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In this This Is Why pharmacology review, Dr. Busti demystifies the monoamine oxidase inhibitors (MAOIs)—an older but still clinically relevant antidepressant class. You’ll learn why MAOIs remain valuable for treatment-resistant depression, how they differ mechanistically from SSRIs/SNRIs/TCAs, and what safe, modern usage looks like. We cover agents and formulations—including the practical distinction between selegiline oral (Parkinson’s disease) vs selegiline transdermal (MDD)—and walk through irreversible MAO-A/MAO-B enzyme inhibition, pharmacodynamic implications, and the rationale behind washout periods. You’ll also get crisp frameworks for drug–drug and drug–food (tyramine) interactions, hypertensive crisis prevention, and real-world monitoring and counseling (patch placement/rotation, MRI precautions, OTC/herbal pitfalls like decongestants and St. John’s wort). Download the companion tables (indications, interactions, tyramine foods, counseling checklists) to keep handy for boards, precepting, and bedside teaching at https://www.thisiswhy.health/topics/p... Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard in this content. 🧭 Chapter Table of Contents 00:00 Introduction to MAOI Antidepressants & Historical Context 01:27 Why MAOIs Caution: Safety Concerns, Side Effects & Drug Interactions 04:54 MAOI Clinical Indications: Depression Subtypes & When MAOIs Are Considered 06:00 MAOI Formulations: Oral Agents vs Selegiline Transdermal Patch 07:46 Mechanism of Action: MAO-A vs MAO-B Inhibition & Neurotransmitter Effects 09:16 Serotonin Modulation & Interaction Risks with Other Antidepressants 14:08 Side Effect Profiles: CNS Effects, Orthostasis, Weight Changes & Sleep Disturbance 28:16 Hypertensive Crisis: Tyramine Reactions & High-Risk Foods to Avoid 30:01 Dietary Restrictions Explained: Tyramine Metabolism & Patient Counseling