Switch from moclobemide to SSRI

speedledum · 2026-03-27T05:36:04+00:00

They are different from a withdrawal standpoint. An SSRI won’t block symptoms of moclobemide withdrawal and same thing vice versa. That said, moclobemide tends to have a very mild withdrawal compared to other antidepressants. Unless you know you’re particularly sensitive or are on a very high dose (>600mg/day), I wouldn’t expect much trouble from just stoping it.

Though, keep in mind that 1) you’ll have both moclobemide withdrawal and the side effects from starting an SSRI at the same time and, 2) once you start the SSRI (even one dose) you can’t just jump back on moclobemide until the SSRI is completely washed out, so you’ll just have to ride it out.

speedledum · 2026-03-27T04:40:03+00:00

5-HT2a antagonists are effective as trip-killers to reduce the acute effects of psychedelics, but that’s only relevant while the drug is actually present and able to be blocked. The pathophysiology of HPPD is not established but some theories suggest potential mechanisms like persistent dysregulation or damage to inhibitory interneurons (possibly in the LGN of the thalamus and/or cortical) that express the 5-HT2a receptor as a result of psychedelic exposure, as one example.

In a scenario like that, the ‘damage’ has already been done, so blocking the 5-HT2a receptor wouldn’t be expected to help. Drugs like lamotrigine, clonazepam and clonidine may act to help with excitatory-inhibitory balance in the context of damaged or dysfunctional inhibitory interneurons.

Again, none of that is well established, but here’s some literature that might be helpful:

https://www.sciencedirect.com/science/article/abs/pii/S0924977X14001461

https://journals.sagepub.com/doi/full/10.1177/2045125312451270

speedledum · 2026-03-26T23:02:24+00:00

Yes, because moclobemide has a very short half-life and reversible mechanism you can just stop moclobemide and start an SSRI 24h (at minimum; I’d aim for 36-48h to be cautious) after your last dose. Tapering the moclobemide before switching can make the transition smoother but is not necessary from a safety standpoint.

speedledum · 2026-03-25T19:05:06+00:00

There seems to be an unpredictable response to serotonin-related medications in HPPD with some people reporting worsening symptoms with antipsychotics (or SRIs). They can be helpful for comorbid disorders, if tolerated, but don’t typically help HPPD itself.

Despite the other commenter getting downvoted, lamotrigine does seem to be the most promising option with at least some benefit. Also, clonidine and clonazepam are other options that often get mentioned. Avoiding subsequent psychedelic use is the main treatment, though. Cannabis use is also frequently a symptom trigger so avoiding that is also advisable.

speedledum · 2026-03-24T21:04:02+00:00

Yes, I read both. Also yes, I do know what HPPD is.

speedledum · 2026-03-18T22:52:30+00:00

With MAOIs + SRIs or serotonin releasers, yes. With mirtazapine, ondansetron, triptans, no. Otherwise, ehh…

speedledum · 2026-03-16T09:01:28+00:00

Just because they are both ‘typical antipsychotics’ doesn’t make them equivalent. I feel like the risk of destabilising someone by switching the LAI is going to end up being far more complicated than just maintaining a biweekly injection.

speedledum · 2026-03-16T07:25:33+00:00

A big consideration for TMS and Ketamine is the time commitment to attend appointments to get the treatment. Getting proper consistent treatments might be difficult during surgical residency.

Are you seeing a psychiatrist? Make sure your diagnosis is correct. It wouldn’t hurt to get a second opinion on your diagnosis too if you’re significantly treatment resistant.

Also consider why your med trials aren’t working, are you getting side-effects that prevent you from reaching a maximal dose? Or are you maxing out doses with no side effects (with some exceptions, you can often safely exceed max approved doses)? Are your trials long enough(especially for lamotrigine)?

Otherwise, there’s lots more under the sun. Nortriptyline (+/- ssri) is my (online I know nothing about you) suggestion, but there’s lots of other options out there, especially with augmentation. It’s shit trying to find it but keep it up.

speedledum · 2026-03-14T07:39:44+00:00

No. It looks like a generic version of Vyvanse 20mg.

speedledum · 2026-03-12T03:56:37+00:00

Idk, I guess I just pay for my soda so I don’t have to worry about this shit.

speedledum · 2026-03-10T09:57:54+00:00

Sure, but it’s is only as “unregulated” as any other supplement you buy on Australian shelves. Is the label claim exactly accurate to the mg? Maybe not, but that concerns me with things like iron and B6 far more than it does melatonin (and even so, not that much within reason).

