What is the recommended tapering schedule for a patient taking Adderall (amphetamine and dextroamphetamine) 30mg and sertraline (Zoloft) 100mg daily?

Tapering Schedule for Adderall 30mg and Sertraline 100mg Daily

Adderall (Amphetamine/Dextroamphetamine) 30mg Daily

Stimulant medications like Adderall do not require a formal taper and can typically be discontinued abruptly without significant withdrawal risks. 1

• Stimulants are not associated with dangerous withdrawal syndromes like those seen with benzodiazepines or SSRIs 1
• Side effects from stimulant discontinuation are rare, short-lived, and self-limiting if they occur 1
• If you choose to taper for patient comfort, reduce by 5-10mg weekly until discontinuation 1
• Monitor for return of ADHD symptoms (inattention, hyperactivity, impulsivity) rather than withdrawal effects 1
• Schedule follow-up at least monthly during any dose adjustment period 1

Common pitfall: Confusing fatigue or mood changes after stopping stimulants with true withdrawal—these typically represent unmasked baseline symptoms rather than medication withdrawal 1

---

Sertraline (Zoloft) 100mg Daily

Sertraline requires a gradual taper over 2-4 weeks minimum, reducing by 25% of the original dose weekly to minimize discontinuation symptoms that occur in approximately 44% of patients who stop SSRIs abruptly. 2

Standard Tapering Protocol

• Week 1: Reduce to 75mg daily (25% reduction from original 100mg dose) 2
• Week 2: Reduce to 50mg daily (another 25% reduction from original dose) 2
• Week 3: Reduce to 25mg daily (another 25% reduction from original dose) 2
• Week 4: Discontinue completely 2

Important Considerations for Sertraline Tapering

• Avoid alternate-day dosing (e.g., 100mg every other day)—this causes pronounced receptor occupancy fluctuations and significantly increases withdrawal risk 3
• For patients on sertraline for prolonged periods (>1 year), consider extending the taper to 10% reductions per month rather than the standard 4-week schedule 4
• The taper rate must be determined by the patient's tolerance of withdrawal symptoms, not a rigid schedule—pauses are acceptable and often necessary 4

Managing Withdrawal Symptoms

• Schedule weekly follow-ups during the tapering period to assess for discontinuation symptoms 2
• Common withdrawal symptoms include: dizziness, nausea, fatigue, flu-like symptoms, sensory disturbances, anxiety, irritability, and sleep disturbances 5
• If severe withdrawal symptoms occur, reinstate the previous dose temporarily and slow the taper rate to 10% reductions per month 2
• Consider adjunctive medications for specific symptoms:
  • Trazodone (short-term) for insomnia 2
  • Gabapentin for anxiety and sleep disturbances 2
  • Clonidine to attenuate adrenergic withdrawal symptoms 2

Critical Safety Points

• Distinguish withdrawal symptoms from depression relapse—withdrawal symptoms typically emerge within days of dose reduction and improve over 1-2 weeks 5
• Sertraline has a shorter half-life than fluoxetine, making gradual tapering essential 5
• The goal is durability of the taper, not speed—taking 6-12 months is acceptable if needed 4

Key pitfall: Reducing too quickly based on a rigid schedule rather than patient tolerance leads to intolerable withdrawal symptoms and taper failure 4