Advice for all antidepressants
You should read our advice for all antidepressant switching before applying that to individual mirtazapine switches below.
- Establishing whether a person needs to switch their antidepressant
- Choosing an antidepressant to switch a person to
- Planning and agreeing an antidepressant switching strategy
- Monitoring a person during and after antidepressant switching
Mirtazapine to agomelatine
Cross-taper
Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.
There is limited experience with this switch so extra caution is required. Although interactions are not expected, agomelatine is not expected to mitigate discontinuation reactions from stopping mirtazapine.
Mirtazapine to moclobemide
Taper, washout and switch
Gradually reduce the dose of mirtazapine and stop; wait 7 days before starting moclobemide.
Cross-tapering is not recommended due to the high risk of serotonin syndrome.
Mirtazapine to monoamine oxidase inhibitors (MAOIs)
Switching to an MAOI is always a complex switch and you should follow specialist advice.
Taper, washout and switch with specialist advice
Gradually reduce the dose of mirtazapine and stop; wait 7 to 14 days before starting the MAOI. The specialist will advise the duration of the washout period on a case-by-case basis taking into consideration the MAOI being started.
Cross-tapering is not recommended due to the high risk of serotonin syndrome.
Mirtazapine to selective serotonin reuptake inhibitors (SSRIs)
Cross-taper
Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.
Mirtazapine to serotonin and noradrenaline reuptake inhibitors (SNRIs)
Cross-taper
Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.
Mirtazapine to trazodone
Cross-taper
Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.
Mirtazapine to tricyclic antidepressants (TCAs)
Switching to dosulepin requires specialist advice and should not be done in primary care due to the increased cardiac risk and toxicity in overdose.
Cross-taper
Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.
Mirtazapine to vortioxetine
There is limited experience with this switch so extra caution is required to avoid serotonin syndrome.
Cross-taper
Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.
Taper, washout and switch
Alternatively, gradually reduce the dose of mirtazapine and stop; wait for a period before starting vortioxetine. Clinicians should decide the duration of the washout period on a case-by-case basis.
Deciding on the switching strategy
Our guidance on Planning and agreeing an antidepressant switching strategy will help you decide which switching strategy to choose.
More advice on individual switches
We have further advice on how to switch between individual antidepressants of different types. Browse our collection below.
- Switching strategies for antidepressants
- MAOI to other antidepressants: switching in adults
- Moclobemide to other antidepressants: switching in adults
- Trazodone to other antidepressants: switching in adults
- Vortioxetine to other antidepressants: switching in adults
- SNRIs to other antidepressants: switching in adults
- Agomelatine to other antidepressants: switching in adults
- Tricyclics to other antidepressants: switching in adults
- SSRIs to other antidepressants: switching in adults