Combined use of tricyclic antidepressants and monoamine oxidase inhibitors.

Combined treatment with tricyclic antidepressants and MAO inhibitors has been an area of some controversy. The efficacy of the combination approach is not established; the only controlled trail showed trimipramine alone to be superior to an MAOI alone and to the combination of trimipramine with an MAOI in treating depressed outpatients not selected for a history of treatment refractoriness. The safety of the combination varies according to the specific drugs used; tranylcypromine and clomipramine are not recommended, and recent pharmacologic studies suggest that specific serotonin reuptake inhibitors are dangerous in combination with MAOIs. Further controlled clinical studies are clearly needed before combined therapy can be recommended for routine clinical use.