Switching Antidepressants: Strategies, Side Effects, & What to Expect

How Do Antidepressants Work?

Antidepressants are usually considered the first line of treatment for depression and anxiety. The antidepressants work by altering natural brain neurotransmitter levels such as norepinephrine and serotonin, which influence mood, anxiety, and emotions. Also, your doctor may consider one antidepressant over the other depending on the nature of your condition, treatment duration, the antidepressant efficacy, and the side effects of the antidepressants.^1,2

Commonly prescribed classes of antidepressants include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). These antidepressants work to relieve the symptoms of anxiety and depression, but their actions are different. SSRIs help to relieve depression and anxiety symptoms by regulating the levels of serotonin in the brain.³ on the other hand, SNRIs help with depression and anxiety by regulating the levels of serotonin and norepinephrine in the brain.⁴

Antidepressants are usually prescribed based on the nature of your condition, treatment duration, efficacy, and side effects. When you have anxiety or depression, your doctor will examine your condition and consider a suitable medication. This helps to address safety concerns and ensure you are safe on the medication.

Commonly prescribed medications for anxiety and depression include:

• SSRIs: Sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), and paroxetine (Paxil)
• SNRIs: Venlafaxine (Effexor), duloxetine (Cymbalta)

Common Reasons for Switching Antidepressants

While antidepressants can help manage symptoms of depression or anxiety, sometimes, they do not effectively provide symptom relief when treating the conditions. Switching antidepressants can be recommended, especially if the medication leads to unwanted results or worsens your condition. However, before switching antidepressants, your doctor must put several factors in place to prevent adverse effects that occur when switching medications abruptly.

Stopping your medication or switching antidepressants without consulting your doctor can trigger serious side effects and create a risk of withdrawal effects. To taper your dose, your doctor will have you take the medication in gradually reducing amounts for some time before being put on another medication.

Below are common reasons why someone may consider switching antidepressants:

Insufficient or Partial Symptom Relief

Sometimes antidepressant medication does not provide adequate relief for depression symptoms or anxiety symptoms. Generally, depression or anxiety is characterized by several symptoms, including nervousness or sleeping problems. Sometimes antidepressant medications may only relieve specific symptoms.

You may consider a different medication if you have treatment-resistant depression or anxiety. These conditions are considered treatment-resistant if symptoms do not respond to standard treatment. This does not mean your condition is untreatable, but it may take more attempts to find a treatment that provides relief.

Intolerable Side Effects

Some people experience side effects in the early stages of adjusting to the medication and do not like how antidepressants make them feel. Side effects may also emerge due to antidepressant interactions with other antidepressant or anti-anxiety medications, dietary supplements, or substances like alcohol. The interactions between these substances can trigger individual side effects that may add more discomfort. These adverse side effects, such as persistent headaches, can discourage people from staying with that medication.

Drug tolerance

When taking antidepressant medications, you may experience side effects associated with them due to direct chemical action of the drug. However, long-term use of the antidepressant can sometimes lead to a person developing tolerance to the drug. Tolerance to antidepressant medication might in some cases make the drug ineffective in relieving symptoms of depression or anxiety. Therefore, drug tolerance is another common reason that can push an individual to consider switching antidepressants.

Health Changes

Some of the side effects of antidepressant medication can lead to health changes. Such side effects include weight changes, appetite issues, and sleeping problems. Depending on the type of antidepressant medication you take, you experience slight weight gain or slight weight loss. The antidepressant can also interfere with your sleeping pattern and affect your appetite, where you may eat emotionally or eat less food than usual. These side effects can potentially make a person consider switching antidepressant medication.

What to Consider Before Switching Antidepressants

As with any medication, antidepressants should be taken as prescribed. This helps prevents possible adverse health implications that can develop when the medications are taken incorrectly. If the antidepressant medication you are taking does not work for you, you should not switch to another one before consulting your doctor. Stopping your medication puts you at risk of antidepressant withdrawal symptoms, which can lead to uncomfortable and potentially dangerous side effects.

