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Experience with moclobemide

From: Jaime Smith <evb@yknet.yk.ca>
Date: Thu, 18 Jan 96 20:42:01 -0800
Subject: Experience with moclobemide

I prescribe moclobemide frequently. It is as effective as any other antidepressant, has limited but seldom limiting side effects (rare nausea and headache) and one very great advantage: it is rapidly metabolized and excreted (48 hour wait to start another antidepressant, not 2 weeks as with the older MAOIs). A recent report in the Canadian Psychiatric Journal demonstrates the safety of immediately starting moclobemide after stopping a tricyclic. I have wondered why such a useful addition to the psychopharmacopeia is not available in the Great Republic to the South.

Date: Thu, 18 Jan 1996 22:44:33 -0500 (EST)
From: Kaan Ozbayrak <Kaan.Ozbayrak@ummed.edu>
Subject: Experience with moclobemide

I had a chance to use moclobemide back in Turkey. It was very effective in 2-3 weeks in almost every form of major depression without any major side effects.

Date: Sat, 20 Jan 1996 00:31:43 +1300
From: felicity@i-max.co.nz (Dr Felicity Plunkett)
Subject: Experience with moclobemide

In theory, from the controlled studies available, it's as effective as any basic antidepressant and is among the mildest regarding side-effects. Another interesting thing is the reported lack of a withdrawal syndrome on cessation. Unfortunately, some of us who have tried it clinically here find it to be very ineffective, and I've stopped using it entirely. It may be OK for mild depression (which of course has a high placebo response), but is not good for true-blue [!] severe major depression, in my experience.

From: langloir@ere.umontreal.ca (Langlois Robert)
Subject: Experience with moclobemide
Date: Sun, 21 Jan 1996 12:58:23 -0500 (EST)

It is not a very good drug, benefitting few patients who get it. At least this seems to be the experience at my hospital. Is it possible, dear colleagues, that sometimes the mental disease is stronger than our vast therapeutic arsenal? The answer is of course yes more often than we like to admit.

Date: Mon, 22 Jan 1996 11:18:05 +1300
From: david.menkes@stonebow.otago.ac.nz (David Menkes)
Subject: Experience with moclobemide

Many of us here in the deepest South have used moclo off and on for years (it's been available since the late 1980s) and have found it useful in "garden variety" outpatient depression, but to be notably lacking in that special something (eg, with TCA-resistant atypical depression) that the older MAOIs have. It does produce pesky insomnia in up to 20% of patients (Menkes DB, Wood K, Wooods D. Efficacy and adverse effects of moclobemide [letter]. Lancet. 343 (8895): 476, 1994 Feb 19. Comment on: Lancet 1993 Dec 18-25; 342 (8886-8887): 1528-32).

On the other hand, it also has some rather interesting features. We found, seredipitously, that it has the ability to suppress menopausal flushing in women for whom estrogens are contraindicated (Menkes DB, Thomas MC, Phipps RF. Moclobemide for menopausal flushing [letter]. Lancet. 344 (8923): 691-2, 1994 Sep 3).

Overall, the drift here is away from moclo as an antidepressant due to both efficacy and cost considerations. It is useful to retain as a 2nd (or 3rd) line alternative, especially as there are always some pts who seem to do very well on it in the longer term.

Date: Tue, 23 Jan 1996 05:53:54 -0500
From: gsdavids@niagara.com (George Davidson)
Subject: Experience with moclobemide

It provides a nice alternative for those with SSRI side effects, and is effective in many cases of depression, panic disorder, OCD, dysthymia, etc. I find it safe, effective, well tolerated overall, and is among my first choices for many patients. It is a valuable tool for those responding to SSRIs but complaining of sexual side effects.

From: JoelSHoffm@aol.com (Joel S Hoffman)
Date: Wed, 24 Jan 1996 01:45:27 -0500
Subject: Experience with moclobemide

The discussion about moclobemide does not sufficiently emphasize that this med is indeed an MAOI, albeit with reversible enzyme inhibition. Trancylpromine, phenelzine and isocarboxazide may appear to be "stronger" antidepressants but there is a major subgroup of patients that preferentially responds to MAOIs but cannot tolerate side effects of orthostatic hypotension, decreased sexual capacity, edema or weight gain.

