Advice for all antidepressants

You should read our advice for all antidepressant switching for the treatment of depression before applying that to individual vortioxetine 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 vortioxetine

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

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 vortioxetine.

Mirtazapine

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.

Stop, washout and switch

Alternatively, stop vortioxetine; wait for a period before starting mirtazapine. 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.

Moclobemide

Taper, washout and switch

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

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

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

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 vortioxetine and stop; wait 14 to 21 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.

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

Selective serotonin reuptake inhibitors (SSRIs)

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

Direct switch

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

Stop, washout and switch

Alternatively, stop vortioxetine; wait for a period before starting the SSRI. 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.

Serotonin and noradrenaline reuptake inhibitors (SNRIs)

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

Direct switch

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

Stop, washout and switch

Alternatively, stop vortioxetine; wait for a period before starting the SNRI. 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.

Trazodone

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.

Stop, washout and switch

Alternatively, stop vortioxetine; wait for a period before starting trazodone. 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.

Tricyclic antidepressants (TCAs)

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

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

To all except clomipramine

Cross-taper

Cross-tapering, starting with a low dose TCA can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.

Stop, washout and switch

Alternatively, stop vortioxetine; wait for a period before starting low dose TCA. 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.

To clomipramine

Cross-tapering is not recommended and should only be undertaken if specialist advice is in place, this is because clomipramine is a potent serotonin reuptake inhibitor so there is a high risk of serotonin syndrome.

Taper, stop and switch

Gradually reduce the dose of vortioxetine and stop. Start low dose clomipramine the following day.

Stop, washout and switch

Alternatively, stop vortioxetine; wait for a period before starting low dose clomipramine. 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.

• MAOI to other antidepressants: switching in adults
• Moclobemide to other antidepressants: switching in adults
• Trazodone to other antidepressants: switching in adults
• SNRIs to other antidepressants: switching in adults
• Agomelatine 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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