How MAOIs Work and Common Side Effects

Table of ContentsView AllTable of ContentsMAOI DrugsHow They WorkSide EffectsPrecautions and ContraindicationsDiscontinuationRisk of Suicide

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Table of Contents

MAOI Drugs

How They Work

Side Effects

Precautions and Contraindications

Discontinuation

Risk of Suicide

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What is the most important information I should know about MAOIs?While taking MAOIs, you should not:Consume foods high in tyramine, including but not limited to beef liver, cured fish, aged cheeses, dried fruit, kimchi, and yogurtTake other serotonergic medication within 14 days of taking an MAOIStop taking your medicines without talking to your physician

What is the most important information I should know about MAOIs?

While taking MAOIs, you should not:Consume foods high in tyramine, including but not limited to beef liver, cured fish, aged cheeses, dried fruit, kimchi, and yogurtTake other serotonergic medication within 14 days of taking an MAOIStop taking your medicines without talking to your physician

While taking MAOIs, you should not:

Monoamine oxidase inhibitors (MAOIs) are a class of drugs developed in the 1950s.They’re effective in treating depression,panic disorder, and otheranxiety disorders. They’re used less frequently than selective serotonin reuptake inhibitors (SSRIs) and other antidepressants because of necessary dietary precautions and risks of adverse reactions when mixed with certain drugs.

If you have been prescribed an MAOI, it’s helpful to know how it works. It’s also important to know the potential side effects to watch for and how to take this type of drug safely. But first, let’s talk about drugs that are categorized as MAOIs.

Some common MAOIs include:

Emsam is a transdermal (skin) patch that’s applied once a day. This mode of administration may be less likely to cause the dietary complications associated with an oral route of administration.

How MAOIs Work

The brain contains numerousdifferent types of neurotransmitters(chemical messengers) that act as communication agents between different brain cells. These chemical messengers are molecular substances that can affect mood, appetite, anxiety, sleep, heart rate, temperature, aggression, fear, and many other psychological and physical functions.

Monoamine oxidase (MAO) is an enzyme that degrades or breaks down three neurotransmitters associated with mood and anxiety:

MAOIs reduce the activity of the enzyme MAO. Less MAO results in higher levels of norepinephrine, serotonin, and dopamine in the brain. The benefits of these increases are improved mood and anti-anxiety effects.

Common Side Effects of MAOIs

This list is not all-inclusive and you may experience other side effects not mentioned here. That said, some of the adverse effects you may experience with MAOIs include:

Report all MAOI side effects to your physician and seek immediate medical attention if you experience severe adverse effects.

Tyramine-Induced Hypertension Crisis

While taking an MAOI, it will be necessary toavoid foods and beverages high in tyramineto prevent potentially fatal high blood pressure spikes.

Before beginning MAOI therapy, tell your healthcare provider if you have any medical conditions, including:

Do not take any medications without your physician’s approval.

Tell all of your treating providers that you’re taking an MAOI. This includes physicians, physician assistants, dentists, and other healthcare providers.

Serotonin Syndrome

Dangerously high levels of serotonin in the brain can cause a potentially life-threatening condition calledserotonin syndrome. This rare condition is usually the result of an interaction of two or moredrugs that affect brain serotonin levels. Even some over-the-counter supplements, such as St. John’s Wort, can result in serotonin syndrome if mixed with MAOIs.

To reduce the risk of serotonin syndrome, MAOIs should never be taken with SSRIs or TCAs.It’s recommended that otherantidepressant therapynot begin until 10 to 14 days after discontinuation of an MAOI.

Pregnancy

The research on pregnancy and MAOI therapy is limited. It’s generally recommended that MAOI therapy is avoided during pregnancy.If you’re nursing or pregnant, it’s best to discuss the risks and benefits of MAOI therapy with your physician.

MAOI Discontinuation Syndrome

Some people have reportedwithdrawal-like symptomswhen decreasing or stopping MAOI therapy. It’s believed that these symptoms are a result of the brain trying to stabilize serotonin and norepinephrine levels after an abrupt change.

