Monoamine oxidase inhibitor explained

Width:300px
Synonyms:MAOI, RIMA
Use:Treatment of major depressive disorder, atypical depression, Parkinson's disease, and several other disorders
Atc Prefix:N06AF
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 effective antidepressants, especially for treatment-resistant depression and atypical depression.[1] They are also used to treat panic disorder, social anxiety disorder, 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,[2] and weaker in increasing the monoamines important in depressive disorder.[3] RIMAs have not gained widespread market share in the United States.

Medical uses

MAOIs have been found to be effective in the treatment of panic disorder with agoraphobia,[4] social phobia,[5] [6] [7] atypical depression[8] [9] or mixed anxiety disorder and depression, bulimia,[10] [11] [12] [13] and post-traumatic stress disorder,[14] as well as borderline personality disorder,[15] and obsessive–compulsive disorder (OCD).[16] [17] MAOIs appear to be particularly effective in the management of bipolar depression according to a retrospective-analysis from 2009.[18] There are reports of MAOI efficacy in OCD, trichotillomania, body dysmorphic disorder, and avoidant personality disorder, but these reports are from uncontrolled case reports.[19]

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.

MAOIs appear to be particularly indicated for outpatients with dysthymia complicated by panic disorder or hysteroid dysphoria.[20]

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.

Pargyline is a non-selective MAOI that was previously used as an antihypertensive agent to treat hypertension (high blood pressure).[21] [22]

Side effects

Hypertensive crisis

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.[23] If large amounts of tyramine are consumed, they may develop a hypertensive crisis, which can be fatal.[24] Examples of foods and beverages with potentially high levels of tyramine include cheese, Chianti wine, and pickled fish.[25] 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.[26] 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,[27] 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).[28] [29]

Drug interactions

The most significant risk associated with the use of MAOIs is the potential for drug interactions with over-the-counter, prescription, or illegally obtained medications, and some dietary supplements (e.g., St. John's wort or 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).

Tryptophan supplements can be consumed with MAOIs, but can result in transient serotonin syndrome.[30]

MAOIs should not be combined with other psychoactive substances (antidepressants, painkillers, stimulants, including prescribed, OTC and illegally acquired drugs, etc.) except under expert care. Certain combinations can cause lethal reactions; common examples include SSRIs, tricyclics, MDMA, meperidine,[31] tramadol, and dextromethorphan,[32] whereas combinations with LSD, psilocybin, or DMT appear to be relatively safe.[33] Drugs that affect the release or reuptake of epinephrine, norepinephrine, serotonin 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.[34] [35] [36]

While safer than general MAOIs, 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.[37]

Withdrawal

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 days, weeks or sometimes months to minimize or prevent withdrawal symptoms.[38]

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.[39] This consideration complicates prescribing between an MAOI and an SSRI, because it is necessary to clear the system completely of one drug before starting another. One physician organization recommends the dose to be tapered down over a minimum of four weeks, followed by a two-week washout period.[40] 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.[40]

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.

Reversibility

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.[41]

Harmaline found in Peganum harmala, Banisteriopsis caapi, and Passiflora incarnata is a reversible inhibitor of monoamine oxidase A (RIMA).[42]

Selectivity

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.[43] 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.[44] Selegiline is selective for MAO-B at low doses, but non-selective at higher doses.

History

The knowledge of MAOIs began with the serendipitous discovery that iproniazid was a potent MAO inhibitor (MAOI).[45] 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.[46]

The older MAOIs' heyday was mostly between the years 1957 and 1970.[43] 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.[47] [48] Moclobemide, was the first reversible inhibitor of MAO-A to enter widespread clinical practice.[49]

A transdermal patch form of the MAOI selegiline, called Emsam, was approved for use in depression by the Food and Drug Administration in the United States on 28 February 2006.[50]

List of MAO inhibiting drugs

Marketed MAOIs

Linezolid is an antibiotic drug with weak, reversible MAO-inhibiting activity.[51]

The antibiotic furazolidone also has MAO-inhibiting activity [52]

Methylene blue (methylthioninium chloride), the antidote indicated for drug-induced methemoglobinemia on the World Health Organization's List of Essential Medicines, among a plethora of other off-label uses, is a highly potent, reversible MAO inhibitor.[53]

