepressants that are now on the market. When studies with other antidepressants are unsuccessful, doctors often prescribe MAOIs. In addition, MAOIs may be utilized for conditions other than depression. A medicine is said to be used for its labeled use when it is taken for the prescribed purposes. In clinical settings, however, doctors often write prescriptions for unapproved (or “off-label”) uses of drugs when the safety and effectiveness of such therapies are supported by published clinical research, case reports, or their own clinical experiences. For instance, MAOIs may be used to treat conditions including posttraumatic stress disorder, generalized anxiety disorder, panic disorder, particular phobias, and migraines that don’t respond to conventional forms of treatment. Although the use of Eldepryl oral tablets to treat depression is not authorized, are recognized by the Food and Drug Administration (FDA) of the United States as effective treatments for Parkinson’s disease, a progressive neurological condition that impairs movement. Recently, selegiline was created and later granted approval to treat depression. 

Information about Dosing

The MAOIs that are most often administered are parnate and nardil. beginning at 15 mg twice or three times a day, the suggested beginning dose for Nardil is to increase it by 15 mg per week until it reaches a therapeutic range of 45–60 mg/day. Parnate should be taken 10 mg twice or three times a day as a beginning dose. If necessary, the dosage may be increased by 10 mg per week to a therapeutic range of 40–60 mg/day. Marplan is often begun at a dosage of 20 mg per day, divided into two doses of 10 mg each. To reach a therapeutic range of 30–60 mg per day, the dosage is raised by 10 mg every two to four days. 

Typical Side Effects

Many adverse effects are linked to MAOIs, which often reduces their efficacy and tolerance. One way to mitigate potential adverse effects is to gradually increase or decrease the dose.
Symptoms as Daytime drowsiness, vertigo, dry mouth, changed taste, anxiety, muscular pains, insomnia, weight gain, sexual dysfunction, and problems urinating are side effects

linked to MAOIs.

Anorgasmia, or the inability to have an orgasm, and impotence are sexual adverse effects caused by MAOIs. Nardil seems to cause these side effects more often than parnate. Prickling or tingling sensations known as paresthesia may cause discomfort to some individuals. This might result from the MAOI interfering with the metabolism of pyridoxine, or vitamin B6. Vitamin B6 at a dosage of 100 mg per day may lessen or perhaps completely eradicate these symptoms. 

Adverse Events and Safety Measures

Combining MAOIs with other drugs that increase serotonin, such SSRIs and tricyclic antidepressants, may create serotonin syndrome, a potentially dangerous response brought on by too much serotonin stimulation in the brain. Serotonin syndrome presents with flushing, profuse perspiration, tremors, restlessness, and involuntary jerks of the muscles. If the medicine is not discontinued, the patient may have further potentially fatal side effects, including as violent convulsions, a high temperature, breathing issues, coagulation issues, hemolysis (which might cause abrupt renal failure), coma, and death. Patients on MAOIs should be made aware of the potential symptoms of serotonin syndrome, which call for stopping the serotonin-boosting drugs and seeking emergency medical assistance.

 In addition to MAOIs, they should exercise caution while taking any other medicines, including over-the-counter drugs and herbal supplements. The tendency of MAOIs to temporarily lower blood pressure might result in dizziness. MAOIs prevent the body from adjusting to keep blood pressure steady when a person shifts from a laying down to a standing position either from a sitting to a standing posture. Orthostatic hypotension is the medical name for this response. 

Elderly people and those on other blood pressure-lowering drugs may be more vulnerable to MAOI-induced orthostatic hypotension. Patients should use caution while abruptly standing up. They should slowly rise from a laying posture to a sitting position and then stand. In order to give their blood pressure time to regulate, people who are feeling lightheaded or dizzy should sit and wait for a minute or two before rising up.

Other crucial safety measures for those using MAOIs include limiting their intake of foods rich in tyramine and several drugs that may cause dan, particularly cold and allergy remedies that include decongestants.

