Switch medication from paroxetine to tranylcypromine.
- Decrease with about 25% of original dose every 3 days
- Stop and wait 7 days for washout
- Start tranylcypromine in a low dosage of 20 mg/day for one week.
- After this week the dosage of tranylcypromine can be increased.
- Occurrence of the serotonin syndrome is possible without wash-out period.
- The reduction of the SSRI doses in 7-14 days could cause emotional instability, headache and flu-like symptoms. One could extend this period.
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