Moclobemide can cause all of those side effects, but less so than the standard MAOIs, and will often have equivalent therapeutic benefit. It is further useful for the not insignificant group of patients who might benefit from MAOIs but are too frightened of a possible hypertensive crisis to proceed with a trial of standard MAOIs.

Date: Wed, 31 Jan 1996 15:57:11 +0200 (EET)
From: Pekka Roponen <shrink@walrus.megabaud.fi>
Subject: Experience with moclobemide

Moclobemide is the most frequently prescribed antidepressant in psychiatric practice in Finland. According to a Finnish double-blind multicenter trial, it was as good as or better than fluoxetine in all aspects when treating major depression (DSM-III-R criteria). Moclobemide was better in patients with atypical features.

According to my judgement moclobemide is the drug of choice in major depression because it does not cause EPS or any other major side effects. Not all patients are helped by it, of course.

Moclobemide is routinely prescribed here in combination with heterocyclic antidepressants (not clomipramine). There is no reason to anticipate any special side effects. I myself combine it with trimipramine or maprotiline to induce nighttime sedation. But the combination with SSRI-type drugs is dangerous -- small overdoses combined can lead to fatal serotonin syndrome.

Date: Tue, 16 Apr 96 09:01:05 UT
From: "Angelo Ferraro" <Ferraro_1@msn.com>
Subject: Experience with moclobemide

Moclobemide has been in widespread use down here in Australia for over 5 years now. As someone has already indicated, it's a reversible inhibitor of monoamine oxidase A. There is no need for a MAOI diet, it is safe in overdose, and its short half life means that there is usually no need for a washout period (unless on a high dose) before trying something else. It is well tolerated, although I think Roche overstates this a bit, as I have seen a few problems in the elderly when I've tried to push the dose above 600 mg daily.

Clinically, it is a rather unusual antidepressant. Firstly, its efficacy is probably not as good as that of the SSRIs and tricyclics, although probably it is better for dysthymia or mild depression. What I have found, however, is that if it is going to work, it does so remarkably quickly. But in a few responders the antidepressant effect wears off despite brief improvement with increases in dose up to 900 mg. However, this subgroup of people virtually all have a good response when switched over to SSRIs.

It doesn't cause as much nausea as the SSRIs. It has tended to become the first line drug for depressive illnesses down here, mainly because of its relatively good side effect profile and the ease with which one can change over to a second line agent. I find it virtually useless for melancholic depression, however; it doesn't seem to work at all in this group.

Date: Wed, 24 Jul 1996 12:14:41 -0700 (PDT)
From: rlam@unixg.ubc.ca (Dr. Raymond W. Lam)
Subject: Experience with moclobemide

On Tue, 23 Jul 1996, Jonathan Pulman wrote:

Woman age 40 reported nausea, headache, insomnia, dirrhoea , feeling confused after one dose of moclobemide 150 mg. Onset was about 4 hours after taking it and it lasted about half a day, which fits with the kinetics. Tried it again 1-2 days later with the same result.

I now use this drug as a first choice in depression (usually mild to moderate depression in my practice). It is usually remarkable in the absence of any exciting side effects (not much to talk about sometimes!) . Has anyone seen this?

In my experience, and in that of the overwhelming majority of Canadian psychiatrists that I have informally polled, moclobemide is less potent than other antidepressants, including SSRIs. In the e-mail survey I did on antidepressant algorithms, several respondents from New Zealand spontaneously wrote that moclobemide was not as effective as other antidepressants.

My population is moderately to severely depressed patients -- I have never actually seen anyone who has had a good response to moclobemide. We routinely push the dose to 750 mg/day. I don't know why it works better in Finland than elsewhere!

Date: Thu, 25 Jul 1996 09:10:12 -0300
From: "marcelo.caixeta" <marcelo.caixeta@netline.com.br>
Subject: Experience with moclobemide

Concerning moclobemide efficacy compared to its tryciclic or non-reversible counterparts there is an interesting article:

Larsen JK et al. Moclobemide in depression: A randomized, multicentre trial against isocarboxazide and clomipramine emphasizing atypical depression. Acta Psychiatrica Scandinavica 84 (6): 564-570, Dec 1991.

They concluded that moclobemide was less effective at 6-week end point than either MAOI and clomipramine.

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[dr. bob] Dr. Bob is Robert Hsiung, MD, dr-bob@uchicago.edu

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