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Monoamine oxidase inhibitor withdrawal phenomena: symptoms and pathophysiology
1Department of Psychiatry, Ohio State University, Columbus.
Abstract:
The author reviews the literature reporting the untoward effects of withdrawing monoamine oxidase inhibitors (MAOIs). The withdrawal of these agents can result in severe anxiety, agitation, pressured speech, sleeplessness or drowsiness, hallucinations, delirium and paranoid psychosis. MAOI withdrawal phenomena resemble the symptoms produced by the discontinuation of chronically administered psychostimulants. The capacity of MAOI to exert amphetamine-like effects presynaptically, and the propensity of somatic treatments for depression to subsensitize presynaptic receptors regulating the release of catecholamines, can provide a basis for the development of psychotic syndromes upon the withdrawal of MAOIs. Evidence for this hypothesis is reviewed.
Insights
Abruptly stopping monoamine oxidase inhibitors (MAOIs) can cause severe psychological and psychotic symptoms. These withdrawal effects are similar to those seen with psychostimulant discontinuation.
Area of Science:
- Psychiatry
- Pharmacology
- Neuroscience
Background:
- Monoamine oxidase inhibitors (MAOIs) are a class of antidepressant medications.
- Understanding MAOI withdrawal is crucial for patient safety and effective treatment management.
Observation:
- Literature review on the adverse effects of discontinuing MAOIs.
- MAOI withdrawal can manifest as anxiety, agitation, psychosis, and delirium.
Findings:
- MAOI withdrawal symptoms share similarities with psychostimulant discontinuation syndromes.
- MAOIs' presynaptic amphetamine-like effects and somatic treatments' impact on catecholamine receptors may explain withdrawal psychosis.
Implications:
- The findings suggest a neurobiological basis for MAOI-induced withdrawal syndromes.
- This review aids clinicians in managing MAOI therapy and preventing adverse withdrawal events.