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What Are MAO Inhibitors: A Beginner's Guide

Just your average apothecary (pharmacist), feet firmly planted behind the pharmacy counter, whose mortar and pestle are hitched to a star.

What is an MAO inhibitor? What does it treat, how does it work, and what are the risks associated with taking it?

What is an MAO inhibitor? What does it treat, how does it work, and what are the risks associated with taking it?

MAO Inhibitors for Depression

If you have ever looked at the warnings on the back of a cough/cold product you may have run across something like this: "Do not take if you are currently using an MAO inhibitor."

An MAO what? This article briefly describes the MAO inhibitor family of prescription medications and explains some of the serious and potentially life-threatening drug interactions that can occur when taking one of these drugs.

MAO stands for Monoamine Oxidase, which is an enzyme responsible for metabolizing neurotransmitters such as serotonin and norepinephrine.

This family of prescription medications is used primarily for treating depression, although one MAO Inhibitor, selegiline, is used to treat Parkinson's disease.

The 4 MAO Inhibitors currently available and used to treat depression are:

  • Isocarboxazid (Brand name Marplan)
  • Phenelzine (Brand name Nardil)
  • Tranylcypromine (Brand name Parnate)
  • Selegeline (Brand name Emsam, a transdermal patch)

MAO inhibitors are only available by prescription.

How Do MAO Inhibitors Work?

MAO Inhibitors (also called MAOIs) work by interfering with the enzyme responsible for metabolizing serotonin, epinephrine, dopamine, and norepinephrine. By binding to this enzyme they effectively increase the concentration of these neurotransmitters which in turn causes changes within specific areas of the CNS (central nervous system). These changes have been shown to result in a decrease in symptoms associated with depression.

I like to illustrate it this way: Neurotransmitters are like mental mail carriers. Monoamine oxidase is like a big scary watchdog that keeps eating the mail carriers and thus keeping him from delivering your mail! MAOI's are like a nice big juicy bone that we give to the dog to keep him busy and distracted so that the mail carrier can do his work. Did that make sense? It is a bit over-simplified for sure, but it gives you a rough (or should I say "ruff ruff"?) idea of how MAO inhibitors work.

MAO inhibitor warning

MAO inhibitor warning

What Risks are Associated With MAO Inhibitors?

MAO Inhibitors do a good job preventing MAO from metabolizing these important neurotransmitters. However, they are so effective, that they can also create problems, particularly with certain over-the-counter cold remedies and specific food items.

Medications to Avoid

Because MAO Inhibitors increase norepinephrine (a powerful blood vessel constrictor) it is important that patients taking one of these products do NOT ingest any other medication which could potentially increase norepinephrine levels even further. The consequences of such a combination could be, in some cases, fatal. Such medications include:

  • Pseudoephedrine (A nasal decongestant, now only available "behind the counter" in a pharmacy, but very commonly included in cold remedies)
  • Phenylephrine (A decongestant used in place of pseudoephedrine in many cough/cold products)
  • Amphetamine or Dextroamphetamine (Often used, by prescription, to treat ADHD)
  • Naphazoline and Oxymetazoline (In nasal sprays)
  • Isometheptene (an ingredient in the prescription drug Migranal)
  • Methylphenidate (also known as Ritalin)
  • Meperidine (the ingredient in prescription Demerol, for pain)
  • Eye drops with decongestants should also be avoided.

This list is not comprehensive but covers some of the most significant culprits. Because of these risks, MAO inhibitors are not used as frequently today as they had been in the past.

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Foods to Avoid

Monoamine oxidase also exists in our intestinal tract and aids in the break down of a substance known as Tyramine. MAO inhibitors interfere with this process, and will allow large amounts of Tyramine (from foods or beverages containing tyramine) to enter the the blood stream and contribute to a sequence of events that could lead to a hypertensive crisis (ie a very dramatic, potentially fatal, elevation of the blood pressure).

Therefore, patients on MAO inhibitors must completely avoid foods and beverages which contain significant amounts of tyramine. These include, but are not limited to:

  • Aged cheese and meats
  • Smoked meats or pickled meats
  • Liver
  • Anchovies
  • Sauerkraut
  • Avacado
  • Bananas
  • Pepperoni
  • Salami
  • Raisins
  • Caffeine should be used sparingly
  • Avoid wine, sherry, beer, and hard liquor

More Information

For more information on MAO Inhibitors, side effects, or manufacturer's guidelines, see the following links:

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.


Jason Poquette (author) from Whitinsville, MA on December 17, 2012:

Hi Syl,

Yes, Yohimbine should not be combined with an MAO inhibitor like Marplan, Nardil or Parnate. Glyfomin is the brand name for metformin, though not available in the U.S. by that name. There does not appear to be any known interactions between the 3 products you mention. Always talk to you doctor when considering a change in your medication. Also, keep an eye on your blood sugars just to be safe. Best wishes.

