Switching antidepressants is common. The first medicine may cause side effects, stop working or never help enough. How the switch is done matters, because some approaches risk discontinuation symptoms or, rarely, dangerous interactions.
Three ways to switch
- Direct switch: stop one and start the other the next day. Often used between similar medicines, such as escitalopram (Lexapro) to sertraline (Zoloft).
- Cross-taper: lower the first medicine over one to several weeks while raising the second. The most common approach, especially between different classes, such as an SSRI to bupropion (Wellbutrin), mirtazapine or venlafaxine (Effexor XR).
- Taper and wait: stop the first completely and wait before starting the second. Required for some combinations, mainly moving to or from an MAOI; because fluoxetine (Prozac) stays in the body for weeks, a long wait is needed after it before an MAOI, and extra care is needed when switching from it to other medicines.
What to watch for
Overlapping serotonin medicines can rarely cause serotonin syndrome: agitation, sweating, fever, fast heartbeat, muscle twitching or stiffness and diarrhea. Get urgent care for these. Discontinuation symptoms such as dizziness, nausea and brain zaps can appear if the first medicine drops too fast.
What to expect
The new medicine still needs four to eight weeks at a good dose for its full effect. Plan a follow-up visit two to four weeks after the switch.
Get help from Hope Integrative Medicine
If your antidepressant is not working or causing side effects, we can plan a safe switch and follow you through it. Our mental health team sees patients in person in West Ashley and by telehealth across South Carolina, and new patients are often able to be scheduled within a week of requesting an appointment. Request an appointment.
This article is general health information and does not replace advice from your own provider. Never start, stop or change a medication without talking with your prescriber. If you are having thoughts of harming yourself, call or text 988 or call 911.
Frequently Asked Questions
Depending on the medicines, by a direct switch, a cross-taper where one is lowered while the other is raised, or a full taper and wait. Your prescriber picks the method based on the two medicines and your history.
Switching between similar SSRIs such as Lexapro and Zoloft is often done directly or with a short cross-taper, under your prescriber's guidance.
Agitation, sweating, fever, a fast heartbeat, muscle twitching or stiffness and diarrhea. It is rare but needs urgent medical care.