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Lexapro Tapering

Last Updated on January 18, 2023 by Carol Gillette

Alternative to Meds Editorial Team
Medically Reviewed by Dr Samuel Lee MD

Explaining the difficulties of Lexapro tapering, weaning, and titration may be completely overlooked at the time of prescribing. Coming off antidepressants is uncharted territory for most physicians, and adequate conversation on the topic may not have taken place.

Alternative to Meds Center is a facility that can help a person navigate Lexapro tapering supported in a health-restoring way.

Does Your Diagnosis Require Lexapro?

successful Lexapro tapering
Alternative to Meds has been a Lexapro tapering help authority for over 17 years. In our published evidence the success of our clients is extremely well-documented. Even with people who have what might be considered the most bizarre symptoms, these same symptoms are more common than we see reported in drug literature. In fact, we specialize in these symptoms. And we are advantaged because many of our team of trained professionals at Alternative to Meds Center, also experienced these symptoms ourselves and this is what helped us to become the compassionate and informed teachers we are.
This video documents the journey of a woman who thought her life was over. She chose the Alternative to Meds Center as a last-ditch hope. Tragically, she was barely able to walk and was not able to work. While in our care, she was able to get off of antidepressants and benzodiazepines. She also regained her professional career and now can power walk with ease.
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Things to Consider Prior to Lexapro Tapering

We would encourage anyone thinking about tapering Lexapro to take at least some time to learn more about antidepressants, and how they affect the CNS. In recently published research, Moncrieff et al challenge the decades-old serotonin-deficiency theory of depression.  Moncrieff found no evidence to back this widely held premise which is usually given as a reason to prescribe SSRI medications. We recommend reading through Moncreiff’s 2022 research and findings.16

There has been other revelatory research done on the causes of depression and other symptoms. Taking time to consider these may help to decide whether continuing or tapering Lexapro is the best action to take. A body of research published by the World Journal of Psychiatry back in 2010 mirrors Moncreiff’s stance, citing various causes for depression, including dysregulated hormones, psychosocial issues, early childhood trauma, environmental factors, sensitivity to stress, abnormal sleep patterns, and many other factors that are usually ignored prior to prescribing an antidepressant. This material would also be good to carefully look over. 17

Whether or not taking an antidepressant further compounded factors such as hormone dysregulation, a fundamental before attempting to taper Lexapro would be to rebuild and strengthen one’s natural neurochemistry. Correcting the diet, improving sleep, and removing sources of stress would be effective steps to take before a tapering program is initiated. A Lexapro tapering program could be likened to a journey requiring preparation, a road map, and knowledgeable guides, in order to successfully and safely reach your desired destination.

Prescription drugs were never designed to fix or cure, but only to mask or dampen symptoms. Of prime importance, therefore, is to discover the underlying reasons that a prescription for Lexapro was first started. Each person will have their own history of symptomology. The process of antidepressant tapering is not something to rush through. Consider setting time aside, time off work or school, to more easily focus on healing, and not too much else for a time. And the process can be considerably eased by addressing the root causes of symptoms as part of the overall plan.

Lexapro Discontinuation Syndrome

lexapro discontinuation syndrome Antidepressant drug sales in Canada doubled from 2002 to 2017, according to government statistical tables.1 American consumers are targeted to purchase $16 billion in antidepressant drugs by 2023 2 with the SSRI drug class — such as Lexapro — leading the way. And these statistics continue to rise around the globe. Yet, despite such an astounding number of people starting an SSRI prescription, there is a deafening silence about antidepressant discontinuation syndrome, which according to even a cursory review of extant medical literature, is a common occurrence when a person tries to stop taking the drug.3 Certainly, most of our clients report no such warnings were given to them prior to beginning on Lexapro. At Alternative to Meds Center, we have specialized for the better part of two decades in successfully assisting thousands of persons who were suffering from discontinuation syndrome. An inpatient setting is often recommended because of the level of support that is needed.

