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Procedure template. Purpose. The purpose of this guidance is to advise clinicians about strategies to swap or stop antidepressants in primary or secondary care. It is a guide only and does not replace clinical judgement or a thorough assessment of the individual circumstances.
1 maj 2023 · Selective serotonin reuptake inhibitors (SSRIs) are a class of medications most commonly prescribed to treat depression. They are often used as first-line pharmacotherapy for depression and numerous other psychiatric disorders due to their safety, efficacy, and tolerability.
some SSRIs, SNRIs, and TCAs (for more details, see Table 3). It is best to switch to an equivalent dose when possible. If the agent was used for a long period, or the patient was taking a high dose of medication, the cross-taper method is recommended. Cross-tapering is beneficial for individuals who are at high risk for relapsing
Switching antidepressants can be accomplished by the following strategies: Direct switch: stop the first antidepressant abruptly and start new antidepressant the next day. Taper & switch immediately: gradually taper the first antidepressant, then start the new antidepressant immediately after discontinuation.
Selective Serotonin Reuptake Inhibitors (SSRIs) neuropathic pain associated with chemotherapy, diabetes, and fibromyalgia. Elderly: sertraline, citalopram, and escitalopram are the preferred agents. Paroxetine should not be used to due heavy anticholinergic activity.
Consider SSRIs when depression, or anxiety disorder is moderate to severe, interferes with daily activities of living, participation in psychotherapy, or when patient has limited improvement despite engaging in psychotherapy.
SSRIs have low known risk, most experience with fluoxetine and sertraline. TCAs also have low teratogenic risk. Imipramine, nortriptyline and sertraline considered safest in breastfeeding. See section 6.3. *Refer to prescribing notes, page 8
