# Moclobemide: about damn time! A live experience report



## euphoria (Jan 21, 2009)

So I got my script for moclobemide, but unfortunately it's only 150mg for 3 days after which she'll increase me to 300mg then higher probably in the coming weeks. I only expect very mild effects from 150mg, similar in strength to rhodiola or St John's Wort.

The pharmacy near my house apparently don't have any moclobemide because it's "too old". Lame. Trying to find it somewhere else.

I expect it to make me more anxious for a while, but the psych woman told me she'd hand out a few benzos if it's bothering me. Looks like I will be getting anxious then...

Okay, I've now located some moclob. First impressions coming shortly...


----------



## beaches09 (Feb 1, 2009)

This is going to be exciting. I'm very curious.


----------



## Medline (Sep 23, 2008)

My Moclobemide starting dose was 600mg and I didn't feel anxious. I went up to 900-1200mg but it didn't really help me. At least I had no bad side effects from this drug.


----------



## Beffrey28 (Jan 15, 2009)

I hope this works for you!


----------



## euphoria (Jan 21, 2009)

I dosed about 40 minutes ago. As expected, nothing dramatic has happened, but the worst of my anhedonia and dysphoria seems to have lessened. I'll increase to 300mg in a few days.

I'd say the serotonin and dopamine effects are pretty equal, and thankfully I'm not noticing any noradrenaline increase. I don't feel any more nervous than before. Music sounds a little better.

This one has potential...


----------



## Medline (Sep 23, 2008)

150mg Moclobemide can't affect dopamine levels - that's psychopharmaco*logical*. And do you really think you can exactly feel which drug affects which neurotransmitter systems in your brain?


----------



## beaches09 (Feb 1, 2009)

We can do our best to try


----------



## euphoria (Jan 21, 2009)

Medline said:


> 150mg Moclobemide can't affect dopamine levels - that's psychopharmaco*logical*.


Sure it can. Dopamine is broken down equally between MAO-A and B.



> And do you really think you can exactly feel which drug affects which neurotransmitter systems in your brain?


I'm getting better at it, yeah.


----------



## Medline (Sep 23, 2008)

> Sure it can. Dopamine is broken down equally between MAO-A and B.


You still haven't got it that Moclobemide is a reversible, selective MAO-A inhibitor. Sure you can raise dopamine levels with it significantly... just overdose, then it's unselective.  If you take normal doses and inhibit something like 80% of MAO-A and 30% of MAO-B that's plenty enough to degrade dopamine. Not being able to strongly raise the levels of serotonin, norepinephrine *and* dopamine is the price one pays for not having to follow dietary restrictions.


----------



## euphoria (Jan 21, 2009)

Maybe I need to start drinking kava again to get MAO-B blocked too. I hate selegiline so that is out of the question.

Update on moclobemide: I took another 150mg dose and I feel awful. Very much the same as when I started Prozac. I am thinking more and more that this "MAOI lite" is nothing better than an SNRI, only with the added bonus of many drug interactions. I am definitely getting some Valium tomorrow.


----------



## Medline (Sep 23, 2008)

> Maybe I need to start drinking kava again to get MAO-B blocked too. I hate selegiline so that is out of the question.


If you take Moclobemide and block MAO-B sufficiently via overdose or another drug, you have to follow dietary restrictions and could take Nardil or Parnate instead.


----------



## euphoria (Jan 21, 2009)

But isn't tyramine destroyed by MAO-A?


----------



## euphoria (Jan 21, 2009)

Yeah I am beginning to think one of the real MAOIs would better suit me. I'd try SSRI + Wellbutrin first though.


----------



## Medline (Sep 23, 2008)

> But isn't tyramine destroyed by MAO-A?


And MAO-B. This article should give you a good understanding, but it's pretty long. 



> *On MAO-B and Tyramine Metabolism:*
> 
> Dear Sir:The Spring issue (Volume 61, #1) of AJPE included an articleby Alsharif, Theesen and Roche on teaching medicinal chemistry. It was particularly interesting and innovative. I would like to pointout, however, that there was an error on page 59 in the section on MAO inhibitors. The authors state that MAO-B is the enzymeresponsible for metabolizing tyramine, and therefore a selective MAO-A inhibitor can be used to avoid the dietary restrictions.
> 
> ...


----------



## Kanes (May 10, 2009)

*interesting*

Thanks for the article Medline. Very interesting.

Euphoria, I have been skeptical about moclobemide's use in treating SA, but you should give it a little time before you come to a final conclusion.

