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Trintellix / Brintellix (Vortioxetine) Tapering Guide

Vortioxetine is a multimodal antidepressant, sold as Trintellix in the US and Brintellix in the UK/EU. It is used for major depression. This guide and medication taper calculator help you plan how to taper off vortioxetine safely with your prescriber.

Dosage

Vortioxetine tablets are typically 5 mg, 10 mg, and 20 mg and are not scored. In the UK, 20 mg/mL oral drops support small final doses; elsewhere a compounded liquid may be needed between tablet strengths.

A very long half-life (~66 hours) softens withdrawal for many people, but gradual steps and liquid dosing still help when tablets cannot be split.

Vortioxetine taper schedule

Choose a common starting dose to preview the full hyperbolic schedule — free, no email required. This schedule has 17 steps and takes about 32 weeks in total; your prescriber may adjust the pace based on how you feel.

Starting dose

Selected start: 10 mg/day · 1× daily
Taper speed: Moderate
Region (formulations): US; Tablet/liquid products used for dosing tips — not your location. Example uses US formulary; change region in the custom builder.
Modelled occupancy at start: ~56.7%

Limited / derived PET anchor — curve is indicative

Swipe sideways to see every column.

Step	Daily (mg)	How to take it	Per dose × 1/day	Hold (weeks)
0	10	Your current dose — hold steady before step 1.	10 mg × 1	—
1	8.8	GPSee liquid / compounding note below	8.8 mg × 1	2
2	7.75	GPSee liquid / compounding note below	7.75 mg × 1	2
3	6.85	GPSee liquid / compounding note below	6.85 mg × 1	2
4	5	Take 1 × 5 mg Trintellix tablet (5 mg active ingredient total).	5 mg × 1	2
5	4.45	GPSee liquid / compounding note below	4.45 mg × 1	2
6	3.95	GPSee liquid / compounding note below	3.95 mg × 1	2
7	3.5	GPSee liquid / compounding note below	3.5 mg × 1	2
8	3.1	GPSee liquid / compounding note below	3.1 mg × 1	2
9	2.75	GPSee liquid / compounding note below	2.75 mg × 1	2
10	2.4	GPSee liquid / compounding note below	2.4 mg × 1	2
11	2.1	GPSee liquid / compounding note below	2.1 mg × 1	2
12	1.8	GPSee liquid / compounding note below	1.8 mg × 1	2
13	1.55	GPSee liquid / compounding note below	1.55 mg × 1	2
14	1.3	GPSee liquid / compounding note below	1.3 mg × 1	2
15	1.05	GPSee liquid / compounding note below	1.05 mg × 1	2
16	1	GPSee liquid / compounding note below	1 mg × 1	2

Rows highlighted: larger occupancy drop than target — consider smaller steps or longer holds. If symptoms are intolerable, return to the previous dose and talk to your prescriber.

Steps that cannot be made from whole or half licensed tablets point to the liquid / compounding note below — ask your prescriber before changing how you take your dose.

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The full vortioxetine schedule is already shown below. Enter your email to also receive a PDF and HTML copy you can save or share with your prescriber — optional, and we never gate the schedule behind it.

It's not a substitute for medical advice. This calculator can help you visualise a tapering schedule but before making any changes to your medication plan it's necessary to consult a medical professional. Ask a psychiatrist — available after you request your protocol.

Dose vs occupancy

This taper is spread across 17 gradual steps. The curve below shows why the last few milligrams matter most: at low doses, small dose changes produce large drops in serotonin-transporter occupancy.

What this shows: the non-linear relationship between dose and serotonin transporter (SERT) occupancy. The curve is flat at high doses — most transporters are already blocked, so a dose cut has little biological impact — and much steeper at low doses, where even a 1–2 mg reduction causes a disproportionately large drop in occupancy. Your taper steps are spaced along this curve so each step removes a similar amount of occupancy.

Modelled Hill-curve occupancy — illustrative only. PET-derived parameters vary by study; your prescriber may use different clinical targets. Small mg changes near zero can still produce large occupancy shifts.

