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MAOI List: Monoamine Oxidase Inhibitors

MAOIs (Monoamine Oxidase Inhibitors) are drugs that are considered “first-generation” antidepressants. This class of drugs was originally developed for the treatment of tuberculosis, but were found to have antidepressant properties when given to depressed patients. In the 1950s, they became very popular as antidepressants. Scientists eventually developed more selective MAOI drugs to reduce side effects and improve upon existing treatments.

Monoamine oxidase inhibitors work by inhibiting activity of monoamine oxidase, which results in increased levels of various neurotransmitters (serotonin, norepinephrine, dopamine). These drugs have been proven effective for depression (specifically atypical subtypes) and are still commonly utilized to help treat Parkinson’s disease (some are considered first-line treatments). They may also be prescribed for panic disorders, social phobia, mixed anxiety with depression, PTSD, some eating disorders, and borderline personality disorder.

The major drawback associated with MAOIs is that the interactions that they have with certain foods can be lethal. Due to various lethal dietary interactions, they are considered a “last-line” treatment option for depression. In other words, people typically use MAOIs when they’ve already tried various SSRIs/SNRIs, new atypical antidepressants, and tricyclic antidepressants. Newer research suggests that the dietary interactions associated with MAOIs may not be as severe as initial claims.

MAOI List: Monoamine Oxidase Inhibitors

There are two common subtypes of monoamine oxidase inhibitors, MAO-A inhibitors and MAO-B inhibitors.

  • MAO-A: The MAO-A subtype specifically focuses on tyramine, serotonin, norepinephrine, and dopamine.
  • MAO-B: The MAO-B subtype focuses more on dopamine, phenylethylamine and trace amines.

It should be noted that some MAOIs consist of a mix of MAO-A and MAO-B targeting.  Additionally some are non-selective and irreversible, while others are selective and reversible.

Marplan (Isocarboxazid)

This is a MAOI that is of the hydrazine class with non-selective and irreversible properties. Marplan is among the oldest few MAOIs that is still sometimes utilized in psychiatric treatment throughout the world. In addition to treating depression, this drug tends to work well for anxiety disorders, and in some cases can help with neurodegenerative diseases like dementia.

Although this drug is considered very effective, it can produce many severe unwanted side effects including: headaches, weight gain, dizziness, fainting, and tremors. An MAOI like Marplan is seldom prescribed this day in age due to side effects as well as potentially dangerous interactions with food.

Moclobemide (Aurorix / Manerix)

This is a selective MAOI with reversible inhibition properties that is most often prescribed for major depression. It is approved in a variety of countries outside the United States including Australia and the United Kingdom. Mclobemide has been found significantly more effective than placebos and equally effective as SSRIs with arguably better tolerability and quicker onset of action.

It works as a selective, reversible inhibitor of MAO-A and increases neurotransmitters serotonin, norepinephrine, and dopamine. The drug inhibits approximately 4/5 of all MAO-A and slightly less than 1/3 of all MAO-B. Contrary to most modern antidepressants, this drug can actually increase libido and improve sexual performance. It also is documented as not being associated with any weight gain as a side effect.

Interestingly long-term use of this drug is associated with increases in neuroprotection and higher testosterone (as opposed to SSRIs which may lower testosterone). This is one of the safest antidepressants on the market and in many cases can be considered a first-line treatment option.

Nardil (Phenelzine)

This is an MAOI with non-selective and irreversible properties of the hydrazine class. It is regarded as one of the most effective non-selective MAOIs that is still clinically prescribed for depression and sometimes anxiety disorders. This drug has been documented as working particularly well among individuals diagnosed with atypical and neurotic depression.  Nardil is often used as a third-line treatment option for individuals with treatment-resistant depression.

The drug works by inhibiting both MAO-A and MAO-B to a similar extent (slightly more MAO-A). In addition to boosting serotonin, norepinephrine, and dopamine, this MAOI also increases concentrations of GABA, which may contribute to its overall efficacy. It should be noted that there are some disputes over the efficacy of the old Nardil vs. new Nardil in regards to changes in the inactive ingredients.

