Many patients struggle when getting off certain psychiatric medications and we don’t always understand why that is happening. When tapering off a medication that can be associated with withdrawal symptoms—for example, serotonergic antidepressants, benzodiazepines, and so on—clinicians and patients are sometimes puzzled as to why the patient has significant withdrawal symptoms in the final stages of the taper, even though the taper was done quite slowly.
It has become increasingly clear in recent years that reducing the dose in a linear fashion often results in withdrawal symptoms, especially with the last few reductions in the dose.
Here’s an example of linear reductions in the dose of medication. Let’s say the patient was on sertraline 200 mg/day, and a decision has been made to discontinue the medication without replacing it with another serotonergic medication. What we now know NOT to do is to recommend something like, say, reducing sertraline by 25 mg every week until stopped.
Important! It would still be linear tapering if, instead of every week, we recommended reducing it every two weeks or if we recommended that each reduction in dose be smaller, for example, by 12.5 mg (half of a 25 mg tablet) at a time.
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