Lexapro Tapering Guidelines and Schedule

lexapro tapering planTapering Lexapro safely is not necessarily as simple as “a gradual reduction of the dose.” Specific guidelines on safe tapering are absent on the FDA-approved drug label.4 While mathematics does play a role, there is much more that can be done to make the process surprisingly comfortable, as well as efficient time-wise. Our goal at Alternative to Meds Center is to make it possible to actually improve the client’s health in the process. A gradual Lexapro withdrawal is important but is one part only of a multi-faceted process that is best done within an individualized step-by-step process designed toward regaining more robust health, and the benefits of natural mental health, without drugs.

If not performed at Alternative to Meds Center, difficulties that emerge with Lexapro tapering would be best monitored under the care of a trusted physician who is familiar with the process. Let your close friends and family know your plans, so they understand this is a challenging time and ask for their support.

An informed physician will know that in the case of Lexapro, the lowest dosage is 5mg white round tablets. The tablets can be cut in half when needed providing a 2.5mg option. Lexapro has a relatively short half-life (27-36 hours),4 but this can extend by as much as 50% for elderly patients, or change unpredictably for persons with hepatic impairments.9 These factors must be watched for as if not accommodated, they can complicate the withdrawal. A good rule of thumb is the longer the half-life, the slower the medication will leave your body, which, generally speaking, makes the tapering easier.

Lexapro Tapering Guidelines include:
  • getting off lexapro safelyGradual reduction of the dose except in the case of a medical emergency such as serotonin syndrome 3,4
  • To simplify the math, use the smallest dose of Lexapro, 5mg white round tablets to configure changing dosages.
  • Your physician can assist you to cut the 5mg pills in half or quarters for smaller dosing. A half pill would be 2.5mg and a quarter would be 1.25mg.
  • Discuss with your doctor a good starting point, something on the order of 10-25% as an example. This could be adjusted as needed for personal sensitivity.
  • Ensure you and your physician are aware of when withdrawal symptoms are expected to emerge — around the drug’s half-life range. In this case, the elimination half-life is 27-33 hours depending on individual variability factors of age, impaired liver, etc.4,9 Onset of Lexapro withdrawal after making a cut may be felt anywhere from one day up till day 2-3. The withdrawal itself may last anywhere from days to weeks … sometimes longer as discussed further below.
  • Work with your physician to make ongoing adjustments, i.e., more or less than 10-25% according to tolerability.
  • Your physician should advise you to settle out at one level before making the next adjustment, for example, a week, two weeks, or longer.
  • It is not uncommon for the last cuts to be the most challenging. Keep in close touch with your prescriber to monitor as you may need to slow down at the end of the taper.
  • You may want to keep notes on reactions and the time it took to settle out at the beginning and throughout the process which might serve as a general measuring stick for going forward.

Sometimes reactions during a taper can become intense and long-lasting, and if a protracted withdrawal develops, you may want to seek out appropriate medical oversight. This is our specialty at Alternative to Meds. Please contact us if questions arise that you find cannot be resolved with your prescribing physician.

Individualized Lexapro Weaning Programs

A responsibly managed Lexapro taper is much more than math, and time. The process should include investigating and then correcting underlying root causes for symptoms. One might regard each individual as a complex but divinely unique expression, who may have accumulated a number of injurious experiences or toxic exposures that negatively affected their health. Exposure to toxic situations or toxic chemicals alike can cause psychiatric symptoms and lasting detrimental effects.10 Exposure to bacterial pathologies can also create psychiatric symptoms.11 These need to be investigated and addressed, rather than simply buried or anesthetized with drugs. Then a person can find authentic and lasting relief.

The last thing anyone wants is to take a person off a drug, and have all their symptoms just come back again.

