[Elderly patients, classical monoamine oxidase inhibitors and intercurrent somatic diseases]

Three patients, a woman aged 70, a man aged 74 and a woman aged 78 years, all using tranylcypromine, a monoamine oxidase inhibitor (MAOI), to prevent the recurrence of severe depressive disorders, developed an intercurrent somatic disease. On admission to a general hospital, the first patient was initially refused her MAOI. The second patient was twice refused anaesthesia and the depression recurred twice when the MAOI was tapered off in connection with his operation. Both recovered after being given tranylcypromine. The third patient received tramadol from her surgeon and read in the directions for use that this drug should not be combined with a MAOI. After discontinuation of the MAOI the depression recurred, her medical condition deteriorated and she died. MAOIs are often a treatment of last resort. Discontinuation of an effective treatment and hence compromising the patient's psychiatric status increases the risk of medical and psychiatric complications and therefore should be avoided. Interdisciplinary consultation is essential in such cases.