Suggested methods for switching safely from mirtazapine to other antidepressants. Switches requiring additional specialist support are highlighted.

Advice for all antidepressants

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

Mirtazapine to agomelatine

Cross-taper

Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.

There is limited experience with this switch so extra caution is required. Although interactions are not expected, agomelatine is not expected to mitigate discontinuation reactions from stopping mirtazapine.

Mirtazapine to moclobemide

Taper, washout and switch

Gradually reduce the dose of mirtazapine and stop; wait 7 days before starting moclobemide.

Cross-tapering is not recommended due to the high risk of serotonin syndrome.

Mirtazapine to monoamine oxidase inhibitors (MAOIs)

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

Taper, washout and switch with specialist advice

Gradually reduce the dose of mirtazapine and stop; wait 7 to 14 days before starting the MAOI. The specialist will advise the duration of the washout period on a case-by-case basis taking into consideration the MAOI being started.

Cross-tapering is not recommended due to the high risk of serotonin syndrome.

Mirtazapine to selective serotonin reuptake inhibitors (SSRIs)

Cross-taper

Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.

Mirtazapine to serotonin and noradrenaline reuptake inhibitors (SNRIs)

Cross-taper

Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.

Mirtazapine to trazodone

Cross-taper

Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.

Mirtazapine to 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.

Cross-taper

Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.

Mirtazapine to vortioxetine

There is limited experience with this switch so extra caution is required to avoid serotonin syndrome.

Cross-taper

Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.

Taper, washout and switch

Alternatively, gradually reduce the dose of mirtazapine and stop; wait for a period before starting vortioxetine. Clinicians should decide the duration of the washout period on a case-by-case basis.

Deciding on the switching strategy

Our guidance on Planning and agreeing an antidepressant switching strategy will help you decide which switching strategy to choose.

More advice on individual switches

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