Parnate (Tranylcypromine)

This is an MAOI that has non-selective and irreversible inhibition properties. It is utilized mostly as an antidepressant and in some cases for certain types of anxiety disorders. It was initially synthesized in 1948 and created with similar structure to an amphetamine.  It has proved to be a very effective medication for treatment-resistant depression, but many people who take it cannot tolerate side effects at higher doses.

It works by inhibiting MAO-B slightly more than MAO-A, releasing norepinephrine and dopamine, and increasing trace amines. It is considered roughly 10% as stimulating as an amphetamine. Unlike other MAOIs, Parnate was not derived from hydrazine and upon being released was thought to have significant clinical potential.

Pirlindole (Pirazidol)

This drug is an MAOI with reverse inhibition properties used primarily in Russia to treat major depression. It is very similar to the drug Metralindole due to the fact that it acts primarily as a reverse inhibitor of MAO-A. This drug tends to have more of an activating profile as opposed to being sedating. It has also been found effective in treating some cases of fibromyalgia.

Selegiline (Deprenyl / Eldepryl / Emsam)

This is an MAOI drug that acts as an irreversible selective MAO-B inhibitor at standard doses. The initial use of this drug was to help treat Parkinson’s disease, but it has since been approved by the FDA to treat major depression (2006) in the form of transdermal patch. At increased doses, the drug becomes non-selective and inhibits both MAO-A and MAO-B. It is currently being investigated for smoking cessation and the treatment of ADHD.

Toloxatone (Humoryl)

This drug is an MAOI that acts as a reverse inhibitor on MAO-A. It was introduced to France in 1984 for depression. This drug tends to have activating properties and in many cases can increase levels of anxiety. Compared to the MAOI Moclobemide, this drug was found to have more side effects and be less effective. It has been suggested that individuals with low norepinephrine and/or anxiety-free depression may be ideal for this medication.

MAOIs: Non-Antidepressants

Additionally there are various drugs that function as MAOIs, but are utilized to treat conditions other than depression.  Listed below are drugs with MAOI properties that are not prescribed to treat depression.

Hydracarbazine: This is a compound with MAOI properties that is utilized primarily to lower blood pressure. There isn’t much formal research that has been conducted utilizing just this compound.

Isoniazid (Nydrazid): Isoniazid is significant and important to note because it lead researchers to investigate biological causes of major depression. This drug is commonly utilized as a first-line prevention option and treatment for tuberculosis. As it became widely utilized for tuberculosis in the 1950s, many people began to note mood elevating side effects. Due to significant reports of mood elevation, it lead researchers to create a new generation of antidepressants; the MAOIs.

Linezolid: This is an example of a medication that has very negligible effects as an MAOI. This drug is used as an antibiotic for infections that resist treatment with other antibiotics. It is used to treat pneumonia, various skin infections, and central nervous system infection.

Procarbazine (Matulane): This is a mild MAOI that is used to treat Hodgkin’s lymphoma and various types of brain cancer as an antineoplastic drug. It has been on the market since 1969 and belongs to a group of drugs called “alkylating agents.” Due to its mild MAO inhibition, it raises levels of neurotransmitters in the brain. It is considered an important drug and has been cited on the World Health Organization’s List of Essential Medicines.

Rasagiline (Azilect): This drug functions as an MAOI with irreversible inhibition properties. It is often used in treatment during the onset of Parkinson’s disease. It affects the inhibition of MAO-B up to 14x that of MAO-A. It has been documented as having neuroprotective effects and was created as a result of possible neurotoxicity resulting from the drug Selegiline.

MAOIs: Discontinued Antidepressants

There are other MAOI drugs that have been withdrawn from the market due to adverse side effects. The majority of discontinued and problematic MAOIs are classified as “hydrazines.” The hydrazines are a group of non-selective MAOIs with irreversible inhibition properties. Most hydrazines were marketed throughout the 1950s and 1960s, but were withdrawn due to causing liver damage.

