Why come off slowly
Stopping escitalopram is usually harder than starting it. The relationship between the dose you take and its effect on the brain isn't a straight line — at lower doses, even a small reduction in milligrams can be a large change in effect. This is why prescribers increasingly recommend hyperbolic tapering: smaller and smaller reductions as the dose gets lower, rather than fixed steps.
In practice that means the standard strengths — designed for the treatment range, not for coming off — often can't give you the small doses the end of a taper needs. That's where a method like the one below, so you can measure a precise fraction, comes in.
The liquid method, step by step
- Cut a tablet to the portion you need with a pill cutter.
- Crush the piece between two spoons over a small plate.
- Stir it into a measured volume of water to make a known concentration — it will look cloudy, which is expected.
- Stir again immediately before drawing your dose; the active ingredient settles quickly.
- Measure your prescribed dose with an oral syringe and take it.
- Make a fresh liquid each day and discard any unused liquid in the rubbish.
Your step-by-step taper schedule
This is the Escitalopram schedule from the RELEASE Toolkit, reproduced with permission. It's a starting point to discuss with your prescriber — you can pause, slow down or speed up depending on how you feel. Aim to reduce roughly every 2–4 weeks.
| Step | Daily dose | Liquid / drops / dilute solution | Capsules option |
|---|---|---|---|
| 1 | 20mg | 2 × 10mg tablet | — |
| 2 | 10mg | 1 × 10mg tablet | — |
| 3 | 7mg | 7 drops liquid (20mg/ml) | — |
| 4 | 5mg | ½ × 10mg tablet | — |
| 5 | 4mg | 4 drops liquid (20mg/ml) | — |
| 6 | 3mg | 3 drops liquid (20mg/ml) | — |
| 7 | 2mg | 2 drops liquid (20mg/ml) | — |
| 8 | 1.2mg | 1.2ml dilute solution (1mg/ml) | 3 × 0.4mg capsules |
| 9 | 0.8mg | 0.8ml dilute solution (1mg/ml) | 2 × 0.4mg capsules |
| 10 | 0.4mg | 0.4ml dilute solution (1mg/ml) | 1 × 0.4mg capsule |
| 11 | Stop | You've completed the taper 🎉 | |
Highlighted steps are the most important — do not skip them.
| Step | Daily dose | Liquid / drops / dilute solution | Capsules option |
|---|---|---|---|
| 1 | 20mg | 2 × 10mg tablets | — |
| 2 | 15mg | 1½ × 10mg tablets | — |
| 3 | 12mg | 1 × 10mg tablet & 2 drops liquid (20mg/ml) | — |
| 4 | 10mg | 1 × 10mg tablet | — |
| 5 | 7mg | 7 drops liquid (20mg/ml) | — |
| 6 | 5mg | ½ × 10mg tablet | — |
| 7 | 4mg | 4 drops liquid (20mg/ml) | — |
| 8 | 3.5mg | 3.5ml dilute solution (1mg/ml) | — |
| 9 | 3mg | 3 drops liquid (20mg/ml) | — |
| 10 | 2mg | 2 drops liquid (20mg/ml) | — |
| 11 | 1.6mg | 1.6ml dilute solution (1mg/ml) | 4 × 0.4mg capsules |
| 12 | 1.2mg | 1.2ml dilute solution (1mg/ml) | 3 × 0.4mg capsules |
| 13 | 1mg | 1 drop liquid (20mg/ml) | — |
| 14 | 0.8mg | 0.8ml dilute solution (1mg/ml) | 2 × 0.4mg capsules |
| 15 | 0.7mg | 0.7ml dilute solution (1mg/ml) | 1 × 0.4mg & 3 × 0.1mg |
| 16 | 0.5mg | 0.5ml dilute solution (1mg/ml) | 1 × 0.4mg & 1 × 0.1mg |
| 17 | 0.3mg | 0.3ml dilute solution (1mg/ml) | 3 × 0.1mg capsules |
| 18 | 0.1mg | 0.1ml dilute solution (1mg/ml) | 1 × 0.1mg capsule |
| 19 | Stop | You've completed the taper 🎉 | |
Highlighted steps are the most important — do not skip them.
