• Welcome to Phoenix Rising!

    Created in 2008, Phoenix Rising is the largest and oldest forum dedicated to furthering the understanding of, and finding treatments for, complex chronic illnesses such as chronic fatigue syndrome (ME/CFS), fibromyalgia, long COVID, postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), and allied diseases.

    To become a member, simply click the Register button at the top right.

MAOIs - Phenelzine

leokitten

Senior Member
Messages
1,595
Location
U.S.
You have to be extremely careful with non-selective, irreversible MAOIs like phenelzine. Irreversibly inhibiting both MAO-A and MAO-B puts you at much higher risk of a tyramine-induced hypertensive crisis.

So you have to religiously avoid all mid to high tyramine containing foods to prevent possibly going into a very dangerous hypertensive crisis while on the drug, and the crisis can easily be fatal. See some info here https://www.mayoclinic.org/drugs-supplements/phenelzine-oral-route/precautions/drg-20073198

That’s why use of these older MAOIs are not that common anymore, it’s just not worth it and difficult to follow the restrictions all the time or else. If you want to take an MAOI, the only safer kinds are selective irreversible or reversible ones.

The only MAO-A selective drug on the market is the reversible MAOI moclobemide (80% MAO-A inhibition, 30% MAO-B inhibition). It’s an antidepressant drug.

For MAO-B selective inhibition you have the irreversible MAOIs selegiline, rasagiline, and safinamide (all Parkinson’s drugs, but they have some antidepressant properties at higher dosages).

You cannot take a selective MAO-A and MAO-B inhibitor together you end up with the same or worse problem as phenelzine and can easily kill yourself just by eating the wrong foods. You have to wash out from one before starting the other.
 
Last edited:

YippeeKi YOW !!

Senior Member
Messages
16,064
Location
Second star to the right ...
I'm with @leokitten on this one ..... I would be extremely, and I mean EXTREMELY careful about taking any MAOI inhibitor, reversible claims or not.

At the very least, do a LOT of research first, and make sure you take a long look at the list of things you absolutely can;t eat or drink, and the ones that may kill you if you do. Leokitten wasn't exaggerating about the potential for death if you have the wrong kind of aged cheese, or maybe a tasty bit of fermented salami .....
 

YippeeKi YOW !!

Senior Member
Messages
16,064
Location
Second star to the right ...
"15 mg phenelzine every other day, and then 15 mg daily. This treatment regimen produced a significant pattern of improvement compared to worsening in 20 self report vehicles of CFS symptoms, illness severity, mood or functional status"
The first questions I always ask myself are: Who oversaw the test, and who funded it? And what were the warnings and caveats, if any ....

I tend to be skeptical about any research that quotes self-reported responses to either the placebo or the actual medication being tested. Highly unreliable, even questionable ....


And evaluating the status of depression in the subjects by what is essentially self-reporting is also a little unnerving ...

"No patient in the trial had a diagnosis of lifetime or current psychiatric disorder
and none had depressed mood in the range of clinically depressed
patients on a paper and pencil test of depression."

And ....

"The study design also allowed us to evaluate patients for a
placebo effect: no evidence for this was found,
suggesting that CFS is not an illness due to patients'
being overly suggestible."

Quite a leap there .... even tho we've all been subjected to the " .... it's all in your silly little wacko head ....", I dont think anyone ever suggested that it was due to suggestibility as much as its being an invention of our own creation .....

The abstract that you posted seems to leave a LOT out, @MrMuffin (love your user name .... cute, comforting, cuddly) ... please be cautious with this 'treatment', yes?

Not saying it won;t work, just saying you want to know what the final tab is going to be, or could be in the worst-case analysis .....
 

leokitten

Senior Member
Messages
1,595
Location
U.S.
If you feel you have depression or other mood disturbances, either from having to live with ME/CFS for so long or actually as a side effect of ME/CFS, then sure antidepressants such as SNRIs, SSRIs, or moclobemide might be very helpful.

They will not help though with exertion capacity, PEM, crashes, and most other core ME/CFS symptoms, but they can help with mood.
 

Rvanson

Senior Member
Messages
312
Location
USA
I've used both Nardil and Parnate. It you are into wine or aged cheeses, you won't be able to consume them anymore, along with a few other foods. Also, cold medicines and you must not use any SSRI/SNRI medication.
 

YippeeKi YOW !!

Senior Member
Messages
16,064
Location
Second star to the right ...
Beat me to it @leokitten .....

It's pretty much anything that you really enjoy, have grown to love, or might use to unwind at the end of a tough day, or share with friends in celebration.


Not that that's an issue for most of us ....

And it's not that you might get a nasty case of hives, it's more like you could get an uncomfortable case of dead ....
 
Messages
10
Is the uncomfortable case of dead worse than the cfs?

