The Shyness & Social Anxiety Workbook
100Monoamine Oxidase Inhibitors (MAOIs)
MAOIs affect three neurotransmitter systems in the brain: serotonin, norepineph -
rine, and dopamine. The most studied MAOI for treating social phobia is phenelzine 
(Nardil). This drug has consistently been found to alleviate the symptoms of social 
phobia (Swinson et al. 2006). Like the other antidepressants, phenelzine takes several 
weeks to have a therapeutic effect.
Despite their effectiveness, MAOIs are rarely used in clinical practice because of 
necessary dietary restrictions and because the side effects tend to be worse than those 
from other medications. When taking MAOIs, you must avoid foods containing a sub -
stance called tyramine. These include aged cheeses, meat extracts, overripe bananas, 
sausage, tofu, soy sauce, draft beer, and many other foods. MAOIs are also dangerous 
when combined with certain other medications, including SSRIs. The most commonly 
reported side effects of MAOIs include dizziness, headache, drowsiness, sleep distur -
bances, fatigue, weakness, tremors, twitching, constipation, dry mouth, weight gain, low 
blood pressure, and sexual disturbances.
Reversible Inhibitors of Monoamine Oxidase (RIMAs)
Reversible inhibitors of monoamine oxidase are a type of MAOI that tend to have 
fewer side effects than traditional MAOIs. In addition, they are less likely than traditional 
MAOIs to interact with other medications and with foods containing tyramine. The only 
RIMA that is available is moclobemide (Manerix in Canada, Aurorix in several other