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Re: Moclobemide dosage and pill frequency Berty McNotBerty

Posted by Tomatheus on November 23, 2005, at 1:03:42

In reply to Re: Moclobemide dosage and pill frequency, posted by Berty McNotBerty on November 21, 2005, at 16:50:05

Berty,

Sorry for not getting back to you sooner. I have not been well as of late (I've been at 60mg of Nardil for four full weeks now, and it still hasn't "kicked in").

It's great to hear that you're responding well to moclobemide, and I'd definitely stick with it as long as it continues to work. If it does start to "poop out" on you, I do think (for the reasons stated in my previous post) that you may benefit from raising your dose. The maximum recommended dose is 600mg/day, but based on patients' experiences posted on this board, doses as high as 1200 mg/day have been used. Furthermore, Lotufo-Neto et al. (1999) suggested that the optimal dose of moclobemide may be higher than most clinicians and researchers believe it to be. As Lotufo-Neto et al. put it, "It would appear, then, that prescription of larger doses (450 to 900mg/day) would be a rational first step for management of an ineffective but well-tolerated trial of moclobemide."

Although moclobemide does tend to get "bad reviews" from patients (moclobemide success stories on this board seem to be few and far between; it did absolutely nothing for me aside from mildly elevating my mood for the first three days of treatment), most comparative research studies show it to be modestly effective. A meta-analysis (Lotufo-Neto et al., 1999) showed moclobemide to be "at least as effective" as the SSRIs, about equally as effective as the TCAs, and somewhat less effective than the irreversible MAOIs (Nardil and Parnate).

Even though moclobemide seems to be less effective in practice than the comparative research studies suggest, I still think it's worth trying, especially after first and second-line antidepressant treatment has failed. In my opinion, it's a shame that such a unique medication is not available in the United States (unless you count the online pharmacies that sell moclobemide to Americans). Moclobemide is one of the safest and best-tolerated psychiatric medications around, and it doesn't carry those pesky dietary restrictions that Nardil and Parnate carry (why do you think I tried moclobemide before Nardil?) And of course, considering the success you've had so far with moclobemide (I'll knock on wood for you as well), I'd definitely stick with it.

Tomatheus

==

REFERENCE

Lotufo-Neto, F, Trivedi, M., & Thase, M. E. (1999). Meta-analysis of the reversible inhibitors of monoamine oxidase type A moclobemide and brofaromine for the treatment of depression. Neuropsychopharmacology, 20, 226-47.

==

> Hey Tomatheus,
> Thanks for the reply, it has helped my understanding of the whole thing. I got the 80% MAO-A inhibition thing from a Canadian monograph
>
> http://www.mentalhealth.com/drug/p30-m04.html
>
> "Pharmacology
> Antidepressant
>
> Moclobemide is a short-acting, reversible inhibitor of monoamine oxidase (MAO). It is a benzamide derivative which inhibits the deamination of serotonin, norepinephrine and dopamine. This action leads to increased concentrations of these neurotransmitters, which may account for the antidepressant activity of moclobemide.
>
> MAOs are currently subclassified into 2 types, A and B, which differ in their substrate specificity. Moclobemide preferentially inhibits MAO-A; at a 300 mg dose, the inhibition of MAO-A is approximately 80%, while that of MAO-B is approximately 20 to 30%. The estimated MAO-A inhibition is short-lasting (maximum 24 hours) and reversible."
>
> The Moclobemide seems to be working anyway for my (self diagnosed) dysthymia. I'm Social Phobic as well and I think it's at least made me "like" people more if not really dealing with the anxiety but it's all early days and encouraging mainly - touch wood it will last. Moclobemide tends to get bad reviews but maybe it's worth trying for milder depressions?
> Thanks again.
>


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poster:Tomatheus thread:579587
URL: http://www.dr-bob.org/babble/20051119/msgs/581482.html