What Are MAO Inhibitors?
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MAO Inhibitors for Depression
If you have ever looked at the warnings on the back of a cough/cold product you may have run across something like this: "Do not take if you are currently using an MAO inhibitor." An MAO what? This article briefly describes the MAO inhibitor family of prescription medications and explains some of the serious and potentially life-threatening drug interactions that can occur when taking one of these drugs.
MAO stands for Monoamine Oxidase, which is an enzyme responsible for metabolizing neurotransmitors such as seratonin and norepinephrine. This family of prescription medications are used primarily for treating depression, although one MAO Inhibitor, selegeline, is used to treat Parkinson's Disease.
The 4 MAO Inhibitors currently available and used to treat depression are:
- Isocarboxazid (Brand name Marplan)
- Phenelzine (Brand name Nardil)
- Tranylcypromine (Brand name Parnate)
- Selegeline (Brand name Emsam, a transdermal patch)
MAO inhibitors are only available by prescription.
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How Do MAO Inhibitors Work?
MAO Inhibitors (also called MAOI's) work by interfering with the enzyme responsible for metabolizing seratonin, epinephrine, dopamine and norepinephrine. By binding to this enzyme they effectively increase the concentration of these neurotransmitters which in turn causes changes within specific areas of the CNS (central nervous system). These changes have been shown to result in a decrease in symptoms associated with depression.
I like to illustrate it this way: Neurotransmiters are like mental mail carriers. Monoamine oxidase is like a big scary watch-dog that keeps eating the mail carriers and thus keeping him from delivering your mail! MAOI's are like a nice big juicy bone that we give to the dog to keep him busy and distracted so that the mail carrier can do his work. Did that make sense? It is a bit over-simplified for sure, but it gives you a rough (or should I say "ruff ruff"?) idea of how MAO inhibitors work.
MAO Inhibitor Warning
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What Risks are Associated with MAO Inhibitors?
MAO Inhibitors do a good job preventing MAO from metabolizing these important neurotransmiters. However, they are so effective, that they can also create problems, particularly with certain over-the-counter cold remedies and specific food items.
Medications to Avoid:
Because MAO Inhibitors increase norepinephrine (a powerful blood vessel constrictor) it is important that patients taking one of these products do NOT ingest any other medication which could potentially increase norepinephrine levels even further. The consequences of such a combination could be, in some cases, fatal. Such medications include:
- Pseudoephedrine (A nasal decongestant, now only available "behind the counter" in a pharmacy, but very commonly included in cold remedies)
- Phenylephrine (A decongestant used in place of pseudoephedrine in many cough/cold products)
- Amphetamine or Dextroamphetamine (Often used, by prescription, to treat ADHD)
- Naphazoline and Oxymetazoline (In nasal sprays)
- Isometheptene (ingredient in the prescription drug Migranal)
- Methylphenidate (also known as Ritalin)
- Meperidine (the ingredient in prescription Demerol, for pain)
- Eye drops with decongestants should also be avoided.
This list is not comprehensive, but covers some of the most significant culprits. Be sure to read labels carefully if you are currently taking an MAOI. Be especially careful about taking herbal products that may have stimulants in them. Because of these risks, MAO inhibitors are not used as frequently today as they had been in the past.
SOME OTHER PHARMACY ARTICLES
- The Best Websites for Drug Information Research
One would think, in the age of Google and Yahoo, doing research on your prescription or OTC (over the counter) medication would be simple. Just punch in your drug name...and TADA...up pops the most useful,... - What are SSRIs?
What is an SSRI? SSRI stands for - Oxycontin, Percocet and Vicodin Information
Maybe the title of this article seems a bit strange to you. Why would I write about Oxycontin, Percocet and Vicodin information?For those who are only infrequently acquainted with pain, or who have never had...
FOODS to Avoid
Monoamine oxidase also exists in our intestinal tract and aids in the break down of a substance known as Tyramine. MAO inhibitors interfere with this process, and will allow large amounts of Tyramine (from foods or beverages containing tyramine) to enter the the blood stream and contribute to a sequence of events that could lead to a hypertensive crisis (ie a very dramatic, potentially fatal, elevation of the blood pressure).
Therefore, patients on MAO inhibitors must completely avoid foods and beverages which contain significant amounts of tyramine. These include, but are not limited to:
- Aged cheese and meats
- Smoked meats or pickled meats
- Liver
- Anchovies
- Sauerkraut
- Avacado
- Bananas
- Pepperoni
- Salami
- Raisons
- Caffeine should be used sparingly
- Avoid wine, sherry, beer, and hard liquor.
Note, patients must wait for 14 days following discontinuation of an MAO inhibitor before they can safely consume any of these foods.
For More Information
For more information on MAO Inhibitors, Side-Effects, or Manufacturer's guidelines, see the following links:
EMSAM (patch) Manufacturer's Website
Marplan by Validus Pharmaceuticals
Parnate Prescribing Information
For information on another class of medications used for depression, known as SSRIs, CLICK HERE.
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I am wondering what state you are in where you were maltreated by a workmens compensation doctor. I've found that in my state, their doctors are all vested in kicking you off the program and back to work or worse--as long as you are not on the payroll so to speak.
is it safe to take wellbutrin with a cold medicine
Hi Jannygirl,
I always recommend people check with their own doctor or pharmacist since they will have the most complete picture of your medication profile and conditions. Do that.
But generally speaking it is safe, though it could result in additional drowsiness. So it should never be done if driving is necessary, and never mixed with alcohol. Best to avoid the ingredient for cough known as "dextromethorphan" since it 'could' contribute to something called "seratonin syndrom.'
As a side note, since this is an MAO inhibitor article, Wellbutring should NEVER be combined with MAO inhibitors. Thats bad!
Take care,
Jason
Your did a great job in explaining MAO inhibitors.
Thanks Triplet!
great article, i'm a pharmacy student and i enjoyed reading it.
