Iproniazid

Abstract

Iproniazid, the first clinically effective MAOI, was studied extensively for its psychiatric effects for a year or two following the favorable report on its effects in withdrawn patients by Loomer, Saunders, and Kline (1957). These authors noted that iproniazid was the first useful drug to “energize” rather than sedate depressed patients. They considered this an important distinction when treating diseases that were associated with deep depression of mood and lack of reactivity to the environment. Unfortunately, iproniazid had to be withdrawn from the market in 1961 because of what was considered an unacceptable incidence of hepatitis (Kline 1970; Kline and Cooper 1980; Kauffman 1979). Other MAOIs were subsequently introduced and studied extensively. However, as noted by Kline and Cooper (1980), the use of MAOIs gradually faded for several reasons. Chief among these was the risk of hypertensive attacks being precipitated by consumption of foods rich in the pressor amine tyramine, since this amine was normally prevented from entering the circulation by MAO activity in intestine and liver (the so-called “cheese effect”). Sandier et al. (1979) considered that the cheese effect was almost entirely responsible for limiting the more general application of the MAOIs. As pointed out by Klein et al. (1980) “…clinical lore suggests that a MAOI should be used only in depressed patients refractory to other treatment methods.”