Volume 732012Supplement 1

A Fresh Look at Monoamine Oxidase Inhibitors for Depression

CME Background

3 Introduction: A Fresh Look at Monoamine Oxidase Inhibitors for Depression

5 The Epidemiology of Depression and the Evolution of Treatment

For Clinical Use
  • Depression is highly prevalent and is a leading cause of disability worldwide.
  • Bipolar disorder is often misdiagnosed as major depression due to patients’ underreporting of manic/hypomanic symptoms.
  • Several medications are effective in treating major depression, including TCAs, MAOIs, SSRIs, and SNRIs.


10 The Role of Monoamine Oxidase Inhibitors in Depression Treatment Guidelines

For Clinical Use
  • Consider prescribing an MAOI for patients with depression who have had 2 or more unsuccessful trials of SSRIs or other newer antidepressants.
  • Guidelines generally reserve MAOIs as third- or fourth-line treatments due to concerns over safety and tolerability, but newer formulations can lessen the risks.
  • When prescribing MAOIs, educate patients about necessary dietary restrictions and the potential for hypertensive crisis and serotonin syndrome due to drug interactions.


17 Dietary Restrictions and Drug Interactions With Monoamine Oxidase Inhibitors: An Update

For Clinical Use
  • Dietary restrictions are required with older, irreversible MAOIs and are lessened with low dosages of selective MAO-B inhibitors and with transdermal formulations.
  • Drug interactions can occur with all MAOIs.
  • Washout periods should be carefully observed when switching between an MAOI and a serotonergic agent.
  • Counsel patients to inform other physicians that they are taking an MAOI and to carefully select over-the-counter drugs.


25 The Transdermal Delivery System of Monoamine Oxidase Inhibitors

For Clinical Use
  • MAO is an enzyme that metabolizes serotonin, norepinephrine, and dopamine; inhibiting MAO allows these neurotransmitters to accumulate in the synaptic cleft.
  • MAOIs have potentially serious side effects, such as hypertensive crisis and serotonin syndrome, due to diet and drug interactions.
  • To avoid these adverse effects, patients should be educated regarding dietary restrictions and drug interactions.
  • A transdermal MAOI formulation with a greater tolerability and safety profile than oral MAOIs is available, which, at the minimum effective dosage, avoids the need for dietary restrictions.


31 Issues in Adherence to Treatment With Monoamine Oxidase Inhibitors and the Rate of Treatment Failure

For Clinical Use
  • Adherence to an antidepressant affects treatment response and remission rates for patients.
  • Patients who appear to be treatment-resistant may be experiencing treatment failure due to nonadherence.
  • Multifaceted strategies employing educational, behavioral, affective, and provider-targeted strategies enhance treatment adherence.
  • A transdermal MAOI formulation may help to address adherence barriers for patients with treatment-resistant or atypical depression.


37 The Use of Monoamine Oxidase Inhibitors in Primary Care

For Clinical Use
  • Consider using MAOIs for patients with atypical depression or patients with depression who have not experienced adequate symptomatic improvement with traditional first-line treatments.
  • Consider MAOIs for other patient populations that may benefit from MAOI treatment, such as those with anxiety or panic disorders or anergic bipolar depression.
  • When prescribing MAOIs, be mindful of drug interactions with the patient’s current medications, follow the required washout period, and advise the patient of dietary restrictions, if necessary.
  • When prescribing MAOIs, consider the transdermal formulation, which mitigates some concerns about adverse events and dietary restrictions that accompany oral MAOIs.


42 Discussion: A Fresh Look at Monoamine Oxidase Inhibitors for Depression

CME Section

46 Posttest

48 Registration Form and Evaluation