  • Benmoxin: This was an irreversible non-selective MAOI that was created in 1967 and was utilized as an antidepressant throughout Europe. It belonged in the hydrazine class of drugs and was eventually discontinued from the market.
  • Caroxazone (Surodil / Timostenil): This is a non-hydrazine MAOI drug that acted on both MAO-A and MAO-B as a reversible inhibitor. When this drug came out, some research suggested that it may be safer than other MAOIs on the market. It affected MAO-B up to 5x that of MAO-A. It would eventually get removed from the pharmaceutical market.
  • Iproclozide (Sursum): This was another hydrazine class MAOI with selective, irreversible properties. It was eventually withdrawn from the market prior to 1980 due to the fact that it resulted in three deaths. Upon investigation it was discovered that this drug lead to symptoms of jaundice followed by acute liver failure.
  • Iproniazid: This MAOI carries irreversible and non-selective properties and is classified as a hydrazine. It was considered the first antidepressant to ever be marketed, but has since been discontinued worldwide. This drug was developed specifically for tuberculosis, but was found to produce antidepressant effects among patients being treated. The drug was approved in the late 1950s, but was removed from the market as a result of causing liver damage.
  • Mebanazine (Actomol): This is a MAOI drug that was utilized throughout the 1960s as a treatment for depression, but has since been removed from the market. It was of the hydrazine class and due to being removed from the market, there isn’t much published research regarding its usage.
  • Minaprine (Cantor): This is an MAOI antidepressant that had been used throughout France until 1996. The drug worked on MAO-A as a reverse inhibitor. It was eventually discontinued as a result of causing seizures.
  • Niamid (Nialamide): This MAOI of the hydrazine class functioned as an antidepressant with non-selective and irreversible properties. Chemically this drug was similar to Iproniazide as a derivative of isonicotinic acid. It was withdrawn by Pfizer from United States, UK, and Canada in 1963 as a result of causing liver damage.
  • Octamoxin (Ximaol / Nimaol): This is an MAOI drug classified as a “hydrazine” that contains irreversible and non-selective inhibition properties. It was used as a treatment for depression but was removed from markets in 1960s.
  • Pheniprazine (Catron): This is another MAOI of the hydrazine class that has irreversible and non-selective inhibition properties. It was used to treat depression throughout the 1960s and in some cases was prescribed for schizophrenia. Various adverse effects associated with this drug included: eye damage and jaundice. As a result, it was deemed unsafe and taken off the market.
  • Phenoxypropazine (Drazine): This drug was marketed in 1961 for the treatment of depression. It worked as an irreversible MAOI and was classified as a hydrazine. It was eventually discontinued five years after its release as a result of possible cases of liver damage.
  • Pivalylbenzhydrazine (Tersavid): This drug worked as an MAOI with non-selective and irreversible properties, classified as a hydrazine. Throughout the 1960s it was commonly used to treat depression, but it has since been removed from the market.
  • Safrazine (Safra): This MAOI has been largely withdrawn from the global market. Like most problematic MAOIs, it resulted in non-selective, irreversible inhibitory effects and was classified as a hydrazine. It was a drug mostly used in the heyday of hydrazine MAOIs in the 1960s.

MAOI Drugs: Should They Be Used More Often?

In many cases MAOIs can be very effective drugs for treating major depression. Although many carry unwanted side effects and dietary interactions, there a few that stand out from the crowd, namely Parnate, Nardil, and Moclobemide. The best MAOI drugs are often under-utilized as antidepressants and yield very good results in treatment-resistant individuals. Unfortunately the class of MAOIs tends to harbor a reputation of being old, outdated, and having dangerous dietary interactions.

Based on what is known about MAOIs, I think that they should be used more often in certain individuals. People who aren’t responding well to the newer classes of medications may want to try a proven MAOI drug. A valid argument could even be made for a person trying certain MAOIs prior to various tricyclics, especially those with a minimal side effect profile like Moclobemide. For a majority of depressed individuals, making dietary compromises to avoid MAOI interactions is a small price to pay for depression relief.

The MAOI class is completely unique in function from other antidepressants in that they don’t inhibit reuptake of neurotransmitters. Instead, these drugs work to inhibit monoamine oxidase which results in increased levels of all neurotransmitters. Some MAOIs inhibit MAO-A more than MAO-B and vice versa.  Inhibition of MAO-A is associated with increases in tyramine, norepinephrine, serotonin, and dopamine, while inhibition of MAO-B is associated with increases in just dopamine; hence being used more often in cases of Parkinson’s disease.

