Manerix – Its unique behaviour very effectively alleviates depressive symptoms

From time to time, we all experience feeling sad, low or moody. But even though we might feel really down, we can usually pinpoint the reason for such feelings and, for most of us, these feelings are just transient. Soon enough, we’re back to our old selves. However, for some these feelings are felt with such a depth and intensity over long periods of time that it’s clear that they are suffering from more than just a low mood. Often there appears to be no identifiable cause or trigger point as to why they feel the way that they do, but in such cases, depression has to be suspected.

Depression is more than just feeling a bit down for a little while - it's a serious illness that can have a huge impact on someone’s life. It causes untold levels of suffering, decreases in the quality of life and impairs both social and occupational ability. Indeed, sufferers are often so affected by their illness that they find it hard just to function on an everyday basis. In the light of this, it is hardly surprising that the World Health Organization found that major depression was the leading cause of disability worldwide.

And depression isn’t just one disease with one set of symptoms. The word depression is really more of an umbrella term that is used to describe all of the different types of depression - each type has its own slightly different symptoms that may require different treatment regimes. The five main forms that depression can take are:

Major (or clinical) depression - a depressed mood that lasts for more than a fortnight Feelings of paranoia (everyone is against you) or visual or auditory hallucinations (seeing or hearing things that are not there) Dysthymia - a less severe depressed mood but one that can last for years Mixed depression and anxiety - a combination of the symptoms of depression and anxiety Bipolar disorder (formerly called manic depression) - characterised by periods of lows (depression) and highs (mania)

If while you are reading this you are thinking that you’ll never suffer from depression, think again. Depression is one of the most common of all mental health problems. It’s estimated that as many as one in five people experience depression at some stage during their lives. Statistics from the National Health and Nutrition Examination Survey, 2005-2006 carried out by the US National Centre for Health Statistics (NCHS) make sobering reading. They established that in any two week period during 2005 and 2006, 5.4% of Americans aged 12 and over were suffering from depression, with rates being higher in women than men and highest amongst 40-59 year olds3. That’s more than 1 in 20 Americans with depression at any one time! And of those people with depression, approximately 80% reported some level of functional impairment because of their illness, and 27% reported serious difficulties in work and home life.

What causes some people to develop depression is also a very complex issue - indeed causes may vary from person to person. Most people assume that depression stems from recent personal difficulties. But whilst such problems might be the trigger in some cases, depression is more often caused by a combination of recent events and other longer-term or personal risk factors. This means that sometimes a depressive episode can appear to have come out of nowhere. Other times, depression may be directly related to a significant life event such as losing a loved one, experiencing trauma, or battling a chronic illness. Risk factors for developing depression include:

Life circumstances; This refers to such things as having to cope with long-term unemployment, being poor (rates of depression are known to be higher amongst lower income rather than higher income groups) or living in an abusive or uncaring relationship

Genetic factors; Depression can run in families putting some people at an increased genetic risk

Physical illness; Common medical causes of depression include low thyroid function, some forms of cancer, brain injuries and diseases such as stroke, epilepsy and Parkinson’s Disease, heart disease, anaemia, chronic pain conditions and blood vessel diseases in the brain caused by diabetes and/or hypertension

Other medical factors - such as quitting smoking. Some steroid and hormonal treatments can also lead to depression

Personality factors; Certain personality traits put you at a much higher risk of developing depression including being a perfectionist, being prone to worrying excessively, being sensitive to personal criticism, being self-critical, being negative with a glass half empty rather than half full attitude to life and being shy with social anxiety and/or low self esteem

Age - people over the age of 65 appear to be especially vulnerable to developing depression

Previous episodes of depression; If you have already experienced a bout of depression, then your chances of developing depression again are increased. According to some estimates, approximately one-half of those who have had depression in the past will experience it again

Even if the exact cause of the depression can’t be identified, what’s most important is to at least recognise the depression itself because depression can and should be treated.

Unfortunately many people fail to seek treatment and try to deal with their depression on their own. There can be many reasons for this such as thinking that depression is not a real illness, that it’s something you should be able to snap out of, feeling embarrassed or awkward about discussing your feelings with someone else or even the mistaken view that your doctor will be dismissive of you and your symptoms.