Symptoms that may occur during discontinuation of MAOI therapy include:

Some people experience more severe discontinuation symptoms when stopping MAOIs, such as feelings of aggression, unresponsiveness while awake (catatonia), cognitive impairment, and psychosis.If this occurs for you or a loved one, seek immediate medical attention as more intensive management may be required.

Don’t reduce or discontinue MAOI therapy without consulting your healthcare provider.Tapering your dosageslowly can help reduce these effects.

The FDA requires that all antidepressant medications include a warning on their products about a possible increased risk of suicidal thinking and behavior in young people up to age 24, particularly during initial treatment. The association of increased suicidal thoughts with antidepressant treatment, especially among adolescents, has been a center of attention and controversy in recent years.

Researchers have not found a definitive answer about the antidepressant-suicide connection. For most people, antidepressants decrease depression and suicidality and alleviate the helplessness and hopelessness that consumes their daily existence. But, for a small percentage of people taking antidepressants, this may not be the case.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.For more mental health resources, see ourNational Helpline Database.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see ourNational Helpline Database.

If you’re concerned about this issue, be open with your healthcare provider. Also, don’t be afraid to ask questions about any antidepressant or other drug you’ve been prescribed. The more you know about that medication and how it may affect you, the more informed decision you can make about its use.

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14 SourcesVerywell Mind 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.O’Connor AD, Mills KC.Monoamine oxidase inhibitors.Crit Care Toxic. 2016:1-18. doi:10.1007/978-3-319-20790-2_28-2Cleveland Clinic.MAOIs (Monoamine oxidase inhibitors).Cristancho MA, Thase ME.Critical appraisal of selegiline transdermal system for major depressive disorder.Exp Opin Drug Deliv. 2016;13(5):659-665. doi:10.1517/17425247.2016.1140145National Library of Medicine.MAOA gene.Cleveland Clinic.Serotonin.Yamamoto K, Shinba T, Yoshii M.Psychiatric symptoms of noradrenergic dysfunction: a pathophysiological view.Psychiatry Clin Neurosci. 2014;68(1):1-20.  doi:10.1111/pcn.12126Cassidy CM, Balsam PD, Weinstein JJ, et al.A perceptual inference mechanism for hallucinations linked to striatal dopamine.Curr Biol. 2018;28(4):503-514.e4.  doi:10.1016/j.cub.2017.12.059American Association of Psychiatric Pharmacists.Monoamine oxidase inhibitors (MAOI): Potential adverse effects: Monitoring, prevention and management.Van den Eynde V, Gillman PK, Blackwell BB.The prescriber’s guide to the MAOI diet—Thinking through tyramine troubles.Psychopharmacol Bull. 2022;52(2):73-116.Edinoff AN, Swinford CR, Odisho AS, et al.Clinically relevant drug interactions with monoamine oxidase inhibitors.Health Psychol Res. 2022;10(4):39576. doi:10.52965/001c.39576Kennedy D, Webster WS, Hill M, Ritchie HE. Abnormal pregnancy outcome associated with high-dose maternal tranylcypromine therapy: Case report and literature review.Reprod Toxicol. 2017;69:146-149. doi:10.1016/j.reprotox.2017.02.012Bhat V, Kennedy SH.Recognition and management antidepressant discontinuation syndrome.J Psychiatry Neurosci. 2017;42(4):E7-E8. doi:10.1503/jpn.170022Rizkalla M, Kowalkowski B, Prozialeck WC.Antidepressant discontinuation syndrome: A common but underappreciated clinical problem.J Osteopath Med. 2020;120(3):174-178. doi:10.7556/jaoa.2020.030Fornaro M, Anastasia A, Valchera A, et al.The FDA “black box” warning on antidepressant suicide risk in young adults: More harm than benefits?Front Psychiatry. 2019;10:294. doi:10.3389/fpsyt.2019.00294Additional ReadingKaplan H, Sadock B.Kaplan & Sadock’s Synopsis of Psychiatry, Eighth Edition.

