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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by peacetoy on December 15, 2005, at 9:16:38
Hi, I posted here on moclobemide a few weeks ago, before I tried it. I've now been taking it for a week, and am up to 450mg.
Some old posts I read on Psycho Babble have made me a bit concerned (to say the least). They are from people who've had a bad reaction to moc and experienced INCREASED depression:
http://www.dr-bob.org/babble/19991108/msgs/15407.htmlI'm worried as I feel like sh*t, and have been experiencing ever increasing suicidal thoughts since stopping Effexor (my last pill was 2 weeks ago after a fairly slow tapering off). I feel the moc is making me feel more anxious and agitated as well....and I suspect coming off the Effexor might have had an adverse effect as well.
Does anyone here have experience with moc they can share? I'm wondering how long to give it, before giving up (and I think ECT might be my next choice)? I'm used to ADs having start-up effects, but I'm feeling so sh*t this is intolerable....
Andrew
Posted by Tomatheus on December 16, 2005, at 0:32:53
In reply to Moclobemide?, posted by peacetoy on December 15, 2005, at 9:16:38
Andrew,
When I took moclobemide, my dysthymic symptoms began to subside for about two to three days, and then I felt as depressed as I normally do once that initial 2-3 day period ended. Of course, my experience is just one person's experience, and I tend to have atypical responses to most meds, so I certainly wouldn't judge just based on my experience.
I would say that from what I've read, moclobemide tends to work fairly quickly. Most of the posts I've read here suggest that moclobemide's long-term response can be felt within a week. Usually, it seems that patients either respond after a few days at a given dose, or they don't get any kind of positive response at all during their treatment. I have rarely read of cases of patients waiting for two weeks or longer on moclobemide with no positive response before finally achieving a beneficial therapeutic response. Unlike other antidepressants, the pharmacological effects of moclobemide do not last for more than two days. With moclobemide, MAO-A activity returns to 100 percent after 16 hours (Nair et al., 1993). But with phenelzine (or Nardil, an MAOI that often takes weeks to "kick in"), it takes more than two weeks for MAO-A and MAO-B activity to return to 100 percent. Additionally, "a full biochemical effect is present after the first dose of moclobemide, and there is a distinct relationship between the plasma concentration of the drug and its pharmacological effect" (Nair et al., 1993). So, to make a long story short, most of what I've read suggests that you should know how you're going to feel after a week on moclobemide.
Considering that doses of 600mg/day or higher are sometimes needed to produce a full response with moclobemide, I would think that in most individuals, a dose increase (from 450mg/day) would be the best logical next step. But since you've been experiencing suicidal thoughts, a dose increase might not be the best idea. I would definitely check with your doctor for further instructions. If you do stop moclobemide, one advantage will be that you'll only need to give it a two-day "washout" before starting another drug, if that's the next step that you take. And I personally wouldn't consider even trying ECT unless I've exhausted my medication options, but that's just me.
Thanks for your post.
Tomatheus
==
REFERENCE
Nair, N. P. V., Ahmed, S. K., & Ng Ying Kin, N. M. K. (1993). Biochemistry and pharmacology of reversible inhibitors of MAO-A agents: Focus on moclobemide. Journal of Psychiatric Neuroscience, 18, 214-25.
==
> Hi, I posted here on moclobemide a few weeks ago, before I tried it. I've now been taking it for a week, and am up to 450mg.
>
> Some old posts I read on Psycho Babble have made me a bit concerned (to say the least). They are from people who've had a bad reaction to moc and experienced INCREASED depression:
> http://www.dr-bob.org/babble/19991108/msgs/15407.html
>
> I'm worried as I feel like sh*t, and have been experiencing ever increasing suicidal thoughts since stopping Effexor (my last pill was 2 weeks ago after a fairly slow tapering off). I feel the moc is making me feel more anxious and agitated as well....and I suspect coming off the Effexor might have had an adverse effect as well.
>
> Does anyone here have experience with moc they can share? I'm wondering how long to give it, before giving up (and I think ECT might be my next choice)? I'm used to ADs having start-up effects, but I'm feeling so sh*t this is intolerable....
