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Re: SSRI's vs. MAOI's

Posted by King Vultan on May 14, 2004, at 12:42:55

In reply to SSRI's vs. MAOI's, posted by Jaylee on May 13, 2004, at 19:45:52

> Whats the major differences/ side effects between SSRI's and MAOI's?

SSRIs only work on serotonin, one of the three principal neurotransmitters involved with mood. They work by preventing the serotonin from being conveyed back into the neuron for storage, which results in the serotonin bouncing around in the synapse for a longer period of time. This sets off a cascade of chemical changes with the final result being an increase in serotonin transmission if the process goes as it should. Common side effects of increasing serotonin transmission are

Lower libido
Delayed or absent orgasm
Plus a whole host of other side effects you can read about from people who have taken one or more of the SSRIs (Lexapro, Celexa, Prozac/fluoxetine, Paxil/paroxetine, Zoloft, and Luvox).

MAOIs work on a different principle. The two traditional ones that are left, Nardil and Parnate, work by knocking out predatory enzymes that consume all three of the neurotransmitters that are involved with mood: serotonin, norepinephrine, and dopamine. Thus, they serve to actually increase the numbers of these neurotransmitters available, similar to eliminating the wolves in an area and winding up with more deer, rabbits, and sheep. Because they work on all three neurotransmitters, they have the potential to be much more powerful than an SSRI, which just works on one.

MAOI side effects really depend on which of the two drugs are considered. Nardil has similar side effects to an SSRI, minus the nausea, with worse insomnia and also the potential for some amount of drowsiness, dry mouth, constipation, and urinary hesitation. However, the last three side effects are not as bad as they are for the tricyclic class of antidepressants. Nardil is also unfortunately notorious for causing weight gain (FWIW, I am on a max dose of Nardil of 90 mg/day and have not experienced this, though).

The other traditional MAOI, Parnate, is noted for having bad insomnia, but it is more stimulating than Nardil and has very little sexual dysfunction. It also does not typically cause weight gain and has fewer side effects overall than Nardil.

Both drugs tend to cause resting blood pressure and heart rate to decrease, and both can also cause hypertensive crises, by far the most notorious MAOI side effect. If a person eats one of the prohibited foods such as cheddar cheese or takes certain OTC or prescription drugs, their blood pressure can skyrocket to dangerous levels. MAOI patients need to familiarize themselves with these problematic foods and drugs and always exercise a certain amount of caution in these areas.





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