Rapid conversion from one monoamine oxidase inhibitor to another.
BACKGROUND
Numerous sources state that switching from one monoamine oxidase (MAO) inhibitor to another can be done only after a 14-day washout period. In hospitalized patients and severely depressed outpatients, such a wait may be impracticable.


METHODS
We reviewed the case histories of eight consecutive and random patients whom we converted from one MAO inhibitor to another within less than the recommended waiting period.


RESULTS
Only one patient experienced troubling adverse effects, and these effects were brief and time-limited. The patient's symptoms were indicative of either withdrawal from tranylcypromine or a mild serotonin syndrome. All other patients tolerated the conversion well with minimal or no adverse effects. Four of the eight patients eventually responded to the new MAO inhibitor.


CONCLUSIONS
These results suggest that some patients can be cautiously but rapidly switched from one MAO inhibitor to another without prolonged drug-free periods. Unquestionably, this strategy should be used only when the clinical picture mandates a rapid conversion. Further, it should be reserved for those patients with established high compliance and should include close monitoring and the use of a low-tyramine diet. Extreme caution must still be undertaken in utilizing this approach until larger studies more accurately determine the frequency of serious adverse effects.
Szuba
M P
MP
Depression Research Unit, University of Pennsylvania Health System, Philadelphia, USA.
Hornig-Rohan
M
M
Amsterdam
J D
JD
D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000188:drug therapy / Q000523:psychology; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D004334:Drug Administration Schedule; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D008995:Monoamine Oxidase / Q000187:drug effects; D008996:Monoamine Oxidase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D010349:Patient Compliance; D012701:Serotonin / Q000502:physiology; D013375:Substance Withdrawal Syndrome / Q000209:etiology / Q000503:physiopathology; D017211:Treatment Failure; D016896:Treatment Outcome; D014439:Tyramine / Q000009:adverse effects
D008996:Monoamine Oxidase Inhibitors; D012701:Serotonin; D008995:Monoamine Oxidase; D014439:Tyramine