MAOIs: issues in treatment adherence and rates of treatment failure

Treatment guidelines recommend initiating newer antidepressants as first-line therapy for patients with depression, but response and remission rates remain low and multiple treatment trials are often needed. Adherence to medication affects response and remission rates, and nonadherence is common among patients with depression. While MAOIs have proven efficacy for depression, particularly for patients with treatment-resistant or atypical depression, this class of drugs is underprescribed due, in part, to concerns over dietary and drug restrictions that are required to avoid potential serious side effects. However, a newer MAOI formulation has an improved safety and tolerability profile and avoids or lessens the need for dietary restrictions, giving clinicians another option for treating patients who may be nonadherent or nonresponsive to their current antidepressant.