psychiatric disorders
Medications for Treatment of Depression
Monoamine Oxidase Inhibitors (MAOIs)
These medications inhibit the oxidative deamination of the 3 classes of biogenic amines (norepinephrine,dopamine, 5-HT) and other phenylethylamines. reuptake inhibitors (SSRIs), tricyclic antidepressants, and sometimes even Electroconvulsive therapy (ECT) (ECT) are ineffective. Monoamine oxidase inhibitors (MAOIs) marketed as antidepressants in the United States (eg,phenelzine,tranylcypromine,isocarboxazid) are irreversible and nonselective (inhibiting MAO-A and MAO-B). Another MAOI (selegiline), which inhibits only MAO-B at lower doses, is available as a patch. Hypertensive crisescan occur if MAOIs that inhibit MAO-A and MAO-B are ingested concurrently with a sympathomimetic medication or food containing tyramine ordopamine. This effect is called the cheese reaction because mature cheese has a high tyramine content. MAOIs are used infrequently because of concern about this reaction. The lower dosage of theselegilinepatch is considered safe to use without specific dietary restrictions, unless the dosage must be higher than starting levels (a 6-mg patch). More selective and reversible MAOIs (eg, moclobemide, befloxatone), which inhibit MAO-A, are relatively free of these interactions but are not available in the United States. To prevent hypertension and febrile crises, patients taking MAOIs should avoid sympathomimetic medications (eg,pseudoephedrine),dextromethorphan, reserpine, andmeperidineas well as malted beers, Chianti wines, sherry, liqueurs, and overripe or aged foods that contain tyramine ordopamine(eg, fava or broad beans, yeast extracts, canned figs, raisins, yogurt, cheese, sour cream, soy sauce, pickled herring, caviar, liver, banana peel, extensively tenderized meats). Common adverse effects of MAOIs include erectile dysfunction (least common withtranylcypromine), anxiety, nausea, dizziness, insomnia, pedal edema, and weight gain. , which has a long half-life) should elapse between use of the 2 classes of drugs. MAOIs used with antidepressants that affect the 5-HT system (eg, SSRIs) may cause Serotonin Syndrome (a potentially life-threatening condition whereby patients may exhibit mental status changes, hyperthermia, and autonomic and neuromuscular hyperactivity). Patients who are taking MAOIs and who also need anti-asthmatic or anti-allergy medications, a local anesthetic, or a general anesthetic should be treated by a psychiatrist plus an internist, a dentist, or an anesthesiologist with expertise in neuropsychopharmacology. 