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Discontinuation of Manufacture of Isocarboxazid

Julian Lieb, MD
JAMA. 1994;272(22):1722. doi:10.1001/jama.1994.03520220016011.
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To the Editor.  —Recently, I and several of my patients discovered that Hoffman-La Roche Inc had discontinued manufacturing isocarboxazid (Marplan). These patients, many of whom had episodes of delusional depression, were chronically ill before being placed on isocarboxazid. All had previously failed on trials of heterocyclic antidepressants as well as the other monoamine oxidase inhibitors.I assume that what Hoffman-La Roche does not comprehend is that there is a high level of specificity in response to antidepressants. Thus, even among those who selectively respond to monoamine oxidase inhibitors rather than to heterocyclics, almost none respond to all three inhibitors, some to two of the three, and many to only one.I currently am treating a woman who, in a 10-year period of recurrent psychotic depression, has had seven lengthy hospitalizations. Hoffman-La Roche's action will condemn this woman to a recurrence of suffering and her family to the burden of having


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