title: MAOIs - does the evidence warrant their resurrection?
abstract: OBJECTIVE
  The place of monoamine oxidase inhibitors (MAOIs) in psychiatry is reviewed, and the question posed as to whether they are now justifiably disregarded by prescribers.
  
  
  METHODS
  Multiple databases (PubMed, Medline, Embase, Cochrane) were interrogated to provide an overview regarding the use, efficacy and toxicity of MAOIs. Data regarding funded use of these agents in New Zealand were obtained from PHARMAC.
  
  
  RESULTS
  Evidence supports the use of MAOIs in major depressive disorder, certain anxiety disorders and, to lesser extent, bipolar depression. Older non-selective agents, such as phenelzine and tranylcypromine, have distinctive efficacy in 'atypical' and treatment-resistant depression, but at the cost of serious tolerability problems. Their relegation and perception by clinicians as 'last resort' medications - if considered at all - has occurred in the context of various concerns, notably dietary restrictions, potential adverse drug interactions and the usual requirement for divided doses.
  
  
  CONCLUSIONS
  Sufficient evidence supports consideration of MAOIs in treatment-refractory and atypical depressive disorders, and in social anxiety disorder. Psychiatrists in training need to gain experience in using these agents.
authors.affiliation: Associate Professor, Psychiatry, Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand david.menkes@auckland.ac.nz.
authors.forename: David
authors.initials: D
authors.lastname: Menkes
authors.affiliation: Clinical Director, Mental Health and Aged Care Services, St Vincent's Hospital, Melbourne, VIC, and; Associate Professor, Department Psychiatry, University of Melbourne, VIC, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Bosanac
authors.affiliation: Chair of Psychiatry, St Vincent's Hospital, Melbourne, VIC, and; Professor, Department Psychiatry, University of Melbourne, VIC, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Castle
mesh_terms: D001008:Anxiety Disorders / Q000188:drug therapy; D001714:Bipolar Disorder / Q000188:drug therapy; D003865:Major Depressive Disorder / Q000188:drug therapy; D061218:Depressive Disorder, Treatment-Resistant / Q000188:drug therapy*; D006801:Humans; D008996:Monoamine Oxidase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D010624:Phenelzine / Q000009:adverse effects / Q000627:therapeutic use*; D000072861:Phobia, Social / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D014191:Tranylcypromine / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D008996:Monoamine Oxidase Inhibitors; D014191:Tranylcypromine; D010624:Phenelzine
keywords: evidence; indications; monoamine oxidase inhibitors; prescribing