The NCHS survey brought this sharply into focus - only 29% of all persons with depression reported contacting a mental health professional in the past year, and among the subset with severe depression, only 39% reported contact3. But there is help available, and, for depression to be properly dealt with, treatment needs to be sought. And that’s where medications such as Manerix come to the fore.

What is Manerix?

Manerix is the brand name for the chemical Moclobemide. Moclobemide is an anti-depressant that belongs to a group of medications known as monoamine oxidase inhibitors (more commonly called MAOIs). MAOIs have the longest history of all the different types of anti-depressants. They were first introduced in the 1950s and at the time were the only type of anti-depressants available. Since then other classes of anti-depressants have been developed such as Selective Serotonin Reuptake Inhibitors (SSRIs) and tricyclics. This has resulted in a decline in the popularity of MAOIs particularly as the use of MAOIs does carry with it the potential for harmful drug and dietary interactions (see further below).

However, despite the introductions of the newer types of anti-depressants, MAOIs still have an important role to fulfil. They have proven to be especially useful in treating those patients who have failed to respond to the newer classes of anti depressants. They are also particularly effective in the treatment of atypical depression, social anxiety, agoraphobia (an anxiety disorder based on a fear of having panic attacks in place from which the sufferer cannot escape), panic disorders and borderline personality disorders. MAOIs have also been successfully used to help people quit smoking.

How does Manerix work?

To answer this question, we first have to look at how the brain acts in relation to a depressive episode. When depression occurs, there may be a decrease in the amount of certain chemicals released from nerve cells (neurons) in the brain. These chemicals are called monoamine neurotransmitters and include norepinepherine, dopamine and serotonin.

Neurotransmitters (and not just monoamine neurotransmitters) act like the brain’s messenger service allowing communication between neurons. Neurons are connected together by synapses. Synapses can either be electrical (where the neurons actually touch each other) or chemical (where minute spaces known as synaptic gaps exist between them). The vast majority of synapses in the human brain are chemical ones. Neurons use nerve impulses to carry information from one neuron to another. When one neuron wants to pass on a signal (impulse) to another neuron it does so by releasing specialised chemicals that effectively ferry the nerve impulse across the synaptic gap. Having crossed the synaptic gap, the neurotransmitters bind with the appropriate receptor sites on the receiving neuron in order to produce an effect on that brain cell.

Once monoamine neurotransmitters have acted by sending a message in the brain, they are absorbed by a protein called monoamine oxidase (sometimes called a monoamine transporter). In humans, there are two types of monoamine oxidase - the more common ‘A’ and the less common monoamine oxidase B. If too many monoamines are absorbed, a chemical imbalance occurs in the brain.

What makes Manerix so unique is, that unlike most MAOIs, it works by specifically inhibiting the activity of monoamine oxidase A. By doing this it prevents the breakdown of some of the brain’s monoamine neurotransmitters. This, in turn, results in an increasing build up of the amounts of serotonin, norepinephrine and dopamine in the brain. And because depression is thought to be associated with low stores of monoamine neurotransmitters, increasing the levels of these neurotransmitters may help to alleviate depressive symptoms.

Manerix’s inhibitive action is reversible and is known to be short acting (the effects last for a maximum of 24 hours).

How quickly does Manerix work?

Manerix is not an instant fix. It may take between two to four weeks for the benefits of the therapy to appear. It can be hard to keep taking something that doesn’t appear to be doing any good but it is vitally important that you keep taking Manerix, even if it doesn't seem to make much difference at first. Support at this time is essential because you will still need to cope with the symptoms of your depression. If the depression seems to be worsening or you experience any distress feelings or side effects (see below) during the first few weeks of treatment, you should consult with your doctor.

Treatment with Manerix can take many months and it is therefore very important not to stop taking Manerix without first consulting with your doctor.

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Dosage

Your doctor will determine your correct dosage, which may require modification. If the effects of Manerix are too strong or too mild, you should consult your doctor as your dose may need adjusting.

The total daily dose should be split into 2 or 3 doses over the course of a day. They should not be taken too late in the day.

Manerix tablets should be taken after meals and swallowed with a large glass of water.

Side effects

As with all medications, it is possible that you may experience side effects when taking Manerix. These side effects may include:

Sleeping difficulties

Feelings of agitation, anxiety or irritability

Dizziness

Nausea and other digestive problems

Headaches

Tingling /prickly feeling

Dry mouth

Skin reactions such as rash or itchiness

A more unusual side effect is to experience a confused state although this disappears quickly once treatment has been concluded.

