This medicine is not effective. Can I try another medicine?
I can’t bear the adverse reactions to the medication. Can I switch to a different medication?
It was working initially, but now it’s not effective anymore. Can I switch medications?
This medicine is too expensive, and I can’t afford it. Please switch to a cheaper alternative!
I heard about a new drug with good efficacy. Doctor, can I try it?
…
Why do you want to switch medications? (Feel free to leave a message)
For patients with depression, it is possible to switch medications, but there is a prerequisite: strictly follow the doctor’s advice.
Under what circumstances do you need to switch medications?
For this matter, it needs to be approached on a case-by-case basis~
1. Poor treatment effectiveness
If you have reached the maximum effective dose of the medication that you can tolerate or the sufficient dose (maximum medication dose), and you have been using it for over 4 weeks with no significant improvement, it is advisable to promptly report to the doctor for a decision on switching medications.
If you have already tried two similar medications without success, it may be necessary to switch to a medication with a different mechanism of action.
2. Intolerable medication side effects
When experiencing side effects from antidepressants such as weight gain, elevated prolactin levels, dry mouth, constipation, blurred vision, among others, that are intolerable, it is recommended to consult with the doctor promptly to discuss medication switch or adjustment.
When side effects occur, doctors often aim to balance the effectiveness of the medication while minimizing the dosage or switching to other antidepressants with lower side effect risks.
3. Economic reasons
If cost is a concern and you prefer not to use expensive original drugs (in our country, “original drugs” mainly refer to imported drugs whose patents have expired) and would rather use cheaper generic drugs, it’s important to note: if the original drug initially led to significant improvement in your condition, you can consult your attending physician to see if it would be possible to use a generic drug with similar effectiveness during the consolidation and maintenance treatment phases.
Despite discussing several scenarios where medication switch is possible, it is important to emphasize two points:
1. Patients need to be cautious and frequent changes in treatment medications during the period of effectiveness are not recommended. Allow the medication time to work and take effect.
2. Whether for initial onset, relapse, or treatment-resistant patients, adhering to a sufficient treatment course and an individualized approach is crucial.
Side effects of changing antidepressants
When switching between antidepressants, it is possible to experience side effects as the body may have become used to the previous medication, particularly if used for over 4-6 weeks.
Most potential side effects are uncomfortable but not dangerous or life-threatening. They may begin within 2-4 days following discontinuation or gradual discontinuation and last for 1-2 weeks.
How to switch for safety and effectiveness?
Once the decision is made to switch medications, the next focus should be on the “how to switch” aspect.
The most important point is to communicate fully with the doctor.
Currently, doctors often employ three methods of switching medications, each with its pros and cons, taking into account factors like the severity of your condition, physical condition, relapse status, etc., to determine the most suitable approach for you.
1. Abrupt switch
Discontinue the original medication immediately and start the new medication at the clinical effective dose right away.
2. Cross-taper switch
Gradually reduce the original medication by 25% to 50% every 4-5 half-lives while introducing the new medication. Once the new medication reaches the clinical effective dose, gradually taper off the original medication.
3. Overlapping switch
Maintain the full therapeutic dose of the original medication while introducing the new medication. Once the new medication reaches the clinical effective dose, gradually discontinue the original medication.
These methods do not have a strict hierarchy in terms of effectiveness.
When you see “abrupt switch,” you might ask, “Isn’t stopping medication immediately likely to cause withdrawal reactions?” NO, NO, NO! It’s not as simple as you think. Can you doubt the doctor’s consideration? The first switching method is for more urgent cases. What qualifies as “urgent”? It’s not your sense of urgency that matters but the urgency of the medical condition, such as severe adverse drug reactions.
During the medication switch, there is a risk of disease exacerbation while the old medication is being tapered and the new one has not yet taken effect, which could lead to deterioration of the condition and even self-harm or suicidal behavior. Therefore, high-risk patients must be cautious when switching medications, follow the doctor’s advice, choose an appropriate switching method to reduce the risk of disease exacerbation.
A final note
The most prudent and safest way to switch medications is to consult your attending physician and follow their advice. Do not switch medications on your own. During the process of changing antidepressants, it is important to schedule follow-up visits promptly based on the doctor’s advice to adjust the medication plan according to your response to the new medication and your body’s tolerance.
References:
[1] Hao Wei, Lu Lin. Psychiatry (8th edition) [M]. Beijing: People’s Health Publishing House, 2018.
[2] Lu Lin. Shen Yu Village Psychiatry (6th edition) [M]. Beijing: People’s Health Publishing House, 2017.
[3] Feng Xinxin, Wang Keqin. Literature Review on the Method of Changing Medication for Patients with Ineffective Antidepressant Treatment[J]. Journal of Jining Medical College, 2017, 40(03): 209-213.
