considerations when etablishing whether a person needs to switch their antidepressant

Last edited 02/2023 and last reviewed 03/2023

Considerations when establishing whether a person needs to switch their antidepressant

• a clinician should adopt a shared approach from the beginning in establishing whether a person might benefit from switching their antidepressant
• discuss existing issues and experiences, and how medicines fit in with a typical day

Points to consider include the following:

• Inadequate response
  • discuss with the person and/or their carer whether their current antidepressant is effective after they have adhered to a therapeutic dose, for an appropriate duration
• Side-effects
  • discuss with the person and/or their carer any side-effects they have experienced (such as weight gain or reduced libido). Abrupt withdrawal should be avoided unless the person experiences a serious side-effect
• New contraindications and interactions
  • people may develop a new contraindication to their existing antidepressant or they may start a new medication that interacts with their existing antidepressant. Establish whether this is the case
• Current symptoms
  • establish current symptoms, particularly where treatment has failed previously. Consider using an evidence-based tool, such as:
• PHQ-9 (Patient Health Questionnaire-9),
• HADS (Hospital Anxiety and Depression Scale) or
• BDI-II (Beck Depression Inventory-II) to assess
• it can be unsafe for some people to remain untreated for extended periods of time (1)
• Agree goals
  • use a shared decision making approach to agree the purpose of the switch with your patient and what will be achieved from it.
• Share decisions
  • discuss with the person and/or their carer the purpose of the switch and what you’re trying to achieve. Consider:
  • what matters to them
  • any concerns they have
  • the extent of the side-effects they could tolerate
  • whether a trial period without an antidepressant might be useful

Reference:

• NHS Specialist Pharmacy Service (February 2023). Establishing whether a person needs to switch their antidepressant