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Switching Antidepressants: Charts and Strategies

Switching from one antidepressant to another
Written by:

Rabia Khaliq

MSc in Applied Psychology
Reviewer:

Dr. Bradley Noon

MD

Content

Medical Disclaimer
The medications listed on this website are provided for informational purposes only. Their inclusion does not guarantee that they will be prescribed to any individual, as treatment decisions are ultimately at the discretion of healthcare providers. This list is not exhaustive, and healthcare providers may prescribe other medications, including non-stimulant options, based on the patient’s unique health circumstances and needs.Read more
The medications listed on this website are provided for informational purposes only. Their inclusion does not guarantee that they will be prescribed to any individual, as treatment decisions are ultimately at the discretion of healthcare providers. This list is not exhaustive, and healthcare providers may prescribe other medications, including non-stimulant options, based on the patient’s unique health circumstances and needs.

Antidepressants are essential for the treatment of mental health issues like depression and provide relief to millions of people worldwide. Nonetheless, there are times when treatment should be adjusted, be it a lack of response to medication, severe side effects, or other reasons.

It is important to explore the specifics of switching from one antidepressant to another. This article provides a thorough guide with helpful charts so that you can prepare questions for your healthcare provider about adjusting your treatment in advance.

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Classes of Antidepressants

Antidepressants function [1*] by changing the brain’s chemical balance, usually targeting norepinephrine and serotonin, but the specifics of their mechanisms of action vary. The most commonly prescribed types of antidepressants are the following: 

  • Selective Serotonin Reuptake Inhibitors (SSRIs): The most often prescribed class of antidepressants, SSRIs, helps with mood regulation by raising serotonin levels in the brain. Prozac (fluoxetine), Zoloft (sertraline), and Lexapro (escitalopram) are a few examples of SSRIs.
  • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): SNRIs affect the levels of serotonin and norepinephrine in the brain. They are used to treat anxiety and depression among other mood disorders. Examples include Effexor (venlafaxine) and Cymbalta (duloxetine).
  • Tricyclic Antidepressants (TCAs): TCAs (imipramine and amitriptyline) are an older class of antidepressants that are no longer as widely recommended because of their adverse effects. They impact numerous neurotransmitters. 
  • Monoamine Oxidase Inhibitors (MAOIs): Due to dietary limitations and possible drug interactions, MAOIs, another older class of antidepressants, are used less commonly. Nardil (phenelzine) and Parnate (tranylcypromine) are two examples.
  • Atypical Antidepressants: Different antidepressants that don’t precisely fit into the aforementioned categories are included in this category. Remeron (mirtazapine), Wellbutrin (bupropion), and Trazodone are a few examples.


Antidepressant treatment is usually supervised by medical professionals and is based on the individual’s condition and health needs.

Why Switch Antidepressants?

The change in the treatment plan may be required for several reasons, from intolerance to ineffectiveness. Some of the most common causes are explained below.

Insufficient or Partial Symptom Relief

If your symptoms of anxiety or depression are not adequately reduced by your current antidepressant, your healthcare provider may recommend switching to another medication. It can be an antidepressant of the same class with another active ingredient or an antidepressant with another mechanism of action.

Example: Despite using a selective serotonin reuptake inhibitor (SSRI) for several months to treat depression, the patient continues to feel down and uninterested in their regular activities. In order to treat symptoms differently, the doctor may consider switching to a different class of antidepressants, such as SNRIs.

Intolerable Side Effects

Some people could have side effects [2*] that are too severe or unpleasant to continue taking their medication as prescribed. It might be advantageous to move to an alternative antidepressant that has a less problematic side effect profile.

Example: A patient takes a tricyclic antidepressant, and it causes extreme sleepiness, weight gain, and dry mouth, which brings additional stress to daily life and work. A person can consult a healthcare provider to switch to a new antidepressant with more manageable side effects.