How to Taper Off Vortioxetine (Trintellix / Brintellix) Safely

How to taper off vortioxetine (Trintellix; Brintellix in some markets) safely is often gentler than short-half-life SSRIs because of its long half-life (~66 hours), which builds in a partial self-taper. It is a multimodal serotonergic antidepressant (reuptake inhibition plus receptor effects). Coming off vortioxetine still benefits from a planned taper schedule with your prescriber, especially from 10–5 mg.

People looking to wean off Trintellix or get off antidepressants after a multimodal SSRI-like course should still avoid abrupt high-dose stops. Gradual deprescribing principles in Maudsley/NICE remain relevant.

What coming off vortioxetine actually feels like, week by week

When withdrawal occurs, it may be delayed by the long half-life: mood irritability, sleep change, dizziness, or headache over one to two weeks rather than overnight zaps.

Judge each reduction after about two weeks. Many people find the upper Trintellix taper easy and only need care at 5 mg.

“Coming off Trintellix was much easier than the venlafaxine I had before — a bit of nausea and nothing like the zaps.”

— paraphrased from patient forums

“The tablets do not split, so getting below 5 mg meant asking for the liquid — that was the only fiddly part.”

— paraphrased from patient forums

Withdrawal or relapse — how to tell them apart

Withdrawal, if present, can be delayed and still tends to improve with reinstatement. Depressive relapse builds over a longer window (Cosci & Chouinard, 2020).

Vortioxetine taper schedules by starting dose (20, 10, 5 mg)

Tablets are commonly 5, 10, and 20 mg. Notes high → low.

From 20 mg: how to taper off vortioxetine 20 mg often steps 20 → 10 with relatively good tolerability.

From 10 mg: a Trintellix taper schedule from 10 mg should consider 5 mg before stopping.

From 5 mg: how to taper off Brintellix 5 mg may use alternate-day strategies briefly or compounded micro-doses if symptoms appear — long half-life helps but does not always make 5 → 0 invisible.

Build your schedule from your dose →

If it gets worse: pausing and reinstatement

If delayed symptoms accumulate, hold or reinstate and allow more time — levels change slowly. Seek advice if mood worsens progressively.

Resume with a smaller final step. Patience matches the pharmacokinetics when you come off vortioxetine.

Small doses of vortioxetine

5 mg tablets are the usual floor; compounding or supervised alternate-day approaches are sometimes used for the last occupancy slice.

Do not crush modified strategies without pharmacist input.

The bottom line

Vortioxetine is usually kinder to stop because of its long half-life, but the last 5–10 mg still deserve a plan. Wean off Trintellix with two-week holds and clinical follow-up.

Milligram scale guidance (advanced — prescriber/pharmacist approval required)

When a dose is below what you can split from a licensed tablet, some people weigh crushed tablet powder. This is not exact chemistry — it is a last resort. Liquid or compounded formulations are safer when available.

Resolution: at least 0.001 g (1 mg) — not a kitchen scale.
Include a calibration weight and use a draft shield if possible.
Weigh on a stable surface; tare your container first.
Crushed tablet weight ≠ exact active ingredient — drug may not be evenly distributed; prefer liquid or compounded specials when available.
Never split enteric-coated (EC) or extended-release (XR) products — discuss with your pharmacist.

Example searches (confirm specs before buying):

Key facts about hyperbolic antidepressant tapering

The calculator algorithm is based on peer-reviewed research and has been reviewed by our medical advisors to ensure the accuracy of the tapering model.

72%
discontinued their antidepressant using hyperbolic tapering strips in a real-world study
71% of the same people had previously tried to stop at least once and been unsuccessful; the study did not record which method those earlier attempts used. Figures come from tapering-strip research and may not generalise to every taper.
Source: Groot et al., Therapeutic Advances in Psychopharmacology 2021
56 days
median taper length in that tapering-strip study — not a target; many people taper over 6–12 months or longer
This median reflects tapering-strip use in one study. Your timeline depends on how long you have taken the medication, your withdrawal symptoms, and previous attempts — slower is often safer.
Source: Groot et al., Therapeutic Advances in Psychopharmacology 2021
10%
serotonin transporter occupancy per tapering step
This linear reduction prevents withdrawal. Slower, more gradual tapering over several months has shown greater success in reducing withdrawal symptoms than short tapers.
Source: Horowitz et al., The Lancet Psychiatry 2019

Claro — tapering companion

A protocol isn’t enough — you need support.

