A survey of prescribing practices for monoamine oxidase inhibitors

Objective: A survey examined prescribing practices for monoamine oxidase in hibitors (MAOIs) and explored reasons for the widely noted decline in their use. Methods: A one-page questionnaire was sent in 1997 to 1,129 members o f the Michigan Psychiatric Association. A total of 717 responses were recei ved, for a response rate of 64 percent. Only data from the 573 psychiatrist s who were currently practicing were used. Results: Twelve percent of the r espondents never prescribed MAOIs, 27 percent had not prescribed them for a t least three years, and 17 percent had prescribed them from one to three y ears ago. Thirty percent of the respondents had prescribed an MAOI within t he past three months, and 14 percent between three and 12 months ago. The m ost frequent reasons for not prescribing the drugs were side effects and in teractions with other medications (46 percent), preference for other medica tions (30 percent), and dietary restrictions necessary for patients taking MAOIs (19 percent). Ninety-two percent of respondents believed that MAOIs w ere useful for atypical depression, 64 percent for major depression, 54 per cent for melancholic depression, 56 percent for panic disorder, 44 percent for social phobia, 27 percent for dysthymia, 12 percent for obsessive-compu lsive disorder, and 19 percent for posttraumatic stress disorder. However, only 2 percent said they would use MAOIs as their first-line treatment in a typical depression, and only 3 percent would use them a first-line treatmen t in social phobia. Conclusions:The results document the commonly held view that practicing psychiatrists believe MAOIs are efficacious but use them i nfrequently, primarily due to concerns about side effects and drug interact ions.