What is the duration of withdrawal from Lexapro (escitalopram)?

From the Guidelines

The duration of withdrawal from Lexapro (escitalopram) should be at least 2-6 weeks or longer, with a gradual tapering process to minimize withdrawal symptoms. When discontinuing Lexapro, it's essential to consider the potential for discontinuation syndrome, characterized by symptoms such as dizziness, fatigue, lethargy, and anxiety, as noted in the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1. The guideline highlights that SSRIs, including escitalopram, can cause discontinuation syndrome, especially when discontinued abruptly or with a rapid dose reduction. Key factors to consider when tapering off Lexapro include:

• Starting with a low dose and gradually increasing it as needed and tolerated
• Tapering the dose slowly, over a period of 2-6 weeks or longer, to minimize withdrawal symptoms
• Monitoring for symptoms, especially in the first 24 to 48 hours after dosage changes
• Considering a personalized tapering plan based on individual factors, such as the duration of treatment and the dose being taken. For example, a common tapering schedule might involve reducing the dose by 5mg every 2-4 weeks under medical supervision, as this approach allows for a gradual adjustment to the chemical changes in the brain caused by Lexapro 1. It's crucial to consult with a healthcare provider before making any changes to the medication regimen, as they can create a personalized tapering plan based on the individual's specific situation.

From the FDA Drug Label

1. 5 Discontinuation of Treatment with Escitalopram tablets Symptoms associated with discontinuation of Escitalopram tablets and other SSRIs and SNRIs have been reported [see Warnings and Precautions (5. 3)]. Patients should be monitored for these symptoms when discontinuing treatment. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate.

The duration of withdrawal from Lexapro (escitalopram) is not explicitly stated in the drug label. However, it is recommended that a gradual reduction in dose be used when discontinuing treatment to minimize symptoms.

• The label recommends monitoring patients for symptoms when discontinuing treatment, but does not provide a specific duration for withdrawal symptoms 2.

From the Research

Duration of Withdrawal from Lexapro (Escitalopram)

• The duration of withdrawal from Lexapro (escitalopram) can vary depending on several factors, including the dosage, duration of use, and individual tolerance 3, 4.
• Studies suggest that tapering off Lexapro over a period of weeks or months can help minimize withdrawal symptoms 4, 5.
• A study published in 2021 found that using tapering strips to gradually reduce the dose of antidepressants, including Lexapro, can be an effective way to discontinue use with minimal withdrawal symptoms 5.
• The median duration of antidepressant use in this study was 5-10 years, and most participants (71%) had tried to come off without tapering strips at least once 5.
• The study found that most patients (72%) were able to discontinue their antidepressant using a median of two strips to taper over a median period of 56 days 5.
• Another study published in 2019 suggested that tapering SSRIs, including Lexapro, over a period of months and down to doses much lower than minimum therapeutic doses can help reduce withdrawal symptoms 4.
• The study recommended a hyperbolic tapering schedule, which involves gradually reducing the dose of the medication in a non-linear fashion to minimize withdrawal symptoms 4.

Factors Influencing Withdrawal Duration

• The duration of withdrawal from Lexapro can be influenced by several factors, including:
  • Dosage: Higher doses of Lexapro may require a longer tapering period to minimize withdrawal symptoms 3, 4.
  • Duration of use: Longer duration of use may require a longer tapering period to minimize withdrawal symptoms 3, 4.
  • Individual tolerance: Individual tolerance to Lexapro can affect the severity and duration of withdrawal symptoms 3, 4.
• A study published in 2021 found that females and individuals with more severe experience of withdrawal during the use of tapering strips, more years of use of antidepressant medication, and more previous attempts at discontinuation were less likely to be able to discontinue their antidepressant medication with tapering strips 5.