Psychiatry & Medication

MAOI (Monoamine Oxidase Inhibitor)

The Bottom Line

  • MAOI is an antidepressant usually prescribed to treat depression.
  • Certain MAOIs are FDA-approved for depression.
  • MAOI medications are not FDA-approved to treat anxiety.
  • Require diet restrictions.

What is an MAOI?

Monoamine oxidase inhibitors (MAOI) were the first type of antidepressants to be developed, in the early 1950s. Examples of MAOIs used to treat depression include: 

  1. Isocarboxazid (Marplan)
  2. Phenelzine (Nardil)
  3. Selegiline (Emsam)
  4. Tranylcypromine (Parnate) 

Although these MAOI medications are prescribed to treat depression, the off-label uses include generalized anxiety disorder(GAD), panic attacks, and obsessive-compulsive disorder(OCD). A doctor may also prescribe them to treat Parkinson’s and other mental health conditions which did not respond to other antidepressants. If you are considering using a prescription medication to treat any condition, always consult a doctor beforehand.

MAOI medications work through affecting monoamine oxidase enzymes, which then modulate certain neurotransmitters in the brain, including serotonin, norepinephrine, and dopamine. By affecting the reuptake of these chemicals, MAOI elevate their levels allowing them to continue influencing cells that have been previously affected.

However, while effective, MAOIs are no longer considered the first-line medications for depression treatment. They may dangerously interact with other medications, health supplements, and even foods. For these reasons, they are often used when a patient does not respond to another treatment.

What are the different MAOIs?

The examples of MAOI medications are:

  • Rasagiline 
  • Selegiline 
  • Isocarboxazid 
  • Phenelzine 
  • Tranylcypromine 

What conditions are MAOIs used for?

MAOI is used for various mental health conditions. A doctor may prescribe them for different types of depression, anxiety disorders, Parkinson’s among others. Also, some MAOIs can be prescribed to treat bulimia nervosa, PTSD, pain, migraine as well as attention deficit disorder (ADD).

Can MAOIs be taken for Anxiety? 

MAOI is believed to be effective for anxiety disorders including generalized anxiety, social phobia, PTSD, OCD, and panic attacks. 

Which MAOI are FDA approved for anxiety?

MAOI medications are not approved for anxiety by the Food and Drug Administration (FDA). However, a doctor may prescribe a MAOI off-label for anxiety. 

Can MAOIs be taken for Depression? 

MAOI is a type of medication prescribed to treat different types of depression. They are most well-known for efficacy in treatment-resistant depression (TRD) and atypical depression, however, they are not the first-line medication for these mental health conditions. They may interact with various medications and health supplements as well as require certain dietary restrictions.

Which MAOIs are FDA approved for depression?

The FDA approved the following MAOI medications for depression:

  • Isocarboxazid (Marplan)
  • Phenelzine (Nardil)
  • Selegiline (Emsam)
  • Tranylcypromine (Parnate)

The FDA also issued a black box warning for MAOI medications, as they have the potential to increase suicidal thinking in adults. Prescription and caution are required.

What research supports MAOIs for anxiety?

There is extensive research supporting MAOI for anxiety:

  • Tranylcypromine was studied for panic disorder and social anxiety efficacy in a double-blind dose comparison trial. Tranylcypromine was administered in 30 mg and 60 mg dosages to subjects for 12 weeks. Tranylcypromine 30 mg reduced panic attacks in 69.9% of subjects, while Tranylcypromine 60 mg reduced panic attacks in 74.8% of subjects. for social anxiety. Tranylcypromine 60 mg was twice as effective compared to the lower dose. 
  • Phenelzine was studied against a placebo for efficacy in treating phobic anxiety in a double-blind trial. 40 subjects with agoraphobia and social phobia were administered either with Phenelzine or placebo for two months. The Phenelzine group reported significant improvements compared to the placebo. The study suggested prescribing Phenelzine for anxiety disorders for at least two months to maximize the benefits of the treatment.
  • Selegiline was studied for efficacy in social phobia treatment. 16 subjects took the Selegiline dose of 5mg/daily for 6 weeks. Subjects were seen weekly by a psychiatrist to examine their clinical state using the the Liebowitz Social Anxiety Scale as well as, the Liebowitz Social Phobic Disorders Scale. The results have demonstrated that only 9 subjects completed the study, while 3 subjects out of total 16 have found Selegiline effective for anxiety and have been clinically improved with social phobia symptoms.

