Monoamine Oxidase Inhibitors: A Modern Guide to an Unrequited Class of Antidepressants

  title={Monoamine Oxidase Inhibitors: A Modern Guide to an Unrequited Class of Antidepressants},
  author={Stephen M Stahl and Angela Felker},
  journal={CNS Spectrums},
  pages={855 - 871}
Monoamine oxidase inhibitors (MAOIs) currently have a "bad rap" and are thus infrequently used in psychopharmacology, even by experienced clinicians. Misinformation about the dietary and drug interactions of MAOIs is widespread, whereas pragmatic tips for utilizing MAOIs to minimize risks and to maximize therapeutic actions are largely lacking in the contemporary literature. While clearly not first-line treatments, MAOIs, in the hands of experienced and well-informed clinicians, can be a… 

Opportunities for reversible inhibitors of monoamine oxidase-A (RIMAs) in the treatment of depression

Recent progress in RIMAs toward the treatment of treatment-resistant depression is discussed, with the new class of reversible monoamine oxidase inhibitors (RIMAs) having shown efficacy in depression, with safety and tolerability comparable to SSRIs.

Dietary restrictions and drug interactions with monoamine oxidase inhibitors: an update.

A better understanding of the foods and drugs that can cause adverse reactions, as well as knowledge of newer MAOIs with mechanisms of action and delivery methods that reduce these risks, may help clinicians to consider the use of these medications, when appropriate, in their patients with depression.

The transdermal delivery system of monoamine oxidase inhibitors.

The mechanism of action of MAOIs is reviewed, along with that of a newer MAOI formulation that lessens the need for dietary restrictions and has a greater safety and tolerability profile than the older oral formulations.

A Concise Guide to Monoamine Oxidase Inhibitors: How to Avoid Drug Interactions: Use These Strategies to Maximize Efficacy and Minimize Adverse Effects When Prescribing an MAOI

This 2-part guide to MAOIs is to educate clinicians about this often-overlooked class of medications and covers how to avoid potential drug interactions that could affect patients receiving an MAOI.

Tricyclic Antidepressants and Monoamine Oxidase Inhibitors: Are They Too Old for a New Look?

This chapter takes a closer look at the arc of MAOI discovery and clinical use, and how these two classes of drugs compare to each other, and argues that TCAs, and particularly MAOIs, should continue to play an important role in the modern treatment of depression, especially in the treatment-resistant patient.

Current Place of Monoamine Oxidase Inhibitors in the Treatment of Depression

This paper reviews the discovery and history of the use of irreversible monoamine oxidase (MAO) inhibitors (MAOIs) such as phenelzine, tranylcypromine and isocarboxazid, as well as the second

Clinically Relevant Drug Interactions with Monoamine Oxidase Inhibitors.

Patients on a MAOI want to avoid two types of medications: those that can elevate blood pressure via sympathomimetic actions and those that could increase serotonin levels via 5-HT reuptake inhibition, as well as avoiding certain OTC medications that can interact adversely with MAOIs.

The Monoamine Oxidase Inhibitor Isocarboxazid is a Relevant Treatment Option in Treatment-Resistant Depression: Experience-Based Strategies in Danish Psychiatry

The aim of the present paper is to give a short overview of the clinical efficacy, mechanisms of action and metabolism of MAOIs, and to discuss how the side effects and interactions with these drugs may be avoided.

The use of monoamine oxidase inhibitors in primary care.

  • L. Culpepper
  • Medicine, Psychology
    The Journal of clinical psychiatry
  • 2012
Although primary care clinicians have developed considerable expertise in managing patients with major depressive disorder, and a range of treatment strategies is currently available, some patients still fail to reach remission and clinicians should still be alert for drug interactions and observe recommended washout periods.

The trace amine theory of spontaneous hypertension as induced by classic monoamine oxidase inhibitors

This paper holds that TYR plays a pivotal role in causing SH, due to its strong pressor effect, and urges reconsideration, following suitable confirmation trials, of antipsychotics as these agents may reduce striatal p-TYR levels.



Transdermal Selegiline: The New Generation of Monoamine Oxidase Inhibitors

Clinicians should familiarize themselves with the properties and indications for the new generation of MAOIs and it is possible that STS may demonstrate benefit in MDD with atypical features or MDD resistant to other antidepressants.

Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication.

  • S. Feinberg
  • Medicine, Psychology
    The Journal of clinical psychiatry
  • 2004
Another possible indication for this therapeutic regimen is treatment of attention-deficit/hyperactivity disorder in an adult patient whose major depression had uniquely responded to the MAOI tranylcypromine.

A clinical overview of monoamine oxidase inhibitors.

  • S. Zisook
  • Medicine, Psychology
  • 1985

Is the failure of (-)deprenyl, a selective monoamine oxidase B inhibitor, to alleviate depression related to freedom from the cheese effect?

There is evidence to suggest that this cheese effect, a facilitated tyramine-induced hypertensive response, is pharmacologically distinct from MAO inhibition proper, and it is conceivable that its central counterpart, an enhanced noradrenaline release due to the access of traces of tyramines to the CNS, is a prerequisite for any therapeutic benifit obtainable with the MAO-inhibitory drugs in general.

Revisiting monoamine oxidase inhibitors.

  • K. Krishnan
  • Medicine
    The Journal of clinical psychiatry
  • 2007
The development of a novel, transdermal MAOI system now offers clinicians an additional option for managing patients with unipolar, bipolar, atypical, and treatment-resistant depression.

CNS stimulant potentiation of monoamine oxidase inhibitors in treatment-refractory depression.

With properly motivated and complaint patients and careful clinical monitoring by the prescribing psychiatrist, stimulant potentiation of MAOIs may be a viable option for treatment-resistant depressed patients.

Monoamine oxidase inhibitor dietary restrictions: what are we asking patients to give up?

A wide variety of tyramine-containing foods and contraindicated medications were commonly used by psychiatric patients prior to evaluation for possible MAOI pharmacotherapy, but the number and diversity of frequently consumed items do not support recommendations to reduce the breadth of restrictions inMAOI diets.

Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity.

  • P. Gillman
  • Biology
    British journal of anaesthesia
  • 2005
Knowledge of the properties of these drugs will help to ensure that problems can be avoided in most clinical situations, and treated appropriately (with 5-HT(2A) antagonists for severe cases) if they occur.