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.