Tapering can take months, sometimes years. Claro helps you track each step, log symptoms, and spot when a reduction was too fast — with psychiatrist-reviewed guidance. Join early access while we launch the app.

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Frequently asked questions about vortioxetine

Common questions about how to taper off vortioxetine, hyperbolic schedules, and withdrawal — written for people who want to come off antidepressants safely with their prescriber.

How do you taper off vortioxetine (Trintellix / Brintellix)?

Vortioxetine is tapered hyperbolically, but its very long half-life (~66 hours) softens the fall, so steps can be a little larger and holds a little longer than with short-acting drugs. Because the 5, 10 and 20 mg tablets are unscored, use the UK oral drops or a compounded liquid for sub-5 mg doses. Judge each step over about two weeks, as reactions can be delayed.

Is vortioxetine easy to stop?

Vortioxetine is usually one of the gentler antidepressants to stop because its long half-life creates a built-in, gradual self-taper — so withdrawal tends to be mild and, like fluoxetine, delayed. The main practical hurdle is that the tablets do not split, so reaching small final doses needs the liquid or a compounded preparation.

What is an antidepressant tapering calculator?

An antidepressant tapering calculator is a free online medication taper calculator that turns your current dose into a step-by-step plan for reducing it over time. The Claro calculator uses the hyperbolic method: each step removes a similar percentage of receptor occupancy rather than the same number of milligrams. The result is a personalised schedule you can review with your prescriber when you decide to wean off antidepressants.

Why use a tapering calculator?

A medication taper calculator turns receptor-occupancy research into a concrete hyperbolic taper schedule you can read in minutes. It is especially useful when you want to come off antidepressants gradually, because the last few milligrams cause the largest change in modelled occupancy. Use it to preview steps, plan liquid or split-tablet doses, and bring a printable plan when you wean off antidepressants with your prescriber.

How does an antidepressant taper calculator work?

The calculator models how much of your serotonin (or noradrenaline) transporter is occupied at each dose using a Hill-equation curve fitted to published PET studies. It then chooses dose reductions so that each step removes a roughly equal amount of occupancy — the hyperbolic method described by Horowitz and Taylor (2019). The schedule is then rounded to doses you can actually achieve with available tablets, capsules, or liquids in your region.

What is hyperbolic tapering and why is it recommended?

Hyperbolic tapering means reducing your dose by smaller and smaller milligram amounts as you get lower, so the change in receptor occupancy at each step stays about the same. It is recommended because antidepressants follow a hyperbolic dose-response curve: at low doses, small milligram changes have outsized effects. Hyperbolic tapering is endorsed in the Maudsley Deprescribing Guidelines (2024), the UK NICE NG222 guideline, and the Dutch multidisciplinary deprescribing document.

What is the safest way to taper off antidepressants?

The safest way is gradual, supervised, and individualised. Work with a prescriber, hold each dose for at least 2-4 weeks before reducing again, and use liquid or compounded formulations once tablets cannot be split small enough. If symptoms become severe, return to the previous stable dose, allow time to settle, then resume with smaller steps. This calculator is educational; do not change medication without clinical supervision.

How slowly should antidepressants be reduced?

Most people benefit from reductions of around 5-10% of the previous dose every 2-4 weeks, and even more slowly toward the end of the taper. Higher-risk drugs — paroxetine, venlafaxine, and duloxetine — typically need slower steps and longer holds. There is no fixed timeline: many people take 6-12 months to fully get off antidepressants and some take longer, especially after years of treatment.

What are common antidepressant withdrawal symptoms?