Generally, SSRI medications are prescribed for groupings of symptoms that have labels affixed to them. These labels, syndromes, disorders, etc., can include what the DSM has collated into such broad terms as “generalized anxiety disorders” or “social anxiety” and similar. Due to their general nature, it could be that the labels themselves are often of lesser (or no) importance in a therapeutic sense, to the degree that they may overlook or even obscure important details of an individual’s history. Often SSRIs are prescribed with no diagnosis at all. The discrepancies in assigning reliable diagnostic labels are widely acknowledged in the medical field itself.6-,8

To bundle all the details specific to any one individual together in such generic terms may serve to abbreviate the vocabulary of the busy clinician. However, the careful assessment of symptoms that someone has suffered or still struggles with can provide important sentinels or pointers that can lead to corrective measures. At Alternative to Meds Center, we feel that taking care and taking the time needed to understand the client and their history fully including addressing what caused the symptoms to emerge in the first place, plays an important role to manage a comfortable, safe Lexapro taper and recovery of improved mental wellness.

Listening to the Client Seeking Tapering Help

integrative psychiatryThe client must be heard. It may take more than a 15-minute doctor’s appointment before correctly prescribing an antidepressant. It would take considerably more time to discover and correct any root causes for the symptoms that Lexapro was, at best, only able to temporarily mask. Because if not resolved, these symptoms are going to resurface when the drug is withdrawn.

In the same way that one would give a person with a broken leg more than an aspirin to fix the situation, helping someone get off Lexapro must include a focus on finding root causes and offering correction or relief for these if the process is to be considered at all complete. There are really no shortcuts to the process.

Who is Prescribing over 80% of Antidepressants like Lexapro?

general practitioners prescribe most antidepressantsThere has been concern that over 80% of antidepressants are not even prescribed by mental health practitioners.8,12 They are prescribed by GPs or other non-mental health practitioners. Why have our general medical doctors become mired in treatment for depression, anxiety, bipolar, PTSD, etc., when their training does in no way cover these aspects of human health, or how to assess, address or successfully resolve them?

And more importantly, why are GPs not given more training in how to discover root causes so that these can be resolved with the correct protocols, rather than defaulting to a quick-fix prescription of antidepressants? One might observe that the pharmaceutical industry itself has pushed medical practitioners into a state of medical carelessness. One could conclude that the journey to health and wellness has been barricaded in the most irresponsible and harmful way for quite a number of patients. Antidepressants have been found to be in the top 4 overprescribed medications today.13

Holistic Psychiatric Treatments for Lexapro Tapering

Holistic and nutritional psychiatry has made great inroads in the treatment of mental distress utilizing lab testing, correction of nutritional deficits, and correcting the diet. A more holistic approach to treating mental or mood disturbance might include a wide range of investigations, such as testing for food allergies, testing for exposure to or accumulated neurotoxins, testing for bacterial pathologies, checking for evidence of a compromised microbiome, and a whole host of valid therapeutic pathways to explore. This is the approach at Alternative to Meds Center.10,11,14

What Did Your Doctor Investigate Before Prescribing Lexapro?

If a patient told their doctor they were depressed, but the doctor did not inquire further, neither the doctor nor the patient might ever come to realize what could be the cause of their depression. Perhaps the patient is not eating properly. They could, in fact, be manifesting a malnutrition-based lethargy and lack of energy. Or the patient’s diet includes foods the person is allergic to. But without further inquiry, a time-pressured diagnostician may decide that the person fits under the “depressed” category of diagnosis because all the checkboxes are filled:  yes they are lethargic, yes they are sad, yes they have no energy, yes they feel hopeless, and yes it’s gone on for X hours a day for more than X number of weeks, etc. There has been much discussion for many years in professional circles about proper diagnosis and treatment.15

comprehensive mental health interviewBut a longer, more directed conversation might reveal they started feeling depressed right around the time they lost a job 6 months ago. Consequently, their reduced income meant cutting down on the quality or quantity of food to eat. Then their energy level tanked so low that they sometimes couldn’t get out of bed and actually cook a nutritious meal. Maybe there is a pandemic going on that has magnified a bunch of “little things” into a dystopian living nightmare! Or, perhaps they still have their high-stress job with a belligerent boss, and constant rumination has caused their sleep to suffer. Perhaps someone close to them died. Perhaps the person’s family is also suffering emotional fallout, and so additionally, the person also feels tremendous guilt, pressure, stress, and anxiety. Perhaps the person moved into a new house last year, and it is older and has asbestos in the insulation. Or molds and spores are leaching through the plaster and the water pipes.

