Antidepressants, a Guide to Switching and Withdrawing

Instructions for changing or stopping antidepressants.

Check at a glance how to change or discontinue antidepressant treatment with the MIMS guide to switching and withdrawing antidepressants.

The tabulated quick-reference guide provides recommendations for patients receiving or switching to:

  • Monoamine oxidase inhibitors (MAOIs), both reversible (moclobemide) and irreversible (phenelzine and tranylcypromine)
  • The noradrenaline reuptake inhibitor reboxetine
  • Serotonin-noradrenaline reuptake inhibitors (SNRIs): duloxetine and venlafaxine)
  • Selective serotonin reuptake inhibitors (SSRIs): citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine and sertraline
  • Tricyclic antidepressants (amitriptyline, clomipramine, dosulepin, doxepin, imipramine, lofepramine, nortriptyline and trimipramine)
  • The tricyclic-like antidepressant trazodone

The newer agents agomelatine (Valdoxan), mirtazapine (Zispin Soltab) and vortioxetine (Brintellix) are also included.

Use the table to check whether agents should be cross-tapered when switching or existing treatment withdrawn with a washout period before starting the next. You can also find advice on the recommended starting dose for the new agent.

For patients who are ready to stop antidepressant treatment, the table provides recommendations for prescribers on the timing of withdrawal.

Drug names link through to the full MIMS entries for more detailed prescribing information on each branded or generic product.

Recommendations are derived from the latest edition of The Maudsley Prescribing Guidelines in Psychiatry and from manufacturers' Summaries of Product Characteristics (SPCs).

Go to the MIMS switching antidepressants table

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