Moclobemide and tricyclic antidepressants in severe depression: meta-analysis and prospective studies

There is no generally accepted definition of severe depression, but hospitalization, high scores on rating scales, and the presence of psychotic 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 hospitalized cases were selected from the current database of comparative studies and compared with the standard tricyclics imipramine and clomipramine. The cases from comparisons of moclobemide and imipramine were analyzed together, because in accordance with the recommended range of doses, the dose ratio over all studies was approximately 3:1 (moclobemide: N = 238, mean dose, 453 mg/day; imipramine: N = 248, mean dose, 159 mg/day). The cases from comparisons of moclobemide and clomipramine could 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 study (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 judged on the Hamilton Rating Scale for Depression (HAM-D) and Global Assessment of Efficacy was analyzed for subgroups of inpatients, according to different severity bands (17-item HAM-D baseline total score, cut-off, 28 points) and according to the presence or absence of mood-congruent psychotic features. The results of our analysis failed to reveal any difference in efficacy between moclobemide and imipramine in any subgroup of hospitalized depressives, including patients in the highest HAM-D severity band and psychotic patients.(ABSTRACT TRUNCATED AT 250 WORDS)