|Monoamine oxidase inhibitor|
|Use||Treatment of major depressive disorder, atypical depression, Parkinson's disease, and several other disorders|
|Mechanism of action||Enzyme inhibitor|
|Biological target||Monoamine oxidase enzymes:|
MAO-A and/or MAO-B
Monoamine oxidase inhibitors (MAOIs) are a class of drugs that inhibit the activity of one or both monoamine oxidase enzymes: monoamine oxidase A (MAO-A) and monoamine oxidase B (MAO-B). They are best known as highly efficacious anti-depressants, as well as effective therapeutic agents for panic disorder and social phobia. They are particularly effective in treatment-resistant depression and atypical depression. They are also used in the treatment of Parkinson's disease and several other disorders.
Reversible inhibitors of monoamine oxidase A (RIMAs) are a subclass of MAOIs that selectively and reversibly inhibit the MAO-A enzyme. RIMAs are used clinically in the treatment of depression and dysthymia. Due to their reversibility, they are safer in single-drug overdose than the older, irreversible MAOIs, and weaker in increasing the monoamines important in depressive disorder. RIMAs have not gained widespread market share in the United States.
New research into MAOIs indicates that much of the concern over their supposed dangerous dietary side effects stems from misconceptions and misinformation, and that they are still underutilized despite demonstrated efficacy. New research also questions the validity of the perceived severity of dietary reactions, which has been based on outdated research. Despite this, many psychiatrists, who have little or no knowledge of and experience with monoamine oxidase inhibitors (and are thus unaware of their significant benefits), still reserve them as a last line of treatment, used only when other classes of antidepressant drugs (for example selective serotonin reuptake inhibitors and tricyclic antidepressants) have failed.
MAOIs have been found to be effective in the treatment of panic disorder with agoraphobia, social phobia, atypical depression or mixed anxiety disorder and depression, bulimia, and post-traumatic stress disorder, as well as borderline personality disorder, and Obsessive Compulsive Disorder (OCD). MAOIs appear to be particularly effective in the management of bipolar depression according to a recent retrospective-analysis. There are reports of MAOI efficacy in obsessive-compulsive disorder (OCD), trichotillomania, dysmorphophobia, and avoidant personality disorder, but these reports are from uncontrolled case reports.
MAOIs can also be used in the treatment of Parkinson's disease by targeting MAO-B in particular (therefore affecting dopaminergic neurons), as well as providing an alternative for migraine prophylaxis. Inhibition of both MAO-A and MAO-B is used in the treatment of clinical depression and anxiety.
Newer MAOIs such as selegiline (typically used in the treatment of Parkinson's disease) and the reversible MAOI moclobemide provide a safer alternative and are now sometimes used as first-line therapy.
People taking MAOIs generally need to change their diets to limit or avoid foods and beverages containing tyramine, which is found in products such as cheese, soy sauce, and salami. If large amounts of tyramine are consumed, they may suffer hypertensive crisis, which can be fatal. Examples of foods and beverages with potentially high levels of tyramine include animal liver and fermented substances, such as alcoholic beverages and aged cheeses. Excessive concentrations of tyramine in blood plasma can lead to hypertensive crisis by increasing the release of norepinephrine (NE), which causes blood vessels to constrict by activating alpha-1 adrenergic receptors. Ordinarily, MAO-A would destroy the excess NE; when MAO-A is inhibited, however, NE levels get too high, leading to dangerous increases in blood pressure.
RIMAs are displaced from MAO-A in the presence of tyramine, rather than inhibiting its breakdown in the liver as general MAOIs do. Additionally, MAO-B remains free and continues to metabolize tyramine in the stomach, although this is less significant than the liver action. Thus, RIMAs are unlikely to elicit tyramine-mediated hypertensive crisis; moreover, dietary modifications are not usually necessary when taking a reversible inhibitor of MAO-A (i.e., moclobemide) or low doses of selective MAO-B inhibitors (e.g., selegiline 6 mg/24 hours transdermal patch).
