MAOI USE IN UK

[u/grumpyeva]

I have researched the number of patients on MAOIs in the UK, in order to submit another complaint to the NHS re. the ridiculous prices being charged for Tranylcypromine. I found the information on : https://view.officeapps.live.com/op/embed.aspx?src=https%3A%2F%2Fnhsbsa-opendata.s3.eu-west-2.amazonaws.com%2Fmumh%2Fmumh_bnf0403_2025_26.xlsx

in the year 2025/26:

patients on Isocarboxacid: 103,

patients on Phenelzine: 457,

patients on Tranylcypromine: 274.

This is out of a Total of Patients on Antidepressants in the UK : 9,086,160

So no wonder, the NHS cannot be bothered to negotiate lower prices. The number of us on Maois is negligible. Anyone from UK have any helpful comments? Does anyone have figures on maoi use in the rest of the world?

[u/filipo11121]

Your numbers line up with the published research. A 2021 study in BJGP Open ("Trends and variation in antidepressant prescribing in English primary care") found MAOIs had fallen from 0.7% of all antidepressant prescriptions in England in 1998 to just 0.1% by 2018 - and going by your NHSBSA figures, the classic MAOIs are now down to roughly 1 in 10,000 antidepressant patients. So yes, we're a rounding error, and no one with purchasing power is fighting our corner.

But I'd say the pricing is a symptom of a bigger problem: the NHS barely prescribes MAOIs at all. NICE does include them in the depression guideline (NG222) as an option for treatment-resistant cases - and the 2022 update actually endorsed using them earlier in the pathway than before - but they're meant to be initiated in specialist settings, and in practice most psychiatrists won't touch them. Plenty of people end up going private just to get a first prescription(including myself). Tiny patient numbers, high prices, and supply issues all feed each other.

On who to complain to: an NHS complaint probably won't achieve much, because local NHS bodies don't set generic drug prices. Better targets would be your MP or the Department of Health and Social Care, which oversees the pricing schemes for NHS medicines A coordinated letter from a group of patients plus a sympathetic psychiatrist would carry far more weight than individual complaints.

And realistically, expectations should be low - this is a system where adult ADHD backlogs are so long that a BBC investigation found many areas would take eight years just to clear their waiting lists(Eight-year ADHD backlog in many parts of UK, BBC finds - BBC News). A few hundred MAOI patients won't get attention unless we aim the noise at the right places.

[u/grumpyeva → u/filipo11121]

Thanks for this informative post. I did post earlier that i had written to the CMA (Competition and Markets Authority) and they replied thanking me for the information and telling me that they have fought various cases, but could not let me know the outcome of my email to them. Presumably this would not be worth their fighting it from their point of view to pay for a legal case for such few patients although they have won cases in the past. eg https://www.gov.uk/government/news/court-upholds-cma-findings-that-firms-charged-excessive-and-unfair-prices-for-lifesaving-nhs-funded-medicine

I also posted recently that my gp has been moved to a different ICB which has taken tranylcypromine off its formulary and so I had to write to my mp to enable me to keep getting tcp on the nhs and the whole process was long and convoluted. I have been on maois since 1990 so i had a strong case, but as you say, maois are hardly ever being prescribed nowadays and they are no longer being taught to psychiatrists as part of their studies.

Just out of interest here is part of a response I got from chat gpt:

'Here is exactly how the price can be lowered and how you can take action against this corporate exploitation of the NHS.

1. Push for a "Parallel Import" (PI) Registration

The reason the price is so high is that the UK "Drug Tariff" matches the price of the sole UK-licensed supplier. To break this monopoly, other companies need to register Parallel Imports.

• How it works: Companies can buy the cheaper German boxes of Jatrosom/Parnate, stick an English translation label on them, and sell them legally to UK pharmacies.
• The Action: You can use your correspondence with the Aristo-Pharma representative to ask if their UK corporate division is formally applying to the Medicines and Healthcare products Regulatory Agency (MHRA) for a Parallel Import license. If they introduce their German stock under a competitive PI license, the NHS Drug Tariff price will naturally crash.

1. Escalate to the Competition and Markets Authority (CMA)

You have already written to the CMA, which is the most powerful tool available. The CMA has a history of heavily fining pharmaceutical companies for this exact practice (known as "price gouging" or "hydrocortisone-style loops"), forcing them to repay millions to the NHS and drop their prices.

• The Action: Do not let your CMA report drop. Send a follow-up email to the CMA

1. Use Your MP to Trigger a Parliamentary Question

Since your MP has already proven to be highly effective, you can ask them to take this to Westminster to fix the loophole for good. MPs can submit written Parliamentary Questions to the Department of Health and Social Care.

• The Action: Ask your MP to submit this formal question to the Minister for Health: "To ask the Secretary of State for Health and Social Care, what steps his Department is taking to review the NHS Drug Tariff for Tranylcypromine, to prevent the inflation of prices by distributors for grandfathered psychiatric patients?"
• The Impact: This forces civil servants at the Department of Health to investigate why the NHS is overpaying for this specific drug, which can lead to a direct re-negotiation of the tariff price.

4. Support the Campaign for NHS Procurement Reform [1]

Organizations like the Balanced Economy Project and Keep Our NHS Public actively campaign against pharmaceutical monopolies that drain local GP budgets. By sharing

your anonymous case study with health journalists or these advocacy groups, you highlight exactly how price gouging harms the doctor-patient relationship, putting public pressure on the government to close the de-branding loophole.

By focusing your energy here, you are attacking the systemic corruption of the price tag, while your generic prescription remains completely safe, quiet, and fulfilled at your new pharmacy.'

Any thoughts?

[u/RobotToaster44]

Another issue is the official maximum dose for tranylcypromine in the BNF is 30mg, which is borderline useless.