Antidepressant drugs MAOIs

Gnkgo (maiden hair tree, kew tree) Ginkgo biloba Raynauds disease, cerebral insufficiency anxiety, stress, tinnitus, dementias, circulatory problems, asthma Rare if used as directed possible effects include headache, dizziness, heart palpitations, Gl effects, rash, allergic dermatitis Do not take with antidepressant drugs, such as the MAOIs, or the antiplatelet drugs such as coumarin, unless advised to do so by the primary care provider. 

By maintaining low concentrations of cytoplasmic noradrenaline, MAO will also regulate the vesicular (releasable) pool of transmitter. When this enzyme is inhibited, the amount of noradrenaline held in the vesicles is greatly increased and there is an increase in transmitter release. It is this action which is thought to underlie the therapeutic effects of an important group of antidepressant drugs, the MAO inhibitors (MAOIs) which are discussed in Chapter 20. 

Drugs that may be affected by duloxetine include drugs extensively metabolized by CYP2D6 (eg, flecainide, phenothiazines, propafenone, tricyclic antidepressants, thioridazine), alcohol, CNS-acting drugs, MAOIs, and drugs highly bound to plasma proteins (eg, warfarin). 

Many antidepressant drugs have pronounced effects on sleep. Several tricyclic compounds (amitriptyline and others) have sedative actions while others (imipramine and others) are less sedative or even stimulant. Monoamine oxidase inhibitors (MAOIs) have central stimulant effects and may cause insomnia. Specific serotonin reuptake inhibitors (SSRls) and combined serotonin, noradrenaline reuptake inhibitors (SNRIs) can also cause insomnia. 

MAOIs had been reserved as a last line of treatment, used only when other classes of antidepressant drugs had failed, because of the mentioned potentially lethal dietary and drug interactions. However, in 2006 a patch form of the drug selegiline, called Emsam, was approved for use by the FDA. When applied transdermally the drug does... 

Tranylcypromine sulfate Is an antidepressant drug and an inhibitor of MAO. Its antidepressant effect is probably due to the accumulation of NE in the brain as a consequence of inhibition of the enzyme. The other MAOI currently used as an antidepressant is phenelzine sulfate. 

Since MAOIs have dangerous risks and since other, less obviously dangerous antidepressants exist, MAOIs are not often prescribed. However, when SSRIs fail, MAOIs may be used and are effective in many cases. Two of the older MAOI drugs still used to treat anxiety disorders are phenelzine, which is sold under the brand name Nardil, and tranylcypromine, which is sold under the brand name Parnate. 

Because of the improved tolerability and safety of newer antidepressants, MAOIs are not currently used as first-line agents. However, MAOIs remain excellent medications for patients whose symptoms do not respond to the newer antidepressant drugs. Patients with atypical depression, characterized by oversleeping and overeating, show a preferential response to MAOI therapy compared with TCAs (Liebowitz et al. 1984 Quitkin et al. 1979 Ra-varis etal. 1980 Zisook 1985). 

Monoamine oxidase inhibitors (MAOIs) are useful as thymoleptic (antidepressant) drugs, especially since the action of some of these agents is very rapid, as compared to the lag period of days or even weeks shown by tricyclic antidepressants. All MAOIs act by increasing the available concentration of the neurotransmitters NE and 5-HT which, because they are not metabolized, accumulate in the synaptic gap and exert an increased postsynaptic effect. The drugs show hypotensive activity as a side effect, and some MAOIs are used as hypotensive drugs. 

We have provided a summary of the results from double-blind, random-assignment studies (usually class I or II designs) comparing HCAs, selective serotonin reuptake inhibitors (SSRIs), other new antidepressants, and MAOIs with placebo or with each other for the acute treatment of depression. Each study was reviewed, and a global judgment made, based on all the evidence presented, as to whether a given drug was more effective than placebo or another control therapy. 

