MOCLOBEMIDE AND TRICYCLIC ANTIDEPRESSANTS IN SEVERE DEPRESSION - METAANALYSIS AND PROSPECTIVE STUDIES

There is no generally accepted definition of severe depression, but ho spitalization, high scores on rating scales, and the presence of psych otic symptoms are widely considered to be indicators of severe cases. For the purpose of this analysis of the antidepressant efficacy of the reversible inhibitor of monoamine oxidase A moclobemide, all hospital ized cases were selected from the current database of comparative stud ies and compared with the standard tricyclics imipramine and clomipram ine. The cases from comparisons of moclobemide and imipramine were ana lyzed together, because in accordance with the recommended range of do ses, the dose ratio over ail studies was approximately 3:1 (moclobemid e: N = 238, mean dose, 453 mg/day; imipramine: N = 248, mean dose, 159 mg/day). The cases from comparisons of moclobemide and clomipramine c ould only be analyzed over all studies if dose was taken into account, because the dose ratio of approximately 3:1 was only given in one stu dy (moclobemide: N = 62, mean dose, 466 mg/day; clomipramine: N = 66, mean dose, 154 mg/day), whereas the dose ratio over the other, earlier studies was approximately 2:1 (moclobemide: N = 58, mean dose, 258 mg /day; clomipramine, N = 59, mean dose, 124 mg/day). The efficacy as ju dged on the Hamilton Rating Scale for Depression (HAM-D) and Global As sessment of Efficacy was analyzed for subgroups of inpatients, accordi ng to different severity bands (17-item HAM-D baseline total score, cu t-off, 28 points) and according to the presence or absence of mood con gruent psychotic features. The results of our analysis failed to revea l any difference in efficacy between moclobemide and imipramine in any subgroup of hospitalized depressives, including patients in the highe st HAM-D severity band and psychotic patients. Further, moclobemide (g reater than or equal to 450 mg/day) appeared to be as effective as clo mipramine (greater than or equal to 150 mg/day) in hospitalized depres sives in both KAM-D severity bands, but patients in the higher severit y band treated with lower doses of moclobemide (less than or equal to 1400 mg/day) responded less well than did those treated with clomipram ine. These findings strongly suggest the necessity to use higher doses of moclobemide (greater than or equal to 450 mg/day) in the treatment of severely depressed hospitalized patients.