Step 2 of 4 · Pre-taper risk

Pre-taper risk check

A six-question, clinically reviewed assessment which estimates what challenges you may experience when tapering your antidepressants. It suggests a tapering speed preset you can use in the calculator. This quiz is built on a hyperbolic tapering model and recommendations from the Maudsley Deprescribing Guidelines.

Dr. Jason TanDr. Alex Curmi
Medically reviewedby Dr. Jason TanDr. Alex Curmi Last reviewed
Question 1 of 617%

Which medication are you planning to taper?

Different drugs carry different intrinsic withdrawal risk — this affects your suggested taper speed.

⚠️ 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 psychiatrist — available after you build your protocol.

Why this risk check matters

Antidepressant withdrawal occurs frequently and for several individuals, it can result in severe symptoms. According to different studies, between 27% and 86% of patients who tried to discontinue their antidepressants reported withdrawal side effects: 46% of them described the effects as severe (Davies et al., Addictive Behaviors 2019). A 2024 systematic review found that adverse effects are often influenced by pharmacology of the drug. Shorter-acting SSRIs, such as paroxetine or sertraline, and SNRIs, such as venlafaxine, duloxetine or desvenlafaxine, showed greater risk of withdrawal symptoms (Henssler et al., The Lancet Psychiatry 2024).

The main issue is that most tapers decrease the dosage in equal steps rather than proportionally. However, because the body's response to antidepressants follows a hyperbolic dose-occupancy curve, the biological impact varies dramatically depending on whether the patient is on a high or low dose. The Horowitz & Taylor research (2019) serves as the central reference for hyperbolic tapering model and its efficacy. It explains that each step during tapering should reduce SERT occupancy by a similar amount — but not necessarily by the same number of milligrams (Horowitz et al., The Lancet Psychiatry 2019).

This pre-taper assessment uses your answers along with the drug-specific risk profiles to identify an optimal speed and first-step size based on your unique situation (Wilson et al., Therapeutic Advances in Psychopharmacology 2015).

Six questions, six-factor model

The quiz combines these published predictors of antidepressant discontinuation difficulty into a suggested starting taper speed.

  1. 1

    Factor #1: Medication you’re currently taking

    Your antidepressant class and its half-life can tell how often withdrawal symptoms may occur and how severe they can be. Paroxetine, venlafaxine, duloxetine, and desvenlafaxine represent the most risky antidepressants regarding withdrawals.

  2. 2

    Factor #2: Duration of antidepressant use

    The likelihood of experiencing withdrawal rises with cumulative exposure. Short tapers are often associated with increased severity and difficulties in managing withdrawal symptoms.

  3. 3

    Factor #3: Previous tapering experience

    In many cases, patients who previously experienced withdrawal symptoms on antidepressants may require tapering at a slower rate, or with liquid or compounded forms of the medication.

  4. 4

    Factor #4: Sensitivity to a single missed dose

    If you notice withdrawal symptoms within hours or days of missing a dose, this indicates a steep dose-occupancy sensitivity. The hyperbolic tapering model can help minimize your discomfort.

  5. 5

    Factor #5: History of severe or prolonged withdrawal

    If you have previously experienced severe withdrawal symptoms from any psychiatric medication, you may be at higher risk of protracted withdrawal during your current taper.

  6. 6

    Factor #6: Prescriber supervision

    Many guidelines support the practice of tapering under active medical supervision. It allows the prescriber to make adjustments in the tapering plan based on your unique circumstances, symptoms, and patterns.

Risk bands and suggested taper speeds

  • Low risk = Preset A (faster)

    ~5% occupancy drop per step, 1-week minimum hold. Suitable for short courses on lower-risk drugs (e.g. fluoxetine, bupropion) with no history of difficult discontinuation.

  • Moderate risk = Preset B (moderate)

    ~2.5% occupancy drop per step, 2-week hold. Default for patients on most SSRIs/SNRIs.

  • High risk = Preset C (slower)

    ~1.5% occupancy drop per step, 4-week hold. Recommended for short-half-life drugs (paroxetine, venlafaxine, duloxetine) and long-duration courses.

  • Very high risk = Preset C plus a written reinstatement plan

    Liquid or compounded formulations from early on; expect a months-to-years timescale; agree in advance with your prescriber on what symptom level should trigger a return to the previous stable dose.

