This is unneassrily dangerous and involves more drugs than are needed.
If you are taking both Selegiline and Moclobremide you might as well just take a full MAOI. However since Selegiline at doses lower than 10-12mg has no antidepressant effect as MAO-B inhbitors aren't antidepressive you might as well take Moclobremide alone.
The risk of a hypertensive episode on Moclobremide and Selegiline is very low provided you are observing a strictly low-tryamine diet and not taking stimulants.
There is very little evidence that Tianeptine is an SSRE and plenty stacked against it. Its more likely to work by modulating glutemate and there by increasing synaptogenesis. There is only a singe case study suggesting Tianeptine is of any use combined with an MAOI and multiple other drugs (topiramate, trazodone and ziprasidone). Although it appeard safe.
There are plenty of sedative antidepressants/agumenters with better evidence that Agomelatine and that have been used alongside MAOI's providing some evidence for safety. Atypical antipsychotics in low to medium doses (particually Quetiapine), a few should be avoided due to SSRI activity like Ziprasidone. Trazadone is very commonly used alongside MAOI's. Its sedative and an approved antidepressant. Doses above 150mg must be avoided as it develops significant SSRI activity above these doses. Mirtazapine is also a good option. The benefit of Trazadone or Mirtazapine is that they are both potent antagonists of Serotonin and add a respected pharmacological antidepressant mechanism. The same can be said for the atypical antipsychotics. Trimipramine is also another reasonable option.
Phenazline and Tranylcypromine both tend to either have sedative or at worst non-stimulant effects.
An effective combination could be Tranylcypromine 20-40mg/Phenalzine 15-60mg and Quetiapine 150-300mg xl (I'm currently on Tranylcypromine 40mg and Quetiapine 300mg xl and 50mg short release) or Mirtazapine 30-45mg. Of course its quite possible, as Tranyclypromine/Phenlazine has been shown to be particually effective in treatment resistant depression, that that alone would be effective.
Edited by Tom_, 23 July 2014 - 01:09 PM.