The Food and Drug Administration (FDA) has approved these MAOIs to treat depression:[54]

MAOIs that have been withdrawn from the market

List of RIMAs

Marketed pharmaceuticals

Other pharmaceuticals

Naturally occurring RIMAs in plants

Only reversible phytochemical MAOIs have been characterized.[56]

Research compounds

See also

Notes and References

  1. Atypical Depression in the 21st Century: Diagnostic and Treatment Issues . . 23 November 2013 . Cristancho . Mario A. . 20 November 2012 . live . https://web.archive.org/web/20131202224433/http://www.psychiatrictimes.com/major-depressive-disorder/atypical-depression-21st-century-diagnostic-and-treatment-issues . 2 December 2013 . dmy-all .
  2. Isbister GK . etal . 2003 . Moclobemide poisoning: toxicokinetics and occurrence of serotonin toxicity . British Journal of Clinical Pharmacology . 56 . 4. 441–450 . 10.1046/j.1365-2125.2003.01895.x . 12968990 . 1884375 .
  3. Web site: Neuroscience Education Institute > Activities > 2012CurbConsultPosted. www.neiglobal.com.
  4. Buigues J, Vallejo J . Therapeutic response to phenelzine in patients with panic disorder and agoraphobia with panic attacks . The Journal of Clinical Psychiatry . 48 . 2 . 55–9 . February 1987 . 3542985 .
  5. Liebowitz MR, Schneier F, Campeas R, Hollander E, Hatterer J, Fyer A, Gorman J, Papp L, Davies S, Gully R . Phenelzine vs atenolol in social phobia. A placebo-controlled comparison . Archives of General Psychiatry . 49 . 4 . 290–300 . April 1992 . 1558463 . 10.1001/archpsyc.49.4.290 .
  6. Versiani M, Nardi AE, Mundim FD, Alves AB, Liebowitz MR, Amrein R . Pharmacotherapy of social phobia. A controlled study with moclobemide and phenelzine . The British Journal of Psychiatry . 161 . 3 . 353–60 . September 1992 . 1393304 . 10.1192/bjp.161.3.353 . 45341667 .
  7. Heimberg RG, Liebowitz MR, Hope DA, Schneier FR, Holt CS, Welkowitz LA, Juster HR, Campeas R, Bruch MA, Cloitre M, Fallon B, Klein DF . Cognitive behavioral group therapy vs phenelzine therapy for social phobia: 12-week outcome . Archives of General Psychiatry . 55 . 12 . 1133–41 . December 1998 . 9862558 . 10.1001/archpsyc.55.12.1133 . 10.1.1.485.5909 .
  8. Jarrett RB, Schaffer M, McIntire D, Witt-Browder A, Kraft D, Risser RC . Treatment of atypical depression with cognitive therapy or phenelzine: a double-blind, placebo-controlled trial . Archives of General Psychiatry . 56 . 5 . 431–7 . May 1999 . 10232298 . 1475805 . 10.1001/archpsyc.56.5.431 .
  9. Liebowitz MR, Quitkin FM, Stewart JW, McGrath PJ, Harrison W, Rabkin J, Tricamo E, Markowitz JS, Klein DF . Phenelzine v imipramine in atypical depression. A preliminary report . Archives of General Psychiatry . 41 . 7 . 669–77 . July 1984 . 6375621 . 10.1001/archpsyc.1984.01790180039005 .
  10. Walsh BT, Stewart JW, Roose SP, Gladis M, Glassman AH . Treatment of bulimia with phenelzine. A double-blind, placebo-controlled study . Archives of General Psychiatry . 41 . 11 . 1105–9 . November 1984 . 6388524 . 10.1001/archpsyc.1983.01790220095015 .
  11. Rothschild R, Quitkin HM, Quitkin FM, Stewart JW, Ocepek-Welikson K, McGrath PJ, Tricamo E . 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 . January 1994 . 8124322 . 10.1002/1098-108X(199401)15:1<1::AID-EAT2260150102>3.0.CO;2-E .
  12. Walsh BT, Stewart JW, Roose SP, Gladis M, Glassman AH . A double-blind trial of phenelzine in bulimia . Journal of Psychiatric Research . 19 . 2–3 . 485–9 . 1985 . 3900362 . 10.1016/0022-3956(85)90058-5 .
