Dietary Restrictions with Monoamine Oxidase Inhibitors (MAOIs)

Rege, S. (2023, April 17). Monoamine Oxidase Inhibitor (MAOI) - Mechanism of Action| Psychopharmacology |Clinical Application. Psych Scene hub. https://psychscenehub.com/psychinsights/maoi-psychopharmacology/

Dietary Restrictions with Monoamine Oxidase Inhibitors (MAOIs) Reference

Onaolapo, A. Y., & Onaolapo, O. J. (2021). Glutamate and depression: Reflecting a deepening knowledge of the gut and brain effects of a ubiquitous molecule. World journal of psychiatry, 11(7), 297–315. https://doi.org/10.5498/wjp.v11.i7.297

References for secondary mechanisms of MA antidepressants

Monoamine antidepressants convey secondary mechanisms that may alter gut microbiota and glutamate to impact MDD symptoms. MDD is associated with elevated glutamate levels in the frontal cortex. These antidepressants work to reduce glutamate signaling to prevent excitotoxicity. This effectively reduced NMDA functioning, increases AMPA signaling, which leads to BDNF production. In MDD, typically low BDNF levels are seen; this mechanism works to reverse this and attempt to effectively treat MDD.

Secondary mechanisms of MA antidpressants

MAOIs inhibit the breakdown of the enzyme that breaks down monoamine neurotransmitters. Some MAOIs have antidepressant effects, including:

- Phenelzine (Nardil)
- Isocarboxazid (Marplan)
- Tranylcypromine (Parnate)

Scripps College

Kalamazoo College

Antidepressants are psychotropic medications prescribed to alleviate symptoms of mood disorders like depression and anxiety. They work by addressing chemical imbalances of neurotransmitters in the brain. Different types of antidepressants target different neurotransmitters; for example, selective serotonin reuptake inhibitors (SSRIs) increase the availability of serotonin, while serotonin-norepinephrine reuptake inhibitors (SNRIs) elevate the levels of both serotonin and norepinephrine. Common SSRIs include Prozac and Zoloft, while tricyclics include Tofranil and Elavil.

Antidepressants

- Monoamine hypothesis
- Monoamine Oxidase (MAO)
- Reserpine
- Tricyclics
- Selective serotonin reuptake inhibitors (SSRIs)

Drug Treatments for Depressive Disorders

The study of the effects of drugs on the brain and behavior.

Psychopharmacology 

National Center for Biotechnology Information (2021). PubChem Compound Summary for CID 3759, Isocarboxazid. Retrieved October 21, 2021 from https://pubchem.ncbi.nlm.nih.gov/compound/Isocarboxazid.

Isocarboxazid (Marplan)

National Center for Biotechnology Information (2021). PubChem Compound Summary for CID 3675, Phenelzine. Retrieved October 21, 2021 from https://pubchem.ncbi.nlm.nih.gov/compound/Phenelzine.

Phenelzine (Nardil)

National Center for Biotechnology Information (2021). PubChem Compound Summary for CID 19493, Parnate. Retrieved October 21, 2021 from https://pubchem.ncbi.nlm.nih.gov/compound/Parnate.

Tranylcypromine (Parnate)

Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs used to treat conditions like depression, which is often associated with low serotonin levels. Unlike agonists or antagonists that bind to receptors, SSRIs work by blocking the reuptake process. This action prevents unused serotonin from being reabsorbed by the presynaptic neuron, allowing it to remain in the synaptic cleft for a longer period. The extended presence of serotonin enhances its interaction with postsynaptic receptors, thereby strengthening its overall effect. Common examples of SSRIs include Prozac, Paxil, and Zoloft.

SSRIs and SNRIs

Tricyclic (or heterocyclic) antidepressants inhibit the reuptake of serotonin and/or norepinephrine, and are thus called due to their three (or more)-ring chemical structure. Some examples include:

- Amitriptyline (Elavil) 
- Nortriptyline (Aventyl)
- Maprotiline hydrochloride (Ludiomil)
- Desipramine hydrochloride (Norpramin)
- Clomipramine (Anafranil)

A similar drug is Bupropion (Wellbutrin), which is an aminoketone that weakly blocks norepinephrine, serotonin, and dopamine reuptake.