The most commonly reported antidepressant withdrawal symptoms include dizziness, "brain zaps" (brief electric-shock sensations), nausea, fatigue, insomnia, vivid dreams, headaches, irritability, anxiety, and mood swings. A 2024 Lancet Psychiatry meta-analysis (Henssler et al.) estimated discontinuation symptoms in around 31% of people, with about 2.8% experiencing severe symptoms. Earlier work (Davies & Read, 2019) reported higher rates of 56% across surveyed populations.

What is the difference between antidepressant withdrawal and relapse?

Withdrawal usually starts within days of a dose reduction, includes physical symptoms like dizziness or brain zaps, and improves when you reinstate the previous dose. Relapse of the original condition typically appears weeks later, is dominated by your original symptoms, and is not relieved within hours by reinstating. The Cosci & Chouinard (2020) framework is the standard taxonomy clinicians use to tell the two apart.

Is it dangerous to stop antidepressants cold turkey?

Stopping antidepressants cold turkey is widely discouraged. Sudden discontinuation increases the risk of severe withdrawal symptoms, including dizziness, brain zaps, and emotional changes, and can trigger reinstatement. Short half-life drugs such as paroxetine and venlafaxine carry the highest risk. If you have already stopped abruptly and feel unwell, contact your prescriber; reinstating the previous dose and then tapering more gradually is the standard recommendation.

Why are the last antidepressant dose reductions often the hardest?

Because the dose-occupancy curve is hyperbolic. At low doses, a 1-2 mg change can produce as much receptor change as a 10-20 mg change at higher doses. This is why people often feel fine for most of the taper and then struggle at the end. A medication taper calculator addresses this by making the final steps in tenths of a milligram, which usually requires a liquid formulation or compounded preparation.

Which antidepressants are hardest to taper off?

Paroxetine (Paxil/Seroxat) and venlafaxine (Effexor) are most often reported as the hardest antidepressants to come off, followed by duloxetine (Cymbalta). They share short half-lives and steep dose-occupancy curves, so missed doses or sharp reductions can trigger withdrawal symptoms within days. Fluoxetine (Prozac), with its very long half-life, is generally the easiest and is sometimes used as a "bridge" when switching off shorter-acting drugs.

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Use the guided builder to enter your current dose, region, and taper preset — then email your personalised protocol.

