Moclobemide versus fluoxetine in the treatment of inpatients with major depression.

Seventy inpatients with a DSM-III-R major depression were included in a double-blind, randomized, clinical trial to compare the efficacy and tolerability of moclobemide versus fluoxetine. After a 3-day placebo run-in phase, treatments were administered for 4 weeks in daily doses of between 300 and 600 mg of moclobemide or 20 to 40 mg of fluoxetine. Efficacy was measured by the Hamilton Rating Scale for Depression (HAM-D), Clinical Global Impression, and subjective mood ratings (45-item self-rating scale). Fifty-three patients (mean age, 40 years; 22 men, 31 women) completed the 4-week treatment. Changes between end of treatment and baseline did not differ between both study drugs. The HAM-D responder rate (50% improvement from baseline) was 59% in the moclobemide group and 58% in the fluoxetine group after 4 weeks. Moclobemide, however, acted therapeutically faster than fluoxetine. After 1 week of treatment, the HAM-D scores were significantly lower in patients on moclobemide than in those on fluoxetine (p < 0.005). The earlier efficacy of moclobemide after 1 week was also detected by the patients' subjective mood ratings (p < 0.02). There were no differences between moclobemide and fluoxetine regarding tolerability ratings. These data suggest that both agents have a similar efficacy and tolerability but that moclobemide has an earlier onset of antidepressive action.