Tapering off psychiatric medication is not one-size-fits-all. The method you use depends on the type of medication you are taking and how your body responds to dose reductions.

Some medications come as tablets, others as capsules with powder or beads. Each requires a different tapering approach.

Important Safety Note

Extended-Release (ER), Modified-Release (MR), and Prolonged-Release (XR) medications must NOT be cut, crushed, or altered.

These medications have a special protective coating designed to release the drug slowly in the body. Damaging this coating can cause too much medication to be released at once, which may lead to overdose or serious harm.

Always confirm whether your medication is extended-release before attempting any taper.

Why Slow Tapering Matters

Reducing psychiatric medication too quickly can be dangerous and, in some cases, life-threatening.

Slow tapering is used to protect the central nervous system (CNS). When reductions happen faster than the nervous system can adapt, severe withdrawal symptoms may occur, including:

• Seizures
• Intense anxiety or agitation
• Brain zaps
• Extreme sensitivity to light, sound, or touch
• Skin rashes and nerve pain
• Profuse sweating and insomnia

Linear vs Hyperbolic Tapering

There are two main tapering principals:

Linear Tapering

A linear taper reduces the medication by the same percentage at each step. Which does not protect our nervous system, especially near the end when withdrawal can be more severe. 

Example:
5% reduction every 4 weeks from start to finish.

Hyperbolic Tapering

A hyperbolic taper slows down as the dose gets lower, which accommodates our nervous system. 

Example:
5% reductions every 4 weeks, then slowing to 2.5% reductions for the lower dosages.

This hyperbolic approach is considered safer, especially at lower doses, because the brain becomes more sensitive as medication levels drop. Many severe reactions occur near the end of a taper, not the beginning.

Click here a copy of the hyperbolic tapering schedule. 

Tapering Methods for Tablets

All methods below involve small reductions, followed by a hold period until symptoms settle.

1. Dry Weighing (Scale Method)

This method uses a high-precision digital scale to remove a small percentage (usually 5–10%) of the medication at each reduction.

• The scale must measure to 0.001g
• Tablets are crushed and weighed
• Reductions are made in accordance with the hyperbolic tapering schedule (Weighing Doses Tapering Schedule.)

2. Water Titration (For Dissolvable Tablets Only)

This method is only suitable for medications that disintegrates in liquid.

• The tablet is dissolved in a 100ml of water. The 100ml of water represents the 100% on the hyperbolic tapering schedule. A syringe (without a needle) is then used to remove a precise amount of the in accordance with the hyperbolic tapering schedule (Weighing Doses Tapering Schedule.)

This method is often more accurate than scales and allows for very gradual reductions.

Helpful resource:

• Video: Water tapering method

3. Compounding Pharmacies

Some pharmacies can prepare a custom liquid formulation of your medication using suspending agents (such as OraPlus).

This allows for precise, gradual dose reductions and can be helpful when tablets are difficult to taper.

Availability depends on your location and pharmacy.

4. Tapering Strips

Pre-made strips made by the pharmaceutical company, containing gradually reducing doses.
These are prescription-only and not currently available in South Africa. Click here for more information.

Tapering Method for Capsules

Some capsules contain hundreds of small beads.

Tapering is done by:

• Opening the capsule
• Counting the total number of beads
• Removing a small number of beads
• Returning the remaining beads to the capsule

This method allows for very gradual reductions, which helps reduce withdrawal severity.

Helpful resource:

For excellent, safe tapering guidance off Cymbalta (Cymgen in South Africa) active ingredient Duloxetine, please join Cymbalta Hurts Worse Facebook tapering support group.

Slow tapering is about reducing harm, not rushing the process. Withdrawal symptoms are signals from the nervous system that it needs more time, not more pressure.

Blessings,

Jane H Kotze