Switch medication from citalopram to tranylcypromine.
- Decrease with about 25% of original dose every 3 days
- Stop and wait 14 days for washout
- a wash-out period of two weeks is safe even in liver malfunction and in the elderly.
- 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 serotonin syndrome is reported when a wash-out period (of one week) is not considered.
- 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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