38 replies to this topic

[Now]

I'm currently reading about antidepressants and I am (positively) surprised about the pharmacology of Moclobemide, a reversible monoamine oxidase inhibitor (MAOI). The (side) effects profile looks a lot better than SSRI's.

This side-effect seems somewhat uncomfortable:
''Moclobemide is relatively well-tolerated. Severe side effects are infrequent. The side effect profile is as follows:
Breast: Rarely secretion of milk in both sexes (due to elevated prolactin levels) and breast enlargement.''

What is the definition/prevalence of 'infrequent' and 'rarely'? Does anyone have experience with moclobemide? What's the catch?

[jadamgo]

If I recall correctly, infrequent means "less than 10% of patients" and rarely means "less than 1%."

Lactation, caused by hyperprolactinemia, often from understimulation of the D2-like receptors when caused by a psychoactive medication.

Moclobemide is safer than irreversible MAOIs because it is weaker -- all reversible compounds are weaker than irreversible compounds. Its reversibility means that a serotonin or norepinephrine overload will kick the moclobemide molecule off the MAO enzyme, permitting the enzyme to degrade the excessive neurotransmitter.

In other words, you can only get so much increase in monoamines from moclobemide, especially dopamine -- it can still be heavily degraded by COMT and MAO-B when using a RIMA (Reversible Inhibitor of Monoamine oxidase A).

So the catch is that moclobemide isn't as strong as the classical, irreversible MAOIs. Don't worry about lactating. It's rare and it's very easy to fix. Just switch from moclobemide to Wellbutrin or Effexor XR. The only thing to worry about is that it might not work better than a plain old SSRI. But if it DOES work better, it's a wonderful drug because the side effects are all pretty mild and rare.

[Now]

Thanks for your detailed explanation Jadamgo!

I'm considering to ask for an antidepressant for years, but sometimes I feel good for a week or two and think physical exercise and meditation is enough. My psychiatrist is really a fan of Risperidone so I hope that I can discuss other options with him as well.

[jadamgo]

Sounds like your psychiatrist is good friends with a Janssen Pharmaceuticals sales rep. People that are "a fan of" any antipsychotic are often biased to use it for conditions it should really not be used for. Risperidone is not good for treating depression. Even bipolar depression tends to respond better to other antipsychotics, if an antipsychotic absolutely must be used. Which antidepressants to use depends on what your symptoms are, but generally the SSRIs and the atypical antidepressants (bupropion, trazodone, mirtazapine, etc.) should be the first choices. Honestly, I'd count moclobemide as an atypical antidepressant because it just doesn't act like the other MAOIs, so you could certainly try it.
.
Needless to say, there's always CBT, behavioral activation, brief psychodynamic therapy, and interpersonal therapy.

[Now]

I have to add that I have autism and Risperidone is registered in America for 'irritability' in children and adolescents with autism, but I think they use it off-label in my country.

The FDA's decision was based in part on a study of autistic people with severe and enduring problems of violent meltdowns, aggression, and self-injury; risperidone is not recommended for autistic people with mild aggression and explosive behavior without an enduring pattern.

I don't have any problems with violent meltdowns, aggression and/or self-injury.

I have made an appointment with a psychiatrist next month. My main problems are lethargy/depression and/or anxiety (generalized, social, OCD). I can control depression somewhat through physical exercise, but exercise isn't beneficial for my anxiety.

What (medications) should I discuss with him? I'm trying to make a comparison (effectiveness/side-effects) between moclobemide, escitalopram, risperidone and NAC, but maybe there are more options to consider. I hope I can have a constructive conversation with him, but I still don't know how open-minded and competent he is. The last time he couldn't answer my questions.

I have read (and worked with) books about CBT, but I think that this method may not work well for me, because a lot of my thoughts can't be proven (easily) as irrational. I'm trying mindfulness and ACT (Acceptance and commitment therapy) now and I hope this will work better for me.

Edited by Now, 19 April 2012 - 08:48 AM.

[spookytooth]

I have been using Moclobemide for almost a year now. Although its antidepressant effect doesn't seem to be as strong as Prozac's or that of most Tricyclics it has been working quite well with the least amount of side effects I have experienced from any antidepressant
so far (and I have been on most of them one time or another). What I like about Moclobemid is that it's very stimulating which helps my ADHD and minimizes my need for stimulants.

[Now]

Thanks spookytooth!

It sounds good. I have an appointment with the psych next week.