Tricyclic Antidepressants

Monoamine Oxidase Inhibitors (MAOIs)

Reference for Side Effects of Antidepressants

Side effects of SSRIs: 
* Headache
* Nausea
* Weight gain
* Drowsiness
* Reduced sex drive

Side effects of Tricyclics:
* Dry mouth
* Constipation
* Blurred vision
* Drowsiness
* Reduced sex drive
* Increased risk of suicide

Side Effects of Antidepressants

A clinician is considering two different types of medication for a patient. Medication A primarily works by increasing the amount of serotonin available between nerve cells. Medication B works by increasing the availability of both serotonin and norepinephrine. Which of the following statements accurately distinguishes between the mechanisms of these two medications?

References for Long-Term Use of Antidepressants

In past years, the overall use of antidepressants has increased. This could be from a mixture of increased "new" users or longer durations of use. Long-term is defined as 12 months or more of consistent medication use. Prevalence and incidence have increased SSRI use specifically. Treatments typically are as follows:

treatment of acute phase: 4-6 weeks
treatment for prevention of relapses: 4 to 12 months
treatment for prevention of recurrence: maintenance treatment (2-5 years)

Long-Term Use of Antidepressants

- A risk of taking SSRIs
- Many over-the-counter drugs may synergize with the drugs to push synaptic serotonin levels too high
- Symptoms include confusion, muscle spasms, and fever

Serotonin Syndrome

Psychedelics, in particular LSD and psilocybin, have been investigated as potential treatments for depressive symptoms. There is evidence for short-, medium-, and long-term usefulness in both micro-dosing and regular studies. In addition to the potential cognitive stimulation (LSD) or emotional well-being effects (psilocybin), these treatments are generally well-tolerated in clinical and general populations. In addition, MDMA has received breakthrough treatment status with the FDA for the treatment of PTSD.

Potential clinical uses for psychedelics

Ketamine, a rapid-acting anesthetic and NMDA receptor antagonist, has been investigated for use in treatment-resistant  depression. When infused in sub-anesthetic doses over a short period (e.g. 40 minutes), ketamine has been shown to have rapid antidepressant effects that can last for up to 4 weeks in some patients.

Using ketamine for treatment-resistant depression

Caffeine has been shown to increase the antidepressant effects of repeated transcranial magnetic stimulation in humans and the antidepressant-like effects of SSRIs, SNRIs, and atypical antipsychotics in mouse models. The proposed mechanism for this is that caffeine's adenosine receptor antagonism increases downstream production of serotonin, dopamine, and norepinephrine.

Caffeine and depression treatments

Psychopharmacology Library

Microdosing is the administration of a psychedelic drug/medication at one-tenth of the dose that would cause hallucinogenic effects.

Microdosing

A class of drugs that typically alleviate symptoms of schizophrenia. (Also called neuroleptics)

- The Dopamine Hypothesis

- Typical Antipsychotics

- Long-Term Effects of Antipsychotic Drugs

- Atypical Antipsychotics

- The Glutamate Hypothesis

Antipsychotic Drugs

Psychoplastogens class of compounds that take effect on neural plasticity in key circuits involved in brain health. Psychoplastogens include psychadelics, and produce a quantifiable change in plasticity within a short time frame (>72 h) post administration.

Psychoplastogens 

The study of the use of extracts and compounds obtained from mushrooms as medicines or health-promoting agents. Mycotherapy, also known as fungal or mushroom therapy, is a branch of natural medicine exploring the therapeutic properties and potential health benefits of various mushrooms. The practice of using mushrooms for medicinal purposes has been observed in different cultures throughout history, and it continues to gain recognition and scientific interest in modern times.

Mycotherapy

Medications that have Anticholinergic effects are associated with central and peripheral side effects. These include constipation, confusion, sedation, and dry mouth. Increased Anticholinergic exposure increases adverse risks.

Anticholinergic Medicines

Psychomotor stimulant drugs, such as amphetamines, are a primary treatment for narcolepsy. These medications function by increasing overall levels of neural activity to combat daytime sleepiness. Examples include modafinil, armodafinil, and various amphetamines.

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