Free Sample Table: Hyperbolic Taper for SSRIs

If a patient is tapering off SSRIs completely — rather than switching to another antidepressant — a hyperbolic taper minimizes the risk of withdrawal. The goal is to reduce the dose in larger increments initially, until the minimally effective dose is reached. After that point, reductions become smaller, often requiring a liquid formulation or compounding pharmacy.

Withdrawal vs. Relapse — How to Tell the Difference

Withdrawal symptoms begin within days of a missed dose, peak within a week, and resolve quickly when the antidepressant is restarted. A new depressive episode returns more gradually — typically weeks after a taper — and improves slowly with treatment. Anxiety, insomnia, and low mood can signal either; timing is the key diagnostic feature.

A Hyperbolic Taper for SSRIs — Step by Step

Lower to the Minimum Effective Dose Reduce the dose to the minimum shown in the table below (e.g., citalopram 20 mg) if not already there. At this stage, reductions can be linear (e.g., by 5–10 mg), since the primary risk here is depressive relapse rather than serotonin withdrawal. Lowering every two to four weeks is reasonable for most patients; longer intervals may be needed for those with a history of withdrawal problems or prolonged treatment.
Assess Baseline Symptoms Before proceeding, check whether the patient is already experiencing any symptoms that overlap with SSRI withdrawal at baseline. This creates a reference point for evaluating any new symptoms that emerge during the taper.
Lower for One Month and Reassess Move to the first tapering dose in the table (e.g., citalopram 10 mg). Monitor for withdrawal symptoms throughout and adjust the pace of the taper based on what the patient reports.
Start the Long-Tail Taper Continue through the tapering doses in the table. How quickly to move between steps depends on each patient's sensitivity to withdrawal — informed by your baseline assessment and the one-month follow-up. Allow at least two weeks between steps; four weeks is a reasonable average. Patients who experience withdrawal effects tend to do better with smaller dose reductions at each step, rather than simply stretching the time between steps.

Table 46-1. Tapering Doses and Liquid Conversions for Common SSRIs

TABLE 46-1 · Tapering Doses and Liquid Conversions for Common SSRIs
Medication	Minimum Daily Dose*	Tapering Doses (mg/day)	Liquid Conversion (mL/day)
Citalopram	20 mg	10 mg → 5 → 3.4 → 2.3 → 1.5 → 0.8 → 0.4 → stop	2 mg/mL: 5 mL → 2.5 → 1.7 → 1.2 → 0.8 → 0.4 → 0.2 → stop
Escitalopram	10 mg	5 mg → 2.7 → 1.7 → 1.2 → 0.7 → 0.4 → 0.2 → stop	1 mg/mL: 5 mL → 2.7 → 1.7 → 1.2 → 0.7 → 0.4 → 0.2 → stop
Fluoxetine	20 mg	8.5 mg → 4.5 → 2.7 → 1.7 → 1.0 → 0.6 → 0.3 → stop	4 mg/mL: 2.1 mL → 1.1 → 0.7 → 0.4 → 0.3 → 0.2 → 0.1 → stop
Fluvoxamine	50 mg	25 mg → 15 → 10 → 8 → 5 → 2 → 1 → stop	No liquid available — use 25 mg tablets or compounding pharmacy
Paroxetine	20 mg	11.4 mg → 7.4 → 5.0 → 3.4 → 2.2 → 1.3 → 0.6 → stop	2 mg/mL: 5.7 mL → 3.7 → 2.5 → 1.7 → 1.1 → 0.7 → 0.3 → stop
Sertraline	50 mg	25 mg → 14 → 9.1 → 5.9 → 3.8 → 2.2 → 0.9 → stop	20 mg/mL: 1.3 mL → 0.7 → 0.5 → 0.3 → 0.2 → 0.1 → 0.05 → stop
* The minimum daily dose represents the dose that typically achieves 80% occupancy at the serotonin receptor. It roughly corresponds with the minimum effective dose for depression.