Reducing Escitalopram from 20 mg to 15 mg: Discontinuation Risk
Discontinuation symptoms are possible but typically mild when reducing escitalopram from 20 mg to 15 mg after 8 months of treatment, especially if the dose reduction is gradual. 1, 2
Understanding Your Risk
The likelihood and severity of discontinuation symptoms depend primarily on the size of the dose reduction and how quickly you taper. 1, 3
- A 25% dose reduction (20 mg to 15 mg) represents a moderate decrease that can trigger withdrawal symptoms in some patients 2
- Higher baseline doses of escitalopram are associated with increased risk of discontinuation syndrome 2
- Escitalopram has a relatively favorable discontinuation profile compared to other SSRIs like paroxetine or sertraline, with milder withdrawal symptoms 4, 5
Common Discontinuation Symptoms to Watch For
If discontinuation symptoms occur, they typically begin within 2-4 days of the dose reduction and include: 3, 2
- Dizziness (44% of patients with discontinuation syndrome) 2
- Muscle tension (44%) 2
- Chills (44%) 2
- Confusion or trouble concentrating (40%) 2
- Anxiety, irritability, or agitation 3
- Sensory disturbances (electric shock sensations) 3
Most reactions are mild and short-lived, typically resolving within 1-2 weeks even without intervention 3
Recommended Tapering Strategy
To minimize discontinuation symptoms, implement a gradual dose reduction rather than an abrupt change: 1, 3
- Week 1-2: Reduce from 20 mg to 17.5 mg (alternate 20 mg and 15 mg every other day, or split tablets if feasible)
- Week 3-4: Continue at 15 mg daily
- Monitor for symptoms during each step before proceeding 1
If intolerable symptoms develop at 15 mg, return to the previous dose (17.5 mg or 20 mg) until symptoms resolve, then attempt a slower taper 1, 3
Critical Monitoring Points
Contact your prescriber within the first week after reducing to 15 mg to assess for: 1
- Emergence of discontinuation symptoms
- Worsening depression or anxiety
- Suicidal thoughts or unusual behavior changes
Very slow tapering is recommended for all patients to prevent symptom re-emergence 2
Common Pitfalls to Avoid
- Do not stop escitalopram abruptly—always use gradual dose reduction 1, 3
- Do not assume that mild initial symptoms will worsen—most discontinuation reactions are self-limited 3
- Do not confuse discontinuation symptoms with depression relapse—withdrawal symptoms typically include physical manifestations (dizziness, chills) that are not characteristic of depression 3, 2
If Symptoms Become Intolerable
Reinstatement of the previous dose (20 mg) usually leads to symptom resolution within 24 hours 3
After symptoms resolve, you can attempt an even more gradual taper (e.g., reducing by 2.5 mg every 2-4 weeks) 3