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Clinical references

[1]Horowitz MA, Taylor D. Tapering of SSRI treatment to mitigate withdrawal symptoms. The Lancet Psychiatry 2019.doi:10.1016/S2215-0366(19)30032-XProposes hyperbolic dose reduction based on receptor-occupancy curves; the methodological basis of every modern taper calculator.
[2]Horowitz MA, Taylor D. The Maudsley Deprescribing Guidelines. Wiley 2024.doi:10.1002/9781394291052Per-drug operational manual for hyperbolic tapering across SSRIs, SNRIs, benzodiazepines, gabapentinoids, and antipsychotics.
[3]Davies J, Read J. A systematic review into the incidence, severity and duration of antidepressant withdrawal effects. Addictive Behaviors 2019.doi:10.1016/j.addbeh.2018.08.027Systematic review: 56% of people who discontinue antidepressants experience withdrawal effects; 46% rate them as severe.
[4]Henssler J et al. Incidence of antidepressant discontinuation symptoms: a systematic review and meta-analysis. The Lancet Psychiatry 2024.doi:10.1016/S2215-0366(24)00133-0Meta-analysis of 79 studies (≈21,000 patients): pooled incidence of discontinuation symptoms ~31%; severe symptoms ~2.8%.
[5]Groot PC, van Os J. Successful use of tapering strips for hyperbolic reduction of antidepressant dose: a cohort study. Therapeutic Advances in Psychopharmacology 2021.doi:10.1177/2045125321103932772% of patients successfully discontinued antidepressants after switching to the hyperbolic model; 71% had previously failed to come off without tapering strips.
[6]Groot PC, van Os J. Antidepressant tapering strips to help people come off medication: real-world outcomes. Therapeutic Advances in Psychopharmacology 2023.doi:10.1177/20451253231171518Of 1,194 patients using hyperbolic taper strips after previous failed attempts, ~71% successfully discontinued their antidepressant.
[7]Framer A. What I have learnt from helping thousands of people taper off antidepressants and other psychotropic medications. Therapeutic Advances in Psychopharmacology 2021.doi:10.1177/2045125321991274Describes the "windows and waves" pattern of withdrawal recovery and supports patient-led pacing.
[8]Hengartner MP et al. Protracted withdrawal syndrome after stopping antidepressants: a descriptive quantitative analysis of consumer narratives. Therapeutic Advances in Psychopharmacology 2020.doi:10.1177/2045125320967183Descriptive analysis of 69 protracted withdrawal cases: median duration 79 weeks; 47% report suicidality during withdrawal.
[9]Cosci F, Chouinard G. Acute and persistent withdrawal syndromes following discontinuation of psychotropic medications. Psychotherapy and Psychosomatics 2020.doi:10.1159/000506868Taxonomy distinguishing new withdrawal symptoms, rebound, and persistent post-withdrawal disorder; the standard framework for withdrawal vs. relapse.
[10]Kalfas M et al. Incidence and Nature of Antidepressant Discontinuation Symptoms. JAMA Psychiatry 2025.doi:10.1001/jamapsychiatry.2025.1362Recent meta-analysis: dizziness was the most common discontinuation symptom in the first 2 weeks after stopping antidepressants, followed by nausea, vertigo, and nervousness.
[11]Gabriel M, Sharma V. Antidepressant discontinuation syndrome. Canadian Medical Association Journal 2017.doi:10.1503/cmaj.160991Clinical review of antidepressant discontinuation syndrome: onset within days of dose reduction, typical symptom course, and management.
[12]Papp A, Onton J. Brain Zaps: An Underappreciated Symptom of Antidepressant Discontinuation. The Primary Care Companion for CNS Disorders 2018.doi:10.4088/pcc.18m02311Characterises "brain zaps" — brief electric-shock sensations — as a common antidepressant discontinuation symptom.
[13]Wang J, Cosci F. Acute and persistent withdrawal syndromes following discontinuation of antidepressants in children and adolescents: a systematic review. Therapeutic Advances in Psychopharmacology 2025.doi:10.1177/20451253251404780Systematic review of acute and persistent antidepressant withdrawal syndromes; reinforces reducing only when stable and under supervision.
[14]Horowitz M, Taylor D. Distinguishing relapse from antidepressant withdrawal: clinical practice and antidepressant discontinuation studies. BJPsych Advances 2022.doi:10.1192/bja.2021.62Frames how clinicians can distinguish antidepressant withdrawal from relapse of the underlying condition.
[15]Sørensen A, Ruhé HG, Munkholm K. The relationship between dose and serotonin transporter occupancy of antidepressants — a systematic review. Molecular Psychiatry 2021.doi:10.1038/s41380-021-01285-wSystematic review of dose–SERT-occupancy relationships across antidepressants; confirms the hyperbolic curve underlying proportional tapering.
[16]Reeve R, Turner JR. Pharmacodynamic models: parameterizing the Hill equation, Michaelis-Menten, the logistic curve, and relationships among these models. Journal of Biopharmaceutical Statistics 2013.doi:10.1080/10543406.2012.756496Explains how the Hill equation, Michaelis-Menten, and logistic models relate — the mathematical basis for the occupancy curve used here.
