Psychiatry & Medication

Phenelzine for Anxiety

The Bottom Line

  • Phenelzine is MAOI antidepressant for depression and anxiety treatment;

  • FDA-approved for depression treatment.

  • Requires a certain diet plan.

  • Nardil is a trade name for Phenelzine.

What is Phenelzine?

Phenelzine is a medication from the monoamine oxidase inhibitor (MAOI) group. It works by balancing natural chemicals (or neurotransmitters) in the brain. This antidepressant also provides an anxiolytic effect.

Phenelzine is used for depression treatment and symptoms of anxiety, panic disorder, fear, or excessive worry in adults. It is not prescribed to treat severe depression, anxiety caused by daily stress, and bipolar disorders. Doctors usually prescribe it for depression when other medications have not been responding or caused side effects.

Phenelzine can be used long-term unlike benzodiazepines. As far as it is an MAOI medication, a patient needs to follow a diet to avoid certain food interactions.

It is available in tablets of 15mg strength. Nardil is a brand name for Phenelzine. 

Can Phenelzine be taken for Anxiety? 

Phenelzine is believed to work in the treatment of all 5 types of anxiety disorders such as generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD) and social anxiety disorder. However, it should not be used as the first-line medication for such health conditions. 

Is Phenelzine FDA approved for anxiety?

Phenelzine is approved to treat depression by the Food and Drug Administration (FDA). An off label indication suggests its use for anxiety treatment. Also, the FDA issued a black box warning for Nardil, as it has been linked to increased suicidal thoughts in both children and adults. Even though short-term treatment with Phenelzine has no evidence about the increase of such risk, it should be prescribed with caution.

What research supports Phenelzine for anxiety? 

  • Phenelzine was studied for efficacy in patients with a social anxiety disorder (SAD). 7 subjects who have been previously treated with other medications and therapies to treat social phobia took 66mg Phenelzine daily. Subjects have reported improvements and gained the confidence to socialize at work or school. It has shown higher efficacy in treating social phobia against previous therapies used by subjects. 

  • Phenelzine was studied in a double-blind experiment to reveal its efficacy in depression-anxiety treatment. 62 subjects with both depression and anxiety symptoms took Phenelzine 60 mg daily against the placebo for 6 weeks. It was found to respond to treatment over the placebo.

  • Phenelzine was studied against Cognitive-Behavioral Group Therapy (GBGT) for social phobia treatment. 133 subjects received GBGT and Phenelzine 45mg daily for 6 weeks. In 12 weeks, both approaches have been successful, however, Phenezile was associated with more efficacy after 6 weeks of treatment.

What do experts say about Phenelzine for anxiety? 

The Nordic Journal of Psychiatry mentioned the treatment of social phobia - “No patient should be considered treatment-resistant without being offered a trial of Nardil.”

What are the possible side effects?

Phenelzine use may be linked to side effects if not taken as directed. Speak to your doctor if you experience these when taking Phenelzine.

  • dizziness;

  • headache;

  • drowsiness;

  • dry mouth;

  • constipation;

  • weight gain;

  • Fatigue;

  • tremor.

As per the Food and Drug Administration (FDA), it has the potential to increase suicidal thoughts and behavior.

Do not abruptly stop taking Phenelzine, as it may result in withdrawal symptoms. Ideally, a doctor gradually discontinues the treatment over 4 weeks.

Withdrawal side effects with sudden discontinuation of Phenelzine:

  • irritability;

  • dizziness;

  • headache.

The medication may be linked to overdose events. Please, do not exceed a dose without your doctor’s approval. If you believe you have overdosed, seek emergency help immediately (call 911).

Overdose symptoms with Phenelzine:

  • faintness;

  • headache;

  • fever;

  • vomiting;

  • excessive sweating.

Doctors should prescribe this medication with caution to people who operate heavy machinery. It may affect driving ability and alertness.

Does Phenelzine have interactions with other medications?

Phenelzine may interact with other medications, herbs, health supplements. Always speak to your doctor about taking Phenelzine alongside other medications.

The following medications may interact with Phenelzine:

  • other MAOIs;

  • Parkinson’s medications;

  • stimulants;

  • Fluoxetine;

  • Paroxetine;

  • Citalopram;

  • Cold medications with dextromethorphan;

  • Weight and anti-appetite medications.

The major interaction refers to certain food and beverages a patient should strictly avoid. 

  • herring;

  • liver;

  • dry sausages;

  • beans;

  • cheese except for cottage and cream cheeses;

  • yogurt;

  • beer and wine.

The use of Phenelzine requires a meal plan prescribed by a doctor. If discontinuing the treatment, a patient should abstain from eating and drinking the mentioned food and beverages for at least two weeks.

Can you take Phenelzine while pregnant or breastfeeding?

The mechanism of action and safety of Phenelzine in pregnant women is not clearly understood.

In animal studies, it slowed down the growth of rats and dogs. Speak to your doctor if you are pregnant or plan to become pregnant. You are likely to need another approach.

There is no evidence about the excretion of Phenelzine when breastfeeding.

Can children take Phenelzine for anxiety? 

Children are not commonly prescribed Phenelzine. It is not approved for pediatric use, however, a doctor may occasionally prescribe it if the benefits of treatment with this medication prevail the risks.

How to take Phenelzine?

The dosage is individually prescribed for depression, anxiety, and other medical conditions. Speak to your doctor to get to know what fits you best. Take it only as directed. 

The initial dosing regimen is usually 15mg 3 times per day. It may be increased by a doctor but not over 90mg. The tablets can be taken with or without food. If you skip a dose, take it as soon as possible. 

It takes approximately 4 weeks to receive a response from this treatment.

Are there alternatives to Phenelzine?

Prescription medications as Alternatives to Phenelzine for Anxiety

Phenelzine is not a first-line medication prescribed to treat anxiety disorders. It can be used in an off-label treatment. Speak to your doctor to choose the right approach for your particular case, as there are many other prescription medications such as:

  • Klonopin

  • Valium

  • Lexapro

  • Prozac

  • Buspirone

  • Xanax

  • Inderal

  • Cymbalta

  • Tofranil

  • Hydroxyzine

  • Zoloft

There are various alternatives. If you’d like to learn more about whether Phenelzine, 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 Phenelzine

Learn more about different therapy options for anxiety here

Energy & Holistic Modalities as an Alternative to Phenelzine

Learn more about different energy & holistics modalities for anxiety here

Tech & Devices as Alternative Treatments to Phenelzine

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