MAOIs and SSRIs
MAOIs are for monoamine oxidase inhibitors.
And SSRIs is for selective serotonin reuptake inhibitors.
The most popular representatives of both of these classes of substances are antidepressants.
MAOIs: Moclobemide, Phenelzine, Tranylcypromine, Selegiline.
SSRIs: Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline.
The combination of MAOIs and SSRIsis can lead to an unpredictable synergy of their action and the development of serotonin syndrome.
This happens because MAOIs destroy monoamine oxidase, an enzyme necessary for the destruction of serotonin and other neurotransmitters. And SSRIs are known to contribute to the accumulation of these same transmitters. Without monoamine oxidase, the body cannot eliminate their excess, allowing them to accumulate to very dangerous levels.
And precisely because of this bidirectional increase in the levels of monoamines, and in particular serotonin, with a combination of MAOIs and SSRIs, serotonin syndrome will develop in a severe form.
Syndrome will manifest itself through a significant increase in pressure and acceleration of the pulse. Against the background of which will appear manic state with thought races, accelerated slurred speech, a mask-like face, increased sweating, sleep disturbances, hyperactivity with muscle hypertonicity and rigidity (especially in the legs). Less often - convulsive seizures, confusion and disorientation.
But the greatest danger will be hyperthermia. The temperature can rise sudden to more than 41 °C. Because of this, cardiovascular disorders develop rapidly, which can lead to death. This variant of serotonin syndrome is also called malignant.
With the development of a condition resembling serotonin syndrome, especially if it`s known that the person has taken or is taking serotonergic drugs, an ambulance should be called immediately.
The prognosis for recovery in a hospital setting is generally good if serotonin syndrome is correctly and rapidly diagnosed. Treatment consists of discontinuing any serotonergic drugs and providing supportive care to control agitation and hyperthermia, usually with benzodiazepines.
Most patients recover within 1 week of stopping the drug that caused serotonin syndrome. Many cases of the disorder resolve within 24 to 72 hours after initiation of treatment and withdrawal of serotonergic agents. However, in patients treated with drugs with a long half-life, active metabolites, or prolonged duration of action, symptoms may persist for a long time.
A few examples of what breaks are recommended to observe when changing an antidepressant from one group to another:
a) After the abolition of Fluoxetine before the appointment of an irreversible MAOI, it is necessary to maintain a gap of 5-8 weeks.
b) After the withdrawal of Citalopram or Fluvoxamine, there must be a break of at least 1 week before the appointment of an MAOI,
c) After the abolition of Paroxetine or Sertraline - at least 2 weeks.
d) When transferring from irreversible MAOIs to SSRIs, a break of 4 weeks should be maintained. There are exceptions, but the meaning is clear.
However, a simultaneous combination of any of these substances is possible. But only as prescribed by a doctor and with a high probability in a hospital setting.
If you are taking any of drugs from these pharmacological groups, be careful with any combination of substances that increase serotonin levels.
The dietary issue with respect to MAOIs is the subject of a separate discussion.
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