Drug Tolerance

Some persons may get less responsive to their antidepressants over time as a result of developing tolerance. In these situations, changing to a different antidepressant may aid in restoring the effectiveness of treatment.

Example: After taking the same SSRI for a long time, a person has discovered that medication is no longer as helpful in controlling their anxiety symptoms. To regain therapeutic benefits, a psychiatrist may suggest trying a different class of antidepressants or another SSRI medication.

Health Changes

Your body’s reaction to antidepressants may change if your health or other medical circumstances change. To account for these changes, a medication adjustment can be required.

Example: The patient has a medical problem that impacts how their body metabolizes medication, and it was just recently diagnosed. Due to these health changes, the current antidepressant may not be working as well as it once did. A healthcare provider may recommend replacing this antidepressant with one that is more appropriate considering current health status.

The Medication Doesn't Fit Your Lifestyle

Occasionally, a medication’s dosage schedule or other treatment criteria could not fit with your way of life. In these situations, you might discuss switching to an antidepressant that better meets your needs.

Example: An antidepressant dose schedule does not align with work shifts and sleep periods. For improved work-life balance, a healthcare provider might advise another antidepressant with a more flexible dosing schedule.

Switching medications requires the guidance of a healthcare provider. Click to book a consultation.

How to Switch Antidepressants?

These are the typical antidepressant-switching strategies:

  1. Direct Switch: There are situations when switching antidepressants directly without a washout or taper phase may be possible. For example, when moving from one serotonin-norepinephrine reuptake inhibitor (SNRI) or selective serotonin reuptake inhibitor (SSRI) to another. It’s important to use equivalent dosages and keep an eye out for any negative effects while making the changeover.
  2. Tapering and Immediate Switch: For some antidepressants, particularly those that include risk of withdrawal or discontinuation symptoms, your doctor could advise tapering off the existing antidepressant while initiating the new one at the same time to avoid antidepressant discontinuation syndrome [3*] .
  3. Tapering, Washout, and Switching: In certain instances, especially when transferring from a long-acting antidepressant to a short-acting one or if one of these antidepressants is MAOI (monoamine oxidase inhibitor), your physician might advise tapering off the existing medication, allowing a “washout” period to eliminate the old medication from the body, and then starting the new one. This is a more advanced strategy that typically serves as a backup for particular circumstances.
  4. Cross Tapering: With this method, the dosage of the new antidepressant is increased at the same time that the old antidepressant’s dosage is gradually reduced. During the changeover, cross-tapering can help reduce side effects and withdrawal symptoms.

The above-mentioned schemes are presented only for informational purposes. Always consult your healthcare provider if you believe you need to switch to another medication. They will assess your current health situation and response to medicine, choose a new medication, and suggest a personalized switching strategy.

Switching Chart

Switching from

Switching to

Possible strategy

SSRIs

Another SSRI

  • Cross tapering
  • Starting another SSRI at a low dose

SNRIs

SSRIs

  • Tapering SNRI
  • Starting SSRi at a low dose

TCAs

SSRIs

  • Tapering TCA
  • Starting SSRI at a low dose

MAOIs

SSRIs

  • Tapering MAOI
  • Waiting for 14 days to wash out and starting the new medication

Atypical Antidepressants

SSRIs

  • Discontinuation of an atypical antidepressant
  • Starting an SSRI

Others (e.g., Bupropion, Mirtazapine)

SSRIs

  • Gradual cross tapering 
  • Direct switch

SSRIs & SNRIs

TCAs

  • Gradual cross tapering
  • Tapering and switching

TCAs

Any antidepressant

  • Cross tapering

Any antidepressant drug

MAOIs

  • Tapering, washout, and switching

Note: The specific situations may differ from those mentioned in the table. It is important to seek the supervision and assistance of a healthcare expert to switch antidepressants safely, avoid or reduce potential adverse effects, and achieve optimal treatment outcomes.

