What antidepressant should be avoided in a male patient with major depressive disorder and a history of substance abuse according to the American Psychological Association (APA) guidelines?

From the Research

According to APA guidelines, monoamine oxidase inhibitors (MAOIs) should be avoided in patients with major depressive disorder who have a history of substance abuse. MAOIs such as phenelzine, tranylcypromine, and isocarboxazid can have dangerous interactions with many substances of abuse, particularly stimulants, opioids, and alcohol, as noted in studies discussing the comorbidity of depression and substance use disorders 1, 2. These interactions can lead to potentially life-threatening hypertensive crises, serotonin syndrome, or enhanced central nervous system depression. Additionally, MAOIs require strict dietary restrictions to avoid tyramine-rich foods, which may complicate treatment adherence in patients with substance use disorders.

Better antidepressant options for these patients include:

• SSRIs (like sertraline or fluoxetine)
• SNRIs (like venlafaxine)
• bupropion, which generally have fewer dangerous interactions with substances of abuse and may be better tolerated, as suggested by research on the efficacy of different antidepressants in patients with co-occurring depression and substance use disorders 3, 4. When treating depression in patients with substance use disorders, it's also important to address both conditions simultaneously, possibly incorporating psychotherapy approaches specifically designed for dual diagnosis, a strategy supported by studies examining the course of depression in substance-dependent patients 5.