Tapering Lexapro 20mg Over 14 Days
For a 14-day taper of Lexapro (escitalopram) 20mg, reduce to 10mg daily for 7 days, then 5mg daily for 7 days before stopping—though this rapid schedule carries significant risk of withdrawal symptoms and a slower taper over several months would be safer.
Understanding the Risks of Rapid Tapering
The 14-day timeframe you're asking about is considerably faster than evidence-based recommendations suggest is optimal. Research demonstrates that:
- Discontinuing antidepressants over 10-14 days is designed to limit withdrawal symptoms, but this approach shows minimal benefits over abrupt discontinuation 1
- Tapers over months down to doses much lower than minimum therapeutic doses have shown greater success in reducing withdrawal symptoms 2
- Very low-certainty evidence suggests that tapered discontinuation (even when lasting four weeks or less) may lead to higher risk of relapse compared to continuation 3
The Recommended 14-Day Schedule (If You Must)
If you are committed to a 14-day taper despite the risks:
Days 1-7: Reduce from 20mg to 10mg daily Days 8-14: Reduce from 10mg to 5mg daily Day 15: Discontinue
This follows the general principle of reducing by approximately 50% at each step 1. However, this schedule does not reach the very low doses that research suggests are important for minimizing withdrawal 2.
Why This Timeframe Is Problematic
- Withdrawal symptoms are commonly mistaken for relapse of depression, making it difficult to distinguish whether symptoms represent true recurrence or medication withdrawal 2, 3
- Common withdrawal symptoms include low mood, dizziness, anxiety, insomnia, nausea, irritability, and tremor 4, 5
- Hyperbolic (exponential) tapering to very low doses is increasingly recognized as superior to linear tapering, as it maintains more consistent receptor occupancy 2, 6
- The minimum therapeutic dose of escitalopram is 10mg, but effective tapering often requires going well below this to minimize withdrawal 2
A Safer Alternative Approach
If circumstances allow, strongly consider extending the taper to at least 4-8 weeks or longer:
- Week 1-2: 15mg daily (if you can obtain this dose via liquid formulation or splitting tablets)
- Week 3-4: 10mg daily
- Week 5-6: 5mg daily
- Week 7-8: 2.5mg daily (requires liquid formulation or careful tablet splitting)
- Then discontinue
Even this 8-week schedule is faster than optimal. Research increasingly supports tapers lasting several months, particularly for patients who have been on antidepressants long-term 2, 3.
Critical Warnings About Alternate-Day Dosing
Do not attempt to taper by taking your medication every other day 7. This approach:
- Leads to pronounced increases in receptor occupancy variation
- Likely increases the risk of withdrawal symptoms
- Cannot be recommended as a prudent tapering strategy 7
Managing Withdrawal Symptoms
If withdrawal symptoms emerge during your taper:
- Return to the previous well-tolerated dose and slow the taper further 4, 5
- Consider short-term use of non-benzodiazepine sleep aids for insomnia 5
- Use supportive medications for specific symptoms like nausea or dizziness as needed 5
- Do not set arbitrary time limits for completing the taper—adjust based on your response 4
Special Populations at Higher Risk
The evidence base is particularly limited for:
- Patients with only one or no prior episodes of depression 3
- People aged 65 years and older 3
- Those taking antidepressants primarily for anxiety 3
These groups may require even more cautious tapering approaches.
The Bottom Line
While a 14-day taper is technically possible using the schedule outlined above, current evidence strongly suggests this timeframe is too rapid for most patients and carries substantial risk of withdrawal symptoms that may be severe enough to compel you to restart the medication 2, 3. If your clinical situation allows any flexibility, extending the taper to at least 4-8 weeks—or ideally several months with hyperbolic dose reductions to very low doses—would significantly improve your chances of successful discontinuation without distressing withdrawal symptoms.