Other Strategies for Maximizing Treatment Effects

Depending on the reason for re-evaluating the treatment plan, your healthcare provider may suggest other options instead of changing or stopping antidepressants. The two most popular approaches are treatment augmentation and dose modification.

Dosage Adjustment

A medical professional could advise raising the dosage of an antidepressant if depression symptoms are not sufficiently controlled. On the other hand, the doctor might advise lowering the dosage if the patient is having severe side effects or has recovered enough to decrease the prescribed amount.

Additionally, splitting the daily dosage into two or more smaller doses might occasionally assist in minimizing adverse effects. It happens due to maintaining a more constant level of the medicine in the bloodstream.

Treatment Augmentation

If one antidepressant medication isn’t effective enough, a healthcare provider may advise adding another medicine. For example, it can be lithium, thyroid hormone, an atypical antipsychotic medication, etc. This treatment approach is called combination therapy.

The efficacy of pharmacological treatment can be increased when antidepressant medication is combined with psychotherapy [4*] , such as cognitive-behavioral therapy (CBT) or interpersonal therapy (IPT).

 If previous approaches have failed, additional treatments like electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS) may be considered.

Side Effects of Switching Antidepressant Medications

Switching antidepressants carries a number of potential adverse effects. People may have withdrawal symptoms from their former antidepressant upon switching to a new one, particularly if it is in a different class or has a different mechanism of action. Typical signs of antidepressant withdrawal include:

  • Nausea
  • Dizziness
  • Headache
  • Fatigue
  • Mood swings
  • Insomnia
  • Flu-like symptoms

A high level of serotonin in the body can lead to an uncommon but potentially fatal disease known as serotonin syndrome [5*] . Its symptoms include:

  • Agitation or restlessness
  • Rapid heart rate
  • Dilated pupils
  • High blood pressure
  • Fever
  • Muscle rigidity
  • Tremors
  • Sweating
  • Confusion
  • Hallucinations
  • Seizures

Reach out to your healthcare provider if you notice severe side effects.

Final Note

It is essential to switch antidepressants under the supervision of a qualified healthcare professional in order to minimize the associated risks. They will develop a personalized transition strategy based on particular medications as well as your health needs. It is crucial to be transparent with your healthcare practitioner about any symptoms and changes you notice throughout the switching process.

Frequently Asked Questions

If the new antidepressant has been chosen correctly, it could take a few weeks to see results. This time frame allows your body to get used to the new medication.
Switching antidepressants can be a challenging process. As you become used to the new medicine, you may initially experience side effects and withdrawal symptoms from the previous one. While some people may experience relief from the new antidepressant relatively quickly, others could require more time for it to take action. It’s essential to show patience and keep your healthcare physician informed about your progress and any negative effects.

To ensure a smooth transition to another antidepressant, it is important to follow these guidelines:

  1. Follow the dose recommendations provided by your healthcare provider.
  2. Keep open communication with your healthcare professional to discuss any concerns or side effects.
  3. Keep track of the overall process by monitoring your energy levels, mood, and any adverse effects.
When compared to other SSRIs, paroxetine is sometimes thought to be linked to more withdrawal symptoms, which can also be more severe and prolonged. It’s important to remember that every person’s experience is unique, and some people may find it simpler to stop taking paroxetine than others.
Before thinking about switching antidepressants, it is usually advised to give the medication at least 4 to 6 weeks to see how well it works. It may take some time for many antidepressants to reach their full therapeutic potential, but in the meantime, you and your doctor can assess if the medication is making a difference in your symptoms.

Sources

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+5 sources
  1. Mechanism of action of antidepressant medications
    Source link
  2. Assessment of the Antidepressant Side Effects Occurrence in Patients Treated in Primary Care
    Source link
  3. Antidepressant discontinuation syndrome
    Source link
  4. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis
    Source link
  5. Serotonin Syndrome
    Source link
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Written by:

Rabia Khaliq

MSc in Applied Psychology
Reviewer:

Dr. Bradley Noon

MD
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