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Monoamine oxidase inhibitors (MAOIs)

Safety concerns with MAOIs

MAOIs can cause dangerous interactions with certain foods and beverages. If you take MAOIs, you'll face dietary restrictions that require you to limit consumption of foods that contain a high level of tyramine, such as many cheeses, pickled foods, chocolates, certain meats, beer, wine, and alcohol-free or reduced-alcohol beer and wine. The interaction of tyramine with MAOIs can cause a dangerously high increase in blood pressure, which can lead to a stroke. Your doctor can give you a complete list of dietary restrictions.

Emsam may offer a way to avoid these dietary restrictions. At its lowest dose of 6 milligrams a day, you don't need to follow those dietary restrictions. At higher doses of Emsam, you do, though. Talk to your doctor or mental health provider to see if this may be an option for you.

MAOIs can also cause serious reactions when you take them while you're also taking certain other medications. Examples of medications to avoid include other antidepressants, certain pain medications such as tramadol (Ultram) and meperidine (Demerol) over-the-counter decongestants and herbal weight-loss products, and St. John's wort. Always check with your doctor or pharmacist before taking any new prescription medication, over-the-counter medication or supplement while taking MAOIs.

Serotonin syndrome and MAOIs

A rare but potentially life-threatening side effect of MAOIs is serotonin syndrome. This condition, characterized by dangerously high levels of serotonin in the brain, can occur when an MAOI interacts with another type of antidepressant called selective serotonin reuptake inhibitors (SSRIs). Because of this, don't take any MAOIs while you're taking any SSRIs or within two weeks of each other. Serotonin syndrome requires immediate medical treatment.

Signs and symptoms of serotonin syndrome include:

  • Confusion
  • Restlessness
  • Hallucinations
  • Extreme agitation
  • Fluctuations in blood pressure
  • Increased heart rate
  • Nausea and vomiting
  • Fever
  • Seizures
  • Coma

Stopping treatment with MAOIs

Discontinuation of MAOIs has been associated with nausea, vomiting and malaise. Rarely, discontinuation has caused an uncommon withdrawal syndrome involving vivid nightmares with agitation, psychosis and convulsions. The syndrome is treated with a low-dose MAOI and more gradual tapering off. Talk to your doctor before stopping treatment with MAOIs.

Suicidal feelings and MAOIs

In some cases, antidepressants may be associated with worsening symptoms of depression or suicidal thoughts or behavior in those ages 18 to 24. It's likely to occur in the first one to two months of treatment or when you change your dosage. Be sure to talk to your doctor about any changes in your symptoms. You may need more careful monitoring when beginning or changing treatment, or you may need to stop the medication if your symptoms worsen. Adults age 65 and older taking antidepressants have a decreased risk of suicidal thoughts.

To nix your irritability, sadness, guilt or anger, work with your doctor or a mental health provider in considering the use of MAOIs to work when other antidepressant medication types haven't. Feel good again.

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References
  1. Questions and answers on antidepressant use in children, adolescents, and adults. U.S. Food and Drug Administration. http://www.fda.gov/cder/drug/antidepressants/QA20070502.htm. Accessed Sept. 29, 2008.
  2. FDA proposes new warnings about suicidal thinking, behavior in young adults who take antidepressant medications. U.S. Food and Drug Administration. http://www.fda.gov/bbs/topics/NEWS/2007/NEW01624.html. Accessed Sept. 12, 2008.
  3. Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 25, 2008.
  4. Ultram (prescribing information). Mississaugo, Ontario, Canada: Biovail Corp.; 2007. http://www.ortho-mcneil.com/ortho-mcneil/shared/pi/ultramer.pdf. Accessed Oct. 5, 2008.
  5. Single interactions table. Micromedex Healthcare Series. http:www.micromedex.com. Accessed Oct. 14, 2008.
  6. Demerol (prescribing information). Bridgewater, N.J.: Sanofi-Aventis; 2007. http://products.sanofi-aventis.us/demerol/demerol.pdf. Accessed Oct. 15, 2005.
  7. Single interactions table. Micromedex Healthcare Series. http:www.micromedex.com. Accessed Oct. 14, 2008.
  8. Monoamine oxidase inhibitors. Drug Facts & Comparisons. http://online.factsandcomparisons.com/MonoDisp.aspx?monoID=fandc-hcp11283&inProdGen=true&quick=monoamine%20oxidase%20inhibitors&search=monoamine%20oxidase%20inhibitors. Accessed Oct. 21, 2008.
  9. Nardil (prescribing information). New York, N.Y.: Pfizer; 2007. http://media.pfizer.com/files/products/uspi_nardil.pdf. Accessed Oct. 21, 2008.
  10. Antidepressants: Selecting one that's right for you. MayoClinic.com. http://www.mayoclinic.com/health/antidepressants/HQ01069. Accessed Oct. 16, 2008.

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