MAOIs for depression in children and teens

Monoamine oxidase inhibitors (MAOIs) are very rarely given to children or teens and usually are not the first medicines given to treat their depression. This is because these medicines have serious side effects when combined with certain foods or medicines. Moclobemide-a reversible MAOI not available in the United States- is the only MAOI with some evidence to support its use in the treatment of childhood depression.¹ No evidence exists that other MAOIs are effective at treating depression in young people, although they are sometimes used when other medicines have failed.

Examples of MAOIs that have been used to treat depression in children and teens include:

• Phenelzine (Nardil).
• Tranylcypromine (Parnate).
• Moclobemide (Manerix, Aurorix). This drug is not available in the United States.

MAOIs sometimes are used to treat unusual symptoms of depression, such as a heavy feeling in the arms and legs or feeling "slowed down."

Side effects of MAOIs can 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.
• Weight gain.
• Negative interactions with other medicines and some foods.

MAOIs must be discontinued gradually to reduce the chance of withdrawal symptoms. MAOIs should only be given 2 to 5 weeks after other depression medicines have been stopped (so the other medicines are out of the person's body).² A child also should not take other medicines for several days to weeks after stopping treatment with MAOIs.³

Due to the possibility of serious consequences for the child or adolescent when taking MAOIs, discuss the dangers as well as any benefits with your doctor. Be sure to get a list of foods and other medicines your child must avoid while taking MAOIs.

Citations

1. Hazell P (2005). Depression in children and adolescents, search date April 2005. Online version of Clinical Evidence (14): 1–16.

2. American Academy of Child and Adolescent Psychiatry (1998). Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 37(10): 63S–83S.

3. Renaud J, et al. (1999). A risk-benefit assessment of pharmacotherapies for clinical depression in children and adolescents. Drug Safety, 20(1): 59–75.