MAOIs in Melancholic Depression: New Review

Out on PubMed, from investigators in the Netherlands, Australia and Canada, is this review:

On the Origins of MAOI Misconceptions: Reaffirming their Role in Melancholic Depression.

Van den Eynde V, Parker G, Ruhé HG, Birkenhäger TK, Godet L, Shorter E, Gillman PK.Psychopharmacol Bull. 2023 Aug 11;53(3):35-54.PMID: 37601082 Review.




The abstract is copied below:

The first monoamine oxidase inhibitors (MAOIs) used for the treatment of depression in the 1950-60s were credited with treating severe melancholic depression (MeD) successfully and greatly reducing the need for electroconvulsive therapy (ECT). Following the hiatus caused by the then ill-understood cheese reaction, MAOI use was relegated to atypical and treatment-resistant depressions only, based on data from insufficiently probing research studies suggesting their comparatively lesser effectiveness in MeD. The siren attraction of new 'better' drugs with different mechanisms amplified this trend. Following a re-evaluation of the data, we suggest that MAOIs are effective in MeD. Additionally, the broad unitary conceptualisation of major depressive disorder (MDD) in the DSM model diminished the chance of demonstrating distinctive responses to different antidepressant drugs (ADs) such as SSRIs, TCAs, and MAOIs, thereby further reducing the interest in MAOIs. More reliable categorical distinction of MeD, disentangling it from MDD, may be possible if more sensitive measuring instruments (CORE, SMPI) are used. We suggest these issues will benefit from re-appraisement via an inductive reasoning process within a binary (rather than a unitary) model for defining the different depressive disorders, allowing for the use of more reliable diagnostic criteria for MeD in particular. We conclude that MAOIs remain essential for, inter alia, TCA-resistant MeD, and should typically be used prior to ECT; additionally, they have a role in maintaining remission in cases treated with ECT (and ketamine/esketamine). We suggest that MAOIs should be utilized earlier in treatment algorithms and with greater regularity than is presently the case.

Keywords: MAOI; depression; melancholia; melancholic; monoamine.

For ECT practitioners of a certain age, myself included, MAOIs have always been a highly respected class of antidepressant. This reappraisal is welcome and probably well presented.
(Psychopharmacology Bulletin makes it difficult to get the full text, so if any blog reader has access, and wants to post it, that would be welcome, thanks.)

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