Combining MAOIs with norepinephrine or drugs that constrict blood
vessels (epinephrine, amphetamines, pseudoephedrine, ephedrine,
phenylpropanolamine, and phenylephrine) may increase blood pressure to dangerous
levels.
The antibiotic linezolid (Zyvox) should not be combined
with MAOIs because linezolid also inhibits monoamine oxidase.
MAOIs should be
discontinued at least two weeks before administration of drugs that interact
with MAOIs. Drugs that interact with MAOIs should be discontinued at least 1-2
weeks before administration of MAOIs. Because the effect of fluoxetine lasts for
several weeks after discontinuation, MAOIs should not be initiated for at least
five weeks after stopping fluoxetine.
Because MAOIs stimulate the nervous system, they may be beneficial for depressed
patients who over-sleep or are fatigued.
Hypertension may occur during therapy
with MAOIs. Therefore, blood pressure should be monitored periodically during
MAOI treatment. Hypertensive crisis may occur when MAOIs are combined with
tyramine containing foods or drugs that constrict blood vessels.
Bleeding in the brain also may occur. Patients should be aware of signs
and symptoms of hypertensive crisis and should seek immediate medical treatment
if these signs or symptoms are present. Hypertensive crisis may be managed with
nitroprusside (Nitropress), labetalol
(Normodyne, Trandate), or phentolamine.
Orthostatic hypotension
(feeling faint upon standing due to decreased blood flow to the brain) also
occurs. Patients should rise slowly from a sitting position to reduce the effect
of orthostatic hypotension. Orthostatic hypotension may be treated with
steroids.
Some patients may experience peripheral edema (swelling of the lower legs and
ankles) which can be improved by wearing support stockings.
Weight gain also
occurs during MAOI therapy, and tranylcypromine (Parnate) causes more weight gain than
other MAOIs. MAOIs also are associated with sexual side effects such as
decreased sexual drive, erectile
dysfunction, difficulty ejaculating or reaching
orgasm. Sexual side effects may diminish with time or a reduction in dose.
What are examples of MAOIs?
phenelzine (Nardil)
tranylcypromine (Parnate)
isocarboxazid (Marplan)
selegiline transdermal system (EMSAM)
What are tricyclic antidepressants (TCAs)?
TCAs have been in use since the 1950s when imipramine (Tofranil) was shown to be
effective for treating depression. TCAs primarily work by increasing the level
of norepinephrine in the brain and to a lesser extent serotonin levels. Some
TCAs also are antihistamines (block the action of histamine) or anticholinergic
(block the action of acetylcholine, a neurotransmitter), and these additional
actions allow for uses of TCAs other than for treating depression as well as additional side effects.
TCAs may inhibit the antihypertensive effect of
clonidine (Catapres). Therefore, combining TCAs with clonidine may lead to
dangerous elevations in blood pressure.
TCAs may affect the heart's electrical
conduction system. Combining TCAs with drugs that also affect the heart's
conduction system [for example, disopyramide
(Norpace), pimozide (Orap),
procainamide (Pronestyl,
Procan SR, Procanbid)] may
increase the frequency and severity of an abnormal heart rate and rhythm.
Combining TCAs with carbamazepine
(Tegretol) may result in lower TCA blood levels because carbamazepine increases
the break down of TCAs, potentially reducing the effect of TCAs.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Fibromyalgia, formerly
known as fibrositis, causes chronic pain, stiffness, and
tenderness of muscles, tendons, and joints without detectable inflammation. Fibromyalgia patients have an unusually low pain threshold. Symptoms of fibromyalgia include fatigue, abnormal sleep, mental/emotional disturbances, abdominal pain, migraine and tension headaches, and irritable bladder. Treatment of fibromyalgia involves patient education, medication, exercise, and stress reduction.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Post-traumatic stress disorder (PTSD), a psychiatric condition, can develop after any catastrophic life event. Symptoms include nightmares, flashbacks, sweating, rapid heart rate, detachment, amnesia, sleep problems, irritability, and exaggerated startle response. Treatment may involve psychotherapy, group support, and medication.
Suicide is the process of intentionally ending one's own life. Approximately 1 million people worldwide commit suicide each year, and 10 million to 20 million attempt suicide annually.
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood stabilizer medications, antidepressants, and psychotherapy.
Overactive bladder is a sudden involuntary contraction of the muscle wall of the bladder causing urinary urgency (an immediate unstoppable need to urinate). Overactive bladder is is a form of urinary incontinence. Treatment options may include Kegel exercises, biofeedback, vaginal weight training, pelvic floor electrical stimulation, behavioral therapy, and medications.
