Table 2. Techniques for switching from one antidepressant to another 6.
| Method | Comment |
|---|---|
| Conservative switch: • the first antidepressant is gradually reduced and stopped • there follows a drug-free washout interval of five half-lives of the first antidepressant • the new antidepressant is started according to its dose recommendation |
Most appropriate for general practice. The risk of drug interactions is very low but discontinuation symptoms may occur. |
| Moderate switch: • the first antidepressant is gradually reduced and stopped • there follows a drug-free washout interval of 2–4 days • the new antidepressant is started at a low dose |
Also recommended for use in general practice. The risk of drug interactions is low but discontinuation symptoms may occur. |
| Direct switch: • the first antidepressant is stopped • the second antidepressant is started the next day at the usual therapeutic dose |
Quick and simple but discontinuation symptoms are likely depending on the second antidepressant. The risk of drug interactions is substantial, depending on the second antidepressant. Method requires clinical expertise and is only feasible in selected instances, such as swapping from one short half-life SSRI to another. |
| Cross-taper switch: • the first antidepressant is gradually reduced and stopped • the second antidepressant is introduced at a low dose at some stage during the reduction of the first antidepressant, so that the patient is taking both antidepressants simultaneously • the dose of the second antidepressant is increased to the therapeutic dose when the first antidepressant has been stopped |
Frequently used for patients with high risk from illness relapse but there is risk of drug interactions and increased adverse effects from combined medications. Only feasible in selected instances. Requires clinical expertise. |