Tapering/Switching Antidepressants

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:

  1. Direct switch: Stop the first antidepressant completely, and start a new antidepressant the next day
  2. Taper and switch immediately: Gradually taper the first antidepressant, then start the new antidepressant immediately after discontinuation
  3. 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.)
  4. Cross-tapering: Taper the first antidepressant (usually over 1-2 weeks or longer), and build up the dose of the new antidepressant simultaneously.
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Several jurisdictions and organizations have published recommendations on how to switch antidepressants.

Switching Guidelines

BC Guidelines[1] SwitchRx Australian Prescriber[2] Royal College of Psychiatrists
Jurisdiction Canada Canada Australian United Kingdom (UK)
Year 2013 - 2016 2020
Link Download SwitchRx.ca Download Link

It is important to monitor for signs of antidepressant discontinuation and withdrawal symptoms during any medication switch.