title: The use of monoamine oxidase inhibitors in primary care.
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.
authors.affiliation: Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA. larry.culpepper@bmc.org
authors.forename: Larry
authors.initials: L
authors.lastname: Culpepper
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D000928:Antidepressive Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D061218:Depressive Disorder, Treatment-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D003937:Diagnosis, Differential; D004347:Drug Interactions; D018565:Food-Drug Interactions; D006801:Humans; D006974:Hypertension, Malignant / Q000139:chemically induced / Q000175:diagnosis; D055118:Medication Adherence; D008996:Monoamine Oxidase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D010353:Patient Education as Topic; D011320:Primary Health Care; D020230:Serotonin Syndrome / Q000175:diagnosis / Q000209:etiology
chemical_list: D000928:Antidepressive Agents; D008996:Monoamine Oxidase Inhibitors