  13. Walsh BT, Gladis M, Roose SP, Stewart JW, Stetner F, Glassman AH . Phenelzine vs placebo in 50 patients with bulimia . Archives of General Psychiatry . 45 . 5 . 471–5 . May 1988 . 3282482 . 10.1001/archpsyc.1988.01800290091011 .
  14. Davidson J, Walker JI, Kilts C . A pilot study of phenelzine in the treatment of post-traumatic stress disorder . The British Journal of Psychiatry . 150 . 2 . 252–5 . February 1987 . 3651684 . 10.1192/bjp.150.2.252 . 10001735 .
  15. Soloff PH, Cornelius J, George A, Nathan S, Perel JM, Ulrich RF . Efficacy of phenelzine and haloperidol in borderline personality disorder . Archives of General Psychiatry . 50 . 5 . 377–85 . May 1993 . 8489326 . 10.1001/archpsyc.1993.01820170055007 .
  16. Vallejo . J. . Olivares . J. . Marcos . T. . Bulbena . A. . Menchón . J. M. . Clomipramine versus Phenelzine in Obsessive–Compulsive Disorder . British Journal of Psychiatry . 2 January 2018 . 161 . 5 . 665–670 . 10.1192/bjp.161.5.665 . 1422616 . 36232956 .
  17. Annesley . P. T. . Nardil Response in a Chronic Obsessive Compulsive . British Journal of Psychiatry . 29 January 2018 . 115 . 523 . 748 . 10.1192/bjp.115.523.748 . 5806868 . 31997372 . free .
  18. Mallinger AG, Frank E, Thase ME, Barwell MM, Diazgranados N, Luckenbaugh DA, Kupfer DJ . Revisiting the effectiveness of standard antidepressants in bipolar disorder: are monoamine oxidase inhibitors superior? . Psychopharmacology Bulletin . 42 . 2 . 64–74 . 2009 . 19629023 . 3570273 .
  19. Liebowitz MR, Hollander E, Schneier F, Campeas R, Welkowitz L, Hatterer J, Fallon B . Reversible and irreversible monoamine oxidase inhibitors in other psychiatric disorders . Acta Psychiatrica Scandinavica. Supplementum . 360 . S360 . 29–34 . 1990 . 2248064 . 10.1111/j.1600-0447.1990.tb05321.x . 30319319 .
  20. http://www.psycom.net/hysteroid.html Book: Dowson JH . MAO inhibitors in mental disease: Their current status . Monoamine Oxidase Enzymes . Journal of Neural Transmission. Supplementum . 23 . 121–38 . 1987 . 3295114 . 10.1007/978-3-7091-8901-6_8 . 978-3-211-81985-2 .
  21. Finberg JP . Update on the pharmacology of selective inhibitors of MAO-A and MAO-B: focus on modulation of CNS monoamine neurotransmitter release . Pharmacology & Therapeutics . 143 . 2 . 133–152 . August 2014 . 24607445 . 10.1016/j.pharmthera.2014.02.010 .
  22. Hayes AH, Schneck DW . Antihypertensive pharmacotherapy . Postgraduate Medicine . 59 . 5 . 155–162 . May 1976 . 57611 . 10.1080/00325481.1976.11714363 .
  23. Gillman. Peter Kenneth. September 2018. A reassessment of the safety profile of monoamine oxidase inhibitors: elucidating tired old tyramine myths. Journal of Neural Transmission. en. 125. 11. 1707–1717. 10.1007/s00702-018-1932-y. 30255284. 52823188. 0300-9564.
  24. Grady MM, Stahl SM . Practical guide for prescribing MAOIs: debunking myths and removing barriers . CNS Spectrums . 17 . 1 . 2–10 . March 2012 . 22790112 . 10.1017/S109285291200003X . 206312008 . https://web.archive.org/web/20170707082406/http://onlinedigeditions.com/display_article.php?id=1047055 . dmy-all . live . 7 July 2017 .
  25. Mosher, Clayton James, and Scott Akins. Drugs and Drug Policy : The Control of Consciousness Alteration. Thousand Oaks, Calif.: Sage, 2007.
  26. Book: Stahl, Stephen . Case Studies: Stahl's Essential Psychopharmacology. vanc . 2011.
