What is the recommended rate for tapering off sertraline (selective serotonin reuptake inhibitor, SSRI)?

Tapering Sertraline to Minimize Withdrawal Symptoms

Sertraline should be tapered gradually with a recommended rate of 10% of the original dose per week to minimize withdrawal symptoms and optimize patient outcomes. 1

Understanding SSRI Withdrawal

Sertraline, like other SSRIs, can cause withdrawal symptoms when discontinued abruptly. These symptoms may include:

• Somatic symptoms: dizziness, light-headedness, nausea, fatigue, flu-like symptoms, sensory disturbances, sleep disturbances 2
• Psychological symptoms: anxiety, agitation, crying spells, irritability 2

Unlike benzodiazepines or opioids, SSRI withdrawal is not life-threatening but can significantly impact quality of life and may be mistaken for relapse of depression.

Recommended Tapering Protocol

1. Initial Reduction Rate: Begin with a 10% reduction of the original dose per week 3

   • For example, if taking 100mg daily, reduce to 90mg for one week, then 80mg, etc.

2. Individualized Adjustments:

   • For patients who have been on sertraline for years, consider slowing to 10% per month 1
   • If withdrawal symptoms emerge, pause taper and restart when symptoms resolve 3

3. Final Phase Considerations:

   • Slow the taper further when reaching lower doses (25mg or less) 1
   • Consider using liquid formulations or splitting tablets for more precise dosing at lower levels

4. Complete Discontinuation:

   • Extend the interval between doses once at the lowest available dose 3
   • Stop completely when taking less than once daily

Special Considerations

• Hyperbolic Tapering: Recent evidence suggests that hyperbolic tapering (making smaller reductions as the dose gets lower) may be more effective than linear tapering 1

• Monitoring: Watch for signs of withdrawal versus relapse of underlying condition:

  • Withdrawal symptoms typically emerge within days of dose reduction and are often somatic
  • Relapse symptoms typically emerge gradually and mirror original depressive symptoms

• Adjunctive Support: Consider non-pharmacological interventions during tapering:

  • Cognitive behavioral therapy
  • Mindfulness techniques
  • Regular exercise
  • Sleep hygiene practices

Common Pitfalls to Avoid

• Tapering too quickly: Standard guidelines often recommend 2-4 week tapers, but evidence shows these are often not tolerated well 1

• Misinterpreting withdrawal as relapse: This can lead to unnecessary reinstatement of medication and long-term use 2

• One-size-fits-all approach: While 8.9% of patients may discontinue without tapering through the lowest dose, it's difficult to identify these patients in advance 4

• Stopping at minimum therapeutic dose: Tapering should continue to doses much lower than minimum therapeutic doses to minimize withdrawal 1

By following this evidence-based approach to sertraline tapering, you can minimize withdrawal symptoms while successfully discontinuing the medication when appropriate.