What is the last choice for antidepressant medication?

Monoamine oxidase inhibitors (MAOIs) are generally considered a last-line treatment for depression, particularly due to their side effect profile and dietary restrictions. They work by inhibiting the monoamine oxidase enzyme, which increases levels of neurotransmitters such as serotonin, norepinephrine, and dopamine in the brain. However, the use of MAOIs is often limited because they can lead to hypertensive crises if patients consume tyramine-rich foods, and they may interact adversely with a variety of medications, including over-the-counter drugs.

These factors contribute to the cautious approach clinicians take when prescribing MAOIs, typically opting for them only when other classes of antidepressants (like SSRIs, TCAs, or NDRIs) have failed to provide relief. In clinical practice, effective management of depression often begins with SSRIs due to their favorable side effect profile and ease of use, while TCAs and NDRIs may be considered if SSRIs are not effective or not tolerated. Hence, MAOIs find their place at the end of the treatment algorithm as a consideration when other options have not yielded sufficient therapeutic response or improvement in the patient's condition.