Syl on December 10, 2012:

I am taking the prescription drug glyfomin for diabetes and I take also an OTC Saw Palmetto for enlarged prostate. I was about to discontinue the Saw Palmetto and substitute it with another OTC Yohimbe & Saw Palmetto when I noticed a warning on the label saying NOT to use Yohimbe & Saw Palmetto with MAO inhibitor. I do not take any MAO inhibitors, but I wonder if there is any danger in taking Glyfomin with Yohimbe & Saw Palmetto

Jason Poquette (author) from Whitinsville, MA on September 25, 2012:

Dawn, I chose your question to be featured this week on my weekly Patient Question feature over at:

Jason Poquette (author) from Whitinsville, MA on September 25, 2012:


Well, several things need to be said. First, you should be certain that the MD intends for you to take BOTH Wellbutrin and Viibryd. Sometimes these are combined, but it is also possible they intended you to switch over slowly to Viibryd from Wellbutrin. Secondly, there is a risk for Serotonin syndrome, but the risk is considered relatively small - but still significant. It should be discussed with your MD. Hope that helps.

Dawn on September 21, 2012:

I was just prescribed Viibryd today from my Dr so googled it and then that said all the info about the MAOI then while reading this article now I am a little freaked out. My pharmacy where I get my meds filled hasn't said anything about the mixture but we all know not all of them pay close attention. I am very confident with my Dr and what he recomends but I am on:

15mg Adderall 2xday

150mg Wellbutrin 2xday

and now he added the Viibryd and of course start out low dose and as weeks go by he wants me to get to 40mg a day of that

Is it even safe to be mixing all these?

Jason Poquette (author) from Whitinsville, MA on June 01, 2012:

r ann,

Ummm. How about this one? :) Epinephrine should be avoided.

Jason Poquette (author) from Whitinsville, MA on May 31, 2012:


You're okay. Zoloft is not an MAOI. Good luck with the workout.

r ann on May 31, 2012:

A hemorhoid caution: Do Not Use Preparation H! Thankfully I glanced at the back of the box, and sure enough, there was the MAOI warning.

r ann on May 31, 2012:

I need to have a cavity filled but when I told the dentist I was on an MAOI and would need him to adjust/change the anesthetic he was clueless. He asked me for more information. What is a good web site or article I can give him so nothing goes wrong?

Ayanna on May 30, 2012:

I have been taking Zoloft for a while now but just recently began a weight loss program. I started taking assault fruit punch to enhance my workout and it does say not to take Mao drugs. Should I stop as my workouts are going so well

Jason Poquette (author) from Whitinsville, MA on May 07, 2012:


There are no reported interactions that I am aware of.

TBR on May 05, 2012:

I was wondering if it is safe to take Anatabloc for arthritis while taking zoloft or an anti depressant?

Jason Poquette (author) from Whitinsville, MA on April 27, 2012:

Hi Lindsey,

Many insurances require doctors to do periodic assessments to ensure the medication is working and not causing side effects. Geodon is preferred on the Florida Medicaid drug list, so it should be covered, though the doctor may just need to confirm he/she is monitoring the patient. You may need to call the "800" number on his insurance card and ask them exactly what needs to still be done to get this covered.

Lindsey on April 27, 2012:

Im not sure if this site is monitored or kept up with, but it's worth a try.

My brother has paranoid schizophrenia and is currently taking geodon and imipramine. He has been on it for almost 3 years now and it has helped him IMMENSELY. We spent a year trying out a myriad of other scripts and this was the only cocktail that offered him any kind of normalcy. We went to pick up his script a few weeks ago and the pharmacy said they needed a prior authorization from his psychiatrist to be sent to the insurance company. Needless to say, his doctor is proving to be just as useless as the Insurance company in helping us understand or execute this stupid PA. He can't work, so affording the meds out of pocket is just not an option ($800/mo is astronomical). He is on Medicaid, and the doctors around here (south Florida) that accept his insurance are horrendous. It has been a struggle to keep up his confidence in his doctor and life in general, and lately he has been threatening to stop his meds all together.

I happened to stumble across this thread during my research of viable options, and I'm so desperate, Im hoping you or someone who reads this will be able to offer any kind of insight or advice on a course of action.

Help!! :(



Jason Poquette (author) from Whitinsville, MA on February 17, 2012:

From a reliable drug-interaction resource:

"Yohimbine may interact with selected Antidepressants. Do not take Yohimbine and any Antidepressant together without talking to your health care provider. In particular, you should never take Yohimbine with drugs known as Monoamine Oxidase Inhibitors (MAOIs). Examples of MAOIs include products like Eldepryl, Marplan, Nardil, and Parnate. Using these drugs together can lead to a serious increase in blood pressure, known as 'hypertensive crisis', confusion, nervousness, palpitations or other serious side effects. You must avoid use of Yohimbine within 2 weeks before starting an MAOI, 2 weeks after stopping an MAOI, and during the use of an MAOI."

MFR on February 16, 2012:

Hello and thanks for the article. I am taking some off-label antidepressant for PE (premature ejaculation) and bought Yohimbe. I took what the label says (2 pills) and after 30 min, I felt terrible. My heart started to race, my eyes were bloody red and very dry, I had to go to the bathroom many times in a short period of time and felt anxious, very anxious and wanted to vomit. I know after this reactions I am asking a stupid question, but why did that occur? Yohimbe and a mild anti-depressant for PE cant be taken together?

Thanks in advanced.

Jason Poquette (author) from Whitinsville, MA on February 14, 2012:

R ann,

Not with the listed injections themselves, but potentially with other drugs that the MD might use in addition to these (e.g. lidocaine or epinephrine). This could be serious. Be sure to let them know before getting any injection.

