Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-19T22:29:46.643Z Has data issue: false hasContentIssue false
  • English
  • Français

Towards Rational Therapy with Monoamine Oxidase Inhibitors

Published online by Cambridge University Press:  29 January 2018

Peter Tyrer
Peter Tyrer*
Affiliation:
University of Southampton, South Academic Block, Southampton General Hospital, Tremona Road, Southampton, SO9 4XY
Get access Rights & Permissions [Opens in a new window]

Summary

A rational approach to the use of monoamine oxidase inhibitors (MAOIs) is outlined. Patients suitable for treatment cannot be classified adequately using conventional diagnostic labels. They include those with primary symptoms of hypochondriasis, agoraphobia and social phobias, irritability, somatic anxiety and anergia; those with primary depressed mood, guilt, ideas of reference and personality disorders seldom respond. There is great variation in the interval between the first administration of these drugs and clinical response, and this may account for the inconsistencies in published trials. The type of drug and its dose may affect rate of response, as may biochemical factors, including acetylator and monoamine oxidase status. To obtain maximum benefit, a course of therapy with MAOIs should last for several months.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 128 , Issue 4 , April 1976 , pp. 354 - 360
Copyright
Copyright © Royal College of Psychiatrists, 1976 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akindele, M. O., Evans, J. I. & Oswald, I. (1970) Monoamine oxidase inhibitors, sleep and mood. Electroencephalography and Clinical Neurophysiology, 29, 47—56.Google Scholar
Blackwell, B. (1963) Hypertensive crisis due to monoamine oxidase inhibitors. Lancet, ii, 849—51.Google Scholar
Boakes, A. J. (1974) Another drug interaction. British Journal of Clinical Pharmacology, 1, 9—10.CrossRefGoogle ScholarPubMed
Boakes, A. J. Laurence, D. R., Lovel, K. W., O'Neil, R. & Verrill, P. J. (1972) Adverse reactions to local anaesthetic/vasoconstrictor preparations. British Dental Journal, 133, 137—40.Google ScholarPubMed
Boakes, A. J. Laurence, D. R., Teoh, D. C., Barar, F. S. K., Benedikter, L. T. & Prichard, B. N. C. (1973) Interaction between sympathomimetic amines and antidepressant agents in man. British Medical Journal, i, 311—15.Google Scholar
Briant, R. H., Reid, J. L. & Dollery, C. T. (1973) Interaction between Clonidine and desipramine in man. British Medical Journal, i, 522—3.Google Scholar
Dunleavy, D. L. F. & Oswald, I. (1973) Phenelzine, mood response and sleep. Archives of General Psychiatry, 28, 353—6.Google Scholar
Elis, J., Laurence, D. R., Mattie, H. & Prichard, B. N. C. (1967) Modification by monoamine oxidase inhibitors of the effect of some sympathomimetics on blood pressure. British Medical Journal, ii, 75—8.Google Scholar
Everitt, B. S., Gourlay, A.J. & Kendell, R. F. (1971) An attempt at validation of traditional psychiatric syndromes by cluster analysis. British Journal of Psychiatry, 119, 399—413.Google Scholar
Greenblatt, M., Grosser, G. H. & Wechsler, H. (1964) Differential response of hospitalized depressed patients to somatic therapy. American Journal of Psychiatry, 120, 935—43.CrossRefGoogle ScholarPubMed
Gurney, C., Roth, M., Garside, R. F., Kerr, T. A. & Schapira, K. (1972) Studies in the classification of affective disorders: the relationship between anxiety states and depressive illnesses. British Journal of Psychiatry, 121, 162—6.CrossRefGoogle ScholarPubMed
Hare, E. H., Dominian, J. & Sharpe, L. (1962) Phenelzine and dexamphetamine in depressive illness: a comparative trial. British Medical Journal, i, 9—12.Google Scholar
Harris, J. S. & Robin, A. A. (1960) A controlled trial of phenelzine in depressive reactions. Journal of Mental Science, 106, 1432—7.Google Scholar
Hendley, E. D. & Snyder, S. H. (1968) Relationship between the action of monoamine oxidase inhibitors on the noradrenaline uptake system and their antidepressant efficacy. Nature (London), 220, 1330—1.Google Scholar
