Professor, Department of Psychiatry, Faculty of Medicine, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada,
CNS Drugs. 2013 Oct;27(10):789-97. doi: 10.1007/s40263-013-0097-3.
This paper reviews the discovery and history of the use of irreversible monoamine oxidase (MAO) inhibitors (MAOIs) such as phenelzine, tranylcypromine and isocarboxazid, as well as the second generation selective and reversible MAOIs such as the MAO-A inhibitor, moclobemide and the MAO-B inhibitor, selegiline. Data for review were identified from a literature search of OvidSP Medline and PsycInfo performed in July 2012, using the subject terms and keywords of 'monoamine oxidase inhibitors', 'major depression', 'depressive disorder' and 'depression (emotion)'. The search was limited to papers published in the English language and from 2007 onward only. Irreversible MAOIs have the potential to treat the most challenging mood disorder patients including those with treatment-resistant depression, atypical depression and bipolar depression. Unfortunately, the use of irreversible MAOIs has been declining sharply due to lack of marketing and the excessive fears of clinicians. Moreover, few clinicians now have any experience, let alone comfort, in prescribing this class of antidepressants. The newer MAOIs are available as another option for the treatment of major depression but have not replaced the irreversible MAOIs for the specific sub-types of depression for which they are now recommended in most consensus guidelines and treatment algorithms. The pharmacology, drug interactions and dietary recommendations associated with the use of MAOIs are reviewed. With the appropriate dietary restrictions and attention to potential drug interactions with serotonin and noradrenaline agents this class of drugs can be used effectively and safely. The MAOIs still represent an important element in our therapeutic armamentarium. Despite recommendations by opinion leaders and consensus guidelines for the use of MAOIs in specific sub-types of depression, the prescription rate of MAOIs is far less than expected and is decreasing. The "bad reputation" and the lack of industry support for this class of agents (especially the irreversible MAOIs) must be overcome in order to continue to provide a potentially useful treatment for a very vulnerable yet substantial sub-population of mood disorder patients.
这篇论文回顾了不可逆单胺氧化酶（MAO）抑制剂（MAOIs）如苯乙肼、反苯环丙胺和异卡波肼的发现和应用历史，以及第二代选择性和可逆 MAOIs 如 MAO-A 抑制剂吗氯贝胺和 MAO-B 抑制剂司来吉兰。综述数据来源于 2012 年 7 月在 OvidSP Medline 和 PsycInfo 上进行的文献检索，使用的主题词和关键词有“单胺氧化酶抑制剂”、“重度抑郁症”、“抑郁障碍”和“抑郁（情绪）”。检索仅限于发表在英语文献中、且发表时间在 2007 年以后的文章。不可逆 MAOIs 有可能治疗最具挑战性的心境障碍患者，包括那些对治疗有抵抗的、非典型的、双相的抑郁症患者。不幸的是，由于缺乏市场推广和临床医生的过分担心，不可逆 MAOIs 的使用已大幅下降。此外，现在很少有临床医生在开这类抗抑郁药时既有经验又有把握。新一代 MAOIs 是治疗重度抑郁症的另一种选择，但尚未取代不可逆 MAOIs，因为它们现在被大多数共识指南和治疗算法推荐用于特定的抑郁症亚型。本文还回顾了 MAOIs 的药理学、药物相互作用和饮食建议。只要遵循 MAOIs 使用的饮食限制和注意与 5-羟色胺和去甲肾上腺素药物的潜在药物相互作用，这类药物就可以安全有效地使用。MAOIs 仍然是我们治疗手段的重要组成部分。尽管意见领袖和共识指南建议在特定的抑郁症亚型中使用 MAOIs，但 MAOIs 的处方率远低于预期且呈下降趋势。为了继续为情绪障碍患者的一个非常脆弱但又非常重要的亚群提供潜在有用的治疗方法，必须克服这类药物的“坏名声”和缺乏行业支持。