If you have tried various MAOIs and/or have an opinion on them, feel free to share your thoughts in the comments section below. Many people are afraid to use them simply because they tend to carry dietary interactions and are essentially “older” drugs. That being said, many MAOIs have proven to be just as effective as other classes of drugs.

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{ 18 comments… add one }
  • Joe Duncan February 24, 2018, 8:11 pm

    I have suffered from depression and anxiety for most of my life. I had tried most classes of medicine and nothing worked. In 1991 my doctor prescribed Nardil and it changed my life. I never knew life could be wonderful before.

    After 10-12 years it began to lose its effectiveness and side effects became more severe; muscle cramps, muscle twitching, gastrointestinal problems, sexual issues, etc. And, of course, the dietary restrictions had always existed.

    I would like to try Moclobermide as it does not have most of the side effects that Nardil has. Unfortunately, it has never been approved in the US. My doctor is not amenable to help me get it from Canada, England, or other countries where it is available. Anyone know how to make this happen?

    • Shane Nason February 25, 2018, 1:18 am

      You should be able to order it online. Have you ever tried Parnate? Some people find it good if Nardil poops out. And sometimes higher doses are the key. I’ve been on both. And moclobemide.

  • Torkel November 15, 2016, 6:15 pm

    Been drugged by psychiatry since 1997. Its soon 2017 and despite asking for MAO inhibitors I haven’t been put on one. It got a dysthymic character after the worst are done away with. The SSRI isn’t working good at least by itself. Bupropion augmentation did help but I got allergic. Methylphenidate worked excellent that week I tried them but they’re illegal and unobtainable if not having an ADHD/ADD diagnoses.

    This type of depression is obviously linked to low dopamine levels and possibly low testosterone most likely worsened by SSRI. At best they help somewhat for anxiety but even for that sort of suck. Also I’ve gotten Restless Leg from them. The treatment for that is usually *surprise* dopamine AGONISTS.. This is Sweden by the way.. Oh yes, Cannabis works against the anhedonia at least the Sativa version but that is of course illegal as well.

    So if you try to treat yourself because your docs are idiots you get penalized. I think I am at my 7th doc or so and I like this one and I’ll see if they gives me some ADD/ADHD diagnose this time as even this one is afraid of MAO-inhibitors. Who knows… I only had one doc where I was close to getting Parnate/Nardil.

    Educated neurologist and older. So it seems that docs education and experience helps increasing ones chance of getting those. Good site btw. Very detailed information. I hadn’t heard of many of the drugs despite considered a living encyclopedia when it comes to psychiatric drugs by some.

  • Shane November 14, 2016, 10:21 pm

    I also have done quite well on medium to very high doses of Parnate. I have tried in with various combinations like high doses of Lyrica and modafinil. (Would not recommend modafinil based on a few interactions reported in the literature). I would only try this under the supervision of an experienced psychiatrist.

    I have been on it about 7 years and have never worried about my diet after the first while. I’ve done a lot of research and found very few examples of people having trouble with food interactions. However, I am not suggesting anyone take risks. But personally I have had no issues with regular cheeses, meats, pickled herring, wine, beer, or anything I’ve eaten.

    In fact, I have pretty much forgotten to use caution at all. Maybe I’m just lucky. Perhaps there are some unusual foods I’ve never had. I have many times eaten a small pizza with extra cheese and no issues. I am definitely not suggesting this, but many experts agree that the diet interactions list is overkill. Doctors hesitate to prescribe Parnate because of the bad rep from many decades ago before they were aware of the interactions and so few people take it.

    Also a person can overdose and commit suicide taking a whole bottle of it, and it can be deadly with other illegal and prescription drugs (ie. SSRI’s). It’s unfortunate that the MAOIs are not utilized more. Especially out of overdone diet fears. I think if the person is responsible and careful, does their research, and very carefully and slowly tries small amounts of some of the foods on ‘the list’, the risk can be quite low and rewards of the medicine can have a high potential.

    I don’t think I’ve ever heard of someone having one or two slices of pizza, or bottled beer, or a piece of pepperoni or salami in moderation. Better to err on the side of caution though. Just my two cents.

