Tranylcypromine: A review

In the six years since it was added to the antidepressant agents, tranylcypromine has attracted wide attention because of toxic side reactions and disputed efficacy. It was the first clinically important nonhydrazine monoamine oxidase inhibitor, and it remains Widely used. This review attempts fully to present the history, pharmacology, clinical toxicology, and evidence for the degree of clinical value of the drug in the treatment of depression. The hypertensive syndrome most notable among the drug's adverse reactions probably occurs very infrequently but is largely an unpredictable phenomenon. Fifty‐four of the fifty‐six published clinical trials have been assessed. Many were uncontrolled, encumbered by other concurrent treatments and heterogeneous patient samples, or inadequately reported. Assessment of trials indicated that the drug alone was beneficial in reactive and psychoneurotic depressions, while it tended not to influence agitated, psychotic, or endogenous depressions. Where the drug was compared to other treatments for depreSsion, it was found equivalent or superior to other monoamine oxidase inhibitors in several trials, while it was generally inferior to iminodibenzyl compounds and to electroshock treatment. The findings support a view that tranylcypromine is not the treatment of choice for depression but that it may be indicated where other drugs or ECT have failed.