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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by DINGBAT on March 1, 2002, at 9:20:29
Hi guys,
I know that the drug of choice for atypical depression is an MAOI (e.g., Parnate). Anyone know if the 'selective' MAOI's like moclobemide or selegiline are AS EFFECTIVE with atypical depression? I'm trying to avoid the (over-stated) side-effects of classical, non-selective MAOI's. But, having said that, selegiline (Deprenyl) is usually only effective for depression at doses that are not selective?! Also, Parnate is much cheaper in South Africa than any of the other AD'sAny comments will be appreciated.
Posted by TSA West on March 2, 2002, at 16:49:49
In reply to ANY SUCCESS-MOCLOBEMIDE AND ATYPICAL DEPRESSION?, posted by DINGBAT on March 1, 2002, at 9:20:29
"We report on the efficacy and apparent tolerability of moclobemide at doses of up to 1,650 mg/day in 13 patients (4 men, 9 women) with major depressive disorder who had been resistant to at least two prior conventional antidepressant treatment trials at standard or higher doses and/or electroconvulsive therapy (ECT). A majority of patients were resistant to a minimum of four trials of antidepressant treatment and/or ECT. Four patients had been unable to tolerate antidepressant therapies at adequate doses and durations. Treatment was initiated at the usual doses of moclobemide, ranging from 300 to 450 mg daily, and progress was monitored. If there was no improvement in mood, doses of moclobemide were progressively increased in 150-mg increments every 2 to 3 weeks, as tolerated, up to a maximum dose of 1,650 mg during a period of 3 to 12 months. It was decided to gradually increase the moclobemide dose with the goal of achieving improvement; the treatment would be discontinued if there were significant adverse events. Lithium augmentation (600-900 mg/ day) was used in some cases to enhance the response at higher doses of moclobemide. Trazodone was administered at a subtherapeutic dose of 25 to 150 mg/day when insomnia was reported...The Clinical Global Impression Scale-Improvement subscale (CGI-I)11 from the initiation of moclobemide treatment to the highest tolerated dose of moclobemide, as well as the Hamilton Rating Scale for Depression (HAM-D, 17-item)12 in some cases, were used to assess mood over a period of 3 to 12 months, depending on each patient's course of therapy. According to scores on the CGI-I, it was found that 7 (54%) of 13 patients were "very much" improved or "much" improved while receiving high-dose moclobemide therapy in combination with trazodone and/or lithium augmentation in some cases. This improvement was maintained for periods of up to 2 years."
--Journal of Clinical Psychopharmacology, June 2000. "Tolerability and Efficacy of High-Dose Moclobemide Alone and in Combination With Lithium and Trazodone"
Posted by ben on March 3, 2002, at 9:33:29
In reply to Moclobemide in atypical depression » DINGBAT, posted by TSA West on March 2, 2002, at 16:49:49
I am trying Aurorix since about six weeks. First it made me paradox. more fatigued than stimulated. I slowly went up to 450 mg (over 3 weeks) and then def. felt to agitated, more anxious, sleep probs.....went back to 300 mg and my mood is getting bader. I think about adding amitryptiline (about neuropathic pain) ore trazadone. Perhaps Remeron could be an adjunct too (last time I was knocked out when I took 7.5 mg to 60 mg of Celexa)
Tried Surmontil/Effexor/Celexa/Edronax/Remeron/Zoloft/Paxil/Deanxit...Lithium, Lamictal, Ritalin, Madopar....and combos of these meds, but no sustained effect. Effexor and Paxil showed the best effects on mood but both made me fat. Effexor excessive sweating and headaches, Paxil liver damage (sic !), bruxism and too much sedation. What about Serzone or Prozac ???
Posted by JohnX2 on March 3, 2002, at 20:25:26
In reply to Re: Moclobemide in atypical depression, posted by ben on March 3, 2002, at 9:33:29
How about Wellbutrin? Are you outside the US?Ads are so hit or miss. Prozac or Serzone may do it.
