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.

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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.

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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.

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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.

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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.

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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.

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

CME Section

46 Posttest

48 Registration Form and Evaluation