Horowitz, 2019 Tapering of SSRI treatment to mitigate withdrawal symptoms

[manymoretodays]

Was this the paper @Sonny?

We've adopted the 10% from each previous dose recommend as the most harm reduction model.

And we don't base it entirely on SERT occupancy or other neurotransmitter occupancy.

 

This is safety and harm reduction in my opinion, and takes into account the individual as well as the occupancy.

 

Sounds like you did a good read through.  I'd err on the side of caution with your own taper, and do it 10% or less of each previous dose.

And I did my last taper that way.

 

I've seen differences too, in some of the papers, yet they often conclude that it might be best to proceed with harm reduction, 10% or less off each previous dose, based on the individual response.

 

Our own Altostrata has communicated greatly with the others, who write these papers, and I give thanks that the science is growing.

 

[Sonny]

Thanks MMT. Yes I'm referring to the same paper. Sorry for inverting the order of the authors' names.

 

You mention other research lit that recommends 10% hyperbolic dose reductions. Other than Altostrata's paper, I haven't seen these. Could you share links?

 

Certainly the slower the taper, the fewer withdrawal effects. But withdrawal effects may not be the only source of harm from SSRIs. Prolonged exposure could also be a risk, not only to the CNS, but other organs as well, particularly the liver. It also means more of one's life spent enduring the adverse, often debilitating effects. Also it's plausible that long term intransigence of these effects would correlate to chronic drug exposure (e.g. PSSD).

 

Horowitz and Taylor's paper is great in that it confirms the SA wisdom of hyperbolic tapering. But their recommendation of a 10% SERT drawdown (8-10 step taper) is so radically different than SA's 2% SERT drawdown (40-50 steps). That's 6 months vs. 2.5 years.

 

I think the reason for the discrepancy is that we don't know the perfect SERT drawdown rate-- 2% and 10% are both arbitrary guesses. Is that fair? Or are there more specific rationales for either recommendation? Does the SA community have experience with faster hyperbolic, Horowitz-style tapers? Is there good reason to expect that it wouldn't work?

 

 

[RobertZ]

For those of us (myself included) coming off antipsychotics, there is another interesting paper co-authored by Horowitz, with insights specific to antipsychotics:

https://academic.oup.com/schizophreniabulletin/article/47/4/1116/6178746?login=false

I think it deserves a separate topic.