Reducing Escitalopram from 20 mg to 15 mg: Withdrawal Risk
Yes, you can reduce escitalopram from 20 mg to 15 mg, but withdrawal symptoms are possible and the risk depends on how quickly you taper and your individual sensitivity to discontinuation effects.
Understanding Escitalopram Discontinuation Risk
The FDA label for escitalopram explicitly states that "symptoms associated with discontinuation have been reported" and recommends "a gradual reduction in the dose rather than abrupt cessation is recommended whenever possible" 1. While the label doesn't specify exact tapering schedules, it emphasizes monitoring patients during dose reductions 1.
Escitalopram has a moderate risk profile for discontinuation syndrome:
- Escitalopram (along with citalopram) carries a relatively lower risk compared to paroxetine, fluvoxamine, and sertraline, which are more commonly associated with severe withdrawal symptoms 2
- However, discontinuation syndrome still occurs frequently—one study found that 56% (14 of 25 patients) experienced withdrawal symptoms when stopping escitalopram 3
- Common symptoms include dizziness (44%), muscle tension (44%), chills (44%), confusion or trouble concentrating (40%), amnesia (28%), and crying (28%) 3
Key Factors That Increase Your Risk
Higher doses carry greater risk:
- Patients taking higher doses of escitalopram had significantly higher rates of discontinuation syndrome compared to those on lower doses 3
- Since you're at 20 mg (the maximum FDA-approved dose), you're at higher risk than someone on 10 mg 3
The size of your dose reduction matters:
- A 5 mg reduction (from 20 to 15 mg) represents a 25% decrease, which is relatively modest
- Research suggests that hyperbolic tapering (reducing the biological effect in equal increments rather than equal dose amounts) minimizes withdrawal symptoms better than linear dose reductions 4
Practical Recommendations
This 5 mg reduction is likely tolerable, but monitor closely:
- The FDA recommends gradual dose reduction and states that "if intolerable symptoms occur following a decrease in the dose, then resuming the previously prescribed dose may be considered" 1
- If withdrawal symptoms emerge, you can return to 20 mg and attempt a slower taper 1
Withdrawal symptoms typically appear within 1-3 days of dose reduction 5, so monitor yourself during the first week after the change.
Very slow tapering is recommended for all patients discontinuing escitalopram 3, and this principle applies to dose reductions as well—the slower you go, the lower your risk.
Critical Caveats
- Traditional guidelines recommending 2-4 week tapers have been shown to provide minimal benefit over abrupt discontinuation and are often not tolerated 4, 6
- Tapers over months, reaching doses much lower than minimum therapeutic doses, show greater success in reducing withdrawal symptoms 4
- The 25% reduction you're planning is more aggressive than the hyperbolic tapering approach would suggest, but may still be tolerable given that you're staying within therapeutic range 4
If you develop symptoms like dizziness, sensory disturbances, anxiety, or flu-like symptoms within days of the reduction, these are likely withdrawal effects rather than depression relapse 2, and you should contact your prescriber to discuss either returning to 20 mg or slowing the taper further.