Hyperbolic tapering of antidepressants

Hyperbolic tapering

• the Horowitz-Taylor method for personalised tapering of psychiatric medication recognises that tapering should be ‘hyperbolic’ to achieve a linear reduction of receptor occupancy to prevent withdrawal which is otherwise more likely to occur, especially at the end of a taper when lower than registered dosages are required, which were and still are not provided by pharmaceutical companies
• hyperbolic means that the steps by which the dose is lowered are made smaller and smaller as the dose decreases
• hyperbolic tapering is essentially what many patients, implicitly and without using the word hyperbolic, have been advocating for many years and have tried to achieve themselves by applying do-it-yourself pharmacotherapy
• hyperbolic tapering has also been implicitly advocated by some professionals and it was the basic idea behind the development of tapering medication in the Netherlands

A study showed that (1)

• antidepressant hyperbolic tapering is associated with limited, rate-dependent withdrawal that is inverse to the rate of taper
• the demonstration of multiple demographic, risk and complex temporal moderators in time series of withdrawal data indicates that antidepressant tapering in clinical practice requires a personalised process of shared decision making over the entire course of the tapering period

Reference:

1. van Os J, Groot PC. Outcomes of hyperbolic tapering of antidepressants. Ther Adv Psychopharmacol. 2023 May 9;13:20451253231171518.