R Ann on February 13, 2012:

Any known complications between MAOI's and regular Botox/Juvederm/Restylane injections?

Jason Poquette (author) from Whitinsville, MA on January 30, 2012:

Hi annafran,

Meperidine, methadone, tramadol and Flexeril must be avoided. Beyond that it is up to the discression of the surgeon and the post-op care provider. Sometimes NSAIDs will be enough.

annafran on January 29, 2012:

I have been taking MAOs for 25 years and I've had 4 surgeries under general with no problems. Post op pain was minimal therefore I only had to take advil and tylenol. My concern is if I had to have surgery which would require narcotics for post op relief. Is there anything that I could take which would control intense post op pain (i.e. joint surgery, internal surgery, etc.)?? Going off the MAOs prior to surgery would be an option but it could be ER surgerywhere going off would not be an option.

Thanking you in advance for your reply.

Helen on January 23, 2012:

I have been taking Parnate for 30 years, and it has been a life saver for me. I had a hysterectomy 15 years ago and had to off Parnate for 2 weeks prior to surgery. I went into a severe depression after going off my MAO Inhibitor and had to have ECT to stabilize my mood. Since that time I have had cataract surgery and a bunionectomy under general anesthesia while taking Parnate and had no complications. My son is a physician, and one of his colleagues is an anesthesiologist who assured me that general anesthesia while taking Parnate doesn't pose the risks that was once commonly thought. I would certainly seek out a physician and ananestheologist who are very familiar with the use of general anesthesia and MAO Inhibitors.

Glenn T. Kitchen on January 16, 2012:

Hello "pharmacist";

I as well like your analogy. I guess the only thing I'd add to it is that the mailman is carrying good mail, the mail that allows us to enjoy life ;-)

I have taken Nardil for many years and it beautifully assisted me out of very serious depression. After many attempts on my life and tons of anti-depressants starting with Tricyclics, then Tetracyclics and moving through many SSRI's and 12 ECT treatments with minimal positive effect, my doctor rightfully suggested I try a MAOI - Nardil. He thoroughly informed and trained me on the proper use of Nardil and it has henceforth allowed me a successful, meaningful happy life. Twenty years now down the road I'm a very successful and happy computer programmer.

Thank you for your analogy and your web site; aiding a patient in understanding their medication is a very powerful and meaningful endeavor - God Bless!


bob on December 30, 2011:

drugs are addictive

stephanie on December 22, 2011:

Great job explaining.

I'm currently in nursing school and using this article as a supplement. :) The mail carrier example was a a good one.

Additionally, I took anti-depressants for a time. Prozac (fluoxetine) but that's an SSRI, I believe. Worked for me and in a relatively short time, too.

Jason Poquette (author) from Whitinsville, MA on December 22, 2011:


Thank you all for your great questions and comments. They have made this article a VERY useful resource to patients and also healthcare providers.

Would you be willing to post a link to this page on your Facebook wall, even for an hour? Or maybe a link in some discussion forum that you frequent?

Doing so would help spread the word about these important medications.



Jason Poquette (author) from Whitinsville, MA on December 04, 2011:

@chetan - not sure what you are asking

@joshua - Best to avoid this combo due to risks like serotonin syndrome

joshua on December 04, 2011:

Can you take wellbutrin a parnate together?

chetan on December 04, 2011:

hello sir,iam a pharmacy student, can u help me out of this that how to moralised the drug interaction?

Jason Poquette (author) from Whitinsville, MA on December 01, 2011:

Hi Ellen,

Mostly you just need to stay away from recipes that would use the food ingredients listed above in the article. Best wishes.

Ellen on November 30, 2011:

Looking for recipes to while taking MAO parnate. any help ? also told to stay away from MSG. Thanks

frank1in on November 19, 2011:

Thanks. The reason I ask is because I was taking anatabloc which contains anatabine marketed as an antiinflammatory for my lower back pain and MSM as well. I remember throwing up immediately after eating an overripe avocado. Also, my bp rose to 150/90 after eating a dinner high in cheese, and the same with a peanut butter sandwich and watermelon. The last two incidences happened after I stopped taking the anatabine and MSM. Could the MSM increase the potency of a weak MAOI? Also, I realize after doing more research on MAOI that a lot of my diet consists of natural MAOI- carrots, celery, green tea, ginger,garlic, etc which never gave me problems before. The MSM also, I don't remember giving me problems with BP and headaches. The only thing new would be the anatabine. My doc is checking my adrenal glands for any problems that might be causing my bp to spike up and down (which I think has to do with certain food intake) Thanks again for sharing your knowledge with us. I really appreciate it.

Jason Poquette (author) from Whitinsville, MA on November 18, 2011:

Hi frank1in,

Cigarette smoke contains some chemicals which function, albeit weakly, as MAOI's. Probably no food or drug concerns though. I recommend tapering off of MAOIs, as well as any medications for depression, when appropriate.

frank1in on November 17, 2011:

Hi, and thanks again for this great forum. My question is if you know about nicotine and anatabine as an MAOI. How strong are they and are there potential side effects with food/or other meds like high BP? Also, are there problems with stopping usage of such MAOI like withdrawal symptoms and lingering side effects etc. Thank you.

