Discussing it with your doctor, without imposing anything.
Many physicians have never had the opportunity to use classic MAOIs — they now account for less than 0.1% of prescriptions. Here is a short, respectful letter to print and bring to an appointment, simply to open the discussion — together with reliable medical sources that a practitioner can verify.
For the attention of my doctor
Dear Doctor,
I would like to put forward a possible subject for discussion regarding my treatment. While trying to understand depression that resists usual treatments, I learned about an older class of antidepressants: the so-called “classic” MAOIs — tranylcypromine (Parnate), phenelzine (Nardil) and isocarboxazid (Marplan).
My understanding is that they are among the most effective options for treatment-resistant forms, but are now prescribed very rarely — not because they lack efficacy, but because they require specific know-how: a low-tyramine diet and certain drug combinations that must be avoided. I understand that these are not trivial treatments.
I am certainly not trying to tell you what course to follow: I would simply like to know whether this option could, at some point, make sense in my situation — and, if so, to discuss it with you.
To make this easier, I have listed below a few recent, reliable medical references, including an open-access prescribing guide endorsed by more than 70 international experts.
Thank you for considering this. I remain open to your advice.
Yours sincerely,
your name
• Van den Eynde V, Gillman PK, et al. “The prescriber's guide to classic MAO inhibitors… for treatment-resistant depression.” CNS Spectrums 2023;28(4):427–440. Open access: doi.org/10.1017/S1092852922000906
• Ulrich S, Ricken R, Adli M. « Tranylcypromine in mind (Part I & II). » European Neuropsychopharmacology 2017;27(8):697–731.
• General information: parnate.ch
Tip: click “your name” in the letter to replace it before printing. Today’s date is inserted automatically.
For your doctor — the sources
What carries weight with a practitioner is not a website but a verifiable primary source. Here are the references underlying this page. The originals are in English (one is in German); the summaries below are ours.
This website provides general information and cannot replace advice from a physician or pharmacist. Do not make any treatment decision without a healthcare professional. MAOIs involve real precautions — dietary and, above all, drug-interaction precautions — which are detailed on the relevant pages.