Patients who take an antidepressant for less than six months are shown to have a high symptomatic relapse rate. However, patients should take the antidepressant for at least six months for the maximal therapeutic benefit. Usually, the medication starts to become effective within two to three weeks. When patients are prescribed antidepressants like MAOIs, they must be aware of the time it takes to start experiencing the therapeutic effects of the drug. The different types of MAOIs approved by the FDA include isocarboxazid, phenelzine, selegiline, and tranylcypromine. Patients with lower doses of MAOIs may not have to be as strict with their diet as those with higher doses. An example of this is selegiline, which can be given in a skin patch and causes fewer side effects than oral administration. The skin patches were FDA approved and can be more beneficial to patients than oral dose forms. MAOI administration is almost always orally but sometimes comes in the form of a skin patch. Selegiline in low doses is a selective, irreversible MAO B inhibitor, but it is no longer selective at higher doses. Moclobemide is an example of a reversible MAOI I (RIMA), tranylcypromine, phenelzine, isocarboxazid, and selegiline irreversibly inhibit MAO.
Selegiline and rasagiline are irreversible and selective inhibitors of MAO type B, but safinamide is a reversible and selective MAO B inhibitor.
Dopamine and tyramine are metabolized by both MAO A and B. The MAO A is mostly distributed in the placenta, gut, and liver, but MAO B is present in the brain, liver, and platelets. Serotonin and noradrenaline are substrates of MAO A, but phenylethylamine, methylhistamine, and tryptamine are substrates of MAO B. There are two types of monoamine oxidase, A and B. MAOIs inhibit the breakdown of these neurotransmitters thus, increasing their levels and allowing them to continue to influence the cells that have been affected by depression. The monoamine oxidase enzyme breaks down different types of neurotransmitters from the brain: norepinephrine, serotonin, dopamine, and tyramine. Monoamine oxidase inhibitors are responsible for blocking the monoamine oxidase enzyme.
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