Antidepressant medication in adults: Switching and discontinuing medication
- Michael Hirsch, MD
Michael Hirsch, MD
- Instructor in Psychiatry
- Harvard Medical School
- Robert J Birnbaum, MD, PhD
Robert J Birnbaum, MD, PhD
- Assistant Professor of Psychiatry
- Harvard Medical School
When patients respond poorly to an antidepressant medication or exhibit intolerable side effects, and switching to another antidepressant is indicated, clinicians should be familiar with the pharmacology of each drug, the potential for drug-drug interactions and discontinuation symptoms, and the time to onset of effectiveness of the new medication.
Switches from one antidepressant to another are common. A study of an administrative claims database found that among patients (n >130,000) who started antidepressant monotherapy for a new episode of depression, switching occurred in 9 percent .
This topic discusses switching from one antidepressant drug to another. Discontinuing antidepressants without switching to another drug and choosing a specific antidepressant regimen for the initial treatment of depression or for treatment resistant depression are discussed separately, as are the pharmacology, administration, and side effects of antidepressants.
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- SWITCHING ANTIDEPRESSANT MEDICATION
- Standard approach
- Specific switches
- - Between SSRIs
- - SSRI to SNRI
- - SSRI to tricyclic
- - SSRI to other antidepressants
- - Between SNRIs
- - SNRI to other antidepressants
- - Switching to or from atypical antidepressants
- - Switching to or from serotonin modulators
- - Switching to or from tricyclics
- - Switching to or from MAOIs
- INFORMATION FOR PATIENTS