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Supplement Article

The Use of Monoamine Oxidase Inhibitors in Primary Care

Larry Culpepper, MD, MPH

Published: July 27, 2012

Article Abstract

Although primary care clinicians have developed considerable expertise in managing patients with major depressive disorder, and a range of treatment strategies is currently available, some patients still fail to reach remission. Two strategies have fallen out of common use: treating patients with monoamine oxidase inhibitors (MAOIs) and subgrouping patients by diagnosis when selecting antidepressant treatment. Monoamine oxidase inhibitors became less popular because other treatments were perceived to be safer and easier to use. However, a newer transdermal formulation of an MAOI that limits the need for the dietary restrictions of oral MAOIs may make it worthwhile to consider using this class of medication in patients who have failed several treatment trials. Although adverse events due to patients’ diets are less likely with the transdermal MAOI, clinicians should still be alert for drug interactions and observe recommended washout periods. Patients who may benefit from MAOI treatment include those with treatment-resistant depression, atypical depression, anxiety, or anergic bipolar depression and those who have experienced intolerable metabolic or sexual side effects with other medications.

(J Clin Psychiatry 2012;73[suppl 1]:37-41)

From the Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts.

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 Pharmaceuticals, L.P.).

Dr Culpepper is a consultant for AstraZeneca, Forest, Merck, Pfizer, and Takeda and is a member of the speakers/advisory boards for Merck.

Corresponding author: Larry Culpepper, MD, MPH, Dowling 5, 771 Albany St, Boston, MA 02118 (

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