Hi Taky Dine,
Glad you enjoyed it. Best wishes in pharmacy school!
Jason
I've had a head ache for 10 days now. I went to my family Dr. for it and he said since I take lexapro I can't take the migrane meds such as maxalt and such. Why is this? I have a dr. apt. with neurolgy at the end of the month, that is the soonest they can get me in. MY head goes from dull throb to blind searing.
Hi Sherry,
The combination has sometimes caused an interaction leading to "seratonin syndrom" which can be, in rare instances, life threatening. From a medical site I have access to: "Serotonin syndrome consists of symptoms such as mental status changes (e.g., agitation, confusion, hallucinations), diaphoresis, hyperreflexia, hypertension, diarrhea, fever, tremor, and, in some instances, respiratory failure."
So, basically, its BAD! If the Lexapro cannot be avoided, then you will have to discuss other headache therapies such as preventatives (like beta blockers) and other forms of pain relievers.
Best wishes,
Jason
I have been on Parnate for over 25 years with no side effects whatsoever. I am able to consume everything on the list of products to avoid. Having said that I scheduled for my first Colostomy and will be placed under general anesthesia. Should I be concerned as to any side effect of Parnate with any anesthesia.
Hi Jim,
It is VERY important that your doctor is aware that you take Parnate prior to the use of general anesthesia. They will need to carefully avoid medications which may cause a drug interaction with Parnate.
Thanks for a very good question!
Interesting that you can consume those items on the list. Every rule has its exceptions...and apparently you are the exception to this rule! :)
Jason
Please I need to know which MAOI would be best to take. I have had severe treatment resistant depression for over twenty five years. Started at age twelve. I have literally been on every single medication that is out there for depression. Sometimes they worked for a little while but they always stopped working. I have been on many at the same time. I have tried a lot of them again over the years in the hope that "maybe it will work this time." I had ECT also which did not help. I also had TMS which did not help. I was going to get VNS, I even met with the surgeon, but I cannot afford it. I am going to try either Marplan, Nardil, or Parnate. I do not understand why none of the doctors which are too many to count never mentioned the option of these meds. I would do anything for relief. I can adhere to not eating what is on the list of what not to eat. Any advice would be greatly appreciated. Thank you, Lorraine
Hi Lorraine,
I have not read any study showing significant advantages of one MAOI over another. Parnate is available generically, so that would be my first choice personally.
Also, consider discussing with your doctor something called "augmentation" which is the use of another drug to improve the effectiveness of the first. Sometimes Geodon has been used to augment the effectiveness of anti-depressants.
It appears you have seen many doctors, but don't give up on seeing other specialists,especially on the advice of others in a similar situation.
Finally, continue to look into non-pharmacological approaches like counseling, spiritual direction, and support groups.
Hope this helps. Best wishes,
Jason
last 8 yrs i have been prescribed oxycontin 80mg x 2 per day
plus 20mg oxynorm once per day for breakthrough pain.primary
pain is from thoracic spine joints with compression at T2/3
my problem is that the oxycontin effect lasts only 8 hours
and then i suffer sweating,leg muscle pain,yawning and pain
which seems to be "withdrawal" symptons.this happens each
12 hr cycle.my doctor will not increase my doses of Oxycontin or oxycodone but added 30mgx1per day Cymbalta
I immediately suffered nausea,dizziness and a massive feeling of unwellness.
Could there be some unwanted reaction between these drugs
your suggestion would be appreciated
Hi Barry,
Sounds like a difficult case, and of course your own doctor is in the best position to advise you on some of these things. The effects you experienced with Cymbalta are not unusual, and could simply be side effects from the drug, and not related to any sort of drug interaction. Nausea is a problem in about 25% of Cymbalta users. That is pretty high.
One possible suggestion would be to see if your doctor would consent to a lower Oxyontin dose, but to authorize takinig it 3 times daily. Like 60mg 3 times daily. The total daily dose wouldn't be that much different, but it might reduce the withdrawl symptoms you are experiencing.
The other thing I always tell people is that you can always get another opinion or see another doctor. The best of men (or women) are men at best. Your doctor may not have the right answers for your case. Be open and honest with your doctor and see what they say. Best wishes.
is it safe to take prozac & efexer xl both at same time
helloo. Enjoyed reading the article. I am detoxing off methadone and was wondering if there was something I could take to help my brain control all of my "happy hormones" as I call them. I know methadone attaches to the transmitters and my body no longer does certain things on its on. Can you suggest anything to help?
Hi Cindy,
Well, your best bet is always to check with your own doctor who knows your whole medical profile and history. Various medications have been used to help with methadone detox. Clonidine, Vistaril, Suboxone, others. I want to commend you for your efforts and hope it goes well for you.
Jason
Nardil saved my life many many years ago during a major depressive episode that didn't respond to any other medication on the market back then. Of course, now we have so many more choices. After about three weeks on Nardil, I told my doctor "I can hear the birds singing"! That is how clear things were while on Nardil & I believe it saved my life. However, I had to be VERY strict with my diet and what I ate..what OTC meds I took, etc. One time I accidentally ate a SMALL piece of Kilbasa and I ended up with a horrible headache (prob due to high BP). Thank God it went away and I was fine..but if you are on one of these drugs..from my experience it DOES work and very well..but you have to stick by strict guidelines about the food and drug interactions. Good luck :)
Sunny,
Thanks for sharing your story! Very good advice.
Sincerely,
Jason
Louis,
As for taking Prozac and Effexor XR together, there is very little research that I know of which would suggest that this combination is safe and/or effective. I know it seems rational that if they both work a little...then together they would work better. But that is not always the case with drugs, as there is a sort of "threshold" of effectiveness that we often reach. Also, you would be combining and increasing the potential for side effects, some of which could be serious. I think the safest approach is to stay with one drug that you tolerate, increase the dose to the maximum (slowly..and with your doctor's direction), and then be patient and give them time. If this doesn't work, then consider tapering off and going on to try a different medication. Very good question!! Thanks for asking!