It may be good to switch routes and try the tricyclics. Parnate may be a good trial (except the crummy diet).-John
> I am trying Aurorix since about six weeks. First it made me paradox. more fatigued than stimulated. I slowly went up to 450 mg (over 3 weeks) and then def. felt to agitated, more anxious, sleep probs.....went back to 300 mg and my mood is getting bader. I think about adding amitryptiline (about neuropathic pain) ore trazadone. Perhaps Remeron could be an adjunct too (last time I was knocked out when I took 7.5 mg to 60 mg of Celexa)
> Tried Surmontil/Effexor/Celexa/Edronax/Remeron/Zoloft/Paxil/Deanxit...Lithium, Lamictal, Ritalin, Madopar....and combos of these meds, but no sustained effect. Effexor and Paxil showed the best effects on mood but both made me fat. Effexor excessive sweating and headaches, Paxil liver damage (sic !), bruxism and too much sedation. What about Serzone or Prozac ???
Posted by DINGBAT on March 4, 2002, at 5:33:14
In reply to Re: Moclobemide in atypical depression » ben, posted by JohnX2 on March 3, 2002, at 20:25:26
Hi JohnX2
I am outside US - I am in South Africa. Wellbutrin is not yet available here.
I've tried nearly everything and various 'cocktails'. Mostly they were ineffectual except for Efexor which was probably the most helpful at 300mg daily. I've never given the MAOI's a chance and I think they may have might have much to offer me. While Parnate is available here (and often the 'drug of choice' for atypical depression), I was thinking of trying moclobemide (brand name Aurorix here) to avoid 'crummy diet'. But other PB posts are encouraging re: "the diet" and it seems that it's not that bad IF you're getting a really good response. Most of my patients (I'm a psychologist) don't seem to have good responses to Aurorix at usual doses. Aurorix is also FAR more expensive than Parnate in South Africa. I have a good pdoc who it sufficiently humble to try any combo's with me. Do you think I should just take the Parnate leap? I could take Rivotril (you call it Klonopin) for any 'over-activation' or sleep problems.
Posted by JohnX2 on March 6, 2002, at 4:40:16
In reply to Re: Moclobemide in atypical depression » JohnX2, posted by DINGBAT on March 4, 2002, at 5:33:14
Hi There,To be honest, the trends I've noticed on moclobemide don't look too good.
But one thing I've noticed is a lot of people (including me)
taking/taken the medicine in the 300-600 mg range did not fare well,
but I seem to see a lot of reports that it may be effective if the dose
is really pushed to 900+ mg.So I think you are in an interesting trade off position that I have
often looked at. Try a medicine with less hassle but fewer fame, or just go
the more proven route. I think one part of the answer is if you can pay
the price of doing a drug trial with a mediocre chance of success? Is the
reward for this (not having the crummy diet and finding a good medicine
maybe you could take for quite a while), going to offset the odds of a better
response and cheaper availability for Parnate? This is a question for
you to decide.Darn, I usually gamble on the low impact of "quality of life" and then
go for the stand-by's after failure, but that's just me. Sometimes you find
a med that allows you to have your cake and eat it to; Lamictal did that for me.Best wishes on your decision.
-John
> Hi JohnX2
>
> I am outside US - I am in South Africa. Wellbutrin is not yet available here.
>
> I've tried nearly everything and various 'cocktails'. Mostly they were ineffectual except for Efexor which was probably the most helpful at 300mg daily. I've never given the MAOI's a chance and I think they may have might have much to offer me. While Parnate is available here (and often the 'drug of choice' for atypical depression), I was thinking of trying moclobemide (brand name Aurorix here) to avoid 'crummy diet'. But other PB posts are encouraging re: "the diet" and it seems that it's not that bad IF you're getting a really good response. Most of my patients (I'm a psychologist) don't seem to have good responses to Aurorix at usual doses. Aurorix is also FAR more expensive than Parnate in South Africa. I have a good pdoc who it sufficiently humble to try any combo's with me. Do you think I should just take the Parnate leap? I could take Rivotril (you call it Klonopin) for any 'over-activation' or sleep problems.
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