The most significant risk associated with the use of MAOIs is the potential for drug interactions with over-the-counter and prescription medicines, ‘controlled’ drugs or medications, and some dietary supplements (e.g., St. John's wort, tryptophan). It is vital that a doctor supervise such combinations to avoid adverse reactions. For this reason, many users carry an MAOI-card, which lets emergency medical personnel know what drugs to avoid (e.g. adrenaline (epinephrine) dosage should be reduced by 75%, and duration is extended.)
MAOIs should not be combined with other psychoactive substances (antidepressants, painkillers, stimulants, including prescribed, OTC and ‘controlled drugs’, etc.) except under expert care. Certain combinations can cause lethal reactions, common examples including SSRIs, tricyclics, MDMA, meperidine, tramadol, and dextromethorphan. Drugs that affect the release or reuptake of epinephrine, norepinephrine, or dopamine typically need to be administered at lower doses due to the resulting potentiated and prolonged effect. MAOIs also interact with tobacco-containing products (e.g. cigarettes) and may potentiate the effects of certain compounds in tobacco. This may be reflected in the difficulty of smoking cessation, as tobacco contains naturally occurring MAOI compounds in addition to the nicotine.
While safer than general MAOIs, RIMAs still possess significant and potentially serious drug interactions with many common drugs; in particular, they can cause serotonin syndrome or hypertensive crisis when combined with almost any antidepressant or stimulant, common migraine medications, certain herbs, or most cold medicines (including decongestants, antihistamines, and cough syrup).
Ocular alpha-2 agonists such as brimonidine and apraclonidine are glaucoma medications which reduce intraocular pressure by decreasing aqueous production. These alpha-2 agonists should not be given with oral MAOIs due to the risk of hypertensive crisis.
Antidepressants including MAOIs have some dependence-producing effects, the most notable one being a discontinuation syndrome, which may be severe especially if MAOIs are discontinued abruptly or too rapidly. The dependence-producing potential of MAOIs or antidepressants in general is not as significant as benzodiazepines, however. Discontinuation symptoms can be managed by a gradual reduction in dosage over a period of weeks, months or years to minimize or prevent withdrawal symptoms.
MAOIs, as with most antidepressant medication, may not alter the course of the disorder in a significant, permanent way, so it is possible that discontinuation can return the patient to the pre-treatment state. This consideration complicates prescribing between a MAOI and a SSRI, because it is necessary to clear the system completely of one drug before starting another. One physician organization recommendeds the dose to be tapered down over a minimum of four weeks, followed by a two week washout period. The result is that a depressed patient will have to bear the depression without chemical help during the drug-free interval. This may be preferable to risking the effects of an interaction between the two drugs.
The MAOIs are infamous for their numerous drug interactions, including the following kinds of substances:
- Substances that are metabolized by monoamine oxidase, as they can be boosted by up to several-fold.
- Substances that increase serotonin, norepinephrine, or dopamine activity, as too much of any of these neurochemicals can result in severe acute consequences, including serotonin syndrome, hypertensive crisis, and psychosis, respectively.
Such substances that can react with MAOIs include:
- Phenethylamines: 2C-B, mescaline, phenethylamine (PEA), etc.
- Tryptamines: DMT (MAOIs prevent oxidization of DMT in the digestive tract, which renders it biologically inert. This allows it to be absorbed in the stomach and small intestine, allowing one to experience the effects of DMT by taking it orally i.e. by Ayahuasca)
- Norepinephrine, and/or dopamine reuptake inhibitors:
- Serotonin-norepinephrine reuptake inhibitors (SNRIs): desvenlafaxine, duloxetine, milnacipran, venlafaxine.
- Norepinephrine-dopamine reuptake inhibitors (NDRIs): amineptine, bupropion, methylphenidate, nomifensine.
- Norepinephrine reuptake inhibitors (NRIs): atomoxetine, mazindol, reboxetine.
- Tricyclic antidepressants (TCAs): amitriptyline, butriptyline, clomipramine, desipramine, dosulepin, doxepin, imipramine, lofepramine, nortriptyline, protriptyline, trimipramine.
