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Re: Help..severe anger....

Posted by SLS on September 14, 2021, at 13:58:37

In reply to Re: Help..severe anger.... linkadge, posted by Jay2112 on September 11, 2021, at 19:14:32

Jay,

My recommendation is that you take a pass on moclobemide. It can produce remarkably quick results for depression, and possibly anxiety. People often begin at 300 mg/day and improve remarkably, but usually only briefly. However, dosage escalation is all but inevitable, and usually results in a failure to remain well at 1200 mg/day. For me, I experienced a noticeable and clean improvement within a couple of days, but I relapsed within 2 days. My reaction became foul quickly, and left me tortured, curled up in a fetal position on the couch, and audibly whimpering.

Personally, I think MAO-A is essential for an MAOI to work for depression, particularly one where anhedonia or anxiety is present. After watching a bunch of RIMAs appear and then disappear, moclobemide is the last one to stand. It has a remarkably short half-life, and is sometimes considered partially irreversible. A low-tyramine diet is still necessary, but the daily intake can be as high as 50 mg. Irreversibility seems all but essential for MAOIs to be effective. Brofaromine and the others that were developed were never approved anywhere in the world with the exception of one of the Balkins, I can't remember which one.

In my early research, I came upon an MAOI called clorgyline. It is a remarkably potent and specific inhibitor of MAO-A. Unlike moclobemide, it is irreversible. It was never developed for marketing. However, it was (and probably still is) the gold standard for manipulating and tagging the MAO-A enzyme. I caught wind that the NIH was using it on their most treatment-resistant cases. My doctor there called it their "ace-in-the-hole". At a time when I was totally unresponsive to all treatments, including Nardil and Parnate, clorgyline kicked a few bricks out of the wall that allowed me to regain some responsivity to future treatments. I was on it for awhile, but the improvement was at best moderate, and very episodic. Before leaving the NIH, asked the head of the department, William Z. Potter, if he would add desipramine. He said yes, but only 10 mg/day. I didn't bother. Perhaps I made a mistake, but ultimately, it wouldn't have made a difference. Unfortunately, there were some reports that among the very, very few people who were taking clorgyline, cardiac side effects emerged in a few of them. They withdrew clorgyline from their patient population. Clorgyline had been considered the most efficacious antidepressant on Earth.

It is important to know that selegiline / l-deprenyl / EMSAM does not produce an antidepressant response until the dosage has reached high enough for it to inhibit MAO-A in addition to the selective inhibition of MAO-B at lower dosages. Therefore, selegiline is selective for MAO-B at the low dosages used to treat Parkinson's, but not at high dosages. If selegiline were specific for MAO-B rather than specific, it would never work to treat depression.


- Scott


Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.

 

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poster:SLS thread:1116908
URL: http://www.dr-bob.org/babble/20210723/msgs/1116938.html