Discontinuing Lexapro (Escitalopram) 10 mg
Taper escitalopram 10 mg gradually over several weeks to months rather than stopping abruptly, reducing the dose incrementally to minimize withdrawal symptoms and prevent relapse. 1
FDA-Approved Tapering Protocol
The FDA label for escitalopram explicitly states that "a gradual reduction in the dose rather than abrupt cessation is recommended whenever possible" to avoid discontinuation symptoms. 1 If intolerable symptoms occur following a dose decrease, resuming the previously prescribed dose should be considered, followed by a more gradual taper. 1
Recommended Tapering Strategy
Duration and Method
- Taper over weeks to months, not days, to allow neuroadaptations time to resolve and minimize withdrawal symptoms. 2, 3
- Studies demonstrate that tapers of 2-4 weeks (as traditionally recommended) show minimal benefit over abrupt discontinuation and are often poorly tolerated. 2
- Longer tapers over several months are significantly more successful at reducing withdrawal symptoms compared to rapid tapers. 2, 4
Dose Reduction Approach
- Use hyperbolic (exponential) tapering rather than linear reductions—meaning each reduction should be a fixed percentage (e.g., 25% or 10%) of the most recent dose, not the original dose. 4, 5
- For a 10 mg dose, consider reducing by 25% increments: 10 mg → 7.5 mg → 5.6 mg → 4.2 mg → 3.2 mg, etc., at intervals of 3-6 weeks. 4, 5
- Some patients may require even slower tapers of 10% of the most recent dose each month. 5
- Final doses before complete cessation may need to be very small (1-2 mg or less) to prevent a large drop in serotonergic activity when stopped entirely. 4
Monitoring Requirements
Assess patients within 1-2 weeks after each dose reduction to evaluate for withdrawal symptoms. 6
Monitor specifically for: 1, 3
- Dizziness, vertigo, paresthesias (tingling sensations)
- Flu-like symptoms (fatigue, headache, myalgias)
- Mood disturbances (irritability, anxiety, low mood)
- Insomnia or vivid dreams
- Gastrointestinal symptoms (nausea)
Continue monitoring every 2-4 weeks throughout the taper and for several months after complete discontinuation, as relapse can occur weeks to months later. 2
Distinguish withdrawal symptoms from relapse of depression—withdrawal typically occurs within days of dose reduction and improves over 1-2 weeks, while relapse develops more gradually. 2, 3
Managing Withdrawal Symptoms
- If intolerable withdrawal symptoms develop, restart the previous dose and then taper even more slowly (e.g., reduce by 10% instead of 25%, or extend intervals to 6-8 weeks). 1, 3
- Provide symptomatic management as needed (e.g., antihistamines for dizziness, NSAIDs for headache). 3
- Patient education and reassurance are critical throughout the process—explain that withdrawal symptoms are temporary and do not indicate addiction. 7
Critical Cautions
- Never abruptly discontinue escitalopram, as this significantly increases risk of withdrawal symptoms and relapse. 1, 2
- Patients with recurrent depression (≥2 prior episodes) have higher relapse rates after discontinuation and may require indefinite maintenance treatment rather than discontinuation. 2
- If switching to another antidepressant, allow at least 14 days between stopping escitalopram and starting an MAOI. 1
- Withdrawal symptoms can last days to months depending on the individual and taper speed. 3
Common Pitfall to Avoid
The most common error is tapering too quickly (over 2-4 weeks) down to only the therapeutic minimum dose (5 mg), which fails to prevent withdrawal symptoms in many patients. 2, 4 Instead, taper slowly over months down to sub-therapeutic doses (1-2 mg or less) before complete cessation. 4