Hollister, L. E. (1973) Clinical Use of Psychotherapeutic Drugs. Springfield, Illinois: Thomas.Google Scholar
Hutchinson, J. T. & Smedberg, D. (1960) Phenelzine (‘Nardil’) in the treatment of endogenous depression, Journal of Mental Science, 106, 704—10.Google Scholar
Hutchinson, J. T. & Smedberg, D. (1963) Treatment of depression: comparative study of ECT and six drugs. British Journal of Psychiatry, 109, 536—8.Google Scholar
Jarvik, M. E. (1970) Drugs used in the treatment of psychiatric disorders. In The Pharmacological Basis of Therapeutics, 4th Edition (eds. Goodman, L. S. and Gilman, S.), pp. 151–203. London: McMillan.Google Scholar
Johnstone, E. C. & Marsh, W. (1973) Acetylator status and response to phenelzine in depressed patients. Lancet, i, 567—70.Google Scholar
Kay, D. W. K., Garside, R. F. & Fahy, T. J. (1973) A double-blind trial of phenelzine and amitriptyline in depressed outpatients: a possible differential effect of the drugs on symptoms. British Journal of Psychiatry, 123 63–7.Google Scholar
Kendell, R. F. (1974) The stability of psychiatric diagnoses. British Journal of Psychiatry, 124, 352—6.Google Scholar
King, A. (1962) Phenelzine treatment of Roth's calamity syndrome. Medical Journal of Australia, 1, 879—83.Google Scholar
Klein, D. F. (1964) Delineation of two drug-responsive anxiety syndromes. Psychopharmacologia, 5, 397—408.Google Scholar
Lascelles, R. G. (1966) Atypical facial pain and depression. British Journal of Psychiatry, 112, 651—6.CrossRefGoogle ScholarPubMed
Lingl, F. A. (1964) Combined drug therapy compared with electric shock in psychotic depression. American Journal of Psychiatry, 120, 808—10.Google Scholar
Lipsedge, M. S. & Rees, W. L. (1971) A double-blind comparison of dothiepin and amitriptyline for the treatment of depression with anxiety. Psychopharmacologia, 19, 153—62.Google Scholar
Lipsedge, M. S. Hajioff, J., Huggins, P., Napier, L., Pearce, J., Pike, D. J. & Rich, M. (1973) The management of severe agoraphobia: a comparison of iproniazid and systematic desensitization. Psychopharmacologia, 32, 67—80.Google Scholar
Marshall, W. K. (1972) Treatment of obsessional illness and phobic anxiety states with clomipramine. British Journal of Psychiatry, 119, 467—8.Google Scholar
Medical Research Council (1965) Clinical trial of the treatment of depressive illness: report by MRC Clinical Psychiatry Committee. British Medical Journal, i, 881—6.Google Scholar
Mountjoy, C. Q. & Roth, M. (1974) A double-blind clinical trial of phenelzine in anxiety states, reactive depression and agoraphobia. Paper given at 9th Congress of C.I.N.P., July 1974.Google Scholar
Pare, C. M. B. (1964) Side-effects and toxic effects of antidepressants. Proceedings of Royal Society of Medicine, 57, 757—8.Google Scholar
Pare, C. M. B., Rees, L. & Sainsbury, M. J. (1962) Differentiation of two genetically specific types of depression by the response to antidepressants. Lancet, ii, 1340—3.Google Scholar
Paykel, E. S. (1971) Classification of depressed patients: a cluster analysis derived grouping. British Journal of Psychiatry, 118, 275—88.Google Scholar
Pilowsky, I., Levine, S. & Boulton, D. M. (1969) The classification of depression by numerical taxonomy. British Journal of Psychiatry, 115, 937—45.Google Scholar
Pitt, B. M. N. (1974) Withdrawal symptoms after stopping phenelzine? British Medical Journal, ii, 332—3.Google Scholar
Raskin, A., Schulterbrandt, J. G., Reatio, N., Crook, T. H. & Odle, D. (1974) Depression subtypes and response to phenelzine, diazepam and a placebo: results of a nine hospital collaborative study. Archives of General Psychiatry, 30, 66—75.Google Scholar
Rees, L. & Davies, B. (1961) A controlled trial of phenelzine (‘Nardil’) in the treatment of severe depressive illness. Journal of Mental Science, 107, 560—6.Google Scholar
Robinson, D. S., Nies, A., Ravaris, C. L. & Lamborn, K. R. (1973) The monoamine oxidase inhibitor, phenelzine, in the treatment of depressive-anxiety states: a controlled clinical trial. Archives of General Psychiatry, 29, 407—13.Google Scholar
