Discuss issues and experiences
You should adopt a shared approach from the beginning in establishing whether a person might benefit from switching their antidepressant for the treatment of depression. Discuss existing issues and experiences, and how medicines fit in with a typical day. Points to consider include the following:
Discuss with the person and/or their carer whether their current antidepressant is effective after they have adhered to a therapeutic dose, for an appropriate duration.
Discuss with the person and/or their carer any side-effects they have experienced (such as weight gain or reduced libido). Abrupt withdrawal should be avoided unless the person experiences a serious side-effect.
New contraindications and interactions
People may develop a new contraindication to their existing antidepressant or they may start a new medication that interacts with their existing antidepressant. Establish whether this is the case.
Establish current symptoms and review the diagnosis, particularly where treatment has failed previously. Consider using an evidence-based tool, such as PHQ-9 (Patient Health Questionnaire-9), HADS (Hospital Anxiety and Depression Scale) or BDI-II (Beck Depression Inventory-II) to assess. It can be unsafe for some people to remain untreated for extended periods of time.
Use a shared decision making approach to agree the purpose of the switch with the person being treated for depression and what will be achieved from it.
Discuss with the person and/or their carer the purpose of the switch and what you’re trying to achieve. Consider:
- what matters to them
- any concerns they have
- the extent of the side-effects they could tolerate
- whether a trial period without an antidepressant might be useful
Establish treatment options
Refer to the NICE guidance on depression in adults: treatment and management to establish where the person being treated for depression is on the treatment pathway and what additional or alternative treatment options are available.
Choosing a new medicine, planning the switch, and monitoring
After you’ve agreed that a switch is necessary, you’ll need to choose a medicine to switch to, and then agree a strategy and monitoring approach.
We have advice on how to switch between individual antidepressants of different types. Browse our collection below.
- Added section on establish treatment options.