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Older patients with refractory depression may not be getting the treatment they need


Monoamine oxidase inhibitors (MAOIs) are a class of antidepressants that continue to be recommended by official guidelines for treating older adults with refractory, atypical and bipolar depression. However, they appear to be under-used in Ontario. Patients taking MAOIs need to adhere to specific dietary restrictions and avoid taking serotonergic and adrenergic drugs at the same time.

Researchers at the Institute for Clinical Evaluative Sciences (ICES), Sunnybrook Health Sciences Centre and Women’s College Research Institute in Toronto found that these concerns about potentially serious food and drug interactions, as well as a lack of promotion of MAOIs by drug companies, may be leading clinicians to avoid prescribing them. From 1997 to 2007, use of MAOIs remained low and decreased dramatically from 3.1/1000, 000 to 1.4/100,000 in older Ontarians.

“It is important for senior clinicians to ensure that training programs include experience with irreversible MAOIs as well as other agents, such as lithium, which are not promoted by the pharmaceutical industry,” says Dr. Ken Shulman, lead author and associate scientist at the Sunnybrook Health Sciences Centre.

Approximately 18 per cent of patients taking MAOIs were prescribed selective serotonin uptake inhibitors (SSRIs), a class of antidepressant that should be avoided in these patients.

However, over the 10-year course of the study, researchers did not find any emergency department or acute care admissions for serious adverse events associated with MAOI use—namely, serotonin syndrome or hypertensive crisis.

The availability of updated dietary guidelines and attention to potential drug interactions create safe conditions for the use of these drugs.

The study “Current prescription patterns and safety profile of irreversible monoamine oxidase inhibitors: a population-based cohort study of older adults” is in the of Journal of Clinical Psychiatry.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.


  • Deborah Creatura
  • Acting Media Advisor, ICES
  • [email protected]
  • 416-480-4780 or cell 647-406-5996
  • Nadia Norcia Radovini
  • Communications Advisor
  • Sunnybrook Health Sciences Centre
  • 416.480.6100, ext. 3207
  • [email protected]
  • www.sunnybrook.ca

Read the Journal Article