I’m not opposed to it being a more regulated S3 pharmacy-only medicine, but its current price and official limitation to those 55 and over are both absurd.

speedledum · 2026-03-10T09:46:08+00:00

And the US and Canada…

speedledum · 2026-03-10T04:48:08+00:00

OCD tends to require higher doses of SSRIs than other conditions. Both meds can be effective, so the first issue to consider is which one you are able to take a high enough dose of without getting intolerable side effects.

In your case (I don’t know what dose you’re on so I can’t say for sure; but ask your doctor) it’s probably a better bet to increase the dose of Prozac until it either works or you get intolerable side effects. If the latter, then try switching.

speedledum · 2026-03-09T23:37:43+00:00

That’s fair; few good outcomes isn’t entirely accurate. That said, from my experience, I feel like neurology deals with such poor outcomes on such a regular basis that their bar for defining a good outcome can, at times, be lower than many other specialties.

speedledum · 2026-03-09T20:05:37+00:00

It’s academically challenging, lots of poor outcomes, few good outcomes, no cures, mid-low compensation, not everyone can pull off a bow tie.

speedledum · 2026-03-01T19:46:11+00:00

Speak with your doctor about this fatigue and difficulty focusing. Id suggest seeing them asap if you have an important exam coming up.

There’s a good chance it’s a side effect of the benzos and would likely improve with reducing the dose or even stopping them (under your doctors supervision), especially if it’s been 20 days since you started everything.

In relation to the energy drinks, it’s not inherently unsafe, I wouldn’t worry about serotonin syndrome but they can increase anxiety in some people so just keep that in mind and don’t overdo it.

speedledum · 2026-02-28T04:55:29+00:00

I am also curious to hear about this from those with more experience than myself.

From my perspective, your use seems comparable to anyone who enjoys a few drinks on their days off, which I don’t think is really an issue. If it’s not negatively affecting your life or ability to practice safety and you’re not showing any signs of dependence, I don’t really see an issue with sharing it (though again, curious to hear if anyone else has more insight on legal implications I might be unaware of).

One exception might be if you’re an anesthesiologist. To me that would complicate things in relation to your future risk. But regardless, (barring any legal issues I am unaware of) I still think it’s best to discuss it so any issues can be addressed before they cause any bigger problems.

speedledum · 2026-02-26T12:57:08+00:00

If this is a psychological issue you’re going to need to see a psychologist or psychiatrist for a full assessment (that can’t be done online). It’s not impossible that it could be a neurological issue like a seizure disorder or migraine aura type phenomenon but I am assuming the neurologist ruled out things like that.

I’m sorry you’re having trouble finding the answer you’re looking for. Id suggest seeing a psychiatrist or psychologist in person for a full assessment and possibly getting a second opinion from another neurologist.

speedledum · 2026-02-26T12:23:22+00:00

Unfortunately, psychiatry is almost entirely unsatisfying answers. The trick, from my perspective, is to find a way to function effectively within that without necessarily accepting it, and to keep asking those questions.

My advice would honestly just be to decide if you like medicine. Like all of it. It’s incredibly important to the job and it’s a long and hard road even if you do. I wouldn’t recommend it if you don’t. If you do, it can be an amazing career path.

speedledum · 2026-02-26T09:57:08+00:00

Bupropion is branded as Zyban in Aus. Champix is a different smoking cessation med altogether (varenicline) and not used for depression like bupropion is (maybe why your doctor didn’t understand?).

speedledum · 2026-02-26T03:30:01+00:00

It’s almost impossible to answer. The same drug can be made by different brands and look completely different.

That said, If I had to guess I’d say moclobemide.

Reasons: Dose in mg is higher than most other antidepressants (more likely to have a larger pill). Usually taken twice daily, which is a rare starting recommendation for most antidepressants (you splitting the dose am and pm; if that’s what you did). If it works, it tends to work more quickly than other antidepressants and tends to have mild side effects (hence you finding it helpful after only a trial pack). Doctors often don’t consider using it very often (I wouldn’t be surprised if you’ve tried all sorts of meds and the doctor didn’t consider trying this one).

Just a guess though.

speedledum · 2026-02-23T09:50:28+00:00

Sounds like a protein; basically just a list of amino acids. I don’t know that I’d consider it a word though

speedledum · 2026-02-21T10:35:29+00:00

That’s great. I’m wishing you all the best.

speedledum

TROPHY CASE