How to Change Antidepressants

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1When should you switch antidepressants?

2Is it bad to keep switching antidepressants?

3How long does it take to adjust to a new antidepressant?

4What are the three strategies for switching antidepressants?

5What is the washout period for antidepressants?

6What is antidepressant discontinuation syndrome?

7What is serotonin syndrome?

8How many types of antidepressants are there?

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Antidepressants can be a powerful tool in helping you fight mood disorders like depression, anxiety, OCD, and PTSD. However, as many as two-thirds of patients don't see the results they want from their first medication. Your doctor might try adjusting your dose first, but if that doesn't work, they may suggest that you try a different medication. Be sure you carefully follow your doctor's instructions—and if you have any questions about the process, we're here to help!

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Question 1 of 8:

When should you switch antidepressants?

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   You might need to switch if you don't see results or you have adverse side effects. It's actually pretty common to need to try out a couple of antidepressants before you find the one that works for you. You might find that you're still struggling with anxiety or depression after you've been on your medication for a few weeks, for instance, or you might be unhappy with certain side effects—like weight gain or a decreased libido. Be honest with your doctor about what's going on, and be open to the idea of switching if they recommend it.

   • Never switch from one antidepressant to another unless you're being supervised by your doctor. Some of these drugs should never be taken at the same time due to the risk of side effects like serotonin syndrome.
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   You might also switch if your depression symptoms return. If you've been on your medication for a while and you start to notice some of the warning signs of depression, set up an appointment with your doctor. They may increase the dose of your current medication or switch you to an entirely new one.

   • For instance, you might notice that you feel persistently sad, have changes to your appetite, have trouble sleeping or sleep too much, or lose interest in things you normally enjoy.
   • If you have thoughts about hurting yourself or someone else, call emergency services or visit an emergency room right away. You can also reach out to a support line—like calling the National Suidice Prevention Lifeline at (800) 273-TALK(8255) or texting HOME to the Crisis Text Line at 741741.
   • Try keeping a thought journal to record your experience with the medication and share that with your therapist or doctor.
   • Remember that the medication only affects the chemical side of things. It doesn't necessarily change how you feel or what you think. That's why it is still a good idea to see some kind of mental health professional.
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Question 2 of 8:

Is it bad to keep switching antidepressants?

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   No, switching is fine as long as it's done under the care of your doctor. It's really normal to need to try different antidepressants, especially at the beginning of your treatment. Just follow your doctor's instructions carefully to avoid side effects like serotonin syndrome, which can occur if you combine antidepressants or you're taking too high of a dose.

   • Don't worry if your doctor prescribes you a similar antidepressant to the first one you tried. Changing to a new medication within the same class is often just as effective as changing to an entirely new class of antidepressants.

Question 3 of 8:

How long does it take to adjust to a new antidepressant?

1. 
   It takes a new medication at least 3-4 weeks to start working. If you haven't noticed any improvement at all by then, that particular antidepressant might not be right for you. However, if you're noticing some progress, it might be worth sticking with your current medication for a few more weeks. It can take anywhere from 4-8 weeks for an antidepressant to take its full effect, and for some people, it might even take a little longer.
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Question 4 of 8:

What are the three strategies for switching antidepressants?

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   You might use taper, washout, and switch if your symptoms are mild. In this approach, your doctor will taper—or gradually reduce—the dose of your current medication. Then, you'll have a short period where you're not taking any medication, called a washout period. Once your first medication is completely out of your system, your doctor will start you on a new antidepressant.

   • The washout period will vary depending on what medication you were taking initially.
   • This can be risky if you have more severe symptoms because your depression could return during the washout period. However, there's the least risk of experience side effects from mixing antidepressants.
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   Your doctor might cross-taper you to avoid a washout period. During a cross-taper, your doctor will start by lowering the dose of your first medicine. Then, they'll introduce a low dose of the new medication before you completely stop taking the old one. They'll gradually increase the dose of the second while lowering the dose of the first until you're only taking the second medication.

   • There can be serious side effects from mixing certain antidepressants, so this can only be done under the close supervision of a doctor, and only if the risk of mixing the first and second medications is relatively low.
   • This is usually used if you have a higher risk of relapsing into your illness.
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   In rare cases, your doctor will do a direct switch. In a direct switch, your doctor will stop giving you your first medication one day and they'll start you on a new one the next day. This is uncommon, because there's a high risk of experiencing side effects from drug interactions, and it can't be done at all if you're taking some medicines. However, if you have experienced severe discontinuation syndrome (or withdrawal when you stopped taking antidepressants), your doctor might opt for this.
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Question 5 of 8:

What is the washout period for antidepressants?

