Menkes David, Bosanac Peter, Castle David
Associate Professor, Psychiatry, Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
Clinical Director, Mental Health and Aged Care Services, St Vincent's Hospital, Melbourne, VIC, and; Associate Professor, Department Psychiatry, University of Melbourne, VIC, Australia.
Australas Psychiatry. 2016 Aug;24(4):371-3. doi: 10.1177/1039856216634824. Epub 2016 Feb 25.
The place of monoamine oxidase inhibitors (MAOIs) in psychiatry is reviewed, and the question posed as to whether they are now justifiably disregarded by prescribers.
Multiple databases (PubMed, Medline, Embase, Cochrane) were interrogated to provide an overview regarding the use, efficacy and toxicity of MAOIs. Data regarding funded use of these agents in New Zealand were obtained from PHARMAC.
Evidence supports the use of MAOIs in major depressive disorder, certain anxiety disorders and, to lesser extent, bipolar depression. Older non-selective agents, such as phenelzine and tranylcypromine, have distinctive efficacy in 'atypical' and treatment-resistant depression, but at the cost of serious tolerability problems. Their relegation and perception by clinicians as 'last resort' medications - if considered at all - has occurred in the context of various concerns, notably dietary restrictions, potential adverse drug interactions and the usual requirement for divided doses.
Sufficient evidence supports consideration of MAOIs in treatment-refractory and atypical depressive disorders, and in social anxiety disorder. Psychiatrists in training need to gain experience in using these agents.
回顾单胺氧化酶抑制剂（MAOIs）在精神病学中的地位，并探讨目前开处方者是否有理由忽视它们。
检索多个数据库（PubMed、Medline、Embase、Cochrane）以提供有关MAOIs使用、疗效和毒性的概述。从新西兰药物评估管理局（PHARMAC）获取有关这些药物在新西兰资助使用的数据。
有证据支持MAOIs用于重度抑郁症、某些焦虑症，在较小程度上也可用于双相抑郁症。较老的非选择性药物，如苯乙肼和反苯环丙胺，在“非典型”和难治性抑郁症中有独特疗效，但存在严重的耐受性问题。临床医生将它们视为“最后手段”药物（如果考虑使用的话），这是在各种担忧的背景下发生的，特别是饮食限制、潜在的药物不良相互作用以及通常需要分剂量服用。
有充分证据支持在难治性和非典型抑郁症以及社交焦虑症中考虑使用MAOIs。接受培训的精神科医生需要积累使用这些药物的经验。
