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Antidepressants are a frequently prescribed class of medications. Monoamine oxidase inhibitors (MAOIs) are a less commonly prescribed subclass and are typically used in resistant major depressive disorder (MDD.). The usage of MAOIs perioperatively is notoriously regarded given the propensity to increase drug interactions and decrease sympathetic stability. We present a 51-year-old male with severe resistant MDD managed now successfully on a MAOI who presented for an elective orthopedic surgery. The patient was maintained on his MAOI through the surgery and through our attentive perioperative plan the patient was able to successfully complete the surgery with no intraoperative concerns.