<prompt> A 25-year-old male presents for ECT electroconvulsive shock therapy at a free-standing facility. He has a life- threatening depressive illness that has not responded adequately to medication, however he is still taking tranylcypramine Parnate. You shouldcancel the procedure, cease the tranylcypramine and perform the ECT in 2 weeksproceed with the ECT, but induce with midazolam and remifentanilproceed with the ECT, but pre-treat with esmololroceed with the ECT with caution, but with your usual drugs  <response>: Concerns regarding MOAI 1. sympathetic hyperreactivity 2. ECT results in vagus stimulus followed by overwhelming sympathetic surge Therefore there is a significant risk of hypeensive crisis with MOAIs in ECT Electroconvulsive therapy in patients taking monoamine oxidase inhibitors. there is no evidence of a dangerous interaction between ECT and MAOI use. In general, a cautious approach would be to discontinue MAOIs before ECT if the medication has not been helpful; however, there is no need for a washout interval before staing ECT. Fuhermore, if there is otherwise a reason for continuing the MAOI, it can be continued during index ECT or initiated during maintenance ECT. 