What is hyperbolic tapering of antidepressants?

It is a tapering strategy for reducing your antidepressant slowly over time based upon our best understanding of how much the medication is working in your brain instead of the number of milligrams on your pill bottle. The reason this matters is because antidepressants do more work in your brain at lower doses than higher doses. Let’s take the antidepressant lexapro as an example:

Changing lexapro from 0mg to 5mg changes SERT receptor occupancy (a measure of how much it is working in your brain) by 57%. So a 5mg change at lower doses of the medication changes a lot. Changing lexapro from 15mg to 20mg changes SERT receptor occupancy by 5%. What?!? So the same change in dose of medication (5mg) has way different effects on your brain depending on if you are at higher or lower doses. 

Hyperbolic tapering tapers the medication based upon SERT receptor occupancy (action in the brain) rather than dose of medication (milligrams on your pill bottle). What this looks like in practice are larger dose decreases at the start of your antidepressant hyperbolic taper and smaller decreases at the end. The steps by which the amount of antidepressant is decreased becomes progressively smaller over time. 

What I’ve seen in practice is that hyperbolic tapering allows people at high risk of antidepressant withdrawal to decrease or even discontinue psychiatric medications they had previously failed to taper as well as allow people to maintain their quality of life with limited withdrawal symptoms. 

Learn more about if hyperbolic tapering is right for you here.