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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by maddog on September 20, 2004, at 20:55:36
Hi Everyone,
I met with a new pdoc today who suggested that I try Manerix (a reversible MAOI) instead of Nardil. I have seen little written about Manerix in terms of its side effects and efficacy, especially with respect to anxiety.
Does anyone out there have experience with Manerix and can compare it to Nardil?
thanks!
maddog
Posted by SLS on September 21, 2004, at 7:32:36
In reply to Moclobemide/Manerix vs. Nardil, posted by maddog on September 20, 2004, at 20:55:36
> Hi Everyone,
>
> I met with a new pdoc today who suggested that I try Manerix (a reversible MAOI) instead of Nardil. I have seen little written about Manerix in terms of its side effects and efficacy, especially with respect to anxiety.
>
> Does anyone out there have experience with Manerix and can compare it to Nardil?
>
> thanks!
> maddog
In my estimation, moclobemide is not nearly as effective for depression as Nardil. However, for most people, moclobemide is virtually without side effects. I can't comment with as much certainty as to how effective it might be for anxiety. However, it did not fair well in US clinical trials for social phobia, and failed to get approved by the FDA.I tried moclobemide. It made my depression much worse. This is not very common, though. What is common is for one to feel better during the first week at dosages no higher than 300mg. However, the improvement most often fades, and necessitates dosage increases to as high as 900-1200mg. I think the reason you don't hear much about moclobemide is simply because it is just not consistently effective. That being said, you still might want to give it a try before moving on to the more potent drugs. Although dietary restrictions are often deemed unnecessary, still it has been recommended by some researchers that one not ingest any more than 50mg at any one meal. There have also been quite a few reports of serotonin syndrome developing with the addition of a SSRI, although there are a few doctors who claim to successfully combine the two drugs.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9860107
I hope this helps.
- Scott
Posted by quarterwit on September 21, 2004, at 7:56:37
In reply to Moclobemide/Manerix vs. Nardil, posted by maddog on September 20, 2004, at 20:55:36
Maybe try the Moclobemide before the hard-core ones. Nardil definitely works, but like a "scatterbomb" (at least for me): once dose gets high enough, there's relief finally, but with me the difficulty in combining other meds (like stims) and weight gain (bloating, like water retention) with nardil was too much.
Please keep us up to date if you try Moclobemide. This board doesn't have much positive feedback on it that I could find, but everyone's different. I also read the log of a bunch of pdocs discussing it (I'll try to find the link). The gist was the same as all ADs: some liked it, some didn't; some had patients who responded robustly, some didn't.
It's available most places but the US. I wouldn't read too much into this, though. It may just be cynicism, but I think MARKETING and various persuasive influences play more of a role in FDA approvals than actual efficacy. If one researches long enough on the web, ALL types of reports (positive and negative) can be found on ALL types of meds! Like Reboxetine, which I read is similar to Straterra, was around several years ago but couldn't get approved here -- coincidently losing bid for US market while Straterra was in late testing!
Again, maybe I'm just being cynical. Good luck whatever your decision.
> Hi Everyone,
>
> I met with a new pdoc today who suggested that I try Manerix (a reversible MAOI) instead of Nardil. I have seen little written about Manerix in terms of its side effects and efficacy, especially with respect to anxiety.
>
> Does anyone out there have experience with Manerix and can compare it to Nardil?
>
> thanks!
> maddog
Posted by King Vultan on September 21, 2004, at 12:54:50
In reply to Moclobemide/Manerix vs. Nardil, posted by maddog on September 20, 2004, at 20:55:36
> Hi Everyone,
>
> I met with a new pdoc today who suggested that I try Manerix (a reversible MAOI) instead of Nardil. I have seen little written about Manerix in terms of its side effects and efficacy, especially with respect to anxiety.
>
> Does anyone out there have experience with Manerix and can compare it to Nardil?
>
> thanks!
> maddogIn "Clinical Advances in Monoamine Oxidase Inhibitor Therapies", there's a chart listing moclobemide side effects vs. amitriptyline and placebo. Moclobemide side effects were nearly identical to placebo in some cases, such as dry mouth and sedation, less than placebo in a couple (constipation and tachycardia), but significantly more than placebo in insomnia (~18% vs. ~2%) and gastrointestinal discomfort (~39% vs. 20%). Amitriptyline had brutal dry mouth (~96% vs. <20% on both moclobemide and placebo) and was signficantly more sedating, at about 53% versus about 16% for both placebo and moclobemide.
Todd
Posted by Jasmineneroli on September 21, 2004, at 20:03:43
In reply to Re: Moclobemide/Manerix vs. Nardil, posted by quarterwit on September 21, 2004, at 7:56:37
Hi Maddog:
I've had no experience with Nardil...you might want to look at past posts by ACE, for info on that (he's our resident "Nardil Champ"!).
However, I did try Moclobemide for about 6 weeks in Spring 2004. In a word *horrible*. I titrated up really slowly from 150mg to 300mg to 600mg. At 300mg I got a headache and body flu-like pains,& no energy at all. At 600mg I got absolutely killer pounding headaches, so bad I couldn't tolerate light. I immediately stopped taking it....and got relief the next day. I actually thought I had a bad flu or something, at first! Realizing I shouldn't just *stop* it, I took 300mg for a further week (headache returned, neck stiffness etc.) then on to 150mg for several weeks. At 150mg I still sometimes had headaches, but my energy returned. My Pdoc said 150mg was too low to be therapeutic, so we stopped it altogether. I had no withdrawal. I think that by week 6 ( the last 2 weeks on 150mg), that it did have a mild lightning effect on my mood and anxiety.
