How would you compare MAOi-s to SSRI-s?

Question

I haven't had lasting results with ssri-s, all of them worked for a month or two and then faded off, have anyone tried any of MAOi-s?

Answer 1

You could characterize the relationship between MAOI's and SSRI's as the relationship between a shotgun and a rifle.  MAOIs inhibit all monamine reuptake - pretty much flooding you with neurotransmitters.  SSRI's are more selective, focusing instead on a variety of specific serotonin receptors.  

Like the other answerer has already mentioned, MAOI's do tend to work in case where SSRI's don't, due primarily to their more general approach.  They do come with more restrictions - foods, medicines, the works.  They also tend to come with more side effects.  

Besides SSRI's and MAOI's, there are plenty of other treatment options you might consider that may have less potent side effects and still be effective.  SNRIs are serotonin and norepinephrine reuptake inhibitors that can be used for treating depression and anxiety disorders.  Other pharmacological treatment modailites you may consider are NRIs (norepinephrine reuptake inhibitors), NDRIs (norepinepherine-dopamine reuptake inhibitors), SSREs (selective serotonine reuptake enhancers), and AAs (adrenergic antagonists).  Many of these are 1st generation tricyclics, the intermediary between full blown MAOIs and SSRIs.  Benzodiazepenes may also be used, but they tend to have more side effects and can be dependency forming.  Some research has indicated that low doses of antipsychotic medications may be effective for treating affective disorders as well.  

Nonpharmacological options include "talk" therapies, such as cognitive behavioral therapies.  Other options may include neurofeedback training (still in it's infancy, but definitely potent), ECT (not as scary as it used to be), and rTMS (also still in it's infancy).    

Answer 2

The MAOI is the last word in depression. For atypical, weird, treatment resistant depressions, nothing on earth has the response rate that these guys do. It's amazing the changes these can bring about. They work better than ECT, than therapy, than brain implants or nerve stimulators. The trade off for this is their potentially deadly interactions with... everything.

With two exceptions, an MAOI will take away your ability to consume foods with tyramine, and half the medicine on the planet. And that's a big deal. There are two exceptions as I mentioned. One is called Aurorix, it's a reversible MAOI developed in the 70s that was never approved for sale in the US. If you're in another country, you can get it. The other is Emsam, which delivers selegiline through a patch on the skin. This delivery method means more of it ends up in the brain and less in the liver - so you don't have to give up food, caffeine and cold medicine. Both these forms aren't quite as potent, but they're a LOT easier to take. A hardcore old-school MAOI like Tranylcypromine means major changes in your lifestyle. You should wear a medic-alert bracelet in case you are ever in an accident - because there's a commonly used emergency medicine that can kill you if mixed with these drugs.

The above is scary, but that's the trade off for extreme potency. MAOIs work miracles where nothing else works at all. I would think that you should try Emsam or Aurorix first, as they're far easier to take.