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Content reviewed by:
Bryan Shapiro, MDHyperbolic tapering (sometimes called the Horowitz-Taylor method) is based on the fact that as antidepressant dose goes up, drug action on brain cells increases, but not in equal steps, higher dosages having less and less additional influence – a decreasing return on investment. The graph showing this is called a hyperbolic curve (goes up faster at low doses and flatter at higher doses).
Tapering based on this method gradually backs you out of the drug with reductions following this natural curve, with the size of dose reduction getting smaller as the dosage gets lower. As very low doses (e.g. 1 or 2mg) have much larger effects than people expect, many people need to taper down to very small doses before stopping so that the final ‘jump’ to zero is not too large a shock to the nervous system.
Compounded medications are often crucial in the tapering process, as commonly available dose sizes aren't small enough to reach the sizes necessary to follow a safe tapering plan. For example, the smallest usually available dose size for venlafaxine is 37.5mg (a drop from 37.5mg to 0mg can easily lead to debilitating withdrawal symptoms).
Compounded medications are often crucial in the tapering process, as commonly available dose sizes aren't small enough to reach the sizes necessary to follow a safe tapering plan. For example, the smallest usually available dose size for venlafaxine is 37.5mg (a drop from 37.5mg to 0mg can easily lead to debilitating withdrawal symptoms).
Citalopram can produce side effects that vary in occurrence and severity among individuals. Common side effects may include nausea, dry mouth, fatigue and drowsiness, increased sweating, sexual dysfunction, low heart rate (bradycardia), tremor, diarrhea, weight gain or loss, and flu-like symptoms.
Celexa (citalopram) has several long-term adverse effects. These include persistent sexual dysfunction, weight gain, and metabolic changes leading to obesity and diabetes. It can also cause QT interval prolongation, increasing the risk of cardiac arrhythmias, and emotional blunting. Long-term use has been linked to increased risk of early-onset dementia.
The half-life of a medication is relevant to understanding its effects and potential withdrawal symptoms. Citalopram has a half-life of approximately 35 hours.
Hyberbolic Tapering
A science-based approach that helps reduce the risk of withdrawal symptoms and relapse.
Expert Clinicians
Outro clinicians are trained by world-leading experts in medication deprescribing.
Use science-based methods
Hyperbolic tapering is the only science-based discontinuation method, based on the neuroscience of how dose changes impact withdrawal symptoms.
Don't do it alone
Work with a healthcare provider knowledgable in the latest tapering practices, and seek additional support from peers, friends or family.
Consider compounded doses
When getting to dose sizes smaller than what are usually available, compounding pharmacies can help formulate custom pills and liquids.
Developed by world-leading experts in deprescribing
Outro's interdisciplinary team of clinicians, researchers and patient advocates is dedicated to building safe, evidence-based options for people looking to live life free of medications.
FAQs
Explore commonly asked questions about Outro's services, medication withdrawal, tapering and more.
Outro is for people 18 years and older who are currently taking an antidepressant medication and thinking about decreasing or stopping the medication altogether.
As a virtual care service, Outro’s services are currently not available for people in certain situations or with certain conditions. These include (but are not limited to) people who:
- Have active and serious substance abuse issues
- Have been diagnosed with dementia
- Have been diagnosed with schizophrenia or schizoaffective disorder
- Have been hospitalized for bipolar disorder in the past 12 months
- Have attempted to end their life in the past 12 months
- Are actively suicidal or in crisis
Safe antidepressant deprescribing requires a comprehensive approach that is often difficult for an individual prescriber to provide, due to the time required. It also requires up-to-date knowledge on the latest techniques in tapering antidepressants that are not yet widely taught in North America. Think of Outro as a specialist in tapering.
At Outro, we walk with you every step of the way. Our specialized, high-touch care team takes time to get to know you and your goals, and provides an advanced, individualized approach to tapering off antidepressants informed by the latest guidance and clinical evidence. Through Outro’s app, your symptoms and progress are continuously monitored by your Provider, who can reach out to offer coping strategies or adapt your care plan accordingly. If you have questions or concerns that arise in between appointments, your Outro provider is available via 1-to-1 chat.
Many people have difficulties when they try to go off antidepressants. Our team of expertly trained clinicians will develop a tailored tapering program, informed by the latest scientific evidence and designed to minimize withdrawal effects - even for these people who have tried to stop before.
We currently offer taper management for antidepressant medications (e.g., duloxetine, escitalopram, sertraline, venlafaxine). You can see the full list here.
We are making preparations to expand to other psychotropic medications like benzodiazepines and gabapentinoids, which also follow the hyperbolic tapering method. You can express an interest in tapering these medications in our sign-up form.