Phenelzine treatment of melancholia.
ABSTRACT Monoamine oxidase (MAO) inhibitor antidepressants are widely thought by clinicians and researchers to be ineffective in the treatment of endogenous depression. This study reports an open clinical trial in which seven of eight outpatients (88%) with melancholia responded to phenelzine treatment. This response rate is comparable to the response to tranylcypromine in a previous study at our clinic. These results suggest that MAO inhibitors are effective for outpatients with endogenous depressive syndromes. The use of MAO inhibitors may be an alternative treatment for patients who cannot tolerate or who have not responded to tricyclic antidepressants.
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ABSTRACT: The EMSAM patch is a unique monoamine oxidase inhibitor (MAOI) being the only antidepressant utilizing a transdermal delivery system. This was welcomed by clinicians who hoped that EMSAM would be better tolerated than oral MAOIs and non-MAOI antidepressants, as well as being effective for treatment in a wide spectrum of depressed patients including atypical depression, bipolar depression, and refractory depression. Unfortunately, the clinical use of EMSAM has been underutilized and its potential usefulness overlooked. This article suggests that fear of possible side effects, particularly the "cheese reaction" and serotonin syndrome, are some of the main contributors to underutilization by clinicians. These risks have been significantly exaggerated with the 6 mg/day dose not even requiring a special diet. Other contributing factors leading to underutilization are reviewed such as: the lack of studies addressing many important clinical questions; inadequate data analyses; not evaluating the effect of EMSAM on comorbid psychiatric conditions, particularly anxiety disorders; lack of antidepressant comparators versus EMSAM; no dose-response relationship examined; various depressive subtypes and conditions are unexplored, eg, bipolar depression and refractory depression; poor insurance coverage for an expensive medication; as well as minimal marketing efforts and postmarketing studies. On the other hand, many potential advantages of EMSAM are not highlighted enough in the literature and by pharmaceutical companies which might have increased clinical interest and utilization of the antidepressant. For example, the advantages of EMSAM include: avoidance of swallowing issues, as can be seen with oral antidepressants; minimal side effects, probably due to a favorable pharmacokinetic profile; minimal evidence of suicidal behavior, probably relating to the transdermal route of administration; low rates of inducing hypomanic/manic episodes; as well as significant efficacy in "anxious depression" and atypical depression. Recent efforts in conducting some post hoc analyses and presentations on EMSAM may yet stimulate further clinical interest and use of this antidepressant.Neuropsychiatric Disease and Treatment 10/2014; 10:1911-23. DOI:10.2147/NDT.S59107 · 2.15 Impact Factor
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ABSTRACT: We review the literature on the effectiveness of the monoamine oxidase inhibitors (MAOIs) and present metaanalyses of controlled trials comparing the FDA-approved MAOIs with both placebo and comparator tricyclic antidepressants. For outpatients, metaanalyses with intent-to-treat samples revealed generally comparable overall efficacy for phenelzine, isocarboxazid, and tranylcypromine. Drug—placebo differences were 29.5% (± 11.1%) (phenelzine; nine studies), 41.3% (± 18.0%) (isocarboxazid; three studies), and 22.1% (± 25.4%) (tranylcypromine; three studies). For inpatients, phenelzine was 22.3% (± 30.7%) (five studies) more effective than placebo, whereas the isocarboxazid—placebo difference was lower (15.3%) (± 12.6%). Both phenelzine and isocarboxazid were significantly less effective than comparator tricyclics for inpatients, whereas tranylcypromine has not been adequately studied. Both phenelzine and tranylcypromine appear to be more effective than tricyclics in depressed outpatients with atypical features. Monoamine oxidase inhibitors are also effective treatments for outpatients who have failed to respond to tricyclic antidepressants. Our review also suggests (1) the FDA-approved MAOIs treat a somewhat different group of patients than tricyclics; (2) more severely depressed inpatients may not respond as well to MAOIs as to tricyclics; and (3) because of preferential MAOI responsivity, atypical or anergic depressions may be biologically different than classical depressions.Neuropsychopharmacology 06/1995; 12(3-12):185-219. DOI:10.1016/0893-133X(94)00058-8 · 7.83 Impact Factor