Switching Antidepressants With an Online Psychiatrist

Why people change antidepressants

Needing a change is common. MedlinePlus says one antidepressant will not work for everyone and that you may need to try two or more. The National Institute of Mental Health (NIMH) says people respond to medicines in different ways and that it may take several tries. There is often another medicine to discuss.

• Side effects. MedlinePlus says that if they bother you too much, you may need to change antidepressants.
• Not enough relief. NIMH says antidepressants usually take 4 to 8 weeks to work, so timing is part of this conversation.
• Symptoms coming back. MedlinePlus says a medicine sometimes helps at first, and then symptoms return while you are still taking it.
• Changes in your life or health. A new diagnosis, a new medicine or plans for pregnancy can all be reasons to review a plan. Tell your prescriber about any of these.

Why you should never change on your own

MedlinePlus says you should never change your dose or stop taking an antidepressant on your own, and that stopping too fast may make depression come back. NIMH says a provider can slowly and safely decrease a dose, giving your body time to adjust.

The sertraline label says reactions after stopping serotonin medicines, particularly when stopped abruptly, include nausea, sweating, low mood, irritability, dizziness, electric shock sensations, anxiety and headache. It also tells prescribers to reduce the dose gradually where possible. The label for venlafaxine says symptoms can be severe and long-lasting in some people. So please avoid using leftover medicine or stopping one because you have started another.

Why the order of a change matters

A change is more than swapping one bottle for another. Some medicines should not overlap at all. The sertraline label says it must not be taken with an MAOI or within 14 days of stopping one, because of an increased risk of serotonin syndrome, a condition that can be life-threatening. Other medicines and products also act on serotonin. NIMH names triptans, often used for migraine, and St. John's wort.

That is why your prescriber needs your whole list. The plan for a change depends on what you take now and what might come next, and how it unfolds is for your prescriber to work out with you. Dose and timing steps are different for each person and each medicine.

Records to bring to your visit

The clearer your history, the better the conversation. NIMH suggests preparing a list of everything you take, including over-the-counter drugs, herbal remedies, vitamins and supplements, and reviewing your family mental health history. You do not need perfect records. Do what you can, and your pharmacy may be able to help you fill in gaps.

• Every antidepressant you have taken, with approximate dates and how long you took it.
• What helped, what did not, and any side effects.
• Your current dose and how you take it, read straight from the bottle.
• All other medicines, including migraine medicines, pain relievers and blood thinners.
• Anything else about your health, such as seizures, an eating disorder, high blood pressure, or a personal or family history of bipolar disorder.
• Your current prescriber's name, and your therapist's if you have one.

What this looks like online

NIMH says virtual care can include an assessment, a treatment plan and a prescription, depending on your insurance and provider. A video visit means you can talk from home, with your bottles in front of you, which helps with accuracy. You need a private spot, and an internet connection that holds up.

Keep your current prescriber in the picture until your care has clearly moved over, so you do not run out of medicine or get mixed instructions. If you are also changing prescribers, our switching psychiatrists page covers that side of things.

How we can help

A licensed psychiatrist on our team, a Doctor of Osteopathic Medicine with more than three decades of practice, offers online depression treatment by secure video for people physically located in Pennsylvania or New York during each visit. Whether any change or medicine is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help, using our medication care contact form.

Our therapists do not prescribe, and they see clients in Pennsylvania, West Virginia, Arizona, Colorado and Florida, not New York. If you are in crisis, call or text 988, or call 911. Locascio Wellness does not provide emergency services.