Also, switching to a different medication can worsen your depression or anxiety symptoms since both substances trigger individual side effects. If the drug does not work for you or leads to intolerable side effects, talk to your doctor to ensure safe tapering before switching to a different antidepressant. When choosing a switching strategy, your prescriber will consider several factors, including your symptoms and side effects.

Before switching your antidepressant, your prescriber will consider the following:

• Your current symptoms
• Your current diagnosis
• Your current medications side effects
• How well you can function in daily life
• Your treatment goals
• Whether you have preexisting medical conditions
• How sensitive are you to the side effects of medication
• Whether you are at risk of life-threatening complications

Strategies to Switch Antidepressants

Several strategies can be applied when switching antidepressants. These include a direct switch, taper, immediate switch, cross taper and taper, washout and switch. When these strategies are applied, you can lower your chances of experiencing antidepressant withdrawal symptoms.

Below are the four main strategies for switching antidepressants:⁵

Direct Switch

With this strategy, you stop your medication one day and start another the next day as your doctor prescribes. This strategy can be used when switching between some SSRIs and SNRIs. However, a direct switch can put you at risk of withdrawal symptoms and drug interactions. Since antidepressants take some time to completely leave based on their half-life, switching to a different medication can result in harmful interactions.

Taper & Immediate Switch

In this antidepressant-switching strategy, your doctor will taper your dosage, where you will take small amounts of the antidepressant over a scheduled duration. After you fully stop your initial prescription, you will start taking the second medication. The primary advantage of this strategy is that the risks of withdrawal effects are reduced. However, small amounts of the initial medication may be present in the body, increasing the risk of possible drug interactions.

Cross Taper

In this strategy, you will be directed to take the initial prescription in small amounts over time while at the same time gradually starting a new medication. This can be beneficial when switching from one antidepressant class to another, either from an SSRI to SNRI or vice versa. However, switching from the medication of the same antidepressant class can lead to worsening symptoms due to possible drug interactions that may trigger individual side effects.

Taper, Washout & Switch

With this strategy, you will be directed to take a small amount of the initial dosage over time, as your doctor recommends. You will then wait several days or a few weeks before beginning your new prescription. The primary advantage of this strategy is that it increases the likelihood the initial antidepressant is completely washed out of the body system preventing possible drug interaction with other medications that have the potential to interact with it.

In choosing a switching strategy, your doctor may consider the following:

• The severity of symptoms: Antidepressants have a different chemical makeup that contributes to the varied side effects experienced from person to person. Your doctor will consider the side effects of the antidepressant before recommending a prescription.
• The medications: While some medications work similarly, they have different actions. Your doctor will consider medication with a faster response time with fewer side effects.
• Your side effect sensitivity: Antidepressants can cause side effects that vary from person to person. Your doctor will consider the severity of your side effects when recommending a medication.
• Preexisting medication problem: To prevent serious health complications, your doctor will check if you have other medical conditions that contribute to adverse side effects when on medication.

Below is a table with information about switching antidepressants:

Switching from:	Switching to:	Possible strategies:
SSRI to SNRI	SSRI or SNRI	Direct switch Cross-taper Tape and switch
SSRI or SNRI	Tricyclic antidepressant (TCA)	Cross taper Taper and switch
SSRI or SNRI	Non-SSRI, non-SNRI, non-TCA	Cross taper Taper and switch
Tricyclic antidepressant (TCA)	Any antidepressant	Cross-taper
Monoamine oxidase inhibitors (MAOI)	Any antidepressant	Taper and switch with washout
Any antidepressant	Monoamine oxidase inhibitors (MAOI)	Taper and switch with washout
Bupropion	Any antidepressant	Cross-taper

Other Medication Strategies

While switching isn’t the only strategy to improve symptom relief, other medication strategies, such as dosage adjustment and treatment augmentation, can help relieve symptoms. Switching is a common primary strategy for someone who doesn’t respond to antidepressant treatment, though your doctor can consider other strategies that best fit your condition. Prescribers recommend this strategy, especially if the antidepressant does not work for you or leads to intolerable side effects.

