Each person may respond differently when switching from one antidepressant to another. Some may experience a smooth transition with minimal side effects, while others may have a more challenging time.
Your sensitivity to the antidepressants you take, the dose adjustments you make, and which medications you choose may all play a role in these differences.
There are a few things to keep in mind when switching antidepressants.
Types of antidepressant
There are several different kinds of antidepressant medication that you might be prescribed. This also means there is a lot of choice for switching if one isn’t working for you.
Selective serotonin reuptake inhibitors (SSRIs)
These are used to increase serotonin levels in the brain. They’re a first-line treatment for depression and anxiety disorders. Examples include fluoxetine Hcl (Prozac) and sertraline (Zoloft).
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
These increase serotonin and norepinephrine levels. They can also be effective for chronic pain conditions in addition to depression. Examples include venlafaxine (Effexor XR) and duloxetine (Cymbalta).
Tricyclic antidepressants (TCAs)
These affect serotonin and norepinephrine levels, and they may also be helpful for chronic pain conditions and some sleep disorders. They’re an older class of medication with more side effects.
Examples include desipramine (Norpramin) and nortriptyline (Pamelor).
Monoamine oxidase inhibitors (MAOIs)
These inhibit the enzyme that breaks down serotonin, norepinephrine, and dopamine in the brain. They require dietary restrictions and are usually reserved for treatment-resistant depression when other options haven’t worked.
Examples include phenelzine (Nardil) and tranylcypromine (Parnate).
Norepinephrine-dopamine reuptake inhibitors (NDRIs)
These affect dopamine and norepinephrine levels in the brain. They may be helpful if you are sensitive to SSRIs or you do not produce enough dopamine. One example is bupropion (Wellbutrin).
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Get free cardReasons to switch
There can be various reasons why people choose to switch antidepressants. Some of the main reasons include:
- Not working well: If your current antidepressant is not helping with your depression, switching to a different one might give you better results. In this situation, including an additional medication for depression (e.g., aripiprazole (Abilify) alongside your current one might be more effective than switching.
- Unwanted side effects: Sometimes, the side effects of your current antidepressant such as weight gain, sexual difficulties, nausea, or fatigue (low energy), can be too challenging. Switching to a different medication might help reduce these side effects.
- Medical factors: Sometimes, changes in your health condition, interactions with other medications you’re taking, or new medical concerns may mean it’s necessary to switch antidepressants.
How to switch safely
There are four main methods of switching from one antidepressant to another:
| Conservative switch: · Gradually reduce and stop the first antidepressant · Allow time for your body to clear antidepressants · Start the new antidepressant according to its recommended dose | · Generally recommended · Provides the lowest chance of drug interactions · There is a low possibility of experiencing discontinuation symptoms · Symptoms might return because you aren’t using medication for some time or taking a lower dose. |
| Moderate switch: · Gradually reduce and stop the first antidepressant · Have a drug-free washout interval of 2–4 days · Start the new antidepressant at a low dose | · Also recommended for use in general practice · The risk of drug interactions is low · Possibility of experiencing discontinuation symptoms · Symptoms might return while you are in the process of switching. |
| Direct switch: · Stop the first antidepressant · Start the second antidepressant the following day at the typical therapeutic dose | · Risk of drug interactions is substantial · Requires clinical expertise · Only suitable switching between very similar antidepressants (e.g., switching from one short half-life SSRI to another) |
| Cross-taper switch: · Gradually reduce and stop the first antidepressant while introducing the second antidepressant at a low dose · Take both medications at the same time, until the first one is fully stopped | · Commonly used for patients at high risk of illness relapse · Requires clinical expertise · Increased risk of drug interactions and adverse effects |
According to some guidelines, you are more likely to switch successfully if you also:
- Consult a healthcare professional before making changes: Work together to create a personalized plan and outline the switching timeline, dosage adjustments, and monitoring arrangements during the transition.
- Monitor for side effects: Pay close attention to any new side effects or changes in symptoms during the transition period. Report any concerns or unusual experiences to a healthcare professional.
- Follow the recommended timeline: Follow the timeline and dosage adjustments outlined by your healthcare professional to reduce side effects and increase the likelihood of a successful switch.
- Keep in touch: Check in regularly with the healthcare professional that is supporting the management of your switchover so that they can assess your progress and make any necessary adjustments.
- Be patient: Adjusting to a new antidepressant can take time. It may take up to 8 weeks before you notice the full effects of your new medication.
Possible side effects
- Withdrawal/discontinuation symptoms: When you reduce your current antidepressant, you may have withdrawal symptoms such as dizziness, nausea, headaches, or feeling irritable. These can vary in intensity and how long they last.
- New medication side effects: Starting a new antidepressant can cause side effects such as upset stomach, changes in appetite or weight, sleep problems, sexual difficulties, dry mouth, drowsiness, or increased anxiety. Not everyone will have these side effects, and they often improve over time.
- Possible interactions: When you switch antidepressants, there’s a chance of interactions with other medications you take. Make sure to tell your healthcare professional about all your current medications, including over-the-counter (OTC) drugs and supplements.
- Serotonin syndrome: Serotonin syndrome is a rare but serious condition. Switching antidepressants can increase the risk, but it’s still uncommon. Symptoms include agitation, confusion, rapid heart rate, tremors, and more. Seek immediate medical attention if you experience these symptoms.
- Worsened symptoms: It’s possible that your symptoms might return or worsen while you’re switching medications due to reduced doses or taking a break between medications.
Summary
Switching antidepressants can be a positive step toward finding the right medication for you.
Work with healthcare professionals to explore different options, transition gradually, stick to your agreed-upon plan, and be sure to address any concerns.
Stay optimistic and keep open communication with your doctor throughout the process.
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