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Monoamine oxidase inhibitors (MAO Inhibitors) are medications used to manage and treat depression, among other neurological and psychiatric illnesses. It is in the Antidepressants class of drugs. This activity reviews the indications, action, and contraindications of the commonly prescribed MAO Inhibitors as a valuable agent in managing depression and other neuropsychiatric disorders. This activity will highlight the mechanism of action, adverse event profile, and other key factors such as off-label use, administration, and relevant molecular interactions pertinent for the interprofessional team members involved in the care of patients with depression and related conditions. Objectives: Review the mechanism of action of MAOIs. Identify the indications for prescribing MAOIs in clinical practice. Summarize the contraindications and potential side effects associated with MAOIs. Outline the importance of effective communication amongst the healthcare team members in delivering quality, complication-free management to the patients under their care. Access free multiple choice questions on this topic.

There is no specific antidote for MAOI toxicity, and dialysis is unhelpful in removing the drug. An overdose of MAOIs, or use in combination with other serotonergic agents, may lead to serotonin toxicity. Likewise, the use of MAOIs with sympathomimetic agents may lead to the development of a hypertensive crisis. When managing serotonin syndrome, early transfer to a medical ICU and consultation with a toxicologist is strongly advised. Diagnosis of serotonin toxicity is possible using the “Hunter criteria” or the “Sternbach criteria” based on physical manifestations.[22] The mainstay of management is the discontinuation of the serotonergic agent and supportive care, where most patients improve within 24 hours.[31] In cases of hypertensive crisis, immediate admission to the ICU for prompt blood pressure control with a parenteral, titratable antihypertensive agent while the patient remains on a vitals monitor is necessary. Urine output measurements and a neurologic examination should also take place. BP correction should be slowly achieved over several minutes to an hour, and not immediately. The goal is to lower the BP to no less than 20% to 25% during the first hour.[32]

Patients requiring MAOI administration often are refractory to other medications and require an interprofessional team of healthcare professionals, including a nurse, laboratory technologists, pharmacists, and several physicians in different specialties. Without proper monitoring, there is a risk of developing potentially fatal adverse effects such as serotonin syndrome or a hypertensive crisis. An MAOI prescription will require the patient to follow up with a dietitian to ensure a safe diet that does not trigger a food-drug interaction with the medication. Moreover, patients who have Parkinson disease may be put on an MAOI as part of early management by a neurologist. PD patients often develop depressive episodes as the disease progresses and may benefit from follow-up with a psychiatrist. Only by working as an interprofessional team can we reduce the likelihood of and monitor potential side effects of MAOIs. Data available from published literature shows that the use of rasagiline improves motor fluctuations and PD symptoms in early course Parkinson’s disease patients on levodopa.[12] [Level 1] Furthermore, research also shows that treatment with the MAOI phenelzine is more effective in alleviating symptoms in chronically ill patients of major depressive disorder in contrast to treatment with the TCA imipramine.[6] [Level 2]