- Tetracyclic antidepressants (TeCAs): amoxapine, maprotiline.
- Phenylpiperidine derivative opioids: meperidine/pethidine, tramadol, methadone, fentanyl, dextropropoxyphene, propoxyphene.
- Others: brompheniramine, chlorpheniramine, cocaine, cyclobenzaprine, dextromethorphan (DXM), ketamine, MDPV, nefazodone, phencyclidine (PCP), pheniramine, sibutramine, trazodone
- Serotonin, norepinephrine, and/or dopamine releasers: 4-methylaminorex (4-MAR), amphetamine, benzphetamine, cathine, cathinone, diethylcathinone, ephedrine, levmetamfetamine, lisdexamfetamine, MDMA ("Ecstasy"), methamphetamine, pemoline, phendimetrazine, phenethylamine (PEA), phentermine, propylhexedrine, pseudoephedrine, phenylephrine, tyramine.
- Local and general anesthetic in surgery and dentistry, in particular those containing epinephrine. There is no universally taught or accepted practice regarding dentistry and use of MAOIs such as phenelzine, and therefore it is vital to inform all clinicians, especially dentists, of the potential effect of MAOIs and local anesthesia. In preparation for dental work, withdrawal from phenelzine is specifically advised; since this takes two weeks, however, it is not always a desirable or practical option. Dentists using local anesthesia are advised to use a non-epinephrine anesthetic such as mepivacaine at a level of 3%. Specific attention should be paid to blood pressure during the procedure, and the level of the anesthetic should be regularly and appropriately topped-up, for non-epinephrine anesthetics take longer to come into effect and wear off faster. Patients taking phenelzine are advised to notify their psychiatrist prior to any dental treatment.
- Certain other supplements may exhibit below-therapeutic-level MAOI activity: Hypericum perforatum ("St John's wort"), inositol, Rhodiola rosea, S-adenosyl-L-methionine (SAMe).
- Antibiotics such as linezolid
- Other monoamine oxidase inhibitors.
Mechanism of action
MAOIs act by inhibiting the activity of monoamine oxidase, thus preventing the breakdown of monoamine neurotransmitters and thereby increasing their availability. There are two isoforms of monoamine oxidase, MAO-A and MAO-B. MAO-A preferentially deaminates serotonin, melatonin, epinephrine, and norepinephrine. MAO-B preferentially deaminates phenethylamine and certain other trace amines; in contrast, MAO-A preferentially deaminates other trace amines, like tyramine, whereas dopamine is equally deaminated by both types.
The early MAOIs covalently bound to the monoamine oxidase enzymes, thus inhibiting them irreversibly; the bound enzyme could not function and thus enzyme activity was blocked until the cell made new enzymes. The enzymes turn over approximately every two weeks. A few newer MAOIs, a notable one being moclobemide, are reversible, meaning that they are able to detach from the enzyme to facilitate usual catabolism of the substrate. The level of inhibition in this way is governed by the concentrations of the substrate and the MAOI.
In addition to reversibility, MAOIs differ by their selectivity of the MAO enzyme subtype. Some MAOIs inhibit both MAO-A and MAO-B equally, other MAOIs have been developed to target one over the other.
MAO-A inhibition reduces the breakdown of primarily serotonin, norepinephrine, and dopamine; selective inhibition of MAO-A allows for tyramine to be metabolised via MAO-B. Agents that act on serotonin if taken with another serotonin-enhancing agent may result in a potentially fatal interaction called serotonin syndrome or with irreversible and unselective inhibitors (such as older MAOIs), of MAO a hypertensive crisis as a result of tyramine food interactions is particularly problematic with older MAOIs. Tyramine is broken down by MAO-A and MAO-B, therefore inhibiting this action may result in its excessive build-up, so diet must be monitored for tyramine intake.
