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Registered: 10/22/02
Posts: 4,061
Last seen: 6 years, 4 months
The Chemistry of MAOI's......seeking information.
    #2045069 - 10/27/03 12:25 AM (19 years, 3 months ago)

Does anyone know of any links to some info on the basics of MAO inhibitors? I've been searching the internet and the shroomery forums but everthing im finding pertains specifically to food interactions, psychadelics and specific stuff like that.

I'm looking for more general info on the chemicals workings of maoi's. I've found a couple of dead links to an maoi faq and one that leads right to the lyceum home page....but the faq is nowhere on the site.

Any links or info would be appreciated. I want to write a paper on maoi's for my chemistry class.

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work in progress

Registered: 04/11/01
Posts: 8,932
Loc: The Netherlands
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Re: The Chemistry of MAOI's......seeking information. [Re: Viveka]
    #2046326 - 10/27/03 09:51 AM (19 years, 3 months ago)


but right now they are down

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Carpal Tunnel
Registered: 08/30/99
Posts: 6,488
Loc: n. e. OH, USSA
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Re: The Chemistry of MAOI's......seeking information. [Re: Viveka]
    #2046662 - 10/27/03 02:05 PM (19 years, 3 months ago)

old enough to know better
not old enough to care

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Registered: 11/01/03
Posts: 37
Last seen: 18 years, 1 month
Re: The Chemistry of MAOI's......seeking information. [Re: gnrm23]
    #2162403 - 12/06/03 02:07 AM (19 years, 2 months ago)

Many fully trained psychiatrists, even psychopharmacologists, have rarely prescribed a monoamine oxidase inhibitor (MAOI), afraid of the possible consequences. One Boston-area psychiatrist who plans to retire soon has 12 patients who have been doing well for years on MAOIs. Before he called us, no psychiatrist in the area was willing to accept these patients who intended to stay on MAOIs.

Despite their potential side effects, the older MAOIs (phenelzine, tranylcypromine, isocarboxazid, and selegiline) have all been proven effective in depression; some studies have found them more effective than tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs).1,2 In our experience, MAOIs succeed in at least one-half the depressed patients who have failed on other antidepressants, and they are highly useful in treatment-resistant depressions and related disorders. Further, hypertensive crises are rare, and dietary restrictions are often exaggerated.

Drawing from the evidence and from our nearly 50 years? experience in the use of MAOIs, we hope to acquaint or re-acquaint you with how to use these agents safely and to maximum effect.

When to use an MAOI
Reviews, meta-analyses, and more than 250 controlled studies have addressed MAOIs in psychiatric conditions.

The bulk of the literature reports a response rate of about 70% in various types of depression and anxiety.3 Unfortunately, because of the absence of major federal or industry funding, the findings are difficult to integrate, with most investigators testing different MAOIs on different subpopulations. This type of fragmented research, however, is not unique to MAOIs.

We at McLean have found MAOIs useful as second-line agents?and occasionally as first-line agents?in treating depression. We also use them as third-, fourth-, or fifth-line agents because we see many patients who have failed to respond to or tolerate several other antidepressants or whose response to other antidepressants has faded.

MAOIs are effective for a range of clinical presentations in inpatients and outpatients?depressive disorders (endogenous and atypical, unipolar and bipolar, neurasthenic and phobic), anxiety disorders (panic disorder and social phobia), and conditions as far afield as borderline personality disorder and the negative symptoms of schizophrenia.4

In controlled trials, many investigators have shown an MAOI to be more effective in some clinical conditions than a tricyclic and than a placebo.5 For example:

? A group at Columbia University studied phenelzine in various permutations of atypical depression (rejection sensitivity, overeating, oversleeping, mood reactivity, severe lack of physical energy).6

? Davidson et al studied isocarboxazid in anxious depression.7

? Thase and Himmelhoch studied tranylcypromine in anergic and bipolar depressions.8

? Liebowitz followed up with studies of phenelzine and tranylcypromine in social phobia.9

? At Yale, early studies were done with phenelzine in posttraumatic stress disorder (PTSD).10

? The British have generally argued for use of MAOIs in mixed anxiety and depression.11

? The magisterial text Manic Depressive Illness recommends MAOIs as first-line treatment for bipolar depression.12

All of these studies yielded clinically and statistically substantial results with modest adverse effects.

Characteristics of each agent
In the United States, a psychiatrist interested in using an MAOI for depressed patients can choose from among four agents. These older MAOIs are irreversible blockers of the enzymes MAO-A and MAO-B (Box 1).13-16

Tranylcypromine has been found effective in patients hospitalized with endogenous depressions.17 Most clinicians experienced with MAOIs prefer this agent because it triggers weight gain to a much lesser degree than other MAOIs. Tranylcypromine can cause insomnia and a greater increase in tyramine sensitivity than other MAOIs, which therefore brings a greater risk of hypertensive crisis.

Phenelzine has the advantage that the effective dosage for depression is probably now known?more than 1 mg/kg body weight?although in three earlier large negative controlled studies, the effective dosage was not known and too little was given for too short a period. Weight gain and hypotension may be more common with this drug than with other MAOIs.