Monoamine oxidase inhibitors may lead to a stroke and dangerously high blood pressure. Tyramine is a naturally occurring chemical that is produced as food and alcohol age. MAO enzymes in the intestines break down tyramine before the body absorbs and distributes any appreciable quantity. Tyramine is not broken down in the presence of MAOIs, and significant doses may be absorbed. Elevations of high tyramine levels may occur rapidly and dangerously.
Blood pressure may rise as a result of interactions between MAOIs and certain prescription and illegal drug use.
A hypertensive crisis develops when blood pressure rises to dangerously high levels without medical intervention. The table below lists food and drug limitations for people on MAOIs. 

Utilization during pregnancy and nursing: Category C
It is unknown whether MAOIs are safe to use when pregnant. However, MAOIs are not advised during pregnancy due to the danger of hypertensive crisis. Additionally, if a lady who is pregnant takes an MAOI, the possibility of drug interactions may make it impossible to take certain prescriptions or make using anesthesia in an emergency more difficult. When taking an MAOI, women should always speak with their doctor if thinking about becoming pregnant or if they do. When they stop taking their antidepressants, some women may suffer a relapse of depression. Under these conditions, the doctor will talk about the course of therapy choices with the patient, such as, if required, continuing to take the MAOI while being closely watched.

Breastfeeding is not recommended for women using MAOIs since minute quantities may enter the breast milk and be ingested by the unborn child. Breastfeeding should not begin if discontinuing the MAOI is not an option, or should be stopped.

 
Potential Interactions with Drugs

With MAOIs, there are a lot of potential medication interactions. 

• Foods you should not eat as cheese that has aged (cottage and cream cheese are OK), Any animal’s liver, as well as liverwurst, foods that have been aged, smoked fish, and smoked meats (such as salami, sausage, pepperoni, and corned beef), Red wine with beer Meperidine, Broad bean pods, or faba, Meat or yeast extracts (yeast-containing baked items are safe), Tofu, soybean paste, miso soup, and fermented bean curd are sources of soy sauce.  
• Foods that are safe to eat in moderation but potentially harmful in excess are: Coffee-based drinks, Ripe fruits such as avocados and bananas, Chocolate and Yogurt.
• Drugs that have to be avoided: Drugs for allergies and colds that include Sinus medicines and nasal decongestants, Inhalers that dilate the bronchi (like Atrovent)
  epinephrine, such as in bee sting kits, Stimulants (such as Ritalin, cocaine, amphetamine, and appetite suppressants), Parkinson’s disease medicine uses levodopa and dopamine. 
• St. John’s wort, stimulants, diet pills, herbal weight-loss products, and Flexeril (cyclobenzaprine) are a few other drugs and herbal items that may interact with MAOIs.

Overdosing

A MAOI overdose might cause sleepiness, irritability, low blood pressure, restlessness, and breathing problems as early symptoms. The individual may have dysphagia, fast heartbeat and respiration, intense headaches and a crisis of hypertension. There might be a coma, convulsions, and even death. The quantity of MAOI consumed and the presence of additional drugs affect how severe the symptoms are.

Treating any suspected overdose as an emergency is imperative. The individual has to be brought to the emergency space for care and observation. It is advisable to include both the prescription bottle of medicine and any other medication suspected in the overdose, since the information on the label may be useful in helping the treating physician figure out how many tablets the patient has taken.
(meperidine) When used with MAOIs, Demerol may cause fever, agitation, seizures, and a coma, as well as death. This response may occur weeks after the cessation of MAOI. 

