To Minimize Medication Withdrawal, Taper Slowly

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From Psychiatric News: “Taylor and Horowitz believe that [withdrawal] symptoms arise when tapering antidepressants because traditional tapering protocols reduce the medication dose by fixed amounts (for example going down by 25% over four weeks), which is inconsistent with how psychotropic medications interact with their biological targets.

A review of pharmacological studies on antidepressant receptor binding (which all companies conduct as one of the first steps of psychiatric drug development) by the pair revealed that antidepressants can effectively bind to targets at low doses. For example, just 1 mg citalopram daily (a fraction of the typical starting dose for treating patients with depression) occupies over 20% of serotonin transporters in the brain; occupancy rises to nearly 60% at 5 mg daily and 80% at 20 mg daily (the typical starting dose of citalopram). The effect plateaus at higher levels; 40 mg of citalopram daily (the maximum recommended dose) occupies about 86% of serotonin transporters, while 60 mg daily occupies about 88% of these receptors.

In the context of tapering, this means that the first reduction of antidepressant dose will have minimal biological impact, but as the antidepressant dose gets lower, the ratio of available receptors and neurotransmitters will change more significantly; it’s this chemical imbalance that can lead to withdrawal symptoms that can persist until the receptors adjust to the new biological environment, Horowitz said.”

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1 COMMENT

  1. Taylor and Horowitz (and others) have done more for the benefit of psychotropic consumers than most of the experts that went before them.

    A lot of Psychiatric Diagnosis was previously based on a persons reaction to the psychiatric drugs prescribed – which could be “anything”.

    I remember a doctor telling me that he could reduce people right down to low doses but if they went any lower they could run into trouble.

    The doctor went on to say that the advances in cancer were more to do with careful use of the ‘drugs’ than the introduction of new techniques. He said that in years to come todays use of Psychiatric drugs would be seen as Madness.

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