[Dexedrine]

It sounds like one of the better antidepressants in terms of effectiveness and side effect profile; speaking of which, don't be frightened about it being an MAOI, it's only a reversible and MAO-A selective MAOI so you're not going to have a heart attack eating cheese while on it. Needless to say taking MDMA, Tramadol or DXM while on it still posses an extreme danger but at least food is safe

[Now]

Thank you for the comments!

I have seen the psychiatrist and after a good conversation (he was very competent and honest) we have decided to begin with a low dose (5 mg) of Escitalopram.

[jadamgo]

If you won't have to pay for it, then good. It's probably the best SSRI for anxiety. But if you're paying a lot of money for brand-name Lexapro, ask him to switch you to citalopram. It's essentially the same stuff, except the dosage is doubled when you take citalopram instead of S-citalopram (which is escitalopram's chemical name).

How about ACT? Did you give it a try?

[magniloquentc0unt]

Has any of you had cognitive impairments as side effect? Im talking about memory, brainfog etc, that kind of things.. For me its a no-go and i have read only 1 anectode that said it had such sideeffects!

[Thorsten3]

It is not that great for obsessive type of depressive disorders. I was almost tempted to use it alongside an SSRI (which totally owns moclebemide in this department).

It can so cause insomnia in quite a few users. Because the half life is poor, you have to take it later in the day to keep levels stable. This can result in overstimulation at night time, hence, interfering with sleep.

The positives I noticed were that it had efficacy for panic, SAD and dysthymia.

[magniloquentc0unt]

What happens if you only take it in the mornings? "You feel sad" by the evening? Personally my problem has lately been nailed to: distimia with atypical depression symptoms, so i guess i could go with a morning dose to make me functional and even if it fades a bit in the evenin it wouldnt be that much a problem... IF it were that simple, wich idoubt it is..

Also, any lasting benefit/side effects?

[jadamgo]

Atypical depressive symptoms respond best to stimulating antidepressants that help you get out of bed in the morning. Not sedating antidepressants like most of the SSRIs. (Prozac and Zoloft can be worth a try, but you'd still be far better off with Wellbutrin or even bright light therapy.)

[magniloquentc0unt]

Prozac did "ok" 3 years ago, i was energetic, but also left me lasting side effects, emotional blunting, hypersomnia, anhedonia

[NeuroNootropic]

It is not that great for obsessive type of depressive disorders. I was almost tempted to use it alongside an SSRI (which totally owns moclebemide in this department).

It can so cause insomnia in quite a few users. Because the half life is poor, you have to take it later in the day to keep levels stable. This can result in overstimulation at night time, hence, interfering with sleep.

The positives I noticed were that it had efficacy for panic, SAD and dysthymia.

At what doses does it act like a stimulant? I took 150 mg 2x a day and it was like a sedative to me. It made me very drowsy, fatigued, and increased my reaction time greatly. It's like it was slowing down my brain. Coffee did not help either.

Maybe I took too low of a dose? Do you think I should try a higher dose? I've read reports of people using up to 1200 mg a day, but none who have reported a sedative-like feeling from it.

[Thorsten3]

Atypical depressive symptoms respond best to stimulating antidepressants that help you get out of bed in the morning. Not sedating antidepressants like most of the SSRIs. (Prozac and Zoloft can be worth a try, but you'd still be far better off with Wellbutrin or even bright light therapy.)

Have you tried bright light therapy? Any experiences?

[Thorsten3]

It is not that great for obsessive type of depressive disorders. I was almost tempted to use it alongside an SSRI (which totally owns moclebemide in this department).

It can so cause insomnia in quite a few users. Because the half life is poor, you have to take it later in the day to keep levels stable. This can result in overstimulation at night time, hence, interfering with sleep.

The positives I noticed were that it had efficacy for panic, SAD and dysthymia.

At what doses does it act like a stimulant? I took 150 mg 2x a day and it was like a sedative to me. It made me very drowsy, fatigued, and increased my reaction time greatly. It's like it was slowing down my brain. Coffee did not help either.

Maybe I took too low of a dose? Do you think I should try a higher dose? I've read reports of people using up to 1200 mg a day, but none who have reported a sedative-like feeling from it.

Hmmm.. I wouldn't read too much into my experiences with it. Everyone reacts differently. I never experimented with higher dosages.

Moclebemide is mostly a reversible MAO-A inhibitor. This means it'll result in more 5HT and NE floating about. Some people might find this sedating, some, might find it stimulating.

