When a patient does not respond to an initial antidepressant, there are several switching strategies that can be used. Alternatively, if a diagnostic clarification is needed and a patient does not respond on an antidepressant, tapering should also be considered. Choosing the right strategy depends on patient preference, antidepressant profile, and patient response/side effects:
Switching | Augmenting (Adding) | |
---|---|---|
Advantage | • Avoids polypharmacy, drug-drug interactions, adverse effects, and costs • Improved adherence | • Preserves partial response • Avoids adverse effects and delays associated with discontinuation or withdrawal |
Disadvantage | • Potential loss of partial response in patients who appeared not to respond to first antidepressant • Risk of adverse effects and delays associated with antidepressant withdrawal • Titration of new antidepressant may take a longer time, resulting in further delays in treatment | • Polypharmacy and associated drug-drug interactions, adverse effects, and costs • Greater potential for non-adherence to medications |
Several jurisdictions and organizations have published recommendations on how to switch antidepressants.
It is important to monitor for signs of antidepressant discontinuation and withdrawal symptoms during any medication switch.