How to switch antidepressants? (3 common strategies) 

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In this blog post, we are going to talk about switching antidepressants. Antidepressants are one of the most commonly used medications. However, they may not work perfectly for every other individual. 

The process of determining the best antidepressant for you is a hard one and you may need to switch your antidepressant over and over again until you finally have the one that works the best. This blog will cover the common antidepressant switching strategies. 

How to switch antidepressants?

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The best ways to switch your antidepressant include

  • Taper off the first antidepressant while starting the new one from the lowest effective dose. 
  • Taper off and stop the first antidepressant, then start the new one 
  • Taper off and stop the first antidepressant, wait 7-14 days, and then start the new one.

Taper off the first antidepressant while starting the new one from the lowest effective dose. 

This is one of the most common ways to switch from one antidepressant to another. However, this strategy does have some restrictions too and it can only be possible when you’re switching to a similar class of antidepressants. 

If you’re switching from one SSRI to another, your doctor may follow this strategy. It can also be followed when you’re switching from an SSRI to an SNRI, or from one SNRI to another. In this method, your doctor first starts to taper off the antidepressant you’re taking at the moment. 

This step is crucial because of the effects of antidepressants on your brain and the fact that your brain is now used to this effect. If you take away the first antidepressant abruptly and give another one right away, your body may start to malfunction. This is because antidepressants make your brain somehow dependent on them. 

When you suddenly take them away, your brain starts to crave the excessive amount of excitatory neurotransmitter serotonin that was present because of an antidepressant. 

This condition can take a disturbing turn because the symptoms associated with antidepressant withdrawal are not so easy to deal with. So, your doctor will gradually decrease the dose of your med to make it easy for your brain to comprehend what’s actually going on. 

Meanwhile, a very low dose of the new med is started to kind of introduce the drug to the brain. This step is crucial as now two antidepressants can be present in your body. 

You have to make sure to stick to your doctor’s recommended dose if you wish to avoid overdosing on your antidepressants. As the process goes on, the first drug is slowly tapered off and then stopped finally, whereas the dose of the new drug is gradually increased until it reaches the most appropriate dose as per your condition. 

Taper off and stop the first antidepressant, then start the new one 

For people who are extremely sensitive to antidepressants, the first option that we have discussed does not really work. This is because their body may not completely understand the process of stopping one antidepressant and starting another one at the same time. 

That’s when this switching strategy comes in handy. If you’re one of the sensitive people, your doctor may start to slowly taper you off your current antidepressant first. 

Once the drug is completely out of your system, that’s when the new drug is started from the lowest effective dose to see how your body reacts to the new antidepressant. If you respond well to it, your dose is then escalated slowly till you reach the most appropriate dose. 

The dose escalation, however, should not be fast. This is because your body may be able to take low doses well and may start to react negatively if you increase the dose too fast. During this switching strategy, you have to be careful and should take your meds properly. 

Taper off and stop the first antidepressant, wait 7-14 days, and then start the new one.

This taper strategy is very important and plays a huge role in the prevention of serotonin syndrome. During this strategy, the first antidepressant is gradually tapered off and is stopped. 

Then a time period of 7 to 14 days is necessary for your body to completely get rid of the first antidepressant, even traces. When there are no traces left, that’s when the new drug is started, and that too from the lowest effective dose. 

This is common in the case of Monoaminoxidase inhibitors (MAOIs), whether you’re switching from MAOIs or to MAOIs. Monoaminoxidase inhibitors are considered stronger than other classes because of their distinct mechanism of action. 

These meds actually inhibit the enzyme monoaminoxidase, which is responsible for the breakdown of monoamine neurotransmitters like serotonin and norepinephrine. When these chemicals are not broken down, more quantity becomes available to bind to the respective receptors. 

If you take any other antidepressant while having even traces of MAOIs in your system, it will dangerously increase the number of excitatory neurotransmitters in your body and you will definitely be subjected to the disturbing symptoms associated with serotonin syndrome. 

This condition can become extremely dangerous and life-threatening. Even lower doses become difficult to manage at times. The common symptoms associated with serotonin syndrome include:

  • The rapid change in blood pressure 
  • Uncontrollable heartbeat
  • Vision problems 
  • Auditory and visual hallucinations
  • Erratic behaviour 
  • Fever with chills
  • Muscle Shivering 
  • Nervousness 
  • Convulsions 
  • Confusion 

