PsychRounds: The Psychiatry Podcast The Monoamine Oxidase Inhibitors (MAOI's)
Mar 12, 2025
Dive into the fascinating world of Monoamine Oxidase Inhibitors (MAOIs), starting with their history and surprise mood-boosting effects since the 1950s. Uncover how they block enzymes that regulate neurotransmitters, alongside their risks like serotonin syndrome. Explore individual MAOIs, their unique properties, and the clinical implications, including side effects and dietary restrictions. Finally, compare their effectiveness with first-line treatments and hear a compelling case study of a writer's battle with severe depression.
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MAOIs' Unique Mechanism
- MAOIs increase neurotransmitter levels by blocking MAOA and MAOB enzymes, unlike typical antidepressants that block reuptake.
- MAO-A mainly breaks down norepinephrine and serotonin, while MAO-B primarily affects dopamine.
Serotonin Syndrome Risks
- MAOIs carry high serotonin syndrome risk, especially combined with other serotonergic drugs.
- A washout period of 1-2 weeks (or 6 weeks for fluoxetine) is essential when switching medications.
Dietary Cautions on MAOIs
- Avoid aged cheeses, homemade wines, fermented soy, and aged sausages on MAOIs to prevent hypertensive crisis.
- Provide patients with detailed dietary lists, like those from Carlat, before starting treatment.