Isocarboxazid is the least studied but has been shown to be effective, with an average 41% drug-placebo difference in two studies.16 One of us (JOC) preferred it for several years, based on good responses in a handful of treatment-resistant patients.

Selegiline is used in low dosages for parkinsonism. At higher dosages (more than 20 mg/d), selegiline is a good antidepressant but is no longer MAO-B selective?inhibiting both the MAO-B and MAO-A enzymes and thus requiring the usual dietary restrictions. One of us (JAB) routinely maintains bipolar patients with mild baseline depression or lethargy on a mood stabilizer plus a low dosage (5 to 10 mg/d) of selegiline. With this combination, patients are more satisfied and compliant with the mood stabilizer regimen and require no dietary restrictions.

Overall, there may be a special clinical benefit to phenelzine in the more anxious, easily distressed patient and to tranylcypromine or selegiline in the more sluggish, lethargic patient. But probably the soundest way to choose MAOIs is if other, more standard treatments have not worked.


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Registered: 12/11/02
Posts: 1,020
Re: The Chemistry of MAOI's......seeking information. [Re: Viveka]
    #2164368 - 12/06/03 11:03 PM (19 years, 2 months ago)

I think this is what you want:

First there are MAOs in your stomach and in your brain, both will become inhibited, but lets talk about the ones in the brain right now. Think of 2 brain cells, one has an axon(sender) which is connected to the other ones dendrite(reciever) and the space between them is the synapse.

So what happens is the psilocin(in this case) goes from the axon, across the synapse, and is either recieved into the dendrite, or it bounces back and is re-uptaken by the axon. Here in this re-uptake is where the MAO waits to break down the psilocin, unless of couse you dont have any MAO(it's inhibitted) then the psilocin is sent across the synapse again. That means the psilocin doesnt break down at all once it gets to your brain, until your MAO is restored.

How prozac works: The prozac has a better affinity for the re-uptake receptor than seritonin, and then the prozac just sticks there on the re-uptake port so that nothing is able to be broken down by the mao in that receptor site.

For me and a few others this experience is valued and not used often. Also for someone who is less experienced with these type things it's probably not a good idea to try this.

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Registered: 05/14/18
Posts: 3
Loc: Los Angeles, CA
Last seen: 4 years, 8 months
Re: The Chemistry of MAOI's......seeking information. [Re: dave52] * 1
    #25203559 - 05/15/18 12:19 AM (4 years, 8 months ago)

MAOIs have a bad rap for one stupid reason: tyramine. No doctor wants a patient to die because she forgot that she can't eat fava beans. If you take selegiline orally, you cannot eat tyramine or you risk a dangerous blood pressure spike. Tyramine is in certain foods that you just have to memorize or carry a reference card. Therefore patient compliance is low/risky from the doctor's perspective and they either don't trust their patients to understand and be compliant or just take the entire risk out of the equation.

However, MAOIs are among if not the most effective antidepressants, esp. for women with treatment resistant depression. ALSO, if you use transdermal selegiline at the lowest manufactured dose (Emsam, 6mg) you typically do not have to worry about tyramine interaction. I eat whatever I want. Maybe once or twice I might've had a headache after eating something, but nothing awful happened and I can't directly attribute it to this combination.

I use 6mg Emsam daily. It's prescribed to me by a doctor for medical purposes (abates my CFS/FM symptoms 85%).

I started taking it because I had a depression and as a CFS/FM Pt, antidepressants that had worked for me prior to my condition either didn't work or I couldn't tolerate. I needed to try a totally new drug class and the transdermal application didn't upset my IBS, which was severe.

Literally overnight, I was less depressed, less anxious, got out of bed in the morning and made myself a cup of coffee. Within 10 days/2 weeks, I no longer had brain fog, my sex drive returned, and my gnawing muscle pain was gone. I realized it was the Emsam after I had no pain for days on end and finally cracked a clever joke to a friend. I hadn't had a one-liner in years.

Emsam gave my my life back and I recreated my life and career. It did NOT 100% clear up my symptoms, but they're manageable and I'm alive.

Selegiline can react badly with other meds, even OTC, such as I can't take Sudafed and other decongestants. I occasionally (1-2 p/yr) take a very small dose of Ritalin to help with fatigue. Even some docs disagree on the safety of these two together.

Not exactly sure of the metabolism, but I think the body creates a certain amount of methamphetamine from the selegiline during metabolism. (That's how people get extra energy, insomnia, and weight loss.)

The high blood pressure warning with selegiline is if you eat tyramine, although at a 6mg transdermal dose, this isn't a problem.

I typically am a lightweight and with other medical issues, I'm not very experimental. But I want to microdose mushrooms (no idea/preference what variety) for psychological "clarity" on some personal matters and issues. I'm looking for info about safety concerns of microdosing psylocibin while taking 6mg transdermal Emsam.

What do I need to look out for? Do I need a washout period?

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