PsychoTropical Research - Dr Ken Gillman, Serotonin Syndrome, Mirtazapine, Dual Action Drugs. Antidepressants - Moclobemide.

PsychoTropicalResearch, serotonin and serotonin syndrome research.

Antidepressants - Moclobemide

Antidepressants - Moclobemide

Date Created: 14/01/1999   Last Modified: 07/10/2002   Last Checked: 03/01/2003

Moclobemide is an MAOI.

It is one of only a few drugs that have appeared, in several well executed clinical trials, to be less effective than other reference drugs and / or indistinguishable in efficacy from placebo (for major depression, for agoraphobia, and for social phobia).

Recent evidence shows moclobemide is a potent inhibitor of cytochrome P450 enzyme 2C19.

One recent US trial constitutes substantive evidence that it is no more effective than placebo for social phobia. The authors concluded ‘At 12 weeks, 35% of subjects on 900 mg of moclobemide (well above the ‘max’ recommended dose of 600 mg) and 33% of those on placebo were at least much improved. In this dose-response trial, moclobemide did not demonstrate efficacy at 12 weeks’.

Gillman's maxim No. 1

Find a drug with no side effects and you may have a drug with no therapeutic effects.
(The pharmacologists' version of 'there is no such thing as a free lunch).

Moclobemide continues to be a drug which, from my analysis of the evidence, should be avoided in cases of major depression because of its low efficacy. I would encourage anyone who uses moclobemide to be very critical about assessing improvement, watch out for partially improved cases. There is accumulating evidence that moclobemide is less effective than a number of other drugs.

It appears that Roche are no longer pursuing their application to license moclobemide with the FDA in USA.

My personal experience, using doses up to 1200 mg, is that it is frequently ineffective for major depression. Current evidence suggests it is not an appropriate treatment choice for major depression.

***** The present evidence suggests it is prudent to regard moclobemide, when used in doses above 600 mg, as an 'MAOI' in all respects. It is advisable to follow an MAOI diet and be alert for the usual MAOI interactions (see MAOI info for patients).

What moclobemide's place may be in the treatment of milder anxiety / depression cases seen in primary care is still uncertain; one might remember that apparent success in cases of mild anxiety / depression is likely to represent spontaneous resolution and placebo response in people who may well have had a good result with no specific intervention, or a better result with CBT.

I will 'nail my colours to the mast' and proffer my view, based on 'experience' and my interpretation of the evidence. My view is that moclobemide comes close to being the most costly placebo-like drug currently on the world market.

It represents a paradigm with important lessons for us all in relation to biasing influences in drug trial research and research methodology. The moclobemide story exemplifies the crucial importance of maintaining a critical and sceptical attitude to published research.