Tranylcypromine sulfate

Tranylcypromine is among the most effective drugs used to treat major depressive disorder, including atypical depression, treatment-resistant depression, treatment-resistant social anxiety disorder, with demonstrated efficiency in the treatment of obsessive-compulsive disease (OCD) and panic disorder.  Multiple studies provide evidence for the efficacy and safety of tranylcypromine in bipolar depression. Moreover it has proven superior to lamotrigine and imipramine.

While chemically, it is an amphetamine derivative, pharmacologically, it acts as a nonselective, irreversible monoaminoxidase inhibitor (MAOI) with a slight preference for MAO-B. Generally speaking, MAO-A is primarily involved in the breakdown of serotonin, norepinephrine, and dopamine. MAO-B mainly metabolizes dopamine. As nonselective MAOI, tranylcypromine prevents both monoaminoxidase enzymes from degrading the previously mentioned neurotransmitters, however, more readily so in case of the latter. This property, together with weak dopamine and norepinephrine releasing action presumably amounts to energizing effects of tranylcypromine and its capacity to alleviate anhedonia.

In a double-blind, cross-over study on young boys diagnosed with ADHD, treated with dextroamphetamine or tranylcypromine (with a two-week placebo washout between active drug periods) both substances had clinically indistinguishable therapeutic benefits. Interestingly enough, clinically significant benefits of tranylcypromine were immediate, which suggests a different mechanism from that involved in its antidepressant effects.

Tranylcypromine, with its preference for MAO-B, might possess some neuroprotective qualities against Parkinson’s, in a manner similar to selegiline and rasagiline.

In comparison with the vast majority of antidepressants, the incidence of such unwanted side effects as sexual dysfunctions and weight gain is extremely low on tranylcypromine. In fact, many patients actually report that it’s easier for them to lose weight. Another interesting observation of those treated with tranylcypromine is that unlike SSRIs an SNRIs, instead of emotional blunting, they experience a wider range of emotions than before the treatment, and feel generally more in touch with their authentic selves.

It is important to note that MAOIs are often considered the last resort treatment for depression due to their bad reputation based on outdated  information and lack of training in their application, while they could be effective, and sometimes lifesaving for many depressed people, sparing their suffering and frustration with near endless switching between various more readily prescribed antidepressants.

Benefits of taking tranylcypromine

Please bear in mind that the below benefits were experienced by often severely depressed patients.

• great alleviation of depressive symptoms;
• greatly reduced social anxiety;
• more resilience and stress-resistance;
• increased energy;
• boost in self confidence;
• higher productivity;
• mild stimulation;
• increased joy and optimism;
• sense of agency and initiative-taking;
• possible aid in losing weight.

 Side effects:

• dry mouth;
• dizziness;
• insomnia;
• sedation;
• headache;
• blurred vision;
• postural hypotension.

On tranylcypromine, it is advised to monitor blood pressure, as in some people, occasional paradoxical hypertension can occur following a dose of the drug.
While it is generally considered not life-threatening, blood pressure should be monitored for two hours.

Interactions:

• SSRIs / SNRIs;
• TCAs: imipramine and clomipramine;
• dextromorphan;
• stimulants (dosage adjustment required);
• analgesics: pethidine (meperidine), tramadol, and tapentadol;
• foods high in tyramine (more details in this publication, or its shorter version);
• nicotine (due to CYP2A6 inhibition, it is metabolized slower, which means increased reinforcement in some people and possibly more adverse reactions in those sensitive to nicotine).

Dosage

Typical dosage of tranylcypromine ranges from 30 to 60 mg, however, in the absence of improvement, higher doses might be applied.

Dosing recommendations are laid out by one world’s leading expert on MAOI, Dr Ken Gilman in this article.