Atypical depression is linked to bipolarity and specific response to mono amino oxidase inhibitors (MAOI), treatments not commonly used due to their complex handling. We describe a successfully treated case.

Clinical description. Depression severity is assessed with Montgomery Asberg depression rating scale (MADRS).

Female, 54-year-old. Major depression, since 2011, refractory to venlafaxine/aripiprazol and escitalopram 20mg/day. Manic episode with psychotic symptoms after potentiation with duloxetine. Diagnose of schizoaffective disorder was made, treated with aripiprazol 10mg/day, with established chronical depressive symptoms, despite addition of valproate and venlafaxine, and partial response to pramipexole up to 1mg/day.

– Decision of cleaning up aripiprazol during 8days and switch to moclobemide monotherapy was made due to atypical features. Baseline MADRS: 31. At week 2, there is change in mood, expression, psychomotor features and speech formal and content alterations. At week 4, activity increases, and biorythms normalize. At week 8 (with 600mg/day increased dose), full response is obtained, including drive, and anxiety, with MADRS 12.

– After one year of treatment, she has kept stability with no manic or psychotic symptoms emergence. Reduction in dose are linked to depression relapses. She still struggles with psychosocial recovery.

– Tolerance has been good in all moment, except for headache crisis, not linked to high blood pressure or diet.

MAOI still has a role in affective disorders treatment, given its effectiveness, unique mechanism of action and good tolerability. Targeted psychopharmacological and phenomenology knowledge can be the key to a recovery.