Psych CASC / OSCE · Psychopharmacology — monoamine oxidase inhibitors
Explaining MAOI diet, washouts and patch options (CASC)
CASC-style communication station: shared decision on classic MAOI versus selegiline patch, practical tyramine teaching, washouts, and absolute drug bans without terror or false reassurance.
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Station instructions (candidate)
You have 7 minutes. Explain why an MAOI is being considered after multiple failed antidepressants, what the tyramine diet means in practical language, which medicines are absolute no-list items (including tramadol and many cold remedies), and how the selegiline patch differs on diet rules at 6 mg/24 h versus higher doses. Balance hope from TRD/atypical-depression evidence with honest safety requirements. Do not guarantee cure. Do not dismiss fear. Offer written materials and follow-up.[1][2][3][6]
References6ShowHide
- [1]Van den Eynde V, Abdelmoemin WR, Abraham MM, et al. The prescriber's guide to classic MAO inhibitors (phenelzine, tranylcypromine, isocarboxazid) for treatment-resistant depression CNS Spectr, 2023.PMID 35837681
- [2]Van den Eynde V, Gillman PK, Blackwell BB The Prescriber's Guide to the MAOI Diet-Thinking Through Tyramine Troubles Psychopharmacol Bull, 2022.PMID 35721816
- [3]Bodkin JA, Amsterdam JD Transdermal selegiline in major depression: a double-blind, placebo-controlled, parallel-group study in outpatients Am J Psychiatry, 2002.PMID 12411221
- [4]Amsterdam JD A double-blind, placebo-controlled trial of the safety and efficacy of selegiline transdermal system without dietary restrictions in patients with major depressive disorder J Clin Psychiatry, 2003.PMID 12633131
- [5]Gillman PK Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity Br J Anaesth, 2005.PMID 16051647
- [6]Liebowitz MR, Quitkin FM, Stewart JW, et al. Antidepressant specificity in atypical depression Arch Gen Psychiatry, 1988.PMID 3276282