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Monoamine Oxidase Inhibitors (MAOIs) in Psychiatric Practice: How to Use them Safely and Effectively

  • Therapy in Practice
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A Letter to the Editor to this article was published on 07 December 2021

A Correction to this article was published on 25 November 2021

This article has been updated

Abstract

Monoamine oxidase inhibitors (MAOIs) were among the first licensed pharmacological treatments for patients with depression but over time have fallen out of mainstream clinical use. This has led to a loss of clinician training opportunities and reduced availability of MAOIs for prescribing. This article provides a concise and practical overview of how to use MAOIs safely and effectively in psychiatric practice. We consider the history of MAOIs, why they are not used more frequently, their mechanisms of action, availability, indications and efficacy, general tolerability, withdrawal symptoms, and safety considerations (including hypertensive reactions and serotonin syndrome). Practical advice is given in terms of dietary restrictions, interactions with other medications (both prescribed and non-prescribed), and how prescribers can stop and switch MAOIs, both within the drug class and outside of it. We also provide advice on choice of MAOI and treatment sequencing. Lastly, we consider emerging directions and potential additional indications.

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Fig. 1
Fig. 2

Reproduced with permission from Stahl SM [96]

Change history

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Acknowledgements

Many thanks to Dr. Mary Houston for expert technical support in the preparation of this article. We thank and acknowledge the RCPsych Psychopharmacology Committee and all authors of the RCPsych Position Statement on “Use of monoamine oxidase inhibitors in psychiatric practice (PS03/20)”. The current article is based partly on this Position Statement and text is reused and adapted with permission. We thank Professor Stephen Stahl for kind permission to reuse and adapt figures and tables from Essential Psychopharmacology and other publications; and we thank the authors of the MAOI dietary guide at the Sunnybrook Health Centre for permission to adapt and reprint their dietary guidelines.

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Authors and Affiliations

  1. Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK

    Samuel R. Chamberlain & David S. Baldwin

  2. Southern Health NHS Foundation Trust, Southampton, UK

    Samuel R. Chamberlain & David S. Baldwin

  3. Department of Psychiatry, University of Cambridge, Cambridge, UK

    Samuel R. Chamberlain

  4. Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK

    Samuel R. Chamberlain

  5. University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

    David S. Baldwin

  6. University Department of Psychiatry, University of Southampton, College Keep, 4-12 Terminus Terrace, Southampton, SO14 3DT, UK

    David S. Baldwin

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  1. Samuel R. Chamberlain
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Correspondence to David S. Baldwin.

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Funding

Prof. Chamberlain’s role in this paper was funded by a Clinical Fellowship from the Wellcome Trust (reference 110049/Z/15/Z and 110049/Z/15/A).

Conflict of interest

Prof. Chamberlain previously consulted for Promentis on work not related to MAOIs. He also receives honoraria from Elsevier for editorial work at the journals Neuroscience and Biobehavioral Reviews and Comprehensive Psychiatry. Prof. Baldwin is President-Elect of the BAP and a medical patron of Anxiety UK. He also receives stipends from Wiley for editorial work relating to the journal Human Psychopharmacology.

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Professors Baldwin and Chamberlain were both involved in all aspects of manuscript development, from conception to submission.

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Chamberlain, S.R., Baldwin, D.S. Monoamine Oxidase Inhibitors (MAOIs) in Psychiatric Practice: How to Use them Safely and Effectively. CNS Drugs 35, 703–716 (2021). https://doi.org/10.1007/s40263-021-00832-x

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