| Step | Daily dose | Daily tablets, drops or dilute solution |
|---|---|---|
| 1 | 40mg | 2 × 20mg tablet |
| 2 | 30mg | 3 × 10mg tablet |
| 3 | 20mg | 2 × 10mg tablet |
| 4 | 17mg | 1 × 10mg & 7 drops liquid (20mg/ml) |
| 5 | 15mg | 1½ × 10mg tablet |
| 6 | 13mg | 1 × 10mg & 3 drops liquid |
| 7 | 12.5mg | 1 × 10mg & 2.5ml dilute solution |
| 8 | 11.25mg | 1 × 10mg & 1.25ml dilute solution |
| 9 | 10mg | 1 × 10mg tablet |
| 10 | 8.7mg | ½ × 10mg & 3.7ml dilute solution |
| 11 | 7.5mg | ½ × 10mg & 2.5ml dilute solution |
| 12 | 6.8mg | ½ × 10mg & 1.8ml dilute solution |
| 13 | 6mg | 6 drops liquid |
| 14 | 5.4mg | ½ × 10mg & 0.4ml dilute solution |
| 15 | 5mg | ½ × 10mg tablet |
| 16 | 4.4mg | 4.4ml dilute solution |
| 17 | 4mg | 4 drops liquid |
| 18 | 3.6mg | 3.6ml dilute solution |
| 19 | 3.3mg | 3.3ml dilute solution |
| 20 | 3mg | 3 drops liquid |
| 21 | 2.72mg | 2.72ml dilute solution |
| 22 | 2.5mg | 2.5ml dilute solution |
| 23 | 2.24mg | 2.24ml dilute solution |
| 24 | 2.04mg | 2.04ml dilute solution |
| 25 | 1.86mg | 1.86ml dilute solution |
| 26 | 1.68mg | 1.68ml dilute solution |
| 27 | 1.52mg | 1.52ml dilute solution |
| 28 | 1.36mg | 1.36ml dilute solution |
| 29 | 1.22mg | 1.22ml dilute solution |
| 30 | 1.08mg | 1.08ml dilute solution |
| 31 | 0.96mg | 0.96ml dilute solution |
| 32 | 0.86mg | 0.86ml dilute solution |
| 33 | 0.74mg | 0.74ml dilute solution |
| 34 | 0.64mg | 0.64ml dilute solution |
| 35 | 0.54mg | 0.54ml dilute solution |
| 36 | 0.46mg | 0.46ml dilute solution |
| 37 | 0.37mg | 0.37ml dilute solution |
| 38 | 0.29mg | 0.29ml dilute solution |
| 39 | 0.21mg | 0.21ml dilute solution |
| 40 | 0.14mg | 0.14ml dilute solution |
| 41 | 0.07mg | 0.07ml dilute solution |
| 42 | Stop | You've completed the taper 🎉 |
Highlighted steps are the most important — do not skip them.
- Do not skip the final small-dose steps — they're the most important for preventing withdrawal.
- Don't skip days, alternate days, or suddenly stop.
- If withdrawal symptoms appear, you can return to your previous dose; when ready, reduce more slowly.
Schedule © The University of Queensland (RELEASE Toolkit), reproduced with permission. Dosing guidance: Dr Mark Horowitz.
Measuring smaller doses accurately
Use the right tool for your method — an oral syringe for liquids (your pharmacist can supply 1 mL, 5 mL and 10 mL sizes), or a milligram scale for weighing. Choose the smallest measuring tool that fits your dose: it's far more accurate for tiny amounts.
- Measure slowly and double-check before you take your dose.
- Read at eye level, against the syringe plunger's flat edge.
- Keep the concentration or method the same each day so doses stay consistent.
What withdrawal can feel like
Withdrawal effects vary a lot between people. They often come in waves — harder days followed by windows of feeling more like yourself. Common, usually-manageable effects include dizziness, "brain zaps", nausea, vivid dreams, irritability and low mood. They tend to ease if you hold at your current dose for a while before reducing again.
Questions for your appointment
- How quickly is it safe for me to reduce, and by how much each step?
- How long should I hold at each dose before the next reduction?
- What should I do on a bad day — hold, slow down, or pause?
- Which symptoms mean I should contact you sooner?
- Would a compounded oral liquid be more accurate for my lowest doses?