One might wonder.

Anyway thanks all for chiming in. I'll agree that it's inconvenient to take something that leaves you on such a restrictive diet. I'm already very familiar with that, avoiding gluten (and most gluten-free alternatives). And on other days when I wonder if this or that is contributing to the fatigue I'll try skipping those as well. This includes fermented foods due to the histamine theory.

I have an issue with being overly irritable and/or borderline tearful, neither of which I appreciate.
 

Mary

Moderator Resource
Messages
17,507
Location
Texas Hill Country
@MrMuffin - 5-htp might be helpful for your mood. It's an amino acid which can help the brain produce serotonin and you don't have to monitor your food while taking it.

Some things that can cause depression or lower your mood are: Low vitamin D - do you know your vitamin D status? A simple blood test can find out. Also, it's important to keep vitamin D levels optimal for your immune system.

Low omega 3 fatty acids are also associated with depression, and so is low cholesterol. Doctors are so nervous about cholesterol - they don't realize it's a necessary nutrient! And that it can go too low and can cause harm especially when taking a statin.

These are things doctors most often don't even look at, and instead just hand out drugs that can have a host of harmful effects.
 
Messages
10
@leokitten - does "irreversible MAOIs" mean what it sounds like - that they cause irreversible effects? That is extremely scary if so!

It means they bind to the MAO enzymes irreversibly. You won't be able to use the bound enzymes again, but you will eventually make new MAO enzymes. Moclobemide is reversible, so you will be able to make use of the enzyme eventually. But I suppose death by hypertension is irreversible.

@MrMuffin - 5-htp might be helpful for your mood. It's an amino acid which can help the brain produce serotonin and you don't have to monitor your food while taking it.

Some things that can cause depression or lower your mood are: Low vitamin D - do you know your vitamin D status? A simple blood test can find out. Also, it's important to keep vitamin D levels optimal for your immune system.

Low omega 3 fatty acids are also associated with depression, and so is low cholesterol. Doctors are so nervous about cholesterol - they don't realize it's a necessary nutrient! And that it can go too low and can cause harm especially when taking a statin.

These are things doctors most often don't even look at, and instead just hand out drugs that can have a host of harmful effects.

Thanks for the suggestions! I bought 5-HTP but got scared away when I read about the cases of EMS when using L-Tryptophan.

I also used to sleep through the night until August last year when I started waking up several times a night. At that point I had been taking 5,000 IU of vitamin D for a couple of months, very anecdotal, but I consistently felt like a high dose vitamin D made me sleep worse so I stopped taking it.
 

leokitten

Senior Member
Messages
1,595
Location
U.S.
@leokitten - does "irreversible MAOIs" mean what it sounds like - that they cause irreversible effects? That is extremely scary if so!

Irreversible means when a molecule of the drug binds to a molecule of MAO-A or MAO-B it permanently takes that molecule out of commission, but new MAO enzyme is always made so eventually it comes back up if you stop taking the drug.

Irreversible MAOIs simply inhibit MAO longer.
 

leokitten

Senior Member
Messages
1,595
Location
U.S.
I have an issue with being overly irritable and/or borderline tearful, neither of which I appreciate.

I get this too and never had mental health issues pre-illness. Especially when overexerting and just before a crash it gets worse, even other very temporary personality changes. After forced rest it all magically goes away by the middle of the crash (every single time), which is a clear indicator the ME is causing this.

I’m mostly bedridden now and I’m also thinking of trialing an antidepressant for the first time.
 

YippeeKi YOW !!

Senior Member
Messages
16,064
Location
Second star to the right ...
Is the uncomfortable case of dead worse than the cfs?

One might wonder.
This one doesn't, but I have the advantage of having gone from lumpen and bed bound to low moderate, so I see hope ....


I've also experienced the extensive and almost terminal damage Drs can do when they don;t have a clue, but just keep throwing shite at the problem til it either goes away or .... uh .... that other more permanent thing ....
 

leokitten

Senior Member
Messages
1,595
Location
U.S.
@MrMuffin I see from this and your TCA thread you are interested in trialing from these two classes of drugs... why not give moclobemide a try?

RIMAs do not have the worry over dietary restrictions unless you take very high dosages you want to check BP after eating tyramine containing foods to see what happens. But at mid and lower therapeutic doses shouldn’t need any dietary restrictions.

I am probably going to give moclobemide a try, I haven’t ever taken any antidepressant.
 

Swim15

Senior Member
Messages
369
IMO the danger from MAOI's is vastly overstated. Yes you need to be careful not to blatantly consume larger quantities of tyramine foods but hypertensive crisis is fairly uncommon.

That said, as someone pointed out, I'd rather be dead than dealing with my worst CFS symptoms so it makes it an easy choice to carefully guinea pig as most people on here have concluded as well.
 
Back