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How to taper off your antidepressant

NOV 2010

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Discontinuing an antidepressant usually involves reducing your dose in increments, allowing two to six weeks or longer between dose reductions. Your clinician can instruct you in tapering your dose and prescribe the appropriate dosage pills. In some cases, you can use a pill cutter to create smaller-dose pills, though be sure to check with your clinician or pharmacist to find out if your antidepressant can be cut. You may also be able to use a liquid formulation for smaller dose adjustments.

Your tapering schedule will depend on which antidepressant you’re taking, how long you’ve been taking it, your current dose, and any symptoms you had during previous medication changes. Below is a chart with sample tapering schedules for some of the most popular antidepressants. However, depending on how you respond to each dose reduction, you may want to taper more gradually using smaller dose reductions, longer intervals between dose reductions, or both. If you experience discontinuation symptoms after a particular dose reduction, you may want to add back half the dose — or all of it — and continue from there with smaller dose reductions. There are no hard and fast rules for getting off antidepressants, other than that the approach should be individualized! Some people can taper off an antidepressant in a matter of weeks, while others may take months.

For more guidance on how to safely discontinue antidepressants, see the books Taking Antidepressants: Your Comprehensive Guide to Starting, Staying On, and Safely Quitting, by Michael D. Banov, M.D. and The Antidepressant Solution: A Step-by-Step Guide to Safely Overcoming Antidepressant Withdrawal, Dependence, and “Addiction,” by Joseph Glenmullen, M.D.

Suggested dose reductions for tapering off antidepressants

Drug

Starting dose (mg)

1st dose reduction (mg)

2nd dose reduction (mg)

3rd dose reduction (mg)

4th dose reduction mg)

fluoxetine (Prozac)

60 mg

40

30+

20

10++

paroxetine (Paxil)

60

40

30

20

10

sertraline (Zoloft)

200

150

100

75

50

citalopram (Celexa)

40

30

20

10


escitalopram (Lexapro)

20

15

10

5


venlafaxine (Effexor)

300

225

150

75

37.5

duloxetine* (Cymbalta)

90

60

30

20


bupropion* (Wellbutrin)

300

200

150

100


+Alternate 40 mg one day and 20 the next to get the equivalent of 30 mg per day.

++Take 20 mg every other day to get the equivalent of 10 mg per day.

*Pill should not be cut.

Sources: Adapted from material found in Banov, Taking Antidepressants: Your Comprehensive Guide… and Glenmullen, The Antidepressant Solution: a Step-by-Step Guide…