Arguably the first modern class of antidepressants, monoamine oxidase inhibitors (MAOIs) were introduced in the 1950s but are now rarely used in clinical practice because of toxicity and potentially lethal food and drug interactions. Their primary use now is in the treatment of depression unresponsive to other antidepressants. However, MAOIs have also been used historically to treat anxiety states, including social anxiety and panic disorder. In addition, selegiline is used for the treatment of Parkinson s disease (see Chapter 28). 

Because suicide is one of the leading causes of death in elderly people and in other populations, rapid and effective treatment of depression is warranted. Current therapies include the use of electroconvulsive (shock) therapy, psychiatric intervention, and antidepressant drugs such as tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and serotonin-selective reuptake inhibitors (SSRIs). Recently, in the U.S., the use of St. John s wort (Hypericum perforatum) has become more prevalent, especially in the treatment of depression. 

MAOIs. MAO inhibitors, a class of antidepressant drugs, can slow the metabolism of amphetamines. This mix of drugs may result in skyrocketing blood pressure, severe headaches, and potentially fatal neurological damage. 

MAOIs affect psychomotor performance driving and operating machinery is not advised. Abrupt termination of antidepressants, including MAOIs, causes severe adverse effects. Symptoms may be treated by gradually withdrawing these drugs.142... 

Monoamine oxidase inhibitors (MAOIs), which were amongst the first antidepressant drugs to be used clinically. They affect one or both of the brain monoamine oxidase enzymes that play a role in the metabolism of serotonin, noradrenaline, dopamine and adrenaline. MAOIs inhibit breakdown of the neurotransmitters important in determining mood, which results in the antidepressant effect. 

MAOI and SSRI are acronyms for two types of antidepression medication. MAOI stands for monoamine oxidase inhibitor. MAOIs must be prescribed and used with caution because they tend to dangerously interact with other types of drugs.Today, other forms of antidepressants are usually prescribed for depression patients first. If those medicines do not work, MAOIs are sometimes used with caution. People taking MAOIs have to restrict their diets and watch what other drugs and medicines they take in order to prevent interactions. SSRI, an antidepressant that is more commonly used, stands for selective serotonin reuptake inhibitor.They are generally able to be tolerated by more people and can be used for more minor depressive illnesses. 

The antidepressant drugs are generally classified according to their chemical structure (e.g., tricyclic antidepressants [TCA]) or according to their pharmacological action (e.g., monoamine oxidase inhibitors [MAOI] serotonin reuptake inhibitors [SSRI]). Certain other antidepressants, which do not fall into the above categories, are sometimes referred to as atypical antidepressants (see below). 

MAPI - There was renewed interest in MAOI since their combination with TCA may be the only alternative to the use of EOT for drug-resistant patients.91 EOT was superior to combined phenelzine and amitriptyline in severe depression,92 but phenelzine alone was as effective as amitriptyline in depressed outpatients.93 Caroxazone, an effective antidepressant drug (29), probably acts through reversible inhibition of the two known forms of IfAO (A and B). ... 

If Wellbutrin is taken at a correct dose, it can be an effective antidepressant. It is an especially useful drug for those who have not responded to SSRI treatment. In one survey, it was the first choice of psychiatrists when patients did not improve while taking an SSRI. Furthermore, it is a safe and effective drug that can augment the therapeutic effects of other antidepressants (except MAOIs). For example, in one study, researchers looked at the addition of Wellbutrin in patients who took antidepressants with little success. Of patients who completed at least six weeks of Wellbutrin, 58 percent experienced remission of depression. 

Antidepressant drugs A major class of psychotropic drugs with diverse chemical configurations including the monoamine oxidase inhibitors (MAOIs), the heterocyclic drugs (composed of mono-, di-, tri-, and hetero-cyclics), the serotonin reuptake inhibitors (fluoxetine, paroxetine, sertraline, trazodone, and venlafaxine), and bupropion are more recent innovations. Antidepressants usually must be taken for several weeks to have the desired effect and they often have a low therapeutic index, so they must be closely monitored. 