I find curcumin (another reversible MAO-A inhibitor - in the same league, potency wise, as moclebemide) to have similar effects on me. It almost feels like I've downed some ephedrine. Although, I don't get insomnia from curcumin (which I do with moclebemide).

Both curcumin and moclebemide defintely share a common effect for me, though, Both, with chronic use, make me feel unusually irritable (almost bordering on aggressive). SJW, also. MAO-B inhibitors don't have this effect, nor do SSRIs. It kind of got me thinking that increasing norepenephrine levels could be a bad thing for me.

[jadamgo]

Atypical depressive symptoms respond best to stimulating antidepressants that help you get out of bed in the morning. Not sedating antidepressants like most of the SSRIs. (Prozac and Zoloft can be worth a try, but you'd still be far better off with Wellbutrin or even bright light therapy.)

Have you tried bright light therapy? Any experiences?

Yes, I use it daily for DSPS, and when needed I bump the time up to 2 hours for light-responsive depression.

How well does it work? Well enough that I wore one out and promptly bought a better model.

The worst part was that I broke the old one right at the start of a 2-week long rainstorm in the dead of winter. 2 weeks! Everything was so dark that by the middle of the second week, I refused to talk to one of my coworkers because I decided that he hated me. (Naturally, there was no good reason to believe this, though in that state of mind I had to do a CBT worksheet to realize it.) Once I got the new light, I got back to normal after about 10 days.

[Thorsten3]

Atypical depressive symptoms respond best to stimulating antidepressants that help you get out of bed in the morning. Not sedating antidepressants like most of the SSRIs. (Prozac and Zoloft can be worth a try, but you'd still be far better off with Wellbutrin or even bright light therapy.)

Have you tried bright light therapy? Any experiences?

Yes, I use it daily for DSPS, and when needed I bump the time up to 2 hours for light-responsive depression.

How well does it work? Well enough that I wore one out and promptly bought a better model.

The worst part was that I broke the old one right at the start of a 2-week long rainstorm in the dead of winter. 2 weeks! Everything was so dark that by the middle of the second week, I refused to talk to one of my coworkers because I decided that he hated me. (Naturally, there was no good reason to believe this, though in that state of mind I had to do a CBT worksheet to realize it.) Once I got the new light, I got back to normal after about 10 days.

Thanks.

I think living in the UK could possibly mean this could be of definite benefit to me. I've always wanted to try it for years, but, wasted much of my time trying drugs that are quick fixes and have no long term efficacy.

[protoject]

Recently I was searching for some info about drug combinations and found this post on Dr Bob's psychobabble which I think pretty much sums up my brief experiences with moclobemide (quote is below). I'm hoping that perhaps the anxiety from low-dose moclobemide can be curbed with another medication; I'm thinking pregabalin because it's in my arsenal, but maybe something else. Also, the dosages I tried that were different from the below user, were 300 mg on the high end and 50 mg on the low end. Also unlike the user below, I didn't feel "happy" at all. Yet, I can't help but to be tempted to try this drug as it seems like maybe it could help in the long term. I also think that its activating properties at the lower dosages has some potential if it were not for that anxiety/ panic that sets in. Also for me I did get a fast heart rate during that period. My confounding factor is that I took a very low dose of vyvanse (15 mg) that day with the low dose. However I don't find that strongly activating on the normal, and the effect I got on the moclobemide was quite strong. It's possible that the two interacted, but I am not sure, because there is not an expected interaction between the two, though theoretically since Moclobemide is an MAO inhibitor, it might have effected it.

I'm thinking of trying again, without vyvanse (dextroamphetamine), and reporting back. Also, I didn't try moclobemide for anything more than 3 days total for obvious reasons

After using Moclobemide for a week - 150mg in one morning dose, I increased to 2 doses/day for a total of 300mg for a couple of days. Felt awful...depressed, stuffed and antisocial. Couldn't get off the couch or out from under the doona.

Cut the dose back to 75mg x twice a day. Interestingly, this was more energising than the single 150mg dose/day. I even experienced some insomnia whereas I hadn't felt it at 150 or 300...quite the opposite in fact.

The side effects of palpitations .....were annoying. .......
found the low dose made me more happy but I started experiencing more panic at the same time. Strange. I felt like my body was revving...sweaty armpits and increased git effects.

