Moclobemide is an antidepressant from the group of MAO inhibitors (monoamine oxidase inhibitors). It is used in the treatment of depressive disorders (phases of major depression). Moclobemide is also used for anxiety disorders and psychosis.
What is moclobemide?
Moclobemide is a so-called monoamine oxidase (MAO) inhibitor. It is one of the antidepressants and is primarily prescribed for depressive disorders, anxiety disorders, and psychosis. It is an activating, mood-lifting and invigorating antidepressant that is available in the form of film-coated tablets. These must be taken two to three times a day after meals.
Pharmacological effects on the body and organs
Depression is usually manifested by a negative mood and lack of drive. A deficiency of monoamines (e.g., serotonin, norepinephrine) in the synaptic cleft is thought to result from decreased production of the neurotransmitters. In addition, altered expressivity at or binding to their receptors can lead to deficiency. The goal of therapy with antidepressants is to increase the amount of monoamines. An increase in the concentration is only possible by inhibiting monoamine oxidase A (enzyme of the outer mitochondrial membrane at the nerve endings of the synaptic nervous system). This has the task of breaking down monoamines. Moclobemide inhibits monoamine oxidase. Because the drug inhibits only monoamine oxidase A but not monoamine oxidase B, fewer side effects and interactions with other drugs occur.
Medical use and use for treatment and prevention.
Moclobemide is used for severe depression (known as major depression), anxiety disorders, and psychosis. Because it has a drive-increasing effect, it is also used in so-called “inhibited” depressions. These are characterized by a particularly strong inhibition of drive, listlessness and a tormenting inner restlessness. It is also used when other antidepressants do not work or do not work sufficiently. Initial improvements may be noticeable after just one week of treatment, although the dose should not be increased during the first week of therapy. Treatment usually lasts between 4 and 6 weeks, which is the only way to assess the effect of moclobemide. It should also be taken during symptom-free periods for 4 to 6 months thereafter. Subsequently, treatment is terminated by gradually reducing the dose.
Risks and side effects
Although moclobemide has fewer side effects and interactions – compared with other antidepressants – they cannot be ruled out. Typical side effects of moclobemide include sleep disturbances, headache, dry mouth, nausea and vomiting, diarrhea or constipation, dizziness (due to low blood pressure), irritability, anxiousness, nervousness, insensitivity (e.g. e.g., tingling), rash, skin reactions (e.g., redness of the skin, itching), edema, confusion, visual disturbances, taste disturbances, decreased appetite, suicidal thoughts and behavior, delusions, or galactorrhea (secretion from the chest). The side effects do not have to occur in everyone. Usually they can be observed in the first weeks of treatment and recede in the further course of therapy. After the end of treatment, discontinuation symptoms may also occur as a side effect, which is why the medication is always gradually discontinued. If several medications are taken at the same time, interactions may also occur. Both the effect and side effects can change as a result. The factors for the occurrence of interactions are very different. Interactions can also occur with moclobemide when tyramine-containing foods (e.g. cheese, white beans, red wine) are taken. However, these are so minor that no special diet is necessary. Only excessive consumption of corresponding foods should be avoided. If opiode analgesics (e.g. tramadol, pethidine) are taken at the same time, their effect is enhanced by moclobemide, which is why the drugs must not be used simultaneously. Simultaneous use of other antidepressants is also not permitted, as this can lead to life-threatening serotonin syndrome. Agents against migraine (e.g.B. Triptans) and the antianxiety agent buspirone can lead to a dangerous increase in blood pressure if taken at the same time and must also not be taken together with moclobemide. The effect of moclobemide is enhanced when alpha-sympathomimetics are taken at the same time, as is the use of the gastric acid inhibiting agent cimetidine. With the latter, a reduction in the moclobemide dose is sufficient; regular medical monitoring is required when taking alpha-sympathomimetics (e.g., ephedrine). Under certain circumstances, moclobemide must not be used. This is the case not only with concomitant use of certain medications, but also with hypersensitivity to the active substance, with acute states of confusion, with hyperthyroidism, and with a tumor of the adrenal cortex. Children under 18 years of age should also not be treated with moclobemide.
