Hyperbolic tapering

Hyperbolic tapering is a way of lowering an antidepressant dose in steps that get smaller as the dose gets lower, often down to very small doses before stopping. It is based on the finding that at low doses even small cuts have a large effect in the brain. In practice each step is usually a share of the current dose. Guidelines recommend reducing this way, although trials comparing it with other methods are still under way.

Also called: Hyperbolic taper, Proportional tapering.

Written by Alena Kozlova, PhD, from published studies and prescribing information.

Definition medically reviewed by Dr. Jason Tan, Consultant Psychiatrist, on October 28, 2026, this definition only. Next review: October 28, 2027.

Why are the last milligrams the hardest?

Because at a low dose each milligram does more in the brain than at a high dose. SSRIs, SNRIs and similar antidepressants block their target, the serotonin transporter, by about 80% already at the usual minimum dose, and above it the effect barely grows, a 2021 review of 17 imaging studies in Molecular Psychiatry found. So halving a full dose changes the effect much less than halving a small dose near the end.

Hyperbolic steps are set so that each one takes away a similar share of that effect. That is why the steps in milligrams get smaller as the dose falls, often below the lowest tablet strength. Few studies measured very low doses, so the curve there is less certain.

How is a hyperbolic taper different from a linear one?

A linear taper takes off the same number of milligrams at each step, and in the short schedules guidelines used to recommend, it reaches the minimum dose within two to four weeks. A 2019 paper by Horowitz and Taylor in The Lancet Psychiatry argued that such tapers do little better than stopping at once, because equal milligram steps make the last steps the largest in effect. They proposed proportional steps that go well below the minimum dose, over months.

Is hyperbolic tapering in the guidelines?

In part. UK guidance from NICE recommends steps that are a proportion of the previous dose and get smaller as the dose falls. In the Netherlands, a multidisciplinary document on stopping SSRIs and SNRIs, first published in 2018 and revised in 2023, describes the approach. The Maudsley Deprescribing Guidelines, a 2024 book by Horowitz and Taylor, who proposed the method, give schedules for each medication.

How do people get the small doses?

Tablets rarely come small enough for the final steps, so prescribers and pharmacists arrange a liquid form, split tablets where the label allows it, or capsules from a compounding pharmacy. Extended-release tablets and capsules, such as venlafaxine XR, are not split. In the Netherlands, tapering strips with a ready-made sequence of doses are used too. In a 2021 survey of 824 people who used them, mostly for venlafaxine or paroxetine after 5 to 10 years of use, 72% came off their antidepressant, and 71% had tried to stop without strips before. The survey had no comparison group, and one of its authors helped develop the strips.

How long does a hyperbolic taper take?

Often a few months. In the 2021 Dutch survey, people who came off with strips took a median of 56 days, and in a 2023 study of 608 people on strips, tapers ran over one, two or three months. Schedules in the Maudsley Deprescribing Guidelines often run for months, and people who have taken an antidepressant for years tend to need more time.

Does hyperbolic tapering prevent withdrawal?

Not entirely. In a 2023 Dutch study of 608 people tapering with strips, most of them after earlier failed attempts to stop, withdrawal stayed limited overall and was milder the slower the taper went: weekly steps of about a third of the dose brought more withdrawal than daily steps of about 4.5%. The study had no group on a linear taper, so it does not show how much hyperbolic tapering lowers the risk compared with other methods. That is why the pace stays adjustable throughout.

Withdrawal during a taper is easy to mistake for the illness coming back, Horowitz and Taylor warn in their Lancet Psychiatry paper. Tell your prescriber about new symptoms rather than restarting or stopping on your own. If you feel much worse or have thoughts of harming yourself, contact your prescriber now rather than at your next appointment, and for thoughts of self-harm call or text 988 in the US or your local emergency number.

What to do

Ask your prescriber whether a proportional taper fits your medication and dose, and how small the steps can go with the forms available to you. The withClaro taper calculator builds a hyperbolic schedule you can bring to that conversation.

Build a hyperbolic schedule in the withClaro taper calculator

How withClaro helps

Each step of your schedule on one timeline
How you felt after each step, logged on the day

Get the withClaro app on the App Store

Related terms

Sources

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