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Switching antidepressant (SSRIs to monoamine oxidase inhibitors (MAOIs)) in adults

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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SSRIs to monoamine oxidase inhibitors (MAOIs)

  • switching to an MAOI is always a complex switch and you should follow specialist advice

Taper, washout and switch with specialist advice

  • for any SSRI, you should gradually reduce the dose and stop
  • a clinician will then need to wait for a period (see below), dependent on the antidepressant being switched from, before starting the MAOI
    • the specialist will advise the duration of the washout period on a case-by-case basis taking into consideration the MAOI being started.

Cross-tapering is not recommended due to the high risk of serotonin syndrome.

From all except fluoxetine

  • after stopping the SSRI, wait 7 to 14 days before starting the MAOI

From fluoxetine

  • after stopping fluoxetine, wait 5 to 6 weeks before starting the MAOI
  • fluoxetine may still cause medicine interactions 5 or 6 weeks after stopping, as fluoxetine and its active metabolite have a long half-life

Reference:

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