Author Topic: Moclobemide & MAOIs for Anxiety & Depression  (Read 5009 times)

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Offline Eon T McKnight

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Moclobemide & MAOIs for Anxiety & Depression
« on: August 10, 2010, 07:12:01 PM »
Hello Good People,

I am starting this thread because I just sent my pal, Cal, some moclobemide.  He's going through a rough spell of anxiety and depression at this time and I am hoping that moclobemide helps him as it has helped me.

While definitely the safest of all MAOIs, there are still some precautions that must be taken with moclobemide.  It is my hope that posting such safety information here will help both Cal and anyone else using MAOIs or moclobemide.

PLEASE ! ! !  No shooting from the hip!

While any and all factual information is welcome here, I purposely started the topic where I still have God-like moderatorial powers.  If a reliable, scientific reference cannot be located, and the information/advice could possibly be harmful, it will be removed.

If you want to contest my decision to remove something, please be so kind as to PM me about it.

I feel very strongly about doing no harm!

Here is an excellent article on antidepressants that came across on the vox list  --  but please note, it does not appear that MAOIs were included in the studies mentioned:

     http://www.newsweek.com/2010/01/28/the-depressing-news-about-antidepressants.html

I find the last paragraph especially insightful:

"As shown by the explicit criticism of drug companies by the authors of the recent JAMA paper, more and more scientists believe it is time to abandon the "don't ask, don't tell" policy of not digging too deeply into the reasons for the effectiveness of antidepressants. Maybe it is time to pull back the curtain and see the wizard for what he is. As for Kirsch, he insists that it is important to know that much of the benefit of antidepressants is a placebo effect. If placebos can make people better, then depression can be treated without drugs that come with serious side effects, not to mention costs. Wider recognition that antidepressants are a pharmaceutical version of the emperor's new clothes, he says, might spur patients to try other treatments. "Isn't it more important to know the truth?" he asks."

While some of my own personal experimentation indicates that some of the interaction and caution information is a bit conservative IF ONE IS EXTREMELY CAREFUL.  (More on that later.)  But, all things considered, the wiki article is a damn good place to start.

Your comments and questions are WELCOME ! ! !

ET McKnight


The wiki entry, can be found in its entirety here:

     http://en.wikipedia.org/wiki/Moclobemide

"Pharmacology

Moclobemide is a reversible inhibitor of monoamine oxidase A (RIMA),[1] a type of monoamine oxidase inhibitor (MAOI), and acts on serotonin, norepinephrine (noradrenaline), and dopamine.[2] Unlike standard MAOIs, possible side effects do not include cardiovascular complications (hypertension) with encephalopathy, liver toxicity or hyperthermia.

A single 300 mg dose of moclobemide inhibits 80% of monoamine oxidase A (MAO-A) and 30% of monoamine oxidase B (MAO-B), blocking the decomposition of norepinephrine, serotonin and, to a lesser extent, dopamine. No reuptake inhibition of any of the neurotransmitters occurs. The pharmacodynamic action encompasses activation, elevation of mood, and improvement of symptoms like dysphoria, fatigue, and difficulties in concentration. The duration and quality of sleep may be improved. In the treatment of depression the antidepressant effect often becomes evident in the first week of therapy (earlier than typically noted with TCAs/SSRIs).

Moclobemide should not generally be taken concurrently with other antidepressants, because of the likelihood of significant drug interactions. Some very specific regimens may combine moclobemide with a tricyclic or SSRI antidepressant. A washout period of two days is necessary when switching to a tricyclic antidepressant, and for SSRIs, a washout period of at least four to five half-lives is required.

Uses

    * Depression; most experience exists with major depression according to DSM-III
    * Social anxiety disorder, as part of an integrated treatment involving cognitive-behavioral therapy

In efficacy studies for the treatment of major depressive disorder, moclobemide has been found to be significantly more effective than placebo, as effective as the tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), and somewhat less effective than the older, irreversible MAOIs phenelzine and tranylcypromine. In terms of tolerability, however, moclobemide was found to be comparable to the SSRIs and better tolerated than the TCAs and older MAOIs.[8]

In addition, moclobemide is occasionally used recreationaly when mixed with the prototypical psychedelic dimethyltryptamine (DMT). Orally ingested DMT is inactive, as it is rapidly metabolized by gut monoamine oxidase enzymes, hence these enzymes must be temporarily inhibited in order for DMT to pass into the bloodstream intact. The combination of DMT-containing plants and the plant-based MAO-inhibiting harmala alkaloids (harmine, harmaline) is referred to as Ayahuasca, a psychedelic brew used by several native tribes of South America in traditional spiritual ceremonies. Moclobemide serves a similar purpose to the harmala alkaloids and has been used in modern synthetic recapitulations of the Ayahuasca ritual and such a mixture, in which a synthetic MAOI is used in conjunction with DMT is commonly being referred to as "Pharmahuasca".

