Abstract: The monoamine oxidase inhibitors (MAOIs) have been in clinical use for five decades. The coincidental discovery that inhibiting brain monoamine oxidase resulted in antidepressant benefits indirectly led to the norepinephrine (NE) and serotonin hypotheses for depression. Phenelzine (PLZ) and tranylcypromine (TCP) typify the classical, nonselective and irreversible inhibitors; selegiline (SEL) selectively but irreversibly inhibits MAO-B and is an established adjunct therapy for Parkinson's disease; while moclobemide and befloxatone represent examples of selective and reversible inhibitors. These agents provide opportunities to examine brain amine and amino acid levels during treatment and have also contributed to emerging aware of neurogenesis and neuronal rescue as potential antidepressant properties. Also of emerging interest are the extended sites of action beyond MAO for these agents including γ-aminobutyric acid (GABA) and imidazoline binding sites. Despite the well-known clinical concerns about food and drug interactions and the high side-effect burden associated with classical MAOIs, they continue to be third line agents for treatment-resistant depression. PLZ is also a second line agent for atypical depression. Moclobemide is the only generally available reversible inhibitor of MAO-A and has obtained limited acceptance as a first line treatment in some countries for major depressive disorder (MDD), particularly in patients with prominent anxiety symptoms. It also has one of the lowest side-effect burdens of the MAOIs and, unlike the SSRIs, rarely produces sexual dysfunction. A transdermal form of SEL has been investigated for treating MDD. With appropriate cautions, the MAOIs continue to provide an important alternative class of antidepressants for the treatment of various forms of depressive illnesses.
Publication Year: 2004
Publication Date: 2004-01-01
Language: en
Type: book-chapter
Indexed In: ['crossref']
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Cited By Count: 7
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