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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by sdb on January 2, 2006, at 16:06:01
Is moclobemide really working for somebody against depression/anxiety....(dosages daily/days until it kicked in)?
There are controversial studies. One of them an US study, which conclusion is, that it does <not> work. And thats what I believe.According to our "smart" national compendium a remarked efficace is just coming after the 7th day and you will sleep immediately better. But it should not be prescribed for some people because they would use it only as a substance to be better in school...I am just laughing :-)...it sounds like fairy stories or sadly a prospectus of the Roches current sold drugs.
In my country moclobemide is considered as the standart treatment for social phobia and for minor depression (they actually replaced moclobemide/tranylc. with moclobemide, I believe because of patent thus money reasons). Roche could really do more, perhaps selling older drugs as generics and invent some other things in their billion CNS research center and do more collaborating with CNS research center next Basel University.
*the life begins with birth and everybody is equal. /civil of law of state ** -somebody read something more dummy?
I am just tired hope the good sleep now will remain.
Posted by blueberry on January 2, 2006, at 18:15:47
In reply to Moclobemide-does it really work for sombody here?, posted by sdb on January 2, 2006, at 16:06:01
For me it works great in bringing on a deep dark depression on top of my already existing depression. I tried it only for 3 days at 150mg and it was aweful. I felt so much better just to get back to my regular depression after stopping moclobemide. Moclobemide was deep and scary for me.
Posted by Phillipa on January 2, 2006, at 19:01:06
In reply to Re: Moclobemide-does it really work for sombody here?, posted by blueberry on January 2, 2006, at 18:15:47
What is it? Fondly, Phillipa
Posted by sdb on January 2, 2006, at 21:18:59
In reply to Re: Moclobemide-does it really work for sombody here?, posted by Phillipa on January 2, 2006, at 19:01:06
its a reversible mao-a inhibitor. not available in the us. there are controversial studies, controversial experiences (placebo?)
Posted by med_empowered on January 3, 2006, at 2:11:55
In reply to Re: Moclobemide-does it really work for sombody here?, posted by sdb on January 2, 2006, at 21:18:59
hi! From the studies I've read, it seems like the big problem is getting the dose high enough. With the SSRIs, usually you hit a plateua of efficacy--you can raise the dose some more, get a few more responders (and more dropouts from side effects), but not major change--with mocobemide, it seems like the dose **has** to be ramped up a good bit to get a significant response...I read one doc's opinion of it, where he recommended at least 900mgs/day, possibly moving up to 1200. That said..it does seem like there are more failures with it than with other meds.
Posted by sdb on January 6, 2006, at 19:04:52
In reply to Re: Moclobemide-does it really work for sombody here?, posted by med_empowered on January 3, 2006, at 2:11:55
thanks for the info. Your doc may be right.
Recommended dosages in FDA docs or in many other compendiums are very rarely right. Dosages may vary from person to person.
In my moclobemide trial i did exatly what was written in the doc. I think that was a mistake.
But what I am angry about is, that the doc of moclobemide promises you just inpossible things. I am wondering about the statement "very good improvement in depression in just 7 days", how it is possible with such low dosages in that short time with a weak reversible mao?sdb
Posted by sdb on January 7, 2006, at 10:10:00
In reply to Re: Moclobemide-does it really work for sombody here?, posted by sdb on January 6, 2006, at 19:04:52
Posted by Tomatheus on January 8, 2006, at 0:12:19
In reply to Re: Moclobemide-does it really work for sombody here?, posted by sdb on January 6, 2006, at 19:04:52
> But what I am angry about is, that the doc of moclobemide promises you just inpossible things. I am wondering about the statement "very good improvement in depression in just 7 days", how it is possible with such low dosages in that short time with a weak reversible mao?
sdb,
Even though I question moclobemide's ability to produce a "very good improvement in depression" in most patients at a low dose, I do think that this improvement (if it were to actually happen) would likely become apparent within a week, if not sooner. How could this be possible? Unlike the irreversible MAOIs (e.g., Nardil and Parnate), moclobemide is extremely short-acting. Because Nardil and Parnate are irreversible, the "effects" of just one dose of either of these medications last for approximately two weeks. So, for every dose of Nardil or Parnate that a patient takes during the first two weeks of treatment, the amount of MAO inhibition in the brain (and elsewhere) rises by a certain percentage. Finally, after approximately two weeks at a given dose of Nardil or Parnate, the percentage of MAO inhibition in the brain stops rising and reaches a relatively constant level.
