Monoamine oxidase inhibitors are an extremely potent class of antidepressants that treat depression by preventing the breakdown of serotonin, dopamine, and norepinephrine in the brain, increasing their availability. These medications are not used often because of their potential for drug interactions that can lead to problems with blood pressure, as well as the need to avoid foods that contain the amino acid tyramine. They also can be highly dangerous if there is an overdose. Generally, like most antidepressants, MAOIs should be used for bipolar depression only in combination with a mood stabilizer such as lithium or valproate, to minimize the risk of inducing mania.
Among these, Parnate has been the most extensively studied specifically in bipolar depression, leading in one randomized trial to improvement in over 80% of subjects. Like other classes of antidepressants, the MAOIs take several weeks to begin working. Your doctor may also prescribe a sedative to help relieve anxiety, agitation, or sleep problems while the antidepressant begins to work. You will also need to monitor what foods you eat to avoid side effects.
MAOI Side Effects
Eating certain smoked, fermented, or pickled foods, drinking certain beverages, or taking certain medications can cause severe, sudden high blood pressure in combination with MAOIs. People taking these antidepressants must follow a special diet, which includes limiting certain cheeses, meats, and alcohol. In addition, some experts think that MAOIs may be especially likely to cause mood switches from depression to mania in people with bipolar disorder, and therefore, mood changes must be monitored closely.
Common side effects of MAOIs may 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