MAO-B inhibition reduces the breakdown mainly of dopamine and phenethylamine so there are no dietary restrictions associated with this. MAO-B would also metabolize tyramine, as the only differences between dopamine, phenethylamine, and tyramine are two phenylhydroxyl groups on carbons 3 and 4. The 4-OH would not be a steric hindrance to MAO-B on tyramine. Selegiline is selective for MAO-B at low doses, but non-selective at higher doses.
MAOIs started off due to the serendipitous discovery that iproniazid was a potent MAO inhibitor (MAOI). Originally intended for the treatment of tuberculosis, in 1952, iproniazid's antidepressant properties were discovered when researchers noted that the depressed patients given iproniazid experienced a relief of their depression. Subsequent in vitro work led to the discovery that it inhibited MAO and eventually to the monoamine theory of depression. MAOIs became widely used as antidepressants in the early 1950s. The discovery of the 2 isoenzymes of MAO has led to the development of selective MAOIs that may have a more favorable side-effect profile.
The older MAOIs' heyday was mostly between the years 1957 and 1970. The initial popularity of the 'classic' non-selective irreversible MAO inhibitors began to wane due to their serious interactions with sympathomimetic drugs and tyramine-containing foods that could lead to dangerous hypertensive emergencies. As a result, the use by medical practitioners of these older MAOIs declined. When scientists discovered that there are two different MAO enzymes (MAO-A and MAO-B), they developed selective compounds for MAO-B, (for example, selegiline, which is used for Parkinson's disease), to reduce the side-effects and serious interactions. Further improvement occurred with the development of compounds (moclobemide and toloxatone) that not only are selective but cause reversible MAO-A inhibition and a reduction in dietary and drug interactions. Moclobemide, was the first reversible inhibitor of MAO-A to enter widespread clinical practice.
List of MAO inhibiting drugs
- Nonselective MAO-A/MAO-B inhibitors
- Selective MAO-A inhibitors
- Selective MAO-B inhibitors
MAOIs that have been withdrawn from the market
- Nonselective MAO-A/MAO-B inhibitors
- Benmoxin (Nerusil, Neuralex)
- Iproclozide (Sursum)
- Iproniazid (Marsilid, Iprozid, Ipronid, Rivivol, Propilniazida) (discontinued worldwide except for France)
- Mebanazine (Actomol)
- Nialamide (Niamid)
- Octamoxin (Ximaol, Nimaol)
- Phenelzine (Nardil, Nardelzine)
- Pheniprazine (Catron)
- Phenoxypropazine (Drazine)
- Pivalylbenzhydrazine (Tersavid)
- Safrazine (Safra) (discontinued worldwide except for Japan)
- Caroxazone (Surodil, Timostenil)
- Selective MAO-A inhibitors
- Minaprine (Cantor)
List of RIMAs
Naturally occurring RIMAs in plants
- Curcumin (selectivity for MAO-A and reliability of research on curcumin are disputed)
- Cristancho, Mario. "Atypical Depression in the 21st Century: Diagnostic and Treatment Issues". Psychiatric Times. Archived from the original on 2 December 2013. Retrieved 23 November 2013.
- Isbister GK, et al. (2003). "Moclobemide poisoning: toxicokinetics and occurrence of serotonin toxicity". British Journal of Clinical Pharmacology. 56 (4): 441–450. doi:10.1046/j.1365-2125.2003.01895.x. PMC 1884375. PMID 12968990.
- "Neuroscience Education Institute > Activities > 2012CurbConsultPosted". www.neiglobal.com.
- Grady MM, Stahl SM (March 2012). "Practical guide for prescribing MAOIs: debunking myths and removing barriers". CNS Spectrums. 17 (1): 2–10. doi:10.1017/S109285291200003X. PMID 22790112. Archived from the original on 7 July 2017.
- Stahl, Stephen M.; Felker, Angela (October 2008). "Monoamine oxidase inhibitors: a modern guide to an unrequited class of antidepressants". CNS Spectrums. 13 (10): 855–870. doi:10.1017/s1092852900016965. ISSN 1092-8529. PMID 18955941. S2CID 6118722.
