A-Z

Antidepressants

Changing antidepressants

We talked to people who had taken a number of different antidepressants over the years, or had tried one or two before finding one that suited them. How people respond to an antidepressant can vary so what works for one person may not work as well for another. Some people find that they experience side effects that are too unpleasant to tolerate, or they don’t feel any positive benefit from one antidepressant, but another might work better. It can sometimes take several tries to find one that works best for any particular individual. Usually when people are prescribed an antidepressant for the first time they are advised to wait a few weeks before considering a change because it can take a few weeks for the benefits to become noticeable, and side effects should wear off after a short time. Emma’s doctor told her to ‘try it for a few weeks and come back... if you’re not feeling any better we’ll change it... it wasn’t just a case of its not working we’ll change it.’ When Stuart was prescribed an antidepressant for the first time he was told by his GP ‘this might not work for you we might need to keep trying different ones until we find something’. Not everyone realised that it was possible to change to a different antidepressant if the one they were prescribed didn’t suit them. Some said they would have liked more information about the options.
 
Several people described having started on one antidepressant, but after a time changing over to another one that might work more effectively, give less side effects, or have a particular desired effect, for example helping with specific symptoms such as anxiety or insomnia. Stuart changed from venlafaxine to citalopram because of the effect venlafaxine had on his libido. Collette’s doctor changed her from fluoxetine to venlafaxine ‘I’d just stopped taking fluoxetine, we just decided to try another one instead... it was just what the GP thought might be better, she obviously looked it up and was like well I think we’ll give this one a try I’ve heard some good reports about it’. Some stopped taking an antidepressant because they had felt better, but their symptoms had returned after a while. When that happened some said their doctor had changed them to a different antidepressant. The effectiveness of the antidepressant may change over time, so the doctor may change the dose, or prescribe a different one. Some had specifically asked to try a different one if they had looked up information on the internet or heard about a particular antidepressant from a friend or relative. People who changed GP sometimes had a medicines review and were changed to a different antidepressant. Some thought different antidepressants were ‘in vogue’ at different times or that doctors had their favourites, but they usually knew why their prescription had been changed. 
 

Stuart changed antidepressants several times to find one that suited him

Stuart changed antidepressants several times to find one that suited him

Age at interview: 52
Sex: Male
SHOW TEXT VERSION
PRINT TRANSCRIPT
So we kept going with that for a while, I forget how long a few months maybe six months. And then the conclusion was that it wasn’t, I was still very down six months in and so at that point the doctor suggested changing to an SSRI.
 
Did you make that switch straight away, did you just go from one, one day to?
 
No they taper it down and then take it.
 
You had to go off and then go back on?
 
Yes, yes.
 
And did that involve any difficulties for you at all? Did you notice any different effects?
 
Not the tapering down but going onto the SSRI I did notice as soon as I started taking it I started to feel light headed and a bit punch drunk. In retrospect I think that was just the, that was a very quick reaction to it.
 
I think had I carried on talking it that would probably have worn off and because I have now again taken that same drug again without any problems.
 
So you were only on that for a short time?
 
Yes.
 
And you didn’t like the effect that it?
 
No.
 
So you went back to which one?
 
I went back to another SSRI then which I didn’t get that effect.
 
Which was citalopram?
 
Yes, yes.
 
So then you changed again, did you have to taper off and change?
 
Yes, it’s but I’ve not, I didn’t have any problems with the tapering at that stage.
 
So it was just taking a bit less each time?
 
Yes that’s right yes. I always in more recent years I’ve always been on lower doses so when I went onto venlafaxine again I didn’t have any problems with the tapering with the coming off or coming on.
 

Emma started on fluoxetine, but had difficulty sleeping...

Emma started on fluoxetine, but had difficulty sleeping...

Age at interview: 30
Sex: Female
Age at diagnosis: 20
SHOW TEXT VERSION
PRINT TRANSCRIPT
I couldn’t t sleep, I couldn’t sleep and I had started taking them when a, in the mornings, was it the mornings yes the fluoxetine I had to take in the mornings and I was hyper and really couldn’t settle and couldn’t relax or anything with them.
 
And then did you change the time of day when you took them?
 
