Last updated 4/4/2024
This page is for people who haven’t been able to taper more simply, as described on my Tapering Antidepressants page.
We’re talking about 10% of each month’s dose. Not your original dose. Even if you go fast this will take over a year. For some people, more like 3.5 years.
Why 10% reductions per month
A very smart, dedicated woman who had severe withdrawal problems coming off an antidepressant founded a support website for others who also had that experience. From her experience, and that of the group, she evolved a logical taper: the closer to zero, the smaller the steps down. Her online name is Altostrata. She deserves great credit for all the support and guidance that people have found on her site — and further credit for bringing the withdrawal experiences of thousands of people to the attention of psychiatrists. (And she’s still working on that).
The logic
Imagine you’re tapering down from 100 mg of sertraline, a common dose. Say you go down by 25 mg steps. The first step, from 100 mg to 75 mg per day, is a 25% reduction, a quarter of your original dose. But when you later go from 50 mg to 25 mg, that is cutting your dose in half. And when you go from 25 mg to zero, that’s a 100% reduction! You see? You’re taking a bigger step down each time, in terms of the percentage change your body will experience.
So instead, the SurvivingAntidepressant website recommends making each step down 10% of the dose-at-the-time. From 100 mg, a 10% reduction is taking 90 mg per day. The next step is 10% of 90 mg (9 mg), to a dose of 81 mg per day. Keep going like that, 10% of the dose, every month.
10% steps: an example
Believe it or not, some people actually have to take 3+ years to get off, as this table shows, if using monthly steps:
10% reductions | |
Start | 100 mg |
Step 1 | 90 mg |
Step 2 | 81 mg |
Step 3 | 73 mg |
Step 4 | 66 mg |
Step 5 | 60 mg |
Step 7 | 54 mg |
Step 8 | 49 mg |
Step 9 | 44 mg |
Step 10 | 40 mg |
Step 11 | 36 mg |
Step 12 | 32 mg |
Step 13 | 29 mg |
Step 14 | 26 mg |
Step 15 | 23 mg |
Step 16 | 21 mg |
Step 17 | 19 mg |
Step 18 | 17 mg |
Step 19 | 15 mg |
Step 20 | 14.5 |
Step 21 | 13 mg |
Step 22 | 12 mg |
Step 23 | 11 mg |
Step 24 | 10 mg |
Step 25 | 9 mg |
Step 26 | 8 mg |
Step 27 | 7 mg |
Step 28 | 6.5 mg |
Step 29 | 6 mg |
Step 30 | 5.5 mg |
Step 31 | 5 mg |
Step 32 | 4.5 mg |
Step 33 | 4 mg |
Step 34 | 3.5 mg |
Step 35 | 3.75 mg |
Step 36 | 3.5 mg |
Step 37 | 3.25 mg |
Step 38 | 3 mg |
Step 39 | 2.75 mg |
Step 40 | 2.5 mg |
Step 41 | 2.25 mg |
Step 42 | 2 mg * |
*From here, according to SurvivingAntidepressant.org, if each step causes no reaction at all, you can “jump” to zero.
Seriously, some people have to do this, using a liquid form of their antidepressant and a calibrated eyedropper. There are thousands of participants on SurvivingAntidepressants.org telling stories about the difficulties they’ve had getting off their antidepressant, and how they’ve done these long slow tapers. Even if for some reason you disbelieve half of those stories, you still have thousands of horrendous experiences to account for.
Go faster? Here’s the expert
Here is the author of SurvivingAntidepressants.org talking to people who think they can go faster than the 3+ years outline above (from this page):
If you think you can taper faster than 10% per month, follow this harm reduction approach to starting your taper:
- Initially, make a 10% reduction and hold there for a MONTH. It can take several weeks for withdrawal symptoms to emerge. Do that again the second month.
- If you have very minor or no symptoms from these 2 reductions, you can try reducing by 10% (calculated on the last dosage, the amount of decrease keeps getting smaller) every 3 weeks. Do that twice. If no problems, you might be able to reduce by 10% every 2 weeks. Be prepared to adjust your rate of taper. When you get down to a lower dose, often you will have to taper SLOWER, or by even smaller percentages.
- If significant withdrawal symptoms appear at any time, STOP TAPERING. Hold at your current dosage for some months, stabilize, then make smaller cuts or go slower. Listen to your body.
- If you get withdrawal symptoms that do not go away after 2 months, consider a slight updose and hold to stabilize. You will not be able to taper faster than 10% per month after that, and may need to go even slower.
- “Jump off” at the end when you are taking less than 98% of the original dose and reductions no longer cause any reaction at all. Usually, this is less than a milligram of the drug.