So I do think it can be worth trying. Headaches are amongst the most common of it's side effects - so if you are at all prone to them from meds (as I am), it might be one to stay away from. Otherwise, I believe it to be fairly benign, and is "easy" to discontinue.
Good luck!
Jas
Posted by yznhymer on September 21, 2004, at 20:07:27
In reply to Re: Moclobemide/Manerix vs. Nardil, posted by King Vultan on September 21, 2004, at 12:54:50
Hi Folks...
I've been on maclobemide for a couple of years at least and my experiences pretty much mirror the description Scott provided. I experienced no side effects whatsoever. It has been easy to purchase from Canada with a doctor's prescription, but my latest pdoc was not able to get any information out of Roche Canada about the drug other than that contained in the monograph. Finding reliable information about augmenting the drug in the states is a bit problematic.
I certainly do think maclobemide is worth a trial because of the side effect cluster. It hasn't pulled me out of my chronic lethargy but I haven't had any scary suicidal I-can't-stand-the-pain periods either. Still, I'm hoping for something more. Cymbalta, Parnate, and ESAM (when available) look like my best AD options at this point.
Mark
> > Hi Everyone,
> >
> > I met with a new pdoc today who suggested that I try Manerix (a reversible MAOI) instead of Nardil. I have seen little written about Manerix in terms of its side effects and efficacy, especially with respect to anxiety.
> >
> > Does anyone out there have experience with Manerix and can compare it to Nardil?
> >
> > thanks!
> > maddog
>
> In "Clinical Advances in Monoamine Oxidase Inhibitor Therapies", there's a chart listing moclobemide side effects vs. amitriptyline and placebo. Moclobemide side effects were nearly identical to placebo in some cases, such as dry mouth and sedation, less than placebo in a couple (constipation and tachycardia), but significantly more than placebo in insomnia (~18% vs. ~2%) and gastrointestinal discomfort (~39% vs. 20%). Amitriptyline had brutal dry mouth (~96% vs. <20% on both moclobemide and placebo) and was signficantly more sedating, at about 53% versus about 16% for both placebo and moclobemide.
>
> Todd
Posted by Jaynee on September 21, 2004, at 21:04:27
In reply to Re: Moclobemide/Manerix vs. Nardil, posted by yznhymer on September 21, 2004, at 20:07:27
Hi, I am back trying Manerix. I tried it last year about the same time and it was wonderful for giving me energy, but didn't work very well for my horrible pms. I was taking Celexa which I like for anxiety, but it is too hard on my stomach and makes my muscles to tense.
The reason I am back on Manerix, is I like the energy and motivation it gives me, and I want that back. I get that with only 150mg. Manerix has been studied and used for chronic fatigue with good results. For my anxiety I am using L-theanine. So far so good. Oh ya, the only side-effect I get from Manerix is having a harder time falling asleep. So I am also taking zopiclone, but I was also taking that with Celexa.
The one thing I love about Manerix is it is so easy to start and quit. Absolutely no weird side-effects like brain zaps etc.
Good luck.
Posted by DonBristol on September 22, 2004, at 6:37:43
In reply to Moclobemide/Manerix vs. Nardil, posted by maddog on September 20, 2004, at 20:55:36
> Hi Everyone,
>
> I met with a new pdoc today who suggested that I try
> Manerix (a reversible MAOI) instead of Nardil. I have
> seen little written about Manerix in terms of its side
> effects and efficacy, especially with respect to anxiety.
>
> Does anyone out there have experience with Manerix and
> can compare it to Nardil?
Maddog, I have tried both Nardil and Moclobemide. My experience with moclobemide is not as bad as that of many of the other posters in this thread. In fact I found it to be very good. But it very quickly (in a matter of months) ran out of steam and I needed to increase the dose. In fact I got to a stage where I couldn't easily increase it an y more because the pdoc was uneasy with the amount.Moclobemide is energising in the same way as Parnate is but Moclobemide seems to me to be rather weaker. It's great advantage is that you do not have to eat a restricted diet of foodstuffs.
I found Nardil made me feel foggy. It slowed me down and made me lethargic. However it did have a positive effect on mood and was probably as good as if not better than Moclobemide.
If your pdoc wants to try Moclobemide then I would give it a go in case it works for you. Some people have posted about adverse effects but I got almost NIL adverse effects. I found it to be a vert clean med from that point of view. OTOH the side effects of Nardil were for me quite unwanted (fuzziness, altered sleep patterns, dietary restrictions, dry mouth, etc).
OTOH as you suffer from anxiety then perhaps an energising med may (or may not) be a problem.
As you can see, my experience does not line up with that of many of the other posters in this thread.
Posted by yznhymer on September 23, 2004, at 10:01:58
In reply to Re: Moclobemide/Manerix vs. Nardil, posted by Jasmineneroli on September 21, 2004, at 20:03:43
In retrospect, I also had quite a few headaches like the ones you described on moclobemide. They did start with a stiffening and pain up the neck as well. I remember at the time wondering if they were caused by spikes in blood pressure, and if this was related to the medication. I never definitively made the connection, but the headaches were one of the reasons I started tapering off the moclobemide. The headaches weren't so bothersome as they were worrisome. In other words, they weren't that frequent or debilitating, but they were unusual.
Thanks for the memory jog,
Mark
This is the end of the thread.
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