switching antidepressant (tricyclic antidepressants (TCA) to serotonin and noradrenaline reuptake inhibitors (SNRIs) (e.g. duloxetine or venlafaxine)) in adults
Last edited 04/2023 and last reviewed 04/2023
Switching antidepressant (tricyclic antidepressants (TCA) to serotonin and noradrenaline reuptake inhibitors (SNRIs))
From all except clomipramine
Cross-taper- cross-tapering starting with a low dose SNRI can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability
From clomipramine
Taper, stop and switch- if switching from clomipramine, gradually reduce the dose of clomipramine and stop. Start low dose SNRI the following day
- cross-tapering is not recommended and should only be undertaken if specialist advice is in place, this is because clomipramine is a potent serotonin reuptake inhibitor so there is a high risk of serotonin syndrome.
- NHS Specialist Pharmacy Service (February 2023). Tricyclics to other antidepressants: switching in adults
summary advice - switching from tricyclic antidepressants (TCAs) to another antidepressant