Yes I took them for about six months and I had another relapse, it’s all coming back to me now and then another relapse so they changed me, don’t remember if it was fluoxetine or Lustral I was on first and they changed that to another one and the same effect... hyper and the doctor changed me to taking them at nights and as soon as I started taking them at night they just went great, they were great for years and then something else happened and put me on sertraline and that was me for years and years and years.
 
But then another disaster, I’m sure I can’t remember what it was now probably an overreaction of some sort and they changed me to Cipramil and I stayed on the same level but oh God what was I on and the figures I’ve given you might not be accurate but I had I had a very bad time when working was bullied and attacked and everything and end up with what I would call a breakdown and I had to come off it and they had me on citalopram.
 

Charlotte tried Cipramil (citalopram) and fluoxetine but they...

Charlotte tried Cipramil (citalopram) and fluoxetine but they...

Age at interview: 34
Sex: Female
Age at diagnosis: 20
SHOW TEXT VERSION
PRINT TRANSCRIPT
Well two years ago I was given some Cipramil I think it is to try because I’d had quite a tough time with the boyfriend I was with at the time who was quite verbally aggressive and I’d had an abortion so I had to take them for obvious reasons then because I was very distressed and upset, very, very depressed. they didn’t work, they made me feel really ill so I was then given fluoxetine again by the GP which I was on for two weeks and in that time I couldn’t stand up, I couldn't move every time I stood up I was nearly falling over really nauseous, really dizzy, really headachy. went back to the GP again after two weeks and said I can’t stay on these, literally I cannot, I couldn’t function, I couldn’t do anything and yes I couldn’t do anything at all and when I went back to the GP they then gave me the venlafaxine again because I kept insisting that that was the only one that had worked for me before, I wanted those again. So they gave me those again and then I was on the maximum dose of 150 milligrams for about a year that must have been about six months, nine months ago I was reduced to 75 milligrams a day just to kind of keep me okay I suppose still taking them daily.
Some people had been advised to gradually stop taking one antidepressant before starting on a new one, but others said their doctors had changed them to a new one straight away. It depends on the particular antidepressant and how long it stays in the body after you stop taking it. Sharon had tried a number of different antidepressants over time and was puzzled about the fact that different doctors had given different advice on changing from one to another. Tapering the dose is sometimes necessary when switching medicines. When people change to a new antidepressant they may experience discontinuation effects from stopping an antidepressant, or side effects from starting a new one. (See ‘Stopping taking antidepressants’).
 

Sharon felt puzzled that ‘different doctors would switch them...

Sharon felt puzzled that ‘different doctors would switch them...

Age at interview: 37
Sex: Female
Age at diagnosis: 22
SHOW TEXT VERSION
PRINT TRANSCRIPT
From some tablets that I've been on I've changed straight over from one day, one tablet to another day, another tablet. Other ones I've had to come off completely and then wait a few weeks and then start gradually.
 
Which ones, is it, was it the SSRIs that you had?
 
The SSRIs, I went from SSRIs straight on to the tricyclic.
 
And so when you say you started taking them the next day at the dose, at the dose that you've been prescribed…?
 
Yeah, yeah I literally just to switch over.
 
And how did that work out?
 
Well I wasn't sure about that, I was, but I trusted the doctor. I thought, 'Well I don't know because it's a different type, it's a different thing…’ Wasn't quite sure, I expected to feel a bit odd and maybe go a bit haywire for a few weeks. The only time, it was only recently when I came off the mirtazapine, went onto the Prozac again that I had to come off the mirtazapine completely and the doctor said it's going to be bumpy ride but it wasn't too bad.
 
It wasn't too bad so the only time I expected it to be or was talked through it that it was going to be horrendous that it was, it was quite concerning how different doctors would switch them over differently.
 
And how did you, what, how do you make sense of that the differences between the different doctors?
 
Well until you've tried another doctor that's done it a different way and they say, "Oh no you shouldn't do it like that," you don't know.
 
Because you're kind of in the hands really aren’t you?
 
Yeah, yeah especially when you're feeling as low as you are at the time anyway you just do as you're told and hope for the best.
 

Catherine has been on several types of antidepressant over...

Catherine has been on several types of antidepressant over...

Age at interview: 41
Sex: Female
Age at diagnosis: 14
SHOW TEXT VERSION
PRINT TRANSCRIPT
When you did those you know you’ve changed from various different antidepressants onto different ones.
 
