How do I taper sertraline (selective serotonin reuptake inhibitor)?

Sertraline Tapering Protocol

Sertraline should be tapered gradually with a reduction of 10% of the most recent dose per week for shorter-term users (less than 1 year) and 5-10% per month for long-term users to minimize withdrawal symptoms. 1

Tapering Schedule for Sertraline

Standard Approach

• For patients on sertraline for less than 1 year:

  • Reduce dose by approximately 10% of the most recent dose per week
  • Example: 100mg → 90mg → 80mg → 70mg → 60mg → 50mg → etc.

• For patients on sertraline for more than 1 year:

  • Reduce dose by 5-10% of the most recent dose per month
  • Example: 100mg → 90mg → 80mg → 70mg → etc. (with 2-4 weeks between each step)

Practical Implementation

1. Use sertraline's available dosages (25mg, 50mg, 100mg tablets) to create a practical schedule
2. For the final stages when reaching very low doses:
   • Consider using sertraline oral concentrate (20mg/mL) for more precise dosing 2
   • Alternatively, extend the interval between doses (every other day) before complete discontinuation

Monitoring During Tapering

Withdrawal Symptoms to Monitor

• Common withdrawal symptoms include:
  • Somatic: Dizziness, nausea, fatigue, flu-like symptoms, sensory disturbances
  • Psychological: Anxiety, irritability, mood changes 3

Adjusting the Taper

• If withdrawal symptoms emerge:
  • Temporarily pause the taper at current dose until symptoms resolve
  • Resume with a slower taper rate (e.g., 5% reduction instead of 10%)
  • Consider returning to the previous dose if symptoms are severe 1

Special Considerations

Patients with Risk Factors

• Elderly patients: Use slower tapering (5% reductions) with more frequent monitoring 1
• Patients with anxiety disorders: Consider adjunctive non-pharmacological approaches during tapering 1
• Pregnant patients: Consult with appropriate specialists before tapering due to risks to mother and fetus 4

Managing Withdrawal with Non-Pharmacological Approaches

• Cognitive behavioral therapy
• Regular exercise
• Sleep hygiene practices
• Stress management techniques 1

Common Pitfalls and How to Avoid Them

1. Mistaking withdrawal for recurrence: Withdrawal symptoms typically emerge within days of dose reduction and are often somatic (dizziness, nausea), while recurrence of depression typically develops gradually over weeks 5

2. Tapering too quickly: Traditional guidelines recommending 2-4 week tapers show minimal benefits over abrupt discontinuation. Slower tapers over months are more successful in reducing withdrawal symptoms 5

3. Not going low enough: Tapering should continue to doses much lower than minimum therapeutic doses (50mg for sertraline) 5, 6

4. Inconsistent dosing: Ensure patient adherence to the tapering schedule, as intermittent non-compliance can trigger withdrawal symptoms 3

5. Inadequate monitoring: Regular follow-up at least monthly during the tapering process is essential 1

By following this structured approach to sertraline tapering, clinicians can minimize withdrawal symptoms and optimize outcomes for patients discontinuing this medication.