Fred on November 02, 2011:

Thank you ! It is interesting you mention toradol- as I just found out that is what I get in trigger point injections, with lidocaine. Was going to find out if that will be safe. Seems as long as no epinephrine or novacaine it is fine with MAOI?

Jason Poquette (author) from Whitinsville, MA on November 01, 2011:


Emsam and Vicodin, if used together, may cause excessive drowsiness. If necessary, the very lowest effective dose of Vicodin should be used. Ideally a non-narcotic pain reliever should be used. Ketorolac has been used by some with success.

Fred on October 31, 2011:

What a fascinating thread. I am waiting to start EMSAM. Is Vicodin safe? I had to washout of tramadol and previous ssri and remeron, but can't find definitive interaction with hydrocodone? What migraine abortives are safe, since I won't be allowed to use imitrex? Dr is thinking EMSAM will help prevent migraine and ease pain, so hopefully pain meds won't be needed. But I am still curious what I would be offered for pain while on EMSAM?

Jason Poquette (author) from Whitinsville, MA on October 22, 2011:


Typically Emsam would be reserved for more severe cases afte multiple treatment attempts with a few more classes of drugs have been tried.

Angela on October 21, 2011:

I was wondering, can i be put on emsam for slight depression, while taking xanax for my panic anxiety disorder. I've tried lexipro and zoloft both made me feel worse.

Jason Poquette (author) from Whitinsville, MA on October 14, 2011:


If it was meant to be a 30 day supply, then probably not. You will need to have your MD call in a new prescription with the higher dosage. Then it will work.

thmccord on October 14, 2011:

I've been on nardil for over a week and am now taking around 45mg/week, my doctor wants me to go up really slow 15mg/2weeks,30mg/2weeks but I'm not feeling any good or bad effects. I'm not going to go this slow. I have one refill, will insurance allow me to get this refill even though I just got this medication 18 days ago?

Jason Poquette (author) from Whitinsville, MA on October 13, 2011:


Great advice!! Thanks for sharing.

Carol Coyne on October 12, 2011:

I have taken Nardil for over 42 years now. Nardil was the first anti-depressant prescribed to me. IMO, it's the best MAOInhib. for me. Nardil does lower one's blood pressure. I also take a tranqu. This way the Nardil and klonopin is balanced out. Another drug I have heard maybe be helping people is Serqueol. May I suggest, people taking a MAOInhib. have braclets made indicating the medication name and drug to take if accidentially given wrong medications.

Ozzie on October 06, 2011:

Another question, if I may. I'm getting a faster heart rate after taking my 10mg second dose of the day. Around 86bpm and it feels fast. Later when that effect stopped I measured my rate to be 49bpm which I read is really low (I'm no athlete). Is this a serious side effect that I need to go back to my psych with, or can I just hope it will pass?

Ozzie on October 05, 2011:

Thanks for responding. Bummer.

Jason Poquette (author) from Whitinsville, MA on October 04, 2011:


They will want to stop Parnate at least 2 weeks before surgery. No working around it I'm afraid.

Ozzie on October 04, 2011:

Hi there,

I've just started taking parnate, currently 20mg per day. I am on a wait list for surgery (fix deviated septum) and I've been reading elsewhere that I'll be told to come off it prior to surgery. Do I really have to? Surely the anesthetist can work around it? TIA

Jason Poquette (author) from Whitinsville, MA on September 29, 2011:

Dear DaniD,

I am sorry you are having trouble with your depression. I understand. Drowsiness is often a side-effect with anti-depressants because of their actions on our central nervous system (CNS). Drowsiness, of course, can be due to many other things. You may want to consider evaluation for sleep apnea. Just a thought.

Lithium augmentation therapy has also been used with some success.

You have 2 challenges. The first is to find the best combination of therapies to restore your energy and motivation. The other is (and I believe this is just as important) finding a method to get done what you need to do even while your energy and motivation to do them is not normal. Rewards and accountability are very important motivators.

Best wishes!

danid,Utah on September 28, 2011:

one more question why would ambien actually wake me up and make me feel good? what is wrong with my chemicals??????

DaniD,UTah on September 28, 2011:

Dear pharmacist, Okay I have suffered sever depression for 15 years I have taken every type of med. Effexor has seemed to work best. I recently have been doing ECT's but I really need energy. I am concerned the effexor is causing the lack of energy? I started taking Adderal for some energy and ADD. It works for like 2 hours. My question is MAO's a good option for me. I don't want anything that makes me tired. I don't understand why anti depressants make u tired. Should they not make u more alive and have more motivation and energy??????

Jason Poquette (author) from Whitinsville, MA on September 08, 2011:


Great advice. B12 deficiency can cause headaches/migraines. Glad they got it figured out for you!

SCrossinTN on September 08, 2011:

Just reading some of these comments and questions that involve migraine headaches. I suffered from migraines for years and had an alergic reaction to imitrex so there was very little I could do. I had every test imaginable ran and finally found that I have a B12 deficiency. (So low that I wasn't even in normal range) I have been on B12 injections for about 4 years now with not the first migraine. Just a suggestion for those suffering from migraines - have your B12 level checked.

