- Last edited on November 29, 2022
Tapering/Switching Antidepressants
Primer
When a patient does not respond to an initial antidepressant, there are several switching strategies that can be used. Choosing the right strategy depends on patient preference, antidepressant profile, and patient response/side effects:
- Direct switch: Stop the first antidepressant completely, and start a new antidepressant the next day
- Taper and switch immediately: Gradually taper the first antidepressant, then start the new antidepressant immediately after discontinuation
- Taper and switch after a washout: Gradually withdraw the first antidepressant, then start the new antidepressant after a washout period (this is important for when switching someone onto an MAOI, and there should be a 7-14 day washout.)
- Cross-tapering: Taper the first antidepressant (usually over 1-2 weeks or longer), and build up the dose of the new antidepressant simultaneously.
Switch Strategies
Several jurisdictions and organizations have published recommendations on how to switch antidepressants.
Discontinuation and Withdrawal
See main article: Antidepressant Withdrawal (Discontinuation) Syndrome
It is important to monitor for signs of antidepressant discontinuation and withdrawal symptoms during any medication switch.