Diet restrictions and other precautions should not deter use of monoamine oxidase inhibitors in adolescent patients, Dr. Ginny Gerbino-Rosen said at the annual meeting of the American Society of Adolescent Psychiatry.
Monoamine oxidase inhibitors (MAOIs) are the granddaddy of antidepressants, she said. They are remarkably effective in adolescents with panic disorders, posttraumatic stress disorder, attention-deficit hyperactivity disorder, and atypical depression.
Dr. Gerbino-Rosen, chief of the young adult service at Bronx Children's Psychiatric Center, New York, gave some tips on treating patients with MAOIs:
* Diet. The diet restrictions associated with MAOI use are often described as oppressive, she said. Yet, experience has shown that these drugs are more user-friendly than people realize.
When providing adolescent patients with a list of diet restrictions, also offer the list to parents.
* Drug interactions. Avoiding drug interactions with over-the-counter medications-especially those influencing serotonin-is important. Take a field trip with the parents and the patient to the drug store and point out what they can and can't have. For example, patients taking MAOIs can use Afrin nasal spray, Benadryl, and plain Robitussin, but they can not have Dimetapp, DayQuil, or Nyquil.
Patients taking MAOIs need to avoid over-the-counter cold medicines containing pseudoephedrine or dextromethorphan, and they should avoid meperidine (Demerol).
Always be on the look out for serotonergic syndrome, which can look like neuroleptic malignant syndrome. Early signs include agitation, restlessness, irritability, anxiety nausea, diarrhea, myoclonus, and shivering. Late signs include nystagmus, hypertension, hyperthermia, flushing, and confusion.
* Switching medications. When switching a patient from an SSRI to an MAOI, a washout period of 4-6 weeks is recommended. If switching between two MAOIs, a washout period of 2 weeks is recommended.
* Hypertensive reaction. If a patient has a hypertensive reaction to an MAOI, try chlorpromazine, which has a long enough half-life to cover most reactions.
Also, consider clozapine or chlorpromazine if combining an MAOI with an antipsychotic.
Source Citation:IMPERIO, WINNIE ANNE. "Despite Restrictions, MAOIs Are Best Bet for Anxious Teens." Clinical Psychiatry News 29.9 (Sept 2001): 17. Academic OneFile. Gale. BROWARD COUNTY LIBRARY. 21 Sept. 2009
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