Efficacy and tolerability of monoamine oxidase inhibitors for the treatment of depressive episodes in mood disorders: A systematic review and network meta-analysis

Anna Giménez-Palomo^{1

2

3

4}, Anjli K Chamdal^{5

6}, Natalie Gottlieb⁵, Mojtaba Lotfaliany⁷, Tahir Jokinen⁵, Eslam M Bastawy^{7

8}, Katherine Adlington⁵, Nawal Benachar^{9

10}, Seetal Dodd^{7

11

12}, Isabella Pacchiarotti^{1

2

3

4

13}, Eduard Vieta^{1

2

3

4

13}, Michael Berk^{7

11

12

14}, Paul R A Stokes⁵

Affiliations

¹ Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain.
² Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain.
³ Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
⁴ Institute of Neurosciences (UBNeuro), Barcelona, Spain.
⁵ Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁶ East Kent University Hospitals NHS Foundation Trust, Kent, UK.
⁷ IMPACT the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University and Barwon Health, Geelong, Victoria, Australia.
⁸ Faculty of Science, Ain Shams University, Cairo, Egypt.
⁹ Department of Psychiatry, East and North Hertfordshire NHS Trust, Hertfordshire, UK.
¹⁰ Faculty of Medical Education, Wolfson College, University of Oxford, Oxford, UK.
¹¹ Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia.
¹² Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
¹³ Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
¹⁴ Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia.

PMID: 39001570
DOI: 10.1111/acps.13728

Review

Efficacy and tolerability of monoamine oxidase inhibitors for the treatment of depressive episodes in mood disorders: A systematic review and network meta-analysis

Anna Giménez-Palomo et al. Acta Psychiatr Scand. 2024 Dec.

. 2024 Dec;150(6):500-515.

doi: 10.1111/acps.13728. Epub 2024 Jul 12.

Authors

Affiliations

¹ Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain.
² Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain.
³ Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
⁴ Institute of Neurosciences (UBNeuro), Barcelona, Spain.
⁵ Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁶ East Kent University Hospitals NHS Foundation Trust, Kent, UK.
⁷ IMPACT the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University and Barwon Health, Geelong, Victoria, Australia.
⁸ Faculty of Science, Ain Shams University, Cairo, Egypt.
⁹ Department of Psychiatry, East and North Hertfordshire NHS Trust, Hertfordshire, UK.
¹⁰ Faculty of Medical Education, Wolfson College, University of Oxford, Oxford, UK.
¹¹ Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia.
¹² Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
¹³ Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
¹⁴ Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia.

PMID: 39001570
DOI: 10.1111/acps.13728

Abstract

Background: Monoamine oxidase inhibitors (MAOIs) are considered third-line treatments for treatment resistant depression; however, they are underused in clinical practice.

Aims: This study aimed to assess the efficacy, tolerability, and acceptability of MAOIs for the treatment of depression in comparison with other antidepressant treatments.

Methods: A systematic review and network meta-analysis of randomised clinical trials was performed to compare the efficacy, tolerability and acceptability between MAOIs and other antidepressant treatments for the treatment of depressive episodes.

Results: A total of 83 double-blinded, randomised controlled trials were included in the analysis, with 7765 participants assigned to an active treatment and 1844 assigned to placebo. Several MAOIs, including isocarboxazid, phenelzine, tranylcypromine and moclobemide, showed significantly higher efficacy compared with placebo. The tolerability and acceptability of MAOIs was comparable to other antidepressants.

Limitations: A disproportionate number of studies investigating the most commonly used MAOIs, such as moclobemide and phenelzine, and a lack of specific studies focusing on treatment-resistant and atypical depression.

Conclusions: MAOIs are similar in efficacy to other antidepressants for the treatment of depression. However, more studies are needed comparing MAOI treatment in people with treatment-resistant, atypical and bipolar depression.

Keywords: antidepressants; depression; monoamine oxidase inhibitors; mood disorders; treatment.

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References

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Efficacy and tolerability of monoamine oxidase inhibitors for the treatment of depressive episodes in mood disorders: A systematic review and network meta-analysis

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Efficacy and tolerability of monoamine oxidase inhibitors for the treatment of depressive episodes in mood disorders: A systematic review and network meta-analysis

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