How Do SSRIs Compare to MAOIs

How Do SSRIs Compare to MAOIs Depression Treatment Medication Print How SSRIs Compare to MAOIs A Comparison Between Types of Antidepressants By Nancy Schimelpfening Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be. Learn about our editorial policy Nancy Schimelpfening Updated on February 04, 2020 Depression Overview Types Symptoms Causes & Risk Factors Diagnosis Treatment Coping ADA & Your Rights Depression in Kids Jonathan Nourok / The Image Bank / Getty Images Monoamine oxidase inhibitors (MAOIs) are considered perhaps the most effective antidepressant agents in the psychiatrists medical arsenal. They work by inhibiting the enzyme monoamine oxidase in the brain. Selective serotonin reuptake inhibitors (?SSRIs), on the other hand, are used to treat depression in addition to many anxiety-related illnesses, including panic disorder (PD).  They work by inhibiting the reuptake of serotonin in the brain, causing an increase of serotonin. How MAOIs Work It is believed that the brain contains several hundred different types of chemical messengers called neurotransmitters that act as communication agents between different brain cells. These chemical messengers are molecular substances that can affect mood, appetite, anxiety, sleep, heart rate, temperature, aggression, fear, and many other psychological and physical functions. Monoamine oxidase (MAO) is an enzyme that degrades or breaks down three neurotransmitters associated with mood and anxiety: serotonin, norepinephrine, and dopamine. MAOIs reduce the activity of the MAO enzyme, leading to higher levels of norepinephrine, serotonin, and dopamine in the brain. The benefits of these increases are improved mood and an anti-panic effect.?? Some common MAOIs include: Nardil (phenelzine)Parnate (tranylcypromine)Marplan (isocarboxazid)Emsam (selegiline) What Are MAOIs? How SSRIs Work Serotonin is a neurotransmitter that is important in modulating a variety of body functions and feelings, including our mood.  According to research, low levels of serotonin transmission has been linked to depression.?? As the name implies, SSRIs inhibit the reuptake of serotonin in the brain. This causes an increase of serotonin in an area of the brain called the synaptic cleft, the small space between brain cells. Examples of SSRIs include: Prozac (fluoxetine)Paxil (paroxetine)Zoloft (sertraline)Celexa (citalopram)Luvox (fluvoxamine)Lexapro (escitalopram)Viibryd (vilazodone) What Are SSRIs? Why SSRIs Prescribed More Often Than MAOIs SSRIs are generally the first choice for treatment of depression because beyond their effectiveness, they generally cause fewer problems with side effects. Because of dietary restrictions and concerns over hypertensive reactions, MAOIs are often used only after other agents have failed.?? Other common side effects of MAOIs include: Decreased sleep/insomniaNauseaDiarrheaDry mouthHypertension (high blood pressure)Hypotension (low blood pressure)DizzinessWeight gainEdema (water retention)Sexual dysfunctionMuscle spasmsWeaknessConfusion One of the attractions of SSRIs is that they are believed to be safer and produce fewer unwanted side effects than other classes of antidepressants.  But any medication can cause side effects, especially at the beginning of treatment.  Some common side effects of SSRIs include: NauseaSexual dysfunction, including reduced desire or orgasm difficultiesHeadacheStomach upsetNervousnessWeight gainDrowsinessInsomnia Some of these side effects will be eliminated after your body adjusts to the medication.?? If they don’t and are bothersome, your doctor may try another SSRI. Although all SSRIs function by a similar mode of action, each drug is different. Certain side effects with one SSRI may not be a problem with another. Discussing the details with your doctor will help choose the best option for you. Depression Discussion Guide Get our printable guide to help you ask the right questions at your next doctors appointment. Download PDF In general, primary care providers should not prescribe MAOIs unless they have experience with these medications. MAOIs Affects serotonin, norepinephrine, and dopamine levels Less commonly prescribed More side effects Requires dietary restrictions SSRIs Affects serotonin levels More commonly prescribed Fewer side effects Other Types of Antidepressants In addition to MAOIs and SSRIs, there are other classes of antidepressant medications available, including serotonin and norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants (TCAs). How SNRIs Work First approved by the FDA in 1992, SNRIs are often used to treat the chronic pain linked to depression as well as generalized anxiety, post-traumatic stress disorder (PTSD), social anxiety disorder (SAD), panic disorder, and nerve pain associated with fibromyalgia. They work similarly to SSRIs, but they inhibit the reuptake of both norepinephrine and serotonin, which may make them more effective than SSRIs for severe depression. SNRIs are also less likely than SSRIs to exacerbate rapid mood cycling in people with bipolar depression. They are most often used for short-term therapy, however, because prolonged use can trigger a  manic  or  hypomanic  episode. How SNRIs, SSRIs, and SNDRIs Differ in Treating Depression Examples of SNRIs include: Effexor (venlafaxine)Cymbalta (duloxetine)Pristiq (desvenlafaxine)Savella (milnacipran)Fetzima (levomilnacipran) Common side effects of SNRIs include: NauseaDrowsinessFatigueConstipationDry mouth How TCAs Work Tricyclic antidepressants (TCAs), which are primarily used to treat depression, bipolar disorder, and other conditions such as chronic pain and insomnia, were first introduced in the 1950s. TCAs work similarly to reuptake inhibitors in that they block the absorption of serotonin and norepinephrine into nerve cells, however, these drugs are known to have more side effects than newer classes of antidepressants like SSRIs. In a meta-analytic review, researchers found that patients with major depressive disorder (MDD) who took TCAs discontinued treatment 27% of the time due to side effects compared with 19% on SSRIs.?? The percentage was even greater in elderly patientsâ€"33% and 16%, respectively.   When compared with MAOIs, TCAs have also been found less effective for treatment-resistant depression  (TRD). However, TCAs still have their place in depression treatment. Examples of TCAs include: Elavil (amitriptyline)Norpramin (desipramine)Asendin (amoxapine)Anafranil (clomipramine)Pamelor (nortriptyline)Tofranil (imipramine)Vivactil (protriptyline)Surmontil (trimipramine)Sinequan (doxepin) Some side effects of TCAs include: ConstipationDry mouthBlurry visionDrowsinessDizzinessWeight gainIrregular heartbeatLow blood pressureSeizures Overview of Tricyclic Antidepressants A Word From Verywell Theres no one-size-fits-all treatment for depression and what works for someone else might not work for you. Since all antidepressants can help with symptoms of depression, deciding which one to take may come down to which side effects you can and cant tolerate. Other factors include your symptoms, treatment history, and current medications (including prescription drugs, over-the-counter medications, vitamins, and supplements). When starting a new drug, do your best to have patience (it can take up to eight weeks to feel substantial improvement) and monitor any drug side effects to discuss with your doctor. If your side effects are intolerable and begin to interfere with your quality of life, call your doctor right away but  dont stop treatment  on your own. Stopping abruptly can cause withdrawal symptoms, including chills, dizziness, fever, headache, lethargy, nausea, and vomiting. How to Know Which Antidepressant Is Right for You