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HISTORY - MAOIs were discovered by accident. A chemical derivative of isoniazid for treating tuberculosis led to the discovery of a new group of agents that were effective against TB. While experimenting with these agents, it was consistently noted that depressed patients had a consistent mood elevation. So in addition to being a mood elevator, some of the older MAOIs have antibiotic effects as well.

USES - MAOIs are highly effective antidepressants for any kind of depression but especially for those with (((marked panic))), phobic or other anxiety symptoms. These are generally SECOND LINE agents for treating depression that will not respond to other treatments. Remember, order of tx for depression usually goes...

1. SSRI’s/Tricyclic
2. MAOIs
3. ECT (electroconvulsive therapy)

ACTION MAOIs inhibit the enzyme MAO which is widely distributed in the body, but esp. in the nerves, the liver and lungs. MAO DEACTIVATES neurotransmitters in the nervous system, in particular, serotonin and dopamine, epinephrine, and norephinephrine (the *feel good* chemicals). MAOIs appear to inhibit the enzyme MAO which results in increased levels of these feel good chemicals, leading to a reduction in depression.

SIDE EFFECTS Orthostatic hypertension; tachycardia; dizziness; anorexia; blurred vision.

FOOD & DRINK TO AVOID -Food with high tyramine content....aged cheese, aged/fermented meats; yeast extracts; red wine. Moderate tyramine content - limited amounts.....Meat extracts; pasteurized light and pale beer; ripe avocado. Low tyramine content - permissible.....Distilled spirits; American & mozzarella cheese; chocolate & caffeine beverages; fruit; soy sauce; yogurt.

INTERACTIONS - Large variety of drug interactions with MAOIs. As noted above, tyramine is (an amino acid) is the primary culprit and a hypertensive crisis is the danger. Sympathomimetic agents can also intereact with MAOIs.

CONTRAINDICATIONS - pts with cerebrovascular or cardiovascular disorders; a known hypersensitive reaction to MAOIs, liver or renal dysfunction. Should also not be used in combo w/ adrenergic agents, tyrmine-rich food.

POPULAR TRADE NAMES - Nardil, Parnate (irreversible MAOIs)

REFERENCE - Lilley, Aucker, Pharmacology and the Nursing Process, 2001 Mosby, Inc., St. Louis, MO

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