With the right information and tools, you can be ready to switch antidepressants and minimize side effects.
When you have depression, the right medication (often coupled with therapy and coping tools) can make a big difference in how you feel. You might regain your energy, motivation, and appetite if those were lost, and you may experience a general boost in mood and functioning.
If you think it might be time to switch antidepressants, you’re not alone. While
Switching antidepressants can take time, but learning what to expect can help you be more prepared, advocate for yourself, and avoid some unwanted side effects.
Terms to know
- Antidepressant class. There are many types of antidepressants, and they’re often organized by “class.“ A few classes include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and norepinephrine-dopamine reuptake inhibitors (NDRIs).
- Tapering. Tapering is the act of gradually lowering or increasing your antidepressant dose.
- Cross-taper. When switching medications, cross tapering means to gradually lower the dose of one medication while gradually increasing the dose of another at the same time.
- Washout period. A washout period is a time period when you’re switching antidepressants and aren’t taking any medication in between the first antidepressant and your new antidepressant. Washout periods are done to help you eliminate the first antidepressant before introducing a new one.
There are several signs that it might be time for you to make changes to your current medications.
You’re not getting symptom relief after 4 to 6 weeks
While everyone will respond to medications differently, antidepressants take time to work.
Typically, people start seeing some symptom relief by 4 to 6 weeks, but this depends on:
- you and your body chemistry
- the type of antidepressant
- other factors, like how long it takes you to taper up to your prescribed dose
Once you’ve hit the prescribed dose,
On the other hand, in the
For this reason, it can be helpful to track your symptoms and side effects. It‘s important to check in with your prescriber consistently so they can figure out if this medication or dose isn’t a good fit for you.
Intolerable side effects
Side effects are pretty typical of most medications, especially in the first few days or weeks after starting them, or in the days following a dose increase. The question is whether you can tolerate your antidepressant’s side effects.
If side effects are mild or common (think headaches or nausea), they may go away on their own in the first 2 weeks, after your body has adjusted.
You may also be OK putting up with some side effects if the medication is working to relieve your depression — but you should never feel pressure to tolerate a medication that’s making you feel awful.
You’ve built up a tolerance
Antidepressant tolerance — known clinically as antidepressant treatment tachyphylaxis — is also called antidepressant “poop-out“ or “breakthrough.“ Basically, it means that your depression symptoms have returned despite taking a medication you’ve previously had success with.
So if you’ve been on your current antidepressant for more than a year and you have a sudden recurrence of symptoms, a healthcare or mental health professional may be able to increase your dosage or make other changes to your treatment plan.
Your health and needs have changed
If you’ve recently been diagnosed with a new health condition or you’re pregnant or want to become pregnant, you may need to change your antidepressant to one that won’t have an interaction.
If you think you may need to stop your antidepressant altogether, consider discussing it with a healthcare or mental health professional. They can help you avoid any withdrawals or other side effects you may face. You can check out these tips for knowing when to stop an antidepressant.
The medication just doesn’t fit your life
Sometimes, a specific medication might not be the right fit for you, and that’s OK.
Certain medications may have side effects or interactions that mean you have to strictly watch your diet or drastically change your behaviors. If you’re not comfortable with it, you may be more likely to stop taking your medication or have unwanted or dangerous side effects.
Sharing details about your health and lifestyle can help you and your healthcare team find a better medication choice for you.
If you make an appointment to discuss switching antidepressants, you’ll typically be asked why you want to make a change.
You’ll want to come prepared with:
- what your current symptoms are
- reasons you want to change the current medication
- the side effects you’ve experienced, if that has been an issue
- a list of other medications you’ve tried if they don’t have your record
The suggested treatment plan will depend on your answers, along with your health and medication history.
You might experience side effects when starting a new medication, during treatment, or while switching medications. The exact side effects you experience depend on the medication and how your body responds.
The most common side effects of antidepressants include:
- nausea and vomiting
- weight gain
- sleepiness or drowsiness
- sexual problems
When switching antidepressants, it’s possible to experience:
- side effects from the new and old medication
- increased side effects if both medications cause the same side effects (e.g., drowsiness)
- drug-drug interactions, like serotonin syndrome
- worsening depression symptoms
- discontinuation or withdrawal symptoms
Discontinuation or withdrawal
Antidepressant discontinuation syndrome, also sometimes called antidepressant withdrawal, can occur when you abruptly stop taking an antidepressant. It can often be avoided with a gradual tapering plan.
Possible symptoms include:
- a recurrence of depression symptoms
- fatigue or lethargy
- sensations of electric shocks
- sleep changes like insomnia or having vivid dreams
If you’re not satisfied with your current antidepressant or treatment plan, one or more of the following strategies might be suggested.
If you’re switching antidepressants, there are four main strategies that may be recommended:
- Direct switch. This is when you stop one medication one day and start a new one the next day.
- Conservative switch (taper/washout/switch). A conservative switch is when you gradually lower your dosage until you’ve stopped, do a washout period to eliminate the medication, and then start the new antidepressant, usually by gradually increasing the new dosage. Your washout period may be a few days or weeks and is sometimes determined by how long the medication stays in your body.
- Moderate switch. A moderate switch may include tapering the first antidepressant and then immediately starting a new medication when you’ve finished, or doing a washout period of just 2 to 4 days.
- Cross taper. Cross tapering is done by gradually lowering the dosage of the first antidepressant, and when at a low dose, introducing the new antidepressant at a low dose so that you’re taking both at the same time. The new antidepressant is slowly increased while the old one is decreased until the old one is stopped and the new one is at the prescribed dose.
The switching strategy recommended might depend on:
- The medications. Not all drugs can be cross tapered. If you’re switching from or to certain medications (such as monoamine oxidase inhibitors, or MAOIs), a washout period may be necessary to make sure no drug interactions occur.
- Your side effect sensitivity. If you’re more sensitive to side effects, tapering may be extended over a longer period of time.
- The severity of your symptoms or risk of recurrence. It isn’t always safe for some people to stop antidepressants for a period of time, so cross tapering might be recommended to avoid the chance of symptom recurrence or discontinuation syndrome.
Changing antidepressant doses
If changing your antidepressant dosage is recommended, you may be able to just go to a lower or higher dosage. If it’s a significant change, you may be told to taper the dosage to minimize side effects.
Augmenting a new medication or treatment
Augmentation — aka adding another medication — can be effective for some people. According to a 2020 study, about 18% of people surveyed were on multiple antidepressants.
Your doctor may recommend augmenting if:
- you’ve had a partial response to your antidepressant
- your current medication is effective for some symptoms but not others
For people with treatment resistant depression, you might be able to augment with other therapies like:
- transcranial magnetic stimulation (TMS)
- electroconvulsive therapy (ECT)
- ketamine therapy
Switching antidepressants can feel like a journey — one that can take several months. While it does take time, most people respond to antidepressants and find relief.
If it sounds like a hassle to remember your switching strategy, you can try using alarms, apps, or writing it on your pill bottle. Leaving that pill bottle in your line of sight can help remind you to take the medication, too.
With support, coping skills, and a flexible treatment plan, you can find relief and hope.