How do you switch between tricyclic, SSRI and related antidepressants?

This updated Medicines Q&A provides advice on the risks and suggested strategies for switching between tricyclic (TCA), selective serotonin reuptake inhibitors (SSRI) and related antidepressants.

Summary

  • Care is required when switching between antidepressants.
  • When switching between selective serotonin reuptake inhibitors, tricyclic and related antidepressants, individual patient circumstances should be considered (see answer section).
  • It is considered safer, in order to avoid precipitating drug interactions, to incrementally reduce the dose of the first antidepressant and discontinue it before starting the second antidepressant. This is not always possible. In severely depressed patients who have failed to respond to one antidepressant, or in cases of severe adverse reaction, it may be necessary to shorten the process of substitution.
  • Cross-tapering is an option for some switches but should always be done cautiously.
  • Patients should be assessed on an individual basis to determine how quickly the switch can be done.
  • The potential for medication errors with complicated switching regimens should be considered.
AgomelatineAmitriptylineCitalopramClomipramineDosulepinDoxepinDrug interactionsDuloxetineEscitalopramFluoxetineFluvoxamineImipramineLofepramineMental health and illnessMirtazapineNortriptylineParoxetineQ&AReboxetineSertralineTrimipramineVenlafaxineVortioxetine

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