The Art of Changing Antidepressants

With changing antidepressants, there are lots of considerations to consider.  Are we going to augment, switch to a different antidepressant in the same class, or switch to a different class? Are we changing up the medication regimen because of side effects or non-response?  Here’s a list of a few important considerations that I would think about first.

Length of use. Has this patient been on the medication that we are going to change for a long time?  If so, I would lean more on the cautious side in recommending tapering down.

Dose.  The dose of the medication that we are stopping is a really important consideration.  If we are at the max dose, or I know that it took a while to taper the patient up to the current dose they are on, I am certainly more likely to recommend a taper period.

Side effects? If side effects are a problem, we are likely going to get off of that medication pretty quickly and get a different one started.  Keep in mind that many side effects are dose dependent, so if a drug has worked for a patient, maybe we can get by with a lower dose.  If it is a serious adverse effect, urgency in stopping the medication becomes more important.

Non-response.  In a patient that hasn’t received any benefit from a medication, and doses have been maximized, we are likely going to want to be off that medication.  In partial responders, some clinicians will try to augment with another medication.

Cross taper or swap out?  I’ve been asked this a number of times.  Let’s say we have a patient on Sertraline 150mg/day. It is desired to try a different SSRI.  Sertraline is definitely at a high enough dose in this scenario to do a tapering down.  I typically prefer a cross taper if the patient is at moderate to high doses.

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Written By Eric Christianson

January 25, 2017

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