switching antidepressants

Question 1

A patient is at risk of suicide. What would you avoid (2)

Answer 1

TCAs (except lofepramine)
Venlafaxine

Question 2

What is cross tapering

Answer 2

usually involves gradually reducing dose of current AD while starting a new one at a low dose, and gradually increasing it as the previous drug is withdrawn

Question 3

When can you switch AD abruptly by withdrawing the current AD and starting the new one the next day?

Answer 3

When switching from one SSRI to another SSRI or SNRI (except fluoxetine, long half life so wash out period needed)

Question 4

Switching from TCA to another TCA

Answer 4

direct switch possible (except clomipramine)

Question 5

Switching from TCA to SSRI (except clomipramine)

Answer 5

gradually reduce TCA to 25-50mg daily or half the usual dose, start SSRI and slowly withdraw TCA over the next 5-7 days

Question 6

switching from TCA (except clomipramine) to SNRI (dulox, venla)

Answer 6

cross taper cautiously starting with low dose SNRI

Question 7

switching from TCA (not clomipramine) to mirtazapine, reboxetine

Answer 7

cross taper cautiously

Question 7

switching from TCA (except clompiramine) to fluoxetine

Answer 7

half dose TCA, add fluoxetine, then slowly withdraw TCA

Question 8

switching from TCA (not clomipramine) to trazodone

Answer 8

half dose TCA, add trazodone, then slowly withdraw TCA

Question 9

switching from SSRI to a TCA (except clomipramine)

Answer 9

cross taper cautiously with low dose TCA

Question 10

switching from SSRI to another SSRi

Answer 10

direct switch possible

Question 11

switching from SSRI to SNRI (dulox, venlafax)

Answer 11

direct switch possible
caution if paroxetine

Question 12

switching from SSRI to fluoxetine

Answer 12

direct switch

Question 13

switching from SSRI to mirtazapine, reboxetine, trazadone

Answer 13

cross taper cautiously

Question 14

Switching from fluextine to
TCA (except clomipramine)

Answer 14

stop fluoextine
start TCA at low dose 4-7 days later and increase dose slowly

Question 15

switching from fluoxetine to SSRI or SNRI

Answer 15

stop fluoextine
start SSRI or SNRI at low dose 4-7 days later

Question 16

switching from fluoextine to mirtazapine, reboxetine, trazadone

Answer 16

cross taper cautiously

Question 17

switching from mirtazapine to any TCA, SSRI, SNRI, reboxetine, trazadone

Answer 17

cross taper cautiously

Question 18

switching from trazadone to TCA except clompiramine

Answer 18

cross taper cautiously with low dose TCA

Question 19

switching from trazadone to SSRI, SNRI, fluoxetine, mirtazapine, reboxetine

Answer 19

cross taper cautiously

Question 20

Other antidepressants should not be started for……… weeks after treatment with MAOIs has been stopped (3 weeks if starting these two)

Answer 20

Other antidepressants should not be started for 2 weeks after treatment with MAOIs has been stopped (3 weeks if starting clomipramine or imipramine

Question 21

A MAOI should not be started until at least …… weeks after a previous MAOI has been stopped (then started at reduced dose)

Answer 21

2 weeks

Question 22

A MAOI should not be started until at least …… after a TCA (3 weeks in the case of …..) has been stopped

Answer 22

7-14 days
3 weeks if clomipramine or imipramine

Question 23

An MAOI should not be started until ……… after SSRI has been stopped ( at least …… weeks if fluoxetine)

Answer 23

a week
5 weeks fluoxetine