Posted by Tomatheus on December 28, 2005, at 17:00:35
In reply to Moclobemide vs P-babble » Tomatheus, posted by ed_uk on December 28, 2005, at 15:23:07
Ed,
I think you made some valid points concerning moclobemide. As you mentioned, moclobemide has demonstrated clinical efficacy in several clinical trials. In a meta-analysis of moclobemide and brofaromine, Lotufo-Neto et al. (1999) found that moclobemide tends to be significantly more effective than placebo, about as effective as the SSRIs, and slightly less effective than the irreversible MAOIs.
And I agree that the Babblers who have taken moclobemide for depression are most likely not representative of the depressed population as a whole. Many of us here are relatively treatment resistant, so if we're more likely to be unresponsive to most drugs than most depressed patients, the same likely holds true for moclobemide. I will say that I've read that moclobemide tends to be less effective in practice than the research studies suggest. Unfortunately, I can't seem to find the source that suggested that right now, so I can't say for sure how valid that point was. I also recall reading that moclobemide was once used as a first-line treatment in New Zealand but has since dropped to second or third-line use because of its lack of efficacy. So, I think the evidence concerning moclobemide's efficacy is mixed, but I still think that the most valid sources would have to be the clinical trials, which (as you mentioned), have shown moclobemide to be relatively effective.
I also recall reading in a research study (but I can't remember which one) that some patients might benefit from doses higher than 600mg/day. And I definitely agree that the moclobemide dosing schedule likely to produce the most benefits would be the one you suggested -- dividing the dose so its taken several times a day at regular intervals. I personally tried that strategy without any success, but just because I didn't respond to moclobemide obviously doesn't mean that others won't. As I've hypothesized in other posts (see http://www.dr-bob.org/babble/20051221/msgs/591806.html if you're interested), I think that an MAOI's ability to inhibit the MAO enzymes consistently has a lot to do with the drug's efficacy. Or it's at least one important factor, IMHO. So, for some patients, it does make sense that taking moclobemide several times a day at regular intervals might be enough to do the trick.
Tomatheus
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REFERENCE
Lotufo-Neto, F., Trivedi, M., & Thase, M. E. (1999). Meta-analysis of the reversible inhibitors of monoamine oxidse type A moclobemide and brofaromine for the treatment of depression. Neuropsychopharmacology, 20, 226-47.
poster:Tomatheus
thread:591969
URL: http://www.dr-bob.org/babble/20051221/msgs/592815.html