Tapering One SSRI to Start Another is Like Making a Gradual Switch Between Beer Brands

I sometimes see even supposedly seasoned clinicians taper a person off one SSRI like escitalopram (Lexapro) and then starting from scratch with another SSRI like sertraline (Zoloft).

In my experience, this is almost never necessary. Think about it, the SSRIs hit the same receptors. Each drug has a somewhat different personality; some are sedating, some a little energizing and so on. You would also have to consider the half life, like fluoxetine (Prozac) has a long one and venlafaxine (Effexor) a short one. Switching between a long acting and a short acting one may require a wait period or a partial taper. But the main action is similar enough that tapering completely off one and on to another is more likely to cause unpleasant reactions (SSRI withdrawal) than a straight one-day switch. I do the same when switching from an SSRI to an SNRI like venlafaxine or duloxetine. I just ballpark the SSRI potency of the two drugs and, wham, we’re done.

So, as long as you hit the same receptor, it’s not a whole lot more complicated than going from Corona to Bud Light. You might want to consider the potency, and to some degree the drug half life, but it’s not quite rocket science.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919171/

2 Responses to “Tapering One SSRI to Start Another is Like Making a Gradual Switch Between Beer Brands”

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1 pauldhillon March 23, 2023 at 3:36 pm

Two websites to have a gander at.

https://www.switchrx.com/

And this really interesting one.

https://hi.gmu.edu/ad/intro

I’m a big fan of the second one and the concept he’s taken and put into practice.

Any chance that you’ll be attending the world and remote conference in Niagara falls in April?

Paul

Maj. Paul Dhillon BA MBBChBAO LRCP&SI MSc DM-EMDM MBA CCFP(EM) DRCOG DTM&H(Lon) FRGS Chief Educational Officer – The Review Course in Family Medicine Flight Surgeon | 12 (Vancouver) Field Ambulance | Brigade Surgeon | 39 Canadian Brigade Group | Canadian Armed Forces paul.dhillon@gmail.com paul.dhillon@ecn.forces.gc.ca/paul.dhillon@forces.gc.ca +1(306)570.1428 GMT-8

- 2 acountrydoctorwrites March 23, 2023 at 6:11 pm
  
  Thanks, I’ll look at them more this weekend. And I’ll ask you while we’re on the subject. I think it was in the 90’s a psychiatrist on the West coast had a protocol where you tried a different antidepressant every day until you found the one that made the light go on. I have googled to no avail trying to find that article/book again.