Attention deficit hyperactivity disorder (ADHD) is a behavioral disorder characterized by the symptoms hyperactivity, impulsivity, and inattention. Treatment for ADHD may involve behavioral therapy and psychostimulant or antidepressant medication.
Orthostatic hypotension symptoms include lightheadedness, weakness, blurred vision, and syncope or passing out. Causes of orthostatic hypotension include dehydration, anemia, medication, blood loss, low blood pressure, heat related illnesses and more. Treatment of orthostatic hypotension depends on the underlying cause.
Seasonal affective disorder is a type of depression that tends to occur as the days grow shorter in the fall and winter. Symptoms of seasonal affective disorder include tiredness, fatigue, depression, irritability, body aches, poor sleep and overeating.
Separation anxiety disorder is a common childhood anxiety disorder that has many causes. Infants, children, older kids and adults can suffer from symptoms of separation anxiety disorder. Common treatment methods include therapy and medications.
Premenstrual dysphoric disorder (PMDD) is considered to be a severe form of premenstrual syndrome (PMS). PMDD has also been referred to as late luteal phase dysphoric disorder. The cause of PMDD is unknown. Some of the common symptoms of PMDD (not an inclusive list) include: mood swings, bloating, fatigue, headache, irritability, headache, breast tenderness, acne, hot flashes and more. Treatment for PMDD is with medication to treat the symptoms of PMDD.
Urinary retention (inability to urinate) may be caused by nerve disease, spinal cord injury, prostate enlargement, infection, surgery, medication, bladder stone, constipation, cystocele, rectocele, or urethral stricture. Symptoms include discomfort and pain. Treatment depends upon the cause of urinary retention.
Childhood depression can interfere with social activities, interests, schoolwork and family life. Symptoms and signs include anger, social withdrawal, vocal outbursts, fatigue, physical complaints, and thoughts of suicide. Treatment may involve psychotherapy and medication.
Enjoying a satisfying sex life as we age is important to both physical and mental health. As we age, diseases and conditions may pose challenges in our sexual health, and sexual experiences. Learn how to manage your conditions and still have a gratifying sex life as you age.
Sleepwalking is a condition in which an individual walks or does other activities while asleep. Factors associated with sleepwalking include genetic, environmental, and physiological. Episodes of sleepwalking may include quiet walking to agitated running. Conditions that may have similar symptoms of sleepwalking, but are not include night terrors, confusional arousals, and nocturnal seizures. Treatment of sleepwalking generally include preventative measures. Medication may be prescribed if necessary.
Compulsive gambling is a disorder that affects millions in the U.S. Symptoms and signs include a preoccupation with gambling, lying to family or loved ones to hide gambling, committing crimes to finance gambling, and risking importance relationships and employment due to gambling. Treatment may incorporate participation in Gamblers' Anonymous, psychotherapy, and medications like carbamazepine, topiramate, lithium, naltrexone, antidepressants, clomipramine, and fluvoxamine.
Bipolar disorder, or manic-depressive illness, is a disorder that causes unusual and extreme mood changes. Symptoms of bipolar disorder in children and teens include having trouble concentrating, behaving in risky ways and losing interest in activities they once enjoyed. Treatment for bipolar disorder in children and teenagers incorporates psychotherapy and medications.
Irritable bowel syndrome (IBS) in children is a functional gastrointestinal disorder with symptoms of abdominal pain, bloating, diarrhea or constipation. The cause of IBS is unknown, however, certain foods, stress, anxiety, and depression may contribute to the symptoms of IBS. There is no cure for IBS in children; however, medications, dietary changes, and stress management may relieve symptoms.
Fast food consumption and lack of exercise are just a couple of causes of childhood obesity. Health effects of childhood obesity include type 2 diabetes, heart attack, stroke, high cholesterol, asthma, sleep apnea, gallstones, fatty liver disease, GERD, depression, and eating disorders.
Depression in the elderly is very common. That doesn't mean, though, it's normal. Treatment may involve antidepressants, psychotherapy, or electroconvulsive therapy.
Munchausen syndrome by proxy (MSBP) is a mental illness (factitious disorder) in which a caregiver secretly abuses a child by faking symptoms in the child. Symptoms present in the child include suffocation, bleeding, poisoning, and induced seizures. Treatment involves maintaining the safety of the child and typically incorporates psychotherapy and psychiatric medications for both the perpetrator and victim.
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