Advice for all antidepressants

You should read our advice for all antidepressant switching for the treatment of depression before applying that to individual moclobemide switches below.

• Establishing if a person needs to switch their antidepressant
• Considerations when choosing an alternative antidepressant
• Planning and agreeing an antidepressant switching strategy
• Monitoring a person during and after antidepressant switching

Specific advice when switching from moclobemide

Strategies for switching from moclobemide to other antidepressants are outlined below.

Agomelatine

Taper, washout and switch

Gradually reduce the dose of moclobemide and stop; wait 24 hours then start agomelatine.

There is limited experience with this switch so extra caution is required. Although interactions are not expected, agomelatine is not expected to mitigate discontinuation reactions from stopping moclobemide.

Mirtazapine

Taper, washout and switch

Gradually reduce the dose of moclobemide and stop; wait 24 hours then start mirtazapine.

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

Monoamine oxidase inhibitors (MAOI)

Switching to an MAOI is always a complex switch and you should follow specialist advice.

Taper, washout and switch with specialist advice

Gradually reduce the dose of moclobemide and stop; wait 24 hours then start 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 MAOIs with moclobemide is not recommended due to the high risk of serotonin syndrome.

Selective serotonin reuptake inhibitors (SSRIs)

Taper, washout and switch

Gradually reduce the dose of moclobemide and stop; wait 24 hours then start the SSRI.

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

Serotonin and noradrenaline reuptake inhibitors (SNRIs)

Taper, washout and switch

Gradually reduce the dose of moclobemide and stop; wait 24 hours then start the SNRI.

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

Trazodone

Taper, washout and switch

Gradually reduce the dose of moclobemide and stop; wait 24 hours then start trazodone.

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

Tricyclic antidepressants (TCAs)

Switching to dosulepin requires specialist advice and should not be done in primary care due to the increased cardiac risk and toxicity in overdose.

Taper, washout and switch

Gradually reduce the dose of moclobemide and stop; wait 24 hours before starting the TCA.

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

Vortioxetine

Taper, washout and switch

Gradually reduce the dose of moclobemide and stop; wait 24 hours before starting vortioxetine.

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

There is limited experience with this switch so extra caution is required to avoid serotonin syndrome.

More advice on individual switches

We have further advice on how to switch between individual antidepressants of different types. Browse our collection below.

• MAOI to other antidepressants: switching in adults
• Trazodone to other antidepressants: switching in adults
• Vortioxetine to other antidepressants: switching in adults
• SNRIs to other antidepressants: switching in adults
• Agomelatine to other antidepressants: switching in adults
• Mirtazapine to other antidepressants: switching in adults
• Tricyclics to other antidepressants: switching in adults
• SSRIs to other antidepressants: switching in adults

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