Jason Poquette (author) from Whitinsville, MA on August 31, 2011:

Hi jada,

Yes, they may be taken together. Remember that synthroid is best taken on an empty stomach without food. Flexeril may be taken with our without food, but if taken with Synthroid, must be on an empty stomach.

Jason Poquette (author) from Whitinsville, MA on August 30, 2011:

Hi Tom,

Yes, MAOI's can be used for atypcial depression, or depression without melancholia. However, the choice to switch to a MAOI should be done carefully. As this article explains, they have several concerning side-effects that must be considered. I'm not sure how long you have been on Cymbalta, but I would suggest you give it a good try (8-10 weeks) before talking to your doctor about other options. Best wishes!

jada on August 29, 2011:

Is it safe to take flexeril and synthroid at the same time.

Tom on August 28, 2011:

Hi there - I'm on Cymbalta for MDD. But I don't show normal signs for it. I eat a lot more, sleep a lot more, and feel very vulnerable. I read an article talking about "atypical depression" and how MAOIs are very good for that. Should I consider switching?

Gary on August 22, 2011:

I took alchol with my 25mg of Trazodone and it work better, is that unusual

Jason Poquette (author) from Whitinsville, MA on May 10, 2011:

Hi darlene,

These medication are safe to use together, although you may notice some additional drowsiness, particularly when just beginning one or the other. Best wishes!

darlene castro on May 09, 2011:

Are there any side effects if im taking lyrica and lexapro together.

Sonja Sheila from Germany on April 06, 2011:

really very useful information you sharing you did a wonderful job..

Chris P on April 05, 2011:

Thanks for the response! I lost this article or I would have thanked you sooner. I am not an abuser, nor do I have an addiction, so I will follow your advice.

Jan on March 28, 2011:

Hi there from Czech republic!

I would like to thank you for your great work on explaining the problem in understandable form, which I didn´t find in my language. The reason why I started to be interested in the MAO issue is yohimbe - old tribal natural drug used for its significant afrodisiacal effect.But it counts as a MAO inhibitor, which is not allowed to be combined with alcohol. I have read that it was used also during the "sexual revolution" in sixties and seventies. That makes me wonder. Did the flower children use this drug and really avoid all others? Is it really so dangerous? I would like to find out if this is more like recomandation what you better shouldn´t do or is the cobination with alcohol really life threatening? Thank you for your answer!

Jan, Prague-Czech republic

Jason Poquette (author) from Whitinsville, MA on March 23, 2011:

Hi Tanya,

I'm afraid not much is really known about exactly how St. John's Wort works as an antidepressant. It is probably a weak MAO inhibitor. I would avoid decongestants, but banana's are probably fine.

Tanya on March 11, 2011:

My doctor has suggested I start taking St. Johns Wort three times a day. Now I have read that it has MAO inhibitors. Does this mean if I take St. Johns Wort that I can't eat bananas and should avoid decongestants while I am on it?

Jason Poquette (author) from Whitinsville, MA on February 14, 2011:


I would stick with the Effexor XR for now. MAO-I drugs are typically only used when most other alternatives have failed. I hope you get well soon!


kez on February 13, 2011:

I have just been diagnosed with social anxiety have had this since i was 15 over the years it has got worse all the anti depressants ive tried have made me feel worse i have recently been put on efexor-xr this one so far has been the best with less side effects i started on 37.5mg for 2 wks now doc has increased dose to 75mg i am also taking 10mg of deralin 3 times a day always unmotivated dont want to do any thing or see anyone having panic attacks all through out the day nervous and paranoid all the time not coping feeling really down and depressed cant work yet cause im too mentally unstable want to be happy and live a normal life for once do you think efexor-xr will benefit me or should i try MAOIs

Jason Poquette (author) from Whitinsville, MA on February 13, 2011:

Chris P,

Personally I would not want to mix a stimulant like methylphenidate with an herbal stimulant like Ginseng. There are no well-documented serious interactions that I could find. But I just would not be comfortable with the combination. My advice is to not do it.

md.tajuddin . lalita college of pharmacy on February 12, 2011:

i got good knowledge from this article. thank you very much

Chris P on February 11, 2011:

I have a quick question. Surprised that no one has asked it. I have recently been prescribed to Ritalin(methylphenidate), not adderall (amphetamine). I am 21, so I am not a child. I was curious if the Ginseng Complex (1000mg), could be taken in conjunction with Ritalin, as I do not want to mix the two if I will die.

Jason Poquette (author) from Whitinsville, MA on December 28, 2010:

Hi Nick,

Getting off the xanax AND treating your anxiety are separate issues. Each one needs a plan. For the anxiety, you will need a good combination of behavioral coping techniques and possibly medication. Buspar is an option the doctor might consider. As for the Xanax, you will need to slowly taper off while implementing the other plan. Stress is challenging because each person handles it differently. From my counseling training I remember that stress is sometimes the result of other unresolved issues...not simply lifestyle issues. Think about that. Hope you get the help you need! Very sincerely,


Nick on December 26, 2010:

I have been taking Xanax for over 4y, because I have very stressful lifestyle and have stomach problems. Every time I get too excited my stomach start producing too much acid, which caused me 3 ulcers in the past and many other stomach problems. My doctor gave me Xanax to calm down the stress in those kinds of moments, but not paying attention how addictive and bad Xanax is for you, I have been taking it for more than 4y. Now when I want to stop it, my psychiatrist gave me Seraquil RX 50mg. I have not felt any relive from the Seraquil at all yet, and I have been taking it for almost a month. What do you suggest I should try for treating anxiety an also getting me off the Xanax?? My life style is very stressful as I mentioned earlier and I can’t stop taking Xanax, plus I can’t just change my lifestyle, because of the problem with taking and wanted to stop the Xanax. Please advice.

electricsky from North Georgia on December 07, 2010:

Thanks for sharing information.

