Unlike older
monoamine oxidase inhibitors, which irreversibly and nonselectively bind
monoamine oxidase (
MAO),
moclobemide is a reversible and selective inhibitor of the
MAO-A isozyme.
Moclobemide only weakly potentiates the pressor response induced by
tyramine or other indirectly acting
sympathomimetics; therefore, there is no need to avoid dietary
tyramine or over-the-counter
decongestants with
moclobemide as there is with older
MAO inhibitors. Recent clinical trials and meta-analyses have confirmed the efficacy of
moclobemide in the treatment of
depressive disorders.
Moclobemide has been shown to have similar efficacy to
tricyclic antidepressants (TCAs),
selective serotonin reuptake inhibitors (
SSRIs) and nonselective, irreversible
MAO inhibitors. Long term follow-up studies of 6 to 12 months' duration have demonstrated that the
antidepressant efficacy of
moclobemide is maintained.
Moclobemide, given alone or in combination with another
antidepressant, has shown some efficacy in patients with
refractory depression; however, comparative trials are required to confirm these findings. Data are also available to show clinical efficacy of
moclobemide in the management of
social phobia. Comparative studies have established that
moclobemide is better tolerated at therapeutic dosages and has less toxicity in overdose than TCAs and nonselective, irreversible
MAO inhibitors.
Moclobemide lacks the
anticholinergic,
sedative and cardiovascular effects associated with many of the older
antidepressants. Compared with
SSRIs,
moclobemide has a similar overall tolerability, although it tends to cause fewer gastrointestinal effects than the
SSRIs and has not been reported to interfere with sexual function. In summary, recent data which confirm and extend its comparative therapeutic efficacy and low potential for adverse effects have established
moclobemide as an effective treatment in
depressive disorders. The
drug is also effective in patients with a primary diagnosis of
social phobia. Its lack of adverse
anticholinergic, cardiovascular, cognitive and psychomotor effects makes
moclobemide a particularly useful option in the elderly or patients with
cardiac disease.