Fluoxetine versus moclobemide: cross-comparison between the time courses of improvement

Competitive statistical methods were used in a meta-analysis of the data of 440 fluoxetine-treated and 437 moclobemide-treated patients in order to address the issue of the timing of recovery from depression, and to elucidate potential differences in the onset of action between the two different classes of antidepressants. In spite of large biochemical and pharmacological differences, fluoxetine and moclobemide turned out to be virtually identical with regard to the overall efficacy, proportions and time characteristics of premature withdrawal, and most notably, the time course of recovery. The onset of improvement occurred in the majority of cases within the first two weeks of treatment and was highly predictive for the outcome after six weeks. The analyses yielded no indication of a delayed onset of action of antidepressants. Given the apparent nonspecificity of antidepressants, together with their relatively modest response rates, future research will need consider whether mechanisms different from those related to the monoaminergic systems may be involved in the pathogenesis of depression.