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Interest has been renewed in using monoamine oxidase inhibitors (MAOIs) for treatment-resistant depression, but the lack of controlled data on their adverse effects continues to make practitioners leery. This case-control, retrospective study identified 51 MAOI users (tranylcypromine, 26; moclobemide, 25) in eight Netherlands hospitals in 2004–2010 and 149 nonusers of MAOIs, matched by hospital, type of surgery and anesthesia, and year. Researchers manually reviewed electronic hemodynamic anesthesia records to identify adverse hemodynamic effects.
The rates of hypertension, bradycardia, and tachycardia did not differ between the tranylcypromine and moclobemide groups and their comparison groups. Episodes of hypotension were fewer in the tranylcypromine group than in its comparison group (46% vs. 73%), but this was not true of moclobemide. No instances of serotonin syndrome occurred. Perioperative treatment with sympathomimetic drugs was given to almost half of the MAOI user groups, without serious adverse effects. Potential MAOI adverse effects were noted in only 40% of case records.
van Haelst IMM et al. Antidepressive treatment with monoamine oxidase inhibitors and the occurance of intraoperative hemodynamic events: A restrospective observational cohort study. J Clin Psychiatry 2012 Jul 10; [e-pub ahead of print]. (http://dx.doi.org/10.4088/JCP.11m07607)
Comment
The results from this simple but elegant study clearly demonstrate that an upcoming surgery does not warrant discontinuing a patient's monoamine oxidase inhibitor. Bias may have been introduced by not including patients whose MAOI was stopped before hospital admission. Although the study did not include phenelzine, it is thought to cause less hypertension than tranylcypromine. Anesthesiologists are aware of MAOIs' potential adverse effects and the need to avoid use of meperidine (because of case reports of its interaction with MAOIs) and indirectly acting sympathomimetics. But they may not always know about patients' MAOI use. Both psychiatrists and their patients need to make sure surgeons and anesthesiologists know when patients are taking MAOIs.