- Ricken, Roland; Ulrich, Sven; Schlattmann, Peter; Adli, Mazda (1 August 2017). "Tranylcypromine in mind (Part II): Review of clinical pharmacology and meta-analysis of controlled studies in depression". European Neuropsychopharmacology. 27 (8): 714–731. doi:10.1016/j.euroneuro.2017.04.003. ISSN 0924-977X. PMID 28579071.
On the other hand, the effort needed to maintain a tyramine-restricted diet may have been overestimated in the perception of both doctors and patients, which may have led to relative underuse of TCP.
- McCabe-Sellers BJ, Staggs CG, Bogle ML (2006). "Tyramine in foods and monoamine oxidase inhibitor drugs: A crossroad where medicine, nutrition, pharmacy, and food industry converge". Journal of Food Composition and Analysis. 19: S58–S65. doi:10.1016/j.jfca.2005.12.008. Archived from the original on 8 April 2013.
- Stahl, Stephen M.; Felker, Angela (7 November 2014). "Monoamine Oxidase Inhibitors: A Modern Guide to an Unrequited Class of Antidepressants". CNS Spectrums. 13 (10): 855–871. doi:10.1017/s1092852900016965. PMID 18955941.
- "Depression (major depressive disorder) – Symptoms and causes". mayoclinic.com. Archived from the original on 29 October 2013. Retrieved 1 May 2018.
- Buigues J, Vallejo J (February 1987). "Therapeutic response to phenelzine in patients with panic disorder and agoraphobia with panic attacks". The Journal of Clinical Psychiatry. 48 (2): 55–9. PMID 3542985.
- Liebowitz MR, Schneier F, Campeas R, Hollander E, Hatterer J, Fyer A, Gorman J, Papp L, Davies S, Gully R (April 1992). "Phenelzine vs atenolol in social phobia. A placebo-controlled comparison". Archives of General Psychiatry. 49 (4): 290–300. doi:10.1001/archpsyc.49.4.290. PMID 1558463.
- Versiani M, Nardi AE, Mundim FD, Alves AB, Liebowitz MR, Amrein R (September 1992). "Pharmacotherapy of social phobia. A controlled study with moclobemide and phenelzine". The British Journal of Psychiatry. 161 (3): 353–60. doi:10.1192/bjp.161.3.353. PMID 1393304.
- Heimberg RG, Liebowitz MR, Hope DA, Schneier FR, Holt CS, Welkowitz LA, Juster HR, Campeas R, Bruch MA, Cloitre M, Fallon B, Klein DF (December 1998). "Cognitive behavioral group therapy vs phenelzine therapy for social phobia: 12-week outcome". Archives of General Psychiatry. 55 (12): 1133–41. CiteSeerX 10.1.1.485.5909. doi:10.1001/archpsyc.55.12.1133. PMID 9862558.
- Jarrett RB, Schaffer M, McIntire D, Witt-Browder A, Kraft D, Risser RC (May 1999). "Treatment of atypical depression with cognitive therapy or phenelzine: a double-blind, placebo-controlled trial". Archives of General Psychiatry. 56 (5): 431–7. doi:10.1001/archpsyc.56.5.431. PMC 1475805. PMID 10232298.
- Liebowitz MR, Quitkin FM, Stewart JW, McGrath PJ, Harrison W, Rabkin J, Tricamo E, Markowitz JS, Klein DF (July 1984). "Phenelzine v imipramine in atypical depression. A preliminary report". Archives of General Psychiatry. 41 (7): 669–77. doi:10.1001/archpsyc.1984.01790180039005. PMID 6375621.
- Walsh BT, Stewart JW, Roose SP, Gladis M, Glassman AH (November 1984). "Treatment of bulimia with phenelzine. A double-blind, placebo-controlled study". Archives of General Psychiatry. 41 (11): 1105–9. doi:10.1001/archpsyc.1983.01790220095015. PMID 6388524.
- Rothschild R, Quitkin HM, Quitkin FM, Stewart JW, Ocepek-Welikson K, McGrath PJ, Tricamo E (January 1994). "A double-blind placebo-controlled comparison of phenelzine and imipramine in the treatment of bulimia in atypical depressives". The International Journal of Eating Disorders. 15 (1): 1–9. doi:10.1002/1098-108X(199401)15:1<1::AID-EAT2260150102>3.0.CO;2-E. PMID 8124322.
