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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Mishal on January 10, 2009, at 8:04:38
I have been recently put on Stablon again (this time 4 pills a day) but after five days on it, Stablon seems to be worsening my mood a bit plus lows in between doses. It affects my cognitive performance too badly. Difficult to recall words, cognitive dullness... Surprising because this med was not supposed to cause any of this.I would like to hear the opinions of those who used both drugs or Moclobemide alone. Is Moclobemide offering any superior performance compared to Stablon? I am supposed to get it within a week. SSRIs..? Please I will send them directly to hell. They are only for drug company's sake. After using all of the available SSRIs, I have taken oath I will never touch those useless stuffs again. Provigil alone is enough in brightening my mood, but I need an antidepressant kick very badly. Provigil is on the verge of exhaustion in me.
So please. how would you compare Stablon's effect to Moclobemide? Latter seems to be a promising stuff especially if it can augment Provigil.
Your two cents will be appreciated greatly.
Posted by SLS on January 10, 2009, at 8:55:56
In reply to Moclobemide or Stablon: Which is more effective?, posted by Mishal on January 10, 2009, at 8:04:38
I do not have very positive comments to make about moclobemide. It works real well starting in the first week at a dosage of 150mg. However, it poops-out quickly, and you need to keep increasing the dosage until you reach a maxiumum of 1200mg, whereupon the drug eventually stops working altogether.
By the way, a friend of mine added Provigil to Wellbutrin, and is now feeling significantly better.
- Scott
Posted by desolationrower on January 10, 2009, at 11:46:31
In reply to Re: Moclobemide or Stablon: Which is more effective?, posted by SLS on January 10, 2009, at 8:55:56
Both drugs i would consider weaker but useful for their lack of side effects. The sort of drugs that should be first-line prescriptions by GPs.
-d/r
Posted by SLS on January 10, 2009, at 12:28:12
In reply to Re: Moclobemide or Stablon: Which is more effective?, posted by desolationrower on January 10, 2009, at 11:46:31
Hi.
> Both drugs i would consider weaker but useful for their lack of side effects. The sort of drugs that should be first-line prescriptions by GPs.
For a number of years, moclobemide was the most widely prescribed antidepressant in various countries around the world. It became popular because its side effect load was low and the onset of clinical improvement was seen very early in treatment (often in the first week). However, it has fallen quickly out of favor for lack of efficacy when used long-term and the need to continually escalate the dosage to retain a therapeutic effect. Moclobemide poops-out more than any other antidepressant I can think of.
Roche, the manufacturer of moclobemide, was forced to discontinue their project to have the drug approved in the U.S. Their U.S. studies, as mandated by the FDA, could not demonstrate efficacy.
- Scott
Posted by Phillipa on January 10, 2009, at 12:39:59
In reply to Re: Moclobemide or Stablon: Which is more effective?, posted by SLS on January 10, 2009, at 12:28:12
Really will have to google that one. Thanks Phillipa
Posted by SLS on January 10, 2009, at 13:01:02
In reply to Re: Moclobemide or Stablon: Which is more effective?, posted by SLS on January 10, 2009, at 12:28:12
> Hi.
>
> > Both drugs i would consider weaker but useful for their lack of side effects. The sort of drugs that should be first-line prescriptions by GPs.
>
> For a number of years, moclobemide was the most widely prescribed antidepressant in various countries around the world. It became popular because its side effect load was low and the onset of clinical improvement was seen very early in treatment (often in the first week). However, it has fallen quickly out of favor for lack of efficacy when used long-term and the need to continually escalate the dosage to retain a therapeutic effect. Moclobemide poops-out more than any other antidepressant I can think of.
>
> Roche, the manufacturer of moclobemide, was forced to discontinue their project to have the drug approved in the U.S. Their U.S. studies, as mandated by the FDA, could not demonstrate efficacy.
Phillipa:I don't know if you can find this information on the Internet. I spoke directly to the project manager at Roche shortly after the decision had been made to discontinue investigations with moclobemide. They even tried to get it approved for social phobia. Again, it proved to be ineffective.
- Scott
Posted by SLS on January 10, 2009, at 13:14:26
In reply to Moclobemide or Stablon: Which is more effective?, posted by Mishal on January 10, 2009, at 8:04:38
An investigation into the use of moclobemide for social phobia:
http://cat.inist.fr/?aModele=afficheN&cpsidt=2767003
Notice what happens after 8 weeks.
This is the same pattern of response demonstrated by moclobemide when treating depression.
Few, if any, studies of moclobemide for the treatment of depression extended beyond 8 weeks. If they had, I doubt it would have been approved for use in so many countries.
- Scott
Posted by Sigismund on January 10, 2009, at 20:58:14
In reply to Re: Moclobemide or Stablon: Which is more effective? » Mishal, posted by SLS on January 10, 2009, at 13:14:26
Moclobemide does make me feel sharper, with better word fluency.
I could never tolerate much of it....75mg, and I needed a stiff drink at the end of the day.
Posted by Tomatheus on January 10, 2009, at 23:46:13
In reply to Moclobemide or Stablon: Which is more effective?, posted by Mishal on January 10, 2009, at 8:04:38
Mishal,
I've taken both moclobemide and tianeptine (Stablon). I took the moclobemide for my depressive symptoms before I began experiencing psychotic symptoms and noticed a modest antidepressant effect that lasted about three days. Each time I increased the dose, I noticed another brief antidepressant effect, but nothing that would ever last. I also noticed a slight increase in irritability when I was taking moclobemide.