With moclobemide, the percentage of MAO inhibition produced by one dose returns to 100 percent after only 16 hours (Nair et al. 1993) - and remember, this is in comparison to two weeks with Nardil and Parnate. This, of course, is due to moclobemide's reversibility. Instead of binding to the MAO enzymes until they lose their functionality, moclobemide only binds to the enzymes (well, in this case just MAO-A) temporarily. Considering that it takes less than a day for the percentage of MAO inhibition from one dose of moclobemide to return to 100 percent, the percentage of MAO-A inhibition produced by moclobemide doesn't continue to rise each day for two weeks until it reaches a constant level of MAO-A inhibition. At most, it would only take a few days for this to happen on moclobemide. From what I can tell, it seems that most MAOIs (if not all MAOIs) begin exerting their therapeutic effects once the percentage of MAO inhibition reaches a constant level. So, because it doesn't take very long for this constant level to be reached on moclobemide, it begins working relatively quickly (i.e., within a week).
Now, I would also argue that the "constant level" of MAO-A inhibition produced by moclobemide is not actually all that constant, especially at the lower doses. I should make it clear that when I said that moclobemide's percentage of MAO-A reaches a "constant level" after a few days at most, I was referring to the fact that the range of MAO-A inhibition does not change from one day to the next. So, if the percentage of MAO inhibition ranged from 30 percent to 80 percent within the course of a day, the MAO-A inhibition would be at a "constant level" (as I described it) if the range of MAO inhibition were to remain the unchanged (still ranging from 30 percent to 80 percent) the following day. As I'm sure you can see, what I described as a "constant level" of MAO-A inhibition is still anything but constant because the level of MAO-A inhibition still varies considerably over the course of a day (btw, the figures of 30 percent and 80 percent are just percentages that I made up to illustrate the fact that the percentage of MAO-A inhibition provided by moclobemide could vary significantly over a given period of time). I'm just hypothesizing here, but I have reason to suspect that this variability in MAO-A inhibition is at least part of the reason why moclobemide tends to be rather ineffective in practice. If you're looking to get any kind of therapeutic response from moclobemide, I think that your best bet would be to take a high daily dose (e.g., 900-1200 mg/day) and to space your doses throughout the day as much as you possibly can. This way, you'll be getting more consistency in moclobemide's MAO-A inhibition than you could get from taking a lower dose and/or taking all of the pills at the same time each day.
Of course, I'm not suggesting that your results will be guaranteed if follow what I described as your "best bet." I tried doing the same thing myself and got no response. But I do think that your likelihood of getting a response would be at its highest if you go with a high daily dose and space your doses out throughout the day.
I hope this makes at least some sense to you. If not, let me know, and I'll try to explain it better.
Tomatheus
==
REFERENCE
Nair, N. P. V., Ahmed, S. K., & Ng Ying Kin, N. M. K. (1993). Biochemistry and pharmacology of reversible inhibitors of MAO-A agents: Focus on moclobemide. Journal of Psychiatric Neuroscience, 18, 214-25.
Posted by sdb on January 8, 2006, at 5:37:01
In reply to Re: Moclobemide-does it really work for sombody here? » sdb, posted by Tomatheus on January 8, 2006, at 0:12:19
Hi Tomatheus,
Thanks for the response to my question. I absolutely agree with you. I had a ten days trial (!) long time ago. Why did I take the moclobemide for only 10 days?- 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!
Phenelzine, marplan...are just no more available in my country and is fully replaced by moclobemide.
What I could to is to do a trial of moclobemide again. You cannot rely on dosages and time of response even in official countries med. book.I will eventually babble-mail you regarding mao's if you are pleased to respond :-)
Kind regards
sdb
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
sdb,
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.
Thanks,
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.
Posted by sdb on January 8, 2006, at 12:29:14
In reply to Re: Moclobemide-does it really work}} Tomatheus, posted by Tomatheus on January 8, 2006, at 11:26:25
Hi Tomatheus,
Thanks for this answer! I sent something through babblemail.
~sdb
> sdb,
>
> 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.
>
> Thanks,
>
> 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.
This is the end of the thread.
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