- Walsh BT, Stewart JW, Roose SP, Gladis M, Glassman AH (1985). "A double-blind trial of phenelzine in bulimia". Journal of Psychiatric Research. 19 (2–3): 485–9. doi:10.1016/0022-3956(85)90058-5. PMID 3900362.
- Walsh BT, Gladis M, Roose SP, Stewart JW, Stetner F, Glassman AH (May 1988). "Phenelzine vs placebo in 50 patients with bulimia". Archives of General Psychiatry. 45 (5): 471–5. doi:10.1001/archpsyc.1988.01800290091011. PMID 3282482.
- Davidson J, Walker JI, Kilts C (February 1987). "A pilot study of phenelzine in the treatment of post-traumatic stress disorder". The British Journal of Psychiatry. 150 (2): 252–5. doi:10.1192/bjp.150.2.252. PMID 3651684.
- Soloff PH, Cornelius J, George A, Nathan S, Perel JM, Ulrich RF (May 1993). "Efficacy of phenelzine and haloperidol in borderline personality disorder". Archives of General Psychiatry. 50 (5): 377–85. doi:10.1001/archpsyc.1993.01820170055007. PMID 8489326.
- Vallejo, J.; Olivares, J.; Marcos, T.; Bulbena, A.; Menchón, J. M. (2 January 2018). "Clomipramine versus Phenelzine in Obsessive–Compulsive Disorder". British Journal of Psychiatry. 161 (5): 665–670. doi:10.1192/bjp.161.5.665. PMID 1422616.
- Annesley, P. T. (29 January 2018). "Nardil Response in a Chronic Obsessive Compulsive". British Journal of Psychiatry. 115 (523): 748. doi:10.1192/bjp.115.523.748. PMID 5806868.
- Mallinger AG, Frank E, Thase ME, Barwell MM, Diazgranados N, Luckenbaugh DA, Kupfer DJ (2009). "Revisiting the effectiveness of standard antidepressants in bipolar disorder: are monoamine oxidase inhibitors superior?". Psychopharmacology Bulletin. 42 (2): 64–74. PMC 3570273. PMID 19629023.
- Liebowitz MR, Hollander E, Schneier F, Campeas R, Welkowitz L, Hatterer J, Fallon B (1990). "Reversible and irreversible monoamine oxidase inhibitors in other psychiatric disorders". Acta Psychiatrica Scandinavica. Supplementum. 360 (S360): 29–34. doi:10.1111/j.1600-0447.1990.tb05321.x. PMID 2248064. S2CID 30319319.
- http://www.psycom.net/hysteroid.html Dowson JH (1987). "MAO inhibitors in mental disease: their current status". Journal of Neural Transmission. Supplementum. 23: 121–38. doi:10.1007/978-3-7091-8901-6_8. ISBN 978-3-211-81985-2. PMID 3295114.
- Gillman, Peter Kenneth (September 2018). "A reassessment of the safety profile of monoamine oxidase inhibitors: elucidating tired old tyramine myths". Journal of Neural Transmission. 125 (11): 1707–1717. doi:10.1007/s00702-018-1932-y. ISSN 0300-9564. PMID 30255284. S2CID 52823188.
- Mosher, Clayton James, and Scott Akins. Drugs and Drug Policy : The Control of Consciousness Alteration. Thousand Oaks, Calif.: Sage, 2007.[page needed]
- Stahl S (2011). Case Studies: Stahl's Essential Psychopharmacology.
- Lotufo-Neto F, Trivedi M, Thase ME (March 1999). "Meta-analysis of the reversible inhibitors of monoamine oxidase type A moclobemide and brofaromine for the treatment of depression". Neuropsychopharmacology. 20 (3): 226–47. doi:10.1016/S0893-133X(98)00075-X. PMID 10063483.
