Advice for all antidepressants

You should read our advice for all antidepressant switching for the treatment of depression before applying that to individual agomelatine switches below.

• Establishing if a person needs to switch their antidepressant
• Considerations when choosing an alternative antidepressant
• Planning and agreeing an antidepressant switching strategy
• Monitoring a person during and after antidepressant switching

Specific advice when switching from agomelatine

Strategies for switching from agomelatine to other antidepressants are outlined below.

Mirtazapine

Direct switch

A direct switch, i.e. stopping one antidepressant and then starting the new antidepressant the following day, is normally possible.

Caution is required as there is limited experience with this switch although interactions are not expected. Abrupt withdrawal of agomelatine does not affect serotonin, noradrenaline, or dopamine and has not been associated with discontinuation symptoms. Since serotonin syndrome is unlikely, no dose tapering is needed.

Moclobemide

Direct switch

A direct switch, i.e. stopping one antidepressant and then starting the new antidepressant the following day, is normally possible.

Caution is required as there is limited experience with this switch although interactions are not expected. Abrupt withdrawal of agomelatine does not affect serotonin, noradrenaline, or dopamine and has not been associated with discontinuation symptoms. Since serotonin syndrome is unlikely, no dose tapering is needed.

Monoamine oxidase inhibitors (MAOIs)

Switching to an MAOI is always a complex switch and you should follow specialist advice.

Direct switch with specialist advice

A direct switch, i.e. stopping one antidepressant and then starting the new antidepressant the following day, is normally possible.

Caution is required as there is limited experience with this switch although interactions are not expected. Abrupt withdrawal of agomelatine does not affect serotonin, noradrenaline, or dopamine and has not been associated with discontinuation symptoms. Since serotonin syndrome is unlikely, no dose tapering is needed.

Selective serotonin reuptake inhibitors (SSRIs)

Direct switch

A direct switch, i.e. stopping one antidepressant and then starting the new antidepressant the following day, is normally possible.

Caution is required as there is limited experience with this switch although interactions are not expected. Abrupt withdrawal of agomelatine does not affect serotonin, noradrenaline, or dopamine and has not been associated with discontinuation symptoms. Since serotonin syndrome is unlikely, no dose tapering is needed.

Serotonin and noradrenaline reuptake inhibitors (SNRIs)

Direct switch

A direct switch, i.e. stopping one antidepressant and then starting the new antidepressant the following day, is normally possible.

Caution is required as there is limited experience with this switch although interactions are not expected. Abrupt withdrawal of agomelatine does not affect serotonin, noradrenaline, or dopamine and has not been associated with discontinuation symptoms. Since serotonin syndrome is unlikely, no dose tapering is needed.

Trazodone

Direct switch

A direct switch, i.e. stopping one antidepressant and then starting the new antidepressant the following day, is normally possible.

Caution is required as there is limited experience with this switch although interactions are not expected. Abrupt withdrawal of agomelatine does not affect serotonin, noradrenaline, or dopamine and has not been associated with discontinuation symptoms. Since serotonin syndrome is unlikely, no dose tapering is needed.

Tricyclic antidepressants (TCAs)

Switching to dosulepin requires specialist advice and should not be done in primary care due to the increased cardiac risk and toxicity in overdose.

Direct switch

A direct switch, i.e. stopping one antidepressant and then starting the new antidepressant the following day, is normally possible.

Caution is required as there is limited experience with this switch although interactions are not expected. Abrupt withdrawal of agomelatine does not affect serotonin, noradrenaline, or dopamine and has not been associated with discontinuation symptoms. Since serotonin syndrome is unlikely, no dose tapering is needed.

Vortioxetine

Direct switch

A direct switch, i.e. stopping one antidepressant and then starting the new antidepressant the following day, is normally possible.

Caution is required as there is limited experience with this switch although interactions are not expected. Abrupt withdrawal of agomelatine does not affect serotonin, noradrenaline, or dopamine and has not been associated with discontinuation symptoms. Since serotonin syndrome is unlikely, no dose tapering is needed.

More advice on individual switches

We have further advice on how to switch between individual antidepressants of different types. Browse our collection below.

• MAOI to other antidepressants: switching in adults
• Moclobemide to other antidepressants: switching in adults
• Trazodone to other antidepressants: switching in adults
• Vortioxetine to other antidepressants: switching in adults
• SNRIs to other antidepressants: switching in adults
• Mirtazapine to other antidepressants: switching in adults
• Tricyclics to other antidepressants: switching in adults
• SSRIs to other antidepressants: switching in adults

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