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Don’t overlook monoamine oxidase inhibitors in psychiatric practice

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Abstract

Monoamine oxidase inhibitors (MAOIs), including phenelzine, tranylcypromine, moclobemide and selegiline are established and effective antidepressants that deserve wider consideration in refractory mood and anxiety disorders. Concerns regarding adverse events, such as tyramine-related hypertension and serotonin syndrome contributed to the decline in MAOI use, despite both events potentially occurring with other drug classes, including serotonin-reuptake inhibitors (SSRIs). Furthermore, the early promise of greater efficacy with SSRIs was another factor associated with diminishing MAOI use. Adverse events and drug interactions are generally manageable with careful prescribing, while educating patients about dietary restrictions can greatly reduce the risk of tyramine-related hypertension. The risks associated with MAOI use are outweighed by their benefits in persistent depression, which itself carries significant health risks when undertreated.

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References

  1. Chamberlain SR, Baldwin DS. Monoamine oxidase inhibitors (MAOIs) in psychiatric practice: how to use them safely and effectively. CNS Drugs. 2021;35(7):703–16.

    Article  CAS  Google Scholar 

  2. Gillman PK, Feinberg SS, Fochtmann LJ. Revitalizing monoamine oxidase inhibitors: a call for action. CNS Spectr. 2019;25(4):452–4.

    Article  Google Scholar 

  3. Cleare A. Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 British Association for Psychopharmacology guidelines. J Psychopharmacol. 2015;29(5):4459–525.

    Article  Google Scholar 

  4. Gelenberg A. American Psychiatric Association practice guidelines for the treatment of patients with major depressive disorder. Am J Psychiatry. 2010;167(Suppl. 10):9–118.

    Google Scholar 

  5. Kennedy SH. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 3. Pharmacological treatments. Can J Psychiatry. 2016;61(9):540–60.

    Article  Google Scholar 

  6. Ricken R. Tranylcypromine in mind (part II): review of clinical pharmacology and meta-analysis of controlled studies in depression. Eur Neuropsychopharmacol. 2017;27(8):714–31.

    Article  CAS  Google Scholar 

  7. Ulrich S, Ricken R, Adli M. Tranylcypromine in mind (part I): review of pharmacology. Eur Neuropsychopharmacol. 2017;27(8):697–713.

    Article  CAS  Google Scholar 

  8. Shulman KI, Herrmann N, Walker SE. Current place of monoamine oxidase inhibitors in the treatment of depression. CNS Drugs. 2013;27(10):789–97.

    Article  CAS  Google Scholar 

  9. Barnet Enfield and Haringey Mental Health Trust. Formulary and prescribing guidelines. 2019. https://www.beh-mht.nhs.uk/. Accessed 21 Apr 2022.

  10. Amrein R. Interactions of moclobemide with concomitantly administered medication: evidence from pharmacological and clinical studies. Psychopharmacology. 1992;106(1):S24-31.

    Article  CAS  Google Scholar 

  11. Greenstone LLC. Phenelzine sulfate tablets: US prescribing information. 2020. https://dailymed.nlm.nih.gov/. Accessed 21 Apr 2022.

  12. Mylan Specialty L.P. EMSAM (selegiline) patch: US prescribing information. 2020. https://dailymed.nlm.nih.gov/. Accessed 21 Apr 2022.

  13. Actavis Pharma. Tranylcypromine sulfate tablets: US prescribing information. 2021. https://dailymed.nlm.nih.gov/. Accessed 21 Apr 2022.

  14. Fiedorowicz JG, Swartz KL. The role of monoamine oxidase inhibitors in current psychiatric practice. J Psychiatr Pract. 2004;10(4):239–48.

    Article  Google Scholar 

  15. Raft D. Relationship between response to phenelzine and MAO inhibition in a clinical trial of phenelzine, amitriptyline and placebo. Neuropsychobiology. 1981;7(3):122–6.

    Article  CAS  Google Scholar 

  16. McGrath PJ. Tranylcypromine versus venlafaxine plus mirtazapine following three failed antidepressant medication trials for depression: a STAR* D report. Am J Psychiatry. 2006;163(9):1531–41.

    Article  Google Scholar 

  17. American Psychiatric Association. Desk reference to the diagnostic criteria from DSM-5™. Arlington: American Psychiatric Publishing, Inc.; 2013.

    Google Scholar 

  18. Henkel V. Treatment of depression with atypical features: a meta-analytic approach. Psychiatry Res. 2006;141(1):89–101.

    Article  Google Scholar 

  19. Fekadu A. Prediction of longer-term outcome of treatment-resistant depression in tertiary care. Br J Psychiatry. 2012;201(5):369–75.

    Article  Google Scholar 

  20. Gillman PK. A reassessment of the safety profile of monoamine oxidase inhibitors: elucidating tired old tyramine myths. J Neural Transm. 2018;125(11):1707–17.

    Article  CAS  Google Scholar 

  21. Suchting R, Tirumalajaru V, Gareeb R, et al. Revisiting monoamine oxidase inhibitors for the treatment of depressive disorders: a systematic review and network meta-analysis. J Affect Disord. 2021;282:1153–60.

    Article  CAS  Google Scholar 

  22. Uhlenhuth E, Warner TD, Matuzas W. Interactive model of therapeutic response in panic disorder: moclobemide, a case in point. J Clin Psychopharmacol. 2002;22(3):275–84.

    Article  CAS  Google Scholar 

  23. Angst J, Amrein R, Stabl M. Moclobemide and tricyclic antidepressants in severe depression: meta-analysis and prospective studies. J Clin Psychopharmacol. 1995;15(4):16S-23S.

    Article  CAS  Google Scholar 

  24. Cipriani A. Comparative efficacy and acceptability of pharmacological treatments for post-traumatic stress disorder in adults: a network meta-analysis. Psychol Med. 2018;48(12):1975–84.

    Article  Google Scholar 

  25. Mayo-Wilson E. Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2014;1(5):368–76.

    Article  Google Scholar 

  26. Ables AZ, Nagubilli R. Prevention, recognition, and management of serotonin syndrome. Am Fam Physician. 2010;81(9):1139–42.

    PubMed  Google Scholar 

  27. Maund E, Stuart B, Moore M, et al. Managing antidepressant discontinuation: a systematic review. Ann Fam Med. 2019;17(1):52–60.

    Article  Google Scholar 

  28. Meister R. Comparative safety of pharmacologic treatments for persistent depressive disorder: a systematic review and network meta-analysis. PLoS ONE. 2016;11(5): e0153380.

    Article  Google Scholar 

  29. Philipp M, Tiller J, Baier D. Comparison of moclobemide with selective serotonin reuptake inhibitors (SSRIs) on sexual function in depressed adults. For the Australian and German Study Groups. Eur Neuropsychopharmacol. 2000;10(5):305–14.

    Article  CAS  Google Scholar 

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    Caroline Fenton & Arnold Lee

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  1. Caroline Fenton
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  2. Arnold Lee
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Correspondence to Arnold Lee.

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The preparation of this review was not supported by any external funding.

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C. Fenton, a contracted employee of Adis International Ltd/Springer Nature, and A. Lee, a salaried employee of Adis International Ltd/Springer Nature, declare no relevant conflicts of interest. All authors contributed to the review and are responsible for the article content.

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Fenton, C., Lee, A. Don’t overlook monoamine oxidase inhibitors in psychiatric practice. Drugs Ther Perspect 38, 215–220 (2022). https://doi.org/10.1007/s40267-022-00917-7

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