Why Aren't MAOIs Used More Often?

While I have spent most of my last 45 years in psychiatry
working in an academic setting and doing clinical research, I
have always had an active practice focused on major affective
disorders, especially treatment-resistant or treatment-refractory
cases. It is my impression that monoamine oxidase inhibitors
(MAOIs) are currently underutilized in the clinical practice of
psychiatry. Very few of the treatment-resistant patients that I
see have received a serious trial of MAOI therapy.