Strategy	Description	Example		Comments
10% reduction per week	Reduce dose every four weeks to match 10% reduction in serotonin transporter occupancy	Citalopram:  40 mg for four weeks  20 mg for four weeks  19 mg for four weeks 9.1 mg for four weeks 5.4 mg for four weeks 3.4 mg for four weeks 2.3 mg for four weeks 1.5 mg for four weeks 0.8 mg for four weeks 0.37 mg for four weeks		Formulated using pharmacokinetic data but difficult to precisely implement
Three- to four-month taper	Reduce dose by 25% every four weeks or by 12.5% every two weeks	Citalopram:  40 mg for four weeks  30 mg for four weeks  20 mg for four weeks  15 mg for four weeks  10 mg for four weeks 7.5 mg for four weeks 5 mg for four weeks 2.5 mg for four weeks		Easier to accomplish in real-world practice, but linear dose decrease may still result in antidepressant discontinuation syndrome
Cross taper	Slowly decrease dose of the current medication while increasing dose of the new medication	Citalopram (current medication, 40-mg starting dose):  30 mg for four weeks  20 mg for four weeks  15 mg for four weeks  10 mg for four weeks 7.5 mg for four weeks 5 mg for four weeks 2.5 mg for four weeks	Sertraline (new medication):  12.5 mg for four weeks  18.75 mg for four weeks  25 mg for four weeks  37.5 mg for four weeks  50 mg for four weeks  75 mg for four weeks  100 mg for four weeks	Exposure to multiple serotonergic agents has inherent risks Potential for cytochrome P450– mediated drug reactions depending on drug choice Increased pill burden and financial strain for patients
Direct switch	Start a new medication immediately after discontinuing the current one	Discontinue citalopram, 20 mg	Initiate sertraline, 50 mg	May be difficult to determine if patient-reported adverse effects are due to the new agent or antidepressant discontinuation syndrome
Moderate switch	Current medication is tapered down, followed by a washout period of two or three days New medication is initiated at a conservative dose, then increased	Citalopram (current medication):  20 mg for four weeks  15 mg for four weeks  10 mg for four weeks 7.5 mg for four weeks 5 mg for four weeks 2.5 mg for four weeks Discontinue for two- to three-day washout period Start sertraline:  25 mg for four weeks  37.5 mg for four weeks  50 mg for four weeks		Potential for antidepressant discontinuation syndrome due to drug-free period More time-consuming but considered to be safer
Conservative switch	Current medication is tapered down, followed by a washout period of four or five half-lives New medication is initiated at a conservative dose, then increased	Same as moderate switch but with longer washout period (seven days for most drugs, except those with long half-lives [e.g., fluoxetine])		Potential for antidepressant discontinuation syndrome due to drug-free period Patients must wait longer for treatment benefit from new medication