SSRI + Wellbutrin sounds like a good combo although I'm still a bit skeptical of the whole reuptake inhibition craze. I might try it though if I can convince my doc, but I am much more interested in trying Adderall at this point since I also have ADD. Plus I think it would be a more effective way of boosting the "big three" than bothering with Wellbutrin.

It seems like you want the benefits of a real MAOI without the drawbacks. There is one big difference though between these tactics and taking Nardil. You realize that nardil has an active metabolite that is GABAnergic right? I really believe this plays a big role in the effectiveness of nardil and that's why I have little excitement over other MAOI's like parnate which have no such action.


----------



## euphoria (Jan 21, 2009)

Kanes said:


> Euphoria, I have been skeptical about moclobemide's use in treating SA, but you should give it a little time before you come to a final conclusion.


If anything I'll just use its mild anxiolytic effect to get myself a job so I can buy the stuff online that really works.

The way I see it, moclobemide's effects are mainly on serotonin because dopamine, noradrenaline and adrenaline are all metabolised by more than one enzyme (unlike serotonin). Dopamine has more catabolic enzymes than noradrenaline and adrenaline, so more adrenergic effects will be present than dopaminergic. In fact moclobemide seems the functional equivalent of Effexor with its weak NDRI properties and strong SRI.



> SSRI + Wellbutrin sounds like a good combo although I'm still a bit skeptical of the whole reuptake inhibition craze. I might try it though if I can convince my doc, but I am much more interested in trying Adderall at this point since I also have ADD. Plus I think it would be a more effective way of boosting the "big three" than bothering with Wellbutrin.


As long as you get neurotransmitters in the synapse, it doesn't really matter what the mechanism is. I've heard good things about tyrosine for motivation and pleasure, and it's especially useful for stimulant crashes.



> It seems like you want the benefits of a real MAOI without the drawbacks. There is one big difference though between these tactics and taking Nardil. You realize that nardil has an active metabolite that is GABAnergic right? I really believe this plays a big role in the effectiveness of nardil and that's why I have little excitement over other MAOI's like parnate which have no such action.


Oh, I'd never take an unselective MAOI again. Too many side-effects. I don't think GABA should be targeted for anxiety or depression, though it does work.


----------



## beaches09 (Feb 1, 2009)

Are you going to give it some more time? You might as well give it at least a week or two just for kicks =P It can't hurt.


----------



## Medline (Sep 23, 2008)

Moclobemide works fast in general, often within 1-2 weeks, but you need a therapeutic dose (300mg bid = 600mg). If it doesn't help within 3 weeks, increase the dose to 600mg in the morning and 300mg at midday and wait another 2 weeks. If it still doesn't help, throw it away.


----------



## euphoria (Jan 21, 2009)

The maximum dosage in my country is 600mg daily.


----------



## Medline (Sep 23, 2008)

Yeah, that's the maximum dosage in every country . My psychiatrist told me Pdocs go above 600mg to 900mg (or even 1200mg) if necessary, because it can help, but it can not hurt. This strategy is especially useful when the patient showed a partial response to 600mg.


----------



## euphoria (Jan 21, 2009)

Still on 150mg, going up to 300mg in a couple of days. On Monday I'll get a week's worth of lorazepam, which I plan to save for using at work so I can finally get things up and running again. So much stuff I need to buy online...

I have noticed a mild antidepressant effect late at night, similar to what I got with SSRIs. Hopefully this will extend to the daytime as the adjustment phase completes.


----------



## BearFan (Mar 22, 2008)

Do you still take the Moclobemide? I found it quite agitating the first week, and felt agorphobia with it even when attempting to combine it with benzos. I've been on it a about a week and was really disappointed. Also I dont know whether it an increase in depression, but my libido seemed liked it died.


----------



## euphoria (Jan 21, 2009)

BearFan said:


> Do you still take the Moclobemide? I found it quite agitating the first week, and felt agorphobia with it even when attempting to combine it with benzos. I've been on it a about a week and was really disappointed. Also I dont know whether it an increase in depression, but my libido seemed liked it died.


Nah, that med was a waste of time for me.


----------



## Medline (Sep 23, 2008)

Selection10 said:


> How come selegiline and rasagiline which completely block MAO-B don't have the dietary restrictions then???


Because at MAO-B selective doses tyramine gets degraded by MAO-A.


----------



## jim_morrison (Aug 17, 2008)

Moclobemide is reversable, if one eats tyramine whilst on it, the tyramine competes with and displaces the moclobemide from it's binding to the MAO-A enzyme so that it can break down the tyramine as normal.

Selegiline and rasagiline are only MAO-B selective at low doses.


----------