- FDA. "EMSAM Medication Guide" (PDF). Archived (PDF) from the original on 10 October 2015.
- Lavian G, Finberg JP, Youdim MB (1993). "The advent of a new generation of monoamine oxidase inhibitor antidepressants: pharmacologic studies with moclobemide and brofaromine". Clinical Neuropharmacology. 16 Suppl 2 (Suppl 2): S1–7. PMID 8313392.
- Boyer EW, Shannon M (March 2005). "The serotonin syndrome". The New England Journal of Medicine. 352 (11): 1112–20. doi:10.1056/NEJMra041867. PMID 15784664. S2CID 37959124.
- Pharmacology from H.P. Rang, M.M. Dale, J.M. Ritter, P.K. Moore, year 2003, chapter 38
- "MHRA PAR Dextromethorphan hydrobromide, p. 12" (PDF). Archived (PDF) from the original on 10 May 2017.
- Berlin I, Anthenelli RM (March 2001). "Monoamine oxidases and tobacco smoking". The International Journal of Neuropsychopharmacology. 4 (1): 33–42. doi:10.1017/S1461145701002188. PMID 11343627.
- Fowler JS, Volkow ND, Wang GJ, Pappas N, Logan J, Shea C, Alexoff D, MacGregor RR, Schlyer DJ, Zezulkova I, Wolf AP (November 1996). "Brain monoamine oxidase A inhibition in cigarette smokers". Proceedings of the National Academy of Sciences of the United States of America. 93 (24): 14065–9. Bibcode:1996PNAS...9314065F. doi:10.1073/pnas.93.24.14065. PMC 19495. PMID 8943061.
- Fowler JS, Volkow ND, Wang GJ, Pappas N, Logan J, MacGregor R, Alexoff D, Shea C, Schlyer D, Wolf AP, Warner D, Zezulkova I, Cilento R (February 1996). "Inhibition of monoamine oxidase B in the brains of smokers". Nature. 379 (6567): 733–6. Bibcode:1996Natur.379..733F. doi:10.1038/379733a0. PMID 8602220. S2CID 33217880.
- Kanski's Clinical Ophthalmology, 8th Edition (2016). Brad Bowling. ISBN 978-0-7020-5572-0 978-0-7020-5573-7 p. 332
- van Broekhoven F, Kan CC, Zitman FG (June 2002). "Dependence potential of antidepressants compared to benzodiazepines". Progress in Neuro-Psychopharmacology & Biological Psychiatry. 26 (5): 939–43. doi:10.1016/S0278-5846(02)00209-9. PMID 12369270. S2CID 14286356.
- Dobson KS, et al. (June 2008). "Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression". Journal of Consulting and Clinical Psychology. 76 (3): 468–77. doi:10.1037/0022-006X.76.3.468. PMC 2648513. PMID 18540740.
- "Switching patients from phenelzine to other antidepressants". Royal Australian and New Zealand College of Psychiatrists. 11 May 2020. Retrieved 25 May 2020.
- "Active ingredient: Amphetamine – Brands, Medical Use, Clinical Data". DrugLib.com. Archived from the original on 21 September 2013. Retrieved 26 May 2013.
- Hammerness P, Parada H, Abrams A (2002). "Linezolid: MAOI activity and potential drug interactions". Psychosomatics. 43 (3): 248���9. doi:10.1176/appi.psy.43.3.248-a. PMID 12075044.
- Fowler JS, Logan J, Azzaro AJ, Fielding RM, Zhu W, Poshusta AK, Burch D, Brand B, Free J, Asgharnejad M, Wang GJ, Telang F, Hubbard B, Jayne M, King P, Carter P, Carter S, Xu Y, Shea C, Muench L, Alexoff D, Shumay E, Schueller M, Warner D, Apelskog-Torres K (February 2010). "Reversible inhibitors of monoamine oxidase-A (RIMAs): robust, reversible inhibition of human brain MAO-A by CX157". Neuropsychopharmacology. 35 (3): 623–31. doi:10.1038/npp.2009.167. PMC 2833271. PMID 19890267.
