Antidepressant medication is one of the most common treatment options for panic disorder. Monoamine oxidase inhibitors, or MAOIs, are a type of antidepressant used to treat panic disorder and other conditions.
General InformationThe first antidepressants developed belong to the category of MAOIs. In the 1950s, a group of scientists were seeking medications that could assist in treating tuberculosis. Noticing how one drug helped enhance mood for many of the patients, these scientists unintentionally discovered MAOIs. Originally used to treat major depressive disorder, MAOIs are currently prescribed for the treatment of a variety of mood and anxiety disorders. Since the discovery of MAOIs in the 1950s, other types of antidepressants have been introduced to the market. Tricyclic antidepressants (TCAs) and selective serotonin inhibitors (SSRIs) are often preferred over MAOIs. In many cases, these newer classes of antidepressants have been found to be just as effective as MAOIs, but do not carry the extensive food and medication restrictions associated with MAOIs. Despite these limitations, MAOIs remain an option to treat numerous conditions, including panic disorder.
Some of the most common MAOIs include:
- Nardil (phenelzine)
- Parnate (tranylcypromine)
- Marplan (isocarboxazid)
- Emsam (selegiline)
How MAOIs Treat Panic DisorderNeurotransmitters are naturally-occurring chemicals that carry messages throughout your brain. Some of these chemicals are thought to be improperly regulated for people with mood and anxiety disorders. MAOIs work to prevent the enzyme monoamine oxidase from breaking down neurotransmitters, keeping them more balanced throughout the brain.
MAOIs are particularly linked to inhibiting the absorption of three neurotransmitters: serotonin, norepinephrine, and dopamine. Serotonin is associated with mood and sleep, among several other brain functions; norepinephrine is linked to a person’s alertness and fight-or-flight stress response; and dopamine is involved in regulating many different functions, such as movement, motivation, and energy. By stabilizing these neurotransmitters, MAOIs help enhance mood and lower feelings of anxiety. Additionally, MAOIs can assist with reducing the frequency and intensity of panic attacks.
Side Effects of MAOIsSome of the most common side effects of MAOIs include:
- Dry mouth
- Digestive issues
- Changes in weight and appetite
- Changes in blood pressure
- Drowsiness and fatigue
- Dizziness and lightheadedness
- Sexual side effects
- Sleep disturbances
These side effects typically subside over time as you become used to the MAOI. Contact your doctor to discuss your options if side effects worsen or become unmanageable. Do not ever abruptly discontinue your prescription on your own. A sudden stop in your medication can lead to withdrawal-like symptoms, such as headaches, nausea, and dizziness. If you decide that you want to stop taking your MAOI, your doctor can assist you in gradually reducing your dosage.
Precautions and Contraindications of MAOIsMedical History: Caution should be taken if you have a history of certain medical conditions. Consult your doctor before taking an MAOI if you have been diagnosed with these or any other medical condition:
- Heart disease
- Thyroid disease
- Kidney disease or liver disease
- Epilepsy or any type of seizure disorder
- High blood pressure
Food and Drug Interactions: There are many medications that produce dangerous effects when taken with an MAOI. Consult your doctor or pharmacist before taking any prescribed or over-the-counter medication. There are also numerous foods that should be avoided when taking MAOIs. In particular, you should not consume foods high in tyramine, such as many cheeses and meat products. Ask your doctor for a complete listing of foods that shouldn't be consumed when taking an MAOI.
Pregnancy and Nursing: It is possible for MAOIs to be passed on to a child during pregnancy or through breastfeeding. If you are pregnant, planning on becoming pregnant, or nursing, consult your doctor about the potential risks of taking MAOIs.
Older Adults: Older adults are often more prone to feeling the effects of MAOIs. Dosage adjustments may be required to help reduce these effects.
Antidepressants and Suicide: In 2007, the Food and Drug Administration (FDA) issued a statement cautioning that antidepressants have the potential to increase risk of suicidal thoughts and behaviors. This warning is especially problematic for adolescents and young adults taking antidepressants. Young people taking MAOIs should be carefully observed for worsening symptoms, including depression, suicidal thoughts, or unusual behaviors.
The information provided here is a basic overview of the use of MAOIs for the symptoms of panic disorder. The general information here does not cover every possible risk associated with taking a MAOI, such as possible adverse side effects, precautions, and contraindications. Always consult your medical provider about any questions and/or concerns you may have about your prescription.
Dudley, William. Antidepressants. San Diego, CA: Reference Point Press, 2008.
Silverman, Harold M. The Pill Book. 14th ed. New York, NY: Bantam Books, 2010.