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Manerix (moclobemide) is an antidepressant, used to treat depression and social phobia, among other off-label uses.

This product is a monoamine oxidase inhibitor (MAOI), but more specifically it is a reversible inhibitor of monoamine oxidase A (RIMA). MAOIs are notorious for interacting with other medications and foods, including tyramine (found in many foods) and seemingly-innocuous over-the-counter supplements and vitamins.

RIMAs do not stay in the body as long as irreversible MAOIs and are less likely to interact with other foods or medications, and in general produce fewer side effects. However, less does not mean none; interactions and side effects are still possible. Patients will need to avoid some foods, many other medications, and be alert for developing side effects.

This product is not suitable for children; it should be used by patients age 18 and up.

Uses of Manerix

Manerix is predominantly used to treat depression and social phobia, but it has seen extensive off-label use in other psychiatric conditions, as well as pain prevention/management. A comprehensive list of conditions treated include:

• Major depressive disorder
• Other depression
• ADHD
• Social phobia
• Panic disorder
• Fibromyalgia
• Migraines
• Chronic tension headaches
• Parkinson's disease
• Bipolar depression (with other medications)

In studies Manerix has shown to have several advantages and disadvantages when compared to other antidepressants, particularly tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and irreversible MAOIs. Manerix was found to be:

• Significantly more effective than placebo
• As effective as TCAs
• As effective as SSRIs
• Less effective than irreversible MAOIs

Yet in terms of tolerability---side effects---Manerix has shown to be:

• About the same as SSRIs
• Better than TCAs
• Better than irreversible MAOIs

Side effects from all antidepressants can be severe. Everything else being equal, choosing the medication least likely to produce side effects is ideal; however, this must be balanced with effectiveness. Those who suffer from severe depression (or other conditions) may find Manerix is insufficient, but most patients will find Manerix works fine and prefer it for its reduced side effects.

Taking Manerix

Manerix comes in tablets of 150 mg or 300 mg. Tablets should be swallowed whole and taken after a meal. In most cases, administration is as follows:

• Start with 150 mg taken twice per day.
• After one to four weeks, dosage may be increased if needed to 300 mg taken twice per day.
• Occasionally patients take 300 mg three times per day.

It takes two to four weeks for full effect to be felt, hence waiting at least one week before adjusting dosage.

Duration of treatment is variable, but typically lasts at least 9 months. It may last considerably longer for some conditions, such as migraine prevention, though it is also typically taken at lower doses.

Potential Complications

This is a potent medication and should be taken with care. Some side effects are relatively common, but not cause for concern unless severe or persistant beyond the first few weeks of treatment:

• Dry mouth
• Headache
• Nausea
• Diarrhea or constipation
• Difficulty sleeping

Less common are more serious side effects, which warrant speaking with a doctor:

• Vision changes
• Rapid, slow, or irregular heartbeat
• Confusion, disorientation, agitation
• Slurred speech, difficulty speaking
• Tiredness, weakness, loss of coordination

Like all antidepressants, Manerix can cause a paradoxical worsening of depression. Patients should be alert for changing moods; restlessness, irritability, agitation, hostility and aggression are all warning signs, as are thoughts of self-harm or harming others. This typically occurs in patients under age 25, but it can occur at any age.

Use of other antidepressants---MAOIs, SSRIs, SNRIs, TCAs---can produce a very serious condition called serotonin syndrome. Some recreational drugs, like MDMA (ecstasy), can also contribute to serotonin syndrome while taking Manerix. Symptoms include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea. This warrants emergency medical attention.

Manerix does not have as strong an interaction with the amino acid tyramine, found in many foods. Cheese and wines should still be avoided, but other foods should be okay.

Unlike irreversible MAOIs, which must be stopped two weeks prior to surgery, RIMAs like Manerix need only be stopped 48 hours prior, and can be resumed 24 hours after.

Check with a doctor or pharmacist before mixing other medications with Manerix, including over-the-counter supplements.