Posted by Tomatheus on January 8, 2006, at 11:26:25
In reply to Re: Moclobemide-does it really work}} Tomatheus, posted by sdb on January 8, 2006, at 5:37:01
See below for my responses...
> In our "holy bible" the official state pharmacology book for medical personal was written: With this dosage (lower than you have suggested) you will have marked improve in seven days! -I think it's totally not true what is written in the thick book!
I agree, and I'm a little perplexed as to how the authors of a state pharmacology book (or any pharmacology book, for that matter) can make the claim that a patient *will* have marked improvement from moclobemide or any other drug. From my perspective, this implies that all patients will be responsive to this drug. And obviously, this isn't true of any drug; if it were, the drug's response rate would be 100 percent in every clinical trial. It would be pretty awesome if such a wonder drug could exist, but as I'm sure you know, it would be impossible to develop such a drug in the "real world" for a variety of reasons. Perhaps the authors of this pharmacology book should try writing fantasy novels instead.
I should point out that it is my understanding that 600mg/day of moclobemide is the highest recommended dose just about everywhere it is available (if not everywhere). I live in the United States, and moclobemide actually isn't available here either by prescription or over the counter, so I ended up obtaining my moclobemide online and getting my information on the drug from Web sites and scientific research articles. Of course, I'm not taking it any more, as my trial was unsuccessful.
Even though it is not officially recommended to exceed 600 mg/day of moclobemide, it has been suggested in the scientific literature that higher doses might be more beneficial. According to Lotufo-Neto et al. (1999), moclobemide has a "wide therapeutic index," and although the therapeutic dosage typically ranges from 300 to 450 mg/day, some patients benefit from doses of 900 mg/day or higher. The authors of this study even pointed out that as much as 20,000 mg of moclobemide have been ingested without fatality, but this isn't something that they recommended, and it's obviously not something that I would recommend either.
> Phenelzine, marplan...are just no more available in my country and is fully replaced by moclobemide.
That, of course, is unfortunate in my opinion. Studies comparing moclobemide with the irreversible MAOIs have consistently shown moclobemide to be less effective than its irreversible counterparts. So, that basically just leaves you hanging and wondering if the best medication for you might be something that you can't even get a hold of. Of course, the same argument can be made about moclobemide (and Marplan) here in the United States, considering that there's no way of getting it by 100 percent legal means.
> What I could to is to do a trial of moclobemide again.
That might not be such a bad idea. At least with moclobemide, you won't have to wait so long at any given dose before finding out whether or not or not it will actually work. But as I said, remember that results are not guaranteed. I don't care what that pharmacology book says.
> I will eventually babble-mail you regarding mao's if you are pleased to respond :-)
Sure, feel free to do so when you get a chance.
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.