What Experts Want You to Know About MAOI DrugsMAO who? Let’s talk.
If you heard about MAOI drugs from a friend or a pharma commercial, you might know the bare minimum: It’s an antidepressant. But if you’re not sure what it does or who it can help, you’re certainly not alone.
There are a ton of antidepressants out there—a great thing, because it means we’ve got options if you, your doctor, or therapist think you’d benefit from treatment. But with so many types of mental health medications (many of which come with their own fancy acronym) and individual drugs within those categories… every commercial might leave you wondering, Wait, do I need this?
So, here’s everything you need to know about MAOI drugs, including how they work, who they’re meant for, and the side effects to keep in mind.
What is an MAOI drug?
MAOI stands for monoamine oxidase inhibitor, and they’re a type of antidepressant used to treat major depressive disorder (MDD) and other mood disorders by inhibiting (hence the I) an enzyme in the body called monoamine oxidase (that would be the MAO), according to the National Institutes of Health (NIH).
This enzyme’s job is to break down certain neurotransmitters, or chemical messengers in the brain that regulate our brain chemistry and moods. There’s a long-standing theory in depression research that one specific category of neurotransmitter called monoamine neurotransmitters plays a role in MDD. You’ve probably heard of them: norepinephrine, serotonin, and dopamine. So, when MAOIs block the enzyme that normally breaks down these neurotransmitters, it enables more of them to float around your body—and that could improve your depression symptoms.
Fun fact: MAOI drugs were the first antidepressants on the market back when they debuted in the 1950s, according to the NIH. They were actually discovered as a treatment for mood disorders by accident, says psychiatrist Alexander Herman, MD, PhD, an assistant professor of psychiatry at the University of Minnesota Medical School. “The original MAOI was being developed as a tuberculosis treatment and they noticed it had mood-boosting effects on people using it,” Dr. Herman explains. After delving deeper, researchers figured out why the drug had this effect and worked to create other medications that did the same thing. The more you know…
What are the side effects of MAOI drugs?
While they may be the OGs, MAOIs have been overshadowed by other kinds of antidepressant medications like selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants, which are considered generally safer. That’s because, when you take an MAOI, you also have to limit certain foods and drinks or face really dangerous health risks. “Oral MAOIs inhibit the MAOs in the gut that are responsible for metabolizing tyramine, which is in foods like aged cheese and soy,” Dr. Herman explains.
Sounds weird, but tyramine has a similar chemical makeup to neurotransmitters like serotonin and dopamine. So, “taking a monoamine blocker can cause tyramine to build up in the body.” That excess can trigger an increased release of adrenaline, which spikes blood sugar and blood pressure in a life-threatening way, Dr. Herman says. Plus, other medications, when mixed with an MAOI, can have the same effect, according to the Mayo Clinic. Yeah, not ideal.
Because of all that, anyone who’s prescribed an MAOI has to follow a low-tyramine diet. That means avoiding things like aged cheeses, cured and smoked meats, pickled and fermented foods, and anything that contains soy. Oh, and alcohol, sourdough bread, and dried or overripe fruits. (So, like, almost everything you’d find on a good charcuterie board.) Eating within those very strict restrictions is hard for a lot of people to follow, Dr. Herman says.
While that’s the biggest bummer, MAOI drugs can also come with the same side effects as other antidepressant meds, like dizziness, dry mouth, nausea, and lightheadedness. Maybe it’s not surprising then that docs prefer prescribing other antidepressants first. “It’s pretty far down on the list for me,” says Philip Lam, DO, assistant clinical professor of psychiatry at the University of Arizona College of Medicine. And Dr. Herman notes that he’s never seen a primary care doctor prescribe these medications for depression and “even psychiatrists are hesitant to do so.”
One thing to note: While MAOI drugs are typically oral medications, some do come in patch form. “Because it’s absorbed through the skin, dietary restrictions may not be as necessary,” says Dr. Lam. The patch MAOIs are usually a lower dose and associated with fewer side effects, per the NIH. But, Dr. Lam adds, it’s harder to get insurance approval for the patch, for whatever reason.
Who are MAOI drugs good for?
Despite being a huge pain, people who’ve tried basically every antidepressant medication there is may find that MAOIs work for them.
Same goes for those with atypical depression, Dr. Herman says. This type of depression, which goes by major depressive disorder with atypical features in the DSM-5-TR, is a subtype of MDD (though some say it’s debatable) that’s associated with symptoms like increased appetite, sleepiness, a feeling of heaviness in your limbs, and an all-consuming sensitivity to feeling rejected by other people. Some research suggests that people who have it respond particularly well to MAOIs.
Still, even if you have atypical symptoms right off the bat, chances are your doctor will have you try other treatments before putting you on an MAOI because of all that food drama.
The bottom line: It’s reasonable to expect a little trial and error to figure out whether any mental health treatment works well for you—most mental health meds take a few months to even start working as they should. But if you’ve been trying to find a solution and feel better for a long time and nothing seems to be working, an MAOI drug may end up being the hidden solution you didn’t know to ask about. “These medications can be prescribed safely, though it does require a little more effort,” Dr. Hermann says.
Wondermind does not provide medical advice, diagnosis, or treatment. Any information published on this website or by this brand is not intended as a replacement for medical advice. Always consult a qualified health or mental health professional with any questions or concerns about your mental health.