>
> Andrew
>
>
>
Posted by peacetoy on December 16, 2005, at 6:19:58
In reply to Re: Moclobemide? » peacetoy, posted by Tomatheus on December 16, 2005, at 0:32:53
Hi, cheers for the info on moclobemide. Well it does sort of feel that I've exhausted medication options. Over the past year, it's been one med and med combo after another and almost NOTHING has worked. This is the list, beginning with a switch from fluoxetine to escitalopram in December last year:
Fluoxetine
Escitalopram
Mirtazapine
Fluoxetine + mirtazapine
Fluoxetine + tradozone
Fluoxetine + Zyprexa (which worked really well, but just for a month)
Fluoxetine + Zyprexa + Wellbutrin/Zyban
Effexor + Zyprexa
Moclobemide + ZyprexaSo I'm not sure what there is left to try. Mood stabilisers like lamictal? I suppose there is always lithium, but I took that for a number of years and didn't get a fantastic response.
So I am thinking seriously about ECT. This depression has lasted over a year, and I'm at the end of my tether!
Andrew
Posted by Declan on December 16, 2005, at 13:48:51
In reply to Moclobemide?, posted by peacetoy on December 15, 2005, at 9:16:38
I woder if you're getting a double whammy of post-Effexor sensitivity and moclobemide anxiety/agitation. Some people do find moclobemide agitating.
Do you feel worse now on moc than you did before you started? Because if you do then it's probably that.
Declan
Posted by Tomatheus on December 17, 2005, at 1:27:48
In reply to Re: Moclobemide? » Tomatheus, posted by peacetoy on December 16, 2005, at 6:19:58
Andrew,
I can definitely relate to the frustration you must be feeling from trying one med (or med combo) after another without much success. Personally, I've only had one partial response -- a Wellbutrin-lithium combo that I stayed on for more than a year -- but even this partial response was woefully inadequate. While I was on the lithium-Wellbutrin combo, I tried mixing all different kinds of supplements at abnormally high doses and went way overboard on caffeine (a definite no-no when taking lithium) to give myself the boost in mood I needed so I could barely get by in the classes I was taking at the time and in the student job I had. I was usually able to get by, but it's obvious in retrospect that my med combo wasn't doing much; otherwise I wouldn't have needed all those supplements just to (oh so barely) get by. Once again, my response to this combo was partial in that it allowed me to get by (sort of) with my classes and my job, but it was a constant painful struggle that really did not produce what I would consider to be an adequate antidepressant response. So, with that being my "best" response, I'm sure you can imagine how unsuccessful the rest of my med trials have been.
Considering your lack of success with meds (or perhaps I should instead say "the drug industry's lack of success of giving you the treatment you need and deserve"), I can understand why you might want to consider ECT. I'm personally not a big proponent of ECT, and that's mostly because ECT success stories tend to be few and far between. From what I've read, those who do get at least a minimally adequate response from ECT usually need to go through regular "maintenance" ECT sessions over extended periods of time so they can still get a therapeutic response. I understand that ECT is a lot safer than it used to be, but the idea of having to go to get my brain electrocuted several times a year is not something that I'm very comfortable with. I guess I'd just rather put up with the the temporary side effects of ineffective meds than the consequences of numerous ineffective ECT sessions (I know ... I'm too cynical about the effectiveness of these treatments).
With respect to your meds, there is still a lot that you haven't tried. I know that this is probably the last thing you want to hear when nothing's been working, but sometimes patients (including some who post on this board) go through years of unsuccessful trials and then finally find a med or combo that actually works. As you mentioned, Lamictal has demonstrated some efficacy at treating both unipolar and bipolar depression, so yes, that's definitely one med to consider, either as monotherapy or in combination with an antidepressants. In terms of antidepressants, you could still try going with another SSRI other than fluoxetine, or you might want to consider the tricyclics or irreversible MAOIs. I know that there are several regular posters here who have benefited tremendously from Nardil (unfortunately, it's looking more and more like I won't be one of them). Then there's also Emsam, the selegiline patch, which is expected to become available some time in 2006.
So, as frustrating as it is to go from med to med (or from combo to combo) with little success, please remember that it might very well possible to achieve remission with one of the meds you haven't tried, either alone as monotherapy, or in combination with another med. ECT is always an option, but keep in mind that ECT success stories are not very common. At least on this board, it seems that more patients get success from meds (even after many frustrating unsuccessful trials) than they do from ECT. But then again, maybe those who succeed with ECT are just not represented here. At any rate, I just wanted to give you a few things to think about and let you know that you do have other med options.
Tomatheus
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