Treatment strategy in depression. II. MAO inhibitors in depression resistant to cyclic antidepressants: two controlled crossover studies with tranylcypromine versus L-5-hydroxytryptophan and nomifensine

Acta Psychiatr Scand. 1988 Dec;78(6):676-83. doi: 10.1111/j.1600-0447.1988.tb06403.x.


Antidepressants are ineffective in about 30% of the patients with major depression. Besides electroconvulsive therapy (ECT) and lithium, MAO inhibitors have been suggested as an alternative in such patients. In 2 controlled, partial crossover studies involving 47 patients with major depression who had already been treated unsuccessfully with at least 2 cyclic antidepressants, the effect of the MAO inhibitor tranylcypromine was studied. The first study was an open comparison with L-5-hydroxytryptophan (L-5HTP), the second study a double-blind comparison with nomifensine. Neither the patients treated with L-5HTP nor the patients treated with nomifensine, except one, improved. In contrast, tranylcypromine was effective in 50% of the patients. The depressions of the responders to tranylcypromine appeared to be more endogenous (according Newcastle Scale II) and of shorter duration than those of the non-responders. It is concluded that MAO inhibitors such as tranylcypromine are an effective alternative to ECT and lithium in patients with major depression who have failed to respond to cyclic antidepressants.

Publication types

  • Clinical Trial
  • Comparative Study
  • Controlled Clinical Trial

MeSH terms

  • 5-Hydroxytryptophan / therapeutic use*
  • Adult
  • Aged
  • Clinical Trials as Topic
  • Depressive Disorder / drug therapy*
  • Depressive Disorder / psychology
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Drug Administration Schedule
  • Drug Resistance
  • Female
  • Fluvoxamine
  • Humans
  • Male
  • Maprotiline / analogs & derivatives
  • Maprotiline / therapeutic use
  • Middle Aged
  • Nomifensine / therapeutic use*
  • Oximes / therapeutic use
  • Psychological Tests
  • Tranylcypromine / therapeutic use*


  • Oximes
  • Nomifensine
  • Maprotiline
  • Tranylcypromine
  • hydroxymaprotilin
  • 5-Hydroxytryptophan
  • Fluvoxamine