  27. Lotufo-Neto F, Trivedi M, Thase ME . Meta-analysis of the reversible inhibitors of monoamine oxidase type A moclobemide and brofaromine for the treatment of depression . Neuropsychopharmacology . 20 . 3 . 226–47 . March 1999 . 10063483 . 10.1016/S0893-133X(98)00075-X . free .
  28. Web site: EMSAM Medication Guide. FDA. Food and Drug Administration. live. https://web.archive.org/web/20151010120216/https://www.fda.gov/downloads/Drugs/DrugSafety/ucm088589.pdf. 10 October 2015. dmy-all.
  29. Lavian G, Finberg JP, Youdim MB . The advent of a new generation of monoamine oxidase inhibitor antidepressants: pharmacologic studies with moclobemide and brofaromine . Clinical Neuropharmacology . 16 . Suppl 2 . S1–7 . 1993 . 8313392 .
  30. Boyer EW, Shannon M . The serotonin syndrome . The New England Journal of Medicine . 352 . 11 . 1112–20 . March 2005 . 15784664 . 10.1056/NEJMra041867 . 37959124 .
  31. Pharmacology from H.P. Rang, M.M. Dale, J.M. Ritter, P.K. Moore, year 2003, chapter 38
  32. Web site: MHRA PAR Dextromethorphan hydrobromide, p. 12 . live . https://web.archive.org/web/20170510182914/http://www.mhra.gov.uk/home/groups/par/documents/websiteresources/con146863.pdf . 10 May 2017 . dmy-all .
  33. Malcolm, B., & Thomas, K . Serotonin toxicity of serotonergic psychedelics . Psychopharmacology . 2022 . 239 . 6 . 1881–1891 . 10.1007/s00213-021-05876-x. 34251464 . 235796130 .
  34. Berlin I, Anthenelli RM . Monoamine oxidases and tobacco smoking . The International Journal of Neuropsychopharmacology . 4 . 1 . 33–42 . March 2001 . 11343627 . 10.1017/S1461145701002188 . free .
  35. Fowler JS, Volkow ND, Wang GJ, Pappas N, Logan J, Shea C, Alexoff D, MacGregor RR, Schlyer DJ, Zezulkova I, Wolf AP . 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 . November 1996 . 8943061 . 19495 . 10.1073/pnas.93.24.14065 . 1996PNAS...9314065F . free .
  36. 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 . Inhibition of monoamine oxidase B in the brains of smokers . Nature . 379 . 6567 . 733–6 . February 1996 . 8602220 . 10.1038/379733a0 . 1996Natur.379..733F . 33217880 .
  37. Kanski's Clinical Ophthalmology, 8th Edition (2016). Brad Bowling. 978-0-7020-5573-7 p. 332
  38. van Broekhoven F, Kan CC, Zitman FG . Dependence potential of antidepressants compared to benzodiazepines . Progress in Neuro-Psychopharmacology & Biological Psychiatry . 26 . 5 . 939–43 . June 2002 . 12369270 . 10.1016/S0278-5846(02)00209-9 . 14286356 .
  39. Dobson KS, Hollon SD, Dimidjian S, Schmaling KB, Kohlenberg RJ, Gallop RJ, Rizvi SL, Gollan JK, Dunner DL, Jacobson NS . 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 . June 2008 . 18540740 . 2648513 . 10.1037/0022-006X.76.3.468 . 1 .
  40. Web site: Royal Australian and New Zealand College of Psychiatrists. 2020-05-11. Switching patients from phenelzine to other antidepressants. 2020-05-25.
  41. 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 . Reversible inhibitors of monoamine oxidase-A (RIMAs): robust, reversible inhibition of human brain MAO-A by CX157 . Neuropsychopharmacology . 35 . 3 . 623–31 . February 2010 . 19890267 . 2833271 . 10.1038/npp.2009.167 .
  42. Book: Handbook of Neurotoxicology. Edward J. Massaro . 9780896037960 . 2002 . Humana Press .
  43. Nowakowska E, Chodera A . [Inhibitory monoamine oxidases of the new generation] . pl . Polski Merkuriusz Lekarski . 3 . 13 . 1–4 . July 1997 . 9432289 . New generation of monoaminooxidase inhibitors .
