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Hyperbolic Tapering 

What is it? 

Hyperbolic tapering simply put, means gradually reducing the dose of a medication over time, in smaller and smaller increments as the dose lowers.

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Many individuals may believe that "low doses" of antidepressants (or other medications) means that the impact of that dose on the body is also low. This is a common misconception, but in fact even small doses of medication can have a big impact on our bodies. 

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Traditional psychotropic medication discontinuation often follows a "linear" pattern of dose decreases, using the available medication strengths made by drug manufacturers (ex. 20mg, 10mg, 5mg). This way of tapering off a medication is not aligned with the changes that a person's brain and body are going through, and therefore often result in withdrawal symptoms. 

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Hyperbolic antidepressant tapering, receptor occupancy, SERT %, gradual dose reductions

If we look at this graph you will see the dose of an antidepressant on the bottom horizontal line, and the receptor occupancy (which can be thought of as the "effect on the brain") on the vertical axis. The dotted yellow line shows the relationship between the dose of medication and the effect on the brain as the dose lowers. This relationship is not linear, but instead the relationship follows a hyperbolic dose curve. 

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This relationship is often why individuals who have tried to follow traditional linear tapering methods (such as cut your tablet in half for a week, then in half again for another week, then stop) experience symptoms of withdrawal which are often worse as the dose gets lower. 

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The hyperbolic tapering method works to gradually reduce doses and allow time for the brain and body to adapt to the reductions, with the aim of mitigating or reducing withdrawal as individuals complete a taper.

Want to Learn More About Hyperbolic Tapering? 

For those who want to learn more about hyperbolic tapering of psychotropic medications, I'd recommend the below resources as a good starting place. Alternatively, please feel free to book an appointment with me to review specific hyperbolic tapering in your unique situation. 

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Academic Journal Articles 

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  • Davies, J., & Read, J. (2019). A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based? Addictive Behaviors, 97, 111–121. https://doi.org/10.1016/j.addbeh.2018.08.027

  • Fava, G. A., Gatti, A., Belaise, C., Guidi, J., & Offidani, E. (2015). Withdrawal symptoms after selective serotonin reuptake inhibitor discontinuation: A systematic review. Psychotherapy and Psychosomatics, 84(2), 72–81. https://doi.org/10.1159/000370338

  • Framer, A. (2021). What I have learnt from helping thousands of people taper off antidepressants and other psychotropic medications. Therapeutic Advances in Psychopharmacology, 11, 204512532199127. https://doi.org/10.1177/2045125321991274

  • Horowitz, M. A., & Taylor, D. (2019). Tapering of SSRI treatment to mitigate withdrawal symptoms. The Lancet Psychiatry, 6(6), 538–546. https://doi.org/10.1016/s2215-0366(19)30032-x

  • Sørensen, A., Ruhé, H. G., & Munkholm, K. (2021). The relationship between dose and serotonin transporter occupancy of antidepressants—A systematic review. Molecular Psychiatry, 27(1), 192–201. https://doi.org/10.1038/s41380-021-01285-w

Books 

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  • The Antidepressant Solution : A Step-by-Step Guide to Safely Overcoming Antidepressant Withdrawal, Dependence, and “Addiction” by Joseph Glenmullen 

  • The Maudsley Deprescribing Guidelines : Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs by Mark Horowitz and David Taylor. 

  • Your Drug May Be Your Problem, Revised Edition : How and Why to Stop Taking Psychiatric Medication by Peter Breggin and David Cohen 

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Websites 

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