From the Guidelines
Tapering off sertraline should always be done under medical supervision, with a gradual reduction in dose over several weeks to minimize the risk of discontinuation syndrome, as noted in the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1. When tapering off sertraline, it's essential to consider the potential for discontinuation syndrome, which can be characterized by symptoms such as dizziness, fatigue, lethargy, and anxiety 1.
- A common tapering schedule might begin with reducing your current dose by 25-50mg every 1-2 weeks, with smaller and more gradual reductions as you reach lower doses.
- For example, if you're taking 100mg daily, you might reduce to 75mg for 1-2 weeks, then 50mg for 1-2 weeks, then 25mg for 1-2 weeks before stopping completely.
- Some people benefit from even slower tapers, especially at the lower doses, such as taking 25mg every other day before stopping.
- During this process, monitor yourself for withdrawal symptoms like dizziness, nausea, headaches, electric shock sensations, irritability, or mood changes.
- If these occur, your doctor may slow the taper further.
- Staying hydrated, maintaining regular sleep patterns, and engaging in gentle exercise can help manage withdrawal symptoms. The gradual reduction allows your brain to adjust to decreasing levels of serotonin, as sertraline is an SSRI that increases serotonin availability in the brain, and sudden discontinuation can cause significant chemical imbalances 1.
- Medical education, training, and experience are necessary to safely and effectively prescribe antidepressant medications, including tapering off sertraline 1.
- A conservative medication trial for mild to moderate anxiety presentations may entail increasing the dose as tolerated within the therapeutic dosage range in the smallest available increments at approximately 1- to 2-week intervals when prescribing shorter half-life SSRIs, such as sertraline 1.
From the FDA Drug Label
If the decision has been made to discontinue treatment, medication should be tapered, as rapidly as is feasible, but with recognition that abrupt discontinuation can be associated with certain symptoms The FDA drug label does not provide specific guidance on how to taper off sertraline, only that it should be tapered as rapidly as is feasible.
From the Research
Tapering Off Sertraline
To taper off sertraline, it is essential to follow a gradual withdrawal plan to minimize the risk of withdrawal symptoms. The following points should be considered:
- Gradual tapering is recommended, with small steps taken especially in the low-dose range 2
- The incidence of antidepressant withdrawal syndrome (AWS) can be reduced by tapering the dose compared to abrupt stoppage, although the difference is not significant 3
- Risk factors for withdrawal symptoms include being female, younger, experiencing adverse effects early in treatment, taking higher doses or longer duration of medication, abrupt cessation of drugs, and those with a lower clearance of drugs or with serotonin 1A receptor gene variation 3
- Symptoms typically occur within a few days from drug discontinuation and last a few weeks, even with gradual tapering 4
- Protracted withdrawal syndrome (PWS) after stopping antidepressants can be severe and long-lasting, with manifestations clinically heterogeneous 5
Withdrawal Symptoms
Withdrawal symptoms from sertraline can be diverse and may include:
- Unspecific physical symptoms, such as headache, fatigue, dizziness, brain zaps, visual changes, muscle aches, tremor, diarrhea, and nausea 2, 5
- Affective symptoms, such as anxiety, depression, emerging suicidality, and agitation 5
- Sleep problems and cognitive impairments 5
- These symptoms can be easily misidentified as signs of impending relapse 4
Clinical Approach
Clinicians should be aware of the potential vulnerabilities induced by sertraline and other antidepressants, and add them to the list of drugs potentially inducing withdrawal symptoms upon discontinuation 4
- A comprehensive assessment of medication history, duration of the withdrawal syndrome, and its various somatic, affective, sleep, and cognitive symptoms is necessary for proper recognition and detection of PWS 5
- Patients should be informed about the risk of withdrawal both as early as the joint decision-making process about treatment initiation and regularly during the course of treatment 2