Switching antidepressants chart 

Antidepressants Switching strategies 
Selective serotonin reuptake inhibitors (SSRIs)To another SSRI: taper SSRI, start new drug from the lowest effective doseTo SNRI: taper SSRI, start SNRI from the lowest effective doseTo TCA:  taper SSRI, start TCA from the lowest effective doseTo MAOI: taper and stop SSRI, wait for 7 days, start MAOI from a low dose 
Serotonin-norepinephrine reuptake inhibitors (SNRIs)To SSRI: taper SSRI, start SNRI from the lowest effective doseTo another SNRI: taper SNRI, start the new drug from the lowest effective doseTo TCA:  taper SNRI, start TCA from the lowest effective doseTo MAOI: taper and stop SNRI, wait for 7 days, start MAOI from a low dose 
Tricyclic antidepressants (TCAs)To SSRI: taper SSRI, start TCA from the lowest effective doseTo SNRI: taper TCA, start SNRI from the lowest effective doseTo another TCA:  taper TCA, start the new drug from the lowest effective doseTo MAOI: taper and stop TCA, wait for 14 days, start MAOI from a low dose 
Monoaminoxidase inhibitors (MAOIs)To SSRI: taper and stop MAOI, wait for 14 days, start SSRI from a low dose To SNRI: taper and stop MAOI, wait for 14 days, start SNRI from a low dose To TCA: taper and stop MAOI, wait for 14 days, start TCA from a low dose To another MAOI: taper and stop MAOI, wait for 14 days, start the new drug from a low dose 

What to expect when switching from one antidepressant to another? 

There are a few things that you should expect when you switch from one antidepressant to another. These include:

  • Your new antidepressant will take time to work
  • The new antidepressant can produce side effects 
  • You may experience some mood changes 

Your new antidepressant will take time to work

It is a known fact that antidepressants take some time to start working. Even if you have been taking an antidepressant for quite a while and you switch it, you still need to give your new antidepressant some time to start working. 

Usually, they start to kick in within 2 to 3 weeks after you have switched, but it can take much longer than that in some cases. This is what you should keep in mind when you switch from one antidepressant to another. 

Depression is a type of illness that does not progress overnight. It takes some time to become problematic. Similarly, the treatment also requires some time to start counteracting the symptoms associated with this mental illness. 

You can’t just expect your antidepressant to treat your depression overnight. This is why you should be patient enough and give the required amount of time for your body to adjust to the new antidepressant. 

Once it settles in, you will start to notice a difference. However, there is no way to be certain that the new antidepressant is the one for you. You may need to switch again if this one doesn’t work as per your expectations. 

The new antidepressant can produce side effects 

You should keep in mind that your new antidepressant can also cause some side effects. According to a survey, the most common cause of switching antidepressants is side effect intolerance. Some people can not deal with the type of side effects antidepressants produce. 

However, there are some safer options, but those safer options are also associated with some side effects. So if your previous antidepressant was unbearable for you and you think this one will be perfect, I hate to break it to you that this may not be the case. 

You will most probably suffer from some side effects with your new antidepressant as well, but if you can tolerate it well, the treatment will be continued. Once your body adjusts to the new med, slowly these side effects will begin to subside. 

You may experience some mood changes 

Mood changes are common when antidepressants are switched. This is because the switching procedure acts like a break in your depression treatment and when that happens, you may feel anxious, irritated, agitated, sad, depressed, and you can suffer from rapid mood changes. 

If that happens, do not worry. Once you become adjusted to the newly switched medication, you will start to feel much better. 

Conclusion 

In this blog post, we have discussed the antidepressant switching strategies. Antidepressants are one of the most commonly used medications. However, they may not work perfectly for every other individual. 

The process of determining the best antidepressant for you is a hard one and you may need to switch your antidepressant over and over again until you finally have the one that works the best. Make sure you stick to your doctor’s prescription and do not take any medication without your doctor’s approval. 

FAQs: Switching antidepressants chart

How do I switch from one antidepressant to another? 

There are many ways to switch from one antidepressant to another. Some of the most common ones include

  • Taper off the first antidepressant while starting the new one from the lowest effective dose. 
  • Taper off and stop the first antidepressant, then start the new one 
  • Taper off and stop the first antidepressant, wait 7-14 days, and then start the new one.

What to expect when switching antidepressants?

When you’re switching from one antidepressant to another, you have to remember that it’s not a magical process. Your new antidepressant won’t start working overnight or treat your symptoms in a blink of an eye. The new drug will take its time to kick in and your body will take its time to adjust to this new antidepressant. You may also suffer from some side effects. However, they will begin to subside soon after your body adapts to the new antidepressant.

How long does a change in antidepressants take to work?

It may take 3 to 4 weeks for your newly switched antidepressant to work. However, this time duration can vary from person to person. Some people may begin to notice a difference earlier than that. Make sure you properly follow your doctor’s directions. 

Can you switch from one SSRI to another without tapering off?

Yes, you can switch from one SSRI to another without tapering off, but only if recommended by your healthcare provider. In some cases, especially when doses are high, direct switching is not recommended. It is best to taper off your medication first. 

Can you switch antidepressants without tapering?

Yes, you may be able to switch antidepressants without tapering, but it depends on the two drugs. If you’re switching from one SSRI to another SSRI, your doctor may not taper off the first drug at all and you may be switched directly to the other antidepressant. However, this is very rare and can only be done if you’re switching from one antidepressant to another antidepressant belonging to the same class. 

References 

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