Moclobemide and Tricyclic Antidepressants in Severe Depression

Abstract

There is no generally accepted definition of severe depression, but hospitalization, high scores on rating scales, and the presence of psychotic symptoms are widely considered to be indicators of severe cases. For the purpose of this analysis of the antidepressant efficacy of the reversible inhibitor of monoamine oxidase A moclobemide, all hospitalized cases were selected from the current database of comparative studies and compared with the standard tricyclics imipramine and clomipramine. The cases from comparisons of moclobemide and imipramine were analyzed together, because in accordance with the recommended range of doses, the dose ratio over all studies was approximately 3:1 (moclobemide: N = 238, mean dose, 453 mg/day; imipramine: N = 248, mean dose, 159 mg/day). The cases from comparisons of moclobemide and clomipramine could only be analyzed over all studies if dose was taken into account, because the dose ratio of approximately 3:1 was only given in one study (moclobemide: N = 62, mean dose, 466 mg/day; clomipramine: N = 66, mean dose, 154 mg/day), whereas the dose ratio over the other, earlier studies was approximately 2:1 (moclobemide: N = 58, mean dose, 258 mg/day; clomipramine, N = 59, mean dose, 124 mg/day). The efficacy as judged on the Hamilton Rating Scale for Depression (HAM-D) and Global Assessment of Efficacy was analyzed for subgroups of inpatients, according to different severity bands (17-item HAM-D baseline total score, cut-off, 28 points) and according to the presence or absence of mood-congruent psychotic features. The results of our analysis failed to reveal any difference in efficacy between moclobemide and imipramine in any subgroup of hospitalized depressives, including patients in the highest HAM-D severity band and psychotic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Meta-Analysis of the Reversible Inhibitors of Monoamine Oxidase Type A Moclobemide and Brofaromine for the Treatment of Depression

“…It is also possible that the optimal dose of MOC for treatment of more severe or refractory mood disorders is higher than currently appreciated. For example, Angst et al (1995) have marshalled data to suggest that MOC at doses of р400 mg/day is a less effective treatment of severely depressed inpatients than either clomipramine (у150 mg/day) or MOC at higher dosages (у450 mg/day). It would appear, then, that prescription of larger doses (i.e., 450 to 900 mg/day) would be a rational first step for management of an ineffective but well-tolerated trial of MOC.…”

Monoamine Oxidase Inhibitors—Revisiting a Therapeutic Principle

“…The majority of clinical studies demonstrated that moclobemide (300 mg -600 mg) was superior to placebo and thereby efficaceous in the treatment of the major depressive episodes (Bonnet, 2003). A meta-analysis of results from clinical studies comparing the effect of moclobemide with imipramine failed to reveal any difference in efficacy between moclobemide and imipramine in any subgroup of hospitalized depressives, including patients in the highest HAM-D severity band and psychotic patients (Angst, Amrein, & Stabl, 1995). When compared to clomipramine (25 -200 mg; tricyclic antidepressant (TCA)) moclobemide was generally better tolerated but showed mixed effects with respect to efficacy.…”

Moclobemide as add-on therapy to agomelatine in a patient with treatment-resistant major depressive disorder: a psychopharmacological case

“…This case also serves to illustrate how different pharmacology can help ensure a satisfactory clinical outcome in treatment-resistant MDD patients. Because of the incompatibility of MOC with other antidepressants, the treatment combinations with MOC are usually limited [2]. In this case, however, this combination not only inhibited MAO-A, but also caused broad receptor activity, especially of MT 1 and MT 2 receptors, which is one possible explanation for positive clinical effect.…”

“…The long-term followup studies lasting 6-12 months have also demonstrated that the antidepressant efficacy of MOC is maintained. Higher doses of MOC (> 450 mg/day) may be more effective in severe depression, while a lower dose tends to 1 3 cause a weaker response than tricyclic antidepressants [2]. MOC is well tolerated by most patients.…”