General considerations concerning switching antidepressants

General considerations

  1. The goal of this switching table is to offer a guide for physician and pharmacist in switching antidepressants. The table should be clear, easy to use and contains the most important information. Therefore, the table only contains the most commonly used antidepressants.
  2. It should be noted that the table only contains a general advice. Deviant metabolism, comorbidity, the elderly etc. needs tailor-made pharmacotherapy!
  3. Because of the risk of acute withdrawal symptoms (e.g. cholinergic rebound) and the risk of relapse, most antidepressants are gradually tapered.
  4. It takes approximately 3-5 times the half-life for a drug to reach steady state plasma levels or to be completely eliminated. This is taken into account in the switching table. This does not apply to MAO-inhibitors.
  5. Warnings and advice are limited to the switch only. Specific drug properties can be found through the links on the right side of each webpage.
  6. Cytochrome P450 drug interactions between different antidepressants were checked with the Flockhart interaction table. No inductors were found; only some inhibitors.
  7. Anticholinergic activity, if relevant, is considered in the switches.
  8. The serotonine syndrome, if relevant, is considered in the switches.
  9. See disclaimer.