Tapering Antidepressants

Withdrawal Risk Calculator. A Preliminary tool for evaluation of withdrawal risk for individual patients *

Total Points

Duration of Use

Short term (1-6 months) 0 pts

Intermediate term (6-12 months) 1 pt

Long term (1-3 years) 2 pts

Very long-term use (> 3 years) 3 pts

Antidepressant Type

Lowest risk (e.g. agomelatine) 0 pts

Low risk (e.g. fluoxetine, milnacipran, trimipramine, doxepin, dosulepin) 1 pt

Moderate risk (SSRIs: citalopram, escitalopram, sertraline, vortioxetine; some TCAs: nortriptyline, clomipramine, lofepramine) 2 pts

High risk (e.g. SNRIs: desvenlafaxine, duloxetine, venlafaxine; paroxetine; MAOIs: phenelzine, moclobemide; some TCAs: amitriptyline, imipramine; mirtazapine) 4 pts

Dosage

Minimum therapeutic dosage or lower 0 pts

Greater than the minimum therapeutic dosage 1 pt

Past Experience of Withdrawal Symptoms

Stopped antidepressant in past with no withdrawal symptoms/unknown 0 pts

Mild to moderate withdrawal symptoms 1 pt

Severe withdrawal symptoms 2 pts

Very severe withdrawal symptoms 3 pts

Recommended Tapering Approach

Note: Very short-term use (<4 weeks) is not normally associated with a significant risk of withdrawal. This is a preliminary assessment tool and should be used in conjunction with clinical judgment.

Reference

Horowitz, M.A., Framer, A., Hengartner, M.P. et al. Estimating Risk of Antidepressant Withdrawal from a Review of Published Data. CNS Drugs 37, 143–157 (2023). https://doi.org/10.1007/s40263-022-00960-y