HWN Suggests

Don’t cast aside an effective antidepressant just because it’s old

At the proverbial end of the road, where every other class of antidepressant and several other types of psychotropic medication had failed, she started me on tranylcypromine (Parnate). It belongs to the first family of antidepressants, called monoamine oxidase inhibitors (MAOIs), which were discovered in the late 1950s. Parnate was approved in the U.S. for treating depression in 1961. Though long acknowledged to be highly effective in the management of treatment-resistant depression, MAOIs have been linked to two potentially serious risks: serotonin syndrome and hypertensive crisis. Later generations of allegedly better antidepressants replaced MAOIs. They are now seen as “drugs of last resort,”…

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Articles of Interest

60 Years of Combining Tranylcypromine

Tranylcypromine is the only irreversible monoamine oxidase inhibitor that is approved in the United States and in Europe for the management of treatment-resistant major depressive disorder. Comprehensive data in the literature regarding the efficacy and tolerability of tranylcypromine (TCP) combination strategies have not been systematically investigated yet.

The Classic MAOIs: Our Capsule Summaries

Parnate (tranylcypromine). It comes in 10 mg pills, and is the most well-studied of the MAOIs. Dose it as high as 60 mg; clinicians comfortable with MAOIs sometimes go even higher... Parnate tends to cause less sedation, but more insomnia, than Nardil...

Tranylcypromine (Parnate)

Tranylcypromine and TCAs have an equal antidepressant effect in a mean sample of depressed patients with mixed psychomotor symptoms. Tranylcypromine might be superior to TCAs in depression with predominant psychomotor retardation.

“Much ado about nothing”: monoamine oxidase inhibitors, drug interactions, and dietary tyramine

What explains this discrepancy between the published literature and the view of experienced practitioners contrasted with the reality of the near-total lack of use of MAOIs? (Current usage is about 0.1% of all antidepressant scripts.Reference O’Brien 7 ) The purpose of this editorial is to address this discrepancy, to draw attention to recent data, to encourage doctors to consider these drugs earlier in the illness-course of patients, and most particularly to illuminate issues that are perceived as major hurdles. These hurdles cause doctors to shy away from using MAOIs, but they are largely illusory.

Resources

StatPearls

The main FDA-approved indication of tranylcypromine is for major depressive disorder without melancholia. The non-FDA-approved indications for this medication include treatment-resistant depression, treatment-resistant social anxiety disorder, treatment-resistant panic disorder, and atypical depression.