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MAOIs for Panic, OCD, Social Anxiety,

PTSD and Depression

The Use of Monoamine oxidase inhibitors, commonly

Anxiety called MAOIs, are the other major

Medications antidepressant family. Phenelzine (Nardil) has

been the MAOI most researched for the
treatment of panic. Another MAOI that may
Anxiety be effective against panic attacks is
Medications
tranylcypromine (Parnate).
Introduction

Guide for Possible Benefits. Helpful in reducing panic

Anxiety,
attacks, elevating depressed mood, and
Panic,
Phobia and increasing confidence. Can also help OCD,
OCD
Medication generalized anxiety, PTSD and social anxiety.
Use Well studied. Tolerance does not develop.
Non-addicting.
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 Medication Possible Disadvantages. Dietary and
Profiles for
medication restrictions are important and
Anxiety, !
Panic and bothersome to some people. These include
OCD
avoiding certain foods like aged cheese or
meat and certain medications like cold

remedies. Some agitation during first days.

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Help Delayed onset requires weeks to months for

full therapeutic effects. Not as helpful for

anticipatory anxiety. Dangerous in overdose.

Dietary Restrictions. Certain foods contain a

substance called tyramine, which when

combined with an MAO inhibitor can cause a

“hypertensive crisis” that can produce

dangerously high blood pressure, a severe

headache, stiff neck, nausea, stroke or even
death.

The patient using an MAO inhibitor must be

quite responsible, since this medication

requires significant dietary restrictions. No

cheese (except cottage, farmer or cream
cheese), sour cream, homemade yogurt, red

wine, vermouth, liquors, beer, ale, sherry,

cognac, Bovril or Marmite yeast extracts
(baked goods prepared with yeast are OK),
aged meats and fish, meat prepared with

tenderizer, liver or liverwurst, overripe

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 bananas, avocados, fava beans, Italian green

beans, Chinese or English pea pods, or lima

beans are to be eaten while on this
medication.

Foods to eat in moderation include avocados,

chocolate, figs, raisins and dates, soy sauce,
caffeinated drinks, white wine and distilled
alcoholic beverages (e.g., whiskey, gin, vodka)

Medication Restrictions. MAOIs have major

interactions with many other drugs including

anesthetics, analgesics, other
antidepressants, and anxiolytics. The patient

using an MAO inhibitor should always consult

the prescribing physician before taking any
additional medications. This especially
includes over-the-counter cold medicines

(including nose drops or sprays),

amphetamines, diet pills, tricyclic
antidepressants, and certain antihistamines.

Possible Side Effects. Difficulty sleeping;

increased appetite; sexual side effects,

especially difficulty achieving orgasms for

men and women; weight gain; dry mouth;

sedation (sleepiness); and low blood pressure
symptoms, particularly on standing up
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 rapidly, which can lead to postural
hypotension.

As with any antidepressant, some patients

will experience “hypomania”, which causes
them to feel unusually “high” and full of

energy, talkative and very self-confident, with

little need for sleep and a high sex drive.
Patients don’t always recognize this as a
problem, but it can certainly be irritating to
those around them.

Phenelzine (Nardil)
Possible Benefits. Useful for panic disorder,
OCD, generalized anxiety, social anxiety, PTSD,
as well as depression. In one study, using
between 45 mg to 90 mg per day, phenelzine
produced significant panic symptom
reduction in more than 75% of patients.

complete control of the panic attacks usually

takes 4 to 6 weeks of treatment. Current
research also suggests it can be beneficial for
social phobia.

Possible Disadvantages. See disadvantages-

Monoamine Oxidase Inhibitors, above. Use

during pregnancy only with the approval of
your physician. Avoid breast-feeding while on
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 this drug.

Possible Side Effects. See side effects-

Monoamine Oxidase Inhibitors, above. Weight

gain, sometimes up to 20 pounds, and

postural hypotension are common. Swelling
around the ankles from fluid retention,
headache, tremors, fatigue, constipation, dry
mouth, loss of appetite, arrhythmias, difficulty
having orgasm, insomnia or sleepiness.
Decreased libido, inhibited orgasm and

difficulty maintaining erection.

Dosages Recommended By Investigators.

Each tablet of phenelzine is 15 mg. The initial
dose is usually 15 mg or less and then

gradually increased to 30 mg daily, in divided

doses. Dosage is then three to six tablets per
day, usually based on body weight. Most
patients need a minimum of 45 mg daily.
Maximum dose is usually 90 mg. You can take
the entire dose at bedtime after one or two
weeks unless you find this interferes with

your sleep.

Tranylcypromine
(Parnate)
Possible Benefits. Useful for panic attacks,
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 OCD, generalized anxiety, PTSD and
depression. Very little anticholinergic or
sedative effect. Little problem with weight
gain.

Possible Disadvantages. See disadvantages-

Monoamine Oxidase Inhibitors, above.
Insomnia and postural hypotension can be
persistent problems.

Possible Side Effects. Insomnia, postural

hypotension, swelling around the ankles,
some trouble having orgasm.

Dosages Recommended By Investigators.

Starting dose is one to two 10 mg tablets.
Increase the dose one tablet every three to
four days. Maintenance dose is 30 to 60 mg in

one or two doses in the morning or early

afternoon.
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