14 Sources

Verywell Mind 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.O’Connor AD, Mills KC.Monoamine oxidase inhibitors.Crit Care Toxic. 2016:1-18. doi:10.1007/978-3-319-20790-2_28-2Cleveland Clinic.MAOIs (Monoamine oxidase inhibitors).Cristancho MA, Thase ME.Critical appraisal of selegiline transdermal system for major depressive disorder.Exp Opin Drug Deliv. 2016;13(5):659-665. doi:10.1517/17425247.2016.1140145National Library of Medicine.MAOA gene.Cleveland Clinic.Serotonin.Yamamoto K, Shinba T, Yoshii M.Psychiatric symptoms of noradrenergic dysfunction: a pathophysiological view.Psychiatry Clin Neurosci. 2014;68(1):1-20.  doi:10.1111/pcn.12126Cassidy CM, Balsam PD, Weinstein JJ, et al.A perceptual inference mechanism for hallucinations linked to striatal dopamine.Curr Biol. 2018;28(4):503-514.e4.  doi:10.1016/j.cub.2017.12.059American Association of Psychiatric Pharmacists.Monoamine oxidase inhibitors (MAOI): Potential adverse effects: Monitoring, prevention and management.Van den Eynde V, Gillman PK, Blackwell BB.The prescriber’s guide to the MAOI diet—Thinking through tyramine troubles.Psychopharmacol Bull. 2022;52(2):73-116.Edinoff AN, Swinford CR, Odisho AS, et al.Clinically relevant drug interactions with monoamine oxidase inhibitors.Health Psychol Res. 2022;10(4):39576. doi:10.52965/001c.39576Kennedy D, Webster WS, Hill M, Ritchie HE. Abnormal pregnancy outcome associated with high-dose maternal tranylcypromine therapy: Case report and literature review.Reprod Toxicol. 2017;69:146-149. doi:10.1016/j.reprotox.2017.02.012Bhat V, Kennedy SH.Recognition and management antidepressant discontinuation syndrome.J Psychiatry Neurosci. 2017;42(4):E7-E8. doi:10.1503/jpn.170022Rizkalla M, Kowalkowski B, Prozialeck WC.Antidepressant discontinuation syndrome: A common but underappreciated clinical problem.J Osteopath Med. 2020;120(3):174-178. doi:10.7556/jaoa.2020.030Fornaro M, Anastasia A, Valchera A, et al.The FDA “black box” warning on antidepressant suicide risk in young adults: More harm than benefits?Front Psychiatry. 2019;10:294. doi:10.3389/fpsyt.2019.00294Additional ReadingKaplan H, Sadock B.Kaplan & Sadock’s Synopsis of Psychiatry, Eighth Edition.

Verywell Mind 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.