    • Eva November 17, 2016, 2:51 pm

      Hi Shane, like so many others, it is fantastic you’re doing so well on Parnate. Regarding the foods that are not recommended to eat whilst taking a MAOI, everyone should follow the guidelines as closely as possible. They should read up on MAOI and Serotonin Syndrome expert Dr Ken Gillman’s very recent research regarding MAOIs and Parnate in particular; they will see the list is far shorter than previously advised, and there are really only a few foods that you absolutely MUST NOT risk eating due to a very high and genuine risk of a hypertensive crisis which as you’ll know, can be fatal. It is also a very scary and painful death.

      With this in mind, it is perhaps more than a little irresponsible to state that you’ve eaten these foods with no problem. Although it may be true that you personally can get away with this, it may not be true for someone else of a different weight and personal biology than you. That the tyramine content in the same foods can be higher or lower depending on the day should also be kept in mind.

      If people do not observe the advised foods to avoid, deaths or near-fatal hypertensive crisis’ could increase due to this, and MAOIs will once again be thought of as dangerous, scary to take, and therefore much less likely to be prescribed by a doctor, or pursued by a desperate patient who may otherwise find relief for the first time in many years. It is already hard enough for many people to find a doctor who will prescribe MAOIs due to the prevailing ignorance about their true abilities and ease of use.

      We do not want MAOIs to become even HARDER to acquire or even be taken off the market due to patient irresponsibility about potential tyramine reactions, as it can certainly be very easily avoided. As is now well-documented all over, MAOIs can be extremely effective antidepressants and often relieve suffering when nothing else can. Let’s not lead people to believe the observed list is just an advised “mild precaution” – that it is fine to be lax in their vigilance – when it certainly is not – the risk is very real and people not observing it could ruin things for everyone else.

      Let’s not do that! All the best to you (and please be careful!). Eva

  • Sue Trupin September 5, 2016, 4:48 am

    I experienced a major depression that went on for more than three years and for which I was hospitalized twice and had about 15 ECT treatments. I was on several medicines from virtually every ‘modern’ family of anti-depressants and other psychiatric medicines as well with absolutely no positive change in symptoms. Without telling my psychiatrist, I tapered myself of all my meds, really just to see who I was at that point without them.

    Indeed I felt worse, unbearably anxious, still suicidal but not in that same flat, numb way I had been for so long. When I told her I had put myself on a ‘drug holiday’ by then for a month or so, she said, “Well, now is a good time to try an MAOI.” I was feeling entirely hopeless but agreed. I started on Parnate and in about ten days I felt a distinct improvement. Miraculously, I have been well now for a couple of years.

    I did experience a brutal insomnia, meaning I literally would be up the entire night. Oddly, though, since I was no longer depressed and am retired, I spent the time awake peacefully, relishing in thoughts of gratitude and joy, music, reading, etc. There was some light-headedness as well on hot days. I reduced the dose, now on 30mg a day, and the insomnia subsided and I remember to stay well hydrated.

    I have had absolutely no food-related problems. I stay away from aged cheeses, red wine, tofu, fava beans, etc, hardly a sacrifice given what I endured. I had a parathyroidectomy last year, a simple surgery and no special precautions were taken in the OR. I think it is appalling that these drugs are withheld from the huge population of people with chronic and major depression who would benefit from them.

  • David April 5, 2016, 10:02 am

    I was on Nardil 30mg a day for 12 years then switched to Parnate 20mg / day. Not huge doses – I’ve always ignored the diet restrictions and ate cheese as often as I liked. Absolutely no adverse side effects as long as I allowed an hour between eating and taking the pill or vice versa. Now I’m down to just 1 parnate pill a day (10mg) and I don’t give the diet advice a second thought.

  • Y2J March 28, 2016, 3:48 am

    Like many others, MAOI’s are the only thing that worked for me. I was about 14 and ridden with depression and social anxiety at the time and had been for years. I tried virtually every antidepressant under the sun, sometimes more than once. MAOI’s would be much more often prescribed if the doctors weren’t afraid and were more informed.

