How do I taper off Lexapro (escitalopram) and start Buspar (buspirone)?

How to Taper Off Lexapro and Start Buspar

When transitioning from escitalopram (Lexapro) to buspirone (Buspar), a gradual taper of escitalopram over several weeks is recommended to minimize withdrawal symptoms, followed by initiation of buspirone after escitalopram is reduced to a low dose or discontinued completely. This approach minimizes the risk of SSRI withdrawal syndrome while allowing for effective anxiety management during the transition.

Escitalopram (Lexapro) Tapering Protocol

• Begin with a slow taper of escitalopram, reducing by approximately 10% of the current dose every 1-2 weeks to minimize withdrawal symptoms 1
• For patients on higher doses (e.g., 20mg), consider an initial reduction to 15mg for 1-2 weeks, then 10mg for 1-2 weeks, then 5mg for 1-2 weeks, before discontinuing 1, 2
• For patients already on 10mg, consider reducing to 5mg for 2 weeks before discontinuing 1, 2
• During the final stages of tapering, consider even smaller dose reductions (e.g., 5mg to 2.5mg) to minimize withdrawal effects 1, 3
• Extended tapering over months may be necessary for patients who have been on escitalopram for years or who experience significant withdrawal symptoms 3, 4

Managing SSRI Withdrawal Symptoms

• Monitor for common withdrawal symptoms including dizziness, nausea, headache, irritability, anxiety, insomnia, and sensory disturbances 2
• If withdrawal symptoms become severe, slow the taper further or temporarily return to the previous dose before attempting a more gradual reduction 2
• Distinguish between withdrawal symptoms (which typically emerge within days of dose reduction and are time-limited) and recurrence of the original condition 1
• Consider using adjunctive medications temporarily to manage specific withdrawal symptoms (e.g., antihistamines for sleep disturbances) 2

Initiating Buspirone (Buspar)

• Begin buspirone after escitalopram has been reduced to a low dose (e.g., 5mg) or completely discontinued 5
• Start with a low dose of buspirone, typically 5mg twice daily 5
• Gradually increase buspirone dose by 5mg every 2-3 days as tolerated 5
• Target buspirone dose is typically 15-30mg daily, divided into 2-3 doses 5
• Allow 2-4 weeks for buspirone to reach full therapeutic effect; it does not work immediately like benzodiazepines 5

Important Considerations

• Buspirone has a different mechanism of action than escitalopram, primarily affecting 5-HT1A receptors rather than blocking serotonin reuptake 5
• Unlike escitalopram, buspirone does not cause physical dependence or withdrawal symptoms 5
• Buspirone has minimal sedation effects and does not impair psychomotor function 5
• Buspirone is specifically indicated for generalized anxiety disorder and may not be effective for all conditions treated by escitalopram 5

Monitoring During Transition

• Schedule follow-up appointments every 1-2 weeks during the transition period to monitor for withdrawal symptoms and therapeutic response 2
• Assess for return of original symptoms versus emergence of withdrawal symptoms 1
• If anxiety symptoms worsen significantly during the transition, consider slowing the escitalopram taper or increasing the buspirone dose more quickly 2
• Document mood, anxiety levels, sleep quality, and side effects at each follow-up 2

Special Considerations

• For patients with a history of severe anxiety or depression, consider overlapping the medications more extensively (starting buspirone while still on a moderate dose of escitalopram) 2
• If the patient is also taking benzodiazepines, prioritize tapering those medications only after the escitalopram-to-buspirone transition is complete, as benzodiazepine withdrawal carries greater risks 6
• Patients with comorbid conditions may require more specialized tapering protocols and closer monitoring 3