Advice for all antidepressants

You should read our advice for all antidepressant switching for the treatment of depression before applying that to individual mirtazapine switches below.

• Establishing if a person needs to switch their antidepressant
• Considerations when choosing an alternative antidepressant
• Planning and agreeing an antidepressant switching strategy
• Monitoring a person during and after antidepressant switching

Specific advice when switching from mirtazapine

Strategies for switching from mirtazapine to other antidepressants are outlined below.

Our page on Switching strategies for antidepressants contains further information on the available strategies.

Agomelatine

Cross-taper

Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.

There is limited experience with this switch so extra caution is required. Although interactions are not expected, agomelatine is not expected to mitigate withdrawal reactions from stopping mirtazapine.

Moclobemide

Taper, washout and switch

Gradually reduce the dose of mirtazapine and stop; wait 7 days before starting moclobemide.

Cross-tapering is not recommended due to the high risk of serotonin syndrome.

Monoamine oxidase inhibitors (MAOIs)

Switching to an MAOI is always a complex switch and you should follow specialist advice.

Taper, washout and switch with specialist advice

Gradually reduce the dose of mirtazapine and stop; wait 7 to 14 days before starting the MAOI. The specialist will advise the duration of the washout period on a case-by-case basis taking into consideration the MAOI being started.

Cross-tapering is not recommended due to the high risk of serotonin syndrome.

Selective serotonin reuptake inhibitors (SSRIs)

Cross-taper

Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.

Selective serotonin and noradrenaline reuptake inhibitors (SNRIs)

Cross-taper

Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.

Trazodone

Cross-taper

Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.

Tricyclic antidepressants (TCAs)

Switching to dosulepin requires specialist advice and should not be done in primary care due to the increased cardiac risk and toxicity in overdose.

Cross-taper

Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.

Vortioxetine

There is limited experience with this switch so extra caution is required to avoid serotonin syndrome.

Cross-taper

Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.

Taper, washout and switch

Alternatively, gradually reduce the dose of mirtazapine and stop; wait for a period before starting vortioxetine. Clinicians should decide the duration of the washout period on a case-by-case basis.

Deciding on the switching strategy

Our guidance on Planning and agreeing an antidepressant switching strategy will help you decide which switching strategy to choose.

More advice on individual switches

We have further advice on how to switch between individual antidepressants of different types. Browse our collection below.

• MAOI to other antidepressants: switching in adults
• Moclobemide to other antidepressants: switching in adults
• Trazodone to other antidepressants: switching in adults
• Vortioxetine to other antidepressants: switching in adults
• SNRIs to other antidepressants: switching in adults
• Agomelatine to other antidepressants: switching in adults
• Tricyclics to other antidepressants: switching in adults
• SSRIs to other antidepressants: switching in adults

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