Jason Poquette (author) from Whitinsville, MA on November 30, 2010:

Dear Frustrated,

First, I am very sorry for the frustrations you have encountered. Clearly you are taking very intellegent steps to seek medical help, and I do hope that you notice improvements. I'm afraid I can only answer your question in a very incomplete fashion.

The goal is to improve life quality. The amount of time it takes will vary greatly between patients. Please give the Wellbutrin some time, as this was just started a week ago.

It would be unrealistic for me to offer any substantial help or advice without much more information. I will just say 1 thing. Remember that feelings are just feelings. That's it. They may be very strong, but they are just feelings. What I tell people is that they need to begin doing the things they used to enjoy, or wish they could spite of the feelings that are absent. What kind of person would you want to be, if your feelings and emotions cooperated? Be that person, do what they would do, and for now...ignore the fact that the feelings are not there. For has worked wonders.

Best wishes,


Frustrated on November 30, 2010:

I have been going through a lot of emotional issues for the past two years. An incident happened at the end of June that I guess you can say, put me over the edge. Since then I have been off of work. I see my family doctor every two weeks and I see a psychiatrist monthly. I have been to a counsellor and am going to do group therapy.

The diagnosis was anxiety/depression/PDS. I started off with Ativan for the anxiety (5mg), Ziplicone (7.5 mg) for sleep, and Cipralex for the depression. I also take Synthroid and atacand. I had a very bad reaction to the cipralex so I was put on Cymbalta (90 mg). This seems to work, but I cant sleep. The most I get is 3 hours straight through the night. To help with this I was put on Gabapentine as a mood stabilizer. Still nothing. So last week my doctor took me off the Gabapentine and put me on Wellbutrin XL (300 mg). So now I take the Cymbalta and Wellbutrin. My question is this: is the point of the medication to get your life back or to just not want to take your life anymore. I find I just exist, I have no social life and dont want one. I cant sleep and I dont know what to do anymore. Any suggestions would be greatly appreciated.

Jason Poquette (author) from Whitinsville, MA on October 28, 2010:

Hi Linds,

It is normal to be anxious about a new medication. In is quite healthy and appropriate to be cautious about any medicine! You are a good patient to ask questions and seek answers. Well done! The doctor likely has started you on a low dose. Venlafaxine has been around a long time. Read the paperwork that came with it about what to avoid. Alcohol is best avoided, especially while starting it. Once you have adjusted well to the medicine, you can talk to your doctor about the safety of having an occasional drink. Best wishes!

linds on October 28, 2010:

Hey a little bit about my medical history.. in the past couple months I have been light headed, dizzy spells, came close to fainting, pressure in my head, reguler headaches ... etc. At first my doctor said I had slow blood pressure and needed to drink lots of water. Well my blood pressure has been normal and all the same symptoms keep happening. I recently had presssure in my head, slurred words and blurred vision. My doctor ran numerous tests on me to find I am one healthy young lady. We just recently dicussed anxiety and stress. He believes alot of my problems are a result of that. So he put me on an antidepressany Venlafaxine. I am nervous about taking new medication. I just recently had a family pass due to the reaction he had with Perkaset. The thought of side effects really freaks me out. I am currently taking amoxicillian and ibuprfren for ear and throat infection. I was told it's ok to mix the amoxicillian and Venlafaxine but I am just scared to take the antidepressent in general. Is it normal to be worried? And if I do end up taking it, can you drink alcohol while on it?

Jason Poquette (author) from Whitinsville, MA on October 09, 2010:

Hi Heather,

I understand your concern about the bad dreams. Remeron (also called "mirtazapine") is "officially" only approved to treat depression. However...there have been studies done to suggest it is also effective for symptoms of anxiety. Often such studies are encouraging enough for doctors to rely on. Hence, they will prescribe Remeron for anxiety even though the FDA has not yet officially approved the medicine for this use. Remeron is unique, and so there is a good chance you will not have the same response to this medication. My advice is to follow the doctor's recommendation and give it a try. Best wishes!

Heather on October 08, 2010:

I have a question for you about a depression med I was taking. I was currently taking Zoloft and seraquel (to sleep) it caused very disturbing thoughts and hallucinations. My doctor seemed very surprised when I told her and said it was rare. She could tell I was very scared to take this medication anymore and took me off of both. I am now prescribed remeron but I am scared to take it because I am worried the same thing will happen again. I am not really a depressed person, I have more anxiety issues and agression. Everything I read about remeron is related to depession. Can this medication be used for anxiety?

