Do You Have to Wean Off Lexapro (Escitalopram)?
Yes, you must gradually taper Lexapro (escitalopram) when discontinuing it—abrupt cessation can cause withdrawal symptoms that begin within 24-48 hours and include dizziness, anxiety, agitation, sensory disturbances, headache, and emotional instability. 1
Why Tapering Is Essential
- All SSRIs, including escitalopram, should be slowly tapered when discontinued because of the risk of withdrawal effects. 2
- The FDA drug label explicitly states that spontaneous reports of adverse events have occurred upon discontinuation of escitalopram, particularly when abrupt, and recommends gradual dose reduction rather than abrupt cessation whenever possible. 1
- Withdrawal symptoms typically begin within 1 week of stopping or reducing the dose, with most symptoms resolving spontaneously within 1-3 weeks. 3
Common Withdrawal Symptoms
The discontinuation syndrome includes: 1
- Dizziness (reported in 44% of patients in one study) 4
- Anxiety and agitation 3
- Sensory disturbances (paresthesias such as electric shock sensations) 1
- Muscle tension and chills (each 44%) 4
- Confusion or trouble concentrating (40%) 4
- Irritability, headache, lethargy, emotional lability, insomnia 1
- Nausea and other gastrointestinal symptoms 1
How to Safely Taper Escitalopram
The recommended approach is to reduce the dose in small increments with adequate time between reductions: 3
- Reduce by 2.5-5 mg at a time (not larger decrements) 3
- Wait 2-4 weeks between each dose reduction to allow stabilization 3
- Monitor closely for withdrawal symptoms in the first 24-48 hours after each dose adjustment 3
- If intolerable symptoms occur, resume the previously prescribed dose and then decrease more gradually 1
Important Clinical Considerations
Higher doses and plasma concentrations of escitalopram are associated with greater risk of discontinuation syndrome: 4
- Patients on higher therapeutic doses require particularly careful, slow tapering 4
- Very slow tapering is recommended for all patients 4
Distinguish withdrawal from relapse: 3
- Withdrawal symptoms appear within 24-48 hours to 1 week and improve gradually over 1-2 weeks 3
- Relapse of the underlying depression/anxiety develops more slowly (after 2-6 weeks) and does not improve spontaneously 3
- At 3 months post-discontinuation, recurrence of symptoms is more likely to represent relapse of the psychiatric condition rather than withdrawal 3
Common Pitfall to Avoid
Do not confuse the relatively short half-life of escitalopram (27-33 hours) with the ability to stop it quickly. 5 Even though steady-state is achieved within 7-10 days, physiological dependence can develop after as little as 10 days of treatment, making gradual tapering necessary regardless of treatment duration. 3