MAOI efficacy and safety in advanced stage treatment-resistant depression - a retrospective study

Objective: Evidence-based data suggest that MAOI therapy may be effective in up to 50% of patients with treatment-resistant depression (TRD). We hypothesized that MAOI therapy is similarly effective in patients with advanced stage TRD who are unresponsive to >= 4 prior antidepressant drug (AD) trials compared to patients with early stage TRD who are unresponsive to <= 3 prior AD trials. Methods: To test this hypothesis, data were harvested from 400 patient charts. Of these, 59 patients received a total of 75 MAOI treatment trials. 50 patients had I MAOI trial and 9 patients had 2 or more MAOI trials. Response was assessed using the Clinical Global Impressions Change (CGI/C) scale. Results: 56% of MAOI trials resulted in a CGI/C score of 1 ("very much better") or 2 ("much better"). Only 25% resulted in a CGI/C score of 4 or more ("no change" or "worse"). 32.5% of MAOI trials resulted in a CGI/C score of 1 in patients with early stage TRD, while only 12.1% of MAOI trials resulted in a CGI/C score of 1 in patients with advanced stage TRD (p = 0.04). There was a significant negative correlation between the number of prior, failed AD trials and the final CGI/C score (p = 0.03). The odds associated with attaining a CGI/C score of 1 diminished by a factor of 30% with each prior failed AD trial. We observed only 1 case of acute hypertension which responded to sublingual nifedipine therapy. Limitations: The sample size was limited, and MAOI outcome was not compared with other AD therapy. The adequacy of prior AD trials could not always be verified. Conclusion: These data suggest that MAOI therapy may be beneficial in patients with early stage TRD who are unresponsive to <= 53 prior treatments. However, the relative efficacy of MAOI therapy in advanced stage TRD remains uncertain. (c) 2005 Elsevier B.V. All rights reserved.