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.
  4. Cross-tapering: Taper the first antidepressant (usually over 1-2 weeks or longer), and build up the dose of the new antidepressant simultaneously.

Several jurisdictions and organizations have published recommendations on how to switch antidepressants.

Switching Guidelines

BC Guidelines[1] SwitchRx Australian Prescriber[2]
Jurisdiction Canada Canada Australian
Link Download SwitchRx.ca Download

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