Meta-analysis of the reversible inhibitors of monoamine oxidase type A moclobemide and brofaromine for the treatment of depression

The reversible inhibitors of monoamine oxidase type A (RIMAs) are a newer g roup of antidepressants that have had much less impact on clinical psychoph armacology than another contemporary class of medications, the selective se rotonin reuptake-inhibitors (SSRIs). The RIMAs agents are distinguished fro m the older monoamine oxidase inhibitors (MAOIs) by their selectivity and r eversibility. As a result, dietary restrictions are not required during RIM A therapy, and hypertensive crises are quite rare. In this article, we desc ribe a series of meta-analyses of studies of the two most widely researched RIMAs, moclobemide (MOC; Aurorex) and brofaromine (BRO). Our findings conf irm that both BRO and MOC are as effective as the tricyclic antidepressants , and they are better tolerated. However, BRO is not being studied at prese nt for reasons unrelated to efficacy or side effects. MOC, which is availab le throughout much of the world (but not the United States), is significant ly more effective than placebo and, at the least, comparable to the SSRIs i n both efficacy and tolerability. For MOC, higher dosages may enhance effic acy for more severe depressions. We also found evidence that supports clini cal impressions that MOC is somewhat less effective, albeit better tolerate d, than older MAOIs, such as phenelzine or tranylcypromine. Little evidence has yet emerged to suggest that the RIMAs share older MAOIs' utility for t reatment of depressions characterized by prominent reverse neurovegetative features. Based on available evidence, the RIMAs appear to have a limited, but useful, role in the differential therapeutics of the depressive disorde rs. [Neuropsychopharmacology 20:226-247, 1999] (C) 1999 American College of Neuropsychopharmacology. Published by Elsevier Science Inc.