Dependence on Monoamine Oxidase Inhibitors in High Dose

Vartzopoulos, Dimitrios; Krull, F.

doi:10.1192/bjp.158.6.856

Cited by 24 publications

(7 citation statements)

References 5 publications

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“…Whilst it is recognised by clinical practitioners as a treatment for minor depressive conditions, the persistence of its therapeutic efficacy has not been evaluated. There is, however, a single case report suggesting the development of tolerance to tranylcypromine at a high dose (22). The significance of this case brings to light the importance of recognising the amphetamine-like effect of tranylcypromine in such doses, since tolerance to this stimulation is known to develop.…”

Section: Studies With Ma0 Inhibitorsmentioning

confidence: 81%

Pharmacological therapy of dysthymia

Lapierre

1994

Acta Psychiatr Scand

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Pharmacological therapy of dysthymia. Acta Psychiatr Scand 1994: 89 (suppl. 383): 42-48. ':(> Munksgaard 1994.For a number of years, dysthymia was considered to be non-responsive to antidepressant treatment. During the last decade, early studies with tricyclic antidepressants (TCAs) demonstrated the superiority of the TCAs over placebo. The side effect profile of the TCAs and the moderate degree of symptomatology resulted in reduced compliance and thus to the clinical impression of lack of efficacy. The newest generation of antidepressants, the SRRIs and the RIMAs. with their more acceptable side effect profiles, allowed for the adequate evaluation of pharmacotherapy in dysthymia. The initial open studies with SSRIs indicate a clear efficacy of this group of antidepressants. Likewise, a 5HT2 antagonist, ritanserin, has been shown to be superior to placebo. More recently, a large placebo-controlled study of moclobemide. a RIMA, clearly demonstrated the superiority of this drug over placebo. Based on this evidence, it is now appropriate to consider antidepressants as a clearly effective method of treating dysthymia.

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Section: Studies With Ma0 Inhibitorsmentioning

confidence: 81%

Pharmacological therapy of dysthymia

Lapierre

1994

Acta Psychiatr Scand

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“…The combination of a past history of substance abuse and a diagnosis of either borderline or histrionic personality disorder seems to render patients at higher risk of developing MAOI dependence [11][12][13][14][15][16][17], perhaps because these medications are either structurally similar to amphetamines [6,17] or are, like selegiline, metabolized into excitatory compounds [18].…”

Section: Discussionmentioning

confidence: 99%

Delirium, thrombocytopenia, insomnia, and mild liver damage associated with MAOI withdrawal

Bellon

Coverdale²

2009

Eur J Clin Pharmacol

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“…However, occasional reports of tranylcypromine abuse (Brady et al 1991) and dependence (Briggs et al 1990;Vartzopoulos & Krull 1991) continue to suggest stimulant-like properties of the drug, particularly at high doses. This might also relate to the only recently appreciated danger of hypertensive crises from a rapid switch from a hydrazine member (phenelzine or isocarboxazid) to tranylcypromine (Chandler 1987;Gelenberg 1987).…”

Section: Classical Mao Inhibitorsmentioning

confidence: 94%

Comparative Tolerability Profiles of the Newer versus Older Antidepressants

1994

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Although the standard tricyclic antidepressants (TCAs) are generally effective in the treatment of depression, they can cause several troublesome adverse effects. Chief among these are their anticholinergic actions, which range from annoying dryness of the mouth and constipation to potentially dangerous urinary retention and confusion or delirium in the ill and elderly. Cardiovascular effects of TCAs include orthostatic hypotension, tachycardia and cardiac conduction slowing. Many TCAs are sedating and promote weight gain. Also problematic is the potential lethality of TCAs in overdose. The continual introduction of a host of new antidepressants over the past 15 years has provided an opportunity to improve the benefit-risk ratio for many patients by reducing medication-related toxicity. Selective serotonin reuptake inhibitors (SSRIs) and amfebutamone (bupropion), among others, are examples of effective antidepressants free of tricyclic-like anticholinergic, cardiovascular, sedating and appetite/weight-increasing effects. However, the new-generation drugs also present adverse effects of their own, including gastrointestinal distress, agitation and drug-drug interactions in the case of the SSRIs, and the risk of seizures or psychosis in amfebutamone recipients. Monoamine oxidase (MAO) inhibitors have also been refined; reversible inhibitors of MAO-type A afford protection against the usually feared hypertensive reaction to indirect sympathomimetic substances. The availability of new-generation antidepressants thus increases the likelihood of clinical response with a reduction in unwanted toxicity.

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Dependence on Monoamine Oxidase Inhibitors in High Dose

Cited by 24 publications

References 5 publications

Pharmacological therapy of dysthymia

Pharmacological therapy of dysthymia

Delirium, thrombocytopenia, insomnia, and mild liver damage associated with MAOI withdrawal

Comparative Tolerability Profiles of the Newer versus Older Antidepressants

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