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Cited by 15Treatment of Major DepressionPharmaceutical Practices and Patient OutcomesMental Health Treatment and Access

Current strategies for tapering psychiatric drugs: Differing recommendations, impractical doses, and other barriers

Eserian, Jaqueline Kalleian, Blanco, Vinícius Paccola, Mercuri, Lucildes Pita, Matos, Jivaldo do Rosario, Galduróz, José Carlos Fernandes·2023·Psychiatry Research
DOI 10.1016/j.psychres.2023.115537
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Abstract

While effective ways to prevent withdrawal symptoms from psychiatric drugs remain unclear, a highly accepted clinical approach for treatment discontinuation is to gradually reduce doses over time. The objective of this review is to gather the current strategies for tapering of psychiatric drugs described in the literature and guidelines in an attempt to identify the most promising one. Literature review and search for practice guidelines provided by government agencies and medical organizations were performed. Different strategies for tapering were found: linear tapering, hyperbolic tapering (by exponential dose reduction and pre-established dose-response curves), extended dosing, and substitution for a long half-life drug. The use of guidelines offers support for patients and prescribers, increasing the likelihood of achieving effective drug discontinuation. Nevertheless, the lack of standardization found among the guidelines makes any attempt to reduce or stop the drug very difficult for prescribers. Hyperbolic tapering by exponential dose reduction appears to be the most promising strategy for psychiatric drug discontinuation. Yet, we still face a constant challenge: how to safely obtain flexible doses for the discontinuation of drugs, particularly during the last steps in which lower doses are required. Further studies are needed to reduce the barriers associated with psychiatric drug discontinuation.

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  • A recent systematic review concluded that hyperbolic tapering appears to be the most promising strategy for psychiatric drug discontinuation.

    “Consistent with this, a recent systematic review of tapering strategies for psychiatric drugs, including benzodiazepines, concluded that ‘hyperbolic tapering…appears to be the most promising strategy for psychiatric drug discontinuation’ (Eserian et al., 2023).”

    From Pharmacological principles for safe benzodiazepine and Z-drug dose reduction (2026) · cites this paper as Eserian et al., 2023

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Authors
Eserian, J. K., Blanco, V. P., Mercuri, L. P., Matos, J. D. R., & Galduróz, J. C. F.
Affiliations
  • Instituto Adolfo Lutz (BR)
  • Universidade Federal de São Paulo (BR)
Corresponding author
Eserian, Jaqueline Kalleian
ORCID
Venue
Psychiatry Research
Publisher
Elsevier BV
Published
2023-11
Volume
329
Pages
115537
ISSN
0165-1781 (ISSN-L)
DOI
10.1016/j.psychres.2023.115537
OpenAlex
W4387447026
Cited by
15
References
70
Citations by year
2026: 6 · 2025: 6 · 2024: 3
FWCI
0.55
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Psychiatry Research (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
treatment discontinuation, extended dosing, drug substitution, withdrawal symptoms, dose-response curves, antipsychotic drugs, antidepressants
MeSH terms
Humans, Remission Induction, Substance Withdrawal Syndrome

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