Advice for all antidepressants
You should read our advice for all antidepressant switching before applying that to individual MAOI switches below.
- Establishing whether a person needs to switch their antidepressant
- Choosing an antidepressant to switch a person to
- Planning and agreeing an antidepressant switching strategy
- Monitoring a person during and after antidepressant switching
MAOIs to agomelatine
Cross-taper with specialist advice
Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability. The specialist will advise on how to cross-taper on a case-by-case basis taking into consideration the MAOI being switched from.
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 MAOI.
MAOIs to mirtazapine
Taper, washout and switch with specialist advice
Gradually reduce the dose of the MAOI and stop; wait 14 days before starting mirtazapine. The specialist will advise on the duration of the washout period on a case-by-case basis taking into consideration the MAOI being switched from.
Cross-tapering is not recommended due to the high risk of serotonin syndrome.
MAOIs to moclobemide
Taper, washout and switch with specialist advice
Gradually reduce the dose of the MAOI and then stop; wait 14 days before starting moclobemide. The specialist will advise on the duration of the washout period on a case-by-case basis taking into consideration the MAOI being switched from.
Cross-tapering is not recommended due to the high risk of serotonin syndrome.
MAOIs to another MAOI
Taper, washout and switch with specialist advice
Gradually reduce the dose of the MAOI and stop; wait 14 days before starting the new MAOI. If switching to tranylcypromine, you should consider starting it at half the usual dose for the first week of treatment. The specialist will advise on the duration of the washout period on a case-by-case basis taking into consideration the MAOI being switched from and the MAOI being started.
Cross-tapering is not recommended due to the high risk of serotonin syndrome.
MAOIs to selective serotonin reuptake inhibitors (SSRIs)
Taper, washout and switch with specialist advice
Gradually reduce the dose of the MAOI and stop; wait 14 days before starting the SSRI. The specialist will advise on the duration of the washout period on a case-by-case basis taking into consideration the MAOI being switched from and the antidepressant being started.
Cross-tapering is not recommended due to the high risk of serotonin syndrome.
MAOIs to serotonin and noradrenaline reuptake inhibitors (SNRIs)
Taper, washout and switch with specialist advice
Gradually reduce the dose of the MAOI and stop; wait 14 days before starting the SNRI. The specialist will advise on the duration of the washout period on a case-by-case basis taking into consideration the MAOI being switched from and the antidepressant being started.
Cross-tapering is not recommended due to the high risk of serotonin syndrome.
MAOIs to trazodone
Taper, washout and switch with specialist advice
Gradually reduce the dose of the MAOI and stop; wait 14 days before starting trazodone. The specialist will advise on the duration of the washout period on a case-by-case basis taking into consideration the MAOI being switched from.
Cross-tapering is not recommended due to the high risk of serotonin syndrome.
MAOIs to 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 with specialist advice
For any MAOI, you should gradually reduce the dose and stop. You will then need to wait for a period, dependent on the antidepressant being switched to (see below), before starting low dose TCA. The specialist will advise on the duration of the washout period on a case-by-case basis taking into consideration the MAOI being stopped.
Cross-tapering is not recommended due to the high risk of serotonin syndrome.
To all except clomipramine or imipramine
After stopping the MAOI, wait 14 days before starting low dose TCA.
To clomipramine or imipramine
After stopping the MAOI, wait 21 days before starting low dose clomipramine or imipramine.
MAOIs to vortioxetine
Taper, washout and switch with specialist advice
Gradually reduce the dose of the MAOI and stop; wait 14 days before starting vortioxetine. The specialist will advise on the duration of the washout period on a case-by-case basis taking into consideration the MAOI being switched from.
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.
- Switching strategies for antidepressants
- Moclobemide 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