title: Moclobemide as add-on therapy to agomelatine in a patient with treatment-resistant major depressive disorder: a psychopharmacological case.
abstract: OBJECTIVE
  Treatment-resistant depression is a major depressive disorder that does not respond to adequate treatment of at least two antidepressants and is one of the major clinical challenges for clinicians and clinical pharmacists. One treatment option is to switch the patient to a different medication. Another option is to add a medication to the patient's current pharmacotherapy. This article presents an improvement of symptoms induced by a combination of moclobemide (MOC) and agomelatine (AG) treatment in a 48-year-old Caucasian woman with treatment-resistant major depressive disorder (MDD). The patient had been treated with numerous antidepressants in the last 2 years that had not been effective or had caused serious adverse effects. When MOC 300 mg daily was added to AG 25 mg daily, the patient recovered progressively without any adverse effects. Her functional status also appeared stable. No other drugs known to interact with AG were administered. The MOC dose was subsequently increased to 600 mg daily and was taken with AG 25 mg daily and zolpidem 5 mg daily.
  
  
  CONCLUSIONS
  The positive effects of AG or MOC on MDD have been widely reported, but there have not been reports of a combined treatment with MOG and AG improving symptoms of treatment-resistant MDD. The exact mechanism of this effect on the central nervous system is unknown. The additive activity could have been caused by a broader spectrum activity of AG and MOC.
  
  
  CONCLUSIONS
  In this report, we identified a case with positive evidence of this antidepressant combination relieving the symptoms of treatment-resistant MDD, which is otherwise difficult to manage. This case report may serve to help clinicians and clinical pharmacists as a new treatment option for treatment-resistant MDD, although further research is needed to confirm this practice.
authors.affiliation: Department for Clinical Pharmacy, Psychiatric Hospital Ormoz, Ptujska Cesta 33, Ormoz, Slovenia. matejstuhec@gmail.com.|Department of Biopharmacy and Pharmacokinetics, School of Pharmacy, University of Ljubljana, Ljubljana, Slovenia. matejstuhec@gmail.com.|Remote Clinical Consultation, VIP World Medical 5702, Innsbruck St, 77401, Bellaire, TX, USA. matejstuhec@gmail.com.|Psychiatric Hospital Ormoz, Ormoz, Slovenia. matejstuhec@gmail.com.
authors.forename: Matej
authors.initials: M
authors.lastname: Stuhec
authors.affiliation: Psychiatric Hospital Ormoz, Ormoz, Slovenia.
authors.forename: Robert
authors.initials: R
authors.lastname: Oravecz
mesh_terms: D000081:Acetamides / Q000008:administration & dosage*; D000928:Antidepressive Agents / Q000008:administration & dosage*; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D008875:Middle Aged; D020912:Moclobemide / Q000008:administration & dosage*; D009281:Naphthalenes
chemical_list: D000081:Acetamides; D000928:Antidepressive Agents; D006993:Hypnotics and Sedatives; D020912:Moclobemide; C084711:agomelatine; D009281:Naphthalenes
keywords: Agomelatine; Antidepressant combination; Moclobemide; Psychiatry; Treatment-resistant depression