The historical roots of the current avoidance of MAOIs are reviewed. A practical approach to the careful prescription of MAOIs is outlined. Medical contraindications, side effects and their management and drug and food interactions with MAOIs are discussed. With careful patient selection, adequate caution by the physican, and appropriate preparation of the patient, MAOIs are often uniquely effective (as in endogenous anxiety) and have an acceptably low potential for serious toxicity.