Speed presets are configurable in the calculator: the suggested preset is just a starting point. See the full methodology.

Use this as a roadmap rather than a strict plan. Before every dose reduction, wait until you feel stable after the previous step. Please discuss each next change in advance with your prescriber.

Frequently asked questions

Answers about how the quiz works and what your result means.

  • What is a pre-taper risk check?

    Pre-taper risk check is a short, evidence-based questionnaire that gives an estimate of how difficult an antidepressant taper is likely to be. The result depends on the antidepressant type, how long you’ve been taking it, your prior taper experience, your sensitivity to missed doses, your history of severe withdrawal, and if a prescriber will assist and supervise your tapering. The outcome is a recommended starting speed preset (fast A, moderate B, or slow C).

  • Why does the medication type matter for measuring the risk?

    Antidepressants vary significantly in terms of how often they can cause withdrawal. A 2024 systematic review found that adverse events are often influenced by pharmacology of the drug itself. Shorter-acting SSRIs, such as paroxetine or sertraline, and SNRIs, such as venlafaxine, duloxetine or desvenlafaxine, showed greater risk of withdrawal symptoms. Fluoxetine, on the contrary, showed the lowest risk.

  • Is longer treatment really associated with harder tapering?

    Yes. The duration of antidepressant use is one of the most important factors influencing withdrawal severity. Many patients require long-term taper schedules, taking months or even years, to successfully discontinue antidepressants — when they’ve been taking them for over 3 years. According to different studies, between 27% and 86% of patients who tried to taper from their antidepressants reported withdrawal side effects.

  • I had a challenging tapering before — does that mean I will have it again?

    Not necessarily. Nevertheless, prior challenging experiences increase the likelihood that you will face difficulties during the next taper. It is the reason to begin tapering slower, use liquid or compounded formulation, and plan the process in advance with your prescriber.

  • Is it a red flag if I notice symptoms within a day of missing a dose?

    Same-day or next-day symptoms after a missed dose can be a clinical sign of withdrawal sensitivity, especially with short half-life antidepressants. Symptoms such as dizziness and nausea suggest that small dose changes may be producing a relatively large biological effect, which is consistent with a hyperbolic dose-occupancy relationship. Based on that, a slower taper is often the safer starting point.

  • What does a "very high risk" result mean?

    It indicates that you need a slow and supervised hyperbolic taper — using liquid or compounded formulations and holding each dosing step for 4 weeks or more. Additionally, it is essential to create a written reinstatement plan with your prescriber. But even in high-risk groups, studies have demonstrated successful tapering with taper strips and patient-controlled pacing.

Medically reviewed by

Last reviewed

  • Dr. Jason Tan

    Dr. Jason Tan

    Consultant Psychiatrist, Medical Director at Cygnet Health Care

    UK consultant psychiatrist trained on the Maudsley Training Programme, Medical Director at Cygnet Health Care. Formerly a Consultant Liaison Psychiatrist at South London and Maudsley NHS Foundation Trust — the home of the Maudsley Deprescribing Guidelines this calculator is built on. Advises Claro on the clinical safety of the tapering calculator and patient-facing copy.

    Read full profile →

  • Dr. Alex Curmi

    Dr. Alex Curmi

    Consultant Psychiatrist, Host of "The Thinking Mind Podcast"

    London-based consultant psychiatrist and podcast host, with deep editorial focus on deprescribing antidepressants — including an interview with Dr. Mark Horowitz, lead author of the foundational hyperbolic tapering paper. Trained at South London and Maudsley NHS Foundation Trust. Alex writes for The Guardian on psychology and mental health. Advises Claro on patient experience, deprescribing methodology, and shared decision-making.

    Read full profile →

References cited on this page

Primary sources behind the pre-taper risk factors.

  1. [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. [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. [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. [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. [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. [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. [7]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.
  8. [8]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.
  9. [9]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.
  10. [10]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.
  11. [11]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.
  12. [12]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.
  13. [13]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.
  14. [14]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.

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If you're in crisis

If your depression symptoms persist, worsen, or you feel unsafe, please contact a qualified professional, your local emergency number, or a mental health helpline. Find a helpline in your location.