Dosage adjustment

This strategy can help relieve depression or anxiety symptoms by optimizing the medication concentration in the body to reach the treatment window. Adjusting the antidepressant dosage can increase its concentration in the body and positively relieve symptoms. It’s important only to adjust your dosage under a doctor’s recommendation if the current medication does not work for you.

Treatment Augmentation

First, treatment augmentation is a medication strategy of adding another antidepressant to an existing medication to improve the medication response and relieve the symptoms of depression or anxiety. Second, treatment augmentation can be effective, especially if the initial prescription response is incomplete. Other treatments, such as psychotherapy and lifestyle changes, can also help to improve the symptoms of psychiatric disorders such as depression and anxiety.

Treatment augmentation options may include:

• Electroconvulsive therapy (ECT): ECT is a procedure done under general anesthesia with small electrical currents passed through the skull, which can help to alleviate symptoms of mental health conditions.⁶
• Ketamine therapy: Ketamine therapy uses low-dose infusion ketamine that helps to improve symptoms of depression and other psychiatric disorders like anxiety.
• Transcranial magnetic stimulation (TMS): TMS involves using a magnetic coil to deliver repetitive magnetic pulses to certain brain areas, which helps to lead to changes in brain activity and produce antidepressant effects.⁷

Side Effects from Switching Antidepressants

Antidepressants have a different chemical composition that influences how they work to relieve symptoms of anxiety or depression. While they effectively address depressive and anxiety symptoms, they can lead to intolerable antidepressant side effects that can make you consider switching medications. Switching antidepressants without your doctor’s advice or stopping the medication and starting a new one puts you at risk of withdrawal symptoms and possible interactions that can be dangerous to your health.

The side effects of switching antidepressants can be very dangerous, especially if no guidance is followed. Switching antidepressants can lead to negative drug interactions, which increases the risk of serotonin syndrome, antidepressant discontinuation syndrome, and other severe side effects. Some side effects, including serotonin syndrome and suicidal thoughts, can be severe, requiring immediate medical attention. However, severe symptoms are usually rare.

Antidepressant Withdrawal

Antidepressant withdrawal may occur if you stop your medication without following your doctor’s guidance—the most common symptoms of antidepressant withdrawal are headaches and hallucinations. The symptoms, including severe headache and sensory disturbances, can be severe, requiring immediate medical attention. Antidepressant withdrawal is not common, but abruptly stopping your medication can lead to withdrawal symptoms.

Common symptoms of antidepressant withdrawal include:

• Difficulties sleeping
• Sweating
• Nausea
• Dizziness
• Drowsiness
• Headache
• Brain zaps

Serotonin Syndrome

Serotonin syndrome is a life-threatening condition due to high serotonin levels in the brain due to using antidepressants or other medications. The symptoms of this condition can be mild or severe and can include agitation, tremors, and rapid heart rate. If you experience serotonin syndrome, it’s best to seek immediate medical attention as the condition can lead to vital organ failure resulting in sudden death.

Common symptoms of serotonin syndrome may include:

• Agitation
• Insomnia
• Confusion
• Rapid heart rate
• High blood pressure
• Muscle rigidity

Severe symptoms of serotonin syndrome may include:

• Coma
• Seizures
• Dilated pupils
• Increased sweating
• Irregular heartbeat

Questions to Ask Your Health Team

Before starting your antidepressant medication, you must talk to your doctor to understand the benefits and risks associated with the medication. Your doctor will help address safety concerns. You can ask your doctor about the risks associated with taking antidepressants or how long it takes for the antidepressant to work.

Questions to ask your care team before switching antidepressants include:

• When switching antidepressants, how long does it take to work?
• What should I do if I experience side effects?
• How often should I see you for checkups while switching antidepressants?
• What are some online therapy options with my insurance that I can pair with my antidepressant treatments?
• Is it possible to combine antidepressant medication?
• What will happen if I stop my medication suddenly?
• What should I do if the antidepressant does not work for me?

In My Experience

In my experience with antidepressant medication for depression, I understand the importance of following prescription guidelines. It’s essential to talk to your doctor before starting any antidepressant medication. Tell your doctor your medical history to ensure you are safe on medication. It’s also important to ask your doctor questions regarding your medication, such as possible drug interactions.