Hostname: page-component-54dcc4c588-mz6gc Total loading time: 0 Render date: 2025-09-26T18:51:34.926Z Has data issue: false hasContentIssue false
  • English
  • Français

Practical guide for prescribing MAOIs: debunking myths and removing barriers

Published online by Cambridge University Press:  26 April 2012

Meghan M. Grady  and
Stephen M. Stahl
Meghan M. Grady*
Affiliation:
Neuroscience Education Institute, Carlsbad, California, USA
Stephen M. Stahl
Affiliation:
Neuroscience Education Institute, Carlsbad, California, USA Department of Psychiatry, University of California–San Diego, San Diego, California, USA Department of Psychiatry, University of Cambridge, Cambridge, UK
*
*Address for correspondence: Meghan M. Grady, BA, Director, Content Development, Neuroscience Education Institute. 1930 Palomar Point Way, Ste 101, Carlsbad, CA 92008 Email mgrady@neiglobal.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Despite the fact that monoamine oxidase inhibitors (MAOIs) can be highly effective therapeutic agents for depression and some anxiety disorders, they tend to be underutilized in clinical practice. This is due at least in part to the fact that there is a great deal of misinformation and mythology about their dietary and drug interactions. This article is intended to serve as a guide for clinicians who are not particularly familiar with MAO inhibitors; its aim is to help these clinicians competently integrate these agents into clinical practice when appropriate.

Keywords

DepressioninteractionMAOImonoamine oxidase

Information

Type
Review Article
Information
CNS Spectrums , Volume 17 , Issue 1 , 26 April 2012 , pp. 2 - 10
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

The activity is supported by an educational grant from Dey Pharma, L.P.