[17]Preskorn SH. The use of biomarkers in psychiatric research: how serotonin transporter occupancy explains the dose-response curves of SSRIs. Journal of Psychiatric Practice 2012.LinkShows how SERT occupancy explains the non-linear dose–response curves of SSRIs.
[18]Cohrs D, Shapiro B. The relationship between SERT occupancy and extracellular serotonin concentration is hyperbolic, not linear: implications for safely tapering SRI antidepressants. SSRN (preprint) 2026.doi:10.2139/ssrn.6176553Argues the SERT-occupancy to serotonin relationship is itself hyperbolic, reinforcing proportional (hyperbolic) tapering.
[19]Moncrieff J et al. Evidence on antidepressant withdrawal: an appraisal and reanalysis of a recent systematic review. Psychological Medicine 2025.doi:10.1017/S0033291725100652Reappraisal of recent withdrawal-incidence evidence; relevant to how withdrawal rates are interpreted.
[20]Wilson E, Lader M. A review of the management of antidepressant discontinuation symptoms. Therapeutic Advances in Psychopharmacology 2015.doi:10.1177/2045125315612334Practical review of how to manage antidepressant discontinuation symptoms, including tapering and reinstatement.
[21]Groot PC, van Os J. Outcome of antidepressant drug discontinuation with tapering strips after 1–5 years. Therapeutic Advances in Psychopharmacology 2020.doi:10.1177/2045125320954609Long-term follow-up (1–5 years) of patients who discontinued antidepressants using hyperbolic taper strips.
[22]Gury C, Cousin F. Pharmacokinetics of SSRI antidepressants: half-life and clinical applicability. L'Encéphale 1999.LinkHalf-life data for SSRIs — explains why short-half-life drugs (paroxetine, venlafaxine) provoke faster withdrawal.
[23]Mayo Clinic. Antidepressant withdrawal: Is there such a thing?. Mayo Clinic — Expert Answers 2024.LinkPatient-facing explainer on antidepressant discontinuation symptoms and gradual tapering.
[24]NHS Scotland — Right Decision Service. Antidepressants — quality prescribing: difficulty withdrawing from an SSRI/SNRI. NHS Scotland 2024.LinkNHS Scotland guidance on recognising and managing difficulty withdrawing from SSRIs/SNRIs.
[25]The Carlat Psychiatry Report. Clinical pearls for hyperbolic tapering of psychiatric medications in older adults. The Carlat Report 2024.LinkPractical clinical pearls for applying hyperbolic tapering, including in older adults.
[26]Royal College of Psychiatrists. Stopping antidepressants — information for patients and carers. Royal College of Psychiatrists 2024.LinkRCPsych patient-facing guidance on coming off antidepressants safely.
[27]National Institute for Health and Care Excellence (NICE). Depression in adults: treatment and management. NICE guideline [NG222]. NICE 2022.LinkUK national guideline endorsing proportional (hyperbolic) tapering and the use of liquid formulations to enable small final doses.
[28]Royal College of Psychiatrists. Stopping antidepressants — position statement (CR225). Royal College of Psychiatrists 2020.LinkRCPsych acknowledges withdrawal can be severe and long-lasting; recommends slow, individualised tapers.
[29]NHG et al. Multidisciplinary document: Discontinuation of SSRIs and SNRIs (2018; revised 2023). Multidisciplinary Document (Netherlands) 2018.LinkFirst national guideline to explicitly endorse hyperbolic tapering and the use of taper strips (compounded by Regenboog Apotheek).
[30]Medicines and Healthcare products Regulatory Agency (MHRA). Summary of Product Characteristics — SSRI and SNRI products (UK). electronic Medicines Compendium (emc) 2023.LinkAuthoritative UK formulary data (tablet strengths, oral solutions) used to validate the UK region in the calculator.
[31]U.S. Food and Drug Administration. Prescribing information (Structured Product Labeling) for SSRI/SNRI products. FDA / DailyMed 2024.LinkAuthoritative US formulary data (tablet strengths, oral solutions/concentrates) used to validate the US region in the calculator.
[32]Health Canada. Health Canada — Drug Product Database. Health Canada 2024.LinkAuthoritative Canadian formulary data used to validate the Canada region in the calculator.
[33]Therapeutic Goods Administration (TGA). Therapeutic Goods Administration — Australian Register of Therapeutic Goods (ARTG). TGA / ARTG 2024.LinkAuthoritative Australian formulary data used to validate the Australia region in the calculator.
[34]College ter Beoordeling van Geneesmiddelen (CBG-MEB). CBG-MEB — Medicines Information Bank (Netherlands). CBG-MEB 2024.LinkAuthoritative Dutch formulary data; cross-checked with Regenboog Apotheek taper-strip availability.
[35]Regenboog Apotheek, Cinetto. Taperingstrip.com — Regenboog Apotheek. Patient resource (NL) 2024.LinkPioneer of standardised taper strips referenced in the Dutch national guideline.

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