  44. Edmondson DE, Binda C, Mattevi A . Structural insights into the mechanism of amine oxidation by monoamine oxidases A and B . Archives of Biochemistry and Biophysics . 464 . 2 . 269–76 . August 2007 . 17573034 . 1993809 . 10.1016/j.abb.2007.05.006 .
  45. Ramachandraih CT, Subramanyam N, Bar KJ, Baker G, Yeragani VK . Antidepressants: From MAOIs to SSRIs and more . Indian Journal of Psychiatry . 53 . 2 . 180–2 . April 2011 . 21772661 . 3136031 . 10.4103/0019-5545.82567 . free .
  46. Shulman KI, Herrmann N, Walker SE . Current place of monoamine oxidase inhibitors in the treatment of depression . CNS Drugs . 27 . 10 . 789–97 . October 2013 . 23934742 . 10.1007/s40263-013-0097-3 . 21625538 .
  47. Livingston MG, Livingston HM . Monoamine oxidase inhibitors. An update on drug interactions . Drug Safety . 14 . 4 . 219–27 . April 1996 . 8713690 . 10.2165/00002018-199614040-00002 . 46742172 .
  48. Nair NP, Ahmed SK, Kin NM . Biochemistry and pharmacology of reversible inhibitors of MAO-A agents: focus on moclobemide . Journal of Psychiatry & Neuroscience . 18 . 5 . 214–25 . November 1993 . 7905288 . 1188542 .
  49. Baldwin D, Rudge S . Moclobemide: a reversible inhibitor of monoamine oxidase type A . British Journal of Hospital Medicine . 49 . 7 . 497–9 . 1993 . 8490690 .
  50. FDA Approves Emsam (Selegiline) as First Drug Patch for Depression. . . 28 February 2006 . 19 November 2009 . live . https://web.archive.org/web/20091121040056/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108607.htm . 21 November 2009 . dmy-all .
  51. Lawrence KR, Adra M, Gillman PK . Serotonin toxicity associated with the use of linezolid: a review of postmarketing data . Clinical Infectious Diseases . 42 . 11 . 1578–83 . June 2006 . 16652315 . 10.1086/503839 . free .
  52. A.M. Timperio . H.A. Kuiper & L. Zolla . Identification of a furazolidone metabolite responsible for the inhibition of amino oxidases . . 33 . 2 . 153–167 . February 2003 . 10.1080/0049825021000038459 . 12623758 . 35868007 .
  53. Petzer A, Harvey BH, Wegener G, Petzer JP . Azure B, a metabolite of methylene blue, is a high-potency, reversible inhibitor of monoamine oxidase . Toxicology and Applied Pharmacology . 258 . 3 . 403–9 . February 2012 . 22197611 . 10.1016/j.taap.2011.12.005 . 2012ToxAP.258..403P .
  54. Web site: An option if other antidepressants haven't helped. 2021-12-09. Mayo Clinic. en.
  55. Donskaya NS, Antonkina OA, Glukhan EN, Smirnov SK . Antidepressant Befol Synthesized Via Interaction of 4-Chloro-N-(3-chloropropyl)benzamide with Morpholine. Pharmaceutical Chemistry Journal . 1 July 2004 . 38 . 0091-150X . 7 . 381–384 . 10.1023/B:PHAC.0000048439.38383.5f . 29121452.
  56. Chaurasiya . Narayan D. . Leon . Francisco . Muhammad . Ilias . Tekwani . Babu L. . 2022-07-04 . Natural Products Inhibitors of Monoamine Oxidases—Potential New Drug Leads for Neuroprotection, Neurological Disorders, and Neuroblastoma . Molecules . 27 . 13 . 4297 . 10.3390/molecules27134297 . free . 1420-3049 . 9268457 . 35807542.
  57. van Diermen . Daphne . Marston . Andrew . Bravo . Juan . Reist . Marianne . Carrupt . Pierre-Alain . Hostettmann . Kurt . 2009-03-18 . Monoamine oxidase inhibition by Rhodiola rosea L. roots . Journal of Ethnopharmacology . en . 122 . 2 . 397–401 . 10.1016/j.jep.2009.01.007 . 19168123 . 0378-8741.

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