Jason
This is SO THOROUGH and HELPFUL!! very very interesting to me.
Carleyj,
Thanks for the kind words! Glad you found the information useful.
Jason
HI THERE, IT SAFE TO TAKE XANAX AND CITALOPRAM AT THE SAME TIME?
Hi Yarsema,
Citalopram (brand name Celexa, an SSRI) and Xanax (aka alprazolam, a benzodiazepine)can be used together, but a person must be aware that side effects of both may be magnified (drowsiness, dizziness) and so caution should be used, especially when having to drive or operate machinery. Alcohol should be avoided if possible, and Grapefruit juice should be avoided with xanax in particular.
Great question!
Hi,
Nice article. I wanted to know whether MAOI inhibitors inteact with valtrex???
Hi Nadine,
There are no reported interactions between any of the available MAO inhibitors and Valtrex that I am aware of. Although each drug can interact with several other drugs, foods, or OTC products. So be sure to read all the material before taking them. Thanks!
Are there any natural MAO inhibitors?
dh,
Good question. I have found some resources that suggest that natural MAOIs are present to some degree in products like yohimbine, nutmeg, St. John's Wort, and others. However, I do not know of any study suggesting they are present in "clinically significant" amounts. The prescription products are likely to be a more reliable and consistent approach, if they are needed. Thanks for the great question!
I have been taking imitex shots for 3 years now for my migraines. I helps reduce swelling and I can funtion for serveral days . However, it does not always work. I would like to fix the problem and find out what is causing the migraines. Do you have any solutions as they dictate my every day living?
Hi Ann,
Sorry to hear about the migraines you suffer from. As you know, there is no real cure for Migraines, although there are medications that may reduce the frequency and can be used for prevention. Things like propranlol or Depakote ER have been used. Also, obviously avoiding anything that triggers them is important. There are other "triptans" on the market now, aside from Imitrex, so they may be worth talking to your MD about. If you can, see a specialist, and always consider getting more than 1 opinion. Best wishes!
Hi pharmacist,
My doc put me on Jumex (5mg) (Selegiline) for depression. (Jumex is what we have here). He says it is a test dose to see how well I put up with MAOI inhibitors and if all goes well he'll switch to Tranylcypromine. Is this a correct approach. He refuses to start with Tranylcypromine, saying he has to see the results with Selegiline first. Would you please tell whether Selegiline is as effective as Tranylcypromine and whether there can be a switch from one to the other at a later stage. Also are you supposed to give a break before starting with Tranylcypromine. Thanks in advance.
Hi Guest,
I believe Jumex (not available as such in the US) is actually indicated for Parkinson's Disease only, although it is the same ingredient as in Emsam, the patch for depression. I am guessing that your doctor had samples of Jumex to give you, and therefore preferred to start with those. It could be argued that selegeline is safer, since it has a somewhat lower possibility of food related interactions. But switching to tranylcypromine is perfectly safe, no break would be needed, but you should be even more careful about the food restrictions as mentioned in this article. Thanks for reading and for the question!
Is there any connection between pain medication such as Fenta 12 (fentanyl transdermal patch) and MAO Inhibitors? Do pain medications work anything similar to medications for depression?
shlo,
That is a great question. The answer isn't easy. They have different "mechanisms." That is, they effect different processes and receptors in our body. However, that said, they may have very similar side-effects and may have some cross benefits. For example, imagine a person is in pain...leading to depression. Treating the pain ultimately helps relieve the depression too! So, they have some common areas, but they work in very different ways. I wrote an article on "researching" drugs which may lead you to some sites with more answers: http://hubpages.com/hub/The-Best-Websites-for-Drug
Is Parnate contraindicated in people who have headaches esp migraines?? If yes, what are other non-selective MAOIs for such people. Thanks for taking time out.
Hi lq,
Generally Parnate should not be taken by those who suffer from chronic headaches or migraines. Here is why: Headache is one of the first symptoms that a VERY serious side-effect from Parnate may be starting. Those with frequent headaches anyway...are less likely to distinguish this side effect from their normal heachache problem. Also, "triptans" (a family of drugs for migraines) cannot be used with MAOI's.
HOWEVER...sometimes Parnate IS used to prevent chronic headache and/or migraines. Patients would be carefully watched and selected for this approach. Here is a good article on the use of Parnate for headache: http://www.headachedrugs.com/archives/migraine_pre
Hi Pharmacist Jason. Thanks for helping us with your clear answers. I am enjoying reading your constructive comments. Please, keep doing your great good works.
Here is my question: Does the list of "food to avoid" having the same effects on Prozac and other SSRI drugs?
Thank You
Hi Paul,
Very good question. The answer is "no." MAOI's can prevent the breakdown of Tyramine in foods. SSRI's do not. Therefore these foods are perfectly safe with SSRI's. Here is an article I wrote on SSRI's: http://hubpages.com/hub/What-are-SSRIs
Thanks for the kind words also! Glad to be of help.
