Depression phenelzine

Monoamine—Oxidase Inhibitors. In the mid-1950s, tuberculosis patients with depression being treated with iproniazid (42) were occasionally reported to become euphoric. This observation led to the discovery of irreversible monoamine—oxidase (MAO) inhibiting properties. Hydrazine and nonhydrazine-related MAO inhibitors were subsequentiy shown to be antidepressants (122). Three other clinically effective irreversible MAO inhibitors have been approved for treatment of major depression phenelzine (43), isocarboxazid (44), and tranylcypromine (45). 

Ginseng tea (38) Female/64 Depression Phenelzine 45-60 mg/d (dose and duration not reported) None mentioned Insomnia, headache, tremulousness Increased cAMP levels by ginsenosides... 

Ginseng (39) Female / 42 Depression Phenelzine 45 mg/d Bee pollen, triazolam, lorazepam Manic symptoms (irritability, hallucinations) Increased cAMP levels by ginsenosides... 

Monoamine oxidase (MAO) is a mitochondrial enzyme found in neural and other tissues, such as the gut and liver. In the neuron, MAO functions as a safety valve to oxidatively deaminate and inactivate any excess neurotransmitter molecules (norepinephrine, dopamine, and serotonin) that may leak out of synaptic vesicles when the neuron is at rest. The MAO inhibitors may irreversibly or reversibly inactivate the enzyme, permitting neurotransmitter molecules to escape degradation and therefore to both accumulate within the presynaptic neuron and to leak into the synaptic space. This causes activation of norepinephrine and serotonin receptors, and may be responsible for the antidepressant action of these drugs. Three MAO inhibitors are currently available for treatment of depression phenelzine [FEN el zeen], isocarboxazid [eye soe kar BOX a zid], and tranylcypromine [tran ill SIP roe meen] no one drug is a prototype. Use of MAO inhibitors is now limited because of the complicated dietary restrictions required of patients taking MAO inhibitors. 

Ms. Jefferson has been taking phenelzine for depression. She reports having a bad headache at the back of her head. Determine what assessment would be most important to make. Explain what action, if any, you would take. 

This belief was further supported by the evidence of a correlation between the clinical response and REM sleep suppression as well as a temporal relationship between the onset of clinical response and REM sleep suppression. However, some of the later studies suggested that REM sleep suppression is not necessary for the antidepressant action (Gillin 1983). For example, some studies show evidence of no change or even an increase in REM sleep with the treatment of depression (Gillin et al. 2001). Recently, Landolt Gillin (Landolt and Gillin 2002) have also demonstrated that the antidepressant response to phenelzine treatment does not depend on elimination of REM sleep or inhibition of slow wave activity in non-REM sleep. However, the generalization of some of these studies is limited because of their small sample size. 

Landolt H. P, Gillin J. C. (2002). Different effects of phenelzine treatment on EEG topography in waking and sleep in depressed patients. Neuropsychopharmacology 27, 462-9. 

During the past year, a 38-year-old female has become progressively depressed and now refuses to leave her house. Physical examination and blood chemistries are negative. She is given phenelzine, which diminishes her depression and enables her to leave her house. 

The monoamine oxidase inhibitors (MAOIs) phenelzine and tranylcypromine increase the concentrations of NE, 5-HT, and DA within the neuronal synapse through inhibition of the monoamine oxidase (MAO) enzyme system. Both drugs are nonselective inhibitors of MAO-A and MAO-B. Selegiline is available as a transdermal patch for treatment of major depression. It inhibits MAO-A and MAO-B in the brain, but has reduced effects on MAO-A in the gut. 

Generalized Sociai Anxiety Disorder, Treatment Resistance. A significant minority of patients will not experience a satisfactory treatment response to antidepressant therapy, even after a trial of adequate duration at full strength doses. For those with comorbid depression who are experiencing no benefit from SSRI treatment for either the anxiety or depression, then switching treatment is advisable. The options include switching to another SSRI, a SNRI (venlafaxine or perhaps dulox-etine), or, when other alternatives fail, phenelzine. 

