Tapering Lexapro from 10 mg in Adults
Discontinue Lexapro gradually over 10-14 days by reducing the dose incrementally to minimize withdrawal symptoms. 1
Recommended Tapering Schedule
The standard approach is to reduce escitalopram by 50% for 5-7 days, then discontinue completely. 1 This translates to:
- Days 1-7: Reduce from 10 mg to 5 mg daily
- Days 8-14: Discontinue completely
Alternatively, for patients with previous withdrawal sensitivity or prolonged treatment duration (>1 year), consider a more conservative taper:
- Week 1-2: 7.5 mg daily (can split 10 mg tablet or use liquid formulation)
- Week 3-4: 5 mg daily
- Week 5: 2.5 mg daily
- Week 6: Discontinue
Critical Monitoring During Taper
Monitor weekly for discontinuation symptoms including dizziness, nausea, headache, irritability, insomnia, and sensory disturbances (electric shock sensations). 1 If significant withdrawal symptoms emerge:
- Return immediately to the previous dose that was tolerated 1
- Hold at that dose for an additional 1-2 weeks before attempting further reduction
- Consider extending the total taper duration to 4-6 weeks
Important Clinical Considerations
The risk of relapse is highest in the first 8-12 weeks after complete discontinuation. 1 Schedule follow-up visits:
- At 2 weeks post-discontinuation
- At 4-6 weeks post-discontinuation
- At 3 months post-discontinuation
Assess for return of original depressive or anxiety symptoms versus withdrawal effects. 1 Withdrawal symptoms typically emerge within 1-5 days of dose reduction and resolve within 1-2 weeks, while relapse symptoms develop more gradually over weeks to months.
Duration of Prior Treatment Matters
After a first episode of depression, continue treatment for 4-12 months before considering discontinuation. 1 Patients with recurrent depression (≥2 prior episodes) face 70-90% relapse risk and may benefit from indefinite maintenance therapy rather than discontinuation. 1
Common Pitfalls to Avoid
Never discontinue abruptly—this dramatically increases withdrawal symptom severity. 1 The 10-14 day taper is the minimum acceptable duration; faster discontinuation is not recommended.
Do not confuse withdrawal symptoms with relapse. 1 Withdrawal symptoms appear rapidly (within days), are often physical (dizziness, paresthesias), and resolve quickly. Relapse symptoms develop gradually (over weeks), are primarily mood/anxiety-related, and persist without treatment reinitiation.
Avoid discontinuing during high-stress periods or major life transitions. This increases relapse risk independent of the taper schedule itself.