References

1.Zisook, S. A clinical overview of monoamine oxidase inhibitors. Psychosomatics. 1985; 26(3): 240–246, 251.CrossRefGoogle ScholarPubMed
2.Tollefson, GD. Monoamine oxidase inhibitors: a review. J Clin Psychiatry. 1983; 44(8): 280–288.Google ScholarPubMed
3.Versiani, M, Nardi, AE, Mundim, FD, et al. . The long-term treatment of social phobia with moclobemide. Int Clin Psychopharmacol. 1996; 11(suppl 3): 83–88.CrossRefGoogle ScholarPubMed
4.Cole, JO, Bodkin, JA. MAO inhibitors: an option worth trying in treatment-resistant cases. Current Psychiatry. 2002; 1(6): 40–47.Google Scholar
5.Magyar, MK, Szatmary, I, Szebeni, G, Lengyel, J. Pharmacokinetic studies of (-)-deprenyl and some of its metabolites in mouse. J Neural Transm Suppl. 2007; (72): 165–173.Google Scholar
6.Stahl, SM. Stahl's Essential Psychopharmacology, 3rd ed. New York, NY: Cambridge University Press; 2008.Google Scholar
7.McCabe, B, Tsuang, MT. Dietary consideration in MAO inhibitor regimens. J Clin Psychiatry. 1982; 43(5): 178–181.Google ScholarPubMed
8.Wimbiscus, M, Kostenko, O, Malone, D. MAO inhibitors: risks, benefits, and lore. Cleveland Clinic J Med. 2010; 77(12): 859–882.CrossRefGoogle ScholarPubMed
9.Gardner, DM, Shulman, KI, Walker, SE, Tailor, SA. The making of a user friendly MAOI diet. J Clin Psychiatry. 1996; 57(3): 99–104.Google Scholar
10.Da Prada, M, Zurcher, G, Wuthrich, I, Haefely, WE. On tyramine, food, beverages and the reversible MAO inhibitor moclobemide. J Neural Transm Suppl. 1988; 26: 31–56.Google ScholarPubMed
11.Shulman, KI, Walker, SE, MacKenzie, S, Knowles, S. Dietary restriction, tyramine, and the use of monoamine oxidase inhibitors. J Clin Psychopharmacol. 1989; 9(6): 397–402.Google Scholar
12.Shulman, KI, Walker, SE. Refining the MAOI diet: tyramine content of pizzas and soy products. J Clin Psychiatry. 1999; 60(3): 191–193.Google Scholar
13.Shulman, KI, Walker, SE. A reevaluation of dietary restrictions for irreversible monoamine oxidase inhibitors. Psychiatr Ann. 2001; 31(6): 378–384.CrossRefGoogle Scholar
14.Angst, J, Amrein, R, Stabl, M. Moclobemide and tricyclic antidepressants in severe depression: meta-analysis and prospective studies. J Clin Psychopharmacol. 1995; 15(4 suppl 2): 16S–23S.CrossRefGoogle ScholarPubMed
15.Amsterdam, JD. A double-blind, placebo-controlled trial of the safety and efficacy of selegiline transdermal system without dietary restrictions in patients with major depressive disorder. J Clin Psychiatry. 2003; 64(2): 208–214.Google Scholar
16.Robinson, DS. Transdermal selegiline: a new-generation MAOI. Primary Psychiatry. 2006; 13(5): 33–35.Google Scholar
17.Zsilla, G, Foldi, P, Held, G, Szekely, AM, Knoll, J. The effect of repeated doses of (-) deprenyl on the dynamics of monoaminergic transmission: comparison with clorgyline. Pol J Pharmacol Pharm. 1986; 38(1): 57–67.Google Scholar
18.Chen, K, Holschneider, DP, Wu, W, Rebrin, I, Shih, JC. A spontaneous point mutation produces monoamine oxidase A/B knock-out mice with greatly elevated monoamines and anxiety-like behavior. Biol Chem. 2004; 279(38): 39645–39652.CrossRefGoogle ScholarPubMed
19.Mendis, N, Pare, CM, Sandler, M, Glover, V, Stern, GM. Is the failure of (-) deprenyl, a selective monoamine oxidase B inhibitor, to alleviate depression related to freedom from the cheese effect? Psychopharmacology. 1981; 73(1): 87–90.Google Scholar
20.Mann, JJ, Frances, A, Kaplan, RD, Kocsis, J, Peselow, ED, Gershon, S. The relative efficacy of l-deprenyl, a selective monoamine oxidase type B inhibitor, in endogenous and nonendogenous depression. J Clin Psychopharmacol. 1982; 2(1): 54–57.Google Scholar
21.Rapaport, MH. Dietary restrictions and drug interactions with monoamine oxidase inhibitors: the state of the art. J Clin Psychiatry. 2007; 68(suppl 8): 4246.Google Scholar
22.Wecker, L, Copeland, JS, Pacheco, MA. Transdermal selegiline: targeted effects on monoamine oxidases in the brain. Biol Psychiatry. 2003; 54(10): 1099–541104.Google Scholar
23.Mawhinney, M, Cole, D, Azzaro, AJ. Daily transdermal administration of selegiline to guinea-pigs preferentially inhibits monoamine oxidase activity in brain when compared with intestinal and hepatic tissues. J Pharm Pharmacol. 2003; 55(1): 27–34.Google Scholar
