The Antidepressant Solution by Joseph Glenmullen M.D

Author:Joseph Glenmullen, M.D.
Language: eng
Format: epub
Publisher: Free Press

How Long the Patient Has Been

on the Drug

Almost all patients who have been on antidepressants for more than a month should use a tapering program when they are ready to try going off the drugs. The few exceptions are patients who have been on low doses for a couple of months or more. These are the lowest doses listed in Table 6.2, like 10 milligrams a day of Paxil, which do not need to be tapered, but instead can just be stopped. Still, many patients are on low doses precisely because they are exquisitely sensitive to drug side effects. So they may find they need to taper after all despite being on relatively low doses. One other exception is patients on 20 milligrams a day or less of Prozac who usually do not need to taper off, as seen in Table 6.2. But at higher Prozac doses, patients should taper off the drug.

Patients who have been on an antidepressant less than a month typically do not need to taper the drug. Since, in just one month, the brain has usually not yet fully adapted to living with the antidepressant, it does not need extra time to readjust to living without the drug. This assumes the dose was not rapidly escalated in the initial month the patient was on the drug. At the end of the first month, most of my patients are still only on the recommended starting dose of an antidepressant, for example 20 milligrams a day of Paxil. If I have put the patient up to 40 milligrams a day within the first month and we then need to stop it for some reason, I probably would put the dose back down to 20 milligrams a day and wait a week or two to see if the patient had any withdrawal symptoms before having him stop the drug altogether.

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