Switching from one antidepressant to another is common when current treatment isn’t effective, side effects are intolerable, or specific reasons warrant change. How to switch antidepressants safely requires considering drug interactions, washout periods, and tapering strategies. Always work with your prescriber.
Approaches to switching
Direct switch: Stop one, start the other. Used between similar medications with low interaction risk.
Cross-taper: Gradually reduce first medication while increasing second. Most common approach for switches.
Washout: Stop first, wait, then start second. Required for MAOI switches.
Cross-tapering example
Switching from sertraline 100 mg to escitalopram 10 mg:
- Week 1-2: sertraline 75 mg + escitalopram 5 mg
- Week 3-4: sertraline 50 mg + escitalopram 10 mg
- Week 5-6: sertraline 25 mg + escitalopram 10 mg
- Week 7+: escitalopram 10 mg only
Specific cross-taper schedules depend on the medications involved.
MAOI switches
Monoamine oxidase inhibitors (MAOIs) require strict washout:
- Switching to MAOI: 5 weeks after stopping fluoxetine, 1-2 weeks after others
- Switching from MAOI: 2 weeks washout before starting new antidepressant
Inadequate washout risks serotonin syndrome (potentially fatal).
Common reasons to switch
- Inadequate response after appropriate trial
- Intolerable side effects
- Sexual side effects
- Weight gain
- Pregnancy planning
- Drug interaction issues
- Specific symptom targeting
Frequently Asked Questions
Can I switch antidepressants without tapering the first?
Sometimes for direct switch between similar drugs. Cross-taper is generally safer.
How long does switching take?
2-8 weeks for cross-tapers depending on medications.
Can I switch from SSRI to bupropion?
Yes, often used. Cross-taper or direct switch with appropriate consideration.
Will I have withdrawal during switching?
Cross-tapering reduces withdrawal compared to abrupt switch.
What about adding rather than switching?
Augmentation therapy adds a second medication rather than switching. Different strategy with specific indications.
The bottom line on switching antidepressants
Antidepressant switches use direct switch, cross-taper, or washout depending on medications and clinical situation. Cross-tapering is most common. MAOI switches require strict washout. Discuss specific approach with your prescriber.