The Pocket Guide to Classic Monoamine Oxidase Inhibitors for Treatment-Resistant Depression

Abstract

Treatment-resistant depression (TRD) remains a significant challenge for clinicians and patients alike, necessitating exploration and understanding of potent but underutilized antidepressant options, such as classic monoamine oxidase inhibitors (MAOIs). This article presents a condensed overview of the fundamental principles outlined in the international consensus guideline on using MAOIs in TRD (the Prescriber's Guide), explicitly focusing on phenelzine and tranylcypromine. These drugs are powerful treatment options for severe depression, including atypical and melancholic subtypes, that have insufficiently responded to first- and second-line treatments. MAOIs are generally indicated before electroconvulsive therapy due to their favorable side-effect profile. However, several contraindications and drug interactions must be considered. This article aims to provide clinicians with a practical, accessible resource for implementing classic MAOIs in the management of TRD. [ Psychiatr Ann . 2023;53(8):347–352.]