Antidepressant Drugs Health Article

Interactions

The antidepressants have many drug interactions, some severe. Although a few are listed here, specific references should be consulted for more complete information.

SSRIs should not be administered with MAOIs. Allow a wash-out period of about four weeks before switching from one class of drugs to the other. Allow five weeks if switching from fluoxetine (Prozac) to an MAOI.

MAOIs have many interactions; however the best known are those with foods containing the amino acid tyramine. These include aged cheese, chianti wine, and many others. Patients and providers should review the MAOI diet restrictions before using or prescribing these drugs. Because of the severity of MAOI interactions, all additions to the patient's drug regimen should be reviewed with care.

Tricyclic compounds have many interactions, and specialized references should be consulted. Specifically avoid other drugs with anticholinergic effects. Tricyclics should not be taken with the antibiotics grepafloxacin and sprafloxacin, since the combination may cause serious heart arrythmias.

Tricyclic compounds should not be taken with the gastric acid inhibitor cimetidine (Tagamet), since this increases the blood levels of the tricyclic compound. Other acid inhibiting drugs do not share this interaction.

SSRIs interact with a number of other drugs which act on the central nervous system. Use care in combining these drugs with major or minor tranquilizers, or with anti-epileptic agents such as phenytoin (Dilantin) or carbamazepine (Tegretol).

PERIODICALS

"Treatment of Depression: Drugs Alone Are Not Enough." Health Facts 20 (February 1995): 189.

Samuel Uretsky, PharmD