What is the recommended tapering schedule for an adult patient with no significant medical history to safely discontinue 25mg of sertraline (Selective Serotonin Reuptake Inhibitor - SSRI)?

How to Taper Off 25mg of Sertraline

For a patient on 25mg sertraline, gradually reduce the dose over 2-4 weeks before complete discontinuation, monitoring closely for withdrawal symptoms. 1

Recommended Tapering Approach

Standard Taper Protocol

• Reduce from 25mg to 12.5mg daily for 1-2 weeks, then discontinue 1, 2
• The FDA label explicitly recommends "a gradual reduction in the dose rather than abrupt cessation" for sertraline 1
• This standard approach works for most patients on low doses like 25mg who have been on treatment for shorter durations 2

Alternative Slower Taper (If Withdrawal Symptoms Emerge)

• Consider reducing by approximately 10% of the current dose every 1-2 weeks 3, 4
• For 25mg: reduce to 22.5mg for 1-2 weeks, then 20mg for 1-2 weeks, continuing this pattern down to very low doses before stopping 3
• Hyperbolic tapering (reducing doses in a way that produces linear reductions in serotonin transporter occupancy) may minimize withdrawal symptoms better than linear dose reductions 3
• This slower approach may require several weeks to months but significantly reduces withdrawal symptoms 5, 4

Monitoring for Withdrawal Symptoms

Common Withdrawal Symptoms to Watch For

• Somatic symptoms: dizziness, light-headedness, nausea, fatigue, flu-like symptoms, sensory disturbances, sleep problems 2
• Psychological symptoms: anxiety, agitation, crying spells, irritability 2
• Typical duration: withdrawal symptoms usually last 1-3 days but can persist longer 5

Management of Withdrawal Symptoms

• If mild symptoms occur: reassure the patient they are typically transient and self-limiting 2
• If severe or intolerable symptoms develop: return to the previous dose and resume tapering at a slower rate 5, 1
• Consider pausing the taper when withdrawal symptoms emerge before proceeding 5

Special Considerations

Duration of Treatment Matters

• Sertraline has a 22-36 hour elimination half-life, making it more prone to withdrawal than fluoxetine but less than paroxetine or venlafaxine 2, 6
• Patients on long-term therapy (>1 year) may need slower tapers similar to the 10% per month approach used for other antidepressants 7

Distinguishing Withdrawal from Relapse

• Withdrawal symptoms typically emerge within days of dose reduction and are self-limiting 2
• Relapse of depression develops more gradually over weeks 2
• Misdiagnosing withdrawal as relapse can lead to unnecessary long-term medication continuation 2

Clinical Pitfalls to Avoid

• Do not stop abruptly: even at 25mg, abrupt cessation can cause withdrawal symptoms 1, 2
• Do not mistake withdrawal for relapse: this leads to unnecessary resumption of medication 2
• Do not use a one-size-fits-all approach: if standard 2-4 week taper fails, switch to slower hyperbolic tapering 3, 4
• Do not ignore patient-reported withdrawal symptoms: these are real and can be distressing enough to cause missed work 2