Monoamine oxidase inhibitors (MAOIs) for social anxiety disorder

Examples

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Brand Name	Chemical Name
Marplan	isocarboxazid

Brand Name	Chemical Name
Nardil	phenelzine sulfate

Brand Name	Chemical Name
Parnate	tranylcypromine sulfate

How It Works

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These medications balance certain brain chemicals (neurotransmitters). When these brain chemicals are in proper balance, the symptoms of anxiety are reduced. Monoamine oxidase inhibitors do this by reducing the amount of monoamine oxidase, the substance that breaks down the neurotransmitters.

Why It Is Used

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Monoamine oxidase inhibitors (MAOIs) usually are not the first medications given for anxiety because they have serious side effects when combined with certain foods and/or medications. They are usually given to people with anxiety who:

• Did not get better with other antidepressants.
• Cannot tolerate the side effects of other antidepressants.
• Have a family or personal history of successful treatment with MAOIs.
• Have unusual depression or anxiety symptoms.

When these drugs are not recommended

MAOIs are not recommended for children or teens.

How Well It Works

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Current research suggests that MAOIs may be less effective than other antidepressants (such as tricyclics) in treating anxiety disorders or major depressive illness.¹ However, MAOIs are still the treatment of choice in cases of anxiety or depression with unusual features, such as a heavy feeling in the arms and legs, sensitivity to rejection, and a reactive mood. MAOIs are often used as an alternative treatment for anxiety or depression that has not responded to other medications.

Side Effects

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Side effects of MAOIs include:

• Difficulty getting to sleep.
• Dizziness, lightheadedness, and fainting.
• Dry mouth, blurred vision, and appetite changes.
• High blood pressure and changes in heart rate and rhythm.
• Muscle twitching and feelings of restlessness.
• Loss of sexual desire or ability.
• Weight gain.
• Negative interactions with other medications and some foods.

FDA Advisory. The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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People who are taking MAOIs need to avoid eating certain foods, such as some cheeses, broad beans like fava beans, pickled foods like sauerkraut, and red wine. Eating these foods can cause dangerously high blood pressure.

People who take MAOIs also need to avoid some nonprescription medications, particularly certain cold remedies and diet pills.

People who stop taking MAOIs need to wait at least 14 days before taking another antidepressant.

MAOIs can cause death if they are combined with certain foods, taken with certain medications, or taken as an overdose. Talk with your health professional about diet and medication restrictions you need to follow if you are planning to take an MAOI.

MAOIs are not recommended for children or teens.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Doris A, et al. (1999). Depressive illness. Lancet, 354: 1369–1375.

Credits

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Author	Jeannette Curtis
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Denele Ivins
Associate Editor	Pat Truman
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Lisa S. Weinstock, MD - Psychiatry
Last Updated	August 27, 2007