What is the recommended tapering schedule for an adult patient with a history of depression or anxiety currently taking Lexapro (escitalopram) 20mg and Luvox (fluvoxamine) 100mg to transition to Luvox monotherapy?

Tapering from Lexapro 20mg and Luvox 100mg to Luvox Monotherapy

Taper Lexapro first while maintaining Luvox 100mg stable, reducing escitalopram by 25% of the current dose every 1-2 weeks until complete discontinuation, then continue Luvox monotherapy. 1

Rationale for This Approach

The key principle is to change only one medication at a time to isolate any withdrawal symptoms or clinical deterioration to a specific agent. Maintaining Luvox stable throughout the Lexapro taper provides continuous serotonergic coverage for your underlying anxiety or depression, minimizing the risk of symptom relapse. 1

Both escitalopram and fluvoxamine are effective SSRIs for depression and anxiety disorders, with fluvoxamine demonstrating efficacy in treating major depression with comorbid anxiety at doses of 100-300mg daily. 2 Since you're already on a therapeutic dose of Luvox (100mg), this provides adequate coverage during the transition. 3, 2

Specific Lexapro Tapering Schedule

Follow this reduction protocol for escitalopram:

• Week 1-2: Reduce from 20mg to 15mg daily (25% reduction) 1
• Week 3-4: Reduce from 15mg to 11.25mg daily (25% of current dose) 1
• Week 5-6: Reduce from 11.25mg to 8.4mg daily (approximately 25% reduction) 1
• Week 7-8: Reduce from 8.4mg to 6.3mg daily 1
• Week 9-10: Reduce from 6.3mg to 5mg daily 1
• Week 11-12: Discontinue completely 1

If withdrawal symptoms emerge at any step, slow the taper rate or temporarily return to the previous dose until symptoms subside. 1 The taper rate must be determined by your tolerance, not a rigid schedule. 4

Monitoring During the Transition

Schedule follow-up appointments every 2-4 weeks during the tapering period to assess for:

• Return of original depression or anxiety symptoms 1
• Withdrawal symptoms: anxiety, irritability, dizziness, paresthesias, headache, nausea, insomnia, or "brain zaps" 5
• Mood changes and suicidal ideation 4

More frequent contact may be needed during difficult phases of the taper. 4

Managing Withdrawal Symptoms

Common SSRI discontinuation symptoms include:

• Dizziness, headache, nausea, fatigue, irritability, and sensory disturbances 5
• These typically emerge within 1-3 days of dose reduction and resolve within 1-2 weeks 5

If withdrawal symptoms occur:

• Slow the taper rate further (reduce by 10-15% instead of 25%) 1
• Consider temporarily adding adjunctive medications: trazodone 25-50mg for insomnia, or NSAIDs/acetaminophen for headaches 4, 1
• Do not increase Luvox dose to compensate—maintain it stable 1

Maintaining Luvox Monotherapy

Continue Luvox 100mg daily unchanged throughout the entire Lexapro taper and afterward. 1 Fluvoxamine 100-300mg daily has demonstrated efficacy in treating both depression and anxiety disorders, with response rates of 38-52% in clinical trials and significant improvement in comorbid anxiety symptoms. 3, 2

Do not adjust Luvox dosing unless:

• Original symptoms return despite complete Lexapro discontinuation (may need to increase Luvox to 150-200mg) 3, 2
• Intolerable side effects emerge (may need to reduce Luvox) 3

Critical Pitfalls to Avoid

Never taper too quickly—rushing the process significantly increases withdrawal symptoms and risk of relapse. 4 Research shows that even aggressive tapers (10% every 3 days) result in only 24% completion rates. 4

Never abruptly discontinue escitalopram—this can cause severe withdrawal syndrome with significant morbidity. 5, 4

Never start adjusting Luvox simultaneously with tapering Lexapro—this makes it impossible to determine which medication is causing any emerging symptoms. 1

Never abandon the patient if tapering is difficult—maintain the therapeutic relationship and consider pausing the taper if needed. 4

Special Considerations

If you experience significant withdrawal symptoms despite slow tapering:

• Consider an even more gradual reduction (10% of current dose every 2-4 weeks instead of 25%) 4
• Pauses in the taper are acceptable and often necessary when withdrawal symptoms emerge 4
• The entire process may take 3-6 months, which is appropriate for safe discontinuation 4, 1

Cognitive-behavioral therapy (CBT) during the taper significantly increases success rates and should be incorporated if available. 4