Switching Antidepressants: What to Expect

Don’t feel like your antidepressants are working effectively? Experiencing annoying, persistent side effects? You’re not alone. The truth is, sometimes, antidepressants don’t work the first time. In fact, it’s not uncommon for people to try multiple antidepressants before finding one that works best for them.

If you’re prescribed an antidepressant medication and don’t feel that it’s working as effectively as expected, or if you have unpleasant or persistent side effects, you should think about talking to your healthcare provider about switching to a new type of medication.

There’s often a certain degree of trial and error involved in finding the right antidepressant. For many people, switching medications several times is an important step in identifying the specific antidepressant that best suits their symptoms and needs.

Below, we’ve listed common reasons for switching antidepressants, as well as the medications you may be prescribed by your healthcare provider. We’ve also explained key information, from side effects to methods of switching, that you should be aware.

Switching Antidepressants: The Basics

• It’s common to switch antidepressants. Changing to a new medication may help you to recover from depression more effectively, or simply avoid unpleasant or persistent side effects that occurred with your previous antidepressant.
  

• If you just recently started taking antidepressants and haven’t noticed any improvement in your mood or general wellbeing, don’t panic. It typically takes several weeks for most antidepressants to start working and sometimes can take months before they reach full effectiveness.
  

• If your antidepressant isn’t working after several weeks, or is causing side effects, you may not need to change to a new medication. Your healthcare provider may suggest a different dosage or frequency of your current medication.
  

• When switching antidepressants, your healthcare provider may recommend switching directly, cross-tapering or tapering down your dosage before you start using your new medication.
  It’s important to closely follow the instructions provided by your healthcare provider, as switching medications incorrectly or too quickly may increase your risk of experiencing drug interactions and side effects.
  

• Don’t ever adjust your dosage or stop taking your antidepressant without talking to your healthcare provider. Changing your dosage or abruptly stopping your medication could cause you to experience antidepressant withdrawal symptoms like "brain zaps".

Reasons to Consider Switching Antidepressants

There are several reasons why you may want to switch antidepressants, from side effects to a lack of effectiveness. Some of the most common reasons to change antidepressants include:

• Common side effects. Many antidepressants can cause side effects, including issues such as nausea, digestive issues, headaches and difficulty sleeping.
  Although many side effects are common across antidepressants, the likelihood and severity of certain side effects can vary from one medication to another. If you experience side effects from one antidepressant, your healthcare provider may advise switching to another.
  

• Lack of effectiveness. Although antidepressants are largely effective at treating major depression disorder, not all people experience improvements after they start taking an antidepressant.
  

• Sexual side effects. Some antidepressants, including commonly prescribed ones from the class known as SSRIs (Selective Serotonin Reuptake Inhibitors), can cause sexual side effects such as erectile dysfunction, delayed ejaculation and difficulty reaching orgasm (anorgasmia).
  For some people, switching to another type of antidepressant can reduce the severity of these sexual side effects.
  

• Weight gain. Some side effects, such as weight gain, occur more frequently with certain types of antidepressant medication. Switching to a new type of antidepressant may help to reverse any weight gain that’s occurred during treatment.
  

Research shows that approximately one third of people with depression have treatment resistant depression (TRD) — a type of depression that doesn’t always improve through standard treatments such as antidepressants or psychotherapy.

If you have treatment resistant depression, or your depression does not respond to the anti-depressant you’re currently taking, you may need to try several antidepressants before finding one that’s effective.

How to Switch to a New Antidepressant

If you think that switching to a new antidepressant could be a good idea, it’s important to talk to your healthcare provider. 

