Rudorfer M V
Clinical Treatment Research Branch, National Institute of Mental Health, Rockville, MD 20857.
Psychopharmacol Bull. 1992;28(1):45-57.
Coincident with and in part fueling advances in diagnostic nosology and drug development, the recent resurgence of interest in monoamine oxidase inhibitors (MAOIs) is reviewed. Accidentally discovered nearly 40 years ago as the first true antidepressants, the MAOIs soon fell into disfavor due to concerns about toxicity and seemingly lesser efficacy compared with the newer tricyclic compounds. Now that we have better understanding of the nature of the hypertensive and hyperpyrexic interactions of MAOIs with other substances, these medications have assumed a role in the treatment of nonendogenous depressive and anxiety syndromes, especially in operationally defined "atypical depression." The discovery of two MAO isoenzymes has resulted in a new generation of selective inhibitors in the search for enhanced efficacy (i.e., clorgyline) or safety (i.e., l-deprenyl). Most promising is the emerging class of reversible selective MAO-type A inhibitors, such as moclobemide, which combine antidepressant potency with freedom from the risk of dangerous tyramine-type adverse interactions.
本文回顾了近期对单胺氧化酶抑制剂（MAOIs）兴趣的再度兴起，这与诊断分类学和药物开发的进展同时出现，并在一定程度上推动了这些进展。MAOIs在近40年前作为首批真正的抗抑郁药被偶然发现，但由于对其毒性的担忧以及与新型三环化合物相比疗效似乎较差，很快就不受欢迎了。现在我们对MAOIs与其他物质的高血压和高热相互作用的性质有了更好的理解，这些药物在治疗非内源性抑郁和焦虑综合征中发挥了作用，特别是在操作性定义的“非典型抑郁症”中。两种MAO同工酶的发现导致了新一代选择性抑制剂的出现，旨在提高疗效（如氯吉兰）或安全性（如左旋异烟肼）。最有前景的是新兴的可逆性选择性MAO-A型抑制剂类，如吗氯贝胺，它兼具抗抑郁效力且无危险的酪胺型不良相互作用风险。