IS IT POSIBLE TO GET A SIDE EFFECT,FROM TAKING AN ANTI DPRESSANT,,LIKE HIVES AFTER DRINKING BEER,,THATS WHATS HAPPENING TO ME,,DRANK FOR 20 YEARS NO PROBLEM UNTIL Y WAS PUT ON THAT DRUG,,,,NOT A HEAVY DRINKER ONLY AT WEEKNDS I DRINK,,BUT NOT ANYMORE AFTER GETTING HIVES,,ANY HELP WOULD BE GREAR THANKS,,
Hi MR,J,
MAO Inhibitors should not be mixed with alcohol ever. Other antidepressants, when mixed with alcohol, may just cause severe drowsiness, dizziness or nausea. Hives can be caused by many things, but should not be ignored. Avoid whatever seems to be triggering it (alcohol) and speak to your doctor about it soon. Best wishes!
hy, pharmacist,,thanks for youre reply, what i was trying to say is that it happened after i stoped the anty depressants, started getting the hives after having just one beer,,never mixed them together,,and thats the only thing i ever took,,always been a healthy person,,thanks again,,,
For those who are on antidepressants, please go see a nutritionist. They can do hair samples to see what vitamins you are lacking and then you are prescribed the vitamins to help replenish your system. Serotonin and dopamine levels can be detected too and can be raised with vitamins. Please go see a nutritionist - I was very depressed a few years ago, had major anxiety, and was too scared to go on antidepressants (I was seeing a therapist and she insisted I go on them but I refused because I have seen loved ones have major difficulties on meds). As a last resort I went to a nutritonist and now I am MUCH better. It took time to get better(about 8 months to a year) but I believe depression/anxiety can be helped/cured naturally. If you don't want to go to one, look up magnesium levels and depression. Also, adrenal glands and depression. Talk to your primary care doctor about going on vitamin supplements that could help with depression. Please just try it.
Oh, and about ten years ago I had panic attacks that were so bad I went to the hospital a few times. Again, no meds because I was scared but the one thing that did work for me was this program called Attacking Anxiety. It is not cheap but it was a last resort and for whatever reason it worked for me. I was able to learn how to control my panic attacks. I just want to offer adivce and help whomever I can.
Hi anon2,
Thanks for sharing! I firmly believe we are far too complicated to expect any one approach to be equally effective for everyone. To quote a favorite verse, we are "fearfully and wonderfully made." Nutritional therapy may be an excellent choice for many folks. I write about medicine...because that is what my training and education involve. Though I am at best still a novice...
Thanks again!
I've read that Selegiline at higher doses acts as a non-selective MAOI Inhibitor very much like parnate. Is this correct? If yes, how high is this dosage and how similar are Parnate and Selegiline in their action in such a situation??? Thanks.
Hi Arni,
Sounds like a good exam question! Yes, I believe you are correct. At anti-depressant dosing levels, selegiline inhibits both. The exact dose at which this transition becomes significant depends on the route of administration. Orally, probably around 10mg or more. Transdermally or sublingually would be lower, I'm guessing 2.5 to 5mg. Yes, at such doses, selegiline and Parnate become similar, inhibiting both MAO-A and MAO-B.
what an absolutely fascinating article and Q&A. how cool of you : )
So, I was reading and a writin' on an another site about how tobacco smoking affected me and how it must have been the dopamine (I switched to an electronic cigarette and smoke fairly minimally anyway and I no longer inhale smoke which is great but thats not the point - just recognizing that its not healthy blah blah blah). I was having a discussion about how I felt after smoking a cigarette and how the tension in my body disappears to the point that I often stretch afterward because I am able to readily and its one of the few times my body isnt tense due to the turbo mode state my brain is typically in. I've been captain ADD since I was but a wee chiddren and its no different now. I hate it! it has its upsides in terms of creativity etc but mostly its highly highly frustrating and I have read that peeps with ADD have low dopamine levels. I then read about Monoamine Oxidase and how it breaks down dopamine among other neurotransmitters. I take adderall very rarely because I have a hard time justifying taking amphetamines even though my brain does slow down and it is very effective. I am curious about trying Parnate and I dont drink so that part is easy - the foods-to-avoid list looked doable and I do not rely on caffeine. So, my question is this - does Parnate (only just found out about it on this site as I started researching MAOI's) come in a table form that I could break into pieces and start with a tiny dose? Are there other ways to increase my dopamine? I know SSRI's exist obviously but do SDRI's exist? and of course, can that been done naturally? I fight being productive every day of my life because my brain DOES NOT SLOW DOWN. I am a very healthy eater too and avoid preservatives (sodium nitrate/nitrite), trans fat, soy, sugars (gotta a large sweet tooth that's more like a rhino horn so I fall off the wagon with the sweet thing) but I exercise regularly and am in otherwise great shape. any suggestions/help would be so very much appreciated. Thanks again!!
AR
I forgot mention that smoking affects my brain the same way it affects my body - some much more at ease and able to focus. A good comparison is how you find your engine revving very high and then look down and realize you had it in first gear instead of drive (for you automatic driver folks) and then switch it to drive and all of a sudden its smooooth sailin. thats how it affects me - dopamine?
And btw, here's a snippet of the article
"Tobacco smoke contains the monoamine oxidase inhibitors harman, norharman,[18] anabasine, anatabine, and nornicotine. These compounds significantly decrease MAO activity in smokers.[18][19] MAO enzymes break down monoaminergic neurotransmitters such as dopamine, norepinephrine, and serotonin."
Thanks for your answer. If Selegiline (at higher doses) and Parnate act in a similar fashion, why is it that Parnate is a more 'dreaded' antidepressant. Selegiline doesn't mess up the sex drive in a way Parnate possibly can. Also I've read comments by Parnate users on forums who point out that Parnate is a more habit-forming medication and it also interferes with the sex drive etc. Surely there got to be some difference between how the two antidepressants act?
Sorry for bothering you again.
Hi Ar,
Long question. Here are some quick answers:
1) Yes, Parnate comes in tablet form
2) Yes, there are drugs that boost dopamine. These are primarily used for Parkinson's Disease or RLS (restless leg syndrom). Drugs like Sinemet or Requip.
3) Note: Parnate is not approved for ADD/ADHD so experimenting for this indication may not be a good idea. Just my thoughs. Best wishes!!
Hi Arni,
No bother. Good questions. I'm not sure why Parnate is more "dreaded." Could just be that it has been around longer, and so more people have encountered it. The hard part about talking about the "differences" between drugs is that it is more complicated than just their structure or chemistry. So much depends upon individual patient response. I have had patients praise a drug as a "life saver" for them, and the same drugs is an absolute failure for someone else with the same condition. Hope you find some good answers. Best wishes!
