PDF(Pubmed)
Abstract：
The first monoamine oxidase inhibitors (MAOIs) used for the treatment of depression in the 1950-60s were credited with treating severe melancholic depression (MeD) successfully and greatly reducing the need for electroconvulsive therapy (ECT). Following the hiatus caused by the then ill-understood cheese reaction, MAOI use was relegated to atypical and treatment-resistant depressions only, based on data from insufficiently probing research studies suggesting their comparatively lesser effectiveness in MeD. The siren attraction of new \'better\' drugs with different mechanisms amplified this trend. Following a re-evaluation of the data, we suggest that MAOIs are effective in MeD. Additionally, the broad unitary conceptualisation of major depressive disorder (MDD) in the DSM model diminished the chance of demonstrating distinctive responses to different antidepressant drugs (ADs) such as SSRIs, TCAs, and MAOIs, thereby further reducing the interest in MAOIs. More reliable categorical distinction of MeD, disentangling it from MDD, may be possible if more sensitive measuring instruments (CORE, SMPI) are used. We suggest these issues will benefit from re-appraisement via an inductive reasoning process within a binary (rather than a unitary) model for defining the different depressive disorders, allowing for the use of more reliable diagnostic criteria for MeD in particular. We conclude that MAOIs remain essential for, inter alia, TCA-resistant MeD, and should typically be used prior to ECT; additionally, they have a role in maintaining remission in cases treated with ECT (and ketamine/esketamine). We suggest that MAOIs should be utilized earlier in treatment algorithms and with greater regularity than is presently the case.
摘要：
1950-60年代用于治疗抑郁症的第一种单胺氧化酶抑制剂（MAOIs）被认为可以成功治疗严重的忧郁抑郁症（MeD），并大大减少了电惊厥治疗（ECT）的需求。在由当时不了解的奶酪反应引起的中断之后，MAOI的使用仅限于非典型和抗治疗性抑郁症，基于来自不足的调查研究的数据，表明它们在MeD中的有效性相对较低。具有不同机制的新型“更好”药物的警笛吸引力放大了这一趋势。在重新评估数据后，我们建议MAOIs在MeD中有效。此外,DSM模型中对重度抑郁症（MDD）的广泛统一概念化减少了对不同抗抑郁药（AD）（如SSRIs）的独特反应的机会，TCA,和MAOIs,从而进一步降低对MAOIs的兴趣。更可靠的MeD分类区分，把它从MDD中解开，如果更灵敏的测量仪器(CORE，使用SMPI)。Wesuggesttheseissueswillbenefitfromre-appraisementviaan归纳推理processwithinabinary(ratherthanunit)modelfordefiningthedifferentdepressingdisords,特别是允许对MeD使用更可靠的诊断标准。我们得出结论，MAOIs仍然是必不可少的，除其他外,抗TCA药物,并且通常应在ECT之前使用；此外，在接受ECT（和氯胺酮/艾氯胺酮）治疗的病例中，它们在维持缓解中起作用。我们建议在治疗算法中更早地使用MAOI，并且比目前的情况具有更大的规律性。
