Antidepressant switching
Our advice on antidepressant switching guides on establishing whether a switch is necessary, choosing an antidepressant to switch to, agreeing a strategy, and monitoring. We also give advice on suitable strategies for a range of potential switches.
Establishing if a person needs to switch their antidepressant
17 February 2023Prior response, side-effects, new contraindications, and current depression symptoms may require switching antidepressants. When it is, establish shared goals.
Considerations when choosing an alternative antidepressant
17 February 2023Consider the risks associated with switching an antidepressant for depression, the patient's individual circumstances and when to seek specialist advice.
Planning and agreeing an antidepressant switching strategy
17 February 2023Guidance on planning and implementing the antidepressant switch after the need and choice of antidepressant have been decided.
Monitoring a person during and after antidepressant switching
17 February 2023Review people at appropriate time points; advise on what to expect and report; and beware of the possibility of withdrawal symptoms and serotonin syndrome.
Switching strategies for antidepressants
22 May 2024The choice of antidepressant switching strategy depends on the person and antidepressant. We describe the current strategies and their application.
MAOI to other antidepressants: switching in adults
17 February 2023Switching between or from a monoamine oxidase inhibitor (MAOI) is a complex switch and requires support from a specialist. General principles are described.
Moclobemide to other antidepressants: switching in adults
17 February 2023Suggested methods for switching safely from moclobemide to other antidepressants. Switches requiring additional specialist support are highlighted.
Trazodone to other antidepressants: switching in adults
17 February 2023Suggested methods for switching safely from trazodone to other antidepressants. Switches requiring additional specialist support are highlighted.
Vortioxetine to other antidepressants: switching in adults
17 February 2023Suggested methods for switching safely from vortioxetine to other antidepressants. Switches requiring additional specialist support are highlighted.
SNRIs to other antidepressants: switching in adults
17 February 2023Suggested methods for switching safely between SNRIs or to other antidepressants. Switches requiring additional specialist support are highlighted.
Agomelatine to other antidepressants: switching in adults
17 February 2023Suggested methods for switching safely from agomelatine to other antidepressants. Switches requiring additional specialist support are highlighted.
Mirtazapine to other antidepressants: switching in adults
17 February 2023Suggested methods for switching safely from mirtazapine to other antidepressants. Switches requiring additional specialist support are highlighted.
Tricyclics to other antidepressants: switching in adults
17 February 2023Suggested methods for switching safely between tricyclics or to other antidepressants. Switches requiring additional specialist support are highlighted.
SSRIs to other antidepressants: switching in adults
17 February 2023Suggested methods for switching safely between SSRIs or to other antidepressants. Switches requiring additional specialist support are highlighted.
Other medicines switches
Switching between oral prednisolone and IV hydrocortisone
29 September 2023Switching between oral prednisolone and intravenous (IV) hydrocortisone requires care due to the risk of adrenal insufficiency or adrenal crisis.
Specific medicine switches for solid dose and liquid formulations
13 September 2023Certain medicines require additional monitoring and dose adjustments when switching between solid dose and liquid formulations.
Considerations when switching between solid doses and liquids
13 September 2023Bioavailability, release profile and licensed uses are some of the considerations needed when changing between solid dose and liquid formulations.
Using amlodipine or MR felodipine for angina and hypertension
13 March 2023Guidance on choosing and switching between amlodipine and modified-release (MR) felodipine for angina and hypertension.
Switching between gabapentin and pregabalin for neuropathic pain
20 January 2023An overview of possible dose equivalences, switching methods and considerations to make before switching between gabapentinoids in adults with neuropathic pain.
Switching between imatinib preparations
15 December 2022Support for decision making when considering switching imatinib preparations including a locally adaptable patient information leaflet.
Switching between neostigmine and pyridostigmine
25 October 2022Switching between neostigmine and pyridostigmine in myasthenia gravis requires care and application of a stepped process
Metolazone preparation differences and safety considerations
7 September 2022Healthcare professionals involved in the use of metolazone need to be aware of the differences between licensed and unlicensed products to ensure safe care.
Switching doxazosin XL tablets to doxazosin standard tablets
12 May 2022Doxazosin XL tablets should not routinely be prescribed. Guidance is provided on switching doxazosin XL tablets to standard release tablets.
Switching between aminophylline and theophylline in adults
19 April 2022Intravenous aminophylline is used acutely for emergency respiratory conditions and we give a stepped approach on how to switch to oral theophylline