From Toronto Star: “A growing number of people are choosing [an] antidepressant exit route [known] as a ‘hyperbolic tapering’ protocol, a new way of thinking about SSRI de-prescribing, which takes into consideration ‘serotonin transporter occupancy’: essentially, how the drug actually works in the brain.
One of the most ardent champions of hyperbolic tapering is Dr. Mark Horowitz, a training psychiatrist and clinical research fellow in psychiatry at North East London NHS Foundation Trust, who studies the neurobiology of depression and how antidepressants work.
‘The key thing is that doubling the dose doesn’t double the effect,’ said Horowitz, while pointing to a graph with a hyperbolic (sharp) curve that shows how the brain reacts to an increased dosage of an SSRI. ‘It goes up very steeply at low doses and it flattens out at higher doses.’
Horowitz explained, ‘When there’s not much drug around, every extra milligram has a big effect because all of the receptors are open.’
Since increased doses don’t have a linear effect, it makes sense that decreased doses don’t either. Horowitz said that a two-milligram dose can have half the effect of a 40-mg dose, as opposed to the one-20th you might expect.
‘If you step down from 20 to 10 milligrams, which is half the dose, there’s a small effect on the brain that people can usually handle,’ said Horowitz. ‘Going from 10 to five is a bigger effect and people often find a bit of trouble with it. But when they go from five milligrams to zero, it’s like jumping off a cliff after walking down a steep hill.’
Horowitz runs a psychotropic drug de-prescribing clinic in the U.K. He said that his email inbox was full of messages from people in North America asking him for help in designing a hyperbolic tapering protocol, since the guidelines here are still largely linear.”
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