The latest edition of the Maudsley Prescribing Guidelines in Psychiatry contains a number of changes relevant to switching between antidepressants.
Key changes to the MIMS table
- When switching from moclobemide to agomelatine it is now recommended to withdraw moclobemide and wait one day before starting agomelatine rather than using cautious cross-tapering as previously advised
- When switching between the following antidepressants it now recommended that a direct switch may be made with no requirement for cross-tapering as previously recommended:
- from duloxetine to an SSRI, venlafaxine or vortioxetine
- from venlafaxine to duloxetine, an SSRI or vortioxetine
- from an SSRI (excluding fluoxetine) to an SNRI, another SSRI or vortioxetine
- from TCADs (excluding clomipramine) to another TCAD
- from vortioxetine to an SSRI or SNRI.
As the Maudsley guidance no longer includes specific advice on stopping individual antidepressants, the information in the 'withdrawal advice' column of the MIMS table has been amended to reflect that provided in the relevant summaries of product characteristics.
Other minor changes to the MIMS table include the replacement of duloxetine and venlafaxine with the drug class (SNRIs) throughout.