- Last edited on February 1, 2024
Tapering/Switching Antidepressants
Primer
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:
- 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.
Switching vs. Adding
Switching vs. Adding
| 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 |
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.
Recommended Reading
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Recommended Reading
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