  • Houstonian January 4, 2016, 11:08 pm

    MAOIs work like magic. You will not be depressed, and there are no direct side-effects. However, to be very clear, the food interactions are very serious. I was skeptical about the food interactions, so I decided to “experiment”. I didn’t have side-effects with many of the foods (e.g., soy sauce, beer, protein extracts, red wine, fava beans, etc.), so I was feeling pretty safe.

    One day, I ordered a salad at a restaurant during a business lunch, and I noticed it had some blue cheese crumbles. I did not eat any of the crumbles intentionally, but there was some residue on the lettuce. I figured it would be safe. I was WRONG. Almost immediately, my head started spinning, and I thought I was going to pass out right there at the table.

    I had an unmistakable sensation that I was dying. After a couple of hours, my head started to clear, and, obviously, I survived the ordeal. Had I actually eaten some of those cheese crumbles, I doubt I would be writing this warning today.

  • Sherry Davis December 5, 2015, 10:44 pm

    I was taking oral Selegiline for Post Polio Syndrome symptoms, mostly muscle fatigue. After one month of taking 5 mg twice daily, I developed a stiff and sore neck. At first, I thought I had slept in an awkward position, but after no improvement I googled side effects for Selegiline and discovered it is a very critical side effect, so I discontinued using it. It has been two weeks since the discontinuation, but my stiff neck remains. I felt the Selegiline was helpful and was wondering if there is another drug that works in a similar way that I could use. I would like to know when my stiff and sore neck will improve. Thank you.

  • Rob November 15, 2015, 6:20 am

    I have taken (arguably) 21 psych meds &/or med “cocktails.” Of those, only Nardil alone, and Nardil with Lamictal, have worked. I tried Parnate, but the dosage never got high enough to know. (Parnate did change my food cravings from chocolate & sugar, to salty foods, however. And the lbs just melted away. No mood enhancement, though). Alas!

    Some med schools (& I strongly suspect most) don’t even teach their psychiatrists how to use MAOIs. Even though for me, and others I have met, Nardil is the ONLY thing that works. Who knows how many patients are suffering because their docs are too ignorant (untrained), or too scared to use Nardil. Thank goodness my doctors were not!

  • Tracy October 23, 2015, 4:49 am

    I, like others here, have tried almost every antidepressant known to man. Even going so far as 25 shots of ECT and very high doses of other antidepressants. After almost 20 years of suffering I finally found the Emsam patch. It was amazing. I didn’t even consider suicide. I had things I wanted to accomplish. I didn’t sleep all of the time. Unfortunately, the patch left my skin raw and at times bleeding in the shape of the patch. I was able to use it for a couple months before I ran out of places that weren’t scabbed/scarred to put the patch.

    Oral selegiline left me with a host of side effects. On to the next MAOI; as long as I’m already going with the diet and trying them, might as well try another. I hope one of them helps like Emsam did. It would turn my life around if it did. I hope more doctors aren’t afraid to try them. The dietary restrictions aren’t so bad and for those of us suffering seemingly endlessly it may just be a life saver.

  • Dave C. October 1, 2015, 1:12 am

    Over the years, I’ve tried nearly all the popular antidepressants. The only only one that had a significant effect was Parnate. Parnate doesn’t give you a “high,” but it increases motivation, which is very important in depression so you can accomplish daily tasks. However, at the normal 30-40 mg/day dosage I experienced the typical afternoon fatigue, where you feel like you MUST lie down, and also insomnia at night – which required a lorazepam if I wanted to sleep (not a sustainable situation).

    We tried simply reducing the dosage. Now I take just 10 mg per day, or even split a pill and take 5 mg. Of course it isn’t quite as effective and takes much longer to work if started that way, but it still works adequately for a person to function. And of course there is less chance of medication and food interactions at the lower dosage. It isn’t a placebo at this level; after so many meds tried I can tell when something is working.

    The only disadvantage now is that you may have to go through a two-week discontinuation if you are having elective surgery, due to the anesthetic interactions – and you must tell your dentist also. I also wear a medic-alert pendant and carry a wallet card in case of emergency room treatment. At the low dosage I have never had a hypertensive event, but did have an elevated blood pressure event (I think from canned fish) at the normal dosage.

