Marplan® (isocarboxazid) Tablets Facts
Identifying Cases of Treatment-Resistant Major Depression* (TRD)
Epidemiologists estimate that nearly 80% of patients may not adequately respond to their first course of antidepressant therapy. Of these there is a subset who may be treatment resistant. TRD is not consistently defined, but the common definition is failure to respond to 3 or more adequate trials of first-line antidepressant drugs10.
Use of MAO Inhibitor drugs in Treatment-Resistant Major Depression
The treatment of depression that has not responded to trials with multiple medications has rarely been systematically studied.
- ECT has been considered the primary option for treatment-resistant depression, but high rates of relapse, cognitive side effects, and poor acceptability make this option problematic3,4.
- MAO Inhibitors, such as Marplan® (isocarboxazid) Tablets, have been used as another alternative for treatment-resistant depression*1.
Avoiding Medication Interactions20
Since some medications can interact with Marplan® (isocarboxazid) Tablets and cause unwanted adverse effects, you'll want to encourage your patients to inform you of all medications they are taking, including OTC products and herbal supplements, before issuing a prescription for Marplan® (isocarboxazid) Tablets therapy.
Below is a list of medication combinations that should be avoided:
- Marplan® (isocarboxazid) Tablets should be used with caution in patients receiving Antabuse® (disulfram).
- The use of Marplan® (isocarboxazid) Tablets in combination with other psychotropic agents is not recommended, because one product can potentially magnify the effects of the other.
Marplan® (isocarboxazid) Tablets should not be used with:
- Other MAO Inhibitors, tri-cyclic medications (dibenzazepine and other); Wellbutrin® (buproprion); SSRI antidepressants; Buspar® (buspirone)
- Sympathomimetic drugs, including amphetamines and over-the-counter cold, hay fever or weight-reducing preparations containing vasoconstrictors (decongestants); tryptophan
- Demerol® (meperidine); the cough preventative, dextromethorphan; anesthetic agents, blood pressure drugs, including thiazide diuretics; excessive amounts of caffeine; central nervous system depressants such as narcotics, barbiturates, and alcohol
The MAO Inhibiting effects of Marplan® (isocarboxazid) Tablets can persist for a substantial period after it has been discontinued, so it is best to wait at least 10 days before prescribing any other psychotropic medication.
Meta-analyses of Marplan® (isocarboxazid) Tablets Clinical Trials
- In 1995 Thase, et al6, conducted a meta-analysis of 12 randomized controlled trials comparing FDA-approved MAO Inhibitor drugs in 434 depressed patients. Using the Intent-To-Treat sample method, the authors concluded that Marplan® (isocarboxazid) Tablets exhibited a 41.3% average difference vs. placebo in the number of patients randomized to treatment who demonstrated improvement. Intent-to-treat samples in five of these 12 studies revealed a Marplan® (isocarboxazid) Tablets efficacy rate of 60.1%.
- In the 1984 study of Giller, et al8, one of seven placebo-controlled studies in the meta-analysis, out-patients who were crossed over from placebo (due to lack of response) achieved a 69% response rate with Marplan® (isocarboxazid) Tablets treatment.
Rediscover efficacy in Treatment-Resistant* Major Depression
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*Treatment failure with first-line antidepressants.
Please see Full Prescribing Information including BOXED WARNINGS regarding increased risk of suicidality in children and adolescents. MAO Inhibitors are contraindicated with certain drugs. Potential hypertensive crises may occur with foods that contain tyramine. As with all antidepressants, patients should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of treatment.
Suicidality and Antidepressant Drugs
Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of Marplan® (isocarboxazid) Tablets or any other antidepressant in a child, adolescent or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Marplan® (isocarboxazid) Tablets is not approved for use in pediatric patients. (See Warnings: Clinical Worsening and Suicide Risk, Precautions: Information for Patients, and Precautions: Pediatric Use).
Pooled analyses of short-term (4 to 16 weeks) placebo-controlled trials of 9 antidepressant drugs (SSRIs and others) in children and adolescents with major depressive disorder (MDD), obsessive compulsive disorder (OCD), or other psychiatric disorders (a total of 24 trials involving over 4400 patients) have revealed a greater risk of adverse events representing suicidal thinking or behavior (suicidality) during the first few months of treatment in those receiving antidepressants. The average risk of such events in patients receiving antidepressants was 4%, twice the placebo risk of 2%. No suicides occurred in these trials.