Establish the need and what to switch to

Before you implement an antidepressant switch for the treatment of depression, you should establish the need for the switch and the antidepressant to switch to.

• Establishing if a person needs to switch their antidepressant
• Considerations when choosing an alternative antidepressant

Planning the switch

Before undertaking the switch, you should plan, discuss, and agree a shared strategy and time scale with which to complete the process. Aspects to consider include:

Urgency of the switch

The urgency of the switch will affect the strategy followed. For people who are severely depressed and have failed to respond to antidepressant treatment or have experienced a severe or intolerable side effects, a fast switching strategy may be required. Where there is less urgency, a slower more cautious approach can be used. Abrupt withdrawal should be avoided unless there has been a serious side-effect.

Physical condition and co-morbidities

Older people and those with co-morbidities may be more susceptible to the additive effects of antidepressants so require caution when switching. People with complex medical and medication histories may be more susceptible to side-effects or medicines interactions.

Explaining the risks

Any antidepressant switch could be associated with risks, and whilst an appropriate strategy will help minimise these, they can never be eliminated completely. The person and/or carer should be aware of the risks associated with the switch and comfortable that the risk of not switching is greater than the risks associated with switching. Withdrawal symptoms and serotonin syndrome should both be explained so individuals know what to look out for and monitor.

Switching strategies

The article below provides details on the different antidepressant switching options available.

Providing a written summary

Once you have agreed your strategy for switching and everyone understands the actions, create a written summary explaining the rationale. Keep a copy in the medical record and give a copy to the person and/or carer too.

Monitoring people

During and after the switch, consider the monitoring that might be necessary.

Individual switches

We have 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
• Mirtazapine to other antidepressants: switching in adults
• Tricyclics to other antidepressants: switching in adults
• SSRIs to other antidepressants: switching in adults

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