What do experts say about MAOIs for anxiety? 

Kenneth Schulman, MD, says about MAOI “Unfamiliarity and ignorance lead to apprehensions concerning MAOIs, removing an excellent therapeutic option.”

Steven Stahl, MD, Ph.D., author of Stahl’s Essential Psychopharmacology says about Nardil “a pharmaceutical secret weapon for patients who fail to respond to the better-known agents.”

What are the possible side effects of the various MAOIs? 

MAOI has an extensive profile of possible side effects, including:

  • drowsiness;
  • nausea;
  • dry mouth;
  • insomnia;
  • hypertension;
  • hypotension;
  • weight gain;
  • confusion.

Do not abruptly stop taking MAOI without speaking to your doctor. Sudden discontinuation may lead to withdrawal symptoms including:

  • insomnia;
  • nightmares;
  • anxiety;
  • irritability.

The full list of side effects and the severity depends on the individual patient’s medical history and treatment regimen.

Overdose incidents have been reported when taking MAOI. 

MAOI may impair your ability to drive. Do not take MAOI until you know how they affect your body. Always speak to your doctor if you experience any side effects when taking MAOI.

MAOI may interact with certain medications. Disclose your full list of medications alongside health supplements to your doctor.

Medications that MAOIs potentially interact with include:

  • Other antidepressants including Fluoxetine;
  • Pain killers;
  • Seizure medications;
  • St.John’s wort.

MAOI medications require dietary restrictions. Abstain from eating and drinking the following products when taking MAOI:

  • Cheese (except for cream cheese and cottage cheese);
  • Sauerkraut;
  • Soy products;
  • Yogurt;
  • Caviar;
  • Fermented sausages;
  • Beer and red wine.

After discontinuing the treatment with MAOI, a patient should abstain from these foods for at least two weeks.

Can you take an MAOI while pregnant or breastfeeding?

MAOI is not recommended for pregnant women. These antidepressants have the potential to harm the fetus. A doctor may occasionally prescribe them if benefits outweigh risks.

MAOI is not recommended when breastfeeding.

Other treatments are available for anxiety in pregnant and breastfeeding mothers.

Can children take MAOIs for anxiety?

The use of MAOI in children is not recommended. Other treatments are available for anxiety in children.

How to take MAOIs?

MAOI dosage is tailored individually based on a patient’s medical history and treatment regimen.

  • The initial dosing regimen with Phenelzine is 15 mg 3 times per day. 
  • Isocarboxazid is 30 mg one time per day.
  • Selegiline is 1.25 mg one time per day.
  • Tranylcypromine is 10 mg one time per day.

MAOI can be taken with or without food as prescribed by the doctor. Be mindful of the dietary restrictions, and do not take certain foods alongside MAOI.

Do not change the dosage without speaking to your doctor.

If you believe you have overdosed seek emergency help immediately (call 911). 

Are there alternatives to MAOIs? 

Prescription medications as Alternatives to MAOIs for Anxiety

MAOIs can be prescribed to treat depression. A doctor may occasionally use these medications off-label for anxiety. Speak to your doctor about taking MAIOs, as it may not be a good fit for your particular case. There are many other prescription medications that may be an alternative. Some of them are:

  • Klonopin
  • Valium
  • Lexapro
  • Prozac
  • Buspirone
  • Xanax
  • Inderal
  • Cymbalta
  • Tofranil
  • Hydroxyzine
  • Zoloft

There are various alternatives. If you’d like to learn more about whether MAOI, another medication or treatment modality is right for you, we recommend that you speak with a licensed psychiatrist. Here are the best online psychiatry platforms so you can speak with someone right away!

Therapy as an Alternative to MAOI

Learn more about different therapy options for anxiety here

Energy & Holistic Modalities as an Alternative to MAOI

Learn more about different energy & holistics modalities for anxiety here

Tech & Devices as Alternative Treatments to MAOI

Learn more about tech & devices for anxiety here

Disclaimer: This website does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on our Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

By Natalie Kirilova

Natalie is a writer with a focus in medical research with over 10 years of experience