• Anesthesia At least ten days before to elective surgery requiring general anesthesia, MAOIs should be stopped. regional sedation cocaine or epinephrine should also be avoided. When used with another antidepressant or soon after starting any of these medications, antidepressants MAOIs may cause a severe serotonin syndrome response or hypertensive crisis. 
• (oxcarbazepine) with (carbamazepine), This combination may result in hypertensive crises, convulsions, and circulatory collapse. 
• (bupropion), An MAOI shouldn’t be used with bupropion in Wellbutrin antidepressants or Zyban (for quitting smoking) A hazardous reaction might be brought on by the combination. 
• Dextromethorphan, such as found in Robitussin MAOIs should not be used with dextromethorphan, a component in many cough preparations. There might be risk with this combination. 
• Decongestants MAOIs should not be used with decongestants such pseudo-ephedrine and phenylpropanolamine, which are often present in over-the-counter drugs for allergies and colds. The mixture might cause a hypertensive emergency.
• bronchodilators (Primatene, Ventolin, etc.), It is best to avoid using bronchodilators for breathing and MAOIs together. The mixture might result in a hypertensive emergency.
• Anti-Parkinson drugs (e.g., Sinemet, levodopa), These drugs together have the potential to trigger a hypertensive crisis. 
• It is not recommended to mix BuSpar (buspirone) MAOIs with BuSpar. Reports of increased blood pressure have been made when BuSpar was added to drug regimens that also included an MAOI. 

Specific Considerations for Inhibitors of Monoamine Oxidase

Major depressive disorder may often be effectively treated with medication, psychotherapy, or both.
For the treatment of moderate to severe depression, the combination of psychotherapy and antidepressants is particularly successful. Medication enhances mood, energy, sleep, and appetite, while therapy helps people develop coping mechanisms, addresses any potential underlying problems and enhances behavior and mental habits. 

60% to 70% of those who take antidepressants on their own report feeling better overall. The majority of people do not see noticeable advantages from their antidepressants until after 3–4 weeks, and it may sometimes take up to 8 weeks for the medicine to have its full effects. A small percentage of people may notice some improvement before the end of the first week. Therefore, it is crucial that patients take their antidepressant for the whole recommended amount of time and that they do not give up and stop taking it too soon if they do not start feeling better right away.
Antidepressants have been shown in short-term trials to raise the likelihood of suicidal thoughts and actions in kids and teenagers suffering from severe depressive illness and other mental health issues. When beginning antidepressant treatment in children and adolescents, the FDA mandates that the prescriber disclose this risk to the patient

According to FDA research, there is an age-related risk of suicide thoughts and actions while using antidepressants. This phenomenon is more likely to manifest early in the course of and is more common in the younger population.
Antidepressant use did not seem to be associated with a higher incidence of suicidality in people over the age of 24, as compared to placebo use. The results demonstrated that antidepressants have a “Protective effect” against acts and ideas of suicide. According to other research, there is a decrease in suicide rates in communities where a higher proportion of the population uses antidepressants. 

• Suicide risk is a part of depression and may not go away until the patient responds to therapy. Upon initiating or modifying antidepressant treatment, the individual particularly if they are a child or adolescent should have continuously monitored for increasing symptoms of depression, and any concerns should be reported to the doctor by the family or caregiver. 
• Caution: If you are experiencing suicidal thoughts, please notify your doctor or a family member right away. Whenever your depressed symptoms increase or you feel like you can’t manage suicide thoughts or desires, see a psychiatrist or your family doctor. 
• Avoid stopping your MAOI suddenly. It is best to take off the drug gradually before quitting it altogether. 
•  If you forget to take a dosage, catch up by taking it two to three hours later than planned. If it’s near, Skip the missed dosage and resume your usual dosing regimen for the next scheduled dose. Never take two doses at once. 
• You may take your MAOI with or without meals. To let medical personnel know that you are taking an MAOI, it is advised that you wear a MedicAlert bracelet or carry an identity card. Tell your dentist and other medical professionals that you take an MAOI. 
•  Steer clear of foods rich in tyramine. Avoid the meal if you are doubtful about it until you speak with your pharmacist or physician. Moreover, it takes around two weeks even after discontinuing your MAOI before it is safe. 
• It’s crucial to stick to your medication and food restrictions for two weeks after stopping your MAOI in order to restart a normal diet or take specific drugs. 
•  Keep the medicine out of direct sunlight and dampness, in the light-resistant container that came with it. Your drug may break down more quickly in hot and humid environments, losing its therapeutic benefits. 

Make sure kids can’t get to your medicine.