If a single one of these factors might precipitate unwanted symptoms, imagine the snowball effects of multiple such factors! Life is complex. Antidepressants may have been inadequate, and one would like to discontinue. But in such a state of “depression”, et al., they are difficult to stop and the problems continue to compound. We can help.

The Role of Holistic Therapies in Lexapro Tapering

getting off lexaproLet us open the doors to discovering the causal factors contributing to their depressed mood, insomnia, anxiety, sadness, etc. Would that allow for a more complete recovery? At Alternative to Meds Center, this has been most positively shown to be the case.

Nutritional counseling and correction of diet, counseling, allergen testing, testing for the presence of neurotoxins, family and relationship counseling, life coaching, goal setting, and neurotoxin removal, are incredibly potent tools that can shed light on how to begin changing conditions for the better. These are just some examples of the comprehensive set of protocols that are used in the Alternative to Meds Center programs. We use them because they are effective.

Proper Diagnosis and Treatment vs Quick Fixes

However, these are not discussions that are commonly held in the doctor’s office. It’s more often all about the checkboxes to fill, the type of insurance the person has or doesn’t have, and above all, the whole game called “Name that mental illness” with which big pharma has frankly embarrassed itself by saturating the market with its sales-driven attempt to turn every challenge or difficulty into a potential new customer for drugs.

The above examples are perhaps oversimplified but are given to illustrate the possible consequences that have cascaded from what is loosely defined as “treatment,” when treatment has become reduced to picking a label and a drug for it and that’s all.

Tapering Lexapro Safely

Alternative to Meds Center has assisted many thousands of clients over the last decade-and-a-half to successfully complete their personal journeys. Clients have found they have become much more able to regain and sustain natural mental health without relying on prescription drugs. Using carefully and individually designed prep work, and on-site holistic treatments, an opportunity to receive proper guidance, the center provides the safest methods available for getting off Lexapro under the oversight and care of our staff: Over 50 licensed medical practitioners, therapists, nurses, and other trained and compassionate care providers are on our team of professionals.

Getting off Lexapro can be done in a healthy, safe way. The Alternative to Meds Center programs utilize a wide range of diagnostic testing and alternative therapies and treatments to greatly assist in Lexapro tapering, and improving mental health naturally in a pristine and comfortable inpatient setting.

Contact Alternative to Meds Center

Trying to quit Lexapro on your own, without competent and experienced help can be difficult, and in some cases even disastrous. Don’t take such a chance on your health. Contact Alternative to Meds Center and find out how restorative a properly executed Lexapro tapering program can be and how such a program is poised to help you or your loved one regain and sustain natural mental health without reliance on prescription medications.

1. Government of Canada Pharmaceutical industry profile published online 2019 [cited 2022 July 5]

2. PR Newswire, “Antidepressant Drugs Market to Reach $15.98 Billion by 2023.” [online] [cited 2022 July 5]

3. Wilson E, Lader M. A review of the management of antidepressant discontinuation symptoms. Ther Adv Psychopharmacol. 2015;5(6):357-368. doi:10.1177/2045125315612334 [cited 2022 July 5]

4. FDA Drug Label Lexapro (escitalopram oxalate) [cited 2022 July 5]

5. Volpi-Abadie J, Kaye AM, Kaye AD. Serotonin syndromeOchsner J. 2013;13(4):533-540.[cited 2022 July 5]

6. Aboraya A, Rankin E, France C, El-Missiry A, John C. The Reliability of Psychiatric Diagnosis Revisited: The Clinician’s Guide to Improve the Reliability of Psychiatric DiagnosisPsychiatry (Edgmont). 2006;3(1):41-50. [cited 2022 July 5]

