How to Switch to a New Antidepressant Safely

If you have been diagnosed with a mental health condition such as depression, your healthcare provider may prescribe antidepressant medication to help treat it. These medications work by rebalancing some of the chemicals in your brain, known as neurotransmitters.1

There are several different types of antidepressant medications and it’s important to find the one that works best for you. According to a 2016 study, up to two-thirds of people who have depression don’t respond to the first antidepressant drug they are prescribed and need to change their medication before they see results.2

As the different types of antidepressants work in different ways, there are multiple techniques to switch antidepressants, depending on what you are taking, says Jeffrey Zabinski, MD, a psychiatrist at Columbia University Medical Center.

Switching Antidepressants Safely

Switching antidepressants is a process that must be approached carefully and under close medical observation.2

Dr. Zabinski shares some steps that can help you make the transition safely:

• Find out what to expect: Ask your psychiatrist about what to expect when you switch antidepressants and what you should do if any symptoms arise.
• Check-in regularly: Your psychiatrist may require you to visit more frequently while you’re in the process of switching antidepressants. Make it a point to check in with them regularly and don’t miss any of your follow-up appointments.
• Report any side effects: If you experience any side effects, discuss them with your doctor. You may need to work together to change the strategy for switching antidepressants, or slow the process down so that you are more comfortable.
• Be prepared for emergencies: If you have depression that gets significantly worse during a medication switch, it may lead to a mental health crisis, which would require emergency care. Inform trusted loved ones that you’ll be changing your medication, tell them what symptoms to look out for, and work on a plan in case of emergencies. It can be helpful to run this plan by your healthcare provider too.

Strategies for Switching Antidepressants

These are some of the strategies that your healthcare provider might employ while changing your medication:

• Direct switch: This method involves stopping your current medication and starting the new medication from the next day onward. As the quickest and simplest way to switch medications, this method can only be used in certain circumstances, such as when you haven’t been on your current medication for very long or are switching between drugs that work in similar ways.
• Taper and immediate switch: This method involves gradually reducing the dosage of your current medication and then switching to the other. This strategy takes longer than the direct switch but may be required if you have been taking your present medication for over six weeks, as you may face discontinuation effects if you stop taking it abruptly.
• Taper, washout, and subsequent switch: This method is used for certain types of medications that require more time and care, says Dr. Zabinski. It involves decreasing and then stopping one medication, waiting for a period of time until it’s out of your system, and then starting the other medication, explains Dr. Zabinski. Using this method can help prevent the two drugs from interacting with each other and potentially causing harmful side effects.
• Cross taper: This is the most common method and involves gradually decreasing one medicine while gradually increasing the other, says Dr. Zabinski.

Factors to Consider Before Switching Antidepressants

According to Dr. Zabinski, these are some of the factors your healthcare provider will take into consideration when switching your antidepressant medication:2

• The type of antidepressant you are currently taking
• The type of antidepressant you will be switching to
• The dosage of medication you are taking
• The amount of time you have been taking the medication
• The severity of your condition and the symptoms you’re experiencing
• The severity of the side effects you are experiencing, if any
• Any other medication you are taking and any potential drug interactions

Side Effects of Switching Antidepressants

When you’re switching between antidepressant medications, you may face side effects because your body may have gotten used to the previous medication, especially if you’ve been taking it for over four to six weeks.3 Therefore, discontinuing it can lead to a type of withdrawal known as antidepressant discontinuation syndrome.

Most of the potential side effects are uncomfortable, but not dangerous or life-threatening, says Dr. Zabinski. They may start within two to four days of stopping or tapering off the medication and last for a week or two.4

The symptoms of antidepressant discontinuation syndrome can include:5

• Digestive issues, such as nausea, vomiting, diarrhea, stomach cramps, or loss of appetite
• Balance issues, such as dizziness or lightheadedness
• Sleep difficulties, such as difficulty sleeping or nightmares
• Movement control issues, such as tremors, restless legs, difficulty chewing, or trouble speaking
• Mood issues, such as anxiety, mania, depression, irritability, agitation, paranoia, confusion, or suicidal thoughts
• Flu-like symptoms, such as tiredness, headache, or muscle pain
• Electrical sensations in the brain, sometimes known as brain zaps, although this only happens in rare cases, according to Dr. Zabinski

In addition, starting the new antidepressant can also cause side effects such as weight gain, fatigue, dry mouth, increased heart rate, and sexual dysfunction.6