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Phenelzine (Nardil, Nardelzine) a MAOI that isn't prescribed for depression very often, but may be just what you need if you haven't responded to other antidepressants. What should you know about this drug?

Nearly 13 percent of US residents over 12 will be using antidepressants during any given month — and while some will be taking them for other reasons, most of these antidepressants are prescribed as a treatment for clinical depression. When you're first prescribed antidepressants, your doctor will try to choose a drug that is likely to be effective while having a relatively low risk of causing unbearable side effects. Most of the time, this will mean a selective serotonin reuptake inhibitor (SSRI), tricyclic antidepressant (TCA), or selective serotonin noradrenaline reuptake inhibitor (SSNRI)

When the more commonly chosen antidepressants don't work for you, however, your healthcare provider will consider other options. Monoamine oxidase inhibitors are an older class of antidepressants, and phenelzine — also available under the brand names Nardil and Nardelzine — is one of its members. What should you know if you're about to start this medication?

What is phenelzine, and why might your doctor prescribe it to you in the treatment of depression?

Phenelzine belongs to the monoamine oxidase inhibitor (MAOI) family of antidepressants — the first kind of antidepressants ever to be developed. These antidepressants are effective, and work by increasing the norepinephrine, serotonin and dopamine available to your brain. 

They've mostly been replaced by newer-generation antidepressants like SSRIS, which come with fewer side effects, are safer to use in terms of the potential for overdose, and do not require dietary restrictions.

Your doctor may consider a MAOI like phenelzine (as a generic or under the brand names Nardil or Nardelzine) if other antidepressants have not been beneficial for you. 

How do you use phenelzine?

Phenelzine, typically taken three times a day, comes in oral tablets with a strength of 10 or 15 mg. Your doctor will start you on the lowest possible dose, which can be increased over time. Research has shown, however, that when MOAIs are prescribed (not very often) doctors often prescribe a weaker dose than needed. According to studies, a dose of between 60 and 90 mg daily is most effective, as long as Nardil is tolerated by the patient. It can, however, take around four weeks for the drug to start "kicking in". 

Your doctor will tell you how, when, and how often, but it is important to read the package insert as well and ask for clarification if you have any questions. Because of the potential for overdose, it is essential not to take more than instructed — but because you need your Nardil to be effective, you shouldn't take less than the prescribed dose, either. Rather, use your phenelzine exactly as directed

What side effects can phenelzine cause?

Phenelzine (Nardil or Nardelzine) can cause a number of side effects:

  • All MAOIs can induce weight gain, but phenelzine seems to be a worse offender in this department.
  • You may feel drowsy and dizzy, which may again be more likely with Nardil than other MAOIs.
  • MAOIs can cause orthostatic hypotension, low blood pressure when you change positions. This can often be managed by drinking more water. 
  • Phenelzine can also lead to a dry mouth, constipation, fluid retention, sexual dysfunction, tremors, and muscle twitching. 
  • Insomnia is reported quite often, but it's not clear if this is a result of taking a MAOI, or of the depression itself — insomnia is a common symptom of depression. 

If you're taking Nardil and you have one or more of these side effects, they are quite severe, and they don't seem to budge, let your doctor know. On the other hand, if you notice any of the following emergency signs, seek immediate medical attention:

  • A stiff or sore neck
  • Headache
  • Chest pain
  • Nausea and/or vomiting
  • Profuse sweating
  • Eyes that are extremely sensitive to light, and/or very dilated pupils
  • Difficulty breathing and/or swelling in the face and other areas of the body (points to an allergy)
  • Jaundice — in rare cases, MAOIs can have a bad effect on your liver
  • Hallucinations
  • An irregular pulse
  • Very high blood pressure
  • Seizures

Phenelzine is not suitable for everyone, so inform your prescribing doctor of:

  • Your medical history
  • Any other drugs — prescription, over-the-counter, and street — you may be taking, as well as nutritional supplements
  • Any other medical conditions you have, such as high blood pressure
  • Whether you are pregnant, nursing, or trying to conceive

Once you are on Nardil, it is also important to let any doctor who is planning to perform surgery on you know this fact. This includes dental surgery. 

What do you need to know about the MAOI diet?

People taking MAOIs need to stick to dietary restrictions because taking high-tyramine foods can lead to dangerously high blood pressure levels (hypertensive crisis). While your doctor will tell you exactly what you can and cannot eat, in general:

  • Foods that have less than 6 mg of tyramine per serving seem to be safe. 
  • You should absolutely stay away from aged cheeses, aged meat, broad beans, soy products, sauerkraut, Marmite, and yes — alcohol, especially tap beer. 
  • Once forbidden on MAOIs, it's now known that you can safely have some avocado, banana, beef, chicken, fish, and mild and fresh cheeses. 

Talk to your doctor about this in detail, and make sure to follow the instructions to the letter for your safety. 

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