    You can carry an emergency blood pressure lowering medication for food or medication interactions if you are going to be away from an emergency room – say when hiking or camping. But you need to discuss this with your doctor, since there is some risk. For others with treatment-resistant depression, Nardil may also work as well, being similar in effect, but I have not tried it. I have read that the side effects are somewhat different than Parnate so it may be better for some people. Unfortunately, the Emsam (selegiline) patches are very, very expensive, so most insurance plans don’t cover them.

    • Eva October 29, 2016, 10:14 am

      I’m pleased to read that you are doing well on Parnate. However, you state that, “…we tried simply reducing the dosage. Now I take just 10 mg per day, or even split a pill and take 5 mg. Of course it isn’t quite as effective and takes much longer to work if started that way, but it still works adequately for a person to function.”

      Parnate is well studied, especially in recent years and confirmed to only work for 1-2% of people at 20mg per day so you are very unusual in that your biology responds tot such an incredibly low dose. 5mg is your *personal* effective dose; and it is blatantly incorrect and untrue to state that, “…it still works adequately for a person to function”. What you should have said is that *you personally* are able to function on this dose.

      This drug is extremely helpful for many people but as with all medications, the dose *must* be sufficient for a satisfactory response, and that dose for the majority of people is between 40mg and 60mg, and sometimes much higher.

  • Robert July 29, 2015, 4:05 pm

    I took Nardil for over 30 years. It was extremely effective. My internist along with other doctors always said I should get off Nardil. I tried several times and the depression returned. I tried an SSRI and became suicidal in a week. The name was Zoloft. I slowly removed Nardil from my system over four months. My Psychiatrist gave me some options. Return to Nardil or try Emsam. I have been on Emsam for three years.

    The issue I have is the cyclical nature of the depression breaks through the Emsam and I become very depressed for weeks at a time. I take the highest dose, 12 MG Patch Delivery every day. The price of EMSAM is extremely expensive.Personally I am in favor of Nardil. I have been taking an MAOI for almost 35 years and have had one food reaction in all that time. I eat and drink almost everything.

    The food reaction I had was to unpasteurized cheese.My BP went over 200 in five minutes. Had to go to ER. I almost checked out permanently. I believe today the FDA has banned unpasteurized cheese. Everyone who suffers from depression must find the drug that will work for them. Sometimes that is a very long and painful journey and sometimes you get it right on the first try.

  • Marcela February 4, 2015, 8:51 pm

    I have social anxiety that has turned into depression several times. Fluoxetine was effective in reliving depression, but I had an “artificial happiness” feeling, which I felt was kind of forced into my life… even at times when I would have liked to feel sad (i.e. at somebody’s death). After ~3 years my libido was completely gone, so I gave up prozac. However social anxiety kicked back and so did depression. This time I was put on moclobemide.

    It relieved depression just as good as prozac had, and it didn’t mess with my libido. Importantly I don’t follow any dietary restrictions, so it is the best thing that has ever happenned to me. I recently moved to the States, wher it is not approved… what a pain… I haven’t figured out what will I do, but I’m not going back to SSRIs because loosing my libido is too much for avoiding depression.

  • herbert segnitz January 25, 2015, 4:16 am

    In the treatment of mood disorders, before a patient is labeled treatment resistant, all distinct classes of antidepressants must be utilized. Any physician who does not do this while an individual is suffering from depression and anxiety is doing a disservice to everyone. The idea that antidepressants are all roughly equipotent and that use of a couple classes constitutes an adequate trial of antidepressant therapy is incorrect. The idea that trials of additional antidepressant classes is exposing the patient to unnecessary adverse drug interactions is shortsighted. Benefit versus risk is the pivot point. A depressed and anxious individual is chronically experiencing significant reductions in their cognitive and emotional range that places them at a high risk each day of damaging reactive behavior and choices in all spheres of human endeavor and interaction.

  • Kathy November 7, 2014, 10:38 pm

    I have tried every anti-depressant out there and none worked. Finally I was placed on parnate and it has helped dramatically. The dietary restrictions really aren’t that bad. I wish someone would have put me on this sooner.

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