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6 fluoxetine to escitalopram answer

Best Evidence Summaries of Topics in Mental Healthcare
clinical question-answering service
Section for Evidence-Based Mental Health P.O. Box 32 Health Services and Population Research Department Institute of Psychiatry De Crespigny Park London SE5 8AF Tel: 020 7848 0498 Email: Question: In adults with depression, what is the best way of swapping from fluoxetine to escitalopram, in terms of side effect profile /
interactions / safe swapping over?
Clarification of question: Patients = adults with depression; Intervention = change from fluoxetine to escitalopram; Comparison =
none, Outcome = safe swapping over.
What does the evidence say?
The Maudsley prescribing guidelines 2005 –2006 (1) provides a table of guidelines concerned with swapping and stopping
antidepressants. The recommendation for swapping from fluoxetine to escitalopram is: “Stop fluoxetine. Wait 4-7 days. Start
citalopram/escitalopram at 10mg/day and increase slowly. Note: Advice given (in this table) is partly derived from manufacturers’
information and partly theoretical. Caution is required in every instance.”(p172)
From the forward to the “antidepressants – swapping and stopping” table: “ ….when switching from one SSRI to another: their effects
are so similar that administration of the second drug is likely to ameliorate withdrawal effects of the first. However there is little firm
evidence of this occurring”. It also stresses, “the advice given (in the following table) should be treated with caution and patients
should be very carefully monitored when switching.” (p171). For further advice, please contact the medicines information service at
the Maudsley, tel: 020 7919 2317.

This answer is a brief summary of the available evidence, if there is anything else you would like to know, please contact me on:
This question was received on 21st June 2006; the answer was completed on 7th July 2006 by Elizabeth Barley PhD CPsychol. This
answer is > 1 year old and so may need updating.
Maudsley Prescribing Guidelines(1) consulted.
Reference List
Taylor D, Paton C, Kerwin R. The Maudsley Prescribing Guidelines 2005 - 2006. 8th ed. London & New York: Taylor & Francis Group; 2005.

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