People may need to switch antidepressants if their existing medication isn’t working as intended. Several strategies can help ease this transition.
If you’re living with depression, your doctor will likely start you on a treatment plan of antidepressants such as a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI).
It can take a few weeks on one of these drugs to see an improvement. However, not everyone will feel better with the first antidepressant they try.
When an antidepressant doesn’t work as intended, doctors can increase the dose or add other treatments such as cognitive behavioral therapy. These strategies sometimes work — but not always.
In other cases, a change of antidepressants is necessary.
Only
You may also need to switch medications if the first drug you try causes side effects you can’t tolerate, such as weight gain or lowered sex drive.
Don’t stop taking your medication without first checking with your doctor. Switching treatment is a careful process. Stopping your current medication too quickly can lead to withdrawal symptoms or cause your depression symptoms to return. Your doctor must monitor you for side effects or problems during the switch.
Doctors use
- Direct switch: In a direct switch, you stop taking your current drug and start on a new antidepressant the next day. It’s possible to make a direct switch if you’re going from an SSRI or SNRI to another drug in the same class.
- Taper and immediate switch: In this switching method, you gradually taper off your current drug. As soon as you’ve fully stopped the first drug, you start taking the second drug.
- Taper, washout, and switch: This is a conservative method of switching in which you gradually taper off the first drug and wait for it to leave your system before switching to the new medication.
- Cross taper: You gradually taper off the first drug while increasing the second dose. This can be beneficial when switching to a drug in a different antidepressant class.
The strategy your doctor will choose will depend on factors such as:
- The severity of your symptoms: It isn’t safe for some people to go off their antidepressants for
several days or weeks. - Concerns over symptoms: Cross-tapering can help prevent you from having withdrawal symptoms.
- Which drugs you take: Certain antidepressants can interact in dangerous ways and
can’t be cross-tapered. For example, doctors won’t combine clomipramine (Anafranil) with SSRIs, duloxetine (Cymbalta), or venlafaxine (Effexor XR).
Here’s a chart with information about how your doctor may
| From | To | How to switch |
|---|---|---|
| SSRI or SNRI | SSRI or SNRI | • Direct switch • Cross taper • Taper, washout, switch • Taper and switch |
| SSRI or SNRI | Tricyclic antidepressant (TCA) | • Cross taper • Taper, washout, switch • Taper and switch |
| SSRI or SNRI | Non-SSRI, non-SNRI, non-TCA | • Cross taper • Taper, washout, switch • Taper and switch |
| TCA | Any antidepressant | Cross taper |
| Monoamine oxidase inhibitors (MAOI) | Any antidepressant | Taper, washout, switch |
| Any antidepressant | MAOI | Taper, washout, switch |
| Bupropion | Any antidepressant | Cross taper |
Changing from one antidepressant to another can cause
Withdrawal
Reducing your antidepressant dose or stopping medication entirely can cause withdrawal symptoms, including:
- restlessness
- trouble sleeping
- stomach problems
- sweating
- unsteadiness
Serotonin syndrome
If you start taking a new medication before the old one is out of your system, you can develop a rare but serious condition called serotonin syndrome.
Certain antidepressants work by increasing the amount of the chemical serotonin in your brain. The added effects of more than one antidepressant can lead to an excess of serotonin in your body.
Symptoms of serotonin syndrome include:
More severe cases can cause symptoms such as:
Call your doctor or go to an emergency room right away if you have any of these symptoms.
Talk with a doctor if you have side effects that don’t improve. You might need to make another medication switch.
Once you’ve been on antidepressants, your body gets used to the drug. When you try to stop taking the antidepressant, you can experience withdrawal symptoms. Slowly tapering off your antidepressant can help you
Doctors will typically lower your antidepressant dose over the course of 4 or more weeks.
A washout period is the waiting time of a few days or weeks after stopping the old drug before starting the new one. This lets your body clear the old drug out of your system. This often takes
Once the washout period is over, you’ll usually start with a low dose of the new drug. Your doctor will slowly increase the dose, titrating up until it starts to relieve your symptoms.
There are different types of antidepressants, and people respond to them differently. Only one-third of people experience symptoms remission from their first course of antidepressants.
If your antidepressants don’t work, you may need to switch medications.
When switching antidepressants, it’s common to taper down your medications before switching, and doctors may also require you to wait days or weeks before taking a new medication. These strategies can help lower the risk of adverse drug interactions.