We met up with Stephen Stahl and found something we all agree on.

Three reasons to use an M-A-O-I.

Welcome to the Carlyte Psychiatry Podcast, keeping psychiatry honest since 2003.

I'm Chris Aiken, the editor-in-chief of the Carlat's Psychiatry Report.

And I'm Kelly Newsom, a psychiatric MP and a dedicated reader of every issue.

Stephen Stahl isn't known as a promoter of generic drugs.

Between 2014 and 2020, Stahl was the top earner on OpenPayments.com, bringing in 8.6 million in speaking and consulting

fees over those six years, more than half of which was from Tequita, maker of Trintellix.

So we were surprised to find Stahl speaking on a long-forgotten generic this year at the APA meeting in San Francisco.

Stahl is writing a book on lithium.

He just finished one on clozapine, and he hosted a seminar at the conference, whose wordy title

is a call to action.

If you are a psychiatrist, you need to know how to prescribe

monoamine oxidase inhibitors guide for MEOIs so an effective treatment option is not lost.

Today, we're going to bring you some highlights from his talk.

MAOIs are known as a second or third line option for treatment-resistant depression,

but Stahl pointed out their benefits in treatment-resistant cases

are not backed by the kind of gold standard science we have for meds like a ripiprosol.

He did highlight a randomized double-blind crossover trial from 1993 that compared to the M-A-O-I-Fenalzine with a tricyclic amypramine in 89 patients with chronic non-melancholic treatment-resistant depression.

The study was done by one of the founders of psychopharmacology, Donald Klein and Jonathan Stewart, who was one of the

presenters at the talk. This was a much-talked-about study in the 1990s, so it was good to see it back

in the slide deck. The patients were not truly treatment-resistant as they had failed just one

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