O’Connor AD, Mills KC.Monoamine oxidase inhibitors.Crit Care Toxic. 2016:1-18. doi:10.1007/978-3-319-20790-2_28-2Cleveland Clinic.MAOIs (Monoamine oxidase inhibitors).Cristancho MA, Thase ME.Critical appraisal of selegiline transdermal system for major depressive disorder.Exp Opin Drug Deliv. 2016;13(5):659-665. doi:10.1517/17425247.2016.1140145National Library of Medicine.MAOA gene.Cleveland Clinic.Serotonin.Yamamoto K, Shinba T, Yoshii M.Psychiatric symptoms of noradrenergic dysfunction: a pathophysiological view.Psychiatry Clin Neurosci. 2014;68(1):1-20.  doi:10.1111/pcn.12126Cassidy CM, Balsam PD, Weinstein JJ, et al.A perceptual inference mechanism for hallucinations linked to striatal dopamine.Curr Biol. 2018;28(4):503-514.e4.  doi:10.1016/j.cub.2017.12.059American Association of Psychiatric Pharmacists.Monoamine oxidase inhibitors (MAOI): Potential adverse effects: Monitoring, prevention and management.Van den Eynde V, Gillman PK, Blackwell BB.The prescriber’s guide to the MAOI diet—Thinking through tyramine troubles.Psychopharmacol Bull. 2022;52(2):73-116.Edinoff AN, Swinford CR, Odisho AS, et al.Clinically relevant drug interactions with monoamine oxidase inhibitors.Health Psychol Res. 2022;10(4):39576. doi:10.52965/001c.39576Kennedy D, Webster WS, Hill M, Ritchie HE. Abnormal pregnancy outcome associated with high-dose maternal tranylcypromine therapy: Case report and literature review.Reprod Toxicol. 2017;69:146-149. doi:10.1016/j.reprotox.2017.02.012Bhat V, Kennedy SH.Recognition and management antidepressant discontinuation syndrome.J Psychiatry Neurosci. 2017;42(4):E7-E8. doi:10.1503/jpn.170022Rizkalla M, Kowalkowski B, Prozialeck WC.Antidepressant discontinuation syndrome: A common but underappreciated clinical problem.J Osteopath Med. 2020;120(3):174-178. doi:10.7556/jaoa.2020.030Fornaro M, Anastasia A, Valchera A, et al.The FDA “black box” warning on antidepressant suicide risk in young adults: More harm than benefits?Front Psychiatry. 2019;10:294. doi:10.3389/fpsyt.2019.00294

O’Connor AD, Mills KC.Monoamine oxidase inhibitors.Crit Care Toxic. 2016:1-18. doi:10.1007/978-3-319-20790-2_28-2

Cleveland Clinic.MAOIs (Monoamine oxidase inhibitors).

Cristancho MA, Thase ME.Critical appraisal of selegiline transdermal system for major depressive disorder.Exp Opin Drug Deliv. 2016;13(5):659-665. doi:10.1517/17425247.2016.1140145

National Library of Medicine.MAOA gene.

Cleveland Clinic.Serotonin.

Yamamoto K, Shinba T, Yoshii M.Psychiatric symptoms of noradrenergic dysfunction: a pathophysiological view.Psychiatry Clin Neurosci. 2014;68(1):1-20.  doi:10.1111/pcn.12126

Cassidy CM, Balsam PD, Weinstein JJ, et al.A perceptual inference mechanism for hallucinations linked to striatal dopamine.Curr Biol. 2018;28(4):503-514.e4.  doi:10.1016/j.cub.2017.12.059

American Association of Psychiatric Pharmacists.Monoamine oxidase inhibitors (MAOI): Potential adverse effects: Monitoring, prevention and management.

Van den Eynde V, Gillman PK, Blackwell BB.The prescriber’s guide to the MAOI diet—Thinking through tyramine troubles.Psychopharmacol Bull. 2022;52(2):73-116.

Edinoff AN, Swinford CR, Odisho AS, et al.Clinically relevant drug interactions with monoamine oxidase inhibitors.Health Psychol Res. 2022;10(4):39576. doi:10.52965/001c.39576

Kennedy D, Webster WS, Hill M, Ritchie HE. Abnormal pregnancy outcome associated with high-dose maternal tranylcypromine therapy: Case report and literature review.Reprod Toxicol. 2017;69:146-149. doi:10.1016/j.reprotox.2017.02.012

Bhat V, Kennedy SH.Recognition and management antidepressant discontinuation syndrome.J Psychiatry Neurosci. 2017;42(4):E7-E8. doi:10.1503/jpn.170022

Rizkalla M, Kowalkowski B, Prozialeck WC.Antidepressant discontinuation syndrome: A common but underappreciated clinical problem.J Osteopath Med. 2020;120(3):174-178. doi:10.7556/jaoa.2020.030

Fornaro M, Anastasia A, Valchera A, et al.The FDA “black box” warning on antidepressant suicide risk in young adults: More harm than benefits?Front Psychiatry. 2019;10:294. doi:10.3389/fpsyt.2019.00294

Kaplan H, Sadock B.Kaplan & Sadock’s Synopsis of Psychiatry, Eighth Edition.

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