Gradual dose reduction to stop an antidepressant
Reduce the dose of the antidepressant gradually, rather than stopping it abruptly, to reduce the risk of discontinuation symptoms. For example, reduce the antidepressant dose by 25 to 50% every 1 to 4 weeks until the daily dose is half the lowest unit strength available1. Continue at the lowest dose for 2 weeks then stop.
However, if the reason for stopping the antidepressant is that a serious adverse effect has occurred, reduce the dose more rapidly.
Conversely, use a slower dose reduction schedule than described above if discontinuation symptoms are more likely; for example, when stopping:
- a high dose of antidepressant
- after a longer duration of antidepressant treatment
- desvenlafaxine, duloxetine, mirtazapine, paroxetine or venlafaxineHorowitz 2024Royal College of Psychiatrists 2024
- an antidepressant in a child or adolescent (reduce over 6 to 12 weeks)
- an antidepressant used for the treatment of an anxiety disorder.
Hyperbolic tapering is an approach that involves the use of smaller dose reductions as the antidepressant dose decreases. It may be an option for some patients at high risk of discontinuation symptomsHorowitz 2024Royal College of Psychiatrists 2024. The use of hyperbolic tapering is limited by the availability of formulations that allow for administration of small doses. Randomised controlled trials on hyperbolic tapering of antidepressants are ongoingWallis 2023.
A gradual dose reduction is not usually required for fluoxetine because fluoxetine and its active metabolite have a long half-life; discontinuation symptoms rarely occur.