What is the recommended tapering schedule for discontinuing Lexapro (escitalopram) 5 mg?

Tapering Off Lexapro 5 mg

For Lexapro 5 mg, taper by reducing the dose by 10% per month or slower, using a hyperbolic tapering schedule that may extend over several months to minimize withdrawal symptoms. 1, 2

Recommended Tapering Schedule for Lexapro 5 mg

Initial Considerations

• Lexapro's FDA label specifically recommends "a gradual reduction in the dose rather than abrupt cessation" to minimize withdrawal symptoms 1
• The 5 mg dose is already at the lower end of the therapeutic range, making careful tapering especially important

Step-by-Step Tapering Plan

1. First Phase (Months 1-2):

   • Reduce from 5 mg to 2.5 mg daily for 4-8 weeks
   • This can be accomplished by cutting the 5 mg tablet in half or taking 5 mg every other day

2. Second Phase (Months 3-4):

   • Further reduce to 2.5 mg every other day (equivalent to 1.25 mg daily) for 4-8 weeks

3. Final Phase (Months 5-6):

   • Take 2.5 mg twice weekly for 4 weeks
   • Then 2.5 mg once weekly for 4 weeks before complete discontinuation

Scientific Rationale

The recommended hyperbolic tapering approach is based on PET imaging data showing that SSRI doses should be reduced hyperbolically to achieve linear reductions in serotonin transporter inhibition 2. This method minimizes withdrawal symptoms by allowing neuroadaptations time to resolve 3.

Monitoring and Managing Withdrawal Symptoms

Common Withdrawal Symptoms to Watch For

• Dizziness (44%)
• Muscle tension (44%)
• Chills (44%)
• Confusion or trouble concentrating (40%)
• Amnesia (28%)
• Crying (28%) 4

Management Strategies

• If intolerable symptoms occur, return to the previous dose and slow the taper further 1
• Consider extending the taper period to 3+ months if withdrawal symptoms emerge 5
• For severe symptoms, reinstate the previous dose and restart with an even more gradual taper 6

Important Caveats

Pitfalls to Avoid

• Avoid abrupt discontinuation - Studies show minimal benefits of short 2-4 week tapers over abrupt discontinuation 2
• Don't confuse withdrawal with relapse - Withdrawal symptoms can be mistaken for depression recurrence, leading to unnecessary long-term medication 2
• Don't rush the process - Evidence suggests physiological processes associated with antidepressant discontinuation last over three months 5

Special Considerations

• If you experience significant withdrawal despite slow tapering, consider temporarily switching to fluoxetine (which has a much longer half-life) before final discontinuation 6
• The final doses before complete cessation may need to be very small (as low as 1/40th of a therapeutic dose) to prevent a large decrease in neurotransmitter effects when stopped 3

This gradual, hyperbolic tapering approach provides the best chance of minimizing withdrawal symptoms while successfully discontinuing Lexapro 5 mg.