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   The washout period will vary depending on the antidepressant you were taking. It usually takes about 4 weeks to taper off of an antidepressant. Then, your doctor will recommend a washout period, or a certain amount of time to let all of the medicine clear your system. That's usually equal to 5 half-lives off the antidepressant. The half-life is the time it takes for the medication to decrease in your body by half, and it varies for each antidepressant. The longer the half-life, the less likely you'll be to have severe discontinuation symptoms.

   • For example, the antidepressant venlafaxine is associated with severe withdrawal symptoms. It has a short half-life—only about 4-7 hours.
   • On the other hand, fluoxetine rarely causes severe withdrawal. Not surprisingly, it has a long half-life—about 7 days.

Question 6 of 8:

What is antidepressant discontinuation syndrome?

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   Discontinuation syndrome refers to unpleasant withdrawal symptoms. This usually happens when you stop taking your antidepressant suddenly or you dramatically decrease the dose. However, you might also experience these symptoms if you stop taking an antidepressant that you've been on for longer than 6 weeks, even if you taper the dose.

   • Symptoms of antidepressant discontinuation syndrome might include feeling like you have the flu, being nauseous or lethargic, feeling anxious or irritable, having trouble sleeping, or feeling a sensation similar to an electric shock.
   • You might also notice your depression symptoms returning. Be sure to call your doctor if this happens, and call for emergency help if you're thinking of hurting yourself.
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Question 7 of 8:

What is serotonin syndrome?

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   This is a side effect that some people experience when switching antidepressants. Typically, it happens when you have two antidepressants in your system at the same time. The symptoms include tremors, nervousness, hypertension, and diarrhea. In rare but severe cases, it can even lead to convulsions and death. That's why it's so important to follow your doctor's instructions while you're switching medications.

   • For instance, you might experience serotonin syndrome if you switch from agomelatine (Valdoxan) to fluvoxamine (Luvox).

Question 8 of 8:

How many types of antidepressants are there?

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   There are 5 major classes of antidepressants. These include selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs), nonadrenaline and specific serotonergic antidepressants (NASSAs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). Each one works in a different way to balance the chemicals in your brain to help regulate your mood.

   • SSRIs: These antidepressants are the most commonly prescribed because they tend to have fewer side effects than the other classes. Some examples of SSRIs include fluoxetine (Prozac), citalopram (Celexa), sertraline (Zoloft), and paroxetine (Paxil).
   • SNRIs: These work similarly to SSRIs, but some people may respond better to SNRIs, so your doctor may switch you to an SNRI if an SSRI isn't working for you. Some common SNRIs include duloxetine (Cymbalta) and venlafaxine (Effexor XR).
   • NASSAs: Sometimes called "atypical antidepressants," NASSAs may be used if you're experiencing unwanted side effects on SSRIs or SNRIs. NASSAs include drugs like mirtazapine (Remeron), buprioprion (Wellbutrin), vortioxetine (Trintellix), and trazodone.
   • TCAs: Tricylic antidepressants aren't used much anymore because the side effects can be more intense than other classes of antidepressants. However, your doctor may prescribe them if you're experiencing severe depression or to treat conditions like bipolar disorder or OCD. Tricylics include imipramine (Tofranil), desipramine (Norpramin), and doxepin.
   • MAOIs: Like tricyclics, MAOIs aren't as common anymore because of the risk of severe side effects and potential drug interactions. You may even have to follow a certain diet, because some foods (like some cheeses and wine) may cause dangerous side effects. However, they may still be used by some psychiatric specialists if other treatments haven't worked. MAOIs include tranylcypromine (Parnate), phenelzine (Nardil), and isocarboxazid (Marplan).
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Expert Q&A

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• Question

  Is it OK to change antidepressants?

  

  Urmi Patel, PsyD
  Licensed Clinical Psychologist

  Dr. Urmi Patel is a Licensed Clinical Psychologist that began her career in mental health in 2000. She spent the first decade of her career providing direct clinical services to adolescents and adults living with persistent mental illness in outpatient, residential, in-patient, and community college settings before transitioning into more strategic leadership roles. Her leadership positions include the Mental and Behavioral Health Program Lead for Mahmee, Director of Clinical Care for Sutter Health, and Consulting Psychologist for the State of California’s Mental Health Commission. She provides Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, and Dialectical Behavioral Therapy to patients. She specializes in life transitions, interpersonal conflicts, eating disorders, grief/loss, and trauma. Dr. Patel is also a Nationally Certified Trainer of the Recognizing and Responding to Suicide Risk module developed by the American Association of Suicidology. She earned a Masters in Marriage and Family Therapy from the University of Southern California and a Masters and Doctorate in Clinical Psychology from Alliant International University.

  

  Urmi Patel, PsyD

  Licensed Clinical Psychologist

  Expert Answer

  Yes, but the change must always be done under medical supervision. Remember, though, that medication treats the biological side of your condition but won't treat your perception of your situation. That's why it's important to work through that in a therapeutic environment during your treatment.

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