Advertisement
Feature Article

Switching or stopping antidepressants: a clinical viewpoint

John W.G. Tiller

Figures

Abstract

As no antidepressant is ideal for all patients, GPs often face the challenge of withdrawing or switching patients’ antidepressants. Considerations before withdrawing or switching an antidepressant, choice of new antidepressant, impact of discontinuation syndrome and switching strategies are outlined in this article.

Key Points

  • As no antidepressant is tolerable or effective for all patients, doctors commonly have to stop or switch their patients’ antidepressants.
  • A recommended approach to antidepressant prescribing is to ‘start low and go slow’ and ensure an adequate dosage is reached.
  • If the treatment response is inadequate after a reasonable period (four weeks at a therapeutic dose) then the diagnosis should be reviewed and a switch to another antidepressant considered.
  • Discontinuation syndrome is common with many antidepressants and can impact on patient adherence to a new medication.
  • Switching strategies include conservative or moderate switching, in which the first antidepressant is slowly tapered and ceased before the next one is started, direct switching and cross-tapering.

    Picture credit: © Jonathan Dimes

Figures