This updated Medicines Q&A provides advice on the risks and suggested strategies for switching between monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRI), tricyclic (TCA) or related antidepressants.

Summary

• Care is required when switching between antidepressants.
• When switching between monoamine-oxidase inhibitor (MAOI) or moclobemide (a reversible inhibitor of monoamine-oxidase type A – RIMA) and other antidepressants, the first antidepressant agent should be withdrawn gradually and discontinued before starting the second antidepressant.
• For switches that involve a MAOI, a washout period is always advised.
• Patients should be assessed on an individual basis to determine how quickly the switch can be made by assessing history of discontinuation reactions, concurrent medication and severity of depression.
• The potential for medication errors should be considered.