If you have been using your current antidepressant for several months and haven’t experienced improvements, or have unpleasant side effects, your healthcare provider may recommend using one of the following types of antidepressants:

• Selective serotonin reuptake inhibitors (SSRIs). SSRIs are modern antidepressants that are commonly used as a first-line treatment for major depressive disorder. Common SSRIs include Prozac® (fluoxetine), Zoloft® (sertraline), Lexapro® (escitalopram) and others.
  Effectiveness and side effect rates can vary between SSRIs. As such, your healthcare provider may suggest switching to a different SSRI even if you currently use this type of antidepressant.
  We have an article on switching from Lexapro to Zoloft if you'd like to learn more.
  

• Serotonin-norepinephrine reuptake inhibitors (SNRIs). SNRIs are another class of modern antidepressants. Common SNRIs include Cymbalta® (duloxetine), Effexor XR® (venlafaxine) and Pristiq® (desvenlafaxine).
  

• Tricyclic antidepressants (TCAs). Tricyclic antidepressants are older antidepressants that, due to their side effect profiles, typically aren’t prescribed as first-line depressions for treatment today.
  Despite their side effects, some tricyclic antidepressants may be effective for improving depression symptoms when other, newer medications aren’t effective.
  

• Atypical antidepressants. Atypical antidepressants like Wellbutrin® (bupropion) work differently than most other medications prescribed to treat depression. Antidepressants of this type often target neurotransmitters other than serotonin.
  Atypical antidepressants are often prescribed when SSRIs and other antidepressants aren’t fully effective. For example, Wellbutrin is often used in combination with SSRIs and SNRIs when a single medication fails to fully treat depression.
  Wellbutrin (bupropion) is also occasionally used on its own or in combination with other antidepressants to reduce sexual side effects.
  

• Monoamine oxidase inhibitors (MAOIs). MAOIs are an older class of antidepressants, primarily used in the 20th century. Because of their side effect and interaction risk, most MAOIs have been replaced by newer antidepressants over the years.
  In some cases, MAOIs may be prescribed to treat depression when newer medications aren’t effective.

In some cases, such as when your current medication isn’t effectively treating your depression, your healthcare provider may suggest changing to a different medication within the same class of antidepressants, such as from one SSRI to another.

Depending on the type of antidepressant you’re currently using and the medication to which you switch, you’ll need to follow one of four different techniques to switch medications.

The first technique is switching directly. If it’s safe to switch from one antidepressant to another immediately, you may be able to stop taking your current antidepressant and immediately start using the new one from the next day.

Switching directly is usually only a safe option for switching between SSRIs and SNRIs with short half-lives, as these medications are less likely to cause interactions or unwanted side effects.

The second technique is cross tapering. To do this, you’ll need to gradually reduce the dosage of your old antidepressant while gradually increasing the dosage of your new medication at the same time.

This technique may be used if your medication puts you at risk of withdrawal symptoms, which may occur when some antidepressants are stopped without a gradual taper.

The third technique is tapering down your dosage to a complete stop and waiting for it to clear your body before starting the newer antidepressant.

You may need to use this technique if you’re using an antidepressant that can interact with the other medication. Some tricyclic antidepressants and MAOIs can cause harmful interactions if they’re used within 14 days of starting treatment with other antidepressants. 

For medications with a shorter half-life, you may only need to wait for two to four days before you begin using the new antidepressant at a low dose.

There’s no one-size-fits-all process for switching from one antidepressant to another. To avoid drug interactions, your healthcare provider will inform you about which process to use and how to switch from one antidepressant to another safely based on your medications and health. 

In Conclusion

Switching antidepressants isn’t uncommon — in fact, many people prescribed antidepressants try several medications before finding the one that works best for them. 

If you’re prescribed an antidepressant and don’t feel that it’s working, it’s essential that you talk to your healthcare provider before you make any changes. 

Make sure that you don’t stop your current antidepressant or adjust your dosage, as this could cause you to experience antidepressant withdrawal symptoms or a relapse of your depression symptoms. 

Based on your symptoms, the medication you’re currently using and your overall health, your healthcare provider will work with you to find an antidepressant that’s safe for you to switch to, effective and suitable for your needs.