How do you switch between monoamine oxidase inhibitors and SSRI, tricyclic or related antidepressants?

Nicola Bradley, Senior Medicines Information Pharmacist, North West Medicines Information CentreSource UKMiPublished

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.


  • 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inhibitor of monoamine-oxidase type A – RIMA) and other antidepressants, the first antidepressant agent should be withdrawn gradually and discontinued before starting the second antidepressant.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.