Nardil is the brand name of phenelzine, a first-generation MAO (monoamine oxidase) inhibitor. MAO inhibitors like Nardil treat depression, anxiety, and other mental health issues by affecting the way that influential neurotransmitters are processed in the brain. The effects of second-generation MAO inhibitors are reversible, compared to first-generation MAO inhibitors, like Nardil, which permanently alter brain chemistry.
Phenelzine prevents the breakdown of monoamine neurotransmitters. Monoamine neurotransmitters that phenelzine impacts include melatonin, serotonin, epinephrine, norepinephrine, dopamine, and trace amine neuromodulators like phenethylamine. By preventing the breakdown of these critical neurotransmitters, Nardil increases the concentrations of them in the brain, allowing them to have a greater impact on mood stabilization as well as reducing depression and anxiety.
MAO inhibitors are most commonly prescribed to treat atypical forms of depression. Phenelzine may also be prescribed to treat panic disorder, persistent depressive disorder (dysthymia), social anxiety disorder, bipolar disorder, post-traumatic stress disorder (PTSD), bulimia, and social anxiety disorder.
Because of the increased risk of harmful interactions with other drugs and food, and the increased risk of side effects, MAO inhibitors tend to be prescribed as a second or third line of treatment after other drugs like tricyclics or selective serotonin reuptake inhibitors (SSRIs) have failed.
Withdrawals from MAO inhibitors like Nardil can result in severe symptoms like the effects caused by the regular use of amphetamine stimulants. Although phenelzine isn’t considered to be psychologically addictive, stopping treatment can still cause side effects. Withdrawal from antidepressants is referred to by medical practitioners as discontinuation syndrome. Discontinuation syndrome from phenelzine can include hallucinations, rushed speech, severe anxiety, paranoid psychosis, drowsiness, delirium, and insomnia.
Although the side effects that characterize withdrawals from Nardil may sound severe, they can be minimized by gradually reducing doses over an extended period of time. While it may take six to eight weeks, on average, to wean patients off SSRIs or tricyclics, doctors may take even more time when halting a patient’s phenelzine treatment.
It isn’t uncommon for the discontinuation phase of Nardil to last several months, gradually lowering the dose every two to three weeks. Depending on how long the patient has been taking Nardil, doctors may choose to extend the discontinuation phase to a year or longer before entirely stopping treatment.
MAO inhibitors like phenelzine can take several weeks for the drug levels in the body to decrease. This makes it easier for doctors to control discontinuance of use symptoms. SSRIs and tricyclic antidepressants can result in severe withdrawal symptoms after missing just a single dose. In contrast, discontinuation from Nardil has a gradual onset.
Because phenelzine can have dangerous complications when mixed with other types of antidepressants, withdrawal symptoms can’t be managed by adding a small dose of another antidepressant. Serotonin syndrome, a severe condition that can result in psychosis, is a major risk when MAO inhibitors like Nardil are mixed with SSRIs like Prozac. Serotonin syndrome occurs when levels of serotonin become extremely high, which is one result of the combined effects of these drugs.
A psychiatrist may decide it’s time for their patient to stop taking Nardil for a variety of reasons. The medication may begin to lose effectiveness, or the patient may develop a poor reaction to the drug with increased side effects. MAO inhibitors, especially first-generation antidepressants like phenelzine, irreversibly alter the expression of several key neurotransmitters.
Liver toxicity can also become an issue since Nardil needs to be broken down by the liver. Eating tyramine-rich foods can increase the chance of liver toxicity. It’s recommended that patients refrain from eating foods that are especially high in tyramine, including meat that may be fermented, spoiled, pickled, or aged. For example, most pork, except for cured ham, is off limits. Other foods that are high in tyramine include alcohol, most cheese, and chocolate.
Nardil Signs, Symptoms and Side Effects
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