24.Feiger, AD, Rickels, K, Rynn, MA, Zimbroff, DL, Robinson, DS. Selegiline transdermal system for the treatment of major depressive disorder: an 8-week, double-blind, placebo-controlled, flexible-dose titration trial. J Clin Psychiatry. 2006; 67(9): 1354–1361.Google Scholar
25.Krishnan, KR. Revisiting monoamine oxidase inhibitors. J Clin Psychiatry. 2007; 68(suppl 8): 35–41.Google Scholar
26.Schatzberg, AF. Safety and tolerability of antidepressants: weighing the impact on treatment decisions. J Clin Psychiatry. 2007; 68(suppl 8): 26–34.Google Scholar
27.Da Prada, M, Kettler, R, Keller, HH, Burkard, WP, Muggli-Maniglio, D, Haefely, WE. Neurochemical profile of moclobemide, a short-acting and reversible inhibitor of monoamine oxidase type A. Pharmacol Exp Ther. 1989; 248(1): 400–414.Google Scholar
28.Lotufo-Neto, F, Trivedi, M, Thase, ME. Meta-analysis of the reversible inhibitors of monoamine oxidase type A moclobemide and brofaromine for the treatment of depression. Neuropsychopharmacology. 1999; 20(3): 226–247.Google Scholar
29.Sternbach, H. Serotonin syndrome: how to avoid, identify, and treat dangerous drug interactions. Current Psychiatry. 2003; 2(5): 15–23.Google Scholar
30.Gillman, PK. A review of serotonin toxicity data: implications for the mechanisms of antidepressant drug action. Biol Psychiatry. 2006; 59(11): 1046–1051.Google Scholar
31.Lawrence, KR, Adra, M, Gillman, PK. Serotonin toxicity associated with the use of linezolid: a review of postmarketing data. Clin Infect Dis. 2006; 42(11): 1578–1583.Google Scholar
32.Dvir, Y, Smallwood, P. Serotonin syndrome: a complex but easily avoidable condition. Gen Hosp Psychiatry. 2008; 30(3): 284–287.Google Scholar
33.Gillman, PK. Tricyclic antidepressant pharmacology and therapeutic drug interactions updated. Br J Pharmacol. 2007; 151(6): 737–748.CrossRefGoogle ScholarPubMed
34.Sun-Edelstein, C, Tepper, SJ, Shapiro, RE. Drug-induced serotonin syndrome: a review. Expert Opin Drug Saf. 2008; 7(5): 587–596.Google Scholar
35.Sternbach, H. The serotonin syndrome. Am J Psychiatry. 1991; 148(6): 705–713.Google Scholar
36.Dunkley, EJC, Isbister, GK, Sibbritt, D, Dawson, AH, Whyte, IM. The Hunter serotonin toxicity criteria: simple and accurate diagnostic decision rules for serotonin toxicity. Q J Med. 2003; 96(9): 635–642.Google Scholar
37.Azzaro, AJ, VanDenBerg, CM, Ziemniak, J, Kemper, EM, Blob, LF, Campbell, BJ. Evaluation of the potential for pharmacodynamic and pharmacokinetic drug interactions between selegiline transdermal system and two sympathomimetic agents (pseudoephedrine and phenylpropanolamine) in healthy volunteers. J Clin Pharmacol. 2007; 47(8): 978–990.Google Scholar
38.Stahl, SM. Essential Psychopharmacology: The Prescribers Guide, 4th ed. New York, NY: Cambridge University Press; 2011.Google Scholar
39.Feinberg, SS. Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication. J Clin Psychiatry. 2004; 65(11): 1520–1524.Google Scholar
40.Feighner, JP, Herbstein, J, Damlouji, N. Combined MAOI, TCA and direct stimulant therapy of treatment-resistant depression. J Clin Psychiatry. 1985; 46(6): 206–209.Google ScholarPubMed
41.Fawcett, J, Kravitz, HM, Zajecka, JM, Schaff, MR. CNS stimulant potentiation of monoamine oxidase inhibitors in treatment-refractory depression. J Clin Psychopharmacol. 1991; 11(2): 127–132.Google Scholar
42.Berlanga, C, Ortega-Soto, HA. A 3-year follow-up of a group of treatment-resistant depressed patients with a MAOI/tricyclic combination. J Affect Disord. 1995; 34(3): 187–192.Google Scholar
43.Huyse, FJ, Touw, DJ, van Schijndel, RS, de Lange, JJ, Slaets, JP. Psychotropic drugs and the perioperative period: a proprosal for a guideline in elective surgery. Psychosomatics. 2006; 47(1): 8–22.CrossRefGoogle Scholar
44.Fuller, RW, Snoddy, HD. Inhibition of serotonin uptake and the toxic interaction between meperidine and monoamine oxidase inhibitors. Toxicol Appl Pharmacol. 1975; 32(1): 129–134.Google Scholar
45.Hartrick, CT, Rozek, RJ. Tapentadol in pain management: a mu-opioid receptor agonist and noradrenaline reuptake inhibitor. CNS Drugs. 2011; 25(5): 359–370.CrossRefGoogle ScholarPubMed
46.Gillman, PK. Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity. Br J Anaesth. 2005; 95(4): 434–441.Google Scholar