Roth, M., Gurney, C., Garside, R. F. & Kerr, T. A. (1972) Studies in the classification of affective disorders. I. The relationship between anxiety states and depressive illnesses. British Journal of Psychiatry, 121, 147—61.CrossRefGoogle ScholarPubMed
Sandler, M., Bonham Carter, S., Cuthbert, M. F. & Pare, C. M. B. (1975) Is there an increase in monoamine-oxidase activity in depressive illness? Lancet, i, 1045—8.Google Scholar
Sargant, W. (1966) Psychiatric treatment in general teaching hospitals: a plea for a mechanistic approach. British Medical Journal, ii, 257—62.Google Scholar
Sargant, W. (1969) Physical treatments of anxiety. In Studies of Anxiety (ed. Lader, M. H.), pp. 1–6. British Journal of Psychiatry Special Publication No. 3.Google Scholar
Sargant, W. & Dally, P. J. (1962) Treatment of anxiety states by antidepressant drugs. British Medical Journal, i, 6—9.Google Scholar
Sargant, W. & Slater, E. (1963) Physical Methods of Treatment in Psychiatry, 4th edition. Edinburgh: Churchill Livingstone.Google Scholar
Schröder, H. (1972) Simplified method for determining acetylator phenotype. British Medical Journal, iii, 506—7.Google Scholar
Schuckit, M., Robins, E. & Feighner, J. (1971) Tricyclic antidepressants and monoamine oxidase inhibitors. Archives of General Psychiatry, 24, 509—51.Google Scholar
Schwartz, M. A., Postna, E. & Gaut, Z. (1971) Biological half-life of chlordiazepoxide and its metabolite, demoxepam, in man. Journal of Pharmaceutical Science, 60, 1500—3.Google Scholar
Sethna, E. R. (1974) A study of refractory cases of depressive illnesses and their response to combined antidepressant treatment. British Journal of Psychiatry, 124, 265—72.Google Scholar
Sjöqvist, F. (1965) Interaction between monoamine oxidase inhibitors and other substances. Proceedings of the Royal Society of Medicine, 58, 967—78.Google Scholar
Snaith, R. P. (1972) A study of imipramine in the treatment of phobias. British Journal of Psychiatry, 121, 238—9.Google Scholar
Snyder, S. H. (1974) Mechanism of antidepressant efficacy of monoamine oxidase inhibitors: inhibition of monoamine oxidase or of catecholamine response. Psychopharmacology Bulletin, 10, 16.Google Scholar
Solyom, L., Heseltine, G. F., McClure, D. J., Solyom, C., Ledwidge, B. & Steinberg, G. (1973) Behaviour therapy versus drug therapy in the treatment of phobic neurosis. Canadian Psychiatric Association Journal, 18, 25—32.Google Scholar
Svedmyr, N. (1968) The influence of a tricyclic antidepressive agent (protriptyline) on some of the circulatory effects of noradrenaline and adrenaline in man. Life Sciences, 7, 77—84.Google Scholar
Tyrer, P. J. (1973) Are monoamine oxidase inhibitors antidepressants? Proceedings of the Royal Society of Medicine, 66, 950—1.Google Scholar
Tyrer, P., Candy, J. & Kelly, D. (1973a) Phenelzine in phobic anxiety: a controlled trial. Psychological Medicine, 3, 120—4.Google Scholar
Tyrer, P., Candy, J. & Kelly, D. (1973b) A study of the clinical effects of phenelzine and placebo in the treatment of phobic anxiety. Psychopharmacologia, 32, 237—54.Google Scholar
Tyrer, P. & Steinberg, D. (1975) Symptomatic treatment of agoraphobia and social phobias: a follow-up study. British Journal of Psychiatry, 127, 163—8.Google Scholar
West, E. D. & Dally, P. J. (1959) Effect of iproniazid in depressive syndromes. British Medical Journal, i, 1491—4.Google Scholar
Wyatt, R. J., Fram, D. H., Kupfer, D. J. & Snyder, F. (1971) Total prolonged drug-induced REM sleep suppression in anxious-depressed patients. Archives of General Psychiatry, 24, 145—55.CrossRefGoogle ScholarPubMed
Youdim, M. B., Collins, G. G. & Sandler, M. (1969) Multiple forms of rat brain monoamine oxidase. Nature (London), 223, 626—8.Google Scholar
Youdim, M. B., Collins, G. G. & Sandler, M. Bevan Jones, A. B., Pare, C. M. B. & Nicholson, W. J. (1972) Human brain monoamine oxidase: multiple forms and selective inhibitors. Nature (London), 236, 225—8.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.