Contraindications and cautions

    * Hypersensitivity to moclobemide
    * States of severe confusion
    * Concomitant treatment with selegiline
    * Concomitant treatment with clomipramine
    * Concomitant treatment with SSRIs. After termination of SSRI treatment, moclobemide should not be used until four to five half-lives of the SSRI have elapsed (five weeks in the case of fluoxetine and two weeks otherwise).
    * Combination treatment with pethidine (Interaction may be fatal)
    * Combination treatment with dextromethorphan
    * Pediatric patients (no sufficient data exists)
    * Caution: Patients with schizophrenia (psychosis may exacerbate, longterm treatment with neuroleptics should be continued.)
    * Caution: Patients with hyperthyroidism (overfunction of the thyroid gland) and phaeochromocytoma. Hypertensive reactions are possible, therefore treatment with moclobemide cannot be recommended.
    * Caution: Patients with uncontrolled hypertension
    * Caution: Patients with bipolar disorder.

Interactions

    * Other MAO-Inhibitors, SSRIs, SNRIs, clomipramine, selegiline, pethidine/meperidine, dextromethorphan, tramadol and MDMA: Development of serotonin syndrome, which may be fatal, is possible. MAOIs, in general, interfere with the metabolism of SSRIs.
    * Opiates: Moclobemide potentiates the analgesic action of opiates.
    * Sympathomimetics: Risk of serious hypertensive crisis. Combination therapy is not recommended.
    * Cimetidine: Metabolization of moclobemide is reduced; dosage of moclobemide should be reduced to 1/3 to 1/2 of the normal dose.
    * Antidepressants without serotonergic action: Moclobemide treatment is possible after a latent period of 48 hours. The moclobemide dose should not exceed 300 mg daily during the first week.
    * Benzodiazepines: Moclobemide doubles the half-life of diazepam and the active metabolite nordiazepam. The diazepam dose should be reduced accordingly.

Dietary advice

No special diet is necessary, in contrast to irreversible MAOIs. Nevertheless, the patient should avoid excessive consumption of foods containing tyramine (e.g. cheddar cheese, fava beans, chianti wine) in order to avoid a rise in blood pressure.

Dosage

    * Depression: The initial dose is 300 mg daily in 2 or 3 divided doses. In cases of severe or resistant depression the dose can be increased to 600 mg daily. One week should elapse before the dose is escalated, because bioavailability increases during the first week. The treatment should be continued for 4 to 6 weeks, before a determination regarding the success of moclobemide treatment is made.
    * Social anxiety disorder: The recommended dose is 600 mg daily in 2 or 3 divided doses. Treatment is usually started with 300 mg daily on the first 3 days. The treatment should be continued for at least 3 to 4 weeks, before the therapeutic gain is determined. Physician and patient should be aware that the therapeutic prospects of moclobemide treatment in patients with chronic alcoholism are bad. As social phobia is a chronic disease, it can be advisable to treat patients on a long-term basis. In clinical studies moclobemide proved to be an efficient drug for maintenance."

Offline Calaquendi

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Re: Moclobemide & MAOIs for Anxiety & Depression
« Reply #1 on: August 12, 2010, 06:22:38 PM »
I love you McKnight - I am only online for a moment right now so I cannot respond in entirety to this thread but will very soon...thanks for everything. BTW I noticed I removed your global mod status but forgot to remove your moderator stat here...would you like me to or would you like to stay on as a board mod here? Talk soon brother!
" I am you and what I see is me..."

Offline Eon T McKnight

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Re: Moclobemide & MAOIs for Anxiety & Depression
« Reply #2 on: August 13, 2010, 02:36:04 AM »
Pal Cal!

I am soooooo hopin' that you report one missing toof next time you log in!

Not to worry about my mod status on this board, I have a fiendishly clever plan:  If I win, I'll have to disqualify myself and we can start the drawing all over again.  That way, I could win twice  --  once from the drawing and a second time by giving it away.

Bet you never suspected what a greedy MFer I truly am...

Be sure to let me know when you get the package.  The first day, you can start with one as soon as you wake up and take another 4 - 6 hours later.  The first day they probably won't disturb you sleep  --  actually, the reduction in anxiety might actually help you sleep until them mischievous brain chemicals get changed.

I sent 300mg tabs, which haven't caused the Cheese Syndrome for me if I only take 2 per day.  WARNING:  1200 mg DID cause it and take my word for it, it is NOT something you want to experience!  Still, best to wait at least .5 - 1 hour after eating tyramine containing foods before a dose.  It's late, and I'll continue w/ my observations later.  Oh, as far as opiates are concerned (the ones the doc gave you after yanking yer toof) there is little to worry about unless you do a lot.  In fact, the moclo reduced opie side effects and extended their effectiveness for me.  But please be careful!

ET