Yes.
 
Has that been, what does the changeover involve? Has it been like one minute you’re taking one and then the next you’re taking some different one?
 
Well it’s been different and I think that’s a good question because the one I do remember and it was when I changed from mirtazapine back to Prozac I was given something and I can’t remember what it was but I was given something to help the changeover because I was told I might struggle with the sort of discontinuation symptoms, certainly with sleep and things like that and she gave me a seven day supply of something to help the transition. And I think there have also been cases where switching from I think Lofepramine to Prozac, you had to have lofepramine out of your system for a period of time, you couldn’t have the two together so you had to reduce off the lofepramine before starting the Prozac.
 
Is that what you did?
 
I did, that was a long time ago but I did that under guidance yeah. I don’t remember, I don’t remember experiencing too many difficulties with that, the lofepramine, at all, the biggest problem I had was with the paroxetine but because I’d not been on it for a long time it wasn’t too bad and actually the side effects for me were worse on it than actually the gradual reduction coming off it.
 
What were the side effects of the gradual reduction, because you said the side effects of being on it were that it decreased your levels of motivation?
 
Yeah, yeah, motivation, yeah, those thought processes the lot. The side effects of coming off it were disturbed sleep, vivid dreams was quite a common one and the continual low, because I was already in a low mood anyway, the low mood stayed to be low. But I think it was the dreams and the sweating, sweating, dreams and sleep they were the main three things from Paroxetine.
 

Sonia points out that each time the dose or medicine is...

Sonia points out that each time the dose or medicine is...

Age at interview: 31
Sex: Female
Age at diagnosis: 17
SHOW TEXT VERSION
PRINT TRANSCRIPT
That’s another thing that is really difficult is that, you know, certainly for me in the last three, since June so the last three months, my medication’s been changed three times and you have to just kind of sit out the side effects and wait for them to calm down. You can’t go back to your consultant and say, you know, after two days ‘Oh do you know what this isn’t working,’ even kind of when I, when she added mirtazapine in June, I was suicidal when she prescribed it, I felt it got worse in the week immediately after I started taking the mirtazapine and I spoke to the mental health team and said I don’t know if it’s a coincidence but I don’t think it is because my moods have deteriorated so rapidly and they kind of insist that you stick with it and you don’t really know which to do because you’re kind of thinking well you know what you’re talking about, you are the experts, you are the doctors but equally you’re thinking, I know what I’m feeling.
 
I’m fairly confident I will be on medication for… a very long time if not the rest of my life. I don’t like it, I don’t really accept it, I kind of half do and half don’t, I am scared that I will have to keep changing because, you know 13 years on God knows how many different medications, I’m scared that’s going to keep happening. 
We spoke to some people who had severe or recurrent episodes of depression and were extremely unwell. Over the course of time doctors had changed their antidepressants many times in an attempt to find something that would help. After so many changes it was difficult to remember which antidepressants they had taken, or when. A few people said that despite many changes they had not found one that helped. 
 

Dina’s antidepressants had been changed several times...

Dina’s antidepressants had been changed several times...

Age at interview: 46
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
I remember that whilst I was seeing the crisis team I was seeing the psychiatrist who was a very decent guy I think and, you know, a very kind of gentle person and he actually said to me that, you know, we are trying a lot of drugs because I think as I said they had changed, perhaps, certainly they had changed the fluoxetine but I don’t, and introduced mirtazapine I don't remember whether they had introduced olanzapine by that time but the message was that because my depression was, treatment ‘resistant’ in inverted commas he sort of explained to me that that was towards the end of that year that, you know, if the drugs don’t work then the next line of treatment would be either lithium or ECT.
 
Did you at the time know anything about those drugs, the lithium or anything?
 
No I didn’t I mean, you know, he said that you know, we’re not, he wasn’t saying ‘we’re giving them to you now’ but he was saying that yes it was a kind of warning, you know, that these are like, this is the last resort kind of thing.
(See also ‘Managing antidepressants’, ‘Stopping taking antidepressants’, ‘Being prescribed an antidepressant’ and ‘Coping with antidepressant side effects’).

Last reviewed June 2016.
 
donate
Previous Page
Next Page