What To Know When Switching Antidepressants

Antidepressants are not a one-size-fits-all solution.

Just because one medication works for one patient doesn’t mean it will work for your specific depression symptoms or situation.

But don’t lose hope: There are several different types, and it may take some trial and error with your doctor to find the right medication for you.

Switching antidepressants isn’t always a straightforward process, but there are some things that can make it easier.

In this article, I’ll explain how antidepressants work, reasons you might want to switch, and specific methods for successfully changing medications.

I will also outline some of the potential side effects of changing antidepressant medications.

What Are Antidepressants?

Antidepressants are medications that treat depression—a condition that impacts an estimated 264 million people across the world.

There are many types of antidepressants.

Most work with substances in your body called neurotransmitters, chemicals that transmit messages between nerve cells.

Most antidepressants work with these chemicals in one of two ways:

• Prevent neurotransmitters from being cleared too quickly
• Help neurotransmitters work in balance with each other

Antidepressants balance brain chemistry—and alleviate depression symptoms—as they adjust neurotransmitters.

This helps to alleviate symptoms of depression like low mood, feelings of sadness, lack of motivation, insomnia, and more.

Antidepressants may not be effective for everyone, but as many as 60% of people report improved symptoms after 6-8 weeks of treatment.

Uses

Antidepressants are prescribed to treat depression, but they may be used to treat other conditions, too, including:

• Seasonal affective disorder (SAD)
• Generalized anxiety disorder (GAD)
• Post-traumatic stress disorder (PTSD)
• Social anxiety disorder
• Bipolar disorder

Types

There are five classes of antidepressants. Each functions slightly differently, but they all target the symptoms of depression. They are:

• Selective serotonin reuptake inhibitors (SSRIs): When a neurotransmitter has finished carrying a neurological message, it is usually reabsorbed by your body, a process called “reuptake.” SSRIs block the reabsorption of serotonin, a mood-lifting neurotransmitter. This increases the amount of serotonin available in the brain. SSRIs are the most commonly prescribed class of antidepressants.

• Serotonin-norepinephrine reuptake inhibitors (SNRIs): These help the brain retain both serotonin and norepinephrine, a neurotransmitter that improves mood and how brain cells communicate with each other.

• Monoamine oxidase inhibitors (MAOIs): These are one of the oldest available classes of antidepressants. MAOIs work to block an enzyme in the brain that breaks down serotonin and other neurotransmitters. By decreasing the breakdown, higher levels of mood-balancing chemicals remain accessible to the brain. MAOIs have the strongest interactions with other medications, foods, and alcohol, so they are not a first-line treatment anymore.

• Tricyclic antidepressants (TCAs): These work to block the removal of both serotonin and norepinephrine, which cause higher levels to be accessible in the brain. They are referred to as tricyclic because the chemical structure contains three rings.

• Atypical antidepressants: These medications don’t fit into one of the other categories. There are many different atypical antidepressants, and each one works in its own way. While they help to support balanced neurotransmitters, the mechanisms are not the same. Bupropion (Wellbutrin) is one of the most commonly prescribed types of atypical antidepressants.

When To Consider Switching Antidepressants

If you have been taking an antidepressant, how can you know when it’s time to make a switch?

Keep an ongoing dialogue with your doctor.

Your doctor may be able to help you recognize signs that your medication is not working as well as it could be.

If you do not feel as good as you expected, or if you feel worse, ask your doctor about other medication possibilities.

Some signs that it might be time to consider changing antidepressants include:

• Change in your medical situation: If you want to become pregnant, it is a good idea to ask your doctor about changing medications. If you receive a new diagnosis for another condition and must start a new medication that interacts with your current antidepressant, or have developed health issues due to taking your current medication, talk to your doctor about your antidepressant medication.

• Symptoms that don’t improve: It takes time for antidepressants to start working, but if you have been taking one for longer than two months and have not noticed improvements, the medication may not be effective for you. Let your doctor know how you are feeling. Your doctor may suggest switching to a different class of antidepressants.

