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If the patient is not yet responding, and if the maximum is not yet reached, consider increasing / optimizing the dose.
If after 4 weeks of treatment, however, there is no response consider switching rather than continuing to increase the dose according to 2023 CANMAT guidelines. If considering switching CANMAT 2023 guidelines recommend switching to an antidepressant with evidence of superior efficacy (escitalopram, sertraline, paroxetine, vortioxetine, venlafaxine XR, bupropion, or mirtazapine).
If you decide to switch from one medication to another, please go to SwitchRx for assistance.
Note: Need to consider severity of the illness when deciding to increase the dose. For patients with mild illness consider waiting longer for response to avoid unnecessary side effects.
Do not increase/maximize the antidepressant dose if:
- There are significant side effects or drug allergies
- Significant risk of drug interactions
Note: Lower doses or less frequent dosage increase may be better for anxious or medically compromised patients.