Jason Poquette (author) from Whitinsville, MA on September 02, 2010:

Bob - Ummm...only prescription strength pot. LOL.

bob on September 02, 2010:

can i smoke pot if i take lexapro?

Jason Poquette (author) from Whitinsville, MA on August 01, 2010:


Decongestants and MAO inhibitors are not safe to be used together. Of course, if by "75mg" you mean something else...then that may be a different story. Always best to check with your pediatrician, because there are sometimes more issues involved in a recommendation than simply the possible medication conflicts. Thanks for reading and asking!

Mooma on July 31, 2010:

Can I give my 10 year old daughter who is on 75mg a day an over the counter decongestant?

Jason Poquette (author) from Whitinsville, MA on July 10, 2010:


I've been on vacation, so I am sorry for the delayed reply. Of course, there are always risks and concerns whenever you start a new medication, and when traveling this can be a problem. However, not starting a medication which you need can also be problematic. It may be best, in this case, to get some feedback from the prescriber about your concerns and your travel plans. Best wishes,


Jason Poquette (author) from Whitinsville, MA on July 10, 2010:


Selegeline, the ingredient in Emsam patches, has been reportedly responsible for false-positives on a drug screen. I do not know for sure if any of the others have been shown to do this. Other anti-depressants like Wellbutrin or tricyclics (like Elavil) have been reported as causing false positives. If you have experienced such a situation with an MAOI, you may want to contact the manufacturer and see if they have any literature to support this. It would help in your attempt to prove it was the MAOI. Best wishes. By the way, here is a link with a list of possible "false positive" producing drugs. I have not confirmed all the sources, but I pass it along for what it is worth:

Doug on July 10, 2010:

Will anyone taking MAOIs test positive in drug testing? Highly appreciate your response.

Ada on July 03, 2010:

I am concern because i was taking another brand for zoloft but the dr. change it because it cut down the effectiveness of my cancer medication "tamoxifen" now they put me on efexor but the other name for it..and I am concern about if I should take it or not. Honestly I am scared and nervous because I have stop taken the zoloft gradually meaning every other day and now its been almost 3 days I haven't take it. I have been dizzy for almost a week and I am tired and scared that if I start the efexor I might feel worst referring to dizziness and headaches and even nausea. What do you think? should I wait another week or so before starting the efexor or should I start now.? I am traveling on friday out of the country and I really am scared to take the efexor not knowing what the reaction might be since I am so sensitive to the way the dosage for the effexor is 37 miligrams once a day.

Jason Poquette (author) from Whitinsville, MA on June 30, 2010:

Hi Arni,

No bother. Good questions. I'm not sure why Parnate is more "dreaded." Could just be that it has been around longer, and so more people have encountered it. The hard part about talking about the "differences" between drugs is that it is more complicated than just their structure or chemistry. So much depends upon individual patient response. I have had patients praise a drug as a "life saver" for them, and the same drugs is an absolute failure for someone else with the same condition. Hope you find some good answers. Best wishes!

Jason Poquette (author) from Whitinsville, MA on June 30, 2010:

Hi Ar,

Long question. Here are some quick answers:

1) Yes, Parnate comes in tablet form

2) Yes, there are drugs that boost dopamine. These are primarily used for Parkinson's Disease or RLS (restless leg syndrom). Drugs like Sinemet or Requip.

3) Note: Parnate is not approved for ADD/ADHD so experimenting for this indication may not be a good idea. Just my thoughs. Best wishes!!

Arni on June 30, 2010:

Thanks for your answer. If Selegiline (at higher doses) and Parnate act in a similar fashion, why is it that Parnate is a more 'dreaded' antidepressant. Selegiline doesn't mess up the sex drive in a way Parnate possibly can. Also I've read comments by Parnate users on forums who point out that Parnate is a more habit-forming medication and it also interferes with the sex drive etc. Surely there got to be some difference between how the two antidepressants act?

Sorry for bothering you again.

AR on June 29, 2010:

I forgot mention that smoking affects my brain the same way it affects my body - some much more at ease and able to focus. A good comparison is how you find your engine revving very high and then look down and realize you had it in first gear instead of drive (for you automatic driver folks) and then switch it to drive and all of a sudden its smooooth sailin. that's how it affects me - dopamine?

And btw, here's a snippet of the article

"Tobacco smoke contains the monoamine oxidase inhibitors harman, norharman,[18] anabasine, anatabine, and nornicotine. These compounds significantly decrease MAO activity in smokers.[18][19] MAO enzymes break down monoaminergic neurotransmitters such as dopamine, norepinephrine, and serotonin."

