RESUMEN
This article is a clinical guide which discusses the "state-of-the-art" usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion-this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy-while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward "bridging" methods that may be used to transition simply and safely from other antidepressants to MAOIs.
RESUMEN
PROBLEM BEING ADDRESSED: Family physicians lack access to psychiatrists and mental health services for patients with serious and persistent mental illnesses. OBJECTIVE OF PROGRAM: To develop a mentoring program to provide FPs with education and e-mail, telephone, and face-to-face support for managing patients with mental illness. PROGRAM DESCRIPTION: The Ontario College of Family Physicians' Collaborative Mental Health Care Network developed a mentoring program. Family physicians are grouped according to clinical interest with psychiatrist and general practice psychotherapist mentors whom they can contact for help. Communication is established via e-mail, telephone, fax, or listserv, or even face to face. Monitoring and evaluation is carried out through surveys and chart audits to examine use of, satisfaction with, and effectiveness of the program. CONCLUSION: Mental health care can be enhanced through collaborative at-a-distance relationships between FPs and psychotherapists and psychiatrists. Family physicians can get timely consultation in the areas of psychotherapy and pharmacotherapy, and access to community resources.
