Reversible selective MAOIs such as<unk>  are widely underprescribed due to the misconception that the side effect profiles are analogous to that of the irreversible and non-selective MAOIs. MAOIs such as<unk>  are reported to have a relatively fast onset of action compared to other antidepressant drug classes, and have good long-term tolerability in terms of side effects. Tolerance does not seem to occur; research has found that<unk>  retains its beneficial therapeutic properties in depression for at least a year. *Unipolar depression.<unk>  has demonstrated effectiveness and efficacy in the treatment and management of major depressive disorder, with both endogenous and non-endogenous depression responding; in addition<unk>  has a fast onset of action compared to other antidepressants and is significantly more tolerable than the tricyclic antidepressants. Due to a very good safety profile and very low incidence of side effects<unk>  is likely to have a high level of acceptability by individuals suffering from depression. Higher doses (>450 mg/day) may be more effective in severe depression, while patients treated with a lower dose tend to respond less well than those treated with tricyclic antidepressants. : Psychotic depression, unipolar endogenous depression, melancholic depression, retarded depression, agitated depression and neurotic depression all respond to<unk> . As does atypical depression. Unipolar endogenous depression is reported to have the best response to<unk>  therapy. Individuals suffering from depression who are given<unk>  are twice as likely to improve on<unk>  than on placebo. A concern of antidepressant adverse effects is sexual dysfunction; however,<unk>  has actually been found to increase the libido and also improve impaired erection, ejaculation and orgasm. Cardiovascular toxicity is a concern with antidepressants such as tricyclic antidepressants as well as the irreversible MAOIs; when cardiovascular toxicity is a concern, SSRIs or the reversible MAOIs such as<unk>  are an option as they lack or have a significantly reduced level of cardiovascular toxicity in terms of adverse effect as well as in overdose. :The effectiveness of<unk>  in agitated depression is equivalent to that of imipramine and sedative antidepressants such as amitriptyline, mianserin and maprotiline. The therapeutic response in agitated depressive individuals is similar to that seen in non-agitated depression; however, a past history of use of antidepressants reduces the chance of successful therapeutic response. The addition of a benzodiazepine to<unk>  therapy has not been found to be of benefit in this population group.<unk>  cause less side effects than imipramine. and it has better tolerability compared to TCAs. * Bipolar depression. While not generally recommended as a monotherapy for bipolar depression (as with all antidepressants) in one clinical trial it appeared (although statistical significance at the p=0.05 was not reached) as though<unk>  was equally effective as imipramine at reducing depressive symptoms, but had a significantly lower risk of causing a manic switch. This is in line with recent findings that MAOIs as a class are superior to other antidepressants (in terms of both their relatively low rate of manic switching and their efficacy) in the treatment of bipolar depression. *Dysthymia;<unk>  has been found to be effective in the treatment and management of this depressive disorder. *Social phobia.<unk>  has been found to be effective for the treatment of social anxiety disorder in both short and long-term placebo controlled clinical trials.<unk>  is effective but not as effective as the irreversible MAOIs in the treatment of social phobia. Maximal benefits can take 8 – 12 weeks to manifest. There is a high risk of treatment failure if there is co-morbid alcohol use disorder, however. The Australian Medicines Handbook lists social phobia as an accepted but not a licensed indication. The use of<unk>  in the treatment of social anxiety disorder has given mixed results with a tendency of response at higher doses (>300 mg/d) compared with placebo. *Smoking cessation.<unk>  has been tested in heavy dependent smokers against placebo based on the theory that tobacco smoking could be a form of self-medicating of major depression, and<unk>  could therefore help increase abstinence rates due to<unk>  mimicking the MAO-A inhibiting effects of tobacco smoke.<unk>  was administered for 3 months and then stopped; at 6 months follow-up it was found those who had taken<unk>  for 3 months had a much higher successful quit rate than those in the placebo group. However, at 12-month follow-up the difference between the placebo group and the<unk>  group was no longer significant. *Panic disorder.<unk>  is useful in the treatment and management of panic disorder. Panic disorder is mentioned as an accepted but unlicensed indication in the Australian Medicines Handbook. *ADHD. Two small studies assessing the benefit of<unk>  in people with attention deficit disorder found that<unk>  produced favourable results. *Fibromyalgia,<unk>  has been found to improve pain and functioning in this group of people. *Migraine.<unk>  has been reported to be effective in the treatment of migraine and chronic tension headache. Similar to other MAOIs, reversible MAOIs such as<unk>  may also be effective in a range of other psychiatric disorders. Menopausal flushing may also respond to<unk> .<unk>  may also have benefit for some patients with Parkinson's Disease by extending and enhancing the effects of l-dopa. In efficacy studies for the treatment of major depressive disorder,<unk>  has been found to be significantly more effective than placebo, as effective as the tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), and somewhat less effective than the older, irreversible MAOIs phenelzine and tranylcypromine. In terms of tolerability, however,<unk>  was found to be comparable to the SSRIs and better tolerated than the TCAs and older MAOIs. There is some evidence that<unk>  on its own or in combination with other antidepressants such as SSRIs is also effective for treatment resistant depression and that the combination can be administered without the development of serotonin syndrome; however, further research is needed before such a combination can be recommended. Follow-up studies show that ongoing use of antidepressants leads to continuing improvement in depression over time; and also have demonstrated that<unk>  retains its therapeutic efficacy as an antidepressant for at least a year. This long-term efficacy is equivalent to that seen with other antidepressant classes. People on irreversible MAOIs have to discontinue these antidepressants two weeks before general anesthesia, however, the use of<unk>  due to its reversible nature, would allow such patients to possibly continue antidepressant therapy. A dexamethasone suppression test (DST) and plasma and urine methoxyhydroxyphenylglycol (MHPG) test can be used to estimate who is likely to respond to<unk>  antidepressant therapy. Pregnancy and lactation The doses of<unk>  in breast milk are very low (0.06% of<unk>  being recovered in breast milk) and therefore it has been concluded that<unk>  is unlikely to have any adverse effect on a suckling baby. Children Use in children is not recommended as there is insufficient data to assess their safety and efficacy in these patients. Elderly Reversible MAOIs such as<unk>  may have advantages in the treatment of depression associated with Alzheimer's disease due to its effect on noradrenaline. Cognitive impairments have been found to improve in people with dementia when depression is treated with<unk> . Due to its superior safety profile,<unk>  has been recommended as a first line agent for the treatment of depression in the elderly. Due to the side effect profile of<unk> , it may be a better option for this sub group of people than other antidepressants. Research has found evidence that<unk>  may be able to counter anti-cholinergic (Scopolamine) induced cognitive impairments thus making<unk>  a good choice in the depression in the elderly and those with dementia.
Moclobemide
Torasemide
Altretamine
Bumetanide
Yohimbine
Brimonidine
Clonidine
Amiloride