Monoamine Oxidase Inhibitors for Various Psychiatric Disorders and Conditions

Abstract

This article explores literature to determine if there are specific psychiatric disorders in which monoamine oxidase inhibition (MAOI) therapy proved effective. Evidence was considered adequate to deem MAOIs indicated for illnesses in which we found two or more randomized controlled trials (RCTs) demonstrating superiority of MAOI relative to a comparator. The comparator could be placebo or active drug. Equivalency studies in which two drugs are not found to differ were considered supportive of efficacy but not definitive, as were systematic case series. We also examined case studies, but consider these studies prone to chance circumstances and possibly based on rare events—thus not definitive in predicting the likelihood of the next such patient experiencing significant benefit. Four of six positive RCTs of panic disorder, 9 of 12 for social phobia, and 5 of 5 for bulimia demonstrate that MAOIs are indicated for these conditions, although the studies of panic disorder suggest MAOIs may be more helpful in alleviating panic attacks than agoraphobia. Three positive studies of selegiline for attention-deficit/hyperactivity disorder (ADHD) indicate its efficacy. Despite three positive RCTs reporting efficacy of MAOIs for melancholia and/or endogenous depression, and similarly, three potentially positive RCTs including placebo comparison in borderline personality disorder, each was problematic; thus, no definitive conclusion was possible. Finally, an equivalence study failed to differentiate clomipramine from phenelzine, suggesting possible efficacy of phenelzine for obsessive-compulsive disorder, but the study cannot be considered definitive. MAOIs appear efficacious for a variety of disorders besides depression, including bulimia, ADHD, social phobia, and panic disorder. [Psychiatr Ann. 2014;44(12):567–573.]

Pharmacological Management of Anxiety Disorders in the Elderly

“…MAOIs such as tranylcypromine and phenelzine have long been efficacious in treatment-resistant depression [44]. In adult studies, they have also been found to be efficacious in panic and social anxiety disorder [45].…”

Interactions of endocannabinoid virodhamine and related analogs with human monoamine oxidase-A and -B

“…Our results suggest potential therapeutic application of virodhamine for the treatment of Parkinson’s disease. Selective irreversible inhibitors of MAO-B have also shown promise for treatment of depression and Attention Deficit Hyperactivity Disorder (ADHD) [49, 50]. Selective MAO-B inhibition also leads to increase in endogenous β-phenylethylamine (PEA) levels in the brain [51].…”

MAOIs – does the evidence warrant their resurrection?

“…34 Nine out of 12 RCTs have demonstrated benefit of irreversible MAOIs in panic and social anxiety disorder. 35 Phenelzine has also been shown to be as beneficial as tricyclic antidepressants in post-traumatic stress disorder (PTSD), 36,37 but not all trials have been consistent. 38…”