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MAOIs - does the evidence warrant their resurrection?
David Menkes1, Peter Bosanac2, David Castle3
1Associate Professor, Psychiatry, Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand david.menkes@auckland.ac.nz.
Summary
Monoamine oxidase inhibitors (MAOIs) remain effective for treatment-resistant depression and social anxiety disorder. Despite tolerability concerns, evidence supports their consideration, and training in their use is recommended.
Area of Science:
- Psychiatry
- Pharmacology
- Clinical Therapeutics
Background:
- Monoamine oxidase inhibitors (MAOIs) are a class of antidepressants.
- Their use has declined due to concerns regarding dietary restrictions, drug interactions, and side effects.
Purpose of the Study:
- To review the current place of MAOIs in psychiatric practice.
- To evaluate whether MAOIs are justifiably disregarded by prescribers.
Main Methods:
- Comprehensive literature search of multiple databases (PubMed, Medline, Embase, Cochrane).
- Inclusion of data on MAOI use, efficacy, and toxicity.
- Inclusion of data on funded MAOI use in New Zealand.
Main Results:
- Evidence supports MAOI use in major depressive disorder, anxiety disorders, and bipolar depression.
- Older non-selective MAOIs show efficacy in atypical and treatment-resistant depression.
- Tolerability issues, dietary restrictions, and drug interactions contribute to their limited use.
Conclusions:
- MAOIs should be considered for treatment-refractory depression, atypical depression, and social anxiety disorder.
- Psychiatrists in training require experience with MAOI prescribing.
