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The prescriber’s guide to classic MAO inhibitors (phenelzine, tranylcypromine, isocarboxazid) for treatment-resistant depression
- Vincent Van den Eynde, Wegdan R. Abdelmoemin, Magid M. Abraham, Jay D. Amsterdam, Ian M. Anderson, Chittaranjan Andrade, Glen B. Baker, Aartjan T.F. Beekman, Michael Berk, Tom K. Birkenhäger, Barry B. Blackwell, Pierre Blier, Marc B.J. Blom, Alexander J. Bodkin, Carlo I. Cattaneo, Bezalel Dantz, Jonathan Davidson, Boadie W. Dunlop, Ryan F. Estévez, Shalom S. Feinberg, John P.M. Finberg, Laura J. Fochtmann, David Gotlib, Andrew Holt, Thomas R. Insel, Jens K. Larsen, Rajnish Mago, David B. Menkes, Jonathan M. Meyer, David J. Nutt, Gordon Parker, Mark D. Rego, Elliott Richelson, Henricus G. Ruhé, Jerónimo Sáiz-Ruiz, Stephen M. Stahl, Thomas Steele, Michael E. Thase, Sven Ulrich, Anton J.L.M. van Balkom, Eduard Vieta, Ian Whyte, Allan H. Young, Peter K. Gillman
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- Journal:
- CNS Spectrums / Volume 28 / Issue 4 / August 2023
- Published online by Cambridge University Press:
- 15 July 2022, pp. 427-440
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This article is a clinical guide which discusses the “state-of-the-art” usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion—this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy—while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward “bridging” methods that may be used to transition simply and safely from other antidepressants to MAOIs.
On the lifespan of recirculating suspensions with pulsatile flow
- Mark D. Jeronimo, David E. Rival
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- Journal:
- Journal of Fluid Mechanics / Volume 928 / 10 December 2021
- Published online by Cambridge University Press:
- 04 October 2021, A2
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A Lagrangian analysis is performed to measure the rate at which recirculating fluid is replaced (depleted) in pulsatile flows. Based on this approach, we then investigate how depletion is affected in dense suspensions. Experiments are conducted for pure liquid as well as suspensions with volume fractions of $\varPhi =5\,\%$, 10 % and 20 %. Using Lagrangian tracking and pathline extension techniques, the depletion of the recirculation region is quantified via the trajectories of individual fluid parcels exiting the domain. Pulsatile flows with varying concentrations of hydrogel beads, up to a volume fraction of 20 %, are compared at mean Reynolds numbers of $Re=4800$, 9600 and 14 400, while the Strouhal number ($St=0.04$, 0.08 and 0.15) and amplitude ratio ($\lambda =0.25$, 0.50 and 0.95) are systematically varied. A so-called ‘depletion efficiency’ is calculated for each test case, which is shown to increase with increasing Strouhal number and amplitude ratio. For most pulsatile cases, periodic vortex formation significantly increases depletion efficiency through enhanced entrainment of recirculating fluid. Conversely, low-amplitude pulsatile flows are dominated by Kelvin–Helmholtz instabilities, which do not penetrate into the recirculation region, and thus their depletion efficiency is markedly lower as a result. The efficiency trends and depletion mechanisms remain virtually unchanged between the pure liquid and each of the suspension concentrations under almost all flow conditions, which forms an unexpected conclusion. The only exception is for low-amplitude and steady flows, where increasing the suspension volume fraction is shown to suppress fluid transport across the shear layer, which in turn slows depletion and decreases the overall depletion efficiency.
Circum-Antarctic coastal environmental shifts during the Late Quaternary reflected by emerged marine deposits
- Paul A. Berkman, John T. Andrews, Svante Björck, Eric A. Colhoun, Steven D. Emslie, Ian D. Goodwin, Brenda L. Hall, Charles P. Hart, Kazuomi Hirakawa, Atsuo Igarashi, Olafur Ingólfsson, Jeronimo López-Martínez, W. Berry Lyons, Mark C.G. Mabin, Patrick G. Quilty, Marco Taviani, Yoshio Yoshida
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- Antarctic Science / Volume 10 / Issue 3 / September 1998
- Published online by Cambridge University Press:
- 07 May 2004, pp. 345-362
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This review assesses the circumpolar occurrence of emerged marine macrofossils and sediments from Antarctic coastal areas in relation to Late Quaternary climate changes. Radiocarbon ages of the macrofossils, which are interpreted in view of the complexities of the Antarctic marine radiocarbon reservoir and resolution of this dating technique, show a bimodal distribution. The data indicate that marine species inhabited coastal environments from at least 35 000 to 20 000 yr BP, during Marine Isotope Stage 3 when extensive iceberg calving created a ‘meltwater lid’ over the Southern Ocean. The general absence of these marine species from 20 000 to 8500 yr BP coincides with the subsequent advance of the Antarctic ice sheets during the Last Glacial Maximum. Synchronous re-appearance of the Antarctic marine fossils in emerged beaches around the continent, all of which have Holocene marine-limit elevations an order of magnitude lower than those in the Arctic, reflect minimal isostatic rebound as relative sea-level rise decelerated. Antarctic coastal marine habitat changes around the continent also coincided with increasing sea-ice extent and outlet glacial advances during the mid-Holocene. In view of the diverse environmental changes that occurred around the Earth during this period, it is suggested that Antarctic coastal areas were responding to a mid-Holocene climatic shift associated with the hydrological cycle. This synthesis of Late Quaternary emerged marine deposits demonstrates the application of evaluating circum-Antarctic phenomena from the glacial-terrestrial-marine transition zone.