If side effects are going to occur, they are usually most noticeable at the beginning of the treatment regime, particularly during the first two weeks of treatment. Generally they will subside as the depression improves. Psychological, mood or behavioural side effects may also be linked to the very nature of the depression that Manerix is attempting to treat.

If you experience any side effects not mentioned above, you should seek the advice of your health care professional.

Note

Do not use Manerix if:

If you know you are allergic to moclobemide

If you are under 15 years of age

If you are feeling confused or disoriented

Also, advise your doctor if you are suffering from:

Insomnia

Nervousness

Hypertension (high blood pressure)

Hepatic insufficiency (liver disease)

Pheochromocytoma (abnormal excrescence of the adrenal medulla, a gland that secretes substances that cause severe high blood pressure)

Thyrotoxicosis (a condition caused by the overproduction of thyroid hormones)

Interactions with other medications:

You should always check with your doctor or pharmacist before taking any new prescription medication, over-the-counter medication or supplement while taking MAOIs. And as with all medications, inform your doctor of any medications or supplements that you are currently taking or have taken recently, both prescription and those bought over the counter before you start taking a new medication.

These warnings are particularly important with Manerix because Manerix can cause serious interactions if you take certain medications at the same time, especially some other types of anti-depressants (particularly MAO inhibitors including Gerovital H3), noradrenaline enhancers (such as Modafinil), some pain medications such as meperidine (Demerol), over-the-counter decongestants, herbal weight-loss products and St. John's Wort.

A rare but potentially life-threatening side effect of MAOIs is serotonin syndrome. This condition, characterized by dangerously high levels of serotonin in the brain, can occur when an MAOI interacts with anti-depressants known as selective serotonin reuptake inhibitors (SSRIs). Its symptoms include confusion, agitation, hallucinations, fever, increased heart rate, nausea and vomiting and seizures. It requires immediate medical attention. Therefore, MAOIs MUST NOT be taken while you are taking SSRIs or within two weeks of each other.

It is also especially important that you DO NOT take Manerix in association with:

Sumatriptan

Almotriptan

Rizatriptan

Zolmitriptan

Pethidine

Tramadol (Ultram)

Selegiline

Dextromethorphan (found in many over the counter cough remedies)

Bupropion

Unless your doctor advises you differently, Manerix should not be taken in association with:

Citalopram

Fluoxetine

Fluvoxamine

Paroxetine

Sertraline

Clomipramine

Imipramine

Amitriptyline

Milnacipran

Venlafaxine

Sibutramine

Naratriptan

Frovatriptan

Eletriptan

Manerix contains lactose. Therefore, do not take Manerix if you are suffering from galactosemia or lactose deficit (both are rare metabolic disorders).

Avoid alcoholic drinks while taking Manerix.

Pregnancy and Breast-Feeding

As a precautionary measure, do not take Manerix while you are pregnant unless you are advised otherwise by your doctor. Also, do not take Manerix while you are breast feeding, because it is excreted into a mother’s milk.

Avoidance of Tyramine

If you take Manerix but also suffer from hypertension (high blood pressure), you should avoid foods and beverages rich in tyramine during treatment. These foods and beverages include certain cheeses and meats, chocolate, pickled foods, brewer’s yeast, beer, wine and alcohol-free or reduced-alcohol beer and wine. The interaction of tyramine with MAOIs can lead to dangerously high increases in blood pressure which may turn cause a stroke. Your doctor will be able to advise you accordingly.

If you are in any doubt at all as to whether or not it is safe for you to take Manerix, it is imperative that you consult your doctor or pharmacist before you start taking Manerix.

References:

1. Wells KB, Stewart A, Hays RD, Burnam MA, Rogers W, Daniels M, et al. The functioning and well-being of depressed patients: Results from the Medical Outcomes Study. JAMA 262, 914-9. 1989



2. Lopez AD, Murray C. The global burden of disease, 1990-2020. Nature Med 4(11):1241-3. 1998



3. Pratt LA, Brody DJ. Depression in the United States Household Population, 2005-2006. NCHS Data Brief Number 7, September 2008