[Tom_]

The incidence of gynecomastia and other boob like side effects in men are almost un-heard of. About one in 5000 if I recall correctly.

Its a very good choice of antidepressant.

If you insist on talking about AAPs then aripiprazole is the drug for you...started 2-6 (preferably six weeks) after starting an approved antidepressant.

[magniloquentc0unt]

Recently I was searching for some info about drug combinations and found this post on Dr Bob's psychobabble which I think pretty much sums up my brief experiences with moclobemide (quote is below). I'm hoping that perhaps the anxiety from low-dose moclobemide can be curbed with another medication; I'm thinking pregabalin because it's in my arsenal, but maybe something else. Also, the dosages I tried that were different from the below user, were 300 mg on the high end and 50 mg on the low end. Also unlike the user below, I didn't feel "happy" at all. Yet, I can't help but to be tempted to try this drug as it seems like maybe it could help in the long term. I also think that its activating properties at the lower dosages has some potential if it were not for that anxiety/ panic that sets in. Also for me I did get a fast heart rate during that period. My confounding factor is that I took a very low dose of vyvanse (15 mg) that day with the low dose. However I don't find that strongly activating on the normal, and the effect I got on the moclobemide was quite strong. It's possible that the two interacted, but I am not sure, because there is not an expected interaction between the two, though theoretically since Moclobemide is an MAO inhibitor, it might have effected it.

I'm thinking of trying again, without vyvanse (dextroamphetamine), and reporting back. Also, I didn't try moclobemide for anything more than 3 days total for obvious reasons

After using Moclobemide for a week - 150mg in one morning dose, I increased to 2 doses/day for a total of 300mg for a couple of days. Felt awful...depressed, stuffed and antisocial. Couldn't get off the couch or out from under the doona.

Cut the dose back to 75mg x twice a day. Interestingly, this was more energising than the single 150mg dose/day. I even experienced some insomnia whereas I hadn't felt it at 150 or 300...quite the opposite in fact.

The side effects of palpitations .....were annoying. .......
found the low dose made me more happy but I started experiencing more panic at the same time. Strange. I felt like my body was revving...sweaty armpits and increased git effects.

very interesting seen that im lethargic and aiming for minimal doses

[riloal]

Hi, I started moclobemide two weeks ago, the first week I feel nothing, but the second week I feel sedated, with lots of fatigue, depressed, sleeping all day. I read it,s stimulating the moclobemide, anyone had this symptons? would be better to take it at night? Thanks

[Atropy]

I have been using Moclobemide for almost a year now. Although its antidepressant effect doesn't seem to be as strong as Prozac's or that of most Tricyclics it has been working quite well with the least amount of side effects I have experienced from any antidepressant
so far (and I have been on most of them one time or another). What I like about Moclobemid is that it's very stimulating which helps my ADHD and minimizes my need for stimulants.

May I ask what your dosage is?And did Moclobemide work well for you from the start?
Lastly,if you are fine with it could you please list your diagnosis?

[spookytooth]

I used Moclobemide at doses between 300 and 450mg per day split up into two to three doses. It seemed to work fairly quickly. The stimulant effect could be observed more or less from the first pill and the antidepressant effect set in after a week or two. I have been off it for a while now although I still keep it around as a stand by in case of mood problems.
My diagnoses are depression and ADHD.

[Atropy]

Thanks.Im on 450mg divided by 2,and Im taking my second dosage at 12 noon to lower my insomnia.

Is there a realistic interaction possibility with low dose Tryptophan and vit.b6 and low dose trazodone?How possible is serotonin syndrome?Not much info on the net with reasoning.

Ill also be taking Melatonin on and off.

[nowayout]

Seems like moclobemide comes with a side order of insomnia. That can't be good. :(

[BlueCloud]

Seems like moclobemide comes with a side order of insomnia. That can't be good. :(

Pretty much all stimulating AD's come with a side effect of insomnia. Though in the case of moclobemide it's kind of worth it ( you just have to accept that you'll need to add something for the insomnia), it was probably the best AD i've tried, a decade ago .

[nowayout]

Seems like moclobemide comes with a side order of insomnia. That can't be good. :(

Pretty much all stimulating AD's come with a side effect of insomnia. Though in the case of moclobemide it's kind of worth it ( you just have to accept that you'll need to add something for the insomnia), it was probably the best AD i've tried, a decade ago .

I wonder though how that squares with the recent studies claiming that normalization of sleep hugely increases the effectiveness of deression treatments.