How to Taper Sertraline
Sertraline should be tapered gradually over 2-4 weeks minimum by reducing the dose approximately 10% of the original dose every 2-4 weeks, avoiding abrupt cessation to prevent discontinuation syndrome. 1
Tapering Strategy
Reduce sertraline by approximately 10% of the original dose every 2-4 weeks to minimize withdrawal symptoms, with slower tapers (10% per month or less) being more appropriate for patients on long-term therapy. 2
For shorter half-life SSRIs like sertraline (elimination half-life approximately 26 hours), dose adjustments can be made at approximately 1-2 week intervals when tapering. 1, 3
Avoid alternate-day dosing when tapering, as this approach causes pronounced increases in receptor occupancy variation and significantly increases the risk of withdrawal symptoms, even at minimum therapeutic doses. 4
Critical Pitfall: Hyperbolic Tapering Required
Standard linear tapers to therapeutic minimum doses (50 mg) or half-minimum doses show minimal benefits over abrupt discontinuation and are often not tolerated by patients. 5
Tapers must extend to doses much lower than minimum therapeutic doses (well below 50 mg) to minimize withdrawal symptoms, as PET imaging data demonstrates that hyperbolically reducing SSRI doses reduces their effect on serotonin transporter inhibition in a linear manner. 5
This means you cannot simply stop at 25 mg or 12.5 mg—the taper should continue to progressively smaller doses (potentially as low as 6.25 mg, 3 mg, or lower) before complete cessation. 5
Monitoring for Discontinuation Syndrome
Watch for discontinuation syndrome symptoms including dizziness, fatigue, myalgias, headaches, nausea, insomnia, and sensory disturbances after each dose reduction. 1
If severe withdrawal symptoms occur, return to the previous well-tolerated dose and slow the taper further before attempting another reduction. 2
Assess for withdrawal symptoms after each dose reduction before proceeding to the next step. 2
Timeline Considerations
Minimum tapering duration should be 2-3 months for short-term users, with extended tapering duration of 6-12 months for long-term users, as slower tapering over months is associated with lower relapse rates compared to rapid tapers over weeks. 2
Most adverse effects emerge within the first few weeks of any dose change, so allow adequate time at each dose level before further reduction. 1
The taper should be considered successful as long as progress is being made, even if temporary pauses are needed. 2
Practical Dosing Adjustments
At low doses of sertraline, some patients may require twice-daily dosing to maintain more stable blood levels during the taper. 1
Sertraline can be administered at any time of day (morning or evening), so timing can be adjusted to minimize specific withdrawal symptoms. 1
Consider using liquid formulations or compounded preparations to achieve the very small doses required for proper hyperbolic tapering below 25 mg. 5
Safety Monitoring During Taper
Continue monitoring for suicidal thinking and behavior during the tapering process, as dose adjustments represent a vulnerable period. 1
Watch for behavioral activation/agitation, hypomania, mania, and serotonin syndrome if the patient is on other serotonergic medications. 1
If symptoms of the original condition re-emerge after complete discontinuation, consider restarting at the last effective dose rather than pushing through severe symptoms. 2