Safely Discontinuing Lexapro (Escitalopram)
Yes, you absolutely need to wean off Lexapro—abrupt discontinuation can cause significant withdrawal symptoms and should be avoided except in emergency situations. 1
Why Gradual Tapering is Essential
A gradual dose reduction rather than abrupt cessation is recommended whenever possible to minimize discontinuation symptoms. 1 Stopping SSRIs like Lexapro suddenly can trigger antidepressant discontinuation syndrome (ADS), characterized by:
- Dizziness, electric shock-like sensations, and paresthesias 1, 2
- Flu-like symptoms including headache, sweating, and nausea 1, 2
- Mood disturbances including anxiety, irritability, and confusion 1
- Sleep disturbances and restlessness 1
- These symptoms can last from days to months depending on the individual 2
Recommended Tapering Approach
The FDA label for escitalopram explicitly states that patients should be monitored for discontinuation symptoms and that gradual dose reduction is preferred over abrupt cessation. 1 If intolerable symptoms occur following a dose decrease, resuming the previously prescribed dose should be considered, followed by an even more gradual taper. 1
Tapering Duration and Strategy
Current evidence suggests that tapers should occur over weeks to months, not the traditional 2-4 weeks recommended in older guidelines. 3, 4, 2 The most recent research indicates:
- Short tapers (2-4 weeks) show minimal benefit over abrupt discontinuation and are often not tolerated by patients 4
- Tapers extending over months and reaching doses much lower than minimum therapeutic doses have shown greater success in reducing withdrawal symptoms 4
- Hyperbolic (exponential) tapering—where each new dose is approximately 90% of the previous dose—may be more effective than linear tapering 4
A practical approach involves:
- Reducing the dose by small increments (e.g., 10% of the current dose, not the original dose) 5, 4
- Waiting 1-2 weeks between dose reductions for shorter half-life SSRIs like escitalopram 5
- Slowing the taper further in the low-dose range, as receptor occupancy changes are more dramatic at lower doses 4
- Continuing to very small doses (potentially 1-2 mg or less) before complete cessation 4
Managing Withdrawal Symptoms
If discontinuation symptoms develop despite tapering, restart the previous dose and then taper even more slowly. 1, 2 Additional symptomatic management may include:
- Clonidine for autonomic symptoms 5
- Symptomatic treatment for specific complaints (e.g., antiemetics for nausea) 2
- Reassurance and patient education that symptoms are temporary 6
Special Considerations
Escitalopram (along with paroxetine, fluvoxamine, and sertraline) has been specifically associated with discontinuation syndrome. 5 This makes careful tapering particularly important for this medication.
Patient education is critical throughout the discontinuation process. 6 Patients should understand:
- What symptoms to expect and that they are temporary, not a return of depression 6
- The importance of not stopping abruptly on their own 1
- When to contact their healthcare provider 1
When Tapering May Not Be Appropriate
The only exceptions to gradual tapering are extreme cases such as:
- Confirmed medication diversion 5
- Serious medical toxicity requiring immediate cessation 5
- Serotonin syndrome or severe allergic reactions 1
Even in these situations, there may be risks associated with abrupt discontinuation that must be weighed against the emergency. 5
Monitoring During Discontinuation
Close observation and support during the taper are critical, with clinician availability to treat symptoms and manage concerns. 5 Contact (in-person or by telephone) should occur regularly after dose reductions to assess for withdrawal symptoms and provide support. 5