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Switching antidepressant (tricyclic antidepressants (TCA) to serotonin and noradrenaline reuptake inhibitors (SNRIs) (e.g. duloxetine or venlafaxine)) in adults

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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.

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