Tapering Lexapro from 10 mg
Reduce Lexapro by 25% of the current dose every 1-2 weeks initially (from 10 mg to 7.5 mg, then to approximately 5.6 mg, etc.), extending to 10% reductions as you approach lower doses, with a minimum total taper duration of 4 weeks but ideally several months. 1
Recommended Tapering Protocol
The hyperbolic (percentage-based) tapering approach is superior to linear tapering because it reduces the biological effect at serotonin transporters in a more even manner, minimizing withdrawal symptoms. 1, 2
Initial Phase (Higher Doses)
- Start by reducing 25% of the current dose (not the original dose) every 1-2 weeks 1
- From 10 mg: reduce to 7.5 mg for 1-2 weeks, then to approximately 5.6 mg for 1-2 weeks 1
Later Phase (Lower Doses)
- As you approach lower doses, slow down to 10% reductions of the current dose 1
- This means progressively smaller absolute dose reductions as the total dose decreases 2
- Final doses before complete cessation may need to be very small (potentially 1-2 mg or less) to prevent a large drop in serotonin transporter occupancy 2, 3
Timeline Considerations
- Minimum duration: 4 weeks, but longer tapers (months) show greater success in reducing withdrawal symptoms 1, 2
- Escitalopram has a relatively short half-life, making gradual tapering particularly important 4
- Some patients may benefit from extending the taper over several months, particularly if they've been on the medication long-term 5
Managing Withdrawal Symptoms
Common Symptoms to Monitor
- Dizziness and light-headedness 4
- Nausea, flu-like symptoms, fatigue 4
- Sensory disturbances (paresthesias) 5
- Sleep disturbances, insomnia 4, 5
- Mood disturbances, anxiety, irritability, crying spells 4, 5
If Withdrawal Symptoms Emerge
- Pause the taper and maintain the current dose until symptoms stabilize 1
- If symptoms are severe, return to the previous higher dose 5
- Once stable, resume tapering with smaller reductions (e.g., 10% instead of 25%) 1
- Extend the time between dose reductions to 3-4 weeks or longer 1
Monitoring Requirements
- Follow up at least monthly during the taper, with more frequent contact during difficult phases 1
- Assess for withdrawal symptoms versus return of underlying depression 5
- Screen for mood changes and ensure symptoms are not being mistaken for relapse 4, 6
Critical Pitfalls to Avoid
Don't Taper Too Quickly
- Traditional guidance recommending 2-4 week tapers shows minimal benefit over abrupt discontinuation and is often not tolerated 2
- Tapers over months are more successful 2
Don't Abandon the Patient
- Maintain frequent follow-up throughout the process 1
- The therapeutic relationship is crucial even if tapering proves difficult 1
Don't Use Linear Dose Reductions
- Reducing by the same absolute amount (e.g., 2.5 mg every week) creates disproportionately large reductions in biological effect as doses get lower 2
- Always reduce by a percentage of the current dose, not the original dose 1
Don't Mistake Withdrawal for Relapse
- Withdrawal symptoms can last days to months and may be misdiagnosed as depression recurrence 4, 5
- This misdiagnosis can lead to unnecessary long-term medication 2
Patient-Centered Approach
The taper rate must be determined by the patient's tolerance, not a rigid schedule. 1 Pauses in the taper are acceptable and often necessary when withdrawal symptoms emerge. 1 Some patients may require even slower tapers (10% per month or less) depending on their individual response. 2