![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Seeker on June 15, 2002, at 17:52:53
I have been doing a lot of research on the web and it seems that moclobemide and adrafinil are the best options for depression/anxiety. This is based on efficacy and low occurance of side effects. Does anyone agree or disagree with this? Amineptine would have been my first choice but the authorities seem to think it is "too effective" in treating depression.
I currently suffer from depression/anxiety/social phobia. I have tried standard treatments and am very interested in new options. I am going to try these two drugs(not at the same time). Does anyone have experience with these two that they would like to share or perhaps some other recommendations? Thanks
Posted by JohnX2 on June 16, 2002, at 8:43:38
In reply to Best New Drugs for Depression/Anxiety, posted by Seeker on June 15, 2002, at 17:52:53
> I have been doing a lot of research on the web and it seems that moclobemide and adrafinil are the best options for depression/anxiety. This is based on efficacy and low occurance of side effects. Does anyone agree or disagree with this? Amineptine would have been my first choice but the authorities seem to think it is "too effective" in treating depression.
> I currently suffer from depression/anxiety/social phobia. I have tried standard treatments and am very interested in new options. I am going to try these two drugs(not at the same time). Does anyone have experience with these two that they would like to share or perhaps some other recommendations? ThanksIf you search through the pbabble archives, you'll
find a lot of unhappy moclobemide trials.Basically the medicine has a low response rate.
But the side effect profile is quite good.I've seen small writeups from doctors however that
indicated the medication really needed to be pushed over
1000-1200+ mg/day. (The usual recommended dose is 300 mg).It would be interesting to see how people would
respond at the higher strengh, but dunno about
safety.John
Posted by JonW on June 16, 2002, at 10:22:06
In reply to Re: Best New Drugs for Depression/Anxiety » Seeker, posted by JohnX2 on June 16, 2002, at 8:43:38
> Basically the medicine has a low response rate.
> But the side effect profile is quite good.Dr. Liebowitz says that moclobemide is far less potent than other drugs (for SP, at least) and this would certainly explain the inconsistent clinical trials.
> I've seen small writeups from doctors however that
> indicated the medication really needed to be pushed over
> 1000-1200+ mg/day. (The usual recommended dose is 300 mg).
>
> It would be interesting to see how people would
> respond at the higher strengh, but dunno about
> safety.When I was seeing Dr. Apter he told me that's what he was hearing from his colleagues -- that you really have to push the dose. That's far from a controlled trial, of course. I'll tell you one thing, 1200mg+ of moclobemide would be expensive! Which, actually, makes me think that Roche would conduct clinical trials with 1200mg if they thought they would get good. Every doctor I've asked seems to agree that moclobemide doesn't have the "magic" that the classic MAOIs seem to have. Why can't they make something just like Nardil without the side-effects or interactions? Why can't lunch be free? :)
Jon
Posted by JohnX2 on June 16, 2002, at 11:30:09
In reply to Re: Best New Drugs for Depression/Anxiety » JohnX2, posted by JonW on June 16, 2002, at 10:22:06
> > Basically the medicine has a low response rate.
> > But the side effect profile is quite good.
>
> Dr. Liebowitz says that moclobemide is far less potent than other drugs (for SP, at least) and this would certainly explain the inconsistent clinical trials.
>
> > I've seen small writeups from doctors however that
> > indicated the medication really needed to be pushed over
> > 1000-1200+ mg/day. (The usual recommended dose is 300 mg).
> >
> > It would be interesting to see how people would
> > respond at the higher strengh, but dunno about
> > safety.
>
> When I was seeing Dr. Apter he told me that's what he was hearing from his colleagues -- that you really have to push the dose. That's far from a controlled trial, of course. I'll tell you one thing, 1200mg+ of moclobemide would be expensive! Which, actually, makes me think that Roche would conduct clinical trials with 1200mg if they thought they would get good. Every doctor I've asked seems to agree that moclobemide doesn't have the "magic" that the classic MAOIs seem to have. Why can't they make something just like Nardil without the side-effects or interactions? Why can't lunch be free? :)
>
> JonYeah but moclobemide is off patent in the US. No way Roche will
fund a clinical trial for a medicine that is immediately a generic.
It's too bad. I think they punted the introduction in the US way way
back because of the stigma surrounding MAOI hypertensive crisis (the pdocs
would never understand the reversable MAOI concept, duh).
You'd think they could make a minor inert tweak to the chemical structure to
get Patent status.John
Posted by JonW on June 17, 2002, at 14:39:49
In reply to Re: Best New Drugs for Depression/Anxiety » JonW, posted by JohnX2 on June 16, 2002, at 11:30:09
> Yeah but moclobemide is off patent in the US. No way Roche will
> fund a clinical trial for a medicine that is immediately a generic.
> It's too bad. I think they punted the introduction in the US way way
> back because of the stigma surrounding MAOI hypertensive crisis (the pdocs
> would never understand the reversable MAOI concept, duh).
