Switching antidepressant (SSRIs to moclobemide) in adults

SSRIs to moclobemide

Taper, washout and switch

• for any SSRI, you should gradually reduce the dose and stop
  • will then need to wait for a period, dependent on the antidepressant being switched from (see below), before starting moclobemide.

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

From all except fluoxetine and sertraline

• after stopping the SSRI, wait 7 days before starting moclobemide.

From fluoxetine

• after stopping fluoxetine, wait 5 to 6 weeks before starting moclobemide
  • clinicians should decide the duration of the washout period on a case-by-case basis
• fluoxetine may still cause medicine interactions 5 or 6 weeks after stopping, as fluoxetine and its active metabolite have a long half-life

From sertraline

• after stopping sertraline, wait 7 to 13 days before starting moclobemide
  • manufacturer advises a 7 day washout period but 13 days may be considered to account for the long half-life of sertraline's active metabolite
  • clinicians should decide the duration of the washout period on a case-by-case basis

Reference:

• NHS Specialist Pharmacy Service (February 2023). SSRIs to other antidepressants: switching in adults