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Old 03-22-2013, 05:19 AM   #1 (permalink)
 
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Default How long after SSRI to take MAOI

How long do I have to wait? I'm withdrawing from Cymbalta. Been about 6 days.
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Old 03-22-2013, 05:47 AM   #2 (permalink)
 
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14 days.
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Old 03-22-2013, 05:54 AM   #3 (permalink)
 
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Quote:
Originally Posted by hikkikomori View Post
How long do I have to wait? I'm withdrawing from Cymbalta. Been about 6 days.
Most TCAs = wait 1 week
Clomipramine/Imipramine = 3 weeks
SNRI = 1 week
SSRI (except Fluoxetine) = 1 or 2 weeks
Fluoxetine >5 weeks

Which means Cymbalta needs at least >1 week washout before starting a MAOI.
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Old 03-22-2013, 06:02 AM   #4 (permalink)
 
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Quote:
Originally Posted by ChopSuey View Post
Most TCAs = wait 1 week
Clomipramine/Imipramine = 3 weeks
SNRI = 1 week
SSRI (except Fluoxetine) = 1 or 2 weeks
Fluoxetine >5 weeks

Which means Cymbalta needs at least >1 week washout before starting a MAOI.
I hope you're right and not the other guy. I need to get on it ASAP.

I don't see my psychiatrist for about another 2 weeks, but I may go to a free clinic tomorrow and see if I can get a script for it.
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Old 03-22-2013, 08:57 AM   #5 (permalink)
 
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I even read a few sources that said Cymbalta only needs to be stopped for 5 days before starting a MAOI, so you should be good to go. But if you want to be on the very safe side, waiting a few extra days wouldn't hurt.
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Old 03-22-2013, 09:26 AM   #6 (permalink)
 
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I've only ever waited a few days. DOn't they generally say it's out of your system in around 5 times the half life ?
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Old 03-22-2013, 09:52 AM   #7 (permalink)
 
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I would stay two weeks.. better safe than sorry
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Old 03-22-2013, 10:04 AM   #8 (permalink)
 
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http://www.fda.gov/Safety/MedWatch/S.../ucm319241.htm

:"The use of MAOIs intended to treat psychiatric disorders with Cymbalta or within 5 days of stopping treatment with Cymbalta is contraindicated because of an increased risk of serotonin syndrome."

http://www.betterhealth.vic.gov.au/bhcv2/bhcmed.nsf/pages/lyccymbt/$File/lyccymbt.pdf

:"You must stop taking CYMBALTA at least 5 days before you start taking a MAOI.

http://www.medicinenet.com/duloxetine/article.htm

:"At least 5 days should be allowed after stopping duloxetine before starting an MAOI. Combinations of SNRIs and MAOIs may lead to serious, sometimes fatal, reactions including very high body temperature, muscle rigidity, rapid fluctuations of heart rate and blood pressure, extreme agitation progressing to delirium, and coma."
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Old 03-22-2013, 06:12 PM   #9 (permalink)
 
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They are going to add a huge buffer though to cover their arses.
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Old 03-22-2013, 07:06 PM   #10 (permalink)
 
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i'd wait at least two weeks, mike.
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Old 03-23-2013, 05:01 AM   #11 (permalink)
 
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My dad just switched from citalopram to Emsam and his doctor is having him wait 2 weeks. I think she's erring on the side of caution, but I think it's probably a good idea.
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Old 03-23-2013, 08:11 AM   #12 (permalink)
 
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Depends on the MAOI you want to start after the wash out.

For all old school non-selective irreversible MAOIs (Nardil, Parnate) 5 x half-life is the general rule, so 1 week is enough for most ADs; 4-5 weeks for Fluoxetine (Prozac) due to the long ***** half-life.
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Old 03-23-2013, 12:17 PM   #13 (permalink)
 
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It's different when going to MAO inhibitor to SSRI or another drug because the MAO enzymes are still inhibited for weeks.

But for SSRI or SNRI to MAO inhibitor it should just be 5 half lives since then the drug is out of your system and then maybe a few days of a buffer so that your CNS monoamines return to a more normal point.

cymbalta halflife = 12 hours, so about 3 days for it to clear then add on another 3 days give or take.

I waited 9-10 days before starting Nardil when moving from cymbalta @ 60 mg. Had no issues, not the slightest bit of SS.

SS is pretty damn difficult to get unless you consume SSRI's with a MAOI at the same time.

I also went from zoloft to Nardil after a 2 day wait period.

I wouldn't wait 2 weeks. Just know the signs of SS and go to the ER if you REALLY have them. (complete disorientation, high fever, bat ****)

If you can wait 2 weeks and you're not in severe agony, then I probably would wait. I just can't be off meds for that long or else I seriously would check myself as in-patient. I get so ****ing low
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