Switching Between Serotonergic "Antidepressants"

October 22, 2025

Key Principles for Switching or Discontinuing Serotonergic "Antidepressants"
How to Switch In situations when there are antidepressant-related side effects, try to stop the first agent before starting the new agent so that side effects of the new agent can be distinguished from withdrawal effects of the first agent Stopping a serotonergic antidepressant often means tapering off since discontinuing many SSRIs can cause withdrawal symptoms If necessary, can cross taper off the first agent while dosing up on the new agent simultaneously, being aware of all specific drug interactions to avoid How to Stop Tapering to avoid potential withdrawal reactions is generally prudent More recently, hyperbolic discontinuation of SSRIs has been recommended in which the dose of the SSRI is halved every 4 weeks and this may be a preferable strategy in youth When SSRIs are stopped, the risk of relapse is highest during the first 8 weeks after discontinuation. If withdrawal symptoms emerge during discontinuation, raise dose to stop symptoms and then restart withdrawal much more slowly

Key Principles for Switching or Discontinuing Serotonergic "Antidepressants"

In situations when there are antidepressant-related side effects, try to stop the first agent before starting the new agent so that side effects of the new agent can be distinguished from withdrawal effects of the first agent
Stopping a serotonergic antidepressant often means tapering off since discontinuing many SSRIs can cause withdrawal symptoms
If necessary, can cross taper off the first agent while dosing up on the new agent simultaneously, being aware of all specific drug interactions to avoid

Tapering to avoid potential withdrawal reactions is generally prudent
More recently, hyperbolic discontinuation of SSRIs has been recommended in which the dose of the SSRI is halved every 4 weeks and this may be a preferable strategy in youth
When SSRIs are stopped, the risk of relapse is highest during the first 8 weeks after discontinuation.
If withdrawal symptoms emerge during discontinuation, raise dose to stop symptoms and then restart withdrawal much more slowly

Cross-titrating from Citalopram/Escitalopram to Other Serotonergic Medications

Cross-titrating from Duloxetine to Other Serotonergic Medications

Cross-titrating from Fluoxetine to Other Serotonergic Medications

Cross-titrating from Fluvoxamine to Other Serotonergic Medications

Cross-titrating from Paroxetine to Other Serotonergic Medications

Cross-titrating from Sertraline to Other Serotonergic Medications

Cross-titrating from Venlafaxine to Other Serotonergic Medications

Related Practice Resources
	Medication Tips and Pearls US FDA Approvals for Serotonergic "Antidepressants"
	Patient Education Medication Guides: Serotonergic "Antidepressants"
	Treatment Algorithms Pediatric Major Depressive Disorder
	Treatment Algorithms Pediatric Anxiety
	Patient Education Treatment and Testing Guides: SSRIs for Teens

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