Lotufo-Neto F, Trivedi M, Thase M E
Instituto de Psiquiatria da Faculdade de Medicina da Universidade de São Paulo, Brazil.
Neuropsychopharmacology. 1999 Mar;20(3):226-47. doi: 10.1016/S0893-133X(98)00075-X.
The reversible inhibitors of monoamine oxidase type A (RIMAs) are a newer group of antidepressants that have had much less impact on clinical psychopharmacology than another contemporary class of medications, the selective serotonin reuptake-inhibitors (SSRIs). The RIMAs agents are distinguished from the older monoamine oxidase inhibitors (MAOIs) by their selectivity and reversibility. As a result, dietary restrictions are not required during RIMA therapy, and hypertensive crises are quite rare. In this article, we describe a series of meta-analyses of studies of the two most widely researched RIMAs, moclobemide (MOC; Aurorex) and brofaromine (BRO). Our findings confirm that both BRO and MOC are as effective as the tricyclic antidepressants, and they are better tolerated. However, BRO is not being studied at present for reasons unrelated to efficacy or side effects. MOC, which is available throughout much of the world (but not the United States), is significantly more effective than placebo and, at the least, comparable to the SSRIs in both efficacy and tolerability. For MOC, higher dosages may enhance efficacy for more severe depressions. We also found evidence that supports clinical impressions that MOC is somewhat less effective, albeit better tolerated, than older MAOIs, such as phenelzine or tranylcypromine. Little evidence has yet emerged to suggest that the RIMAs share older MAOIs' utility for treatment of depressions characterized by prominent reverse neurovegetative features. Based on available evidence, the RIMAs appear to have a limited, but useful, role in the differential therapeutics of the depressive disorders.
A型单胺氧化酶可逆抑制剂（RIMAs）是一类新型抗抑郁药，与另一类当代药物——选择性5-羟色胺再摄取抑制剂（SSRIs）相比，它们对临床精神药理学的影响要小得多。RIMAs药物因其选择性和可逆性而有别于较老的单胺氧化酶抑制剂（MAOIs）。因此，在RIMA治疗期间无需进行饮食限制，高血压危象也相当罕见。在本文中，我们描述了对两种研究最广泛的RIMAs——吗氯贝胺（MOC；Aurorex）和溴法罗明（BRO）的一系列荟萃分析。我们的研究结果证实，BRO和MOC都与三环类抗抑郁药一样有效，而且耐受性更好。然而，目前未对BRO进行研究，原因与疗效或副作用无关。MOC在世界大部分地区（但在美国没有）都有供应，其疗效明显优于安慰剂，至少在疗效和耐受性方面与SSRIs相当。对于MOC，较高剂量可能会增强对更严重抑郁症的疗效。我们还发现有证据支持临床印象，即MOC的疗效略低于较老的MAOIs，如苯乙肼或反苯环丙胺，尽管耐受性更好。几乎没有证据表明RIMAs具有老一代MAOIs治疗以明显反向神经植物性特征为特点的抑郁症的效用。基于现有证据，RIMAs在抑郁症的鉴别治疗中似乎具有有限但有用的作用。
