Posted by Tomatheus on December 16, 2005, at 0:32:53
In reply to Moclobemide?, posted by peacetoy on December 15, 2005, at 9:16:38
Andrew,
When I took moclobemide, my dysthymic symptoms began to subside for about two to three days, and then I felt as depressed as I normally do once that initial 2-3 day period ended. Of course, my experience is just one person's experience, and I tend to have atypical responses to most meds, so I certainly wouldn't judge just based on my experience.
I would say that from what I've read, moclobemide tends to work fairly quickly. Most of the posts I've read here suggest that moclobemide's long-term response can be felt within a week. Usually, it seems that patients either respond after a few days at a given dose, or they don't get any kind of positive response at all during their treatment. I have rarely read of cases of patients waiting for two weeks or longer on moclobemide with no positive response before finally achieving a beneficial therapeutic response. Unlike other antidepressants, the pharmacological effects of moclobemide do not last for more than two days. With moclobemide, MAO-A activity returns to 100 percent after 16 hours (Nair et al., 1993). But with phenelzine (or Nardil, an MAOI that often takes weeks to "kick in"), it takes more than two weeks for MAO-A and MAO-B activity to return to 100 percent. Additionally, "a full biochemical effect is present after the first dose of moclobemide, and there is a distinct relationship between the plasma concentration of the drug and its pharmacological effect" (Nair et al., 1993). So, to make a long story short, most of what I've read suggests that you should know how you're going to feel after a week on moclobemide.
Considering that doses of 600mg/day or higher are sometimes needed to produce a full response with moclobemide, I would think that in most individuals, a dose increase (from 450mg/day) would be the best logical next step. But since you've been experiencing suicidal thoughts, a dose increase might not be the best idea. I would definitely check with your doctor for further instructions. If you do stop moclobemide, one advantage will be that you'll only need to give it a two-day "washout" before starting another drug, if that's the next step that you take. And I personally wouldn't consider even trying ECT unless I've exhausted my medication options, but that's just me.
Thanks for your post.
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.
==
> Hi, I posted here on moclobemide a few weeks ago, before I tried it. I've now been taking it for a week, and am up to 450mg.
>
> Some old posts I read on Psycho Babble have made me a bit concerned (to say the least). They are from people who've had a bad reaction to moc and experienced INCREASED depression:
> http://www.dr-bob.org/babble/19991108/msgs/15407.html
>
> I'm worried as I feel like sh*t, and have been experiencing ever increasing suicidal thoughts since stopping Effexor (my last pill was 2 weeks ago after a fairly slow tapering off). I feel the moc is making me feel more anxious and agitated as well....and I suspect coming off the Effexor might have had an adverse effect as well.
>
> Does anyone here have experience with moc they can share? I'm wondering how long to give it, before giving up (and I think ECT might be my next choice)? I'm used to ADs having start-up effects, but I'm feeling so sh*t this is intolerable....
>
> Andrew
>
>
>
poster:Tomatheus
thread:589301
URL: http://www.dr-bob.org/babble/20051211/msgs/589514.html