AR on June 29, 2010:

what an absolutely fascinating article and Q&A. how cool of you : )

So, I was reading and a writin' on an another site about how tobacco smoking affected me and how it must have been the dopamine (I switched to an electronic cigarette and smoke fairly minimally anyway and I no longer inhale smoke which is great but that's not the point - just recognizing that its not healthy blah blah blah). I was having a discussion about how I felt after smoking a cigarette and how the tension in my body disappears to the point that I often stretch afterward because I am able to readily and its one of the few times my body isn't tense due to the turbo mode state my brain is typically in. I've been captain ADD since I was but a wee chiddren and its no different now. I hate it! it has its upsides in terms of creativity etc but mostly its highly highly frustrating and I have read that peeps with ADD have low dopamine levels. I then read about Monoamine Oxidase and how it breaks down dopamine among other neurotransmitters. I take adderall very rarely because I have a hard time justifying taking amphetamines even though my brain does slow down and it is very effective. I am curious about trying Parnate and I dont drink so that part is easy - the foods-to-avoid list looked doable and I do not rely on caffeine. So, my question is this - does Parnate (only just found out about it on this site as I started researching MAOI's) come in a table form that I could break into pieces and start with a tiny dose? Are there other ways to increase my dopamine? I know SSRI's exist obviously but do SDRI's exist? and of course, can that been done naturally? I fight being productive every day of my life because my brain DOES NOT SLOW DOWN. I am a very healthy eater too and avoid preservatives (sodium nitrate/nitrite), trans fat, soy, sugars (gotta a large sweet tooth that's more like a rhino horn so I fall off the wagon with the sweet thing) but I exercise regularly and am in otherwise great shape. any suggestions/help would be so very much appreciated. Thanks again!!


Jason Poquette (author) from Whitinsville, MA on June 21, 2010:

Hi Arni,

Sounds like a good exam question! Yes, I believe you are correct. At anti-depressant dosing levels, selegiline inhibits both. The exact dose at which this transition becomes significant depends on the route of administration. Orally, probably around 10mg or more. Transdermally or sublingually would be lower, I'm guessing 2.5 to 5mg. Yes, at such doses, selegiline and Parnate become similar, inhibiting both MAO-A and MAO-B.

Arni on June 21, 2010:

I've read that Selegiline at higher doses acts as a non-selective MAOI Inhibitor very much like parnate. Is this correct? If yes, how high is this dosage and how similar are Parnate and Selegiline in their action in such a situation??? Thanks.

Jason Poquette (author) from Whitinsville, MA on June 17, 2010:

Hi anon2,

Thanks for sharing! I firmly believe we are far too complicated to expect any one approach to be equally effective for everyone. To quote a favorite verse, we are "fearfully and wonderfully made." Nutritional therapy may be an excellent choice for many folks. I write about medicine...because that is what my training and education involve. Though I am at best still a novice...

Thanks again!

anon2 on June 16, 2010:

For those who are on antidepressants, please go see a nutritionist. They can do hair samples to see what vitamins you are lacking and then you are prescribed the vitamins to help replenish your system. Serotonin and dopamine levels can be detected too and can be raised with vitamins. Please go see a nutritionist - I was very depressed a few years ago, had major anxiety, and was too scared to go on antidepressants (I was seeing a therapist and she insisted I go on them but I refused because I have seen loved ones have major difficulties on meds). As a last resort I went to a nutritonist and now I am MUCH better. It took time to get better(about 8 months to a year) but I believe depression/anxiety can be helped/cured naturally. If you don't want to go to one, look up magnesium levels and depression. Also, adrenal glands and depression. Talk to your primary care doctor about going on vitamin supplements that could help with depression. Please just try it.

Oh, and about ten years ago I had panic attacks that were so bad I went to the hospital a few times. Again, no meds because I was scared but the one thing that did work for me was this program called Attacking Anxiety. It is not cheap but it was a last resort and for whatever reason it worked for me. I was able to learn how to control my panic attacks. I just want to offer adivce and help whomever I can.

MR, J on June 14, 2010:

hy, pharmacist,,thanks for you're reply, what i was trying to say is that it happened after i stoped the anty depressants, started getting the hives after having just one beer,,never mixed them together,,and that's the only thing i ever took,,always been a healthy person,,thanks again,,,

Jason Poquette (author) from Whitinsville, MA on June 14, 2010:

Hi MR,J,

MAO Inhibitors should not be mixed with alcohol ever. Other antidepressants, when mixed with alcohol, may just cause severe drowsiness, dizziness or nausea. Hives can be caused by many things, but should not be ignored. Avoid whatever seems to be triggering it (alcohol) and speak to your doctor about it soon. Best wishes!

MR,J on June 14, 2010:


Jason Poquette (author) from Whitinsville, MA on May 28, 2010:

Hi Paul,

Very good question. The answer is "no." MAOI's can prevent the breakdown of Tyramine in foods. SSRI's do not. Therefore these foods are perfectly safe with SSRI's. Here is an article I wrote on SSRI's:

Thanks for the kind words also! Glad to be of help.

Paul on May 28, 2010:

Hi Pharmacist Jason. Thanks for helping us with your clear answers. I am enjoying reading your constructive comments. Please, keep doing your great good works.

Here is my question: Does the list of "food to avoid" having the same effects on Prozac and other SSRI drugs?

Thank You

Jason Poquette (author) from Whitinsville, MA on May 28, 2010:

Hi lq,

Generally Parnate should not be taken by those who suffer from chronic headaches or migraines. Here is why: Headache is one of the first symptoms that a VERY serious side-effect from Parnate may be starting. Those with frequent headaches anyway...are less likely to distinguish this side effect from their normal heachache problem. Also, "triptans" (a family of drugs for migraines) cannot be used with MAOI's.

HOWEVER...sometimes Parnate IS used to prevent chronic headache and/or migraines. Patients would be carefully watched and selected for this approach. Here is a good article on the use of Parnate for headache:

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