- Edward J. Massaro (2002). Handbook of Neurotoxicology. ISBN 9780896037960.
- Nowakowska E, Chodera A (July 1997). "[Inhibitory monoamine oxidases of the new generation]" [New generation of monoaminooxidase inhibitors]. Polski Merkuriusz Lekarski (in Polish). 3 (13): 1–4. PMID 9432289.
- Edmondson DE, Binda C, Mattevi A (August 2007). "Structural insights into the mechanism of amine oxidation by monoamine oxidases A and B". Archives of Biochemistry and Biophysics. 464 (2): 269–76. doi:10.1016/j.abb.2007.05.006. PMC 1993809. PMID 17573034.
- Ramachandraih CT, Subramanyam N, Bar KJ, Baker G, Yeragani VK (April 2011). "Antidepressants: From MAOIs to SSRIs and more". Indian Journal of Psychiatry. 53 (2): 180–2. doi:10.4103/0019-5545.82567. PMC 3136031. PMID 21772661.
- Shulman KI, Herrmann N, Walker SE (October 2013). "Current place of monoamine oxidase inhibitors in the treatment of depression". CNS Drugs. 27 (10): 789–97. doi:10.1007/s40263-013-0097-3. PMID 23934742. S2CID 21625538.
- Livingston MG, Livingston HM (April 1996). "Monoamine oxidase inhibitors. An update on drug interactions". Drug Safety. 14 (4): 219–27. doi:10.2165/00002018-199614040-00002. PMID 8713690. S2CID 46742172.
- Nair NP, Ahmed SK, Kin NM (November 1993). "Biochemistry and pharmacology of reversible inhibitors of MAO-A agents: focus on moclobemide". Journal of Psychiatry & Neuroscience. 18 (5): 214–25. PMC 1188542. PMID 7905288.
- Baldwin D, Rudge S (1993). "Moclobemide: a reversible inhibitor of monoamine oxidase type A". British Journal of Hospital Medicine. 49 (7): 497–9. PMID 8490690.
- "FDA Approves Emsam (Selegiline) as First Drug Patch for Depression" (Press release). U.S. Food and Drug Administration. 28 February 2006. Archived from the original on 21 November 2009. Retrieved 19 November 2009.
- Lawrence KR, Adra M, Gillman PK (June 2006). "Serotonin toxicity associated with the use of linezolid: a review of postmarketing data". Clinical Infectious Diseases. 42 (11): 1578–83. doi:10.1086/503839. PMID 16652315.
- Petzer A, Harvey BH, Wegener G, Petzer JP (February 2012). "Azure B, a metabolite of methylene blue, is a high-potency, reversible inhibitor of monoamine oxidase". Toxicology and Applied Pharmacology. 258 (3): 403–9. doi:10.1016/j.taap.2011.12.005. PMID 22197611.
- "Urgent message from PHARMAC re discontinuation of phenelzine (Nardil) tablets". RANZCP.org. Retrieved 12 September 2020.
- Donskaya NS, Antonkina OA, Glukhan EN, Smirnov SK (1 July 2004). "Antidepressant Befol Synthesized Via Interaction of 4-Chloro-N-(3-chloropropyl)benzamide with Morpholine". Pharmaceutical Chemistry Journal. 0091-150X. 38 (7): 381–384. doi:10.1023/B:PHAC.0000048439.38383.5f. S2CID 29121452.
- Kulkarni SK, Bhutani MK, Bishnoi M (December 2008). "Antidepressant activity of curcumin: involvement of serotonin and dopamine system". Psychopharmacology. 201 (3): 435–42. doi:10.1007/s00213-008-1300-y. PMID 18766332. S2CID 33184265.
- Nelson KM, Dahlin JL, Bisson J, Graham J, Pauli GF, Walters MA (March 2017). "The Essential Medicinal Chemistry of Curcumin". Journal of Medicinal Chemistry. 60 (5): 1620–1637. doi:10.1021/acs.jmedchem.6b00975. PMC 5346970. PMID 28074653.