Bupropion (brand name Wellbutrin) An antidepressant drug known to induce seizures and therefore administered with specific recommendations on dosage ranges. It should not be administered concurrently with MAOIs. 

Clomipramine (brand name Anafranil) A heterocyclic antidepressant drug that is also effective in the treatment of obsessive-compulsive disorders. This drug should not be taken with the MAOIs. 

Doxepin (brand name Sinequan) A commonly prescribed heterocyclic antidepressant drug. It is also occasionally used for the treatment of anxiety. This medication should not be used with an MAOI. 

AD Antidepressant drug CBZ Carbamazepine ECT Electroconvulsive therapy MAOI Monoamine oxidase inhibitor... 

Following the first report of this syndrome, many other cases have been described involving tryptophan and MAOIs ,(p. 1151), the tricyclic antidepressants and MAOIs , (p.ll49), and, more recently, the SSRIs , (p.ll42) but other serotonergic drugs have also been involved and the list continues to grow. 

Relative history of seizure disorder, bipolar disorder (may induce mania), urinary retention, narrow-angle glaucoma, delirium, hyperthyroidism, bradycardia (or drugs that cause bradycardia), or electrolyte disturbance (esp. K+ or Mg ). Use caution in conjunction with other antidepressants (including MAOIs and SSRIs), other anticholinergic medications, drugs that increase plasma levels (phenothiazines, haloperidol, cimetidine), or drugs that lower seizure threshold (esp. tramadol). Use caution in elderly, children/adolescents. 

Another class of antidepressant drug targets the enzyme monoamine oxidase which breaks down the neurotransmitter molecules (serotonin, dopamine, norepinephrine, etc.) after use. By preventing this enzyme from working, the neurotransmitters survive for longer, increasing their effectiveness. The so-called monoamine oxidase inhibitors (MAOIs) have been used to treat... 

Clinical use of MAOI in psychiatry is potentially dangerous. Patients must take care to avoid foods containing high levels of amines (fermented cheese). Concomitant administration of another class of tricyclic antidepressant drugs such as amytryptiline, which potentiates, sometimes fatally, the pharmacological effects of MAOI, is forbidden. 

The MAOI antidepressant drag s are contraindicated in patients widi known hypersensitivity to die drug s, liver and kidney disease, cerebrovascular disease, hypertension, or congestive heart failure and in die elderly. These drag s are given cautiously to patients witii impaired liver function, history of seizures, parkinsonian symptoms, diabetes, or hyperthyroidism. 

Because of their lack of selectivity and their irreversible inhibition of MAO, the first MAOIs to be developed presented a high risk of adverse interactions with dietary tyramine (see Chapter 20). However, more recently, drugs which are selective for and, more importantly, reversible inhibitors of MAO-A (RIMAs) have been developed (e.g. moclobemide). These drugs are proving to be highly effective antidepressants which avoid the need for a tyramine-free diet. 

The main problems with early, irreversible MAOIs were adverse interactions with other drugs (notably sympathomimetics, such as ephedrine, phenylpropanolamine and tricyclic antidepressants) and the infamous "cheese reaction". The cheese reaction is a consequence of accumulation of the dietary and trace amine, tyramine, in noradrenergic neurons when MAO is inhibited. Tyramine, which is found in cheese and certain other foods (particularly fermented food products and dried meats), is normally metabolised by MAO in the gut wall and liver and so little ever reaches the systemic circulation. MAOIs, by inactivating this enzymic shield, enable tyramine to reach the bloodstream and eventually to be taken up by the monoamine transporters on serotonergic and noradrenergic neurons. Fike amphetamine, tyramine reduces the pH gradient across the vesicle membrane which, in turn, causes the vesicular transporter to fail. Transmitter that leaks out of the vesicles into the neuronal cytosol cannot be metabolised because... 

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