I am concern because i was taking another brand for zoloft but the dr. change it because it cut down the effectiveness of my cancer medication "tamoxifen" now they put me on efexor but the other name for it..and I am concern about if I should take it or not. Honestly I am scared and nervous because I have stop taken the zoloft gradually meaning every other day and now its been almost 3 days I haven't take it. I have been dizzy for almost a week and I am tired and scared that if I start the efexor I might feel worst referring to dizziness and headaches and even nausea. What do you think? should I wait another week or so before starting the efexor or should I start now.? I am traveling on friday out of the country and I really am scared to take the efexor not knowing what the reaction might be since I am so sensitive to medication..by the way the dosage for the effexor is 37 miligrams once a day.
Will anyone taking MAOIs test positive in drug testing? Highly appreciate your response.
Doug,
Selegeline, the ingredient in Emsam patches, has been reportedly responsible for false-positives on a drug screen. I do not know for sure if any of the others have been shown to do this. Other anti-depressants like Wellbutrin or tricyclics (like Elavil) have been reported as causing false positives. If you have experienced such a situation with an MAOI, you may want to contact the manufacturer and see if they have any literature to support this. It would help in your attempt to prove it was the MAOI. Best wishes. By the way, here is a link with a list of possible "false positive" producing drugs. I have not confirmed all the sources, but I pass it along for what it is worth: http://www.askdocweb.com/falsepositives.html
Ada,
I've been on vacation, so I am sorry for the delayed reply. Of course, there are always risks and concerns whenever you start a new medication, and when traveling this can be a problem. However, not starting a medication which you need can also be problematic. It may be best, in this case, to get some feedback from the prescriber about your concerns and your travel plans. Best wishes,
Jason
Can I give my 10 year old daughter who is on 75mg a day an over the counter decongestant?
Mooma,
Decongestants and MAO inhibitors are not safe to be used together. Of course, if by "75mg" you mean something else...then that may be a different story. Always best to check with your pediatrician, because there are sometimes more issues involved in a recommendation than simply the possible medication conflicts. Thanks for reading and asking!
can i smoke pot if i take lexapro?
Bob - Ummm...only prescription strength pot. LOL.
I have a question for you about a depression med I was taking. I was currently taking Zoloft and seraquel (to sleep) it caused very disturbing thoughts and hallucinations. My doctor seemed very surprised when I told her and said it was rare. She could tell I was very scared to take this medication anymore and took me off of both. I am now prescribed remeron but I am scared to take it because I am worried the same thing will happen again. I am not really a depressed person, I have more anxiety issues and agression. Everything I read about remeron is related to depession. Can this medication be used for anxiety?
Hi Heather,
I understand your concern about the bad dreams. Remeron (also called "mirtazapine") is "officially" only approved to treat depression. However...there have been studies done to suggest it is also effective for symptoms of anxiety. Often such studies are encouraging enough for doctors to rely on. Hence, they will prescribe Remeron for anxiety even though the FDA has not yet officially approved the medicine for this use. Remeron is unique, and so there is a good chance you will not have the same response to this medication. My advice is to follow the doctor's recommendation and give it a try. Best wishes!
Hey a little bit about my medical history.. in the past couple months I have been light headed, dizzy spells, came close to fainting, pressure in my head, reguler headaches ... etc. At first my doctor said I had slow blood pressure and needed to drink lots of water. Well my blood pressure has been normal and all the same symptoms keep happening. I recently had presssure in my head, slurred words and blurred vision. My doctor ran numerous tests on me to find I am one healthy young lady. We just recently dicussed anxiety and stress. He believes alot of my problems are a result of that. So he put me on an antidepressany Venlafaxine. I am nervous about taking new medication. I just recently had a family pass due to the reaction he had with Perkaset. The thought of side effects really freaks me out. I am currently taking amoxicillian and ibuprfren for ear and throat infection. I was told it's ok to mix the amoxicillian and Venlafaxine but I am just scared to take the antidepressent in general. Is it normal to be worried? And if I do end up taking it, can you drink alcohol while on it?
Hi Linds,
It is normal to be anxious about a new medication. In fact...it is quite healthy and appropriate to be cautious about any medicine! You are a good patient to ask questions and seek answers. Well done! The doctor likely has started you on a low dose. Venlafaxine has been around a long time. Read the paperwork that came with it about what to avoid. Alcohol is best avoided, especially while starting it. Once you have adjusted well to the medicine, you can talk to your doctor about the safety of having an occasional drink. Best wishes!
I have been going through a lot of emotional issues for the past two years. An incident happened at the end of June that I guess you can say, put me over the edge. Since then I have been off of work. I see my family doctor every two weeks and I see a psychiatrist monthly. I have been to a counsellor and am going to do group therapy.
The diagnosis was anxiety/depression/PDS. I started off with Ativan for the anxiety (5mg), Ziplicone (7.5 mg) for sleep, and Cipralex for the depression. I also take Synthroid and atacand. I had a very bad reaction to the cipralex so I was put on Cymbalta (90 mg). This seems to work, but I cant sleep. The most I get is 3 hours straight through the night. To help with this I was put on Gabapentine as a mood stabilizer. Still nothing. So last week my doctor took me off the Gabapentine and put me on Wellbutrin XL (300 mg). So now I take the Cymbalta and Wellbutrin. My question is this: is the point of the medication to get your life back or to just not want to take your life anymore. I find I just exist, I have no social life and dont want one. I cant sleep and I dont know what to do anymore. Any suggestions would be greatly appreciated.
Dear Frustrated,
First, I am very sorry for the frustrations you have encountered. Clearly you are taking very intellegent steps to seek medical help, and I do hope that you notice improvements. I'm afraid I can only answer your question in a very incomplete fashion.
The goal is to improve life quality. The amount of time it takes will vary greatly between patients. Please give the Wellbutrin some time, as this was just started a week ago.
