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.

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

• Horowitz, M. A., & Taylor, D. (2019). Tapering of SSRI treatment to mitigate withdrawal symptoms. The Lancet Psychiatry, 6(6), 538-546.
• BCGuidelines.ca Appendix D: Switching Antidepressants