Posted by Elizabeth on February 23, 2002, at 19:42:37
In reply to Re: Why isnt Moclobemide available in the USA? » OldSchool, posted by jay on February 22, 2002, at 2:46:58
> Moclobemide, which I have taken here in Canada, just doesn't seem to cut it as an a.d.
This is consistent with most of what I've heard: it seems that (in actual practice, as opposed to clinical trials -- for whatever reason, the results of trials don't always bear out in real life) moclobemide is a decent first-line antidepressant, but it isn't that great for depressives who've failed to respond to many other treatments (that is, the treatment-resistant). Its mechanism of reversible (competitive) binding to the MAO-A isoenzyme doesn't compare favorably with the irreversible inhibition of both MAO-A and MAO-B in terms of efficacy, although it does have the advantage that the moclobemide can be displaced by tyramine so that food-drug interactions are unlikely.
Moclobemide also has its own side effects -- agitation, headache seems to be very common -- and many patients do have a hard time tolerating it. I also think its tolerability is questionable: sometimes it's comparable to the SSRIs, but it's quite a bit more likely to cause potentially dangerous side effects (as opposed to simply unpleasant ones) than the SSRIs are. This makes a big difference.
It might well be that the reported lack of efficacy of moclobemide results from insufficient doses (I think the same may be true of Buspar), but if this is true, then tolerability at effective doses would likely be worse than has been reported. Agitation -- quite common with moclobemide -- is a serious side effect in depressed people, since agitated depression is often associated with suicidality. There are of course other side effects, but agitation is very common, and the other side effects are unpleasant but not dangerous. The lack of sexual side effects is a plus, but moclobemide is hardly unique in this regard.
I think that if you want to take a dopaminergic AD without dietary restrictions, low-dose (5-10 mg) selegiline would be a better choice. (I'm not convinced that there's any way to predict what neurotransmitter needs to be targeted in the treatment of any individual with depression.)
As to the reason why moclobemide wasn't marketed in the USA: Roche decided it wasn't worth it because the market here was already flooded, of course.
Personally, I haven't heard any success stories from people with TRD who tried moclobemide. But if you really want to see how moclobemide works for you, you can arrange to get it from Canada. I don't know the exact procedure, but I do know that it's 100% legal. Ask your pdoc about it if you're interested; he ought to be able to figure out what to do, if he agrees that moclobemide would be a good thing for you to try.
-elizabeth
poster:Elizabeth
thread:94769
URL: http://www.dr-bob.org/babble/20020222/msgs/95262.html