Antidepressants. In the early 1980s, the recognition that depression is a frequent comorbid feature of BN coupled with the observation that appetite changes are a common feature of depression led researchers to evaluate antidepressant treatment for BN. Since that time, a series of controlled studies have demonstrated efficacy for a wide assortment of antidepressants including the TCAs imipramine (Tofranil) and desipramine (Norpramin), the MAOl phenelzine (Nardil), the SSRl fluoxetine (Prozac), and the atypical antidepressants trazodone (Desyrel) and bupropion (Wellbutrin). Overall, approximately two-thirds of antidepressant-treated patients with bulimia experience symptomatic improvement while nearly one-third achieves complete remission of binging and purging. In addition, the improvement in the symptoms of BN is not dependent on the presence of comorbid depression. 

Ginseng interacts with phenelzine, a drug used to treat depression, stimulating the central nervous system. 

Phenelzine is a MAO inhibitor which is used for treating patients with depressive characteristics such as atypical, nonendogenous, or neurotic conditions in which a combination of anxiety, depression, or phobia are observed. Phenelzine is not a drug of first choice, and it is used in depressions that do not respond to other medicinal drugs. Nardil is a synonym of phenelzine. 

Isocarboxazid is a powerful MAO inhibitor. As with phenelzine, isocarboxazid is used for depressions that do not respond to other drugs. Marplan is a synonym of isocarboxazid. 

Side effects, mainly due to serotonin reuptake inhibition include G1 upset, nervousness, and sexual dysfunction. SSRls are associated with an increased risk of falls. Hyponatraemia due to SIADH is an uncommon, but important side effect in elderly patients. Selective serotonin and norepinephrine reuptake inhibitors (S SNRls) such as venlafaxine and duloxetine are also useful in older patients. Other heterocyclic antidepressants of importance in older patients because of relative safety include bupro-prion and mirtazepine. They are reserved for patients with resistance to or intolerance of SSRls. Currently, trazodone is used mostly for sleep disturbance in depression in doses of 50-100 mg at bedtime. The monoamine oxidase inhibitors phenelzine. 

Examples of monoamine oxidase inhibitors are phenelzine, tranylcypromine, isocarboxazid and mo-clobemide. They are indicated for atypical depression. Changes in the neurotransmitter levels are seen in several days but the clinical effect may lag by several weeks. Phenelzine is a non-selective hydrazine-type monoamine oxidase inhibitor while the also non-selective inhibitor tranylcypromine is of the non-hydrazine-type. Phenelzine, tranylcypromine and isocarboxazid are irreversible inhibitors. Phenelzine is partly metabolized by acetylation and slow acetylators are more prone to toxicity. It has anxiolytic properties and superior efficiacy in treating severe anxiety. 

MAOI agents was synthesized and tested for antidepressant properties. Three MAOI agents are approved in the United States for use in major depression isocarboxazid (Marplan), phenelzine Nardil), and tranylcypromine (Parnate). 

The potential for toxicity that is associated with the administration of the MAOIs restricts their use in major depression. Hepatotoxicity is likely to occur with isocarboxazid or phenelzine, since hydrazine compounds can cause damage to hepatic parenchymal cells. This is true particularly for patients identified as slow acetyla-tors (see Chapter 4) of hydrazine compounds. Fortunately, the incidence of hepatotoxicity is low with the available agents. 

In the United States, the three MAOIS available for the treatment of psychiatric conditions are phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan). All three agents have indications for adult major depression (>16 years old) and, more specifically, atypical depression (anergia, hypersomnia, hy-perphagia, somatization, and anxiety symptoms). Although not indicated for anxiety, the MAOIs can also be particularly helpful in treatment of these disorders. Selegiline or L-deprenyl (Eldepryl) is also available in the United States and indicated for symptoms of Parkinson s disease and depression. 