It would be unrealistic for me to offer any substantial help or advice without much more information. I will just say 1 thing. Remember that feelings are just feelings. That's it. They may be very strong, but they are just feelings. What I tell people is that they need to begin doing the things they used to enjoy, or wish they could enjoy...in spite of the feelings that are absent. What kind of person would you want to be, if your feelings and emotions cooperated? Be that person, do what they would do, and for now...ignore the fact that the feelings are not there. For some...it has worked wonders.
Best wishes,
Jason
Thanks for sharing information.
I have been taking Xanax for over 4y, because I have very stressful lifestyle and have stomach problems. Every time I get too excited my stomach start producing too much acid, which caused me 3 ulcers in the past and many other stomach problems. My doctor gave me Xanax to calm down the stress in those kinds of moments, but not paying attention how addictive and bad Xanax is for you, I have been taking it for more than 4y. Now when I want to stop it, my psychiatrist gave me Seraquil RX 50mg. I have not felt any relive from the Seraquil at all yet, and I have been taking it for almost a month. What do you suggest I should try for treating anxiety an also getting me off the Xanax?? My life style is very stressful as I mentioned earlier and I can’t stop taking Xanax, plus I can’t just change my lifestyle, because of the problem with taking and wanted to stop the Xanax. Please advice.
Hi Nick,
Getting off the xanax AND treating your anxiety are separate issues. Each one needs a plan. For the anxiety, you will need a good combination of behavioral coping techniques and possibly medication. Buspar is an option the doctor might consider. As for the Xanax, you will need to slowly taper off while implementing the other plan. Stress is challenging because each person handles it differently. From my counseling training I remember that stress is sometimes the result of other unresolved issues...not simply lifestyle issues. Think about that. Hope you get the help you need! Very sincerely,
Jason
I have a quick question. Surprised that no one has asked it. I have recently been prescribed to Ritalin(methylphenidate), not adderall (amphetamine). I am 21, so I am not a child. I was curious if the Ginseng Complex (1000mg), could be taken in conjunction with Ritalin, as I do not want to mix the two if I will die.
i got good knowledge from this article. thank you very much
Chris P,
Personally I would not want to mix a stimulant like methylphenidate with an herbal stimulant like Ginseng. There are no well-documented serious interactions that I could find. But I just would not be comfortable with the combination. My advice is to not do it.
I have just been diagnosed with social anxiety have had this since i was 15 over the years it has got worse all the anti depressants ive tried have made me feel worse i have recently been put on efexor-xr this one so far has been the best with less side effects i started on 37.5mg for 2 wks now doc has increased dose to 75mg i am also taking 10mg of deralin 3 times a day always unmotivated dont want to do any thing or see anyone having panic attacks all through out the day nervous and paranoid all the time not coping feeling really down and depressed cant work yet cause im too mentally unstable want to be happy and live a normal life for once do you think efexor-xr will benefit me or should i try MAOIs
Kez,
I would stick with the Effexor XR for now. MAO-I drugs are typically only used when most other alternatives have failed. I hope you get well soon!
Jason
My doctor has suggested I start taking St. Johns Wort three times a day. Now I have read that it has MAO inhibitors. Does this mean if I take St. Johns Wort that I can't eat bananas and should avoid decongestants while I am on it?
Hi Tanya,
I'm afraid not much is really known about exactly how St. John's Wort works as an antidepressant. It is probably a weak MAO inhibitor. I would avoid decongestants, but banana's are probably fine.
Hi there from Czech republic!
I would like to thank you for your great work on explaining the problem in understandable form, which I didn´t find in my language. The reason why I started to be interested in the MAO issue is yohimbe - old tribal natural drug used for its significant afrodisiacal effect.But it counts as a MAO inhibitor, which is not allowed to be combined with alcohol. I have read that it was used also during the "sexual revolution" in sixties and seventies. That makes me wonder. Did the flower children use this drug and really avoid all others? Is it really so dangerous? I would like to find out if this is more like recomandation what you better shouldn´t do or is the cobination with alcohol really life threatening? Thank you for your answer!
Jan, Prague-Czech republic
Thanks for the response! I lost this article or I would have thanked you sooner. I am not an abuser, nor do I have an addiction, so I will follow your advice.
really very useful information you sharing you did a wonderful job..
Are there any side effects if im taking lyrica and lexapro together.
Hi darlene,
These medication are safe to use together, although you may notice some additional drowsiness, particularly when just beginning one or the other. Best wishes!
I took alchol with my 25mg of Trazodone and it work better, is that unusual
Hi there - I'm on Cymbalta for MDD. But I don't show normal signs for it. I eat a lot more, sleep a lot more, and feel very vulnerable. I read an article talking about "atypical depression" and how MAOIs are very good for that. Should I consider switching?
Is it safe to take flexeril and synthroid at the same time.
Hi Tom,
Yes, MAOI's can be used for atypcial depression, or depression without melancholia. However, the choice to switch to a MAOI should be done carefully. As this article explains, they have several concerning side-effects that must be considered. I'm not sure how long you have been on Cymbalta, but I would suggest you give it a good try (8-10 weeks) before talking to your doctor about other options. Best wishes!
Hi jada,
Yes, they may be taken together. Remember that synthroid is best taken on an empty stomach without food. Flexeril may be taken with our without food, but if taken with Synthroid, must be on an empty stomach.
Just reading some of these comments and questions that involve migraine headaches. I suffered from migraines for years and had an alergic reaction to imitrex so there was very little I could do. I had every test imaginable ran and finally found that I have a B12 deficiency. (So low that I wasn't even in normal range) I have been on B12 injections for about 4 years now with not the first migraine. Just a suggestion for those suffering from migraines - have your B12 level checked.
SCrossinTN,
Great advice. B12 deficiency can cause headaches/migraines. Glad they got it figured out for you!