> You'd think they could make a minor inert tweak to the chemical structure to
> get Patent status.
>
> JohnBut like you said, even if they could do it, there's all the stigma surrounding the MAOIs. If it weren't about money moclobemide may never have been developed, but if it weren't about money, moclobemide would be in the US right now. I think it's a catch 22 of sorts. Does this mean that other countries are able to understand the concept of *reversible* and we aren't? I hope not, because that's embarassing. I was at a lecture at Princeton University a year or so ago about evolution and they said that of all the nations in the world we have the lowest percentage of people who accept the theory of evolution. I'm speechless on that one, these things just baffle me!
Jon
Posted by missliz on June 18, 2002, at 0:27:18
In reply to Best New Drugs for Depression/Anxiety, posted by Seeker on June 15, 2002, at 17:52:53
I have the same problems, depression anxiety social phobia, and Nardil changed my life. Pizza is a small trade off for calm and happy and a social life. The diet is a pain in the tush sometimes but you can still go for sushi.
I haven't seen much to recommend wasting ones time with mobeclomide, but Parnate and selegeline are just fabulous for a lot of people. MAOIs are really impressive stuff for some people's social phobia. In my research mobeclomide looked like a waste of time as it inhibits MAO-A, which is the kind mostly in the body. MAO-B is what you want to get rid of as it's the kind in your brain. Social anxiety does not reside in the small intestine. It only seems to.
I've never heard of the other drug, but mixing MAOIs of any sort with other stuff is a tricky last resort kind of thing. (Do you mean anafranil?) You need to talk to a full on biopsychopharmachologist about that.
Been there, done it, hope you feel better soon
Miss Liz
Posted by JohnX2 on June 21, 2002, at 1:27:46
In reply to Re: Best New Drugs for Depression/Anxiety » JohnX2, posted by JonW on June 17, 2002, at 14:39:49
> > Yeah but moclobemide is off patent in the US. No way Roche will
> > fund a clinical trial for a medicine that is immediately a generic.
> > It's too bad. I think they punted the introduction in the US way way
> > back because of the stigma surrounding MAOI hypertensive crisis (the pdocs
> > would never understand the reversable MAOI concept, duh).
> > You'd think they could make a minor inert tweak to the chemical structure to
> > get Patent status.
> >
> > John
>
> But like you said, even if they could do it, there's all the stigma surrounding the MAOIs. If it weren't about money moclobemide may never have been developed, but if it weren't about money, moclobemide would be in the US right now. I think it's a catch 22 of sorts. Does this mean that other countries are able to understand the concept of *reversible* and we aren't? I hope not, because that's embarassing. I was at a lecture at Princeton University a year or so ago about evolution and they said that of all the nations in the world we have the lowest percentage of people who accept the theory of evolution. I'm speechless on that one, these things just baffle me!
>
> JonSome good points. I think that the cost of getting the medication
through the regulatory commissions in the foreign countries is much
cheaper thus justifying the risk/reward of the investment by Roche.
Ultimately good marketing would get around the hypertensive crisis
issue.Are you a Princeton Alum/Attendee?
John
Posted by JonW on June 21, 2002, at 16:20:00
In reply to Re: Best New Drugs for Depression/Anxiety » JonW, posted by JohnX2 on June 21, 2002, at 1:27:46
Hi John,
Wow! You're rollin' out the responses to everyone! You should be paid!
No, I'm not a Princeton University student or alumni -- my dad was, though... Actually, I didn't even graduate high school due to my mental health (I got my GED and somehow I was no. 1 in my class for network engineering at The Chubb Institute. How'd that happen?) I just live in the area so I attended a public lecture there. At my last appointment with Dr. Liebowitz he confirmed that Nardil is the single most effective drug for SP and that docs are afraid to use it. That's certainly been my experience along with many other people here... I'm sure glad it exists and is on the market and really hope it works out for me!
Jon
> Some good points. I think that the cost of getting the medication
> through the regulatory commissions in the foreign countries is much
> cheaper thus justifying the risk/reward of the investment by Roche.
> Ultimately good marketing would get around the hypertensive crisis
> issue.
>
> Are you a Princeton Alum/Attendee?
>
> John
Posted by astridj on June 25, 2002, at 2:28:55
In reply to Best New Drugs for Depression/Anxiety, posted by Seeker on June 15, 2002, at 17:52:53
What treatments/meds have you already tried?
> I have been doing a lot of research on the web and it seems that moclobemide and adrafinil are the best options for depression/anxiety. This is based on efficacy and low occurance of side effects. Does anyone agree or disagree with this? Amineptine would have been my first choice but the authorities seem to think it is "too effective" in treating depression.
> I currently suffer from depression/anxiety/social phobia. I have tried standard treatments and am very interested in new options. I am going to try these two drugs(not at the same time). Does anyone have experience with these two that they would like to share or perhaps some other recommendations? Thanks
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.