• Symptoms that come back: If you have taken your antidepressant for a long time and start to feel your symptoms return, a different medication could be more effective. Tell your doctor if you start to feel your symptoms come back.

• New symptoms: Whether you have recently started an antidepressant or have taken one for a while, if new symptoms that you have never experienced before appear, tell your doctor right away.

• Side effects that are hard to live with: All antidepressants may cause side effects, but some may be more tolerable than others. If you feel that the side effects of your medication outweigh the benefits, let your doctor know.

• Medication that is hard to fit into your routine: If you cannot remember to take medication as directed, or you must take it at a time of day that does not fit into your schedule, tell your doctor. Medication is only effective when you take it, and if the timing adds stress or is not workable with your routine, your doctor may be able to suggest an alternative.

• Starting antidepressants again after a break: If you used to take an antidepressant, and want to start taking one again, you may or may not want to continue taking the same one. Ask your doctor about new treatment options, or medications that may be more applicable for your current stage of life.

Methods for Switching Antidepressants

Never stop taking an antidepressant suddenly, unless your doctor tells you to.

Do not adjust your dose unless your doctor has told you this is needed. 

Most antidepressants require a method for changing or stopping them to decrease the chance of serious side effects.

There are four common ways to transition from one antidepressant to another.

Taper and switch

Your doctor reduces your dose gradually over a period of a few weeks or longer.

As soon as you reach the point where you can stop the first antidepressant, you immediately start taking the new one.

Your doctor may also have a short period in between medications where you don’t take the old or new one—usually 2-4 days.

Immediate switch

Your doctor has you immediately stop taking the old antidepressant and start taking a new one, without any tapering.

This is only possible when you are staying within the same class of drugs, or within a similar class (such as switching from one SSRI to another).

Taper, washout, then switch

Your doctor tapers you off the first antidepressant, then when you have finished you have a “washout” period where you wait for the medication to be fully out of your system.

Typically this lasts for 1-6 weeks, depending on the type of drug and dosage you were on.

After the washout period, you start the new medication.

This is done when you are changing to a class of antidepressants that is different from the first one, where potential interactions may occur.

Cross-taper

Your doctor tapers you slowly off the first antidepressant while you slowly start to add in the second antidepressant.

Over the course of a few weeks, you may wean off the first drug while building towards your new normal dose of the second one.

This method may be preferred if you are switching to a drug from a different class of antidepressants that has no interaction potential with the first.

Possible Side Effects of Switching Medications

You can experience side effects from antidepressants, and changing to a different drug can cause side effects of its own.

Your brain must adjust to differing messages from drugs that affect neurotransmitters and your mood.

If not done carefully and under the guidance of a physician, switching antidepressants can have some serious complications.

Serotonin syndrome happens when you have too many antidepressants in your system, leading to symptoms like:

• Confusion
• Agitation
• Nervous feelings
• Tremoring
• Sweating
• Rapid pulse
• Diarrhea

Serotonin syndrome can be life-threatening. Seek emergency medical help right away if you notice any of the following symptoms:

• Seizure
• High blood pressure
• Irregular heartbeat or palpitations
• Twitching or stiff muscles

When to See a Doctor

See your doctor if you are changing antidepressant medications and experience concerning symptoms.

If you are taking an antidepressant and want to consider switching to a different medication, talk to your doctor about possibilities and ways to improve your symptoms.

How K Health Can Help

Did you know you can get affordable primary care with the K Health app?

Primary care providers on the K Health platform are licensed clinicians who can chat with you right from your home.

If you take antidepressants, want to try them, or have questions about switching medications, your clinician can take the time to chat or talk with you about your questions.

If needed, they can even send a prescription directly to your pharmacy.

Download K Health to check your symptoms, explore conditions and treatments, and if needed text with a provider in minutes. K Health’s AI-powered app is based on 20 years of clinical data.