I currently take tianeptine as part of my treatment regimen for schizoaffective disorder, and I've found it to be helpful at taking the edge off of my depressive symptoms and at reducing feelings of irritability. For me, tianeptine's antidepressant effect was strongest on day one and seemed to fade slightly with time. However, it still seems to be working to a small extent, and I've been on it for more than five months. I attempted to discontinue the tianeptine that I'm taking at one point and noticed that my depressive symptoms returned to their baseline level. I didn't notice a worsening of symptoms after I discontinued moclobemide, which to me is a sign that it completely stopped working after my first few days on it. So, considering that tianeptine does something for me in the long term (as opposed to moclobemide, which worked for a few days and then stopped working) and that it reduces feelings of irritability (as opposed to moclobemide, which increased feelings of irritability), I would say that tianeptine has been the more effective medication for me.
Tomatheus
Posted by desolationrower on January 11, 2009, at 1:56:39
In reply to Re: Moclobemide or Stablon: Which is more effective? » Mishal, posted by Tomatheus on January 10, 2009, at 23:46:13
I don't think the selectivity of the MAO forms for their substrates is absolute. I wonder if the body is increasing MAO production after one starts moclobemide, and MAOb is doing more of the work and offsetting the benefit.
-d/r
Posted by Mishal on January 11, 2009, at 4:21:13
In reply to Re: Moclobemide or Stablon: Which is more effective?, posted by desolationrower on January 11, 2009, at 1:56:39
Hi to all,After reading much of your responses, I understand Moclobemide is effective in short term. As many pointed out, if it works to alleviate depression for the first three days on the standard dosage 300mg, then I would consider it taking for three days only. Three days of abstinence will be enough to reverse the tolerance.
My goal will be:
* Three days on Moclobemide 300mg. No provigil for these three days.
* Then three days off Moclobemide. Provigil will be substituted for moclobemide for these days.
IF something is only working for a few days, still it is okay for me because at least I can have a few good days in a week. I found Provigil retains its efficacy after a short break. So, this intermittent dosing should work. three good days on Provigil, followed by three fine days on Moclobemide... what about this cycle?
What do you think?
Posted by psychobot5000 on January 11, 2009, at 21:47:53
In reply to Re: Moclobemide: What about Intermittent dosing?, posted by Mishal on January 11, 2009, at 4:21:13
>
> After reading much of your responses, I understand Moclobemide is effective in short term. As many pointed out, if it works to alleviate depression for the first three days on the standard dosage 300mg, then I would consider it taking for three days only. Three days of abstinence will be enough to reverse the tolerance.
> ...
>
> IF something is only working for a few days, still it is okay for me because at least I can have a few good days in a week. I found Provigil retains its efficacy after a short break. So, this intermittent dosing should work. three good days on Provigil, followed by three fine days on Moclobemide... what about this cycle?
>
> What do you think?For what it's worth, I think it might well be worth a try. However, I have a couple of caveats:
Not sure if you've ever been on an MAOi before, but in my experience, they make you (me, actually) feel better at the beginning, possibly by increasing levels of monoamines (noradrenaline, dopamine, serotonin...), whose digesting enzymes they block. ...Then the body presumably down-regulates their efficacy, in response to that. So then, unless you get a genuine long-term antidepressant response (which I would cautiously posit might be a separate effect, something more 'downstream'), you might be back to square one, or somewhere close to it. The reason that I feel this is relevant is because, while raising an MAOi dose can be pleasant, lowering it or going off of it is often unpleasant for patients. Possibly because your body is suddenly stuck with a -lower- level of neurotransmitters than it's used to. This is all speculation, I suppose. But what I'm getting at is that, on a 3-day on, 3-day off schedule, you might (might!) pay for the boost on the 'on' days, with lower mood on the off days. You never know, but I thought I'd throw it out there as a thought.
My only other comment is that several years ago, I read what I remember as a large meta-analysis of antidepressant results. Bucking the CW (at least among SSRI-promoting pharmaceutical reps), they rejected the idea that all antidepressants are created equal in efficacy, and tried to gather data and determine if any were better than others. They sorted it by catagories--MAOis, Tricyclic antidepressants, and SSRIs, and looked at several of each type. The results (I'm sure I remember this part accurately, if nothing else):
1: Unselective MAOis (parnate and nardil, I think--moclobemide's more powerful cousins)
2: Tricyclics
3: SSRIs
4: Moclobemide.
But hey, it presumably works for some people, right? And with fewer side-effects. Best of luck to you!
Posted by mav27 on January 12, 2009, at 5:11:08
In reply to Re: Moclobemide or Stablon: Which is more effective?, posted by SLS on January 10, 2009, at 8:55:56
> I do not have very positive comments to make about moclobemide. It works real well starting in the first week at a dosage of 150mg. However, it poops-out quickly, and you need to keep increasing the dosage until you reach a maxiumum of 1200mg, whereupon the drug eventually stops working altogether.
>Ive given moclobemide a few goes and its always done stuff all except cause insomnia for me. I've only gone to the 1200mg but i've read of people taking up to 3000mg with still no luck.
This is the end of the thread.
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