A number of case reports describe
serotonin syndrome, in patients given
SSRIs with MAOIs: some have been fatal.
Direct information about the interaction between
MAOIs and
SSRIs is limited, and given that concurrent use is contraindicated, further reports seem unlikely. The manufacturers say that citalopram, escitalopram,
fluvoxamine,
paroxetine or sertraline should not be given within 14 days of discontinuing an irreversible MAOI nor should any type of MAOI be added until sertraline has been stopped for 14 days, or citalopram, escitalopram,
fluvoxamine or
paroxetine have been stopped for 7 days, (14 days in the US). The manufacturers of fluoxetine recommend that at least 5 weeks should elapse between stopping the fluoxetine and starting the MAOI and 2 weeks between stopping an MAOI and starting fluoxetine. A longer interval is suggested if long-term or high-dose fluoxetine has been used.