theproblemisman replies:

Thanks to all those who replied to my last inquiry about the new
Deprenyl patch in clinical trials. Here is some additional information.

I spoke with one of the chief researchers on this project. He told
me that he felt that MAOI would be significantly less with the
transdermal patch, but that at higher doses, users of the patch
may still require dietary restrictions. He also pointed out a couple
of Archives of General Psychiatry studies, which I have not had
a chance to read that indicates that Deprenyl can be an effective
antidepressant at higher doses. (I have read other studies which
said Deprenyl was marginally effective; not as efficacious as other
MAOIs.

(Quoting from LA Times, Jan 15: "the patch delivers the medicine right into
the {*filter*}stream without passing through the stomach and liver, so there is
no problem with foods. Preliminary studies with the patch found no risk
for hypertension or stroke.")

So the question I have is whether at dosages of say 30mg on up, it offers any
advantages as far as {*filter*} pressure increases/dietary requirements as
other, older, pill form MAOI {*filter*} such a phenelzine.

I know of one patient who had an increase in BP of about 10% over baseline
to about 140/90 with Nardil which could not be attributed to dietary
non-compliance;was associated with frequent mild headaches, which led to
discontinuation of the drug, despite it's other beneficial effects. Any
further comments?

 >I have not heard of MAOI patches. The liver and gut wall MAO will still be

This only avoids the "first-pass" effect of {*filter*}absorption. It still
has to be metabolised in the liver, via systemic circulation (as distict
from portal circulation), so there will still be MAO inhibition in the
liver, too. Not as much, but it will still happen.

As I recall Deprenyl is a selective inhibitor of MAO-B and it is because
of THIS that hypertension is less likely. It is also less effective in
treating depression compared with the old A & B inhibitors like Nardil.
Moclobemide, a MAO-A inhibitor is a very weak antidepressant in clinical
practice. You really need to block A & B to get a good effect (and a
higher risk of hypertension, too)

The most common vascular effect is hypotension. Headaches without
hypertension are not uncommon (mechanism is unclear). A BP of 140/90 is
barely borderline hypertension and may be a red herring.

--
Larry Brash

Deprenyl does start to inhibit MAOA, at doses typically of 10mg or
more daily. This may be why larger doses are more effective as
antidepressants. BTW, it's an "irreversable" MAOI.

Moclobemide does work pretty well for depression for many people.
Note that serotonin is (mostly) metabolized by MAOA, so it's
inhibition would be expected to be better for depression than MAOB
inhibition.

Mind Books offers publications about psychedelics;

In Australia, we have had moclobemide for eight years and the consensus
among psychiatrists is that its clinical efficacy in depression is not
all at impressive.

Roche's main marketing ploy was to push it in the General Practitioner
field. It might work for very mild depressions that were probably going
to get better anyway. Yes, some patients do well on it but they are few
in number. In retrospect one would have to question the studies claiming
60-70% efficacy. The reality is nothing like that.

When it first came out, I switched quite a few people from Nardil or
Parnete to moclobemide with very disappointing results. Thay all ended
up going back to their old drug.

--
Larry Brash