The first stop for professional medicines advice

Monitoring a person during and after antidepressant switching

Published
Topics: Mental health and illnessSwitching

Review people at appropriate time points; advise on what to expect and report; and beware of the possibility of discontinuation and serotonin syndromes.

Contents
  1. Establish the need, what to switch to, and the strategy
  2. Monitoring schedules
  3. Advising people
  4. Discontinuation symptoms
    1. Symptoms
  5. Serotonin syndrome
    1. Symptoms
  6. Individual switches

Establish the need, what to switch to, and the strategy

Before you are able to monitor an antidepressant switch, you’ll need to establish the need for the switch, the medicine to switch to, and the strategy you’re following.

Monitoring schedules

Generally, people should be reviewed within 2 weeks after starting the new antidepressant. People with suicide risk or aged 18 to 25 should be reviewed 1 week after starting the new antidepressant, and then again as often as needed (but no later than 4 weeks after initiation).

Advising people

Ensure the person knows the monitoring they can expect after the switch, by whom, and when. Advise people at their review appointment on aspects such as the:

Discontinuation symptoms

People may experience discontinuation symptoms from abruptly stopping their antidepressant treatment. Gradual withdrawal may minimise risk and the person’s symptoms should guide the speed of the switch.

Symptoms

Discontinuation symptoms may include:

  • restlessness
  • trouble sleeping
  • unsteadiness
  • sweating
  • stomach problems
  • feeling as if there’s an electric shock in your head
  • feeling irritable, anxious or confused

Serotonin syndrome

Health Education England provides a good overview of serotonin syndrome, an uncommon but potentially serious side effect of most antidepressants. Concomitant or sequential use of antidepressants can increase the risk of serotonin syndrome as most antidepressants increase serotonin levels in the brain.

Symptoms

Can be mild to life-threatening and include:

  • autonomic dysfunction (tachycardia, blood pressure changes, hyperthermia, sweating, shivering and diarrhoea)
  • neuromuscular hyperactivity (tremor, rigidity, myoclonus, clonus and hyperreflexia)
  • altered mental state (agitation, confusion, mania and coma)

Individual switches

We have advice on how to switch between individual antidepressants of different types. Browse our collection below.