7. Garand L, Lingler JH, Conner KO, Dew MA. Diagnostic labels, stigma, and participation in research related to dementia and mild cognitive impairment. Res Gerontol Nurs. 2009 Apr;2(2):112-21. doi: 10.3928/19404921-20090401-04. PMID: 20077972; PMCID: PMC2864081. [cited 2022 July 5]

8. Mojtabai R, Olfson M. Proportion of antidepressants prescribed without a psychiatric diagnosis is growing. Health Aff (Millwood). 2011 Aug;30(8):1434-42. doi: 10.1377/hlthaff.2010.1024. PMID: 21821561. [cited 2022 July 5]

9. Tholey D, “Effects of Liver Disease on Drug Metabolism.” published by Merck Manual (Professional version) [online] Oct 2019 [cited 2022 July 5]

10. ICEH authors Mental Health and Toxic Exposures  From the Learning and Developmental Disabilities Initiative [published online Nov 2008] [cited 2022 July 5]

11. Ouabbou S, He Y, Butler K, Tsuang M. Inflammation in Mental Disorders: Is the Microbiota the Missing Link? Neurosci Bull. 2020 Sep;36(9):1071-1084. doi: 10.1007/s12264-020-00535-1. Epub 2020 Jun 27. PMID: 32592144; PMCID: PMC7475155. [cited 2022 July 5]

12. Lee E, Teschemaker AR, Johann-Liang R, Bazemore G, Yoon M, Shim KS, Daniel M, Pittman J, Wutoh AK. Off-label prescribing patterns of antidepressants in children and adolescents. Pharmacoepidemiol Drug Saf. 2012 Feb;21(2):137-44. doi: 10.1002/pds.2145. Epub 2011 Apr 28. PMID: 21538674. [cited 2022 July 5]

13. Safer DJ. Overprescribed Medications for US Adults: Four Major ExamplesJ Clin Med Res. 2019;11(9):617-622. doi:10.14740/jocmr3906 [cited 2022 July 5]

14. Adan RAH, van der Beek EM, Buitelaar JK, Cryan JF, Hebebrand J, Higgs S, Schellekens H, Dickson SL. Nutritional psychiatry: Towards improving mental health by what you eat. Eur Neuropsychopharmacol. 2019 Dec;29(12):1321-1332. doi: 10.1016/j.euroneuro.2019.10.011. Epub 2019 Nov 14. PMID: 31735529 [cited 2022 July 5]

15. Nemeroff CB, Weinberger D, Rutter M, MacMillan HL, Bryant RA, Wessely S, Stein DJ, Pariante CM, Seemüller F, Berk M, Malhi GS, Preisig M, Brüne M, Lysaker P. DSM-5: a collection of psychiatrist views on the changes, controversies, and future directions. BMC Med. 2013 Sep 12;11:202. doi: 10.1186/1741-7015-11-202. PMID: 24229007; PMCID: PMC3846446. [cited 2022 July 5]

16. Moncrieff J, Cooper RE, Stockmann T, Amendola S, Hengartner MP, Horowitz MA. The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry. 2022 Jul 20. doi: 10.1038/s41380-022-01661-0. Epub ahead of print. PMID: 35854107. [cited 2023 Jan 18]

17. Hasler G. Pathophysiology of depression: do we have any solid evidence of interest to clinicians? World Psychiatry. 2010 Oct;9(3):155-61. doi: 10.1002/j.2051-5545.2010.tb00298.x. PMID: 20975857; PMCID: PMC2950973. [cited 2023 Jan 18]

Originally Published Oct 16, 2019 by Diane Ridaeus

This content has been reviewed and approved by a licensed physician.

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.

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