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The Role of Monoamine Oxidase Inhibitors in Depression Treatment Guidelines

J Clin Psychiatry 2012;73(suppl 1):10-16
10.4088/JCP.11096su1c.02

Monoamine oxidase inhibitors (MAOIs) have proven efficacy for treating depression and for decades have been a preferred treatment for patients with atypical depression, high levels of anxiety, anergic bipolar depression, and treatment-resistant depression. However, MAOIs are infrequently used due to safety and tolerability concerns and the need for dietary restrictions. Current guidelines, which are reviewed here, recommend MAOIs as third-, fourth-, or fifth-line treatments due to these concerns. However, a transdermal formulation of selegiline limits the need for dietary restrictions and has fewer side effects than many more widely used antidepressants. The availability of a safer and more tolerable formulation gives clinicians another option in their armamentarium for treating depression.

(J Clin Psychiatry 2012;73[suppl 1]:10–16)

From the Departments of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia Veterans Affairs Medical Center, and the University of Pittsburgh Medical Center, Philadelphia and Pittsburgh.

This article is derived from the planning teleconference series “A Fresh Look at Monoamine Oxidase Inhibitors for Depression,” which was held December 2011 through February 2012 and supported by an educational grant from Mylan Specialty L.P. (formerly known as Dey Pharma, L.P.).

Dr Thase is a consultant for Alkermes, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Dey, Forest, Gerson Lehman, Guidepoint Global, Lundbeck, MedAvante, Merck, Neuronetics, Otsuka, Ortho-McNeil, Pamlab, Pfizer (formerly Wyeth-Ayerst), PGx Health, Shire, Takeda, and Transcept; has received grant support from the Agency for Healthcare Research and Quality (AHRQ), Eli Lilly, Forest, National Institute of Mental Health (NIMH), and Otsuka; is a member of the speakers’ bureaus for Bristol-Myers Squibb, Dey, Merck, and Pfizer (formerly Wyeth-Ayerst); has equity holdings in MedAvante; receives royalties from American Psychiatric Foundation, Guilford Publications, Herald House, and W W Norton & Company; and his spouse is an employee of Embryon, which does business with Bristol-Myers Squibb and Pfizer (Wyeth).

Corresponding author: Michael E. Thase, MD, 3535 Market St, Ste 670, Philadelphia, PA 19104 (thase@mail.med.upenn.edu).

Monoamine Oxidase Inhibitors