Posted by King Vultan on July 24, 2004, at 10:49:43
In reply to Switching to MAOI??? Please advise.., posted by RetiredYoung on July 24, 2004, at 10:02:37
The Surmontil is okay (it is a TCA but has nearly zero effect on amine reuptake and IMO is completely safe to use with an MAOI), but it is absolutely essential that the Lexapro be tapered down and eliminated. There is simply no way to combine an SSRI with an MAOI because of the likelihood of serotonin syndrome occurring. I am not an expert on amphetamines--there are people here who are, though--but the books say that these are also contraindicated. If it were me, I would also drop the Adderall.
You also do need some kind of washout period after completely discontinuing the Lexapro. Two weeks is the standard amount because it's long enough for every antidepressant I can think of except for Prozac and Vivactil, but the actual amount of time needed to completely clear a particular drug is five half lives. My "Mosby's 2004 Drug Guide" lists Lexapro as having a mean half life of 27-32 hours. Taking 32 x 5 = 160 hours or about one week. The metabolites of Lexapro do not appear to have any real SSRI activity, so for most people, waiting one week should be a sufficient amount. My pdoc is conservative and cautious enough so that he would probably make me wait the two weeks, anyway, but I think other doctors might see this differently.
Todd
poster:King Vultan
thread:369906
URL: http://www.dr-bob.org/babble/20040724/msgs/369920.html