Dear pharmacist, Okay I have suffered sever depression for 15 years I have taken every type of med. Effexor has seemed to work best. I recently have been doing ECT's but I really need energy. I am concerned the effexor is causing the lack of energy? I started taking Adderal for some energy and ADD. It works for like 2 hours. My question is MAO's a good option for me. I don't want anything that makes me tired. I don't understand why anti depressants make u tired. Should they not make u more alive and have more motivation and energy??????
one more question why would ambien actually wake me up and make me feel good? what is wrong with my chemicals??????
Dear DaniD,
I am sorry you are having trouble with your depression. I understand. Drowsiness is often a side-effect with anti-depressants because of their actions on our central nervous system (CNS). Drowsiness, of course, can be due to many other things. You may want to consider evaluation for sleep apnea. Just a thought.
Lithium augmentation therapy has also been used with some success.
You have 2 challenges. The first is to find the best combination of therapies to restore your energy and motivation. The other is (and I believe this is just as important) finding a method to get done what you need to do even while your energy and motivation to do them is not normal. Rewards and accountability are very important motivators.
Best wishes!
Hi there,
I've just started taking parnate, currently 20mg per day. I am on a wait list for surgery (fix deviated septum) and I've been reading elsewhere that I'll be told to come off it prior to surgery. Do I really have to? Surely the anesthetist can work around it? TIA
Ozzie,
They will want to stop Parnate at least 2 weeks before surgery. No working around it I'm afraid.
Thanks for responding. Bummer.
Another question, if I may. I'm getting a faster heart rate after taking my 10mg second dose of the day. Around 86bpm and it feels fast. Later when that effect stopped I measured my rate to be 49bpm which I read is really low (I'm no athlete). Is this a serious side effect that I need to go back to my psych with, or can I just hope it will pass?
I have taken Nardil for over 42 years now. Nardil was the first anti-depressant prescribed to me. IMO, it's the best MAOInhib. for me. Nardil does lower one's blood pressure. I also take a tranqu. This way the Nardil and klonopin is balanced out. Another drug I have heard maybe be helping people is Serqueol. May I suggest, people taking a MAOInhib. have braclets made indicating the medication name and drug to take if accidentially given wrong medications.
Carol,
Great advice!! Thanks for sharing.
I've been on nardil for over a week and am now taking around 45mg/week, my doctor wants me to go up really slow 15mg/2weeks,30mg/2weeks but I'm not feeling any good or bad effects. I'm not going to go this slow. I have one refill, will insurance allow me to get this refill even though I just got this medication 18 days ago?
thmccord,
If it was meant to be a 30 day supply, then probably not. You will need to have your MD call in a new prescription with the higher dosage. Then it will work.
I was wondering, can i be put on emsam for slight depression, while taking xanax for my panic anxiety disorder. I've tried lexipro and zoloft both made me feel worse.
Angela,
Typically Emsam would be reserved for more severe cases afte multiple treatment attempts with a few more classes of drugs have been tried.
What a fascinating thread. I am waiting to start EMSAM. Is Vicodin safe? I had to washout of tramadol and previous ssri and remeron, but can't find definitive interaction with hydrocodone? What migraine abortives are safe, since I won't be allowed to use imitrex? Dr is thinking EMSAM will help prevent migraine and ease pain, so hopefully pain meds won't be needed. But I am still curious what I would be offered for pain while on EMSAM?
Fred,
Emsam and Vicodin, if used together, may cause excessive drowsiness. If necessary, the very lowest effective dose of Vicodin should be used. Ideally a non-narcotic pain reliever should be used. Ketorolac has been used by some with success.
Thank you ! It is interesting you mention toradol- as I just found out that is what I get in trigger point injections, with lidocaine. Was going to find out if that will be safe. Seems as long as no epinephrine or novacaine it is fine with MAOI?
Hi, and thanks again for this great forum. My question is if you know about nicotine and anatabine as an MAOI. How strong are they and are there potential side effects with food/or other meds like high BP? Also, are there problems with stopping usage of such MAOI like withdrawal symptoms and lingering side effects etc. Thank you.
Hi frank1in,
Cigarette smoke contains some chemicals which function, albeit weakly, as MAOI's. Probably no food or drug concerns though. I recommend tapering off of MAOIs, as well as any medications for depression, when appropriate.
Thanks. The reason I ask is because I was taking anatabloc which contains anatabine marketed as an antiinflammatory for my lower back pain and MSM as well. I remember throwing up immediately after eating an overripe avocado. Also, my bp rose to 150/90 after eating a dinner high in cheese, and the same with a peanut butter sandwich and watermelon. The last two incidences happened after I stopped taking the anatabine and MSM. Could the MSM increase the potency of a weak MAOI? Also, I realize after doing more research on MAOI that a lot of my diet consists of natural MAOI- carrots, celery, green tea, ginger,garlic, etc which never gave me problems before. The MSM also, I don't remember giving me problems with BP and headaches. The only thing new would be the anatabine. My doc is checking my adrenal glands for any problems that might be causing my bp to spike up and down (which I think has to do with certain food intake) Thanks again for sharing your knowledge with us. I really appreciate it.
Looking for recipes to while taking MAO parnate. any help ? also told to stay away from MSG. Thanks
Hi Ellen,
Mostly you just need to stay away from recipes that would use the food ingredients listed above in the article. Best wishes.
hello sir,iam a pharmacy student, can u help me out of this that how to moralised the drug interaction?
Can you take wellbutrin a parnate together?
@chetan - not sure what you are asking
@joshua - Best to avoid this combo due to risks like serotonin syndrome
***TO ALL MY READERS***
Thank you all for your great questions and comments. They have made this article a VERY useful resource to patients and also healthcare providers.
Would you be willing to post a link to this page on your Facebook wall, even for an hour? Or maybe a link in some discussion forum that you frequent?
Doing so would help spread the word about these important medications.
Sincerely,
Jason
Great job explaining.