Structurally, all MAOIs are either hydralazines or nonhydralazines. Iproniazid, the first MAOI used for depression, is a hydralazine. There are currently two hydralazines available, phenelzine and isocarboxazid. Tranylcypromine is a nonhydralazine with a unique structure. Although tranylcypromine is considered to be a reversible inhibitor of MAO, clinically, the return of normal enzymatic activity is delayed, similar to phe-... 

Gracious, B.L. and Wisner, K.L. (1997) Phenelzine use throughout pregnancy and the puerperium a case report, review of the literature, and management recommendations. Depression Anxiety 6 124-128. 

Those patients presenting with atypical symptoms of depression (i.e., rejection-sensitivity, hypersomnia, hyperphagia, and hysteroid personality types] were confirmed as a unique subgroup responsive to MAOls including phenelzine (Liebowitz et al. 1988]. There are indications that atypical symptomatology may also be responsive to the RlMAs such as moclobemide (Lonnqvist et al. 1994 Paykel 1995] however, results are preliminary. 

Recently, studies have addressed the use of MAOls in clinically defined populations. Liebowitz et al. [1984] studied phenelzine and imipramine in atypical depression, characterized by social rejection sensitivity similar to that seen in social phobia. Phenelzine was found to be superior to imipramine in the symptomatic relief of this interpersonal sensitivity. This finding led to subsequent studies of MAOls in populations with social phobia. 

Dunbar GC, Fuell DL The anti-anxiety and anti-agitation effects of paroxetine in depressed patients. Int Chn Psychopharmacol 6 [suppl 4) 81-90, 1992 Dunleavy DLF, Oswald 1 Phenelzine, mood response and sleep. Arch Gen Psychiatry 28 353-356, 1973... 

D PP, Tam YK, Young LT, et al Dthium decreases Gs, Gi-1 and Gi-2 alpha-subunit mRNA levels in rat cortex. Eur J Pharmacol 206 165-166, 1991 Debhch I, Yirmiya R Naltrexone reverses a long term depressive effect of a toxic lithium injection on saccharin preference. Physiol Behav 39 547-550, 1987 DebowitzMR Social phobia. Mod Probl Pharmacopsychiatry 22 141-173, 1987 Debowitz MR, Quitkin EM, Stewart JW, et al Phenelzine vs. imipramine in atypical depression a preliminary report. Arch Gen Psychiatry 41 669-677, 1984 liebowitz MR, Quitkin EM, Stewart JW, et al Antidepressant specificity in atypical depression. Arch Gen Psychiatry 45 129-137, 1988 Liebowitz MR, Schneier F, Campeas R, et al Phenelzine vs atenolol in social phobia. Arch Gen Psychiatry 49 290-300, 1992... 

Mountjoy CQ, Roth M, Garside RE, et al A chnical trial of phenelzine anxiety, depressive and phobic neurosis. Br J Psychiatry 131 468-492, 1977... 

Robinson DS, Lerfald SG, Bennett B, et al Continuation and maintenance treatment of major depression with the monoamine oxidase inhibitor phenelzine a double-blind placebo-controUed discussion study. Psychopharmacol Bull 27 31-39, 1991... 

Liebowitz MR, Quitkin FM, Stewart JW, et al Phenelzine v imipramine in atypical depression a preliminary report. Arch Gen Psychiatry 41 669-677, 1984... 

Ravaris CL, Robinson DS, Ives JO, et al Phenelzine and amitriptyline in the tteatment of depression a comparison of present and past smdies. Arch Gen Psychiatry 37 1075—1080, 1980... 

In depression, serotoninergic and/or noradrenergic neurotransmission is assumed to be deficient. One of the approaches to increase the availability of these neurotransmitters is to inhibit the activity of MAO, the enzyme involved in the degradation of serotonin and noradrenaline. Older drugs such as phenelzine and recently also moclobemide are representatives of this therapeutic approach used in some forms of depression. 

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