Phenelzine, which is sold under the brand name Nardil, is a type of antidepressant that was developed in the 1950s. Nardil is one of the first effective antidepressants. MAO inhibitors like phenelzine impact brain chemistry by increasing the expression of monoamine neurotransmitters. These neurotransmitters include epinephrine, norepinephrine, melatonin, and serotonin.
There are two primary types of monoamine neurotransmitters: MAO-A and MAO-B. Different kinds of MAO inhibitors act on these neurotransmitters to various degrees. Phenelzine inhibits the breakdown of MAO-A and MAO-B neurotransmitters equally.
Modern SSRIs and second-generation tricyclic antidepressants are part of the newer generation of antidepressants that have fewer harmful interactions and milder side effects. They’re usually the first types of antidepressants to be prescribed to new patients.
Phenelzine, however, is commonly prescribed for medication-resistant and atypical types of depression. Atypical types of depression, like melancholic depression, often present alongside other disorders such as bipolar disorder, major depressive disorder (MDD), seasonal affective disorder (SAD), and cyclothymia.
Phenelzine has anxiolytic (anti-anxiety) effects through the promotion of GABA expression in the brain. GABA is the brain’s primary inhibitory neurotransmitter. Its role is to calm overactive brain activity, and it can be under-expressed in people with anxiety. Nardil is also occasionally prescribed for the treatment of social anxiety disorder, bipolar depression (BD), post-traumatic stress disorder, dysthymia, panic disorder (PD), and bulimia.
MAO inhibitors like Nardil and other antidepressants are not considered to be psychologically addictive because cessation of use doesn’t result in drug cravings. However, several side effects can accompany the use of phenelzine.
Side effects of Nardil may include dry mouth, dizziness, headache, blurry vision, somnolence, anorexia, sedation, insomnia, lethargy, nausea, vomiting, weight fluctuation, infrequent urination, diarrhea, constipation, profuse sweating, muscle tremors, high or low blood pressure, and low sex drive. On rare occasions, treatment with Nardil can cause psychosis, mania, and acute liver failure.
Stopping treatment with phenelzine can trigger withdrawal symptomsreferred to as discontinuation syndrome. Discontinuation syndrome from phenelzine is characterized by symptoms similar to those which are witnessed in patients reacting poorly to long-term amphetamine use.
These symptoms include rapid speech, mania, and psychosis when doses of the drug are reduced too quickly. Treatment with phenelzine, although not technically addictive, can still develop a level of psychological reliance. Discontinuance symptoms from MAO inhibitors like Nardil are never as severe as those from anti-anxiety drugs like the benzodiazepine Xanax, which acts directly on GABA receptors.
Due to the lack of addictive qualities of Nardil, there aren’t any rehabilitation programs specifically designed for recovery from phenelzine use. Discontinuation syndrome from Nardil can be managed by gradually reducing dosage over an extended period of time. First-line antidepressants like SSRIs can result in a sudden onset of withdrawal symptoms within just 24 hours of missing a dose. These symptoms can include suicidal thoughts, especially among patients under the age of 25. Missing a dose of Nardil, in contrast, doesn’t normally result in such dramatic side effects.
Withdrawals from MAO inhibitors like Nardil rarely require overnight hospitalization. No inpatient treatment programs exist for recuperating from Nardil use, however, hospitalization may become necessary if symptoms of mania and amphetamine-like psychosis occur.
MAO inhibitors like phenelzine are known to cause a deficiency in vitamin B6. Supplementing the patient’s diet with vitamin B6 can reduce the likelihood of developing severe side effects while taking Nardil. Patients with pre-existing liver damage from old age, viral infection, or a history of alcohol consumption are at a higher risk for liver failure. If liver toxicity occurs, hospitalization may become necessary.
It’s common practice for the prescribing psychiatrist to dictate the patient’s detox program. No relevant outpatient treatment programs exist. The rate at which the patient’s doses are decreased will depend on the duration and dosage level of the treatment. Patients who have been taking large doses for several years may take anywhere from several months to a year before treatment with Nardil is stopped entirely.
Being a first-generation MAO inhibitor means that phenelzine’s effects on brain chemistry are irreversible. When the patient stops taking Nardil, their brain will continue to inhibit the breakdown of serotonin, melatonin, epinephrine, and norepinephrine, at least to some degree.
Individuals withdrawing from phenelzine should never hesitate to notify their doctor of changes in depressive symptoms. Antidepressants don’t treat the cause of depression, they only mask symptoms. Cessation of Nardil treatment may result in the return of pre-treatment issues with depression. An open line of communication with the psychiatrist along with support from family and friends is critical to safely stopping phenelzine treatment.
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