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How Do SSRIs Compare to MAOIs?

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Updated May 09, 2013

Question: How Do SSRIs Compare to MAOIs?
How do the SSRIs compare to the MAOIs? Are the MAOIs stronger but with added risks?
Answer: MAOIs are perhaps the most effective antidepressant agents in the psychiatrist's medical arsenal, but because of dietary restrictions and concerns over hypertensive reactions, they are often used only after other agents have failed. MAOIs are useful for atypical depression. Criteria for atypical depression include reactive mood disturbance, prominent anxiety, histrionic features, phobic features, marked fatigue, reversed neurovegetative features, insomnia combined with sleeping abnormally long periods of time, adequate premorbid personality, psychosomatic complaints and/or hypochondriasis. SSRIs are generally the first choice for treatment of depression because they are effective and they have fewer problems with side effects. With MAOIs, adverse effects and potentially severe drug-drug and drug-food interactions are possible. Fatal hypertensive crisis has occurred with concomitant use of tryptophan or tyramine. Serotonin Poisoning or Serotonin Syndrome has also occurred with combination tryptophan or tyramine and MAOI use, and is characterized by mental status changes, hyperreflexia, tachycardia, fever, sweating, shivering, diarrhea, and/or incoordination. Primary care providers should not prescribe MAOIs unless they have experience with these medications.
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