I'm currently in nursing school and using this article as a supplement. :) The mail carrier example was a a good one.
Additionally, I took anti-depressants for a time. Prozac (fluoxetine) but that's an SSRI, I believe. Worked for me and in a relatively short time, too.
drugs are addictive
Hello "pharmacist";
I as well like your analogy. I guess the only thing I'd add to it is that the mailman is carrying good mail, the mail that allows us to enjoy life ;-)
I have taken Nardil for many years and it beautifully assisted me out of very serious depression. After many attempts on my life and tons of anti-depressants starting with Tricyclics, then Tetracyclics and moving through many SSRI's and 12 ECT treatments with minimal positive effect, my doctor rightfully suggested I try a MAOI - Nardil. He thoroughly informed and trained me on the proper use of Nardil and it has henceforth allowed me a successful, meaningful happy life. Twenty years now down the road I'm a very successful and happy computer programmer.
Thank you for your analogy and your web site; aiding a patient in understanding their medication is a very powerful and meaningful endeavor - God Bless!
Glenn
I have been taking Parnate for 30 years, and it has been a life saver for me. I had a hysterectomy 15 years ago and had to off Parnate for 2 weeks prior to surgery. I went into a severe depression after going off my MAO Inhibitor and had to have ECT to stabilize my mood. Since that time I have had cataract surgery and a bunionectomy under general anesthesia while taking Parnate and had no complications. My son is a physician, and one of his colleagues is an anesthesiologist who assured me that general anesthesia while taking Parnate doesn't pose the risks that was once commonly thought. I would certainly seek out a physician and ananestheologist who are very familiar with the use of general anesthesia and MAO Inhibitors.
I have been taking MAOs for 25 years and I've had 4 surgeries under general with no problems. Post op pain was minimal therefore I only had to take advil and tylenol. My concern is if I had to have surgery which would require narcotics for post op relief. Is there anything that I could take which would control intense post op pain (i.e. joint surgery, internal surgery, etc.)?? Going off the MAOs prior to surgery would be an option but it could be ER surgerywhere going off would not be an option.
Thanking you in advance for your reply.
Hi annafran,
Meperidine, methadone, tramadol and Flexeril must be avoided. Beyond that it is up to the discression of the surgeon and the post-op care provider. Sometimes NSAIDs will be enough.
Any known complications between MAOI's and regular Botox/Juvederm/Restylane injections?
R ann,
Not with the listed injections themselves, but potentially with other drugs that the MD might use in addition to these (e.g. lidocaine or epinephrine). This could be serious. Be sure to let them know before getting any injection.
Hello and thanks for the article. I am taking some off-label antidepressant for PE (premature ejaculation) and bought Yohimbe. I took what the label says (2 pills) and after 30 min, I felt terrible. My heart started to race, my eyes were bloody red and very dry, I had to go to the bathroom many times in a short period of time and felt anxious, very anxious and wanted to vomit. I know after this reactions I am asking a stupid question, but why did that occur? Yohimbe and a mild anti-depressant for PE cant be taken together?
Thanks in advanced.
From a reliable drug-interaction resource:
"Yohimbine may interact with selected Antidepressants. Do not take Yohimbine and any Antidepressant together without talking to your health care provider. In particular, you should never take Yohimbine with drugs known as Monoamine Oxidase Inhibitors (MAOIs). Examples of MAOIs include products like Eldepryl, Marplan, Nardil, and Parnate. Using these drugs together can lead to a serious increase in blood pressure, known as 'hypertensive crisis', confusion, nervousness, palpitations or other serious side effects. You must avoid use of Yohimbine within 2 weeks before starting an MAOI, 2 weeks after stopping an MAOI, and during the use of an MAOI."
Im not sure if this site is monitored or kept up with, but it's worth a try.
My brother has paranoid schizophrenia and is currently taking geodon and imipramine. He has been on it for almost 3 years now and it has helped him IMMENSELY. We spent a year trying out a myriad of other scripts and this was the only cocktail that offered him any kind of normalcy. We went to pick up his script a few weeks ago and the pharmacy said they needed a prior authorization from his psychiatrist to be sent to the insurance company. Needless to say, his doctor is proving to be just as useless as the Insurance company in helping us understand or execute this stupid PA. He can't work, so affording the meds out of pocket is just not an option ($800/mo is astronomical). He is on Medicaid, and the doctors around here (south Florida) that accept his insurance are horrendous. It has been a struggle to keep up his confidence in his doctor and life in general, and lately he has been threatening to stop his meds all together.
I happened to stumble across this thread during my research of viable options, and I'm so desperate, Im hoping you or someone who reads this will be able to offer any kind of insight or advice on a course of action.
Help!! :(
Thanks,
Lindsey
Hi Lindsey,
Many insurances require doctors to do periodic assessments to ensure the medication is working and not causing side effects. Geodon is preferred on the Florida Medicaid drug list, so it should be covered, though the doctor may just need to confirm he/she is monitoring the patient. You may need to call the "800" number on his insurance card and ask them exactly what needs to still be done to get this covered.
I was wondering if it is safe to take Anatabloc for arthritis while taking zoloft or an anti depressant?
TBR,
There are no reported interactions that I am aware of.
Jim 3 years ago
I have been on many different anti depressents and I am still depressed. I am on a new one called Cymbalta because it helps with chronic pain caused by nerve damage. I have been diagnosed with chronic pain depression due to back, neck and shoulder pain. I was sent to a Psychiatrist working for the workers compensation. He suggested maoi in his report. My own Psychiatrist and Family Doctor said after asking them what they think...said they don't even use them anymore for the reasons you mention in this article. I have high blood pressure and asthma and I am on all kinds of other meds. as well. It sounds to me that this Doctor was not looking after my best interest to even mention these to the Workers compensation board. He knew I had high blood pressure and other was on pain meds.. This article has helped me in deciding to stay away from maoi's all together.....Thank You